SBRT Treatment Planning: Practical Considerations

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<strong>SBRT</strong> Lung/Liver/Abdominal Cases • If non-gating, may consider one or both arms on the side. Non-coplanar beams could be used to compensate for lateral beams. If gating is used, only coplanar beams can be used for some machines, arms on the side could further limits beams. • VMAT is a good option (can not be combined with gating for many machines) • Gating + fixed beam IMRT or EDW is not advisable (takes way too long to deliver), use FIF instead if you must. • Beam arrangement should consider collision possibility for lateral tumors. Keep beams /arcs on the ipsilateral side.
<strong>SBRT</strong> Lung/Liver/Abdominal Cases • If no fiducials, create fluoro beam aperture that hugs GTV. • If there is fiducials, create fluoro beam aperture that use fiducials as corners. • CBCT alignment with GTV, bony landmark secondary but should be less than 1cm discrepancy. Otherwise, reposition patient. • CBCT sometimes do not align well with average sim CT due to breathing variation • Fluoro to verify positioning after CBCT. • Fluoro between fields to monitor setup consistency.
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SBRT Treatment Planning: Practical
Page 3 and 4:
Outlines • The Basic Principles o
Page 5 and 6:
Montefiore-Einstein SBRT Experience
Page 7 and 8:
RTOG SBRT Protocols • 0631 Spine
Page 9 and 10: If beam margin is close to beam pen
Page 11 and 12: For single isocenter dose distribut
Page 13 and 14: Conventional SBRT (Ablative intent)
Page 15 and 16: For SBRT plans Prescription Isodose
Page 17 and 18: Requirements of SBRT Plan (from RTO
Page 19 and 20: The published protocols usually do
Page 21 and 22: 10cm Conventional Cord 10cm RTOG 06
Page 23 and 24: For Spine Cases: IMRT or VMAT is re
Page 25 and 26: Cord: Max point dose 9.33 Gy V100%
Page 27 and 28: Prescription Isodose Surface Covera
Page 29 and 30: Conformality : Prescription Dose Vo
Page 31 and 32: COR CAX SAG No need to do any non-c
Page 33 and 34: Single Arc Collimator 45 CAX Two Ar
Page 35 and 36: Additional 15 cc volume of normal t
Page 37 and 38: Fixed IMRT Fields 100% PD and above
Page 39 and 40: 9 Field IMRT: Cord Dose DVH 10 Gy 0
Page 41 and 42: Arc2: Couch 15, Gantry 330-110 Arc1
Page 43 and 44: Prescription Isodose Surface Covera
Page 45 and 46: High Dose Spillage PD = 100% = 20 G
Page 47 and 48: Intermediate Dose Spillage: R 50% a
Page 49 and 50: 12.5% isodose restricted mainly in
Page 51 and 52: Liver Montefiore-Einstein Cancer Ce
Page 53 and 54: Hepatocellular Carcinoma Five Fract
Page 55 and 56: SBRT CT simulation • For upper th
Page 57 and 58: SBRT T-Spine • CT scan has to eit
Page 59: SBRT Lung/Liver/Abdominal Cases •
Page 63 and 64: GTV is 5mm too inferior (MLC acts a
Page 65 and 66: What is a ‘Dry Run’? • Treatm
Page 67 and 68: Acknowledgements • Physics Jin Sh
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SBRT Treatment Planning: Practical Considerations

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