This document discusses the implementation of a stereotactic radiosurgery (SRS) program at Utah Valley Hospital using image-guided radiation therapy (IGRT) and surface-guided radiation therapy (SGRT) for confident and efficient treatment. It outlines the SRS workflow including simulation using customized masks, planning using single isocenter optimization, rigorous quality assurance procedures, and real-time surface monitoring during treatment for precise patient positioning and alignment. The detailed treatment timeline shows how these techniques allow for accurate and efficient SRS delivery in under 30 minutes on average.
Vmat technique for Breast, Head and Neck, Brain and Craniospinal irradiation ...Biplab Sarkar
Past, present and future of VMAT technique in different sites: Breast, Head and Neck, Brain and Craniospinal irradiation for medduloblastoma and PNET treatment.
MD. Motiur Rahman is the Chief Medical Physicist and Assistant Project Director at TMSS Cancer Center in Bogura, Bangladesh. The document discusses the history and importance of radiation dosimetry in cancer treatment. It describes how radiation dose is measured using instruments like ionization chambers placed in the radiation beam. Dose measurements must be standardized according to dosimetry protocols to ensure cancer patients receive the prescribed radiation amounts accurately. Absolute and relative dosimetry methods are outlined as well as factors like accuracy, precision, and uncertainty which are important for high quality dose measurements.
The document discusses the use of Tomotherapy for radiation treatment planning and delivery. It provides examples of how Tomotherapy allows for:
1) Highly conformal radiation plans that sculpt dose around complex tumor target shapes while minimizing dose to nearby organs.
2) Daily image guidance that enables adjustment of targets to account for changes in patient anatomy and tumor size during treatment.
3) Delivery of simultaneous integrated boosts to multiple tumor sites.
The document discusses a medical linear accelerator (LINAC). It begins with an overview and definition, explaining that a LINAC uses high-frequency electromagnetic waves to accelerate charged particles like electrons through a linear tube to produce x-rays for radiation therapy. The document then covers the history, generations, major components, and functioning of LINACs, describing how they have advanced from early bulky machines to today's computer-controlled systems that produce precise radiation beams for cancer treatment. Key components discussed include the electron gun, magnetron/klystron, waveguide system, bending magnet, and treatment head.
This document discusses the clinical implementation of volumetric modulated arc therapy (VMAT) at UT M.D. Anderson Cancer Center. It provides an overview of VMAT, the advantages it offers over other radiation therapy techniques, and the steps taken to configure the accelerator, treatment planning system, and quality assurance processes for VMAT delivery. Key aspects covered include accelerator prerequisites, TPS commissioning, patient-specific quality assurance using films and ion chambers, monthly constancy checks, and tips for rapid arc treatment planning for prostate cases.
This document discusses quality assurance parameters and test frequencies for medical linear accelerators. It outlines electrical, mechanical, and dosimetry QA parameters that are tested daily, weekly, monthly, and yearly. Daily tests check parameters that could affect patient positioning, radiation field definition, output constancy, and safety. Weekly tests add checks for beam congruence, flatness, and symmetry. Monthly tests expand to all mechanical and electrical components. Annual tests involve re-calibration and more stringent tolerance levels to establish new baseline values. Tests ensure spatial and dosimetric accuracy within clinically acceptable limits.
Quality assurance of linear accelerator DHXSohail Qureshi
This document outlines the daily quality assurance procedure for a linear accelerator. It describes turning on the machine, performing mechanical checks like gantry and couch movement tests, warming up the machine using various electron and photon energies, and performing dosimetry measurements to ensure parameters are within tolerance levels. Results are documented in a QA sheet for record keeping. The purpose is to ensure consistent machine quality and patient safety by verifying proper dose delivery and checking for any mechanical or software errors.
Immobilization techniques in SRS and SBRTShreya Singh
Immobilization and positioning techniques are essential for accuracy in stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). There are invasive and non-invasive immobilization systems for the head and body that use customized masks, frames, or bite blocks. Repositioning is aided by various fiducial marker systems. Motion management techniques include gating using the active breathing coordinator or respiratory position management systems. Emerging real-time tumor tracking methods allow for continuous beam adjustment to target motion during treatment. Precise immobilization and motion management are needed to minimize positioning errors and ensure accurate dose delivery in SRS and SBRT.
Vmat technique for Breast, Head and Neck, Brain and Craniospinal irradiation ...Biplab Sarkar
Past, present and future of VMAT technique in different sites: Breast, Head and Neck, Brain and Craniospinal irradiation for medduloblastoma and PNET treatment.
MD. Motiur Rahman is the Chief Medical Physicist and Assistant Project Director at TMSS Cancer Center in Bogura, Bangladesh. The document discusses the history and importance of radiation dosimetry in cancer treatment. It describes how radiation dose is measured using instruments like ionization chambers placed in the radiation beam. Dose measurements must be standardized according to dosimetry protocols to ensure cancer patients receive the prescribed radiation amounts accurately. Absolute and relative dosimetry methods are outlined as well as factors like accuracy, precision, and uncertainty which are important for high quality dose measurements.
The document discusses the use of Tomotherapy for radiation treatment planning and delivery. It provides examples of how Tomotherapy allows for:
1) Highly conformal radiation plans that sculpt dose around complex tumor target shapes while minimizing dose to nearby organs.
2) Daily image guidance that enables adjustment of targets to account for changes in patient anatomy and tumor size during treatment.
3) Delivery of simultaneous integrated boosts to multiple tumor sites.
