Brain SRS/SRT: Dynamic

Conformal Arc and Rapid

Arc for a single lesion
MaryKate Janita
 Patient Information
• 63 year old male
• Stage IV Metastatic Melanoma to the brain
• Right basal ganglia lesion
• 2 cerebellar lesions
• Right parietal lobe
 Treatment Plan
• 20 Gy in 1 fraction using 3
noncoplanar VMAT arcs
normalized to 99.8% so that 95%
of the PTV is covered by 20Gy
• GTV receives 24Gy
 Immobilization
Supine
Encompass Board/headrest*
Encompass mask with integrabite bite*
1mm shim
Knee sponge
Hands on chest holding ring
 Brain 4500
Brainstem 5000
Optic Chiasm/Nerve 5000
Lens 1000
TD 5/5s of OAR Retina 4500
Spinal Cord 4700
Cochlea 4500
 Dynamic Conformal Arc
• Gantry rotates around the patient while the MLCs conform to the shape of
the target as seen from BEV
• Used for more spherical lesions
• Utilizes the advantages of arc-based delivery to spare dose to the
surrounding normal tissue with homogeneous dose distribution, and uses
conformal beams to achieve high dose conformity
• Static gantry speed/dose rate
• Low MUs
 • Forward Planning
• Depends on geometric relationship
between the tumor and critical structures
• Dosimetrist plans gantry start/stop,
couch/collimator angles, weight of arcs,
dose rate, and target and avoidance
Dynamic structures.
Conformal Arc: • TPS creates a plan with MUs necessary
Planning to deliver specific dose to tumor, as well
as creates the distribution of dose in
the body.
• Use imaging such as CT, MRI, and DRRs
to localize target as well as plan beam
arrangement to avoid critical
structures. DRRs are used in BEV to
create MLC patterns
Planning Objectives
 DCA Plan

• 3 arcs
• 6MV
• FFF
• Low MU
 • Gantry rotates around the patient and the MLCs
continuously move to modulate the beam
• MLC aperture shape, dose rate, and the speed of
gantry rotation are continuously varied during the
gantry rotation to achieve conformal dose
distribution
• Used for asymmetrical lesions or lesions close to critical
structures
Rapid Arc • Usually around 3 arcs, most of which are noncoplanar in
order to create conformal dose distribution
• Pick beams angles that enter through least amount
of brain tissue
• Aware of not only entrance of beam but also exit—
avoid critical structures
• Non-coplanar beams—table kicks—clearance issues
 Rapid Arc: Planning
• Inverse Planning
• Less dependent on geometric parameters but more on specific volumes
of targets, critical structures and their dose constraints
• Dosimetrist enters goals, constraints and optimization parameters
• Dose volume objective (upper, lower)
• MU objective
• Normal tissue objective
• 178 control points in 360 degree arc (114, 98, 98)
• # of MUs, MLC shape, max dose rate, max gantry speed
• Optimization occurs in four resolution levels
• Majority of optimization happens in 1-2 level
• TPS finds best result to fit all parameters
Optimization Objectives
 Treatment Plan

• 3 arcs
• 6MV
• FFF
• Higher MU than DCA
Oversight by Physics
 Summary
DCA Rapid Arc
• MLCs conform to PTV • Modulation of beam
• Spherical lesions • Asymmetric lesions & close to OAR
• Forward planning • Inverse Planning
• No VMAT QA • Optimization

• Fast planning and delivery • VMAT QA required