IMRT

Simultaneous
Integrated Boost
Ashley Coey
December 3, 2014

Integrated Boost
Using IMRT to treat mulAple volumes
simultaneously
Results in dierent doses in each
volume
Allows for increase dose to PTV(s) and
achieve a safe dose to structures
BeLer local control

Bene5its of SIB
Less total treatments and CT simulaAons
More ecient

BeLer biological eecAve dose

Less dose to achieve results
Tissue sparing with IMRT
Less MU and machine use

Inverse Planning
Fuse CT and PET
Contour necessary structures
Input planning goals into system
Given by physician
Push constraints unAl achieve opAmal plan

IMRT with SIB

Squamous cell of tonsil
Stage IVA T3N2M0
3 separate volumes
70/63/56 Total Gray
2/1.8/1.6 Gray per fracAon
35 fracAons
97.5% NormalizaAon value
Shi^ 2 inferior and 3 anterior

Contours
With No
PTVs

Contours
With PTVs

Plan Report

Beams and Segments

Total 9 beams each 40 degrees apart
Between 13 and 21 segments per beam
More than typical IMRT
Need more segments per angle to cover
mulAple volumes
More MLC conguraAons needed to
conform to each PTV

Beam Arrangement and Segments

Planning Objectives

Frontal Dose

Sagittal Dose

Axial Dose

Axial Dose
Superior to Central Axis

Inferior to Central Axis

Setup Fields and SSD

AP
SSD: 92.1

Right Lateral
SSD: 94.3

DVH of PTVs
Red (Tumor): 70Gy
Mean: 7329Gy

Blue (High Risk): 63Gy
Mean: 6256Gy
(para-pharyngeal nodes)

Green (Low Risk): 56Gy
Mean: 5089Gy
(supraclav)
*Approved by MD*

DVH of Critical Structures

Spine (purple):
Min: 1.0%
Max: 63.4%
Mean: 43.1%

Brain Stem (brown):

Min: 3.4%
Max: 65.1%
Mean: 14.4%

ParoAds (green and blue):

Min: 5.0%
Max: 108.8%
Mean: 48.7%

Brachial Plexus (doLed green/

blue):
Min: 56.0%
Max: 101.3%
Mean: 76.4%

Critical Structures
Spine goal: Less than 45Gy
Spine Mean: 43.1% (3017 Gy)
GOOD

Brain Stem goal: Less than 50Gy

Brain Stem mean: 14.4% (1008 Gy)
GOOD

ParoAds goal: Less than 26Gy (Limit of 36Gy)

ParoAds mean: 48.7% (3409Gy)
In limit

Brachial Plexus goal: less than 60Gy

Brachial Plexus mean: 76.4% (5348 Gy)
GOOD

Why IMRT?
MulAple sites need some dose but many criAcal
structures
Use of IMRT to shape dose to tumor
Avoid spine, brain, other structures
SAll get signicant dose to PTVs
Conformal would cause too much damage and
side eects

IMRT: Head and Neck vs.

Prostate
Similar
Beam arrangements
are similar
9 beams
40 degrees apart
Dose with small
margin sculpted to
PTV

Dierent
Smaller separaAon
Less Assue in head and
neck
Less energy needed

CriAcal structures are

avoided in H&N
In prostate, criAcal
structures pushed
via contouring