Interventional radiotherapy and radiation therapy

1. Radiation Therapy Treatment
Techniques and Treatment
Planning Systems

2. Snowball
Look at the picture and na
me from 5 to 10 words that
you see
RT treatments involve most body sites
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3. There are now a multitude of interventional radiology procedures available.
In many cases, these "minimally invasive" procedures can replace more
invasive measures (such as surgery) that were used in the past.
In turn, these techniques may have fewer complications, involve smaller
incisions, cause less discomfort, and help people recuperate more rapidly
than had been possible in the past. They are often less expensive. Some of the
conditions that may be treated in this way are listed below.
, MP WB

4. To Detect and Open a Blocked Blood Vessel
Pulmonary emboli: When blood clots (deep vein
thromboses) occur in the legs or pelvis, they may break off
and travel to the lungs (pulmonary emboli). When there is a
large clot in the lungs, a radiologist may sometimes insert a
catheter into the artery to break up the clot.
To Block a Blood Vessel - interventional radiology may be
used to block a vessel. For example, vein embolization may
be done for varicose veins, whereas artery embolization
(uterine artery embolization) may be done to treat fibroids.

5. Treatment of Aneurysms
Aneurysms are sections of an artery than are dilated and
weak and hence, are subject to rupture or bleed. Via
interventional radiology, a radiologist may place a stent graft
in the region of an aneurysm thus essentially relining the
blood vessel.
To Control Bleeding
interventional radiology may be used to control bleeding
(hemorrhage) in conditions ranging from gastrointestinal
bleeding, to postpartum bleeding, to trauma. Bleeding may
be controlled by blocking a blood vessel (as noted above),
placing a stent, using a balloon to apply pressure, and more.

6. Central Line Placement
When a person is seriously ill, or will be receiving caustic
medications such as chemotherapy, rapid access to larger
blood vessels for infusion is needed. (Peripheral veins, such
as a vein in the hand or forearm, are often insufficient.)
Examples of central lines include ports and PICC lines.
Feeding Tube Placement
The placement of feeding tubes (gastrostomy, jejunostomy)
are a relatively common interventional radiology procedure.
These are frequently used when a person is unable to eat
food for any reason.

7. Tissue Biopsies
A number of different types of biopsy procedures may be performed by a
radiologist, and are often guided by ultrasound or CT. Examples include
needle biopsies and stereotactic biopsies.
Cancer Treatment
A number of interventional radiology procedures may be used to treat
either a primary tumor or metastases (cancer that has spread). Tumors
may be addressed by ablative treatment such as radio frequency ablation
or microwave ablation, or instead by tumor embolization (blocking a blood
vessel that feeds a tumor so that the tumor dies).
Alternatively, either chemotherapy or radiation can be directly delivered to
an area of tumor or metastasis (chemoembolization/radioembolization).

8. For Fractured Vertebrae
Procedures known as vertebroplasty or kyphoplasty can be used to treat
collapsed vertebrae, a cement type substance is injected by the radiologist
to effectively repair a fracture.
To Treat Blockages
When blockages occur in different regions of the body, an interventional
radiologist may apply a stent. This may be done to open up a blocked
esophagus, blocked bile ducts, a blockage of the ureter draining from the
kidney, or a blockage in the bowel.
Drainage
When fluid collects in a region of the body, an interventional radiologist
may insert a drain to remove fluid or pus to drain recurrent pleural
effusions, in the brain (shunting), and much more.
Procedures to Treat Back Pain

9. Cancer Incidence 2018
World Africa
Data Source: GLOBOCAN 2018
Botswana
Frequency of different cancers varies around the globe

10. Cancer: Clinical Sites
RT treatments involve most body sites
from: http://2.bp.bIogspot.com/-J2GpKI2IRdc/Ta4lKpAyqWI/AAAAAAAAAMs/IhveE-fJfmkI/s16£Kt/Types+of+Cancer.jpg , MP WB

11. Radiation Therapy
There are a number of ways in which radiation therapy or
proton therapy may be given, and the particular use often
depends on the goal of treatment.
It's thought that roughly 50% of people with cancer will
undergo some form of radiation therapy.

12. External Beam Radiotherapy
In external beam radiotherapy, radiation is applied from
outside of the body on a table resembling a CT machine. It
may be used:
Before surgery (neoadjuvant radiation therapy) to reduce the
size of a tumor
After surgery (adjuvant radiation therapy) to "clean up" any
leftover cancer cells and reduce the risk of recurrence
As a palliative therapy to reduce pain (such as with bone
metastases) or an obstruction due to a tumor
As definitive radiotherapy, where the goal is to cure.

13. Brachytherapy
Brachytherapy is similar to external beam therapy except
that the radiation is delivered internally, often through beads
that are inserted into an area during surgery or after.
Stereotactic body radiotherapy (SBRT) or Cyberknife
refers to a procedure in which a high dose of radiation is
directed to a localized area of tissue. SBRT allows a curative
dose of radiation to be delivered to the tumor cells while
minimizing damage to nearby healthy tissues, used to treat
small tumors as an alternative to surgery, especially in
people who would not be expected to tolerate surgery as
well, often used to treat areas of metastases, such as brain
metastases due to a lung cancer or breast cancer.

14. Gamma knife radiosurgery
Gamma Knife radiosurgery is a noninvasive treatment for brain tumors
that allows physicians to preserve most of the patient’s healthy brain
tissue. This game-changing procedure has been especially effective in
helping to reduce the size of metastatic tumors—tumors that develop in
the brain due to cancer that has spread from another part of the body.
Gamma Knife surgery is an outpatient procedure that typically lasts at
least four or five hours, depending on the condition of patient.
Gamma knife:
•Used for people with brain metastases
•There is little recovery time involved—some may experience fatigue
and/or headaches
•Involves Neurosurgery and Therapeutic Radiology
Focused ultrasound thalamotomy is used to treat: Parkinson's disease and
Essential tremor.

