The document discusses recommendations from reports by the International Commission on Radiation Units and Measurements (ICRU) for defining volumes used in radiation therapy planning and reporting. ICRU Report 62 provides additional details on volumes such as the internal target volume (ITV) and planning organ at risk volume (PRV), and introduces metrics like the conformity index. It also further classifies organs at risk as serial, parallel or serial-parallel based on their radiosensitivity.
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
This seminar is presented as a part of weekly journal club and seminar presented in Apollo Hospital,Kolkata Department of Radiation Oncology.This seminar is moderated by Dr Tanweer Shahid.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: La prescrizione della dose nei trattamenti stereo-RT e radiochirurgici: dall’ICRU a ROSEL ed altro
ICRU 83 report on dose prescription in IMRTAnagha pachat
this slide is about the report 83 which is published by international commission for units and measurements on the topic dose prescription reporting and recording in intensity modulated radiation therapy . it is useful for personals and students in the field of radiation oncology.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
2. INTERNATIONAL COMISSION ON
RADIATION UNITS AND MEASUREMENTS
( ICRU )
ICRU Report No - 29 (1978)
Dose specification for reporting external beam therapy in
photons and electrons
ICRU Report – 50 (1993)
Supercedes and updates Report 29
Prescribing, Recording, and Reporting photon beam therapy
ICRU Report – 62 (1999)
Supplement to ICRU Report No: 50
(ICRU 50 still valid)
3. ICRU 29
First report of ICRU 29 was published in 1978.
Defined the target volume as the volume containing those
tissues that are to be irradiated to a specified absorbed dose
according to a specified time–dose pattern .
Following parameters were considered when describing the
target volume:
1. Expected movements (e.g., caused by breathing) of those
tissues that contain the target volume relative to anatomic
reference points (e.g., skin markings, suprasternal notch).
2. Expected variation in shape and size of the target volume
during a course of treatment (e.g., urinary bladder, stomach).
3. Inaccuracies or variations in treatment setup during the
course of treatment.
4. • ICRU Report 29 defined two other volumes:
1. Treatment volume - defined as the volume
enclosed by the isodose surface
representing the minimal target dose.
2. Irradiated volume - defined as the volume
that receives a dose considered significant
in relation to normal tissue tolerance (e.g.,
50% isodose surface).
These volumes were not based on
anatomy, but instead were based on the
dose distribution.
5. Defined organs at risk (OAR) as radiosensitive organs in or
near the target volume whose presence influences
treatment planning and/or prescribed dose.
Hot spot - Tissues outside the target area that received a
dose higher than 100% of the specified target dose, and was
considered clinically meaningful only if the corresponding
isodose curve enclosed an area of at least 2 cm2 in a section.
6. DRAWBACK
• However, the report did not address the issues of coordinate
systems (e.g., patient vs. treatment machine), and no
attempt was made to define and explicitly separate the
margins for the different types of uncertainties.
• ICRU Report 29 recommendations were well suited for the
technology of the 1970s and 1980s, using a conventional
simulator to generate a planning radiograph for designing
beam portals based on bony and soft tissue landmarks.
7. Volumes defined prior to treatment planning :
- Gross Tumor Volume (GTV)
- Clinical Target Volume (CTV)
Volumes defined during the treatment planning :
- Planning target Volume (PTV)
- Organs at risk
- Treated Volume
- Irradiated Volume
ICRU 50
9. GROSS TUMOR VOLUME ( GTV )
Gross palpable or visible/demonstrable extent and location
of the malignant growth.
It consists of :
Primary tumor
Metastatic lymphadenopathy
Other metastasis
Corresponds to those parts of the malignant growth where
the tumor density is largest.
If the tumor has been removed prior to radiotherapy then
no GTV can be defined.
10. GTV can be determined by using either clinical
examination (inspection, palpation) and by various
imaging techniques (X-rays, CT, MRI etc.)
Method used for determination of GTV should
meet the requirements for staging the tumor
according to the clinical TNM (AJCC).
11. Reasons for identification of GTV :
An adequate dose should be delivered to the
whole of GTV to obtain local tumor control in
radical treatments.
To allow for recording of tumor response in
relation to dose and its variation, and to other
relevant factors.
