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planning:userguide:walkthroughs:prostate_plan [2016/10/03 13:14] – kmobileplanning:userguide:walkthroughs:prostate_plan [2021/07/29 18:28] (current) – external edit 127.0.0.1
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-====== Prostate Plan Walkthrough ======+===== Prostate Plan Walkthrough =====
  
-  - Select the CT image set from the list of available files for import +==== Launching Planning ==== 
-  - Ensure that the MR is correct +  - Open the Astroid Launcher and login{{ :- planning:userguide:walkthroughs:launcher_1.jpg?nolink&400 |}} 
-    - If MR needs to be changed you may edit it by choosing the //Edit// button to the left +  - Select your realm 
-  - Click the //Create New Patient// button to start the import process +  - A list of available apps will be listed on the left, select //Planning// from this list 
-  - Fill in the Patient Intent information and select the appropriate HU to RSP curve (as shown below) <WRAP group> +  - If you see an Install button click it and wait for the version to install. You will know it is installed when you see a LAUNCH button 
-<WRAP half column><WRAP center>{{ :planning:userguide:walkthroughs:pro3.png?300 |}}</WRAP> +  - Click the LAUNCH button. The version of planning that is installed in your realm will now open 
-</WRAP> + 
-<WRAP half column><WRAP center>{{ :planning:userguide:walkthroughs:pro1.png?300 |}}</WRAP> <WRAP center>{{ :planning:userguide:walkthroughs:pro2.png?300 |}}</WRAP> +==== Creating a Patient ==== 
-</WRAP> + 
-</WRAP> +  - From within the Planning App click on the Imports block 
-  - Click the //Create Patient// button and wait for the import to complete +  - Select the CT image set (SBRT Prostate) from the list of available files for import 
-  - Click the //Back to Imports// button <WRAP center>{{ :planning:userguide:walkthroughs:pro4.png?300 |}}</WRAP> +  - Ensure that the MRN is correct 
-  - Select the Structure Set file that is associated with this patient +  - Click the //Create Patient// button to start the import process{{ :planning:userguide:walkthroughs:pro_patient_select_2.png?400 |}} 
-    - Make sure Structure Set MR matches CT image set MR (make any edits to the MRN that are needed) +  - In the control pane on the left hand side, the patient model will be automatically selected based on the structure set DICOM UID information 
-  - Click the //Import into Patient// button in the patient information window <WRAP center>{{ :planning:userguide:walkthroughs:importpro.png?300 |}}</WRAP> +  - Fill in the Patient Data and select the appropriate treatment site and HU to RSP curve (as shown below){{ :planning:userguide:walkthroughs:patient_data_1.jpg?nolink&400 |}} 
-  - In the control pane on the left hand side, the image snapshot will be automatically selected based on the structure set DICOM UID information, and then the //Import Structure// block will automatically expand. <WRAP center>{{ :planning:userguide:tutorials:import_5.png?200 |}}</WRAP> +  - You will see a list of the imported structures. Here you may choose whether or not to import each structure by checking or unchecking the box beside each structure name.{{ :planning:userguide:walkthroughs:import_structures_1.jpg?nolink&400 |}} 
-  - You will see a list of the imported structures. Here you may choose whether or not to import each structure by checking or unchecking the box beside each structure name. +    - For this case, we will import all available structures and there is nothing to change on this page 
-    - For this case, we will import all available structures +    - You also have the ability to assign or edit any structures that are shown as //custom//, which indicates the name did not exactly match a site structure from the treatment site template list you specified during patient creation  
-  - You also have the ability to assign or edit any structures that are shown as //custom//, which indicates the name did not exactly match a directive structure from the treatment site template list you specified during patient creation.  +    - Matched, Assigned, and Custom structures are designated with corresponding tags at the end of the structure name in the structure list.  
