Evaluation of Three-dimensional Conformal Radiotherapy and Intensity Modulated Radiotherapy Techniques in High-Grade Gliomas

Size: px
Start display at page:

Download "Evaluation of Three-dimensional Conformal Radiotherapy and Intensity Modulated Radiotherapy Techniques in High-Grade Gliomas"

Transcription

1 1 Carol Boyd Comprehensive Case Study July 11, 2013 Evaluation of Three-dimensional Conformal Radiotherapy and Intensity Modulated Radiotherapy Techniques in High-Grade Gliomas Abstract: Introduction: This study aimed to evaluate the treatment planning techniques of threedimensional conformal radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT) in treatment of patients with high grade gliomas. Using an IMRT technique for treatment of high grade gliomas improved target coverage and reduced radiation dose to the brain, brainstem, and optic chiasm particularly when there is an overlap of target volume and critical structures. Case Description: The treatment planning techniques of 3D-CRT and IMRT will be demonstrated in the following case studies. These patients were planned with 3D-CRT using a 3-4 field, non-coplanar beam arrangement with wedged fields and were then replanned utilizing an IMRT technique with 5-10 beam arrangement for comparison. Both planning techniques were assigned the prescription of 4600 centigray (cgy) to the initial plan and 1400 cgy to the boost plan for a total dose of 6000 cgy. Conclusion: Doses to critical structures, planning target volume (PTV), and normal brain tissue were evaluated and compared through dose volume histograms (DVH) and isodose distributions for both the 3D-CRT and IMRT plans. The IMRT technique resulted in comparable target dose coverage, lower maximum doses to the optic chiasm, the brainstem and lower maximum doses to normal brain tissue receiving 1800 cgy and 2400 cgy as compared to the 3DCRT technique. Key Words: Glioblastoma (GBM), high-grade gliomas, normal tissue effects, IMRT, 3DCRT Introduction: The standard approach to the treatment of high grade gliomas is a combination of surgery, chemotherapy and radiation therapy. The goal of treatment planning is to spare the critical structures while providing adequate prescription dose coverage to the target volume. Threedimensional conformal radiotherapy treatment planning technique typically consists of multiple

2 2 planar and noncoplanar beams used with static or enhanced dynamic wedges (EDW) and static multileaf collimators (MLC). These beams are created around the planning volumes contoured based on the magnetic resonance imaging (MRI) studies fused with the computed tomography (CT) simulation scan. With conventional therapy, any effort to spare dose to critical structures may compromise target coverage. A more advanced form of 3D-CRT is IMRT. The goal of IMRT planning technique is to allow for improved target dose conformality and reduce the maximum doses to critical structure, while achieving comparable target dose coverage as compared to a 3DCRT planning technique. When a total surgical resection is not feasible, radiation therapy is the primary treatment for high grade gliomas. There are many radiation therapy planning techniques for the treatment of high grade gliomas. The two treatment planning techniques, 3D-CRT and IMRT will be used as comparison for this study. Adequate target coverage is often achieved with a 3D-CRT planning technique. A typical 3D plan will include 3-4 static MLC beams and optimization is controlled manually by the medical dosimetrist. Some brain tumors such as gliomas can be irregular in shape. An IMRT technique has been demonstrated to improve tumor coverage especially for irregular tumor volumes. 1 An IMRT plan relies on the linear accelerator and MLCs to deliver a non-uniform beam intensity by modulating the intensity of the radiation beam. An IMRT technique usually requires multiple beams thus increasing the number of monitors units (MU) required to deliver the prescription dose compared to a 3DCRT technique. An advantage of an IMRT technique may also permit safe dose escalation to the target volume while minimizing dose to surrounding structures. Treatment planning for gliomas can be challenging for the medical dosimetrist. High-grade gliomas have a very poor prognosis especially when the tumor is considered inoperable as in most high-grade gliomas. The goal of radiation therapy planning is to adequately provide target coverage while sparing critical structures. When using 3D-CRT or an IMRT technique, the medical dosimetrist should choose beams arrangements that have the shortest pathway to the target volume. Avoiding entering through normal brain tissues may possibly decrease late term effects in the brain. A 3D-CRT technique may require fewer beams to provide adequate tumor coverage. An IMRT technique may provide a more uniform coverage and better critical tissues sparing but will require more beams thus increasing dose to normal brain tissue.

