1. 第三讲： Basic treatment planning － Dengsong Zhu, MS, DABR Medical Physicist Radiation Safety Officer

2.  Saint Thomas Health is a member of Ascension Health, a Roman Catholic organization that is the largest not-for-profit health system in the United States. STH is composed of five hospitals: Saint Thomas West Hospital and Saint Thomas Midtown Hospital (Nashville)s and The Hospital for Spinal Surgery in Nashville, Saint Thomas Rutherford Hospital in Murfreesboro and Saint Thomas Hickman Hospital in Centerville. It also has affiliation agreements with some smaller hospitals which it does not own.Ascension Health, a Roman Catholic organization that is the largest not-for-profit health system in the United States. STH is composed of five hospitals: Saint Thomas West Hospital and Saint Thomas Midtown Hospital (Nashville)s and The Hospital for Spinal Surgery in Nashville, Saint Thomas Rutherford Hospital in Murfreesboro and Saint Thomas Hickman Hospital in Centerville. It also has affiliation agreements with some smaller hospitals which it does not own. Ascension Health Type Nonprofit Industry Healthcare Founded 1999 Headquarters Edmundson, MO, USA Edmundson, MO, USA Area served United States Key people Robert J. Henkel, President/CEO and Charles J. Barnett, President, Healthcare Operations and COO, Services Hospital management Hospital management Revenue $15.56 billion USD (2011)USD (2011) Number of employees 113,500 (2011) Website http://www.ascensionhealth.org/ http://www.ascensionhealth.org/

3.   How a Linear Accelerator Works How a Linear Accelerator Works

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9.  3D Conformal Plan -block (Cerrobend, MLC)MLC -6 MV, 10 MV, 18 MV, 20 MV, etc -Physical Wedge, EDW -Bolus

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15.  F. M. KHAN, The Physics of Radiation Therapy

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17.  - Lung, Bone, Spine, Muscle, etc -Some time, only use PA to treat Spine -Off Cord Oblique Fields 3D Conformal Plan -AP/PA

18.  Example Lung – AP/PA

19.  做一个治疗计划，精确找到 GTV, 是至关重要

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21.  Tumor motion during breathing At my clinic, for Lung patient, except for general CT, 4D CT will be taken to check tumor’s movement to create an ITV.

22.  T. Bunyaviroch, MD, R. E. Coleman, MD, PET Evaluation of Lung Cancer, The Journal of Nuclear Medicine, Vol. 47, No. 3, 2006

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26.  J. Y. Luh, MD, FACP, C. R. Thomas, Jr.,MD, Radiation Therapy for Non-Small Cell Lung Cancer, Caring Ambassadors Program 2012

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28.  一般 AP/PA 之后，由于要降低 cord dose, off cord fields will be used.

29.   Perform CT, Motion Management: 4DCT, Hold Breath, Breathing Control, etc  Fusion between PET, CT  Contour GTV, CTV, PTV, OAR (Organ at Risk) precisely.  Add beams, blocks  Use wedges or FIF to reduce hot spot Summary

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39.  Wedge/EDW http://www-personal.umich.edu/~swhadley/2005/09/why-does-wedge-tray- have-hole-in-it.html

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45.   4 fields box  IMRT  SBRT  VMAT  Prostate Implant  At my hospital, -VMAT only (Initial +BST) -I-125 Prostate implant only (145 Gy) -VMAT (45 Gy) + I-125 Prostate implant (105Gy)

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56.   2 Tangent beams (APBI) 266 cGy x 16 fx  2 Tangent beams 180 cGy x 28 fx  SAVI/Mammosite （ 3400 cGy/10 fx in 1 week, 6 hours minimum gap)  2 Tangent beams + SC+PAB -5040 cGy, 4000 cGy -Multiple ISO -Single ISO Breast Case

57.  Craniospinal (CNS) case

58.  Must consider Divergence

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63.   -PET, MRI, CT, 4DCT  Non-coplanar 3D conformal radiotherapy (3DCRT), dynamic conformal arc radiotherapy (DCA), co- planar intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT).  At my hospital, 3DCRT and DCA are used for Lung, etc, VMAT is only used for spine. SBRT

64.   1. 理解自己的单位的机器和机器的特性  2. 理解 3D, IMRT, VMAT ，什么样的情况用什么技术 做计划最合适  2. 尽量把剂量限制在治疗区域 (PTV, CI, HI)  3. 尽量减少其他区域的的剂量 (OAR ， tolerance table)  4. 确认病人之前有没有接受过放射治疗，如有，需要 把之前治疗的剂量考虑进去。（ Planning CD, Re- create a plan based on the treatment information, such as DRR, ISO, beam parameters)  5. 避免重叠区。（ Overlapping Area) 一点感受

65.  Comparative DVHs of PTV and Total Lung - GTV. The graph depicts the relative dose- volume- histogram for the three techniques of 3D, IMRT and combined IMRT + AP-PA Soyfer et al. Radiation Oncology 2012 7 :23 doi:10.1186/1748-717X-7- 23 Download authors' original image Download authors' original image

66.  References  F. M. KHAN, The Physics of Radiation Therapy  T. Bunyaviroch, MD, R. E. Coleman, MD, PET Evaluation of Lung Cancer, The Journal of Nuclear Medicine, Vol. 47, No. 3, 2006  J. Y. Luh, MD, FACP, C. R. Thomas, Jr.,MD, Radiation Therapy for Non-Small Cell Lung Cancer, Caring Ambassadors Program 2012  http://www-personal.umich.edu/~swhadley/2005/09/why-does-wedge-tray-have-hole-in-it.html http://www-personal.umich.edu/~swhadley/2005/09/why-does-wedge-tray-have-hole-in-it.html  http://ijcto.org/index.php/IJCTO/article/view/Casesnoves/ijcto.0203.1html http://ijcto.org/index.php/IJCTO/article/view/Casesnoves/ijcto.0203.1html  AAPM TG 74 Report

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