-    - Matched, Assigned, and Custom structures are designated with corresponding tags at the end of the structure name in the structure list. +    - Assigning a custom structure to a defined site structure will result in the imported structure inheriting all the predefined structure properties (e.g. name, type, color) 
-    - Assigning a custom structure to a defined directive structure will result in the imported structure inheriting all the predefined structure properties (e.g. name, type, color) +    - For all custom structures the type is by default set to "Other" unless it contains the letters "TV" (as in PTV or CTV), in which case it is assigned the type of "Target"; this may be changed here if needed 
-    - For all custom structures the type is by default set to "Other" unless it contains the letters "TV" (as in PTV or CTV), in which case it is assigned the type of "Target"; this may be changed here at the import +  - Click the //Import// button to create the patient and import the CT Images and Structures into it 
-    - You will see a list of structures that have been contoured on the image set. Here you may choose to delete (not importing it) the structure hitting the x beside the structure name.  +  - The patient is now created and all available data has been imported, so it is time to proceed with entering the prescription information 
-  - Simply expand the collapsed structure to edit and you will be given choices such as assigning that structure as the patient structure by clicking the blue "Assign Patient Structure".  +  - Click on the //Open Patient// button{{ :planning:userguide:walkthroughs:pro_open_patient_3.png?400 |}} 
-  - You also have the ability to edit any custom structure that does not match the directive level structures defined in the site configuration. These custom structures are designated with an asterisk(*) at the end of the structure name in the structure list.  + 
-    - You may chose to optionally assign a custom structure to a defined site structure. Doing so will result in the imported structure inheriting all the predefined structure properties (e.g. type, color). +==== Course Prescription ==== 
-    - For a custom structure the type is by default set to "Other", but may be changed here at the import. +Prescription information is stored in the //Course// and must be added prior to making a treatment plan for a new patient. 
-  -  Once you have all your structures customized as you would like, click the orange "Import Structures" button <WRAP center>{{ :planning:userguide:tutorials:import_6.png?200 |}}</WRAP> + 
-  - After your structures are imported you may either choose to proceed to clicking "Open Patient" or you may import more patients by clicking "Back to Imports" <WRAP center>{{ :planning:userguide:tutorials:import_7.png?200 |}}</WRAP>   +  - Open the patient after importing the CT and Structure Set 
-  - Click on the //Back to Import// button +  - Open the Patient Course (note: it will automatically open if the patient is freshly created) 
-  - Click the //Planning// task +  - Next proceed to //Prescriptions// 
-  - Click the new patient entry from the table +    - Select //Create New Prescription//{{ :planning:userguide:walkthroughs:pro_create_new_rx.png?400 |}} 
-  - First the patient prescription information will be filled  +    - Select PTV from the Prescription drop down menu 
-  - Open //Directive// block +     - For this example the dose will be 79.2Gy in 44 fractions to the PTV (as shown below){{ :planning:userguide:walkthroughs:pro_new_rx.png?400 |}} 
-  - Under //General// fill in //Goals//  +    - //Label// and //Description// are free text fields that allow you to "name" each Prescription and provide any description or notes necessary to distinguish between each in the case of multiple prescriptions. You must enter a "name" in the //Label// in order to proceed. You are free to enter your own values in these fields for this walkthrough. Click //Add// when completed 
-    - In the example below a minimum dose to the PTV7920 was set at 79.2Gy and the maximum dose was set at 85.5Gy was set to the prostate bed <WRAP center>{{ :planning:userguide:walkthroughs:general.png?300 |}}</WRAP> +   - Fill in the //Clinical Goals//  
-  - Under //Phases// fill in //label//, //fraction// and //prescription// +       - Choose the structure from the dropdown to add your goal 
