<?xml version="1.0" encoding="utf-8"?>
<TreatmentInstruction>
  <SchemaVersion>2.0</SchemaVersion>
  <Identifier>125f9b2a-a579-4cd7-a325-86462497b35d</Identifier>
  <DisplayName>*AOS_Prostate_IR SBRT 40Gy 5 fx v1</DisplayName>
  <AnatomicalRegion>Pelvis</AnatomicalRegion>
  <AnatomicalSite>Prostate</AnatomicalSite>
  <Notes>*AOS_Prostate SBRT 40Gy 5fx
AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist

Summary: 5 fx Prostate SBRT to 40 Gy.  Prostate to 40 Gy, PTV to 36.25 Gy

References: """Multicenter Trial of Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: Survival and Toxicity Endpoints"", Kaplan et. al"; RTOG 0938


Version 1.3


Created: 7/8/2024    
Last updated: 4/7/2025 (PHH) - Adjusted target P levels and sub-priority ordering
*********************************************************************

Structures have been named according to TG 263.</Notes>
  <OARs>
    <Structure Id="OAR1">
      <Code>14544</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Rectum</Meaning>
      <Color>4282384384</Color>
      <Name>Rectum</Name>
    </Structure>
    <Structure Id="OAR2">
      <Code>15900</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Urinary bladder</Meaning>
      <Color>4294967168</Color>
      <Name>Bladder</Name>
    </Structure>
    <Structure Id="OAR3">
      <Code>19386</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Seminal vesicle</Meaning>
      <Color>4280929392</Color>
      <Name>Testes</Name>
    </Structure>
    <Structure Id="OAR4">
      <Code>19614</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Penile bulb</Meaning>
      <Color>4285123625</Color>
      <Name>PenileBulb</Name>
    </Structure>
    <Structure Id="OAR5">
      <Code>32842</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Femur head &amp; neck right</Meaning>
      <Color>4291581481</Color>
      <Name>Femur_R</Name>
    </Structure>
    <Structure Id="OAR6">
      <Code>32843</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Femur head &amp; neck left</Meaning>
      <Color>4280929420</Color>
      <Name>Femur_L</Name>
    </Structure>
    <Structure Id="OAR7">
      <Code>19667</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Urethra</Meaning>
      <Color>4280923852</Color>
      <Name>Urethra</Name>
    </Structure>
    <Structure Id="OAR8">
      <Code>7199</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Bowel</Meaning>
      <Color>4286595136</Color>
      <Name>Bowel</Name>
    </Structure>
    <Structure Id="OAR9">
      <Code>45643</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Genitals</Meaning>
      <Color>4278222912</Color>
      <Name>Genitals</Name>
    </Structure>
    <Structure Id="OAR10">
      <Code>19386_Proximal</Code>
      <Schema>99VMS_STRUCTCODE</Schema>
      <SchemaVersion>1.0</SchemaVersion>
      <Meaning>Proximal seminal vesicle</Meaning>
      <Color>4280917964</Color>
      <Name>SeminalVes_Prox</Name>
    </Structure>
    <Structure Id="OAR11">
      <Code>9600</Code>
      <Schema>FMA</Schema>
      <SchemaVersion>3.2</SchemaVersion>
      <Meaning>Prostate</Meaning>
      <Color>4286458316</Color>
      <Name>Prostate</Name>
    </Structure>
  </OARs>
  <Targets>
    <Structure Id="Target1">
      <Code>R-429EC</Code>
      <Schema>SRT</Schema>
      <SchemaVersion />
      <Meaning>Planning target volume</Meaning>
      <Color>4294901760</Color>
      <Name>PTV</Name>
      <ContouringProtocol><![CDATA[<StructureArithmetic>
  <Union>
    <Operands>
      <Margin>
        <Operands>
          <Structure>
            <Identifier>Target2</Identifier>
            <ClassificationCode>
              <Code>R-429EB</Code>
              <Schema>SRT</Schema>
              <SchemaVersion />
              <Meaning>Clinical target volume</Meaning>
            </ClassificationCode>
          </Structure>
        </Operands>
        <MarginValue>3</MarginValue>
      </Margin>
      <Margin>
        <Operands>
          <Structure>
            <Identifier>OAR10</Identifier>
            <ClassificationCode>
              <Code>19386_Proximal</Code>
              <Schema>99VMS_STRUCTCODE</Schema>
              <SchemaVersion>1.0</SchemaVersion>
              <Meaning>Proximal seminal vesicle</Meaning>
            </ClassificationCode>
          </Structure>
        </Operands>
        <MarginValue>3</MarginValue>
      </Margin>
    </Operands>
  </Union>
</StructureArithmetic>
]]></ContouringProtocol>
    </Structure>
    <Structure Id="Target2">
      <Code>R-429EB</Code>
      <Schema>SRT</Schema>
      <SchemaVersion />
      <Meaning>Clinical target volume</Meaning>
      <Color>4280918220</Color>
      <Name>CTV</Name>
      <ContouringProtocol><![CDATA[<StructureArithmetic>
  <IdentityOperation>
    <Operands>
      <Structure>
        <Identifier>OAR11</Identifier>
        <ClassificationCode>
          <Code>9600</Code>
          <Schema>FMA</Schema>
          <SchemaVersion>3.2</SchemaVersion>