3 3 The following cases demonstrate the use of conformal radiation therapy techniques of high grade gliomas. Standard fractions sizes of 180 cgy to 200 cgy per day were utilized for each of the five case studies. In the patient cases, doses to critical structures, PTV mean, and normal brain tissue will be evaluated and compared through DVH and isodose distributions. The organs at risk (OR) doses evaluated include the maximum doses to the brainstem, the optic nerves, and the optic chiasm and the percentage of volume receiving at least 1800 cgy (V18) or 2400 cgy (V24) of normal brain tissue. Increasing dose to normal tissue may potentially increase the incident of second malignant carcinoma. 2,3 Methods and Materials: Patient Selection Each patient chosen for the case study was diagnosed and biopsy pathology confirmed GBM. The cases were associated by the necessity of conformal radiation therapy therefore requiring the comparison of a traditional 3DCRT radiation therapy planning technique and an IMRT planning technique for each patient. A total dose of cgy in cgy was prescribed. A total of 3-5 non-coplanar beams were configured for the 3D-CRT plan and a total of 5-10 noncoplanar beams were used in the IMRT plan. Multiple trails with various beam arrangements were performed in both the 3DCRT and IMRT cases. For the purpose of this study, only one trial with superior critical structures sparing from each planning technique will be compared. Patient 1, a 51 year old male, diagnosed with a grade IV GBM involving the frontal-parietal and superior-temporal region of the brain. A 3D-CRT technique utilizing wedges and 6 megavoltage (MV) was created with a 4 field beam arrangement. A boost plan was created with the same beam arrangements and conformed to the boost target volumes. An IMRT technique optimized with 6 MV included 9 equidistant beams and 1 non-coplanar beam with a couch rotation to the initial plan. The boost plan consisted of the same 9 coplanar beams used in the initial plan. Patient 2, a 36 year old male diagnosed with a grade IV GBM involving the left temporal lobe of the brain. The 3D-CRT technique utilized included a 3 non-coplanar beam arrangement. The 3D-CRT plan was optimized using wedges and 6 MV. The IMRT technique included 5-6 noncoplanar beams and 6MV.

4 4 Patient 3, a 65 year old male, diagnosed with grade IV GBM involving right-posterior, parietal region of the brain. The 3DCRT plan included 3 non-coplanar beams utilizing wedges and a combination of 6 MV and 18 MV for optimization. The IMRT technique was incorporated using 5 non-coplanar beams using 6 MV. Patient 4, a 22 year old female, diagnosed with grade IV GBM involving the right frontal lobe lesion extending via the anterior corpus callosum to the left frontal lobe. The 3DCRT plan consisted of a 4 field beam arrangement including 1 couch rotation and optimized with wedges and a combination of 6 MV and 18 MV. The IMRT plan utilized a 5-7 beam arrangement using 6 MV. Patient 5, a 65 year old male, diagnosed with grade IV GBM involving the left frontal lobe and left ventricle. The 3DCRT plan consisted of a 4 field beam arrangement including 1 couch rotation. The 3D plan was optimized using EDW and a combination of 6 MV and 18 MV. The IMRT plan included a 10 field beam arrangement and 1 couch rotation and was optimized using 6MV. Patient Set-up A simulation CT scan was performed on each patient. All patients were positioned supine on the simulation table with the head resting on a B headrest. A knee sponge was placed under each patient s knees for comfort. To immobilize the patients for radiation therapy treatment to the brain, a thermoplastic face mask was customized and molded to the patient s head and face. Fiducials were placed on each patient s mask to aid in positioning and imaging during treatment utilizing image guided radiation therapy (IGRT). Target Delineation After each patient completed a CT simulation, target delineation was performed in the Pinnacle 3.0 treatment planning system (TPS). Patient 1 had undergone pre-operative and post-operative MRI scans that were fused with the CT simulation scan to assist the radiation oncologist in contouring the gross tumor volume (GTV). The GTV1 included the enhanced lesion and the surrounding edema demonstrated on the MRI studies. A 2 centimeter (cm) margin was expanded from GTV1 to create the clinical target volume (CTV) and labeled CTV1. The physician then added a 5 millimeter (mm) margin around CTV1 to create a PTV defined as PTV1. The radiation