-    - For this example the dose was 79.2Gy in 44 fractions to the PTV7920 <WRAP center> {{ :planning:userguide:walkthroughs:script.png?300 |}}</WRAP> +       - In this example we will set a minimum dose to the PTV at 79.2Gy and the maximum dose at 85.5Gy as shown below{{ :planning:userguide:walkthroughs:pro_new_clinical_goals.png?400 |}} 
-  - Click the //Add Request// +  - Click //Done// to complete the //Course// editing   
-    - If this plan will only fulfill a portion of the prescription, then the //Request// should be edited to reflect this, otherwise just proceed to adding a plan + 
-      - In this case, we will be fulfilling the entire prescription with a single plan, so no editing is needed +==== Plan Creation ==== 
-  - Click //Add Plan// +The required //Course// and //Patient Model// information was selected during import, so now we can move to creation of a treatment //Plan// 
-    - Name the plan and click //Save// + 
-  - Open the //Plan// by selecting the //Open// button in the block +  - From the Patient Overview tree, click //Add Plan// under the Patient Model entry{{ :planning:userguide:walkthroughs:plan_4.jpg?nolink&400 |}}  
-  - In the //Patient Geometry// block, create any planning structures that may be needed (if not created in contouring software), such as a combination of the left and right femoral heads (see [[planning:userguide:walkthroughs:creating_structures|Structure Geometry]] for details on how to Create structures) +    - Name the plan and click //OK// (the description is optional) {{ :planning:userguide:walkthroughs:plan_5.jpg?nolink&400 |}} 
-    - We will create a point to use for the isocenter (note this step is done for illustration purposes is not necessary for most plans)  +    - This creates an empty plan with its prescription set to fulfill all portions of the Course Prescription 
-      - Select a type of isocenter and create the point at the centroid of the prostate <WRAP center>{{ :planning:userguide:walkthroughs:pro8.png?300 |}}</WRAP> <WRAP center>{{ :planning:userguide:walkthroughs:pro9.png?300 |}}</WRAP> +  - Now open the new plan by clicking the //Open// button under the new plan entry in the Patient Overview tree 
-  - Open the //RSP Image// block+ 
 +==== Plan Prescription Implementations ==== 
 + 
 +    - Click the // General / History// heading to expand this block 
 +      - Notice here that our empty plan starts out with its prescription set to fulfill all portions of the Course Clinical Goals and Prescriptions 
 +      - If a plan will only fulfill a portion of the Prescription, then this information should be edited to reflect this, otherwise just proceed past this block 
 +    - In this case, we will be fulfilling the entire prescription with a single plan, so no editing is needed 
 +  - Generating our plan will now progress to the //Patient Geometry// block, where we will create any points or planning structures that are needed (if not created in contouring software), such as a combination of the left and right femoral heads (see [[planning:userguide:tutorials:all_tutorials#patient_geometry|Structure Geometry]] for details on how to create structures) 
 +    - We will create a new point to use for the isocenter (note this step is done for illustration purposes and is not necessary for most plans){{ :planning:userguide:walkthroughs:pro_new_create_new_point.png?400 |}} 
 +      - Select a type of isocenter and create the point at the centroid of the PTV (as shown below){{ :planning:userguide:walkthroughs:pro_new_create_new_point_2.png?400 |}}  
 +      - Click //DONE// button at the bottom of the page 
 + 
 +==== HU to RSP ==== 
 +Next we will move on to defining the HU to Proton Relative Stopping Power (RSP) conversion 
 +  - Click to open the //RSP Image// block
     - If any density overrides are needed they are entered here in the //RSP Image// block     - If any density overrides are needed they are entered here in the //RSP Image// block
-    - If the HU to RSP curve was not chosen upon patient import the user may do so at this point +    - If the HU to RSP curve chosen upon patient import needs to be changed the user may do so at this point 
-    - We do have any density overrides to apply for this case and the proper HU curve has already been selected, so we can move past this block +    - We do have any density overrides to apply for this case and the proper HU curve has already been selected 
-  - Open //Calculation Grid// block and define the dose calculation grid (see [[planning:userguide:walkthroughs:defining_dose_grid|Defining the Dose Grid]] for a detailed explanation) +     - Click the //Cancel// button to close this block if you have already clicked on the //edit// button 
