1.Stereotactic Radiosurgery (SRS)
SRS is a precise and focused delivery of a single, high dose of irradiation to a small and critically located intracranial volume while sparing normal structure
2.Stereotactic Body Radiation Therapy (SBRT)
SBRT is a treatment procedure similar to SRS, except that it deals extra-cranial radiosurgery
3.Flattening Filter Free (FFF) mode
FFF beam is produced without the use of flattening Filter
In the 1990s, several groups studied about FFF high-energy photon beams. The main interest for that, is to increase the dose rate for radiosurgery or the "physics interest”.
Need of increase in dose rate from traditional 300-600 to 1400-2400MU/min to overcome time-inefficiency and to improve patients comfort specially in SRS/SBRT
Flattening Filter Free (FFF) mode
FFF beam is produced without the use of flattening Filter
In the 1990s, several groups studied about FFF high-energy photon beams. The main interest for that, is to increase the dose rate for radiosurgery or the "physics interest”.
Need of increase in dose rate from traditional 300-600 to 1400-2400MU/min to overcome time-inefficiency and to improve patients comfort specially in SRS/SBRT
Tema IV CATEGORÍAS FUNDAMENTALES DEL DERECHO AMBIENTAL INTERNO.Joel Navarro
Diferenciación conceptual y metodológica —conforme a criterios de la Teoría General del Derecho—, entre «principios generales o rectores», «derechos y garantías constitucionales», «principios de política estatal», lo que denominamos también «deberes político—institucionales del Estado» y el «régimen constitucional de las funciones institucionales de los órganos del Poder Público»; todo ello, como es lógico, relativo al ámbito de la cultura en las normas de la novísima Constitución de la República Bolivariana de Venezuela.
La participacion de los padres en los habitos de estudioIES Luis Buñuel
Qué supone estudiar.
Qué es un hábito y cómo se consigue. Su importancia.
Cuáles son los factores que influyen en el estudio.
Qué agentes están implicados en el estudio.
Algunas dificultades.
Cómo se aprende
1.Stereotactic Radiosurgery (SRS)
SRS is a precise and focused delivery of a single, high dose of irradiation to a small and critically located intracranial volume while sparing normal structure
2.Stereotactic Body Radiation Therapy (SBRT)
SBRT is a treatment procedure similar to SRS, except that it deals extra-cranial radiosurgery
3.Flattening Filter Free (FFF) mode
FFF beam is produced without the use of flattening Filter
In the 1990s, several groups studied about FFF high-energy photon beams. The main interest for that, is to increase the dose rate for radiosurgery or the "physics interest”.
Need of increase in dose rate from traditional 300-600 to 1400-2400MU/min to overcome time-inefficiency and to improve patients comfort specially in SRS/SBRT
Flattening Filter Free (FFF) mode
FFF beam is produced without the use of flattening Filter
In the 1990s, several groups studied about FFF high-energy photon beams. The main interest for that, is to increase the dose rate for radiosurgery or the "physics interest”.
Need of increase in dose rate from traditional 300-600 to 1400-2400MU/min to overcome time-inefficiency and to improve patients comfort specially in SRS/SBRT
Tema IV CATEGORÍAS FUNDAMENTALES DEL DERECHO AMBIENTAL INTERNO.Joel Navarro
Diferenciación conceptual y metodológica —conforme a criterios de la Teoría General del Derecho—, entre «principios generales o rectores», «derechos y garantías constitucionales», «principios de política estatal», lo que denominamos también «deberes político—institucionales del Estado» y el «régimen constitucional de las funciones institucionales de los órganos del Poder Público»; todo ello, como es lógico, relativo al ámbito de la cultura en las normas de la novísima Constitución de la República Bolivariana de Venezuela.
La participacion de los padres en los habitos de estudioIES Luis Buñuel
Qué supone estudiar.
Qué es un hábito y cómo se consigue. Su importancia.
Cuáles son los factores que influyen en el estudio.
Qué agentes están implicados en el estudio.
Algunas dificultades.
Cómo se aprende
Suppliers of Mechanic Torque Wrench DC Without Scale, Mechanic Torque Wrench DSG Without Scale, Torque Wrench DSG Without Scale, Mechanic Torque Wrench DSG Without Scale (DSG-00/4 15 - 85 Nm).