5 5 oncologist defined the boost gross tumor volume as GTV2, which included the contrast enhanced lesion, with the aid of a fused post operative MRI study. A boost clinical target volume (CTV2) was created by expanding GTV2 by 2 cm. The CTV2 was expanded to 3 mm to create the boost planning target volume defined as PTV2. Additionally, the critical surrounding structures were delineated to be spared based on the normal tissue tolerance. In this case, OR delineation included the brainstem, optic nerves, optic chiasm, the left and right cochlea, pituitary, left hippocampus, lenses of the eyes and the globes of the eyes. The OR contoured by the medical dosimetrist were reviewed and approved by the radiation oncologist. Patient 2 had undergone a MRI scan with contrast that was fused with the CT simulation scan. The radiation oncologist contoured the GTV defined as GTV1 with the aid of the fused preoperative and post-operative MRI studies. The GTV1 included the enhanced lesion and the surrounding edema demonstrated on the MRI studies. A 2 cm margin was expanded from GTV1 to create the CTV and labeled as CTV1. The physician then added a 3 mm margin around CTV1 to create a PTV defined as PTV1. The radiation oncologist defined the boost gross tumor volume as GTV2 which included the contrast enhanced lesion with the aid of a fused post operative MRI study. A boost clinical target volume CTV2 was created by expanding the GTV2 by 2 cm. The CTV2 was expanded 5 mm to create the boost planning target volume defined as PTV2. In addition to the planning volumes, the physician also contoured the right hippocampus as an avoidance structure. Minimizing dose to the hippocampi may reduce neurotoxicity and cognitive deficits which may lead to a better quality of life for patients after radiotherapy. 4 The medical dosimetrist was instructed to contour the OR which included the eyes and lens of the eyes, the optic nerves, the optic chiasm, the pituitary gland, the brainstem and the cochleas. Patient 3 had undergone pre and post-operative scans that were fused with the CT simulation scan to assist the radiation oncologist in contouring the operative site, the CTV. A 2.5 cm margin was created around the CTV to form the PTV. The medical dosimetrist contoured the OR which included the lenses of the eyes, the retinae, the brainstem, the optic nerves, the optic chiasm and the brain. Each of the OR was reviewed and adjustments were made by the radiation oncologist. Patient 4 had undergone a post operative MRI and were used for target delineation. The radiation oncologist contoured the GTV defined as GTV1 with the aid of the fused post-operative MRI

6 6 study. The GTV1 included the surgical cavity and surrounding edema demonstrated on the postoperative MRI study. A 2.5 cm margin was expanded from GTV1 to create the CTV and labeled as CTV1. The physician then added a 5 mm margin around CTV1 to create a PTV defined as PTV1. The radiation oncologist defined the boost gross tumor volume as GTV2 which included the contrast enhanced lesion and surgical margins with the aid of a fused post-operative MRI study. The GTV2 was expanded 2.5 cm to create the boost planning target volume defined as PTV2. The medical dosimetrist contoured OR which included the lens of the eyes, the optic nerves, the retinae, the optic chiasm, the spinal cord and the brainstem. Patient 5 underwent a pre-operative and post-operative MRI which was fused by the medical dosimetrist to aid the radiation oncologist for target delineation. The radiation oncologist contoured the GTV which included the enhanced contrast lesion with surrounding edema labeled as GTV1. The GTV1 was expanded 2.5 cm to create CTV1. The CTV1 was then expanded 5 mm to create the PTV1. The radiation oncologist delineated the boost volume by contouring the contrast enhanced lesion on the pre-operative MRI study to define GTV2. A 2.5 cm margin was expanded and labeled CTV2. A 5mm expansion was made to define PTV2. The medical dosimetrist contoured the OR to include the brainstem, the optic chiasm, the optic nerves, the pituitary gland, the right and left cochleas, and both eyes and lens. Treatment Planning The treatment planning parameters for the five GBM cases are presented in Table 1. Both planning techniques were assigned the prescription of 4600 cgy to the initial plan and 1400 cgy to the boost plan for a total dose of 6000 cgy. For Patient 1, the radiation oncologist defined the dose prescription and planning objectives for both the 3D-CRT and IMRT treatment plan. The 3D-CRT plan consisted of a 2 lateral beams 90 and 270,superior-anterior oblique (SAO), and a superior-posterior oblique (SPO). Fifteen and 25 wedges and a combination of 6 MV and 18 MV were used to optimize the plan. The same fields were used for the boost plan and coned down to PTV2. The IMRT plan utilized a 10 beam IMRT technique to optimize the prescription dose distribution within the target volumes while minimizing dose to normal surrounding structures in the brain. The gantry beam angles used for the initial plan included 9 photon, coplanar beams: 180, 140, 100, 60, 20, 340, 300, 260, 220 and 1 photon non-coplanar beam at gantry angle 43 and couch angle of 90 (vertex). The beam angles were optimized