-    - Use the following grid settings: + 
-      - Set the base grid to 8 mm +==== Calculation Grid ==== 
-      - Set the 2cm structure to 4 mm +We are now ready to define the dose calculation grid (see [[planning:userguide:tutorials:all_tutorials#dose_grid|Defining the Dose Grid]] for a detailed explanation) 
-      - Set the PTV and the Prostate to 2 mm <WRAP center>{{ :planning:userguide:walkthroughs:pro10.png?300 |}}</WRAP> +  - Click to open the //Calculation Grid// block 
-  - Open the //Beams// block (see [[planning:userguide:walkthroughs:creating_a_beam|Creating a New Beam]] for detailed explanation) +    - Click the //Edit// button 
-    - Choose "Gantry 2" from the //Treatment Room// dropdown <WRAP center>{{ :planning:userguide:walkthroughs:pro12.png?300 |}}</WRAP> +    - Create a grid by performing the following steps: 
-    - Expand the //spot placements// sub-block and set the following values (note this is the plan level spot placement, so it will apply to all our beams) +      - Set the base grid resolution to 8 mm 
-      - Lateral margin- 15 mm +      - Click on //Add Structure// drop down menu and select the "2cm" structure then set the size to 4 mm 
-      - Distal margin- 10 mm +      - Click on //Add Structure// drop down menu and select the "PTV" then set the size to 2 mm {{ :planning:userguide:walkthroughs:pro_new_grid.png?400 |}} 
-      - Spot spacing- 1 sigma +      - The Prostate is included in the PTV volume so there is no need to set a separate grid size  
-      - Layer spacing- .8 Distal 80 <WRAP center>{{ :planning:userguide:walkthroughs:pro11.png?300 |}}</WRAP>  +      - Click the //OK// button 
-    - Now we will make our beams + 
-    - Start by clicking //Create New Beam//+ 
 +==== Beams ==== 
 +We are now ready to begin defining the treatment beams 
 +  - Click to expand the //Beams// block (see [[planning:userguide:tutorials:all_tutorials#creating_a_pbs_beam|Creating a New Beam]] for detailed explanation) 
 +    - Before defining individual beams, we will first set some shared beam properties 
 +    - Set the //Treatment Room// by clicking on //treatment room// (this will bring up a drop down menu where the appropriate treatment room can be selected){{ :planning:userguide:walkthroughs:pro_new_choose_machine.png?400 |}} 
 +    - Click the //OK// button 
 +  - Click on the //Spot Placement// sub-block to set the following values (note these are the plan level spot placement parameters, so it will apply to all our beams, unless we specifically override the values within an individual beam){{ :planning:userguide:walkthroughs:pro_new_spot_placement.png?400 |}} 
 +     - Lateral margin- 15 mm 
 +     - Distal margin- 10 mm 
 +     - Spot spacing- 1 sigma 
 +     - Layer spacing- 0.8 Distal W80  
 +    - Click the //OK// button 
 +   - Now we are ready to make our beams 
 +    - Start by clicking //Create New PBS Beam//{{ :planning:userguide:walkthroughs:pro_new_create_new_beam.png?400 |}}
       - Enter the following for each beam        - Enter the following for each beam 
-        - General (target) +        - General 
-          - The user may choose to automatically generate the beam label or manually enter a label +          - Select the PTV as the Geometric Target and if desired, enter a description for the beam, for other selections leave the defaults (see [[planning:userguide:tutorials:all_tutorials#patient_geometry|Structure Geometry]]){{ :planning:userguide:walkthroughs:pro_new_beam_geo_target.png?400 |}}
-            - if the user chooses to automatically generate the label the label will contain the gantry angle, the couch angle, the snout and the shifter  +
-            - the user may choose the color that the beam will be denoted in  +
-            - the user will need to choose a target from the dropdown or create a new target +
-            - In the example below the PTV was chosen as the target (see [[planning:userguide:walkthroughs:creating_structures|Structure Geometry]]){{ :planning:userguide:walkthroughs:pro13.png?300 |}}+
         - Approach         - Approach
-          - At this point the use will choose the isocenter as well as enter the gantry angle and the couch angle  +          - At this point the user will specify the geometry of the beam by setting the isocenter as well as the gantry and couch angles  
-          - Beam orientation should be chosen so as to have the shortest and most homogeneous distance to the target +          - Two beams at gantry angles of 90 and 270, respectively, will be used here, which is typical (+/- 5 degrees) for standard prostate plans such as this example 
