The Radixact X9 Tomotherapy system is an advanced form of radiation therapy utilizing a CT scanner-based platform for delivering precise and flexible treatment to cancer patients. Its unique features include customizable radiation delivery, minimal exposure to healthy tissue, and efficient multi-angle treatment options, making it suitable for complex tumors and various cancers. The system integrates imaging and treatment planning to enable accurate dose delivery and adapt treatment plans as needed.

1. RADIXACT X9 TOMOTHERAPY SYSTEMRADIXACT X9 TOMOTHERAPY SYSTEM
OVERVIEWOVERVIEW
SUBRATA ROY.
RADIOTHERAPY TECHNOLOGIST.
HCG–ICS KHUBCHANDANI CANCER
CENTRE.
MUMBAI COLABA.

2. TOMOTHERAPY
Tomo therapy is intensity-modulated rotational Radiotherapy
utilizing a photon fan beam.
Radiation therapy device designed on a CT scanner-based
platform.
Tomo therapy literally “Slice therapy” IMRT delivered using
narrow slit rotational beam.

3. TOMOTHERAPY CONCEPT
In line short length LA.
Mounted on a continuously rotatable ring directed at its center.
The patient will be slowly translated through the ring.
So Spiral of slit field Radiation, directed at the patient, which
is modulated bi m-MLC 64 binary leaves. Low dose MVCT
images , virtually eliminates the artifacts.
MVCT [3.5MV]detector mounted opposite to the source for
setup registration , treatment planning and verification
purposes.
3D CT image guidance before each treatment.

4. BASIC PRINCIPLES TOMOTHERAPY
Rotation therapy is relatively insensitive to the energy of the beam.
Before megavoltage beams were developed , rotation therapy was
used to deliver X-radiation deep within the body.
The lower exit dose of the Ortho-voltage photon beams
approximately compensated for the high entrance dose.

5. RADIXACT TREATMENT DELIVERY SYSTEM
The new Radixact System is advanced version of
Tomotherapy-HDA machine.
This is a uniquely smart radiation therapy system that enables
optimal treatment for cancer. It is basically the Tomotherapy
platform, designed to enable more efficiently and effectively
deliver precise radiation treatments to patients.
The System features fully integrated treatment delivery,
treatment planning and data management systems, designed to
provide the imaging capabilities, treatment flexibility and
precise dose delivery come to expect with the Tomotherapy
Treatment System.

6. CONTD….
The Radixact Systems Precisely target cancer cells, enabling
effectively treat hard-to-reach and complex tumors.
Customize treatment delivery specifically for each patient.
Minimize exposure to surrounding healthy tissue.
Are generally non-invasive, and as painless as having a CT scan or
an X-ray.
Can result in fewer and less severe ,Many patients feel better than
they expected they would while undergoing treatment.
Can be used in combination with surgery, chemotherapy and other
medications.

7. WHAT MAKES TOMOTHERAPY UNIQUE
Patient can be treated up to 135cm,with no reposition, no
field matching
 Faster Treatment deliver because of dose rate 1000cGy/min
Precise tumor dose.
Sophisticated Multi leaf collimator.
360 degree delivery.
CT Scanner like gantry allows for continuous delivery.

8. WHY TOMOTHERAPY?
The Tomotherapy platform gives clinicians everything they
need to deliver the best radiation therapy possible.
Tomotherapy users have the unique ability to Use daily CT
imaging to guide treatment based on patient anatomy for that
day, rather than for last week or last month.
Customize delivery for each patient, surrounding the target
with highly-precise radiation delivered from all angles
Minimize radiation exposure to healthy tissue. If necessary,
adapt the treatment plan at any point.

9. TREATMENT BEAM COMPONENTS
An enclosed Gantry.
Fixed and rotating assemblies.
Slip ring technology.
Linear accelerator.
Primary collimator.
Secondary collimator.
Multi leaf collimator.
MVCT imaging system.
Beam stopper.

