Implementation of advanced RT Techniques
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1 Implementation of advanced RT Techniques Tibor Major, PhD National Institute of Oncology Budapest, Hungary 2. Kongres radiološke tehnologije, Vukovar, September 2016.
2 Current RT equipments at NIO, Budapest 1 TrueBeam - Varian 1 Artiste - Siemens (IMRT, IGRT with MV-CBCT and on-rail kv-ct) 2 Primus - Siemens (6 and 18 MV, +electrons) 1 Primus - Siemens (6 MV) 1 Theratron cobalt unit + Lantis, Pinnacle, Aria, Eclipse 2 VitalBeam Unique
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5 Road map to first treatment Removal of Mevatron 15 January, 2014 Bunker reinforcement January 2014 Installation February - March 2014 Commissioning, training April 2014 Measurements April-May 2014 First treatment 15 May, 2014
6 Before TrueBeam experience with 3D-CRT IMRT with step and shoot technique IGRT with MV-CBCT, on-rail kv-ct and EPID Pinnacle, Lantis New challenges with TrueBeam IMRT with sliding window technique and RapidArc IGRT with kv-cbct and kv 2D imaging Eclipse Aria (+IGRT) integration New treatment techniques (SBRT, radiosurgery, SIB, APBI)
7 Available beams and energies Photons Electrons 6, 10 and 18 MV (600 MU/min) 6 MV FFF (1400 MU/min) 10 MV FFF (2400 MU/min) 6 MV SRS (1000 MU/min) 6, 9, 12 and 15 MeV (1000 MU/min) 6 MeV HDTSE (2500 MU/min) High Dose Total Skin Electron
8 RapidArc Distribution of treatment techniques in 2015 IMRT 13% 3D-CRT 13% SBRT 4% SIB 16% RapidArc 74% Conv. RapidArc 80%
9 Distribution of tumor sites treated in 2015 Breast 4% Brain 4% Lung 8% Other 10% H&N 18% GI 2% Pelvis 54% Total patient number = 635
10 Special treatments on TrueBeam prostate IMRT/IGRT with gold markers simultan integrated boost (SIB) - prostate stereotactic body radiotherapy (SBRT) - lung stereotactic radiosurgery (brain) accelerated partial breast irradiation (APBI) total skin irradiation
11 Prostate IGRT with gold markers and 2D imaging DRR-s kv X-ray images fused images
12 Prostate IGRT with gold markers and 3D imaging
13 Simultan integrated boost (SIB) technique Prostate gland: 70 Gy 28 x 2.5 Gy Vesicula seminalis: 57.4 Gy 28 x 2.05 Gy
14 Simultan integrated boost (SIB) technique 2 full rotation with RapidArc RapidArc technique dose distribution
15 Stereotactic Body Radiotherapy (SBRT) 4D CT with Anzai belt system (slow CT with respiratory curve) GTV delineations on CT series reconstructed in 7 phases ITV creation with union of GTVs followed by CTV/PTV definition RapidArc treatment plan for PTV with 2 partial arcs Treatment delivery with 6 MV FFF (8 x 7.5 Gy) IGRT with kv-cbct before each fraction On-line correction with 6DoF table Irradiation time: Treatment time: < 2 min ~12 min
16 4D imaging for SBRT 4D CT with Anzai belt evaluation of target movement
17 Definition of ITV GTV contours in each phase ITV includes all GTV contours
18 Irradiation with RapidArc technique Treatment with two partial arcs
19 Conformal dose distribution in 3D
20 Static dose distribution with moving target
21 IGRT with daily kv-cbct fused planning CBCT CT CT
22 planning ITV on ITV average PET on kv-cbct and planning kv-cbct CT
23 Stereotactic radiosurgery Head fixation with invasive frame Treatment with four non-coplanar beams
24 Dynamic conformal arc irradiation Beam aperture continuously conforms to the shape of the PTV
25 Dose distribution in transversal and sagittal planes
26 Verification with kv-cbct CBCT planning planning CBCT
27 Accelerated partial breast irradiation (APBI) Beam arrangements for APBI (5-6 co-planar IMRT beams with sliding window)
28 IMRT with sliding window technique At fix gantry angle the MLC-s are moving while the beam is on
29 Dose distributions in transversal and coronal planes Prescribed dose: 9 x 4.1 Gy
30 IGRT with kv-cbct using the clip positions
31 Setup errors without corrections
32 Total skin irradiation large source skin distance (430 cm) 6 MeV HDTSE 2500 MU/min 6 patient positions (3 + 3 in two days) 2 gantry angles (106.5 and 73.5 ) for each position
33 User s statements about TrueBeam Versatile equipment for all needs in radiation oncology (simple and complex treatments for cancer anywhere in the body) Flawless integration with treatment planning and R&V system Fast imaging and accurate dose delivery Automated workflow with optimized patient throughput Very reliable with high uptime (> 98%) good service Extensive training and continuous support from the company
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