SBRT Treatment Planning: Practical Considerations

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Bottom line for <strong>SBRT</strong> • Without an approved plan in the patient’s chart, no treatment verification can be done. Physics must be present for treatment verification. • If IMRT, without IMRT QA documented, no 1 st treatment should be done. • Attending must be present for every treatment fraction. Physics should be available for every treatment.
What is a ‘Dry Run’? • <strong>Treatment</strong> verification – Reproduce setup – Verify isocenter – Clinically mode up each treatment field Check beam clearance (collision) Check any interlock MLC interlock? Reinitialized but can not clear means corruption of MLC files undeliverable beam Potential MU problem? For example > 1000 for any single field beyond machine capability for non-SRS beams Clearly mark immobilization devices after successful dry run.
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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 and 60: SBRT Lung/Liver/Abdominal Cases •
Page 61 and 62: SBRT Lung/Liver/Abdominal Cases •
Page 63: GTV is 5mm too inferior (MLC acts a
Page 67 and 68: Acknowledgements • Physics Jin Sh
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SBRT Treatment Planning: Practical Considerations

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