Clinical

Practicum II Clinical Lab Assignment

Parotid treatment technique comparison: Find one or two head and neck CT data
sets that you can use for mock plans. Look for one with the chin extended up and
one with a neutral head position, if possible. This project can be done without an
extended chin (neck flexed back) CT data set, if it is not available.
Using a head and neck CT image set, contour the parotid gland (GTV) and add a
1cm margin (PTV). Contour all surrounding critical structures.
The goal for each of the 3 plans below will be to obtain 60 Gy to the GTV with the
95% isodose surrounding the PTV.
For each plan:
1) Make a chart listing all of the surrounding critical structures and their
tolerance doses. After completing each plan, record the dose that each
structure actually received in a column next to the maximum tolerance dose.
Indicate in a 3rd column whether the structure tolerance was met or
exceeded.
2) Print or capture an image of at least one transverse slice of the plan showing
the isodose coverage of the parotid and the PTV, the maximum dose location
and the 100%, 95%, 75%, and 40% isodose lines. (Label the isodose levels).
3) Provide a DVH with the GTV, PTV and all surrounding critical structures.
4) Provide a detailed description of each plan (beam angles, energy, cone or
field size, wedges used, and any other parameters that you may have
changed: couch angle, collimator angle, etc). This can be a print out or it can
be typed in a separate document but all information required to treat this
patient must be provided for each of the 3 final plans.
PLAN #1
1) Design an ipsilateral wedged pair plan for the parotid (use references or
mentors if needed).
a) How would, or how does, the patient position (chin extended) affect your beam
arrangement?
b) If you were not able to get adequate coverage on the parotid using the
wedged pair technique, what were your constraints?
Even if you are not able to get an acceptable plan on this CT data set, go ahead
and add a lower anterior ipsilateral neck field that abuts the bottom of your
wedged pair fields using a half beam technique. Use the image below to design
your anterior field.

Plan this lower neck field (medial edge of the field should be off the cord) to 50.4
Gy at 1.8 Gy/day using a depth of 3.0 cm for the anterior neck nodes.
For this project turn in a plan sum showing the isodose coverage of the parotid,
the PTV, and the lower neck nodes.
Show the max dose location and the 100%, 95%, 75%, and 40% isodose lines.
(Label the isodose levels).
Show your DVH with the GTV, PTV and all surrounding critical structures.

PLAN #2
Ipsilateral Photon/Electron (Mixed beam)
Achieve the required coverage on the parotid gland and PTV using electrons for
the superficial gland and photons to reach the deeper lobe.
a) How does this plan compare to your wedged pair plan?
b) Were there any dose constraints not met?

PLAN #3
a. Using an IMRT technique of your choice find the beam arrangement needed to
achieve the required coverage on the parotid gland while sparing the critical
structures.
For each plan in assignment #3 answer the following:
a) What beam arrangements did you try?
b) Why did you decide on your final one?