The document discusses a medical linear accelerator (LINAC). It begins with an overview and definition, explaining that a LINAC uses high-frequency electromagnetic waves to accelerate charged particles like electrons through a linear tube to produce x-rays for radiation therapy. The document then covers the history, generations, major components, and functioning of LINACs, describing how they have advanced from early bulky machines to today's computer-controlled systems that produce precise radiation beams for cancer treatment. Key components discussed include the electron gun, magnetron/klystron, waveguide system, bending magnet, and treatment head.
This document discusses the clinical implementation of volumetric modulated arc therapy (VMAT) at UT M.D. Anderson Cancer Center. It provides an overview of VMAT, the advantages it offers over other radiation therapy techniques, and the steps taken to configure the accelerator, treatment planning system, and quality assurance processes for VMAT delivery. Key aspects covered include accelerator prerequisites, TPS commissioning, patient-specific quality assurance using films and ion chambers, monthly constancy checks, and tips for rapid arc treatment planning for prostate cases.
This document discusses quality assurance parameters and test frequencies for medical linear accelerators. It outlines electrical, mechanical, and dosimetry QA parameters that are tested daily, weekly, monthly, and yearly. Daily tests check parameters that could affect patient positioning, radiation field definition, output constancy, and safety. Weekly tests add checks for beam congruence, flatness, and symmetry. Monthly tests expand to all mechanical and electrical components. Annual tests involve re-calibration and more stringent tolerance levels to establish new baseline values. Tests ensure spatial and dosimetric accuracy within clinically acceptable limits.
Quality assurance of linear accelerator DHXSohail Qureshi
This document outlines the daily quality assurance procedure for a linear accelerator. It describes turning on the machine, performing mechanical checks like gantry and couch movement tests, warming up the machine using various electron and photon energies, and performing dosimetry measurements to ensure parameters are within tolerance levels. Results are documented in a QA sheet for record keeping. The purpose is to ensure consistent machine quality and patient safety by verifying proper dose delivery and checking for any mechanical or software errors.
Immobilization techniques in SRS and SBRTShreya Singh
Immobilization and positioning techniques are essential for accuracy in stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). There are invasive and non-invasive immobilization systems for the head and body that use customized masks, frames, or bite blocks. Repositioning is aided by various fiducial marker systems. Motion management techniques include gating using the active breathing coordinator or respiratory position management systems. Emerging real-time tumor tracking methods allow for continuous beam adjustment to target motion during treatment. Precise immobilization and motion management are needed to minimize positioning errors and ensure accurate dose delivery in SRS and SBRT.
This document discusses various sources of uncertainty and errors in radiation therapy delivery due to patient and target motion. It describes advances in imaging guidance and motion management techniques like 4D imaging, respiratory gating, abdominal compression, and deep inspiration breath hold to minimize the effects of respiratory motion. Real-time tracking methods like RPM and ExacTrac systems are highlighted which allow continuous monitoring of tumor position throughout treatment. Managing respiratory motion remains an important area of focus to ensure accurate radiation delivery.
A linear accelerator uses high-frequency electromagnetic waves to accelerate charged particles like electrons in a linear path inside an accelerator waveguide. It can be used to treat both superficial and deep-seated tumors by either using the high-energy electron beam directly or by directing it at a target to produce x-rays. The first medical linear accelerators were installed in the early 1950s and since then the technology has advanced through multiple generations with improved waveguides, bending magnets, dose rates and computer control.
Brachytherapy techniques have evolved over time from early historical systems like the Paris and Stockholm systems to more modern techniques. The document discusses the key aspects of different brachytherapy systems including: the Paris system which used small amounts of radium over 5 days, the Stockholm system which used repeated high dose radium treatments over shorter times, and the Manchester system which modified the Paris system and introduced standardized dose measurement points like Point A. Modern brachytherapy planning incorporates 3D imaging, contouring of tumor and organ-at-risk volumes, and advanced dose reporting metrics to better optimize treatment while sparing healthy tissues.
Tomotherapy combines intensity modulated radiation therapy with computed tomography scanning to treat cancer. It can treat multiple tumors simultaneously with daily 3D imaging to improve accuracy and minimize side effects. Tomotherapy uses a sophisticated multi-leaf collimator and 360 degree delivery of many narrow beamlets to provide conformal, even radiation doses to tumors while avoiding healthy tissue for shorter treatments and fewer side effects than other radiation therapies. It can treat many cancer types, including mesothelioma.
Motion management strategies in radiation therapy aim to account for tumor movement during treatment. Key strategies include gating methods that deliver radiation only during specific respiratory phases, breath hold methods that immobilize tumors during deep inhalation or exhalation, tracking methods that follow tumor motion in real-time and adjust beam targeting accordingly, and encompassing methods that define larger target volumes to cover full respiratory excursion. No single approach is clearly superior, as appropriate management depends on tumor location, motion extent, and available technology. The goal of all motion management is to safely escalate dose to tumors while reducing dose to surrounding healthy tissues.
A linear accelerator (LINAC) is a device that uses radiofrequency electromagnetic waves to accelerate electrons to high energies in a linear path inside a tube. The electrons are then collided with a heavy metal target to produce high-energy x-rays. The x-rays are directed to the patient's tumor from any angle by rotating the gantry and moving the treatment couch. LINACs have evolved from early machines with limited motion and lower energies to modern machines with wider ranges of beam energies, dose rates, field sizes, and operating modes that provide more precise and accurate radiation treatment for cancer patients. Key components of a LINAC include the drive stand containing the klystron or magnetron to generate microwave power, the accelerator waveguide
This study investigated generating improved 3D treatment plans for telecoabalt machines without MLC by using locally available materials like universal shielding blocks. The study aimed to see if plans similar to IMRT could be created on telecoabalt to help poor patients who cannot afford linear accelerator treatment but need advanced techniques. Two case studies are presented where improved 3D plans were created for telecoabalt that provided dose coverage and sparing of normal tissues comparable to IMRT plans. The conclusion is that 3DCRT/IMRT type plans are feasible on telecoabalt with careful planning using field-in-field techniques and custom shielding blocks.
