Radiotherapy Plan Competition TomoTherapy Planning System. Dmytro Synchuk. Ukrainian Center of TomoTherapy, Kirovograd, Ukraine

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1 Radiotherapy Plan Competition 2016 TomoTherapy Planning System Dmytro Synchuk Ukrainian Center of TomoTherapy, Kirovograd, Ukraine

2 Beam Geometry 6MV fan beam 3 jaw options 1.0, 2.5 and 5 cm 64 leaves binary collimator Leaf measurement at isocenter 0.65cm

3 Delivery regimes HELICAL Continuous gantry rotation at a constant rate Continuous couch movement in superior direction DIRECT Discrete 2-12 static directions Continuous couch movement in superior direction for each direction separately

4 Objective function F Plan F Targets F OARs where F ROI voxels (D prescr D calc ) 2 importance dose penalties DVH penalty ROI volume The smaller volume we can control the better

5 Beam blocking None (Default) Critical Structure Directional Blocking Critical Structure Complete Blocking Critical Structure Allowed Beam Direction Prohibited Beam Direction Target Target Target Directional Blocking only those beam directions that first go through the target are allowed Complete Blocking all beam directions that go through the completely blocked structure are prohibited

6 Troubleshootings: Time cumbersome Works only for PTV_BREAST Steel needed additional structures How I did my first Plan

7 Additional Contours Dmin2 Dmin2 Dmin1 Dmin1 Dmin1 0,5 cm margin around the PTV to create steep dose gradient around the target Dmin2 2,5-3 cm margin around the PTV to avoid high doses in body

8 Additional Contours Breast Right Block LUNG RIGHT BLOCK HEART BLOCK LUNG LEFT BLOCK LUNG LEFT Plan Brest Right Block 3 mm outer ring completely blocked to achieve no more than 2Gy dose inside right breast HEART BLOCK part of the hard that is further than 3 cm from PTV (completely blocked) HEART Plan - part of the hard that is closer than 3 cm to PTV (here I optimize) LUNG LEFT BLOCK part of the left lung that is further than 3 cm from PTV (completely blocked) Dmin Lung Left part of the left lung that is closer than 1.5 cm to PTV LUNG LEFT Plan part of the left lung that is closer than 3 cm to PTV excluding Dmin Lung Left

9 Additional contours Avoidances LUNG RIGHT LUNG LEFT Top LUNG RIGHT LUNG RIGHT BLOCK LUNG LEFT Top Emergence of PTV SC leads to: LUNG LEFT Top part of the left lung that is closer than 3 cm to PTV on the slices where PTV SC is present LUNG RIGHT BLOCK part of the right lung that is 1.5 cm lover than PTV SC Avoidances some volumes where some dose problems are predicted or found

10 Additional contours PTV Min BLOCK Block structure in the inferior part of the body made as the prolongation of the blocked regions PTV Min small part of the PTV made to shrink the volume of minimum dose

11 General Parameters Calculation Grid Fine resolution equal to imported planning images (256x256) Field width 2.5 cm was set according to the PTV length Beamlet Mode is a general mode in clinical practice - optimizer uses pre-computed dose volumes and simply re-weightings them Max beamlet open time MF Average beamlet open time for used beamlets Pitch dcouch/rotation field width

12 General Parameters Calculation Grid Fine resolution equal to imported planning images (256x256) Field width 2.5 cm was set according to the PTV length Beamlet Mode is a general mode in clinical practice - optimizer uses pre-computed dose volumes and simply re-weightings them Max beamlet open time MF Average beamlet open time for used beamlets Pitch dcouch/rotation field width

13 Starting restrictions

14 First Results First I protect OARs

15 Further optimization Now I work with Targets Don t forget about OARs

16 Further optimization

17 Final restrictions

18 Final Histogram Full Dose Final Dose

19 Final Dose Distribution

20 Main difference from my first plan

21 Evaluation Old Results New Results

22 Thank You!

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