This document discusses 3D conformal radiotherapy (3D CRT) and the process used in Tanzania. 3D CRT allows for radiation treatment plans to be customized for each patient's tumor and organs at risk by shaping the radiation fields based on 3D imaging. The process involves patient immobilization and simulation with CT imaging, tumor and organ contouring, beam placement and dose calculation, plan evaluation, data transfer to the treatment system, treatment delivery and verification, and patient follow up. Accurate imaging, planning and delivery are essential for 3D CRT to achieve dose escalation for tumor control while sparing healthy tissues and reducing side effects.

1. 3D CONFORMAL RADIOTHERAPY
EXPERIENCE IN TANZANIA

2. S. N. Kaale- DDR-UDSM, B.TECH,-J’burg
SA, MSc fellow SHU,-UK.
Radiotherapist
3D CRT-OVERVIEW

3. OVERVIEW
 The design and delivery of radiotherapy
treatment plans based on 3-D image
data
 Treatment fields individually shaped to
conform to the treatment target volumes
(TV),
 Sparing critical organs or all Organs At
Risk OAR

4. Rational of Conformal
Therapy
 Achievement of Dose Escalation
 To improve Tumor Control
 Increase overall survival
 Reduction of Normal Tissue
Complications
 To improve quality of life.
ALL THIS REQUIRES A HIGH LEVEL
OF ACCURACY

5. TECHNOLOGICAL INNOVATION
 Invention of CT ,MRI, PET, Ultrasound
 Image FUSION and better target delineation
 Developments in network and data transfer
technology (DICOM )
 Developments in software for Computer
Controlled MLC.
 Developments in TPS, and RVS

6. 3D CRT AS A COMPLEX
PROCESS
• Disease Treated
• Technology Employed
• Information Flow
• Human Interactions
• Treatment Evaluation

7. THE PROCESS OF RADIATION
TREATMENT
.
Verification
Prescription
Simulation
Planning
Diagnosis
Delivery
Following/Evaluation
IMAGING IS CENTRAL
TO EACH STEP IN THE
PROCESS

9. TYPICAL - 3D WORKFLOW
 Immobilization
 Simulation
 Contouring
 Beams placement and Dose Calculations
 Plan Evaluation and Approval.
 Data transfer to RVS for treatment.
 Treatment Verification (part of QC)
 Dose delivery and follow up.

10. Immobilization
Roles:
 Maintain patient position during the course of
radiotherapy by using different immobilization
devices.
 For accurate dose delivery to the target volume,
while sparing organ at risk
 Reduces setup error and patient movement
during treatment.(Random and systematic error)

11. Immobilization cont…
 Proper immobilization reduces risk of side
effects
 Proper immobilizing reduce the time for daily
patient set up
 Help to stabilize the relationship between
external skin marks and internal structures

12. Immobilization cont…

13. SIMULATION
 Image acquisition provides foundation for
treatment planning.
 Usually more than one imaging modalities are
required for better delineation of target volume
Images are acquired for :
 Treatment planning
 Image guidance and/or treatment verification
 Follow-up studies (during & after treatment)

14. Simulation cont…
 CT is done with patient in the treatment
position in immobilization device .
 Radio opaque mark are placed .
 These mark assist in any coordinate
transformation needed as a result of 3D
planning and eventual plan
implementation.

15. Simulation cont…
 A topogram is generated to insure that patient
alignment is correct & then using localizer,
area to be scanned is selected.
 The FOV is selected to permit visualization of
the external contour, which is required for
accurate dose calculations.
 Using site dependent protocols, images are
acquired.
 The planning CT data set is transferred to a
3D-TPS or workstation via a computer
network.

16. SIMULATION DEVICES
PET Scan
CT Simulator
Ultrasound machi
MRI

17. IMAGE SEGMENTATION OR
CONTOURING

18. PLAN EVALUATION
 The following tools are used in the evaluation
of the planned dose distribution:
 2-D display
 Isodose lines
 Color wash
 DVHs (Dose volume histograms )
 Dose distribution statistics

19. Dar es salaam city 1961 Dar es salaam city 201
THANK YOU
FOR
LISTENIN
G

20. A 61 years old male with Sino nasal tumor
who presented at Besta super specialized
polyclinic for 3D CRT.
SINONASAL TUMOR 3D CRT-CASE
PRESENTATION

21. Reuben Mringo- Bsc RTT-(MUHAS)
Radiotherapist
Immobilization and Simulation

22. Head rest
Base plate
Immobilizing devices

24. Head
Mask
H n N
ABDOMEN

26. WATER
HEATER

28. DIAGNOSTIC CT

29. CT SIMULATOR

30. WALL
LASER

31. PATIENT SET UP

32. RADIOPAQUE MATERIAL FOR REFERENCE

33. IMAGE AQUISITION

35. Thank you
UDZUNGWA FALLS TANZANIA

36. Tumor delineation (GTV,CTV,PTV) and
OAR
Dr. Y. Ndibalema-MD (MUHAS), MMED(MUHAS/KOREA)
Radiation oncologist

37. CT SIM IMAGE

38. GTV

39. GTV+CTV

40. GTV+CTV+PTV

41. OA
R

42. OAR

43. SAGITAL VIEW

44. DRR IMAGE

45. DRR WITH MLC FIELD

46. THE BEAUTY OF MOUNT KILIMANJARO IN
TANZANIA

47. Beam placement and dose
evaluation
Mr. E.L.S. MWILIKE (Bsc ,Msc)
Medical physicist

48. GA 0°

49. BEAM EYE VIEW AT 0°

50. GA 270°+WEDGE

51. BEAM EYE VIEW AT 270°

52. GA at 0° ,90°,270°+wedge

53. BEAM EYE VIEW AT 90°

54. ROOM EYE VIEW

55. DOSE VOLUME HISTOGRAM(DVH)

56. PLAN EVALUATION

59. TREATMENT PLAN
VERIFICATION

60. The beauty of serengeti national par

61. PATIENT REVIEW AFTER 2 WEEKS OF
TREATMENT

62. GTV BEFORE TREATMENT

63. GTV 2 WEEKS AFTER
TREATMENT

64. NEW PTV

65. NEW PLAN

66. DVH NEW PLAN

67. NEW PLAN EVALUATION

69. ACCURATE TUMOR
LOCALIZATION,PRECISE TREATMENT
PLANNING FOR BETTER OUTCOME
3D CONFORMAL
RADIOTHERAPY

70. THANK YOU