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Para-spinal Tumors Encircling the Spinal Cord IMRT

Para-spinal Tumors Encircling the Spinal Cord IMRT. Comparison of Several Target Definitions. SLICE 116 CTV Superior Brain stem and L & R eyes. Slice 104 CTV , Spinal cord L & R Parotid glands. Slice 83 Mid Volume CTV 3 – 5 mm separation between spinal cord and CTV.

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Para-spinal Tumors Encircling the Spinal Cord IMRT

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  1. Para-spinal Tumors Encircling the Spinal Cord IMRT Comparison of Several Target Definitions

  2. SLICE 116 CTVSuperior Brain stem and L & R eyes

  3. Slice 104 CTV , Spinal cord L & R Parotid glands

  4. Slice 83 Mid Volume CTV 3 – 5 mm separation between spinal cord and CTV

  5. Slice 63 Inferior CTV 13 mm Separation of spinal cord and CTV

  6. Planning Volumes CTV 3mm Expansion 63 Gy Spinal Cord 3mm Expansion 43 Gy Rt & Lt Eyes 3mm Expansion 3 Gy Brain Stem 3mm Expansion 43Gy Parotid Glands 3mm Expansion 30 Gy

  7. Beam Arrangement

  8. Beam Arrangement Gantry 0 Gantry 40 Gantry 80 Gantry 160 Gantry 200 Gantry 315

  9. Basic Target Type

  10. Dose Statistics 63 Gy Target Type Basic

  11. DVH 63 Gy Target Type Basic 63 Gy @ ~76% Volume

  12. Isodose Slice 104 Basic

  13. Homogenous Target Type

  14. Dose Statistics 63 Gy Target Type Homogenous

  15. DVH 63 Gy Target Type Homogenous 63Gy @ ~46 % Volume

  16. Isodose Slice 104 Homogenous

  17. IMRS Target Type

  18. Dose Statistics 63 Gy Target Type IMRS Emphasizes Conformality

  19. DVH 63 Gy Target Type IMRS 63Gy @ ~90% Volume

  20. Isodose Slice 104 IMRS

  21. Esophagus IMRT Sparing Kidneys and Spinal Cord

  22. DVH 50.4Gy

  23. IMRT 5 Field IMRT with Intensity Maps

  24. Intensity Levels 10 Step Increment 1cm MLC leaf 1cm

  25. Step Increment 1cm step with 0.5cm MLC 0.5cm step with 0.5cm MLC 9991-959-08C

  26. Intensity Level Comparison

  27. Lung IMRT 60 Gy 5 Field 6 MV X-rays

  28. Lung IMRT DVH

  29. Large Field IMRT Plan with Dose Painting

  30. Large Complex Treatment Volume Long (~ 60 cm) volume needed 27 junctioned IMRT fields and an 16 MeV electron field

  31. IMRT plan avoiding spinal cord and kidneys Superior Tumor Volumes

  32. Treatment Volumes Lower Abdomen

  33. Treatment Volume Change in Dose Nodal Volume

  34. Treatment Volume Pelvis Superficial Nodes

  35. Inferior Volumes Increase in Dose Using an Electron Field

  36. ELECTRON BEAM CHARACTERISTICS

  37. Location of (a)Flattening Filter and (b) Electron Scattering Foils

  38. Isodose Curves for 7 and 18 Mev Electron Beams

  39. Small Fields with Photon Component

  40. 12 Mev Beam at 00 12 Mev beam at 400

  41. 12 Mev Beam with Density Correction

  42. AXILA TANGENTS & ELECTRON BOOST

  43. Breast Boost Technique

  44. 9 Mev Electron Boost Posterior Neck Nodes

  45. Interoperative Radiation Therapy The benefit of IORT normal tissues are removed from the treatment fields and the dose is delivered locally. The enengy of the electron beams used is usually between 9-16 Mev. The use in the country has been developed used at large medical centers.

  46. IORT Isodose Curve 15 Mev Electron Beam

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