10. GANTRY SPECIFICATION & COUCH
IMPROVEMENTS
Rotates around IEC-Y axis ,Continuous 360 degree rotation
with a accuracy of angles within 0.1 Degree.
Gantry Speed B/W 1 & 5.08 RPM for treatment,10 RPM for
imaging with a nominal SSD of 85 cm.
This rotational speed set During the Treatment Planning.
Bore diameter: 85cm.
Minimum Rotation Per Minute:1 rpm.
Maximum Rotation Per Minute: 10 rpm.

11. GANTRY ASSEMBLY

12. WHAT IS C-TRUE IMAGING IN TOMO
See true position with simple,
Accurate patient setup.
See True delivery with
efficient 3D image guidance
for every patient.
See True density with
consistent image quality at a
low dose.
See True Dose guided Daily
Treatment.

13. C-TRUE IMAGING SPECIFICATION
Geometry : Helical Fan Beam.
Image resolution: 512x512(0.76mm Pixels)
Dose/MVCT image : 0.5-3cGy [Depending on resolution and
body thickness & acquisition Pitch]
Detector Configuration : 528 channels ,single row xenon ion
chamber array used for image acquisition.
Field of view: 39 cm diameter.
Source to detector distance: 140 cm.
Image reconstruction with filtered back projection algorithm.
Image reconstruction in Real Time slice by slice at time.

14. MLC SPECIFICATIONS
64 binary interlaced leaves with 10 cm leaf thickness in beam
direction.
Leaf width projected to isocentre:6.25mm.
Leakage :≤0.5%.
Leaf transition time :<40ms.
Travel in longitudinal Direction.
Tungsten material MLC moves with pneumatic pressure.

15. PHOTON BEAM
Single therapy energy spectrum of 6MV.
Standing wave.
Dose rate 1000cGy.
D-max 1.5 cm

16. BEAM COLLIMATION
Flattening filter free.
6MV fan beam.
One set of moveable jaw
Pneumatic, Binary MLC (64 leaves).
20ms leaf transit time.
Largest field size 5cmX40cm at Isocentre.
Smallest field size 1cmX0.625cm at isocentre

17. RADIXACT COUCH
Incorporated with Medical intelligence Indexing System.
Provides Sub-millimetre Positioning accuracy in translational
movements.
Couch catcher to maintain optimal Table sag top position and to
reduce the couch sage from 5mm to 2mm
Couch tolerance maximum weight 0f 200kg

18. TREATMENT DELIVERY CONSOLE
The Treatment Delivery Console is the workstation that
connects to the treatment system and provides control of C-true
MVCT imaging, patient treatment and quality assurance
delivery, procedure verification functionality and delivery of
calibration and QA procedures. Control of the Radixact Couch
is included, allowing patient shifts to be made at the Treatment
Delivery Console after image registration.

19. TDC

20. PRECISE ART
The precise Adaptive Radiation therapy System allows to track
delivered Dose relative to the planned dose over the entire course of
multi-fraction treatment using the MVCT data and the patient
positioning system. It provides tools to aid in the efficient
generation of new treatment plans for patients currently or
previously under treatment.

21. PLANNING STATION
Contour patient.
Specific planning parameters.
Monitor optimization progress: adjust planning parameters as
needed.
Optimize MLC intensity pattern.
Determine gantry and couch speed.

22. TREATMENT MODE
Tomo Helical and Tomo Direct modalities deliver
individualized treatment for both routine and complex
indication. Tomo-EDGE treatment modality spares normal
tissue while enabling increased patients throughput.
Tomo Direct.
Tomo Helical.