-          - Gantry angles in the range of 90 and 270 (+/- 5 degrees) are typical for prostate plans +          - Couch angle of 0 is used here for each beam 
-          - If the patient has hip prothesis the angles may need to be increased in order to get adequate coverage  +            - You may use the sliders, the +/- buttons, or simply type in the values to adjust these angles {{ :planning:userguide:walkthroughs:pro_new_approach.png?400 |}}
-          - A couch angle of 0 and collimator angle of 0 is typical for prostate plans  +
-            - As above with the gantry angle the user may need to kick the table +/- 5 degrees in order to avoid hip prosthesis <WRAP center>{{ :planning:userguide:walkthroughs:pro_14.png?300 |}}</WRAP> +
         - Snout         - Snout
-          - The user will choose a snout next +          - For this example any snout can be selected {{ :planning:userguide:walkthroughs:pro_new_snout.png?400 |}} 
-          - Depending on the size of the prostate a 12cm snout should be adequate.  +
-          - If the pelvic nodes need to be included the user may need to increase the snout size to the 18 or 25cm snout <WRAP center>{{ :planning:userguide:walkthroughs:pro15.png?300 |}}</WRAP>+
         - Aperture (if desired)         - Aperture (if desired)
-          - If there is the need to use an Aperture for sharper penumbra the user can do so at this juncture (see [[planning:userguide:walkthroughs:creating_an_aperture|Creating an Aperture]]) +          - If there is the need to use an Aperture for sharper penumbra the user can do so at this time (see [[planning:userguide:tutorials:all_tutorials#creating_an_aperture|Creating an Aperture]]) 
-          - ASTROID has the ability to utilize an Aperture with pencil beam scanning (IMPT)+          - Note that Astroid has the ability to utilize an Aperture with pencil beam scanning for both SFUD and IMPT plans and the aperture construction will be based on the Geometric Target selection 
 +          - For this plan, no apertures are necessary 
         - Shifter         - Shifter
-          - For prostate plans there tpically is no need to add a shifter +          - Simply choose a shifter from the list if one is needed 
-          - If there is a need to add one the user may choose one from the list <WRAP center>{{ :planning:userguide:walkthroughs:pro16.png?300 |}}</WRAP>+          - For this plan, no shifters are necessary {{ :planning:userguide:walkthroughs:pro_new_shifter.png?400 |}}
         - Air gap         - Air gap
-          - Depending on patient size, gantry angle etc the user may choose to enter an air gap +          - The air gap is specified as the distance from the final beamline device (aperture or shifter) or the snout end if no devices are present 
-          - The default air gap in 30mm +          - The view automatically shifts to the 3D view when entering this sub-block and you can adjust the air gap to ensure patient collisions are avoided 
-          - By clicking on the + or - at the sides the user can increase/decrease the airgap+          - The default air gap is sufficient for both beams in this example 
         - Spot placement          - Spot placement 
-          - may choose individual spot placements for each beam or leave with original chosen placements+          - Since we want both beams to use the same spot settings, we have those at the plan level and there is no need to edit the spot placements here for the beams
         - DRR options         - DRR options
-          - The user may choose one of the preset //Density Presets// from the drop down or manually set the //level, window, min HU// and //max HU// +          - The Proton DRRs shown in the //Beam// task are generally used to help determine appropriate treatment angles 
-          - The user may also choose to go into //Advanced Options// for more control of the DRR's <WRAP center>{{ :planning:userguide:walkthroughs:pro18.png?300 |}}</WRAP> +          - In cases such as these, appropriate angles are readily determined and there is no need to utilize the DRR sub-task 
-      - After one beam is created the user may clone it and change beam angles etc as necessary or they may choose to create a whole new beam +            - If you wish to explore this feature however, you may choose one of the preset //HU Settings// from the drop down or manually set the //level, window, min HU// and //max HU// or go into //Advanced Options// for additional control of the DRR's 