Surface Guided Radiotherapy for Accuracy, Volume Reduction, Real time Trackin...SGRT Community
1) Surface guided radiotherapy uses optical cameras to track the external surface of a patient in real-time during treatment and provides sub-millimeter accuracy for patient positioning and motion management.
2) The technique has been used at MSKCC for several clinical applications including frameless SRS for brain tumors, head and neck cancers, and deep inspiratory breath hold treatments for breast cancers.
3) Preliminary results found surface guided radiotherapy improved patient comfort for frameless SRS over framed SRS and doubled the treatment throughput. Motion tracking also ensured frameless SRS accuracy to within 1mm.
This document discusses modern radiotherapy techniques including conformal radiotherapy and intensity-modulated radiation therapy (IMRT). It describes the planning steps which involve CT scanning of the patient, delineating the tumor and organ-at-risk volumes, dose analysis, and treatment delivery with quality assurance and patient positioning. IMRT allows for improved target conformality and reduced radiation exposure to surrounding healthy tissues compared to traditional radiotherapy through inverse planning optimization of multiple modulated radiation beams. Image-guided radiotherapy (IGRT) further improves treatment accuracy by accounting for organ motion and setup variations using frequent imaging.
The document summarizes interstitial brachytherapy, including indications, contraindications, isotopes used, and details of various planning systems like Paterson-Parker, Quimby, Paris, and computer-based systems. It discusses dose rates, types of implants, applicators, volume definition, and dosimetry parameters like reference isodose and uniformity criteria for different planning approaches.
This document discusses various techniques used for treatment verification in radiation therapy. It describes electronic portal imaging devices (EPID) which can be used for daily treatment localization and verification through portal images with little additional dose. Cone beam computed tomography (CBCT) is also discussed, which provides volumetric CT images with submillimeter resolution, allowing verification of patient positioning before treatment. Both EPID and CBCT help ensure the correct radiation dose is delivered to the intended target volume.
Quality assurance of treatment planning system by Rahim GoharRahim Gohar
The document discusses quality assurance of 3D treatment planning systems for external photon and electron beams. It covers international reports on QA of TPS from organizations like IAEA, AAPM Task Group 53, and CAPCA. The presentation reviews aspects of TPS QA like system/software configuration, data entry, and evolution over time. It provides examples of important quality control checks for components like the CPU, digitizer, backups, CT transfer, and validating basic beam data. Tolerances for dose calculation accuracy are also addressed.
This document summarizes key considerations for intensity-modulated radiation therapy (IMRT) treatment planning and dosimetry. It discusses beam modeling, dose calculation, inverse planning, and quality assurance. Accurate modeling of beam penumbra, multileaf collimator characteristics, output factors for small fields, and dose calculation algorithms are essential for ensuring dosimetric accuracy. Proper target and organ-at-risk delineation and appropriate margins are also important for effective IMRT planning.
QUALITY ASSURANCE IN LINAC AND CYBERKNIFE.pptxSuryaSuganthan2
This document discusses quality assurance procedures for a linear accelerator (linac) and CyberKnife system. It outlines the various QA tools used, including phantoms for checking beam parameters like flatness, symmetry and output. Daily, weekly, monthly and yearly QA tests are described for parameters like lasers, optical distance indicator and radiation output. Tolerance levels are provided. Procedures for specific tests using tools like the Pentaguide and SunNuclear profiler are detailed step-by-step. Results of sample daily output and beam profile measurements are also shown.
Implementing an End-to-End SGRT Workflow for Breath-Hold SABRSGRT Community
SGRT Europe 2022
Ellen Dear
Senior Regional Therapeutic Radiographer
Genesis Care
Chelsea Carnall
Senior Regional Therapeutic Radiographer
Genesis Care
This document discusses various time-dose models used in radiotherapy, including the Strandqvist, Cohen, NSD, and TDF models. It explains the need for these models to optimize treatment regimes for tumor control while sparing normal tissues. The document also covers gap correction factors used when treatment schedules are interrupted and the various factors that can affect tumor control outcomes due to gaps in treatment. Compensatory methods like accelerated scheduling and increased dosing are presented to account for treatment gaps.
Radiation Shielding for Mega-voltage Photon Therapy Machines Daryoush Khoramian
Radiation shielding is needed for megavoltage photon therapy machines to limit radiation exposure and reduce effective dose outside of treatment rooms. Approximately 50% of cancer patients receive radiation therapy. Shielding barriers like lead and concrete are used to reduce radiation levels in uncontrolled and controlled areas like corridors and waiting rooms based on factors like workload, use, and occupancy. Proper machine orientation and maze or direct door designs can further reduce dose near room entrances. Ducting and electrical routing must also consider radiation protection. Skyshine radiation from scattered photons above the treatment room requires special consideration in shielding design.
1. The document evaluates volumetric modulated arc therapy (VMAT) for craniospinal irradiation (CSI) treatment planning.
2. It aims to standardize and simplify the CSI planning technique while improving dose conformity and homogeneity in the target volume and reducing dose to organs at risk.
3. VMAT plans for 4 patients using 3 isocenters and 2 arcs each achieved good target coverage with a conformity index of 0.99 and homogeneity index of 1.13 on average while sparing organs at risk.
