Brain met Cavity SRS plan evaluation
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This document appears to be a checklist for evaluating the treatment plan for stereotactic radiosurgery (SRS) for a brain metastasis cavity. It includes sections for patient information, tumor details, surgery details, target delineation, dose constraints, plan evaluation metrics, and organ at risk dose limits. Key information includes location and size of the lesion(s), prior treatments, plan type, prescribed dose, target coverage metrics, dose fall-off evaluations, and eye and brain stem dose constraints.
![DR KANHU CHARAN PATRO
BRAIN MET CAVITY SRS PLAN EVALUATION CHECK LIST
I. NAME UMR
II. DIAGNOSIS Age sex
III. PRIOR TREATMENT
IV. Imaging details
I. Location and size
II. Edema
III. Dural sinus
involvement
IV. Distance from skull
V. Dural involvement
V. SURGERYDETAIL
Date
VI. Target delineation Adjacent dura
Bone flapalong tract
Cavity proper
Dural sinus
Enhancing component
VII. POST OP MRI DATE
CT PLANNING DATE
VIII. DISEASE SPECIFICGRADED PROGNOSTICASSESSMENT SURVIVAL
IX. PRIOR WBRT YES NO DOSE INTERVAL
X. PRIOR SRS YES NO DOSE INTERVAL
XI. NUMBER OF METASTASIS/CAVITY
XII. LOCATION SIDE SIZE max [mm] PTV MARGIN VOLUME-CC DOSE
1. GTV PTV
2. GTV PTV
3. GTV PTV
4. GTV PTV
5. GTV PTV
XIII. PLAN TYPE-[3DCRT/VMAT/DCR/IMRS]
XIV. PRESCRIBED MARGINALISODOSE](https://image.slidesharecdn.com/cavitysrsplanevaluation-200724121123/85/brain-met-cavity-srs-plan-evaluation-1-320.jpg)
![DR KANHU CHARAN PATRO
LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
D MAX
LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
D95% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
D100% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
V95% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
V100% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
V120% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
V130% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
DISTANCE BETWEEN 80% ISODOSE AND 60% ISODOSE-[<2mm]
LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
DISTANCE BETWEEN 80% ISODOSE AND 40% ISODOSE-[<8mm]
LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
CONFIRMITYINDEX [IDEAL 1] VOLUME OF PRESCRIPTION ISODOSE/VOLUME OF PTV
LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
HOMOGENITYINDEX [BETWEEN 1.1-1.3] MAX DOSE/ PRESCRIPTION DOSE
LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
GRADIENT INDEX [BETWEEN 0.3-0.9] [RADIUS OF PRESCRIPTION ISODOSE -RADIUS OF HALF PRESCRIPTION ISODOSE]
LESION 1 LESION 2 LESION 3 LESION 4 LESION 5
XV. 1. BRAIN-GTV[12Gy volume]<10cc and D50% <5Gy
2. BRAIN-GTV[30Gy volume]<10.5CC- 5 MULTIPLE FRACTION
XVI. OAR SINGLE FRACTION 5 FRACT. [ALT. DAY] ACHIEVED
1. RIGHT EYE MAX<8Gy MAX <22.5Gy
2. LEFT EYE MAX<8Gy MAX <22.5Gy
3. RIGHT OPTIC NERVE MAX<8Gy MAX <22.5Gy
4. LEFT OPTIC NERVE MAX<8Gy MAX <22.5Gy
5. OPTIC CHIASM MAX<8Gy MAX <22.5Gy
6. BRAIN STEM MAX <15Gy MAX <31Gy
7. RT. COCHLEA MEAN <9Gy MEAN <25Gy
8. LT. COCHLEA MEAN <9Gy MEAN <25Gy](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Brain met Cavity SRS plan evaluation
- 1. DR KANHU CHARAN PATRO BRAIN MET CAVITY SRS PLAN EVALUATION CHECK LIST I. NAME UMR II. DIAGNOSIS Age sex III. PRIOR TREATMENT IV. Imaging details I. Location and size II. Edema III. Dural sinus involvement IV. Distance from skull V. Dural involvement V. SURGERYDETAIL Date VI. Target delineation Adjacent dura Bone flapalong tract Cavity proper Dural sinus Enhancing component VII. POST OP MRI DATE CT PLANNING DATE VIII. DISEASE SPECIFICGRADED PROGNOSTICASSESSMENT SURVIVAL IX. PRIOR WBRT YES NO DOSE INTERVAL X. PRIOR SRS YES NO DOSE INTERVAL XI. NUMBER OF METASTASIS/CAVITY XII. LOCATION SIDE SIZE max [mm] PTV MARGIN VOLUME-CC DOSE 1. GTV PTV 2. GTV PTV 3. GTV PTV 4. GTV PTV 5. GTV PTV XIII. PLAN TYPE-[3DCRT/VMAT/DCR/IMRS] XIV. PRESCRIBED MARGINALISODOSE
- 2. DR KANHU CHARAN PATRO LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 D MAX LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 D95% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 D100% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 V95% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 V100% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 V120% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 V130% LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 DISTANCE BETWEEN 80% ISODOSE AND 60% ISODOSE-[<2mm] LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 DISTANCE BETWEEN 80% ISODOSE AND 40% ISODOSE-[<8mm] LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 CONFIRMITYINDEX [IDEAL 1] VOLUME OF PRESCRIPTION ISODOSE/VOLUME OF PTV LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 HOMOGENITYINDEX [BETWEEN 1.1-1.3] MAX DOSE/ PRESCRIPTION DOSE LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 GRADIENT INDEX [BETWEEN 0.3-0.9] [RADIUS OF PRESCRIPTION ISODOSE -RADIUS OF HALF PRESCRIPTION ISODOSE] LESION 1 LESION 2 LESION 3 LESION 4 LESION 5 XV. 1. BRAIN-GTV[12Gy volume]<10cc and D50% <5Gy 2. BRAIN-GTV[30Gy volume]<10.5CC- 5 MULTIPLE FRACTION XVI. OAR SINGLE FRACTION 5 FRACT. [ALT. DAY] ACHIEVED 1. RIGHT EYE MAX<8Gy MAX <22.5Gy 2. LEFT EYE MAX<8Gy MAX <22.5Gy 3. RIGHT OPTIC NERVE MAX<8Gy MAX <22.5Gy 4. LEFT OPTIC NERVE MAX<8Gy MAX <22.5Gy 5. OPTIC CHIASM MAX<8Gy MAX <22.5Gy 6. BRAIN STEM MAX <15Gy MAX <31Gy 7. RT. COCHLEA MEAN <9Gy MEAN <25Gy 8. LT. COCHLEA MEAN <9Gy MEAN <25Gy