Documento de trabajo colaborativo realizado por los miembros del Foro de Emprendedores de Adegi.
Es una propuesta que parte del análisis de varias fuentes de datos relevantes con el objeto de ofrecer la foto de la situación actual del emprendimeitno en el País Vasco.
En el estudio se constata que el perfil medio del emprendedor es de mediana edad, que arranca negocios en sectores maduros, con mucha competencia, donde el capital lo aporta el promotor o el círculo cercano y donde el tamaño de la empresa es micropyme.
El estudio aporta claves para la mejora del ecosistema emprendedor guipuzcoano, articuladas en torno a tres ejes. Educación, Administración y Competitividad Territorial.
The fifth rendition of my Beautiful Web Typography with some updates, additional info, more links and whatnot. A new section has been added focusing on webfonts (font linking and embedding) with the recent developments in that regard.
Kudos should go out to the chaps listed in the end as well as inspirational peeps like Ellen Lupton, whose categorisation of things type into letter, text, grid I’ve used to structure this talk.
New, important anti-discrimination legislation that starts coming into force in the UK in 2010.
I hope these slides are both of interest and of use when presenting to people within your organisation.
While most of the slides contain information which your staff will need to know, some of the slides are interactive just to keep them awake.
Have fun and use & adapt as you feel fit.
Jim McNeill
Sweet TLC Ltd
Dosimetric evaluation of the MLCs for irregular shaped radiation fieldsIOSR Journals
The three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and image-guided radiotherapy (IGRT) are the most advanced techniques in radiotherapy, which use irregular fields–using multileaf collimators in a linear accelerator. The accuracy of these techniques depends on dosimetric characteristics of the multileaf collimators. There is an option for optimizing the jaws to the irregular MLC field to reduce the scattered radiation and intra- and inter-leaf radiation leakage beyond the field. In this study, ,80 leaf MLC system has been taken to compare and differentiate their characteristics with 6-MV, and 10-MV photon beams.
The MLC system in Elekta linear accelerator is used as a separate unit, that is, The dosimetric characteristics include dose rates, percentage depth doses, surface dose, dose in the build-up region, penumbra, and width of 50% dose levels
A summary of recent innovations in radiation oncology focussing on the priniciples of different techniques and their application. An overview of clinical results has also been given
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
TomoTherapy
1. Scope of Talking
TomoTherapy Overview of Tomotherapy
Tomotherapy Process
Clinical Application
Concerned Issues
Lalida Tuntipumiamorn
Division of Radiation Oncology
Future Direction
Department of Radiology,
Faculty of Medicine, Siriraj Hospital
MAHIDOL UNIVERSITY
2
Acknowledgement To Get the Satisfied Dose
Distribution
• Some of materials provided by
-Timothy Holmes- PhD : St Agnes
Cancer Center, Baltimore MD
-Thomas Rockwell Mackie – PhD :
U of Wisconsin and TomoTherapy
Inc.
- Chester Ramsey-PhD : Thompson
Cancer Center, Tenessee , USA
3 4
-Limited Number of Beams and Directions
Cone Beam Non-uniform Intensities
with the Conventional Linac plus MLC -Limited Number of Field Segmentations
Limited Degree of Intensity Level
5 6
Siriraj Radiation Oncolgy
2. Serial Tomotherapy : Peacock system
Fan Beam Intensity TM
Modulation
• Common Name :
Slice Therapy or
Tomotherapy
- Sequential /Serial
Tomotherapy
- Helical Tomotherapy
1994
Conventional Linear Accelerator added with
Special MLC + Couch Control
7 8
Serious Problem in Serial Tomotherapy!
Binary MLC MIMiC:
NOMOS
Maximum Field Size
2 x 20 OR 4 X 20 cm2
Indexing and couch
immobilization device
( CRANE) Over or under dose
9 10
The New IMRT Delivery with
Helical Tomotherapy …….
