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The external beam radiotherapy and Image-guided radiotherapy (4). Somvilai Mayurasakorn , MD. Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University. Helical Tomotherapy. Smaller field widths, smaller pitches and higher modulation factors .
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The external beam radiotherapy and Image-guided radiotherapy (4) SomvilaiMayurasakorn, MD. Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University
Helical Tomotherapy • Smaller field widths, smaller pitches and higher modulation factors Tomotherapy Planning Parameters More conformal plans But increased treatment time !!
Helical Tomotherapy Image acquisition and matching • MVCT fan-beam images • In-plane resolution of 0.78 mm at the bore center ; mean beam energy = 0.75 MeV • Set up slices thickness of 2, 4 or 6 mm • ‘fine’, ‘normal’ and ‘coarse’ settings • The scan length is kept as short as possible • always within the region of the PTV
Helical Tomotherapy Image matching
Dept. of Radiation Oncology M.D. Anderson Cancer Center Orlando
Dept. of Radiation Oncology M.D. Anderson Cancer Center Orlando
Helical Tomotherapy Dept. of Radiation Oncology M.D. Anderson Cancer Center Orlando
Helical Tomotherapy Palma et al. Cancer Treatment Reviews 2010;36 :393–399
Helical Tomotherapy Conclusions • Combination of IGRT and IMRT • Use ARC therapy : all angles are available to deliver radiation to target • Treatment field length up to 160 cm • More conformal and homogeneity while sparing of OARs than IMRT
Helical Tomotherapy • Successful implementation of Tomotherapy • Careful planning and effective teamwork Daily image guidance Positional correction Intensity-modulated delivery
Tomotherapy Treatment Centers : Asia-Pacific • South Korea • Incheon St. Mary’s Hospital, Catholic Medical Center • KangNam St Mary’s Hospital, Catholic University Hospital • Yonsei Cancer Center, Severance Hospital (2) • GangNam Severance Hospital • National Cancer Center • Catholic Medical Center, St.Vincent’s Hospital • Yongdong Severance Hospital • Samsung Medical Center • KyungHee University Medical Center • Korea University Anam Hospital • China • PLA General Hospital , Beijing • Airforce Hospital, Beijing • Beijing PLA General Hospital • Chung Shan Hosp , Shanghai • Hong Kong • Hong Kong Sanatorium and Hospital • Queen Elizabeth Hosp
Taiwan National Taiwan University Hospital China Medical University Hospital Shin Kong Wu Ho-Su Memorial Hospital Yuan General Hospital Far Eastern Memorial Hospital(2) Chung Shan Medical University Hospital Kaoshiung Hospital India Tata Memorial Hospital, Delhi Tata Memorial Hospital, Calcutta AIIMS, Delhi Indo American Hospital, Bangalore Singapore Mount Elizabeth Hospital National Cancer Center Malaysia Prince Court Medical Center Sime Darby Medical Center Japan Clinic – C4 Chiba Fukui Prefecture Saiseikai Hosp Fukui Saiseikai Hosp Fukushima Medical Centerl Towada City Hospital Koga Hospital 21 Aizawa Hospital Saiseikai Kumamoto Hospital Takeda Hospital Nagoya Daini Red Cross Hospital Kizawa Memorial Hospital Hokuto Hospital Hidaka Hospital Edogawa Hospital Aichi Cancer Center Hospital and Research Institute Thailand Chiang Mai University Hosp Australia Royal Brisbane & Women’s Hospital Tomotherapy Treatment Centers in Asia-Pacific
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Quality Depends on Number of Beams Coming soon 1 Beam 11 Beams 5 Beams 17 Beams 25 Beams 51 Beams
Helical Tomotherapy Dose distribution for one patient of regular delivery A. 2.5-cm-field width (REG 2.5) B. 5-cm-field width (REG 5) doses are shown in Gy STERZING et al. Int. J. Radiation Oncology Biol. Phys. 2010;76 (4):1266–1273
Helical Tomotherapy • A modulation factor of 2 or 3 is usual • For relatively simple cases, such as the prostate alone, a value of 2 is normally sufficient • For cases with more complex, intricate shapes, such as HNC, a modulation factor of 3 is usually selected University of Cambridge /Burnet et al. Clinical Oncology 2010;22:294–312
Gross Tumor Volume (GTV) • GTV contour definition • The primary tumor (GTV 1) • A 1 cm peripherally enhancing lymph node (GTV2) GTV1 GTV2