1) The document discusses the implementation of the SGRT system across four sites of The Christie NHS Foundation Trust to provide DIBH for breast cancer patients.
2) Timelines show that SGRT was installed and validated at Oldham by October 2020 and the other three sites by November 2020, allowing DIBH to be offered to all left-sided breast patients across the Trust.
3) Results found translations within tolerance, reduced need for corrections, and average time savings of over 2 minutes per patient for standard positioning compared to pre-SGRT workflows. DIBH average time was 16 minutes compared to 30 minutes for spirometer.
This document discusses various sources of uncertainty and errors in radiation therapy delivery due to patient and target motion. It describes advances in imaging guidance and motion management techniques like 4D imaging, respiratory gating, abdominal compression, and deep inspiration breath hold to minimize the effects of respiratory motion. Real-time tracking methods like RPM and ExacTrac systems are highlighted which allow continuous monitoring of tumor position throughout treatment. Managing respiratory motion remains an important area of focus to ensure accurate radiation delivery.
A linear accelerator uses high-frequency electromagnetic waves to accelerate charged particles like electrons in a linear path inside an accelerator waveguide. It can be used to treat both superficial and deep-seated tumors by either using the high-energy electron beam directly or by directing it at a target to produce x-rays. The first medical linear accelerators were installed in the early 1950s and since then the technology has advanced through multiple generations with improved waveguides, bending magnets, dose rates and computer control.
Brachytherapy techniques have evolved over time from early historical systems like the Paris and Stockholm systems to more modern techniques. The document discusses the key aspects of different brachytherapy systems including: the Paris system which used small amounts of radium over 5 days, the Stockholm system which used repeated high dose radium treatments over shorter times, and the Manchester system which modified the Paris system and introduced standardized dose measurement points like Point A. Modern brachytherapy planning incorporates 3D imaging, contouring of tumor and organ-at-risk volumes, and advanced dose reporting metrics to better optimize treatment while sparing healthy tissues.
Tomotherapy combines intensity modulated radiation therapy with computed tomography scanning to treat cancer. It can treat multiple tumors simultaneously with daily 3D imaging to improve accuracy and minimize side effects. Tomotherapy uses a sophisticated multi-leaf collimator and 360 degree delivery of many narrow beamlets to provide conformal, even radiation doses to tumors while avoiding healthy tissue for shorter treatments and fewer side effects than other radiation therapies. It can treat many cancer types, including mesothelioma.
Motion management strategies in radiation therapy aim to account for tumor movement during treatment. Key strategies include gating methods that deliver radiation only during specific respiratory phases, breath hold methods that immobilize tumors during deep inhalation or exhalation, tracking methods that follow tumor motion in real-time and adjust beam targeting accordingly, and encompassing methods that define larger target volumes to cover full respiratory excursion. No single approach is clearly superior, as appropriate management depends on tumor location, motion extent, and available technology. The goal of all motion management is to safely escalate dose to tumors while reducing dose to surrounding healthy tissues.
A linear accelerator (LINAC) is a device that uses radiofrequency electromagnetic waves to accelerate electrons to high energies in a linear path inside a tube. The electrons are then collided with a heavy metal target to produce high-energy x-rays. The x-rays are directed to the patient's tumor from any angle by rotating the gantry and moving the treatment couch. LINACs have evolved from early machines with limited motion and lower energies to modern machines with wider ranges of beam energies, dose rates, field sizes, and operating modes that provide more precise and accurate radiation treatment for cancer patients. Key components of a LINAC include the drive stand containing the klystron or magnetron to generate microwave power, the accelerator waveguide
This study investigated generating improved 3D treatment plans for telecoabalt machines without MLC by using locally available materials like universal shielding blocks. The study aimed to see if plans similar to IMRT could be created on telecoabalt to help poor patients who cannot afford linear accelerator treatment but need advanced techniques. Two case studies are presented where improved 3D plans were created for telecoabalt that provided dose coverage and sparing of normal tissues comparable to IMRT plans. The conclusion is that 3DCRT/IMRT type plans are feasible on telecoabalt with careful planning using field-in-field techniques and custom shielding blocks.
Surface Guided Radiotherapy for Accuracy, Volume Reduction, Real time Trackin...SGRT Community
1) Surface guided radiotherapy uses optical cameras to track the external surface of a patient in real-time during treatment and provides sub-millimeter accuracy for patient positioning and motion management.
2) The technique has been used at MSKCC for several clinical applications including frameless SRS for brain tumors, head and neck cancers, and deep inspiratory breath hold treatments for breast cancers.
3) Preliminary results found surface guided radiotherapy improved patient comfort for frameless SRS over framed SRS and doubled the treatment throughput. Motion tracking also ensured frameless SRS accuracy to within 1mm.
This document discusses modern radiotherapy techniques including conformal radiotherapy and intensity-modulated radiation therapy (IMRT). It describes the planning steps which involve CT scanning of the patient, delineating the tumor and organ-at-risk volumes, dose analysis, and treatment delivery with quality assurance and patient positioning. IMRT allows for improved target conformality and reduced radiation exposure to surrounding healthy tissues compared to traditional radiotherapy through inverse planning optimization of multiple modulated radiation beams. Image-guided radiotherapy (IGRT) further improves treatment accuracy by accounting for organ motion and setup variations using frequent imaging.
The document summarizes interstitial brachytherapy, including indications, contraindications, isotopes used, and details of various planning systems like Paterson-Parker, Quimby, Paris, and computer-based systems. It discusses dose rates, types of implants, applicators, volume definition, and dosimetry parameters like reference isodose and uniformity criteria for different planning approaches.
