Stephanie Olson

Dos 772-Clinical Lab Assignment

July 17, 2015
PLAN #1-chin extended wedge pair plus lower neck nodes plan
(1a) When I compared the chin extended plan to a plan done on a chin neutral parotid plan, the main
differences I saw were lower maximum doses to the oral cavity, right submandibular gland and
mandible. Maximum doses to the spine, brainstem, skin and left parotid were approximately the same.
The maximum dose to the right cochlea was approximately 8 Gy higher.
(1b) With the wedge pair plan, I was able to get 97.72% coverage of the 60 Gy dose to the GTV and
85.01% coverage of the 57 Gy dose to the PTV.

Figure 1. Beam parameters for the chin extended wedge pair plan.

Figure 2. Location of maximum hotspot of 65.8 Gy and isodose lines of 100% (red), 95% (green),
75% (magenta), and 40% (khaki).

Figure 3. Isodose distribution in the axial, sagittal, and coronal planes and 3D rendering of beam
and wedge arrangements.

Figure 4. Dose volume histogram for the chin extended wedge pair plan.

Structures
Spinal Cord
Brainstem
Cochlea_R
Parotid_L
Oral cavity
Submandibular_R
Skin
Mandible

Max tolerance dose (Gy)

47
50
40
32
60
Mean < 35
50
70

Plan dose (Gy)

23.52
24.43
29.61
1.31
26.27
16.41
63.47
65.12

Met/Exceeded
Met
Met
Met
Met
Met
Met
Exceeded
Met

Table 1. Tolerance and plan doses for the chin extended wedge pair plan.

Figure 5. Isodose lines of the parotid (red) and PTV (green) for the chin extended wedge pair plus
lower neck nodes plan.

Figure 6. Isodose lines of the lower neck nodes (orange) for the chin extended wedge pair plus
lower neck nodes plan.

Figure 7. Dose volume histogram for the chin extended wedge pair plus lower neck nodes plan.
Structures
Spinal Cord
Brainstem
Cochlea_R
Parotid_L
Oral cavity
Submandibular_R
Skin
Mandible

Max tolerance dose (Gy)

47
50
40
32
60
Mean < 35
50
70

Plan dose (Gy)

31.11
24.86
29.77
1.52
26.66
48.49
63.52
65.28

Met/Exceeded
Met
Met
Met
Met
Met
Exceeded
Exceeded
Met

Table 2. Tolerance and plan doses for the chin extended wedge pair plus lower neck nodes plan.

PLAN #2-chin extended photon/electron mixed beam plan

(2a) For the photon/electron mixed beam plan, 99.45% of the GTV was covered by the 60 Gy isodose
line and 87.77% of the PTV was covered by the 57% isodose line so there was slightly better coverage
to both planning volumes.
(2b) The right cochlea maximum dose was 43.68 Gy which is slightly higher than the maximum
tolerance dose of 40 Gy and the skin maximum dose was over the 50 Gy maximum tolerance dose at
81.21 Gy however this was a very small point dose of only 0.01 cc.

Figure 8. Beam parameters for the chin extended photon/electron mixed beam plan.

Figure 9. Location of maximum hotspot of 86 Gy and isodose lines of 100% (red), 95% (green),
75% (magenta), and 40% (khaki).

Figure 10. Isodose distribution in the axial, sagittal, and coronal planes and 3D rendering of beam
and wedge arrangements.

Figure 11. Dose volume histogram for the chin extended photon/electron mixed beam plan.

Structures
Spinal Cord
Brainstem
Cochlea_R
Parotid_L
Oral cavity
Submandibular_R
Skin
Mandible

Max tolerance dose (Gy)

47
50
40
32
60
Mean < 35
50
70

Plan dose (Gy)

25.80
27.52
43.68
19.18
50.85
29.68
81.21
66.16

Met/Exceeded
Met
Met
Exceeded
Met
Met
Met
Exceeded
Met

Table 3. Tolerance and plan doses for the chin extended photon/electron mixed beam plan.

PLAN #3-chin extended IMRT plan

(3a) For the IMRT plan, I used a five field technique which can be seen below in Figure 15. I started my
first beam 10 degrees off of midline angled towards the patients left side. From there, I made four
additional beams spaced every 40 degrees to avoid having any coplanar beams.
(3b) I felt using these five beams created an acceptable plan with adequate coverage to the GTV and the
maximum tolerance doses were met for all structures except the skin. Out of all three plans I created,
the IMRT plan had the best GTV and PTV coverage while having the most critical structure maximum
doses met.

Figure 12. Beam parameters for the chin extended IMRT plan.

Figure 13. Location of maximum hotspot of 86 Gy and isodose lines of 100% (red), 95% (green),
75% (magenta), and 40% (khaki).

Figure 14. Isodose distribution in the axial, sagittal, and coronal planes.

Figure 15. Beam arrangement for the IMRT plan.

Figure 16. Dose volume histogram for the chin extended IMRT plan.
Structures
Spinal Cord
Brainstem
Cochlea_R
Parotid_L
Oral cavity
Submandibular_R
Skin
Mandible

Max tolerance dose (Gy)

47
50
40
32
60
Mean < 35
50
70

Plan dose (Gy)

16.27
20.23
21.26
8.34
36.47
11.44
60.77
61.16

Met/Exceeded
Met
Met
Met
Met
Met
Met
Exceeded
Met

Table 4. Tolerance and plan doses for the chin extended IMRT plan.