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VMAT

Rx: 21Gy+18Gy/1fx

Five brain mets, three on the same plane

 

Beams
DVH
Metrics

Name (ID): P3Brain, P3Brain (P3Brain)
Plan or PlanSum ID: HyperArc

Structure IDStructure CodePatient StructureDVH ObjectiveEvaluatorVariationPriorityMetAchieved
4GyBrain_noPTVBRAIN_PTVV4Gy[cc]157.13 cc
12GyBrain_noPTVBRAIN_PTVV12Gy[cc]15.69 cc
21GyBrain_noPTVBRAIN_PTVV21Gy[cc]0.86 cc
Brain_noPTVBRAIN_PTVMean[Gy]2.680 Gy
PTV11PTV_LP_21V100%[%]>=99Goal99.80 %
GTV11GTV_LPMax[%]135.2 %
GTV11GTV_LPMax[Gy]28.387 Gy
GTV11GTV_LPMin[Gy]25.003 Gy
GTV11GTV_LPV100%[cc]0.22 cc
GTV11GTV_LPVolume[cc]0.22 cc
PTV22PTV_LPG_21V100%[%]>=99Goal99.00 %
GTV22GTV_LPGMax[%]125.0 %
GTV22GTV_LPGMax[Gy]26.248 Gy
GTV22GTV_LPGMin[Gy]22.435 Gy
GTV22GTV_LPGV100%[cc]1.15 cc
GTV22GTV_LPGVolume[cc]1.15 cc
PTV33PTV_RP_21V100%[%]>=99Goal99.35 %
GTV33GTV_RPMax[%]133.1 %
GTV33GTV_RPMax[Gy]27.949 Gy
GTV33GTV_RPMin[Gy]23.127 Gy
GTV33GTV_RPV100%[cc]1.36 cc
GTV33GTV_RPVolume[cc]1.36 cc
PTV44PTV_RF_21V100%[%]>=99Goal100.00 %
GTV44GTV_RFMax[%]147.5 %
GTV44GTV_RFMax[Gy]30.975 Gy
GTV44GTV_RFMin[Gy]27.539 Gy
GTV44GTV_RFV100%[cc]0.07 cc
GTV44GTV_RFVolume[cc]0.07 cc
PTV55PTV_RT_18V18Gy[%]>=99Goal99.48 %
GTV55GTV_RTMax[%]111.7 %
GTV55GTV_RTMax[Gy]23.454 Gy
GTV55GTV_RTMin[Gy]20.145 Gy
GTV55GTV_RTV100%[cc]1.76 cc
GTV55GTV_RTVolume[cc]1.92 cc
BrainstemBrainstemMax[Gy]9.908 Gy
ChiasmChiasmMax[Gy]6.743 Gy
OpticNerve_LOptNrv_LMax[Gy]3.419 Gy
OpticNerve_ROptNrv_RMax[Gy]6.115 Gy
Eye_LEye_LMax[Gy]2.922 Gy
Eye_REye_RMax[Gy]2.904 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.
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