          <Meaning>Prostate</Meaning>
        </ClassificationCode>
      </Structure>
    </Operands>
  </IdentityOperation>
</StructureArithmetic>
]]></ContouringProtocol>
    </Structure>
  </Targets>
  <ControlRegions>
    <Structure Id="ControlRegion1">
      <Code>NormalTissue</Code>
      <Schema>99VMS_STRUCTCODE</Schema>
      <SchemaVersion>1.0</SchemaVersion>
      <Meaning>Unidentified structure</Meaning>
      <Color>4289604044</Color>
      <Name>NVB</Name>
    </Structure>
    <Structure Id="ControlRegion2">
      <Code>PRV</Code>
      <Schema>99VMS_STRUCTCODE</Schema>
      <SchemaVersion>1.0</SchemaVersion>
      <Meaning>Planning organ-at-risk volume</Meaning>
      <Color>4280891084</Color>
      <Name>Urethra_PRV_02</Name>
      <ContouringProtocol><![CDATA[<StructureArithmetic>
  <Margin>
    <Operands>
      <Structure>
        <Identifier>OAR7</Identifier>
        <ClassificationCode>
          <Code>19667</Code>
          <Schema>FMA</Schema>
          <SchemaVersion>3.2</SchemaVersion>
          <Meaning>Urethra</Meaning>
        </ClassificationCode>
      </Structure>
    </Operands>
    <MarginValue>2</MarginValue>
  </Margin>
</StructureArithmetic>
]]></ContouringProtocol>
    </Structure>
    <Structure Id="ControlRegion3">
      <Code>NormalTissue</Code>
      <Schema>99VMS_STRUCTCODE</Schema>
      <SchemaVersion>1.0</SchemaVersion>
      <Meaning>Unidentified structure</Meaning>
      <Color>4294934656</Color>
      <Name>NVB_PRV_02</Name>
      <ContouringProtocol><![CDATA[<StructureArithmetic>
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            <Identifier>ControlRegion1</Identifier>
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              <Code>NormalTissue</Code>
              <Schema>99VMS_STRUCTCODE</Schema>
              <SchemaVersion>1.0</SchemaVersion>
              <Meaning>Unidentified structure</Meaning>
            </ClassificationCode>
          </Structure>
        </Operands>
        <MarginValue>2</MarginValue>
      </Margin>
      <Structure>
        <Identifier>Target2</Identifier>
        <ClassificationCode>
          <Code>R-429EB</Code>
          <Schema>SRT</Schema>
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        </ClassificationCode>
      </Structure>
    </Operands>
  </Subtraction>
</StructureArithmetic>
]]></ContouringProtocol>
    </Structure>
    <Structure Id="ControlRegion4">
      <Code>NormalTissue</Code>
      <Schema>99VMS_STRUCTCODE</Schema>
      <SchemaVersion>1.0</SchemaVersion>
      <Meaning>Unidentified structure</Meaning>
      <Color>4289604044</Color>
      <Name>Skin_PRV_03</Name>
      <ContouringProtocol><![CDATA[<StructureArithmetic>
  <Wall>
    <Operands>
      <Structure>
        <Identifier>Body</Identifier>
        <ClassificationCode>
          <Code>BODY</Code>
          <Schema>99VMS_STRUCTCODE</Schema>
          <SchemaVersion>1.0</SchemaVersion>
          <Meaning>Body plus other external items</Meaning>
        </ClassificationCode>
      </Structure>
    </Operands>
    <InnerWallValue>3</InnerWallValue>
    <OuterWallValue>0</OuterWallValue>
  </Wall>
</StructureArithmetic>
]]></ContouringProtocol>
    </Structure>
  </ControlRegions>
  <TargetEvaluationPoints />
  <Phases>
    <Phase Id="1" Adaptive="true" Bolus="false" Stereotactic="false">
      <TreatmentFrequency>
        <OneSessionPerDay />
      </TreatmentFrequency>
      <PrescriptionTargets>
        <PrescriptionTarget>
          <StructureId>Target1</StructureId>
          <FractionDoseGy>7.25</FractionDoseGy>
          <QualityIndices />
          <Objectives>
            <Objective>
              <ClinicalGoal>
                <Type>VolumeDose</Type>
                <Qualifier>ShouldBeMoreOrEqual</Qualifier>
                <Volume>
                  <Value>95</Value>
                  <Unit>Relative</Unit>
                </Volume>
                <Dose>
                  <Value>36.25</Value>
                  <Unit>Absolute</Unit>
                </Dose>
              </ClinicalGoal>
              <AcceptableVariation>
                <Type>VolumeDose</Type>
                <Qualifier>ShouldBeMoreOrEqual</Qualifier>
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                <Dose>
                  <Value>36.25</Value>
                  <Unit>Absolute</Unit>
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              </AcceptableVariation>
              <Priority>2</Priority>
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            <Objective>
              <ClinicalGoal>
                <Type>DoseVolume</Type>
                <Qualifier>ShouldBeMoreOrEqual</Qualifier>
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                  <Unit>Relative</Unit>
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                <Dose>
                  <Value>35</Value>
                  <Unit>Absolute</Unit>