-  - With the beams complete, we can now move on organizing our treatment fraction groups and specifying the constraints and objectives +            - These proton DRRs are used only for visualization purposes and will have no effect on the plan construction process {{ :planning:userguide:walkthroughs:pro_new_drr.png?400 |}} 
-  - Open the //Optimization// block (see [[planning:userguide:walkthroughs:finding_optimal_plan|Astroid Optimization]] for a detailed explanation of //Optimization//, //Feasibility// and //Constraints//, as well as //Running the Optimizer//) +      - Click //Done// to complete the first beam 
-    - //Create a New Fraction Group// under the //Fraction Group// block (See [[planning:userguide:tutorials:fraction_group|Fraction Groups]] for a more detailed explanation) +   - After creating the first beam, at gantry angle 90, it is recommended that you //Clone// it and simply change new beam's ganry angle to save time in creating the second beam at gantry angle 270 (the //Clone// button is available under a beam when it is selected for viewing from the list of beams){{ :planning:userguide:walkthroughs:pro_new_clone.png?400 |}}  
-      - Enter a Fraction Count of 44 +      - Once you have //Cloned// the beam choose the //Edit// button to make changes to the gantry angle {{ :planning:userguide:walkthroughs:pro_new_edit_beam.png?400 |}} 
-      - Create Group Constraints +        - Note for more complex plans, there are often additional parameters to change (such as the aperture and the air gap) when creating additional beams via the //Clone// option  
-        - From the drop down choose the structure you want. In this example the user chose the PTV + 
-        - Enter the doses that should be achieved to this structure. Here the user chose a min dose of 79.2Gy (1.8Gy per fx) and a max dose of 87Gy. + 
-      - Add a new Target to the //Target List// +==== Optimization ==== 
-        - Set the Target to the PTV +With the two beams completely defined, we can now move on to organizing our treatment fraction groups and specifying the constraints and objectives for the treatment 
-        - Create the following //Beam Set//  +  - Open the //Optimization// block (see [[planning:userguide:tutorials:all_tutorials#astroid_optimization|Astroid Optimization]] for a detailed explanation of //Optimization//, //Feasibility// and //Constraints//, as well as //Running the Optimizer//) 
-          - Select the beams that will be associated with this fraction group + 
-          - In this case it will be the G90 and G270 beams in the same beam set + 
-            - This means the optimizer will try to give 50% of the dose from each beam +=== Fraction Group === 
-        - Constraints for the associate target  +    - Choose //Create a New Fraction Group// under the //Fraction Group// block (See [[planning:userguide:tutorials:all_tutorials#fraction_groups|Fraction Groups]] for a more detailed explanation){{ :planning:userguide:walkthroughs:pro_new_fraction_group.png?400 |}} 
-          - Typically the user will put in the prescription dose for the target as a min or mean contstraint and the max dose they are willing to allow as a max constraint +      - In the //Prescription// drop down, select the Prescription that was created earlier in the Course ("PRO") 
-          - Here the user chose the PTV as the target from the dropdown and doses of 79.2Gy min dose and 87Gy  +      - Enter 44 for the //Number of Fractions// 
-         - Here we is an example of how the above parameters will look in the //Fraction Group// block <WRAP center>{{ :planning:userguide:walkthroughs:fraction.png?300 |}}</WRAP> +      - Select IMPT as the //Type// 
-      - Click //Create// to complete the Target entry and then //Create// again to complete the //Fraction Group// +      - Set the //Target// to the PTV 
-    - Open the //Plan Constraints/Objectives// block  +      - Add both beams that were created above 
-      - Enter the //Constraints// for the planning volumes first +      - Next to //Constraints// click the //Add Structure// drop down and choose the PTV 
-        - These are the "hard stops/non negotiables" for the plan +        - Add a min dose constraint of 79.2 Gy (1.8 Gy per fx) 
-        - These doses will be decided per the users' department protocols +        - Add a max dose constraint of 85.5 Gy  
