Rx: 70Gy/35fx to PTV70, also PTV63 and PTV56 (simultaneous integrated boost)

2013 Pinnacle ROR Plan Challenge


2:50 VMAT treatment arc delivery time

Simple DVH Metrics

Plan or PlanSum ID: Arcsm1IDS1a

Structure ID Structure Code Patient Structure DVH Objective Evaluator Variation Priority Met Achieved
PTV7000org   PTV7000org V70.0Gy[%] >=95 90   Goal 97.87 %
PTV7000org   PTV7000org V66.5Gy[%] >=99 97   Goal 100.00 %
PTV7000org   PTV7000org D0.03cc[Gy] <=72.8 77   Variation 74.006 Gy
PTV_6300_EVAL   PTV_6300_EVAL V63.0Gy[%] >=95 90   Goal 96.80 %
PTV_6300_EVAL   PTV_6300_EVAL V59.85Gy[%] >=99 97   Goal 99.87 %
PTV_5600_EVAL   PTV_5600_EVAL V56.0Gy[%] >=95 90   Goal 95.81 %
PTV_5600_EVAL   PTV_5600_EVAL V53.2Gy[%] >=99 97   Goal 99.30 %
SPINAL_CORD   SPINAL_CORD D0.03cc[Gy] <48     Goal 45.647 Gy
SPINAL_CORD_PRV5   SPINAL_CORD_PRV5 D1.0cc[Gy] <=50 54   Goal 47.055 Gy
BRAINSTEM   BRAINSTEM D0.03cc[Gy] <54     Goal 52.888 Gy
BRAINSTEM_PRV5   BRAINSTEM_PRV5 D1.0cc[Gy] <=57 60   Goal 56.356 Gy
PAROTID_L   PAROTID_L Mean[Gy] <=26 40   Variation 26.236 Gy
PAROTID_R   PAROTID_R V30.0Gy[%] <=50 65   Variation 50.95 %
LARYNX   LARYNX Mean[Gy] <=40 55   Goal 31.826 Gy
SUBMND_SALV_L   SUBMND_SALV_L Mean[Gy] <=35 65   Variation 37.031 Gy
COCHLEA_L   COCHLEA_L D0.03cc[Gy] <=15 40   Variation 15.396 Gy
COCHLEA_R   COCHLEA_R D0.03cc[Gy] <=15 40   Variation 15.224 Gy
MANDIBLE   MANDIBLE V70.0Gy[%] <=0 5   Variation 0.63 %
LIPS   LIPS V30.0Gy[%] <=0 30   Variation 1.79 %
POST_NECK   POST_NECK V35.0Gy[%] <=10 40   Goal 5.86 %
ScoreCard Metrics
Technical Plan Comments

Four (4) arc VMAT technique was chosen and (4) four almost complete arcs were used. Each arc used a different start and stop angles offset by 1 degree in order to stagger the available control points throughout each arc rotation. VMAT is an excellent treatment technique for regular (spherical) shaped targets when the isocenter can be placed inside the target volume, however, for highly irregular shaped targets like the lowest dose level target in this head and neck plan, a VMAT technique proved to be unable to match the plan quality achieved in the static gantry plan (#4 Bilateral Head & Neck (IMRT). With a treatment delivery time within 60 seconds of the comparable IMRT plan and more optimization time required for VMAT planning, the IMRT plan could be considered preferable to in this case. This plan might have been improved by utilizing unique collimator rotations in each arc. This VMAT plan scored better than 80%-90% of the plans submitted to the plan challenge.

Physician Comments

There is very little difference between this VMAT plan versus for the 9F IMRT plan for the same case. Homogeneity and conformity are respected. OARs are well within constraint goals. Both plans do an excellent job at sparing the contralateral parotid, with mean doses around 25 Gy. This is clearly an acceptable plan.

Comparative Plan Quality

3rd party software plan report


     Dosimetric ScoreCard


DICOM patient export         


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.
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