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IMRT1

Rx: 52Gy/26fx to Pancreas and 46.8Gy to PTV

2012 AAMD / ROR Plan Challenge

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2:21 IMRT treatment field delivery time

 

Beams
DVH
Metrics

Name (ID): Z002442-ABD, AAPM (AAPM Z002442-ABD)
Plan or PlanSum ID: 8fld1

Structure ID Structure Code Patient Structure DVH Objective Evaluator Variation Priority Met Achieved
PTV_5200   PTV_5200 V52.0Gy[%] >=95 93   Goal 95.30 %
PTV_5200   PTV_5200 V49.4Gy[%] >=99 97   Goal 100.00 %
PTV_5200   PTV_5200 D0.03cc[Gy] <=53 56   Variation 53.921 Gy
CTV_5200   CTV_5200 V52.0Gy[%] >=99 97   Goal 100.00 %
PTV4680-PTV5200   PTV4680-PTV5200 V46.8Gy[%] >=95 93   Variation 94.88 %
PTV4680-PTV5200   PTV4680-PTV5200 V44.66Gy[%] >=99 97   Goal 99.63 %
CORD   CORD D0.03cc[Gy] <45     Goal 31.775 Gy
RT KIDNEY   RT KIDNEY V18.0Gy[%] <=10 50   Goal 8.85 %
LT KIDNEY   LT KIDNEY V18.0Gy[%] <=0 30   Variation 1.53 %
BOWEL   BOWEL V45.0Gy[cc] <=175 250   Goal 160.93 cc
LIVER   LIVER Mean[Gy] <=5 10   Variation 5.058 Gy
STOMACH   STOMACH D25%[Gy] <=10 30   Goal 9.966 Gy
PERIPHERAL_RING   PERIPHERAL_RING V23Gy[cc] <=20 100   Variation 46.32 cc
Technical Plan Comments

This nine (9) field IMRT utilized manually selected gantry positions to follow the shape of the target in the transverse view.  The biggest challenge in this case proved to be the amount of prescription dose outside of the high dose target (volume of regret) and the metrics assessing max dose (penalty in score above 102% of Rx) and target homogeneity.  This plan still featured a max dose <105%, and these strict metrics may or may not be clinically relevant, however challenging to achieve.  Even with 1cm leaves (the effect of which was minimized by rotating the collimator to unique angles per gantry position) this plan was still able to retrospectivly achieve a score >80% of the plans submitted to the study. 

Physician Comments

Both pancreas RT plans were acceptable. The IMRT plan is slightly better. In both cases, the OARs, specifically the bowel. The homogeneity requirements are pretty tight and a priority in this case. These are achieved with good sparing of bowel and kidneys.

Comparative Plan Quality
Links

Review 3rd party software generated full treatment plan report

PDF

                              

Download full DICOM CT, struct, plan and dose file         

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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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