7 7 using 6 MV. The beam configuration used in the boost plan was the same as the initial plan excluding the vertex beam. The boost beams also included collimator rotations of approximately 7 on each beam. There were two prescriptions used in this plan. The initial prescription was 4600 cgy to PTV1 followed by 1400 cgy to PTV2. The total prescription for this plan was 6000 cgy to PTV2. The objectives for both plans were to cover 95% of PTV with 100% of the prescription. In addition, the OR dose constraints included: the maximum dose to the lenses of the eyes was to be less than 1000 cgy, the optic nerve was to be less than 5500 cgy, the optic chiasm was to be less than 5600 cgy and the brainstem was to be less than 6000 cgy. The radiation oncologist also instructed the medical dosimetrist to minimize dose to the right and left hippocampi. Minimizing dose to the hippocampus may reduce neurotoxicity and cognitive deficits. 4 The medical dosimetrist contoured the brain and excluded the target volumes to create a body minus structures constraint to minimize dose to normal brain tissue. After coverage of the planning target volumes was achieved, the medical dosimetrist reviewed the isodose distributions, the dose to OR volumes and the calculated DVH for both plans. The left optic nerve received maximum doses of 6017 cgy and 3335 cgy, the optic chiasm received maximum doses of 6218 cgy and 5591 cgy, and the brainstem received 6240 cgy and 6000 cgy for the 3D-CRT and IMRT plan respectively. The radiation oncologist chose the IMRT plan for treatment for sparing the critical structures. The medical dosimetrist was unable to keep the brainstem below dose tolerance in the 3DCRT plan because of the overlap between the brainstem and PTV. Because of the location of the lesion, the structures situated on the right side of the brain received higher doses. The plan for Patient 2 demonstrated the use of dynamic MLC (DMLC) using an IMRT technique to minimize dose to critical structures without compromising target coverage. The radiation oncologist defined the dose prescription and planning objectives for both the 3D-CRT and IMRT treatment plan. The medical dosimetrist started the treatment planning process with a 3D-CRT technique. Prescription dose and normal-tissue constraints were identical for the 3D-CRT and IMRT plans. The initial prescription was 4600 cgy to PTV1 followed by 1400 cgy to PTV2. The total prescription for both plans was 6000 cgy at 200 cgy per fraction. The objective was to optimize the prescription dose distribution within the target volumes while minimizing dose to normal surrounding structures in the brain. The objectives for these plans were to cover 95% of PTV1 and PTV2 with 100% of the prescription. In addition, the OR dose constraints included:

8 8 the maximum dose to the lens of the eyes was to be less than 1000 cgy, the optic nerves was to be less than 5500 cgy, the optic chiasm was to be less than 5600 cgy and the brainstem was to be less than 6000 cgy. The medical dosimetrist created a non-target tissue volume and added a dose constraint to avoid dose to exceed the prescription dose. The medical dosimetrist contoured the brain and excluded the target volumes to create a body minus structures dose constraint to minimize dose to normal brain tissue. Because the PTV overlapped with the brain stem, the medical dosimetrist created a PTV- brainstem volume and set a dose constraint parameter to prevent from exceeding dose tolerance to the brainstem and while maximizing target coverage. In both 3D-CRT and IMRT plans, hot spots may occur at the field-border intersections. Graphic displays of the 3D-CRT and IMRT plan isodose distributions were compared in the transverse, sagittal, and coronal views. After coverage of the planning target volumes was achieved, the medical dosimetrist reviewed the isodose distribution of the plan, the dose to OR volumes and the calculated dose volume histogram. The left optic nerve received a maximum dose of 5048 cgy and 4064 cgy in the 3D-CRT and IMRT plan respectively. The optic chiasm received a maximum dose of 5498 cgy and 4596 cgy in the 3D-CRT and IMRT respectively. The maximum dose of the brainstem in the IMRT was superior to the 3DCRT demonstrating 5864 cgy and 6086 cgy respectively. Maximum doses of the right optic nerve were below 3100 cgy for both plans. After review of both treatment plans, the radiation oncologist selected the IMRT plan for treatment. While the target dose coverage was comparable in both the 3D-CRT and IMRT plan, the IMRT plan was superior in sparing dose to critical structures. The plan for Patient 3 demonstrated the use of 3DCRT using multiple non-coplanar fields to the defined target volume and adjust beam weighting, wedge orientation and placement, to minimize cortical dose and maximize dose homogeneity within the high-dose region while providing adequate dose coverage to the target volume. The prescription dose to the 3DCRT plan with 3 non-coplanar fields was prescribed to isocenter placed in the CTV by the medical dosimetrist. Gantry angles were carefully chosen to enter the shortest path through normal brain tissue and avoid entering or exiting through critical structures. The beam arrangement for the 3DCRT plan included gantry angles of 310, 243 and 154. The radiation oncologist instructed the medical dosimetrist to place a 1 cm blocked margin around the PTV for each field. A combination of 6 MV and 18 MV energy beams and wedges were used to optimize the beam weightings. A prescription dose of 6000 cgy at 200 cgy per day for 30 fractions to the PTV was prescribed to