This document discusses various techniques used for treatment verification in radiation therapy. It describes electronic portal imaging devices (EPID) which can be used for daily treatment localization and verification through portal images with little additional dose. Cone beam computed tomography (CBCT) is also discussed, which provides volumetric CT images with submillimeter resolution, allowing verification of patient positioning before treatment. Both EPID and CBCT help ensure the correct radiation dose is delivered to the intended target volume.
Quality assurance of treatment planning system by Rahim GoharRahim Gohar
The document discusses quality assurance of 3D treatment planning systems for external photon and electron beams. It covers international reports on QA of TPS from organizations like IAEA, AAPM Task Group 53, and CAPCA. The presentation reviews aspects of TPS QA like system/software configuration, data entry, and evolution over time. It provides examples of important quality control checks for components like the CPU, digitizer, backups, CT transfer, and validating basic beam data. Tolerances for dose calculation accuracy are also addressed.
This document summarizes key considerations for intensity-modulated radiation therapy (IMRT) treatment planning and dosimetry. It discusses beam modeling, dose calculation, inverse planning, and quality assurance. Accurate modeling of beam penumbra, multileaf collimator characteristics, output factors for small fields, and dose calculation algorithms are essential for ensuring dosimetric accuracy. Proper target and organ-at-risk delineation and appropriate margins are also important for effective IMRT planning.
QUALITY ASSURANCE IN LINAC AND CYBERKNIFE.pptxSuryaSuganthan2
This document discusses quality assurance procedures for a linear accelerator (linac) and CyberKnife system. It outlines the various QA tools used, including phantoms for checking beam parameters like flatness, symmetry and output. Daily, weekly, monthly and yearly QA tests are described for parameters like lasers, optical distance indicator and radiation output. Tolerance levels are provided. Procedures for specific tests using tools like the Pentaguide and SunNuclear profiler are detailed step-by-step. Results of sample daily output and beam profile measurements are also shown.
Implementing an End-to-End SGRT Workflow for Breath-Hold SABRSGRT Community
SGRT Europe 2022
Ellen Dear
Senior Regional Therapeutic Radiographer
Genesis Care
Chelsea Carnall
Senior Regional Therapeutic Radiographer
Genesis Care
This document discusses various time-dose models used in radiotherapy, including the Strandqvist, Cohen, NSD, and TDF models. It explains the need for these models to optimize treatment regimes for tumor control while sparing normal tissues. The document also covers gap correction factors used when treatment schedules are interrupted and the various factors that can affect tumor control outcomes due to gaps in treatment. Compensatory methods like accelerated scheduling and increased dosing are presented to account for treatment gaps.
Radiation Shielding for Mega-voltage Photon Therapy Machines Daryoush Khoramian
Radiation shielding is needed for megavoltage photon therapy machines to limit radiation exposure and reduce effective dose outside of treatment rooms. Approximately 50% of cancer patients receive radiation therapy. Shielding barriers like lead and concrete are used to reduce radiation levels in uncontrolled and controlled areas like corridors and waiting rooms based on factors like workload, use, and occupancy. Proper machine orientation and maze or direct door designs can further reduce dose near room entrances. Ducting and electrical routing must also consider radiation protection. Skyshine radiation from scattered photons above the treatment room requires special consideration in shielding design.
1. The document evaluates volumetric modulated arc therapy (VMAT) for craniospinal irradiation (CSI) treatment planning.
2. It aims to standardize and simplify the CSI planning technique while improving dose conformity and homogeneity in the target volume and reducing dose to organs at risk.
3. VMAT plans for 4 patients using 3 isocenters and 2 arcs each achieved good target coverage with a conformity index of 0.99 and homogeneity index of 1.13 on average while sparing organs at risk.
1) The document discusses the implementation of the SGRT system across four sites of The Christie NHS Foundation Trust to provide DIBH for breast cancer patients.
2) Timelines show that SGRT was installed and validated at Oldham by October 2020 and the other three sites by November 2020, allowing DIBH to be offered to all left-sided breast patients across the Trust.
3) Results found translations within tolerance, reduced need for corrections, and average time savings of over 2 minutes per patient for standard positioning compared to pre-SGRT workflows. DIBH average time was 16 minutes compared to 30 minutes for spirometer.
RADIOTHERAPY IN CARCINOMA BREAST (EARLY AND LOCALLY ADVANCED)DrAnkitaPatel
This document discusses radiation therapy for breast cancer. It begins by outlining the important role of radiation therapy at various stages of breast cancer, including as part of breast conservation and after mastectomy. It then discusses indications for adjuvant radiation therapy based on factors like tumor size and lymph node involvement. The document reviews evidence from clinical trials demonstrating the benefits of radiation therapy after breast-conserving surgery in reducing recurrence rates and improving survival. It also discusses techniques, dosing, and toxicity considerations for radiation therapy delivery.
Role of Nurses in a Radiotherapy Unit.pptxSayan Das
The document discusses the role of nurses in a radiotherapy unit. It outlines that nurses function independently and with the radiation oncology team to provide quality patient care. Their roles include administering medications and therapies, wound dressing, providing physical and psychological support, educating patients and families, and collaborating with other team members. Key tasks of nurses in radiotherapy include assessing patients, managing side effects of treatment like dermatitis and diarrhea, assisting with procedures like CT simulation and brachytherapy, and educating patients.
This document provides information about computed tomography (CT) scans of the chest, including high-resolution CT. It describes what a chest CT is used for, how it is performed, what the equipment looks like, benefits, and normal findings. A chest CT can detect abnormalities in the lungs, chest wall, heart and blood vessels. It is performed by positioning the patient on a table that slides into a donut-shaped machine. Rotating x-rays create cross-sectional images which are analyzed to diagnose conditions like lung cancer, pneumonia and tumors.