15. Proton Beam Therapy
Proton beam therapy is similar to conventional radiation
therapy but uses high energy protons instead of photons or
X-rays to damage tumors. It was first used in 1990, and offers
similar effectiveness to radiation therapy.
Due to the way the radiation is delivered, it may be less likely
to damage nearby healthy tissue. For this reason, proton
beam therapy can sometimes be used in an area that was
previously treated with radiation (and thus, cannot be
treated again with conventional radiation).

16. Steps in
Radiation
Treatment
Process
• Multiple steps
• Complex
.
" Fo r Ea c h Trea t me n t F ract ion -

17. Treatment Techniques:
Head Neck Cancers
Patient immobilization for
reproducible set-ups
http://www.aboutcar<er.œm/neck_slmulation_lma es.gIf
hotons
Electrons
Treatment_and_Support/Cancer_Services/Radiation_Oncology/head%20andS20neck%20setupa1.jpg7n=8095&n=809S
MPW

18. Breast Techniques
Electrons
https://www.breastcancertare.org.uk/information-support/lacing-breast-cancer/going-through-breast-cancer-treatment/radiotherapy-primary//what is radiotherapy
Photons
MPYB

19. Lung Cancer
Conventional 2-field technique Stereotactic Body Radiotherapy (SBRT)

20. Prostate Cancer
Conventional treatment
4-field box
Anterior-Posterior View
Latera View » »

21. Intensity Modulated Radiation Therapy
(IMRT)
• Define objectives
• Use inverse planning
• Determine beam
intensities

22. 5-Field S&S IMRT Single 360- RA

23. Components of Modern TPS
• Hardware
• CPU
• High resolution graphics
• Mass storage (hard disc)
• CD/DVD
• Keyboard & mouse
• Printer
• Backup storage facility
• Network connections
Elekta Xio

24. Components of 3-D TPS
• Software
• Input routines
• Anatomy modeling
• Beam geometry
(virtual
Dose calculation
• Dos
histograms/evaluation tools
• Digitally reconstructed radiographs
• Output [hardcopies, network, web
connection (RTOG)]
TPP Nucletron
https://n7aIamy.com/zooms/82cdbbb3db54491bbafe48cb70aed145/dosimetrist-calculating-dosImetry-for-radiation-therapy-of-head-and-e5rh3d.jpg

25. Calculation Methodologies
• Methods
• Pencil beam
• Convolution/superposition
• Boltzmann transport
• Monte Carlo
• Radiobiological models
• Issues to consider
• Accuracy
• Speed of calculation
• User friendly
• Ease of commissioning and QA
• Options
• Price
Beam Slab Pencil Point
Kernel Kernel Kernel Kernel

26. National/lnternational Protocols
Fi ure 3
300 pages
• IAEA TRS-430, 2004
Figure 2
Available in pdf format from:
http://www-pub.iaea.org/MTCD/publications/PDF/TRS430_web.pdf MPW

27. Auditing Accuracy for IMRT, IROC

28. Various P h a n t o m s .. Forcommissioing/QA/QC
CIRS Inc. Modus Medical Devices Inc.
Stan ar Imaging Inc.
Med-Tec

29. Pelvis (10)
H&N IMRT
IROC Audit Phantoms
— SRS Head (4
)
orax
(15)
iver MPW

30. Deep brain stimulation
involves implanting electrodes within areas of the brain.
The electrodes produce electrical impulses that affect brain activity to treat certain medical
conditions. The electrical impulses also can affect cells and chemicals within the brain that
cause medical conditions.
The amount of stimulation in deep brain stimulation is controlled by a pacemaker-like device
placed under the skin in the upper chest. A wire that travels under the skin connects this
device to the electrodes in the brain.
Deep brain stimulation is commonly used to treat a number of conditions, such as:
Parkinson's disease.
Essential tremor.
Conditions that cause dystonia, such as Meige syndrome.
Epilepsy.
Tourette syndrome.
Obsessive-compulsive disorder.

31. Deep brain stimulation

32. Focused ultrasound
Focused ultrasound thalamotomy describes the use of focused waves of sound to treat an
area deep in your brain called the thalamus. This procedure can reduce or eliminate
symptoms of essential tremor and can help with the tremor symptoms associated with
Parkinson’s disease.
In focused ultrasound thalamotomy, sounds waves come from different directions and
generate heat at the point where the waves converge. The heat ablates a portion of the
thalamus. This prevents the firing of the circuits responsible for essential tremor, thus
eliminating or reducing the tremor.
A thalamotomy is any procedure that ablates a part of the thalamus, using heat for the
intentional destruction of tissue for therapeutic purposes.
Techniques have included inserting a radiofrequency probe through a hole made in the skull,
delivering focused radiation (similar to what is used for some tumors), and, more recently,
focused ultrasound.
Focused ultrasound thalamotomy does not require incisions or drilling of the scalp or skull. In
addition, the sound waves do not have enough energy to cause damage except at the point
where they converge. This means that portions of the brain more than a few millimeters from
where the ultrasound is being targeted are not at risk of being damaged.
Focused ultrasound thalamotomy is used to treat: Parkinson's disease and Essential tremor.

33. Summary
• Incidence of different cancers varies around the world
• Radiation therapy techniques cover the entire body
• Each site requiring its own details
• While different techniques have some commonality
• They are developed uniquely for each department
• Treatment planning systems are at the core of the
treatment planning process
• Treatment planning requires imaging
• Clinical implementation requires commissioning,
verification and QA procedures