3. Improving radiation technology from radium and cobalt to image guided IMRT ( Tomotherapy ) and stereotactic radiosurgery ( Cyberknife )
4. CT scan and sometimes a PET scan are obtained at the time of simulation CT images (or fusion with PET scans) are then imported into the treatment planning computer to develop sophisticated targeting plans
11. Dose reconstruction for cord compressions retreatments using helical tomotherapy S.L. Mahan, C. Ramsey IJROBP Volume 60, Issue 1, Pages S640-S641 (September 2004) patients with cord compressions that had received previous radiation therapy were imaged and treated on a HI-ART helical tomotherapy system dose calculations for no image guidance, the mean increase in spinal cord dose was 86.4% making treatment delivery impossible without image-guidance. Dose calculations were also made considering image guidance. These doses represent what should have been delivered using daily MVCT imaging. The mean increase in spinal cord dose was 5.2% making fractionated treatment delivery to 30 Gy possible even with minimal immobilization.
22. Internal doses of radiation surface doses of radiation Computer generated breast radiation Tumor site in breast lung lung Spinal cord heart breast
23. Computer generated anatomy images that will identify all the important structures to be sure the radiation covers the area of breast cancer and limits the dose to other areas
24. Viewed from the side, the radiation stops before hitting the lung
25. Typical CT Scan after Lumpectomy for Radiation Planning, sometimes fluid collects at the surgery site (seroma) and sometimes the surgeon places clips to mark the area clip clip seroma Boost target heart lung lung
26. Radiation boost targets the high risk area, identified by the lumpectomy incision, or the seroma or surgical clips if placed
27. Helical Tomotherapy Planning for Left-Sided Breast Cancer Patients With Positive Lymph Nodes: Comparison to Conventional Multiport Breast Technique Goddu. IJROBP 2009;73:1243 The tomotherapy plans provided better dose conformity and homogeneity than did the three-dimensional plans for treatment of left-sided breast tumors with regional lymph node involvement, while allowing greater sparing of the heart and left lung
53. Tomotherapy Shrinking field technique, the first phase covers a large area and the final boost phase is more targeted
54.
55. Low risk parotid gland tumor (in red) may be possible to keep the radiation zone (blue) as small as possible , computer plan
56. Low risk parotid gland tumor, then using Tomotherapy to ensure coverage of the tumor on the left, but avoiding going too deep and hitting normal parotid on other side
57. Since Tomotherapy takes a CT scan daily prior to radiation it is often possible to observe the tumor shrinking during the course of the radiation
58. Seeing the cancer shrink during a course of Tomotherapy. Nasopharynx cancer after just 8 treatments Cancer mass Cancer mass Blue = radiation target
59. Squamous cell carcinoma in upper jaw behind left eye treated with Tomotherapy CT scan at 6 months cancer Radiation zone
60. For patients with dental work, a conventional CT (kV) will have artifact obscuring the anatomy that can be eliminated using the Tomo CT images (MV)
63. Computer generated images will show how close the cancer is to other important structures (like the spinal cord, the heart and the liver, and how much normal lung is near
64. Using CT scans the computer can generate the target for a cancer in the upper part of the lung
65. Using CT scans the computer can generate the target for a small cancer growing inside the trachea
67. Tomotherapy images showing the radiation zone in red surrounds the cancer area (in blue) and limits the dose of radiation that hits the normal lung, heart or spinal cord
68. Lung cancers shrink slowly during the radiation, this picture from the daily Tomo image shows good regression only half way through the course of radiation
69. CT Scan prior to radiation Tomo image after only 19 treatments cancer cancer Radiation and chemotherapy for NSCL, the mass may shrink significantly during the course of radiation
70. Adaptive Radiotherapy – adjusting the radiation target during treatment as tumor shrinks Tomotherapy Plan at start Tomotherapy Plan at finish
71. Dose as a Function of Lung Volume and Planned Treatment Volume in Helical Tomotherapy Intensity-Modulated Radiation Therapy-Based Stereotactic Body Radiation Therapy for Small Lung Tumors Joseph M. Baisden, M.D., Ph.D IJROBP Volume 68, Issue 4, Pages 1229-1237 (15 July 2007) Tomotherapy can be used for highly targetted intense radiation (radiosurgery)
73. PET Scan showing complete remission of the cancer in the left lung at 7 months
74. PET scan showing near complete remission, 2 months after radiation alone for NSCL
75. PET scan showing degree of tumor shrinkage 6 weeks after completion chemoradiation for NSCL lung cancer (the tumor will continue to shrink for weeks to months)
79. bladder Radiation zone prostate rectum Goal = radiation zone precisely around the prostate cancer
80. With Tomotherapy the beam can hit the target (nodes) in the upper abdomen and avoid the bladder and small intestine and lower in the pelvis hit the prostate, nodes and seminal vesicles and still avoid the bladder and rectum
81. Significant movement of the prostate gland based on daily gas in rectum Planned target Rectal gas No Rectal gas Planned target, missed badly if rectal gas pushes the prostate forward
82. Significant movement of the prostate gland based on daily gas in rectum Initial computer target for prostate (red circle) would have badly missed the target if no adjustments were made based on the amount of rectal gas
83. Importance of daily CT targeting on Tomotherapy and adjusting the treatment daily Very little bowel gas on initial study and the dose (red) targets the prostate gland closely large bowel gas on later treatment day and the dose (red) will cover half the rectum if an adjustment is Not made
86. Using Tomotherapy to tightly target the prostate with very little radiation hitting the bladder or rectum
87. Tomotherapy is particularly useful in men with hip replacements where the metal creates artifacts in normal kv CT
88. Dose as a function of liver volume and planning target volume in helical tomotherapy, intensity-modulated radiation therapy–based stereotactic body radiation therapy for hepatic metastasis International Journal of Radiation Oncology, Biology, Physics 01 October 2006 (Vol. 66, Issue 2, Pages 620-625) TomoTherapy can be used for many other sites, e.g. liver metastases