13. CLINICAL TARGET VOLUME ( CTV )
It is a tissue volume that contains a GTV and/or subclinical
microscopic disease, which has to be eliminated.
This volume has to be treated adequately in order to
achieve the aim of therapy : cure or palliation.
The delineation of this volume requires consideration of
factors like local invasive capacity of the tumor and its
potential to spread to different regions ( eg: regional lymph
nodes).
15. The delineation of GTV and CTV are
based on purely anatomic-topographic
and biological considerations without
regard to technical factors of treatment.
16. PLANNING TARGET VOLUME ( PTV )
It is a geometrical concept, and is defined to select
appropriate beam sizes and arrangements, taking into
consideration the net effect of all possible geometrical
variations, in order to ensure that the prescribed dose is
actually absorbed in the CTV.
It is used for dose planning and for specification of dose.
It has to be clearly indicated on sections used for dose
planning and the dose distribution to the PTV has to be
considered to be representative of the dose to the CTV.
18. TREATED VOLUME
Definition:-
It is the volume enclosed by an isodose surface that is
selected and specified by the radiation oncologist as being
appropriate to achieve the purpose of treatment (palliation
or cure).
Usually taken as the volume enclosed by the 95% isodose
curve.
Ideally dose should be delivered only to the PTV but due to
limitations in the radiation treatment technique.
ICRU-50
19. Reasons for identification of Treated Volume are :
1. The shape and size of the Treated Volume relative to the
PTV is an important optimization parameter.
2. Recurrence within a Treated Volume but outside the PTV
may be considered to be a “true”, “in-field” recurrence
due to inadequate dose and not a “marginal” recurrence
due to inadequate volume.
21. IRRADIATED VOLUME(IRV)
Definition:-
It is the volume that receives a dose considered significant in
relation to normal tissue tolerance
Usually taken as the volume enclosed by the 50% isodose
curve.
It depends on the treatment technique used.
ICRU-50
22. ORGANS AT RISK ( OAR )
• These are normal tissues whose radiation sensitivity may
significantly influence the treatment planning and/or
prescribed dose.
• They may be divided into 3 classes :
1. Class I : Radiation lesions are fatal or result in severe
morbidity.
2. Class II : Radiation lesions result in mild to moderate
morbidity.
3. Class III : Radiation lesions are mild, transient, and
reversible, or result in no significant morbidity.
29. ICRU REPORT 62 ( Supplement to ICRU
REPORT 50 )
• Gives more detailed recommendations on the different
margins that must be considered to account for anatomical and
geometrical variations and uncertainties.
• Introduces a Conformity Index ( CI )
• Gives information about how to classify Organs at Risk.
• Introduces a Planning Organ at Risk Volume ( PRV )
• Gives recommendations on graphics.
33. INTERNAL MARGIN
A margin that must be added to the CTV to compensate
for expected physiologic movements and the variations in
size, shape and position of the CTV during therapy in
relation to the Internal Reference Point and its
corresponding Coordinate System. Motion is associated
with adjacent respiratory and digestive organs.
INTERNAL TARGET VOLUME (ITV)
It is the margin given around the CTV to compensate for all
variations in the site, size and shapes of organs and tissues
contained in or adjacent to CTV.
These may result from respiration, different fillings of the
bladder and rectum, swallowing, heart beat, movements
of bowel etc.
40. SET-UP MARGIN ( SM )
•SET-UP MARGIN ( SM ) is the margin that must be added to
account specifically for uncertainties (inacuracies and lack of
reproducibility) in patient positioning and aligment of the
therapeutic beams during treatment planning and through all
treatment sessions.
•There can be many uncertainties ( inaccuracies and lack of
reproducibility ) in patient positioning and alignment of the
therapeutic beams during treatment planning and through all
treatment sessions.
41. •These uncertainties depend on factors like :
• Variations in patient positioning
• Mechanical uncertainties of the equipment (sagging of gantry,
collimators, and couch)
• Dosimetric uncertainties
• Transfer set-up errors from CT & simulator to the treatment
unit
• Human factors
43. SYSTEMATIC AND RANDOM ERRORS
Systematic errors – treatment preparation errors (influence
all fractions) like full rectum
Random errors – treatment execution errors (influence only
the single fraction) like positioning
ICRU-62
44. CONFORMITY INDEX ( CI )
• It is defined as the quotient of the Treated Volume and the
volume of PTV.