This document summarizes the implementation of Vision RT at a radiation oncology clinic that opened in March 2015. It discusses the clinic planning starting in 2012, staff training in 2014, and problems encountered go-live such as long treatment times and issues with breast setup due to the small bore size of the PET/CT simulator. It also describes solutions developed for breast and pelvis region of interest design in Vision RT, as well as applications of Vision RT for DIBH, extremities, prone prostate, radiosurgery, SBRT lung, and SRS immobilization and workflow.
This document discusses patient radiation dose management in medical imaging. It describes how patient dose is estimated using entrance skin exposure, bone marrow dose, and gonadal dose. Factors that influence patient dose include equipment design and operator technique. Unnecessary dose should be avoided by restricting unnecessary exams, repeats, and optimizing techniques like collimation and shielding. Special considerations are discussed for mammography, CT imaging, and protecting dose to pregnant patients.
This document discusses various immobilization devices used in radiotherapy treatment. It begins by defining immobilization and its importance for accurate radiation dose delivery. Various desirable characteristics and materials for immobilization devices are described, including plaster of Paris, thermoplastics, and Vac-Lok systems. The document outlines the history of immobilization methods and discusses techniques for specific treatment sites like head and neck, brain, thorax, pelvis, and extremities. Common devices include thermoplastic masks, bite blocks, and frames or boards customized for different body regions. Proper immobilization aims to reproducibly position patients for each fraction to minimize treatment errors.
Vision RT was implemented at Children's Hospital Los Angeles in 2013. Initially, therapists were reluctant to change workflows but found that using Vision RT decreased repeat imaging and increased treatment efficiency. Key aspects of the workflow include using separate set up and monitoring fields, tight positioning tolerances, and patient monitoring. Vision RT has been used for treatments such as chest, abdomen, pelvis, craniospinal, head and neck, and extremities. Benefits include decreased imaging, more efficient treatments, and allowing some patients to be treated without anesthesia through monitoring. Troubleshooting considerations include limited body contours, lines/tubes in the ROI, belly breathing, movement, and inadvertent items in the ROI.
EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
Conventional planning
Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
AlignRT provides detailed patient positioning information that simplifies complex setups and decreases setup times. The presentation reviewed several case studies where AlignRT helped with challenging treatments, including a patient in a decubitus position, electron treatments to the foot, prone breast and pelvis treatments, and bilateral extremity treatments. AlignRT also allowed replication of immobilization devices when they became displaced, avoiding additional imaging and treatment delays.
Optimization of ct scan protocol in acute abdomen 2003 revised aaHisham Khatib
This document provides guidance on optimizing CT scan protocols for evaluating acute abdomen. It defines acute abdomen and lists common causes such as appendicitis, cholecystitis, and bowel obstruction. The document recommends CT as the best first-line imaging modality for evaluating upper right quadrant and pelvic pain. It provides details on oral, IV, and rectal contrast administration as well as scanning parameters and protocols for common acute abdomen conditions to optimize diagnostic image quality while minimizing radiation dose.
Occupational radiation safety in Radiological imaging, Dr. Roshan S Livingstoneohscmcvellore
Occupational radiation safety in Radiological imaging
1) There is increased use of radiation-based medical imaging globally, but many staff lack proper training in radiation safety techniques.
2) Workers in cardiology cath labs receive the highest radiation doses, followed by radiology cath labs and other interventional procedures. Prolonged fluoroscopic screening can lead to hair loss and cataracts in interventionalists.
3) Basic principles of radiation safety include minimizing time, maximizing distance, and using shielding. Monitoring staff doses with dosimeters and following safety protocols helps ensure doses are as low as reasonably achievable.
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Clinical implementation of Surface Guided Radiotherapy (SGRT) for palliative ...SGRT Community
Jack Hannant
Senior Radiographer
The Christie at Oldham NHS Foundation Trust
UK
Helen Squibbs
Superintendent Radiographer
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UK
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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4. Intermountain Healthcare
Radiation Oncology
Provides care across Utah
• 9 Facilities with linacs
• As of 2018:
o 1 location with a Gamma Knife
o 1 location with linac SRS
• Access to care due to distance is
a common concern
o Guiding principle of “Cancer Care
Close to Home”
5. New Center, New Capabilities
“Normalizing SRS” was a primary clinical goal
• Complete replacement of original Radiation Oncology
department that was ~40 years old
o 2/12/2018: New center opened with TrueBeam and OSMS
o 11/6/2019: 1st SRS patient
• 31 SRS cases treated in ~1.5 years
o 82 SRS treatments to date
6. SRS Program Development
Adopting SRS Planning Approaches
Used prior SRS patient CTs UAB ring optimization technique SRS phantom dosimetry audit
Establishing SRS QA Tools
W/L Testing Isocenter Characterization Film & Ion Chamber SRS MapCheck
Learning to Use and Trust Surface Guidance
SBRT Monitoring Breast Breath Hold Initial Patient Setup
Non-SRS
Open Face Masks
8. Workflow Overview
Simulation:
• CT Sim using Qfix Encompass™ masks
o Very stiff material
o Clamshell design only requires a shallow “pull”
• Klarity SRS Masks are also now also available
• MINIMUM 2 sets of hands
o Discuss ideal mask position on the forehead before beginning
o More forehead variations than you might have guessed…
o One person holds the forehead in place and provides pressure on the chin
o The second person pulls and pins the mask
• Practice and experience matters
o Bite tab is not used
o Chin pressure is equally effective and MUCH more comfortable
• Integrated shims are a good insurance policy but rarely used clinically
9. Workflow Overview
Planning & QA:
• Plan using single isocenter, ring-based
optimization per the UAB approach
o Clark, Grant M et al. “Plan quality and treatment planning technique for single isocenter
cranial radiosurgery with volumetric modulated arc therapy.” Practical radiation
oncology vol. 2,4 (2012): 306-313.