Couch Indexing Error of as little as
1 mm can increase the total non-
uniformity to as much as 25%
11
Siriraj Radiation Oncolgy
3. Concept for Helical Tomotherapy :
Since 1993
CT ring gantry
would be ideal for
Tomotherapy with
the modulated slit
beam using the
bank of fast moving
collimators
Spiral delivery should
improve the hot-spot
or cold spot problem
Thomas Rockwell Mackie at the junction
13 14
Linac is mounted on a slip ring that allow
Helical Tomotherapy is a Fusion of a continuous rotation around the patient (15-60 sec)
Radiation Therapy Linear Accelerator
and a Helical CT Scanner
Independent Primary
Jaws in the Superior-
Inferior Direction
15 16
MLC
TOMO Binary MLC
Characteristic
Optical sensors and
pneumatic driven
17 18
Siriraj Radiation Oncolgy
4. Increase Degree
of Freedom Megavoltage CT Imaging
Capability
51
projections/
revolution
e
ag
Im o r
CT tect
e
d
Capability of obtaining a CT ,
before , after or even during the
treatment will be possible
19 20
TOMO Beam
Characteristic
Lack of the Flattening Filter
-No scatter caused outside the field
- High dose rate
Helical Tomotherapy
Tomo Beam Characteristic
Geometry
Conical –shaped Profile
Radial Profile
6 MV High Dose Source
(860 MU/min, 1.5 mm
point source) Low penumbra
3.5 MV Low Dose Source
(20 MU/min, 1.5 mm
point source)
Lateral Profile
23 24
Siriraj Radiation Oncolgy
5. Dose at Depth More Uniform
MVCT Image Guidance
5 x5 cm Field Size
26
25
27 28
MVCT Imaging Quality
High contrast resolution
= 1.2-1.6 mm
Low Contrast resolution =
2-4%
29 30
Siriraj Radiation Oncolgy
6. Don’t Forget for the
MVCT Number to
Electron Density
Conversion Table
31 32
Helical Tomotherapy Process
TomoTherpy Process
• Imaging / Contouring
• Planning / Optimizing
• In-room Megavoltage CT Imaging
• Image Registration ( IGRT )
• Treatment Verification
• Treatment Delivery
34
Optimization
Create ROI Dose Delivery Capabilities
Set initial value s for Importance
Using maximum
and Penalty
U-shaped tumor likelihood Estimator
Optimization
Total 91,800 pencil
beam were used in
Spinal cord
the optimization
35
Siriraj Radiation Oncolgy
7. Planned Fluence Sinogram
in Tomotherapy
Leaf Control
Planned Fluence Sinogram
Sinogram Corrected
From optimization process
tongue & groove ,
2D array of energy fluence that corrleate
thread time
between the projection and intensities
37 38
Plan QA
39 40
IGRT
Total delivery time
≅ 30 minutes
41 42
Siriraj Radiation Oncolgy
8. TomoTherapy
vs.
Clinical Application
Only single , 6 MV Photon Beam ?
No Electron Beam ?
Questions Coplanar Only ?
IMRT Only?
Dosimetric/Clinical Advantage ?
How about Integral Dose?
44
Dosimetric gain in CI and HI of PTV and sparing of OARs
was significantly obtained in HT vs. Conventional IMRT
But clinical advantage needs furthur investigation
45 46
HT prostate planning generally provided treatment
plans with excellent target homogeneity and
favorable critical structure sparing when compared to
conventional IMRT
47 48
Siriraj Radiation Oncolgy
9. Prostate , Vertebral –body retreatment = PTV Coverage + Sparing
OAR , HT = Linac
Pediatric ethmoid sacroma retreatment =PTV Coverage both OK ,
but HT show a little bit better sparing OAR
Subtle dosimetric difference
But no marked advantage with either system
49 50
SRS
Capability
51 52
Helical Tomo shows larger lower isodose line
volumes, longer treatment time , and can treat
a much larger lesion than Gamma-knife
53 54
Siriraj Radiation Oncolgy
10. 55 56
57 58
Dosimetric Advantage from
Tomo but Integral Dose
increase 6.5 %
59 60
Siriraj Radiation Oncolgy
11. TomoTherapy
Integral Dose!!
A Potential Risk Factor for
Secondary Cancer ?
61
Integral Dose = Mean Dose x
Volume
TOMO IMRT
6 MV 3DCRT 6 MV IMRT
63 64
AAPM 2007
Same protocol
Adult prostate treatment
Linac vs. Helical Tomo
Pediatric CSI
65 66
Siriraj Radiation Oncolgy
13. Future of
TomoTherapy
Prepare for Adaptive RT
73
74
75 76
Thank You for Your
Attention!
Future Direction
TomoDirect
Discrete -angle
delivery mode
77 78
Siriraj Radiation Oncolgy
