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VMAT

Rx: 21Gy/1fx

Three brain mets on different planes

 

Beams
DVH
Metrics

Name (ID): P4Brain, P4Brain (P4Brain)
Plan or PlanSum ID: HyperArc

Structure ID Structure Code Patient Structure DVH Objective Evaluator Variation Priority Met Achieved
4GyBrain_noPTV   BRAIN_PTV V4Gy[cc]         58.56 cc
12GyBrain_noPTV   BRAIN_PTV V12Gy[cc]         6.37 cc
21GyBrain_noPTV   BRAIN_PTV V21Gy[cc]         0.77 cc
Brain_noPTV   BRAIN_PTV Mean[Gy]         1.440 Gy
PTV1   1PTV_RF_21 V100%[%] >=99     Goal 99.54 %
GTV1   1GTV_RF Max[%]         141.0 %
GTV1   1GTV_RF Max[Gy]         29.607 Gy
GTV1   1GTV_RF Min[Gy]         24.703 Gy
GTV1   1GTV_RF V100%[cc]         0.30 cc
GTV1   1GTV_RF Volume[cc]         0.30 cc
PTV2   2PTV_RC_21 V100%[%] >=99     Goal 99.05 %
GTV2   2GTV_RC Max[%]         136.7 %
GTV2   2GTV_RC Max[Gy]         28.705 Gy
GTV2   2GTV_RC Min[Gy]         19.207 Gy
GTV2   2GTV_RC V100%[cc]         0.39 cc
GTV2   2GTV_RC Volume[cc]         0.40 cc
PTV3   3PTV_LC_21 V100%[%] >=99     Goal 99.64 %
GTV3   3GTV_LC Max[%]         140.8 %
GTV3   3GTV_LC Max[Gy]         29.564 Gy
GTV3   3GTV_LC Min[Gy]         26.622 Gy
GTV3   3GTV_LC V100%[cc]         0.27 cc
GTV3   3GTV_LC Volume[cc]         0.27 cc
Brainstem   Brainstem Max[Gy]         1.914 Gy
Chiasm   Chiasm Max[Gy]         1.527 Gy
OpticNerve_L   OptNrv_L Max[Gy]         1.499 Gy
OpticNerve_R   OptNrv_R Max[Gy]         1.243 Gy
Eye_L   Eye_L Max[Gy]         0.504 Gy
Eye_R   Eye_R Max[Gy]         0.777 Gy
Technical Plan Comments

HyperArc was utilized for this case which means it used a very simplified workflow for planning and delivery.  First the immobilization device is added as a structure model to the patient.  Then, creating a new HyperArc plan walks the user through the process of placing the isocenter of the predefined HyperArc beam set and identifying the target structures and their desired Rx dose.  At that point the Photon Optimizer can be launched automatically which includes preset lower objectives for each target with 100 priority and the HyperArc exclusive SRS NTO (also with 100 priority) which is tuned specifically to enforce a sharp dose falloff and prevent dose bridging of adjacent disparate targets.

Eclipse 15.5+ also features the Automatic Lower Dose Objective (ALDO) which, when enabled in the Photon Optimizer, in the background automatically adjusts dose/priority to keep dose converge on targets near 98%.  Enabling ALDO thereby balances dose received by each target prescribed to the same dose level during optimization.

The plan presented here was created with no user interaction during optimization.  ALDO was enabled and optimization was started.  The Photon Optimizer calculation option Convergence Mode was set to Extended.

Links

Review 3rd party software generated full treatment plan report

PDF

                              

Download full DICOM CT, struct, plan and dose file         

ZIP        

Any reference to a "plan study" are simply what the organizers call each case and may not be a "study" in the FDA sense as they may not have been published in a peer reviewed journal.
Varian does not provide medical advice and these are illustrative examples only.
Leading plans by expert planner. Your results may vary.

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