9 9 the 3DCRT plan. The prescription was also planned with IMRT for comparison. Five gantry angles were configured which included beam angles of 160, 88, 16, 304 and 232. The objective of the IMRT plan was to see if dose to critical structures could be further minimized. The PTV was in close proximity to the brainstem. The medical dosimetrist created a planning PTV (PTV-brainstem+ 3 mm) in an attempt to minimize dose to the brainstem. The planning objectives were entered into the IMRT module of the TPS using a uniform, minimum and maximum dose corresponding to the prescription dose. In addition, the OR dose constraints included: a maximum dose to the lenses of the eyes less than 300 cgy, the optic nerves less than 500 cgy, the optic chiasm less than 1000 cgy, the retinae less than 800 cgy and the brainstem was to be less than 5000 cgy or as low as possible. An objective was also used to minimize the dose to normal brain tissue. The TPS optimized the IMRT plan by using the DMPO dose calculation. Other optimization parameters included using a maximum number of 50 segments, a minimum segment area of 6 cm 2 and a minimum segment MU of 6. Once adequate dose coverage was achieved to the target volumes, the medical dosimetrist reviewed the doses to the OR, the isodose lines and the DVH. The OR on the DVH reflected a maximum dose of 5931 cgy and 4935 cgy to the 3DCRT and IMRT plan respectively to the brainstem. The maximum dose to the optic chiasm was 1925 cgy and 761 cgy to the 3DCRT plan and IMRT plan respectively. The IMRT plan spared the dose to the lenses of the eyes, the optic nerves and the retinas by almost 50 % compared to the 3DCRT. The IMRT plan proved to be superior in CTV coverage and achieved a more uniform PTV dose coverage compared to the 3DCRT plan. In addition, the brainstem and optic chiasm were better spared in the IMRT plan. The radiation oncologist reviewed the plans and chose the IMRT plan for treatment. In Patient 4, the radiation oncologist defined the dose prescription and planning objectives for both the 3D-CRT and IMRT treatment plans. The medical dosimetrist started the treatment planning process with a 3D-CRT technique. Prescription dose and normal-tissue constraints were identical for the 3D-CRT and IMRT plans. The initial prescription was 4600 cgy to PTV1 followed by 1400 cgy to PTV2. The total prescription for both plans was 6000 cgy at 200 cgy per fraction. The objective was to optimize the prescription dose distribution within the target volumes while minimizing dose to normal surrounding structures in the brain. The objectives for these plans were to cover 95% of PTV1 and PTV2 with 100% of the prescription. In addition, the OR dose constraints included: the maximum dose to the left lens of the eyes was to be less