-        - For this case we will enter the following for the targets first: +      - At this point your //Fraction Group// should appear as shown below {{ :planning:userguide:walkthroughs:walkthrough_prostate_fg_complete.png?400 |}} 
-          - prostate min 79.2Gy +      - Click //Done// to complete the //Fraction Group// 
-          - prostate max 87Gy + 
-          - PTV min 75.24Gy + 
-          - PTV max 87Gy +=== Constraints and Feasibility === 
-      - After the target constraints have been entered, the user may start the Feasibility calculation by clicking calculate in the Feasibility block. The Feasibility calculation is based solely on the constraints and it should be used to ensure there is a feasible plan possible. The Feasibility calculation may be an iterative processes in order to get appropriate constraints established for a particular plan. In other words, the user may need to enter a constraint, check the feasibility, then progressively drop the constraint and check the feasibility until the plan is no longer feasible. It is recommended practice to start by obtaining a feasible plan utilizing only target constraints then add OAR constraints as desired. Remember, using a narrow range of constraints can improve the optimizer performance and improve the resolution of the Pareto surface navigation. +    - Open the //Constraints / Feasibility// sub-block  
-      - Run the //Feasibility// by choosing the calculate option <WRAP center>{{ :planning:userguide:walkthroughs:pro23.png?300 |}}</WRAP> +      - First we will enter the //Constraints// for the planning (target) volumes and a global maximum constraint 
-      - Enter the //Constraints// for the OAR's +        - For this example do the following: 
-        - Constraints for OAR's are like the constraints for the planning volumes- non negotiable+          - Click the //Edit// button 
 +          - Click //Add Structure// and select (Skin) 
 +            - Add a max set to 85.5 
 +          - Click the //OK// button 
 +<WRAP center round info 85%> 
 +After the target constraints have been entered, it's generally good practice to test the plan feasibility. The Feasibility calculation is run by clicking //calculate// at the bottom of this block. The Feasibility calculation is based solely on the constraints and it should be used to ensure there is a possible solution (plan) that can meet the specified constraints. Establishing Feasibility is often an iterative process in order to get appropriate constraints established for a particular plan. In other words, the user may need to enter a constraint, check the feasibility, then progressively tighten the constraint and check the feasibility until the plan is no longer feasible. It is recommended practice to start by obtaining a feasible plan utilizing only target constraints (and a global max constraint) then add OAR constraints as desired. Remember, using a narrow range of constraints can improve the optimizer performance and improve the resolution of the Pareto surface navigation. 
 +</WRAP> 
 + 
 +      - Run the //Feasibility// by clicking the //calculate// link <WRAP center>{{ :planning:userguide:walkthroughs:pro23.png?400 |}}</WRAP> 
 +        - The feasibility should return as passing, if not, please confirm your plan parameters match those shown throughout this walkthrough and try again 
 +      - Now with the target constraints set, we'll continue to add our OAR's
         - Again these will be set per department protocol         - Again these will be set per department protocol
-        - For this example we will use the following constraints for the OAR's: +        - For this example create the following OAR constraints: 
-          - Rectum max mean 60Gy +          - Rectum max mean 50 Gy 
-          - Bladder max mean 60Gy +          - Bladder max mean 60 Gy {{ :planning:userguide:walkthroughs:fesability_1.jpg?nolink&400 |}} 
-          - Skin max 82.5Gy +      - Run //Feasibility// as before 
-          - Skin max mean 50Gy +        - The feasibility should return as passing again, if not, please confirm your plan parameters match those shown throughout this walkthrough and try again 
-      - Run //Feasibility// +      - If the feasibility has passed click the //OK// button
-      - Enter the //Objectives//  +
-        - //Objectives// are the goals the user would like to achieve and these will be the driving forces for the optimizer +
-        - For this example use the following objectives  +
-          - Rectum max_mean  +
-          - Prostate max_min +
-          - Prostate max_underdose 79.2Gy +
-          - Testes min_max +
