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Planning Project Rectum
Planning Project Rectum
Use a CT dataset of the pelvis. Create a CTV by contouring the rectum (start
at the anus and stop at the turn where it meets the sigmoid colon). Expand
this structure by 1 cm and label it PTV.
Create a PA field with the top border at the bottom of L5 and the bottom
border 2 cm below the PTV. The lateral borders of the PA field should extend
1-2 cm beyond the pelvic inlet to include primary surrounding lymph nodes.
Place the beam isocenter in the center of the PTV and use the lowest beam
energy available (note: calculation point will be at isocenter).
Contour all critical structures (organs at risk) in the treatment area. List all
organs at risk (OR) and desired objectives/dose limitations, in the table
below:
Organ at risk
Bladder
Desired objective(s)
<50% to receive 45Gy
Achieved objective(s)
50% receiving 35.8Gy
Small Bowel
5% receiving 21.7Gy
Large Bowel
5% receiving 51Gy
Femoral Heads
all 3 fields. Calculate the dose and apply equal weighting to all 3
beams. Describe this dose distribution. The CTV and PTV are
getting the coverage that is needed but there is a lot of dose
distributed lateral to the treatment volume. The hotspot is
117.6% and it is outside of the PTV (posterior and right of the
PTV). The dose distribution does not look conformal.
d. Change the 2 lateral fields to a higher energy and calculate. How did
this change the dose distribution? The CTV and PTV are getting the
coverage that is needed. The higher doses are around the
treatment volume. The dose distribution lateral to the PTV is
lower with the energy of 23MV than 6MV. The hotspot is 113.2
in ~ the same spot as the hotspot was with the 6MV.
e. Increase the energy of the PA beam and calculate. What change do you
see? The coverage actually looks very similar for both plans.
The CTV and PTV is covered with both plans. The hotspot is
reduced with 23MV, however the exit dose from the PA beam
is slightly more anterior than the plan with the 6MV PA beam.
f. Add the lowest angle wedge to the two lateral beams. What direction
did you place the wedge and why? How did it affect your isodose
distribution? (To describe the wedge orientation you may draw a
picture, provide a screen shot, or describe it in relation to the patient.
(e.g., Heel towards anterior of patient, heel towards head of patient..) I
added the physical wedge of 15. The toe of the wedge is
anterior to the patient and the heel of the wedge is posterior. I
4 field pelvis
Using the final 3 field rectum plan, copy and oppose the PA field to create an
AP field. Keep the lateral field arrangement. Remove any wedges that may
have been used. Calculate the four fields and weight them equally. How does