10 10 than 700 cgy, the right lens should kept as low as possible, the left optic nerve was to be less than 5500 cgy and the right optic nerve should receive dose between 5500 cgy-6000 cgy, the optic chiasm was to be less than 5600 cgy and the brainstem was to be less than 6000 cgy. The medical dosimetrist expanded the brainstem and the optic chiasm 3 mm to create the planning organ-at-risk volumes (PRV). 5 Because there was overlap of the PTV and the brainstem and the optic chiasm, the medical dosimetrist set a high priority maximum dose constraint of 5400 cgy to the brainstem and a maximum dose of 5000 cgy to the optic chiasm. The medical dosimetrist contoured the brain and excluded the target volumes to create a body minus structures dose constraint to minimize dose to normal brain tissue. The medical dosimetrist created a PTVoverlap. The PTV-overlap is defined as the overlap between the PTV and the particular PRV. Creating a PTV-overlap would aid the medical dosimetrist in obtaining adequate target dose coverage while not exceeding dose tolerance to critical structures due to the overlap of the planning target volumes with the critical structures. In this particular case, the PTV-overlap was the intersection between the PTV and the brainstem and optic chiasm. The medical dosimetrist created a non-target tissue volume and added a dose constraint to avoid exceeding the prescription dose. Displays of the 3D-CRT and IMRT plan isodose distributions were compared in the transverse, sagittal, and coronal views. After coverage of the planning target volumes was achieved, the medical dosimetrist reviewed the isodose distribution of the plan, the dose to OR volumes and the calculated DVH. The left optic nerve received a maximum dose of 5542 cgy and 5034 cgy in the 3D-CRT and IMRT plan respectively. The optic chiasm received a maximum dose of 6001 cgy and 5518 cgy in the 3D-CRT and IMRT respectively. The maximum dose of the brainstem in the 3DCRT plan was 6102 cgy and 5563 cgy in the IMRT plan. Maximum dose of the right optic nerve was 5976 cgy and 5622 cgy in the 3DCRT and IMRT plan respectively. The maximum dose in the left optic nerve was lower in the IMRT plan compared to the 3DCRT plan. After review of both treatment plans, the radiation oncologist selected the IMRT plan for treatment. The medical dosimetrist was unable to keep the brainstem below dose tolerance in the 3DCRT plan because of the overlap between the brainstem and PTV. While the target dose coverage was comparable in both the 3D-CRT and IMRT plan, the IMRT plan was superior in sparing dose to critical structures. The IMRT plan also produced a much higher conformity of dose distributions compared to the 3DCRT plan.

11 11 For Patient 5, the radiation oncologist defined the dose prescription and planning objectives for both the 3D-CRT and IMRT treatment plan. The 3DCRT plan consisted of a 2 lateral beams 90, 270 and SAO and SPO. Forty-five degree, 30 and 25 wedges and a combination of 6 MV and 18 MV were used to optimize the plan. The same fields were used for the boost plan and coned down to PTV2. The IMRT plan utilized a 10 beam IMRT technique to optimize the plan. The gantry beam angles used for the initial plan included 9 photon, coplanar beams: 160, 120, 80, 40, 0, 320, 280, 240, 200 and 1 photon non-coplanar beam at gantry angle 25 and couch angle of 90. In this particular case, the brainstem and optic chiasm were overlapping the PTV. Beam angles were difficult to select to avoid entering or exiting critical structures. The medical dosimetrist created a PTV-brainstem and optic chiasm defined as a planning PTV to gain adequate dose coverage and to avoid exceeding dose to critical structures. The beam angles were optimized using 6 MV. There were two prescriptions used in this plan. The initial prescription was 4600 cgy to PTV1 followed by 1400 cgy to PTV2. The total prescription to this plan was 6000 cgy to PTV2. The objectives for both plans were to cover 95% of PTV with 100% of the prescription. In addition, the OR dose constraints included: the maximum dose to the lenses of the eyes was to be less than 1000 cgy, the optic nerve was to be less than 5500 cgy, the optic chiasm was to be less than 5600 cgy and the brainstem was to be less than 6000 cgy. Plan Analysis & Evaluation The medical dosimetrist optimized each 3DCRT plan using 3-4 non-coplanar beams and EDW as required. In each of the IMRT cases, the medical dosimetrist optimized the target volumes with a planning PTV in the IMRT optimizing module of the TPS. The plans were evaluated visually by isodose distributions on the axial, sagittal and coronal slices for the conformity of the prescribed dose to the PTV. A comparison of each case was evaluated by the cumulative DVH of the OR, PTV mean dose and normal brain-ptv tissue and shown in Table 2. For Patient 1, the evaluation of both the 3DCRT and the IMRT technique seen in Figure 1 demonstrated that not all cumulative dose constraints and objectives were achieved. The critical structures in the 3DCRT plan such as the brainstem and the optic chiasm exceeded dose tolerance. The 3DCRT plan demonstrated maximum doses of 6217 cgy and 6240 cgy to the optic chiasm and the brainstem respectively reflected in a comparison DVH (Figure 2). The OR dose constraints included in the IMRT plan demonstrated the maximum dose of 5591 cgy to the