-          - Testes min_mean +
-          - Left & Right Femur min_overdose 45Gy +
-          - PTV min_max +
-          - PTV max_min <WRAP center>{{ :planning:userguide:walkthroughs:constraintobjectives.png?300 |}}</WRAP> +
-      - Run the MCO  +
-  - Once the MCO has been completed, you can adjust the objectives using the slider bars in the //Navigation// block (see [[planning:userguide:walkthroughs:finding_optimal_plan|Astroid Optimization]] //Navigating the Solutions// for a detailed explanation of using the slider bars) +
-    - Adjust the slider bars in the //Navigation// block to find what you feel is the optimal plan for this case +
-      - Note: All of these adjustments are made without the user having to run a new plan +
-    - If you find a plan that you like, but wish to continue exploring further, you can click the //Save// button to save the current slider state +
-    - You may then return to the last saved state at any time by clicking the //Reset// button +
-    - The //Cancel// button will close the navigation block without saving the current state {{ :planning:userguide:tutorials:navigation_1.png?200 |}} +
-  - The plan is ready for physician review at this point +
-  - After the physician has decided on a treatment plan the user may then proceed to export the chosen plan to the EMR  +
  
 +=== Objectives and Optimizer ===
  
- +      - With narrow constraints set and feasibility established, we will now turn our attention to //Objectives//  
 +        - //Objectives// are the goals that you would like to achieve and these will be the driving forces for the //Optimizer// 
 +        - Expand the //Objectives / Optimizer// sub-block and then click //Edit// under the //Objectives// section 
 +        - For this example we will use the following objectives (Click the //Add structure// drop down menu to add the following) 
 +          - The External_Body (Skin) will automatically populate 
 +          - Rectum min_mean (Minimize the mean dose to the Rectum) 
 +          - Testes min_max (Minimize the maximum dose to the Testes) 
 +          - Left & Right Femur min_overdose 45 Gy (Minimize the amount of the structure the receives dose above 45 Gy) 
 +          - PTV min_max (Minimize the maximum dose within the PTV) {{ :planning:userguide:walkthroughs:optimizer_1.jpg?nolink&400 |}} 
 +      - Click //OK// to complete the //Objectives// 
 +      - We are now ready to run the MCO, by clicking the //calculate// link 
 +        - This may take up to 10 minutes for this plan depending upon your available cloud services resources 
 +        - Keep in mind that even though this process may take some time, the planner will be able to make adjustments easily in the Navigation without running a new plan 
 +=== Navigation === 
 +  - Once the MCO has been completed, you can adjust the relative importance of the objectives using the slider bars in the //Navigation// block by clicking the //Edit// button in the //Navigation// block(see [[planning:userguide:tutorials:all_tutorials#astroid_optimization|Astroid Optimization]] //Navigating the Solutions// for a detailed explanation of using the slider bars){{ :planning:userguide:walkthroughs:pro_new_navigation_1.png?400 |}} 
 +    - Adjust the slider bars in the //Navigation// block to find what you feel is the optimal plan for this case 
 +      - Note: All of these adjustments are made without having to run a new plan 
 +    - If you find a plan that you like, but wish to continue exploring further, you can click the //Save// button to save the current slider state and then continue exploring 
 +    - You may return to the last saved state at any time by clicking the //Reset// button 
 +    - The //Cancel// button will close the navigation block, reverting back to the last //Saved// state{{ :planning:userguide:walkthroughs:navigation_1.jpg?nolink&400 |}} 
 +  - The plan is ready for physician review at this point 
 +    - Physicians often find it useful to Navigate the solution and explore trade-offs in real time, which can often alter the traditional physician approval process into an interactive, real-time trade-off analysis and on the spot plan approval 
 +  - After the physician has decided on a treatment plan the user may then proceed to export the chosen plan to the EMR 
 +    - Note that these standard (non-plan specific) features are covered in other guides and not repeated herein
  
  
planning/userguide/walkthroughs/prostate_plan.1475500449.txt.gz · Last modified: 2021/07/29 18:25 (external edit)