1. Treatment planning - basics
Christian Kirisits

2. Standard loading pattern
Point A
20 mg
10 mg
10 mg
15 mg
20 mg
Point A
45 Gy EBRT + 4 x BT:
85 Gyαβ10
60 Gyαβ10

3. Standard loading pattern

4. Standard loading pattern

5. Standard loading pattern

6. Shifting and skipping dwell positions

7. Standard loading pattern

8. Optimized loading pattern

9. Standard loading

10. Inverse optimization
without thinking

11. Taking into account experience from manual opt.
Inverse optimization
Taking into account experience from manual opt.

12. Dose Optimization DVH parameters (D90, D100, D2cc, D0.1cc)
Spatial dose distribution (Hot and Cold spots)
Dwell time distribution to take into account
not contoured structures
parametrial tissue
vagina
nerves
vessels
ureter

13. Manual optimization

14. Inverse optimization

15. Manual plan

16. IPSA

17. Vpd 96 cm³ V2pd 28 cm³ 100% 200% 100% 200% A A A A
standard plan: prescribed dose to point A (left and right)
no needles

18. Vpd 103 cm³ V2pd 30 cm³ 100% 200% 100% 200% A A + 11 mm
optimized plan: prescribed dose to point A (right)
1 needle loaded

19. 100%
200%
100%
200% A A
Vpd 109 cm³
V2pd 33 cm³
optimized plan: prescribed dose to point A (right)
2 needles loaded

20. 100%
200%
100%
200% A A
Vpd 114 cm³
V2pd 36 cm³
optimized plan: prescribed dose to point A (right)
3 needles loaded

21. However, every optimization is limited by anatomy, topography and
application technique.
Jamema et al. Radiother Oncol 2010

22. Source loading - optimization
Training
Experience (learning curve)