12 12 optic chiasm and maximum dose of 5999 cgy to the brainstem. The radiation oncologist reviewed the volumes and accepted a 90% PTV 2 dose coverage of the prescription dose achieved by the IMRT plan. For Patient 2, the evaluation of both the 3DCRT and the IMRT technique demonstrated all dose objectives and dose constraints were achieved. The percentage of PTV 1 and PTV 2 at 100% of each prescription line dose (V 100 ) was 99% and 100% respectively. After coverage of the planning target volumes were achieved, the medical dosimetrist reviewed the isodose distribution of plans (Figure 3), the dose to organs at risk volumes and the calculated dose volume histogram. Maximum doses to the OR of both plans were reflected in the DVH (Figure 4). The left optic nerve, the optic chiasm and the maximum dose to the brainstem was better spared in the IMRT compared to the 3DCRT. Maximum doses of the right optic nerve were below 3100 cgy for both plans. After review of both treatment plans, the radiation oncologist selected the IMRT plan for treatment. While the target dose coverage was comparable in both the 3D-CRT and IMRT plan, the IMRT plan was superior in sparing dose to critical structures. For Patient 3, the evaluation of the IMRT technique and 3DCRT technique demonstrated all dose objectives and dose constraints were accomplished. A comparison of dose coverage through isodose distributions (Figure 5) and critical structures in both plans are reflected in Figure 6. The percentage of PTV at 100% of each prescription line dose (V 100 ) was 95% and 98% for the IMRT plan and 3DCRT respectively. For Patient 4, once coverage of the PTV was achieved, the medical dosimetrist reviewed the isodose distribution of the plan (Figure 7), the dose to OR volumes and the calculated DVH. Maximum doses to the OR of both plans were reflected in the DVH (Figure 8). The maximum doses of the brainstem, the right optic nerve and the left optic nerve was lower in the IMRT plan compared to the 3DCRT plan. After review of both treatment plans, the radiation oncologist selected the IMRT plan for treatment. The medical dosimetrist was unable to keep the brainstem below dose tolerance in the 3DCRT plan because of the overlap between the brainstem and PTV. While the target dose coverage was comparable in both the 3D-CRT and IMRT plan, the IMRT plan was greater in sparing dose to critical structures. The IMRT plan also produced a much higher conformality of dose distributions compared to the 3DCRT plan.

13 13 For Patient 5, The medical dosimetrist reviewed the isodose distributions (Figure 9), the dose to OR volumes and the calculated DVH for both plans (Figure 10). Because of the overlap of critical structures in the PTV, the radiation oncologist accepted 90% of PTV covered by the prescription dose achieved by the IMRT plan. Maximum doses to the OR were compared in the DVH for both techniques. The medical dosimetrist was unable to keep the brainstem and the optic chiasm below dose tolerance in the 3DCRT plan because of the overlap between the brainstem and PTV. The isodose distributions and DVH of the PTV, normal brain tissue and relevant critical structures were compared. The isodose distributions were compared in the transverse, sagittal and coronal views in both the 3D-CRT and IMRT plan for each patient. The benefit of IMRT was more noticeable when there was an overlap of the PTV and critical structures such as the brainstem and the optic chiasm as in Patient 1, Patient 4 and Patient 5. There were no significant differences in the mean dose PTV coverage between the IMRT technique and the 3DCRT technique. Within the 5 patients, only one 3D-CRT plan demonstrated both adequate target coverage and acceptable critical structures sparing as in Patient 3. The normal brain tissue-ptv dose at 1800 cgy and 2400 cgy were relative with the size of the planning volumes. However, the comparison between the IMRT technique and the 3DCRT technique in Patient 3 resulted in the IMRT technique receiving a slightly lower percentage of normal tissue receiving 1800 cgy and 2400 cgy compared to the 3DCRT technique, possibly decreasing neurotoxicity. Results and Discussion: The patient cases represented two different techniques in the treatment of high grade gliomas. While overall mortality rates remain high in gliomas, there have been many improvements in radiation therapy techniques. The goal of treatment planning is to spare the critical structures while providing adequate prescription dose coverage to the target volume. Adequate target coverage is often achieved with a 3DCRT planning technique; however, an IMRT technique has been shown to improve the dose distribution to the target volume as well as sparing dose to normal tissues when compared with 3DCRT technique. There are many discussions and comparison studies demonstrating IMRT superior to 3DCRT planning techniques for high grade gliomas. Intensity modulated radiation therapy planning can be less labor intensive, less time consuming to treat, while better sparing the normal brain and other critical structures and is more

14 14 feasible and efficient as demonstrated in a study done by Chan et al. 6 Treatment planning for brain tumors requires special attention especially when the irradiated target volume is in close proximity to critical organs such as the optic chiasm and the brainstem. Although an IMRT technique will allow higher radiation doses to be focused at regions within the tumor while sparing or minimizing dose to normal surrounding critical structures, less latitude will be given for daily patient set up because of the decreased margins around the planning volume in an IMRT technique as compared to a 3DCRT technique. Configuring the IMRT beam arrangements to provide for adequate dose coverage should be considered carefully to minimize the dose to normal brain tissue possibly reducing acute and late reactions due to radiation therapy. An IMRT technique plan is recommended for cases where critical structures are in close proximity to the target volume. The main advantage of an IMRT technique for treatment of high grade glioma is the ability to permit safe dose escalation to the GTV or center of the volume while keeping the dose to critical structures and non-target brain tissue within dose tolerance. With attentive treatment planning, careful beam arrangement selection and skillful treatment parameters, IMRT proved to better spare dose to critical structures and improved planning target dose conformity as compared to 3DCRT.

