Radiation Therapy Treatment Protocol

1. Pre-Treatment Assessment

Initial Evaluation

• Complete medical history
• Physical examination
• Review of prior imaging studies
• Assessment of performance status (ECOG/KPS)
• Evaluation of potential contraindications

Treatment Planning Requirements

• High-quality CT simulation scan
• Immobilization device fitting
• Target volume delineation (GTV, CTV, PTV)
• Organs at risk (OAR) contouring

2. Treatment Planning Process

Simulation

1. Position patient using appropriate immobilization
2. Perform CT simulation
3. Mark reference points
4. Acquire additional imaging if needed (PET/MRI fusion)

Volume Definition

• GTV: Gross Tumor Volume
• CTV: Clinical Target Volume (GTV + margin for microscopic spread)
• PTV: Planning Target Volume (CTV + setup margin)

Dose Prescription

• Total dose
• Dose per fraction
• Number of fractions
• Treatment schedule

3. Quality Assurance

Pre-Treatment QA

• Plan verification
• Independent dose calculation
• Patient-specific QA measurements

During Treatment

• Weekly physics QA
• Image guidance protocol
• Setup verification

4. Treatment Delivery

Daily Procedures

1. Patient positioning verification
2. Image guidance (IGRT)
3. Treatment delivery
4. Documentation

Monitoring

• Weekly physician visits
• Toxicity assessment
• Treatment response evaluation

5. Follow-up Protocol

Post-Treatment

• First follow-up: 2-4 weeks
• Subsequent visits: per disease protocol
• Imaging studies as indicated
• Management of side effects