• Patient QA using SNC SRS MapCheck®
o Very efficient and easy to use
10. Workflow Overview
Region Of Interest Creation:
• Create high accuracy body/face structure
• ROI close to mask but not including any mask
• Use SRS tolerances of +/- 1mm & 1.0°
o STOP and correct this if imported wrong!
Planning System AlignRT Advance
BAD EXTERNAL CONTOUR
Good ROI
12. Sample Case Timeline
•Patient gets on table
12:55
•Surface guidance cameras monitoring
•Rough positioning with surface guidance
12:57
•Mask on
•Coach patient position guided by deltas
12:58
•Flip through video views
•All deltas green
12:59
•CBCT #1 acquisition start
1:00
•CBCT alignment using Bone and Soft Tissue
•Max shift 0.14cm, 0.3°
1:03
•CBCT #2 acquisition start
1:04
•Max shifts 0.02cm, 0.1°
1:06
•CAPTURE REFERENCE SURFACE
1:07
•MV AP image
1:07
•Couch = 0°
•Treatment beam delivery start
1:08
•Couch = 45°
•Max deviation during delivery: 0.04cm, 0.3°
1:10
•Couch = 315°
•Max deviation during delivery: 0.04cm, 0.3°
1:12
•Couch = 270°
•Max deviation during delivery: 0.03cm, 0.4°
1:13
•Treatment Complete
1:15
•Patient walking out of the room
1:17
24Gy in 1 fraction:
• 10FFF
• 4 couch angles
o All rotations remotely applied
• 30 min time slot
o 22 minutes door to door in this typical case
• Mid-treatment re-CBCT adds ~5 minutes if needed
13. •Patient gets on table
12:55
•Surface guidance cameras monitoring
•Rough positioning with surface guidance
12:57
•Mask on
•Coach patient position guided by deltas
12:58
•Flip through video views
•All deltas green
12:59
•CBCT #1 acquisition start
1:00
•CBCT alignment using Bone and Soft Tissue
•Max shift 0.14cm, 0.3°
1:03
•CBCT #2 acquisition start
1:04
•Max shifts 0.02cm, 0.1°
1:06
•CAPTURE REFERENCE SURFACE
1:07
•MV AP image
1:07
•Couch = 0°
•Treatment beam delivery start
1:08
•Couch = 45°
•Max deviation during delivery: 0.04cm, 0.3°
1:10
•Couch = 315°
•Max deviation during delivery: 0.04cm, 0.3°
1:12
•Couch = 270°
•Max deviation during delivery: 0.03cm, 0.4°
1:13
•Treatment Complete
1:15
•Patient walking out of the room
1:17
Sample Case Timeline
Pre-treatment:
• Thermal drift magnitude of ~0.5mm is significant at when
using 1mm tolerances!
• Stabilizes nicely after ~10 minutes
• Just turn on monitoring during setup and leave on
[mm]
14. •Patient gets on table
12:55
•Surface guidance cameras monitoring
•Rough positioning with surface guidance
12:57
•Mask on
•Coach patient position guided by deltas
12:58
•Flip through video views
•All deltas green
12:59
•CBCT #1 acquisition start
1:00
•CBCT alignment using Bone and Soft Tissue
•Max shift 0.14cm, 0.3°
1:03
•CBCT #2 acquisition start
1:04
•Max shifts 0.02cm, 0.1°
1:06
•CAPTURE REFERENCE SURFACE
1:07
•MV AP image
1:07
•Couch = 0°
•Treatment beam delivery start
1:08
•Couch = 45°
•Max deviation during delivery: 0.04cm, 0.3°
1:10
•Couch = 315°
•Max deviation during delivery: 0.04cm, 0.3°
1:12
•Couch = 270°
•Max deviation during delivery: 0.03cm, 0.4°
1:13
•Treatment Complete
1:15
•Patient walking out of the room
1:17
Sample Case Timeline
Pre-treatment:
• Initial alignment of the patient is critical at this point
o Verbally coach the patient to minimize rotational deltas
o Preferable to have the patient make the needed motions to maintain comfort
o Mask can be partially clipped in to allow more motion
• Rotational alignment is particularly important
o 6DOF couch can correct some deviation but has a limited range of motion
o Misalignment of the head with the mask could be unstable
o Single isocenter-multi-target treatments are very sensitive to rotational
misalignment
15. •Patient gets on table
12:55
•Surface guidance cameras monitoring
•Rough positioning with surface guidance
12:57
•Mask on
•Coach patient position guided by deltas
12:58
•Flip through video views
•All deltas green
12:59
•CBCT #1 acquisition start
1:00
•CBCT alignment using Bone and Soft Tissue
•Max shift 0.14cm, 0.3°
1:03
•CBCT #2 acquisition start
1:04
•Max shifts 0.02cm, 0.1°
1:06
•CAPTURE REFERENCE SURFACE
1:07
•MV AP image
1:07
•Couch = 0°
•Treatment beam delivery start
1:08
•Couch = 45°
•Max deviation during delivery: 0.04cm, 0.3°
1:10
•Couch = 315°
•Max deviation during delivery: 0.04cm, 0.3°
1:12
•Couch = 270°
•Max deviation during delivery: 0.03cm, 0.4°
1:13
•Treatment Complete
1:15
•Patient walking out of the room
1:17
Sample Case Timeline
Pre-treatment:
• CBCT acquisition using SRS protocol
o 100kV, 30mA, 540mAs
Mao, Weihua et al. “On the improvement of CBCT image quality for soft tissue-based SRS
localization.” Journal of applied clinical medical physics vol. 19,6 (2018): 177-184.
