Biomedical Engineering Reference
In-Depth Information
to the target volume or sensitivity makes them of particular
interest.
2
4.
Establish the planning aims for the treatment.
5.
Design one or more plans
−
i.e., sets of beams each of which,
together with their weights, fulfill to the extent possible the
requirements of the planning aims.
6.
Evaluate these plan(s) and either select one of them for use in
treatment or, if its requirements cannot be met, revise the plan-
ning aims and return to step 5.
7.
Finalize the prescription.
8.
Simulate the selected plan to ensure that it is deliverable and
that all parameters have been correctly established.
9.
Deliver the treatment, and verify that the delivery is correct,
usually in many fractions over many weeks.
10.
Re-evaluate the patient during the course of treatment to ensure
that the plan remains appropriate (e.g., weight loss or tumor
regression have not affected the treatment geometry unduly, or
that there have been no unexpected toxicities) and, if it does
not, return to step 5, or even 2, to replan the remainder of the
treatment.
11.
Document and archive the final treatment plan.
12.
Review the treatment plan at the time of patient follow-up or
possible recurrence.
Steps 2 and 3 have already been described in Chapter 3. Tra-
ditionally, the term
treatment planning
has tended to be used for
steps 5 through 7 but I take the broader view that the task spans the
whole sequence listed here and that the medical physicist or
dosimetrist should be involved in all of them.
You may, with some justice, feel that step 5 is the step that, given the
title of this chapter, should receive the greatest focus here. However,
so much of the planning process revolves around identifying the
problem(s) and evaluating the solution(s) that we need first to address
these issues. The discussion of step 5 is deferred until Chapters 8
and 9 and, in the case of protons, Chapter 11.
2
See Chapter 3 for an explanation of these acronyms.