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                <Dose>
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          </Objectives>
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        <PrescriptionTarget>
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            <Objective>
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                <Qualifier>ShouldBeLessOrEqual</Qualifier>
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                  <Unit>Absolute</Unit>
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              <Unit>Absolute</Unit>
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              <Unit>Absolute</Unit>
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              <Unit>Absolute</Unit>
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              <Unit>Absolute</Unit>
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              <Unit>Absolute</Unit>
            </Dose>
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              <Unit>Absolute</Unit>
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              <Unit>Absolute</Unit>
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            <Dose>
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            <Type>VolumeDose</Type>
            <Qualifier>ShouldBeLessOrEqual</Qualifier>
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            <Dose>
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              <Unit>Absolute</Unit>
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              <Unit>Absolute</Unit>
            </Volume>
            <Dose>
              <Value>40.5</Value>
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          <ClinicalGoal>
            <Type>DoseVolume</Type>
            <Qualifier>ShouldBeLessOrEqual</Qualifier>
            <Volume>
              <Value>0.03</Value>
              <Unit>Absolute</Unit>
            </Volume>
            <Dose>
              <Value>41</Value>
              <Unit>Absolute</Unit>
            </Dose>
          </ClinicalGoal>
          <Priority>2</Priority>
          <PriorityWithinGroup>10</PriorityWithinGroup>
        </Objective>
        <Objective>
          <StructureId>ControlRegion3</StructureId>
          <ClinicalGoal>
            <Type>MeanDose</Type>
            <Qualifier>ShouldBeLessOrEqual</Qualifier>
            <Dose>
              <Value>36</Value>
              <Unit>Absolute</Unit>
            </Dose>
          </ClinicalGoal>
          <AcceptableVariation>
            <Type>MeanDose</Type>
            <Qualifier>ShouldBeLessOrEqual</Qualifier>
            <Dose>
              <Value>38</Value>
              <Unit>Absolute</Unit>
            </Dose>
          </AcceptableVariation>
          <Priority>3</Priority>
        </Objective>
        <Objective>
          <StructureId>ControlRegion4</StructureId>
          <ClinicalGoal>
            <Type>DoseVolume</Type>
            <Qualifier>ShouldBeLessOrEqual</Qualifier>
            <Volume>
              <Value>0.03</Value>
              <Unit>Absolute</Unit>
            </Volume>
            <Dose>
              <Value>10</Value>
              <Unit>Absolute</Unit>
            </Dose>
          </ClinicalGoal>
          <AcceptableVariation>
            <Type>DoseVolume</Type>
            <Qualifier>ShouldBeLessOrEqual</Qualifier>
            <Volume>
              <Value>0.03</Value>
              <Unit>Absolute</Unit>
            </Volume>
            <Dose>
              <Value>30</Value>
              <Unit>Absolute</Unit>
            </Dose>
          </AcceptableVariation>
          <Priority>4</Priority>
        </Objective>
        <Objective>
          <StructureId>OAR9</StructureId>
          <ClinicalGoal>
            <Type>DoseVolume</Type>
            <Qualifier>ShouldBeLessOrEqual</Qualifier>
            <Volume>
              <Value>0.03</Value>
              <Unit>Absolute</Unit>
            </Volume>
            <Dose>
              <Value>0.5</Value>
              <Unit>Absolute</Unit>
            </Dose>
          </ClinicalGoal>
          <Priority>4</Priority>
        </Objective>
      </PhaseOARObjectives>
      <Normalization>
        <Type>NoNormalization</Type>
      </Normalization>
      <MotionManagement IsEnabled="false" />
    </Phase>
  </Phases>
  <PrescribedSessions>
    <Session Id="1">
      <ReferencedPhase>1</ReferencedPhase>
      <Imaging>None</Imaging>
    </Session>
    <Session Id="2">
      <ReferencedPhase>1</ReferencedPhase>
      <Imaging>None</Imaging>
    </Session>
    <Session Id="3">
      <ReferencedPhase>1</ReferencedPhase>
      <Imaging>None</Imaging>
    </Session>
    <Session Id="4">
      <ReferencedPhase>1</ReferencedPhase>
      <Imaging>None</Imaging>
    </Session>
    <Session Id="5">
      <ReferencedPhase>1</ReferencedPhase>
      <Imaging>None</Imaging>
    </Session>
  </PrescribedSessions>
</TreatmentInstruction>