• It can be employed when the PTV is fully enclosed by the
Treated Volume.
• It can be used as a part of the optimization procedure.
45. CLASSIFICATION OF ORGANS AT RISK
• Classified as :
Serial – whole organ is a continuous unit and damage at one point will cause
complete damage of the organ (spinal cord, digestive system). So even point
dose is significant.
Parallel – organ consists of several functional units and if one part is
damaged, the rest of the organ makes up for the loss (lung, bladder). Dose
delivered to a given volume or average/mean dose is considered
Serial-parallel – kidney (glomerulus- parallel, tubules- serial), heart
(myocardium- parallel, coronary arteries- serial).
ICRU-62
46. PLANNING ORGAN AT RISK VOLUME ( PRV )
• This is a volume which gives into consideration the
movement of the Organs at Risk during the treatment.
• An integrated margin must be added to the Organ at Risk to
compensate for the variations and uncertainties, using the
same principle as PTV and is known as the Planning Organ at
Risk volume ( PRV ).
• A PTV and PRV may occasionally overlap.
47. GRAPHICS
• These are used to delineate the different volumes and the
other landmarks.
• These are in different colors for an easy and uniform
interpretation.
• The convention recommended and used in ICRU 62 are:
GTV - Dark Red
CTV – Light Red
ITV – Dark Blue
PTV – Light Blue
OR – Dark Green
PRV – Light Green
Landmarks - Black
49. AIM
Promote uniformity between radiotherapy centres.
Exchange information.
Use same terminology and definitions.
Deals with volumes and doses.
Valid for photon beam therapy.
50. DOSE REPORTING
Acceptable dose heterogeneity :
+7% to - 5% of the prescribed dose.
Doses reported are :
Minimum dose to PTV
Maximum dose to PTV
Mean dose to PTV
Modal dose
Median dose
Dose at ICRU reference point
ICRU-50
51. MAXIMUM DOSE ( Dmax )
• It is the maximum dose to the PTV and the Organ at Risk.
• The maximum dose to normal tissue is important for
limiting and for evaluating the side-effects of treatment.
• Dose is reported as maximum only when a volume of
tissue of diameter more than 15mm is involved (smaller
volumes are considered for smaller organs like eye, optic
nerve, larynx).
• When the maximum dose outside PTV exceeds the
prescribed dose, then a “Hot Spot” can be identified.
52. MINIMUM DOSE ( Dmin )
It is the smallest dose in a defined volume.
In contrast to maximum adsorbed dose, no volume limit
is recommended when reporting minimum dose.
53. HOT SPOTS
It represents a volume outside the PTV which receives a
dose larger than 100% of the specified dose.
A Hot Spot is considered significant only if the minimum
diameter exceeds 15mm (in smaller organs like eye, optical
nerve, larynx etc. a diameter smaller than 15mm is also
considered significant).
54. ICRU REFERENCE POINT
• It has to be selected according to the following general
criteria :
- the dose at the point should be clinically relevant.
- the point should be easy to define in a clear and
unambiguous way.
- the point should be selected so that the dose should be
accurately determined.
- the point should be in a region where there is no steep
dose gradient.
55. The recommendations will be fulfilled if the ICRU
reference point is located :
• Always at the centre ( or in the central part ) of
PTV, and
• When possible, at the intersection of the beam
axes.
56. ICRU REFERENCE DOSE
It is the dose at the ICRU Reference Point and
should always be reported.
57. • According to the recommendations of ICRU, as a
basic requirement, the following doses should always
be reported :
the dose at ICRU reference point
the maximum dose to the PTV
the minimum dose to the PTV
58. CONCLUSIONS
• Proper identification and delineation of GTV is the most
important factor in treatment.
• Other volumes like CTV, PTV, ITV should also be properly
delineated.
• The errors like set-up error and human errors should be
kept to a minimum.
• Dose prescription, fractionation and calculation should be
done in the same way by all the different centers throughout
the world for the proper exchange of information and
reporting.