• Repeat CBCT to confirm shifts and patient stability
Plan CT CBCT
16. •Patient gets on table
12:55
•Surface guidance cameras monitoring
•Rough positioning with surface guidance
12:57
•Mask on
•Coach patient position guided by deltas
12:58
•Flip through video views
•All deltas green
12:59
•CBCT #1 acquisition start
1:00
•CBCT alignment using Bone and Soft Tissue
•Max shift 0.14cm, 0.3°
1:03
•CBCT #2 acquisition start
1:04
•Max shifts 0.02cm, 0.1°
1:06
•CAPTURE REFERENCE SURFACE
1:07
•MV AP image
1:07
•Couch = 0°
•Treatment beam delivery start
1:08
•Couch = 45°
•Max deviation during delivery: 0.04cm, 0.3°
1:10
•Couch = 315°
•Max deviation during delivery: 0.04cm, 0.3°
1:12
•Couch = 270°
•Max deviation during delivery: 0.03cm, 0.4°
1:13
•Treatment Complete
1:15
•Patient walking out of the room
1:17
Sample Case Timeline
Pre-treatment:
• CAPTURE REFERENCE SURFACE
o Cameras are warmed up
o kV arms are out of the way
o Gantry is at 180° after the CBCT
• Reference surface is the confirmed, ideal treatment position TODAY
o Eliminates uncertainty from posterior hair, settling into the mask and any
swelling of the facial tissue
17. •Patient gets on table
12:55
•Surface guidance cameras monitoring
•Rough positioning with surface guidance
12:57
•Mask on
•Coach patient position guided by deltas
12:58
•Flip through video views
•All deltas green
12:59
•CBCT #1 acquisition start
1:00
•CBCT alignment using Bone and Soft Tissue
•Max shift 0.14cm, 0.3°
1:03
•CBCT #2 acquisition start
1:04
•Max shifts 0.02cm, 0.1°
1:06
•CAPTURE REFERENCE SURFACE
1:07
•MV AP image
1:07
•Couch = 0°
•Treatment beam delivery start
1:08
•Couch = 45°
•Max deviation during delivery: 0.04cm, 0.3°
1:10
•Couch = 315°
•Max deviation during delivery: 0.04cm, 0.3°
1:12
•Couch = 270°
•Max deviation during delivery: 0.03cm, 0.4°
1:13
•Treatment Complete
1:15
•Patient walking out of the room
1:17
Sample Case Timeline
Pre-treatment:
• AP MV image acquisition
o Very quick “Sanity Check”
o Independent of CBCT accuracy and surface guidance accuracy
o No shifts are applied from this image, re-CBCT if uncertain
18. •Patient gets on table
12:55
•Surface guidance cameras monitoring
•Rough positioning with surface guidance
12:57
•Mask on
•Coach patient position guided by deltas
12:58
•Flip through video views
•All deltas green
12:59
•CBCT #1 acquisition start
1:00
•CBCT alignment using Bone and Soft Tissue
•Max shift 0.14cm, 0.3°
1:03
•CBCT #2 acquisition start
1:04
•Max shifts 0.02cm, 0.1°
1:06
•CAPTURE REFERENCE SURFACE
1:07
•MV AP image
1:07
•Couch = 0°
•Treatment beam delivery start
1:08
•Couch = 45°
•Max deviation during delivery: 0.04cm, 0.3°
1:10
•Couch = 315°
•Max deviation during delivery: 0.04cm, 0.3°
1:12
•Couch = 270°
•Max deviation during delivery: 0.03cm, 0.4°
1:13
•Treatment Complete
1:15
•Patient walking out of the room
1:17
Sample Case Timeline
Treatment Delivery:
• Total beam delivery time of 6 minutes
o Very little time for the patient to move or
become uncomfortable
• 10/22 minutes spent on positioning, alignment &
verification
o This is time well spent!
25. Intermountain Healthcare
Radiation Oncology
Provides care across Utah
• 9 Facilities with linacs
• As of 2021:
o 1 location with a Gamma Knife
o 3 locations with linac SRS
• SRS is now a normal procedure
o Everyone “LOVES IT!” because it
follows such a reliable process
o Confidence feels good
"Retrieved Fri, 26 March 2021 from the Utah Department of Health, Indicator-
Based Information System for Public Health Web site: http://ibis.health.utah.gov"
Current generation of software and calibration protocols allows for excellent stability. Watching the Rotation delta track the patient and then just land perfectly is consistently satisfying.
Gentle blinking is not a problem. Curiosity while the gantry is moving overhead can cause measurable delta changes. This is due to the eyebrow motion when “looking” at something vs just blinking. Removing the eyes from the ROI would not remove the brow motion and the contours of the brow are too valuable to remove from the ROI. Video view allows correlating small patient motions like this with the observed deltas so position confidence remains high when deltas come back to within tolerance.
Instructing patients to keep their eyes closed is still the best practice overall though.
Undesired motion that might cause a loss of confidence in the skull position turn out to be not catastrophic.
Good ROI (ample lateral coverage) minimizes delta jumping during “eclipse” of the cameras. Be prepared for slight changes in stability of deltas during camera Eclipse events. Don’t overreact. Learn the system’s behavior