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Treatment planning - basics

Treatment planning - basics. Christian Kirisits. Standard loading pattern. Point A. 20 mg. 10 mg. 10 mg. 15 mg. 20 mg. Point A. 45 Gy EBRT + 4 x BT: 85 Gy αβ 10 60 Gy αβ 10. Standard loading pattern. Standard loading pattern. Standard loading pattern.

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Treatment planning - basics

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  1. Treatment planning - basics Christian Kirisits

  2. Standard loading pattern Point A 20 mg 10 mg 10 mg 15 mg 20 mg Point A 45 Gy EBRT + 4 x BT: 85 Gyαβ10 60 Gyαβ10

  3. Standard loading pattern

  4. Standard loading pattern

  5. Standard loading pattern

  6. Shifting and skipping dwell positions

  7. Standard loading pattern

  8. Optimized loading pattern

  9. Standard loading

  10. Inverse optimization without thinking

  11. Inverse optimization Taking into account experience from manual opt.

  12. Dose Optimization DVH parameters (D90, D100, D2cc, D0.1cc) Spatial dose distribution (Hot and Cold spots) Dwell time distribution to take into account not contoured structures parametrial tissue vagina nerves vessels ureter

  13. Manual optimization

  14. Inverse optimization

  15. Manual plan

  16. IPSA

  17. 100% 200% 100% 200% A A A A Vpd 96 cm³ V2pd 28 cm³ standard plan: prescribed dose to point A (left and right) no needles

  18. 100% 200% + 11 mm 100% 200% A A Vpd 103 cm³ V2pd 30 cm³ optimized plan: prescribed dose to point A (right) 1 needle loaded

  19. 100% 200% 100% 200% A A Vpd 109 cm³ V2pd 33 cm³ optimized plan: prescribed dose to point A (right) 2 needles loaded

  20. 100% 200% 100% 200% A A Vpd 114 cm³ V2pd 36 cm³ optimized plan: prescribed dose to point A (right) 3 needles loaded

  21. However, every optimization is limited by anatomy, topography and application technique. Jamema et al. Radiother Oncol 2010

  22. Source loading - optimization • Training • Experience (learning curve)

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