23. TOMO DIRECT
Tomo Direct delivery mode is a discrete angle delivery with
continuous couch motion.
It is a non-rotational treatment option.
During Treatment delivery, all beams for each target are
delivered sequentially with the couch passing through the bore
of the system at an appropriate speed for each gantry angle.
Targets of up to 135 cm in length can be treated.
Fixed jaw and optional dynamic jaw (Tomo EDGE) modes are
available with Tomo Direct mode.
With Tomo EDGE mode, field width varies during delivery to
decrease the width of the dose gradient outside the target.

24. TOMO HELICAL
Tomo Helical delivery mode provides IMRT and 3DCRT
Treatment delivery in a continuous helical pattern, using
thousand of narrow beam lets, which are individually optimized
to target the tumor.
During delivery, the linear accelerator completes multiple 360
degree rotations around the patient while the couch passes
through the bore of the system.
Fixed jaw and optional dynamic jaw (Tomo EDGE) modes are
available with the Tomo Helical delivery mode.
With Tomo EDGE mode, field width varies during delivery to
decrease the width of the dose gradient outside the target.

25. TOMO DIRECT&TOMO HELICAL

26. WHO SAID RT HAD TO BE COMPLICATED?
No Electrons
No Wedges.
No Couch Angles.
No collimator angles.
No MLC Shapes.
No Field light.

27. REGISTRATION
CONSULTATION WITH
RADIATION ONCOLOGIST
PRESCRIPTION OF DOSE
PLAN APPROVAL BY
ONCOLOGIST
PRE VERIFICATION IN
CONSOLE AREA
DOCUMENTATION
TARGET CONTOURING
TREATMENT PLANNING
PREMEDICATION
[IF REQUIRED]
PATIENT SETUPIN
TREATMENT ROOM
CT SIMULATION
COMMENCEMENT OF
TREATMENT
IMMOBILISATION
ACHIEVE CRITERIA FOR
TREATMENT
TREATMENT APPROVAL
SIGN BY ONCOLOGIST &
PHYSICIST
MONITORING THE
PATIENT THROUGHOUT
THE OF TREATMENT
TOMOTHERAPY
WORK FLOW

28. RADIXACT SYSTEM UTILIZATION AT
TREATMENT
Complex cases with targets in close proximity to OARs
Head &Neck
Breast (Comprehensive nodal irradiation)
 Extended fields
Pelvic or Para-aortic
CSI
Special Cases
Spine Tumours
Pediatric Cancers.

29. Differences of 3DCRT & IMRT With Tomo
therapy Treatment contours and Dose
Distribution……………………….

30. 3D-CRT VERSUS TOMO

32. EXAMPLE OF MVCT REGISTRATION(H&N)

33. EXAMPLE OF MVCT REGISTRATION
ABDOMEN

34. UPDATES
RADIXACT X9 TOMO H-SERIS
Dose rate 1000cGy/min. Dose rate 850cGy/min.
10 RPM For MVCT imaging. 6 RPM For MVCT imaging.
Dose Per MVCT image 0.5-
3cGy.
Dose Per MVCT image 1-3cGy.
X,Y & Z Axis moves
Independently.
Cobra Couch Motion.
Couch Catcher Available No Couch Catcher

35. RADIXACT SYSTEM TREATMENT DELIVERY
EFFICIENCY
Faster Image Acquisition:- 10 rpm gantry rotation
increased from the 6 rpm.
40% shorter Scan Time:-
6 Second Beam on Warm up decreased from 10 sec.
15% Reduced the treatment Delivery Time.
1000 MU/min dose rate increased from 850MU/min.

36. DISADVANTAGES
Manual radiation is not possible.
All should be CT based.
No intra-fractional image guidance.
Summation of total integral dose will be more.
Diagnostic CT scanner is needed for planning.

37. CONCLUTIONS
Tomo therapy treatment is a new standard if cancer care is
capable of delivering a well Tolerated treatment, the rapid wide
spread embrace of tomo therapy process is one way To gauge its
impact on cancer care, but it is the growing global community of
people served By this technology that's most important to all.

38. THANK YOU FOR ATTENTION