15 15 Figures Figure 1. Patient 1: A comparison of the 3DCRT plan (top) and IMRT plan (bottom) shown in the transverse, sagittal and coronal views. Target volumes: PTV1 shown in (blue) and PTV2 shown in (red). The prescription isodose line, 6000 cgy (red) and 4600 cgy (slateblue).

16 16 Figure 2. Patient 1: A DVH comparison of the 3DCRT (dash line) and IMRT (solid line) of the brainstem, the optic chiasm, the brain-ptv and the PTV.

17 17 Figure 3. Patient 2: A comparison of the 3DCRT plan (top) and IMRT plan (bottom) shown in the transverse, sagittal and coronal views. Target volumes: PTV1 shown in (orange) and PTV2 shown in (green). The prescription isodose line, 6000 cgy (red) and 4600 cgy (slateblue).

18 18 Figure 4. Patient 2: A DVH comparison of the 3DCRT (dash line) and IMRT (solid line) of the brainstem, the optic chiasm, the brain-ptv and the PTV.

19 19 Figure 5. Patient 3: A comparison of the 3DCRT plan (top) and IMRT plan (bottom) shown in the transverse, sagittal and coronal views. Target volumes: PTV shown in (blue). The prescription isodose line, 6000 cgy (dark blue).

20 20 Figure 6. Patient 3: A DVH comparison of the 3DCRT (dash line) and IMRT (solid line) of the brainstem, the optic chiasm, the brain-ptv and the PTV.

21 21 Figure 7. Patient 4: A comparison of the 3DCRT plan (top) and IMRT plan (bottom) shown in the transverse, sagittal and coronal views. Target volumes: PTV1 shown in (green) and PTV2 shown in (tomato). The prescription isodose line, 6000 cgy (red) and 4600 cgy (slateblue).

22 22 Figure 8. Patient 4: A DVH comparison of the 3DCRT (dash line) and IMRT (solid line) of the brainstem, the optic chiasm, the brain-ptv and the PTV.

23 23 Figure 9. Patient 5: A comparison of the 3DCRT plan (top) and IMRT plan (bottom) shown in the transverse, sagittal and coronal views. Target volumes: PTV1 shown in (blue) and PTV2 shown in (tomato). The prescription isodose line, 6000 cgy (red) and 4600 cgy (slateblue).

24 24 Figure 10. Patient 5: A DVH comparison of the 3DCRT (dash line) and IMRT (solid line) of the brainstem, the optic chiasm, the brain-ptv and the PTV.

25 25 Table 1. Treatment Planning Parameters listed for GBM patients by site, beam energy, number of gantry angles and total number of monitor units. Case Study Site Beam Energy # of Gantry Angles Total Monitor Units Treatment Planning Parameters Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 IMRT/3D IMRT/3D IMRT/3D IMRT/3D IMRT/3D Frontal Temporal Parietal Frontal Frontal lobe lobe Lobe lobe lobe 6MV/ 6 MV/ 6 MV/ 6 MV/ 6 MV/ 6MV+18 6MV+18 6 MV+18 6 MV+18 6 MV+18 MV MV MV MV MV 9-10/ 4 6/ 3 5/3 5-7/ / 4 732/ / / / / 570

26 26 Table 2.Plan Analysis and Evaluation for PTV mean dose and maximum doses to the brainstem, the optic nerves and normal brain tissue-ptv. Structure Patient 1 Patient 2 Patient 3 Patient 4 Pateint 5 IMRT/ 3D IMRT/ 3D IMRT/ 3D IMRT/ 3D IMRT/3D PTV Mean dose (cgy) Brainstem Max dose(cgy) Optic chiasm Max dose (cgy) Normal Brain- PTV % volume receiving 1800 cgy % volume receiving 2400 cgy 6190/ / / / / / / / / / / / / / / %/ 76% 55%/ 53% 42%/ 47% 93%/ 77% 91%/69% 79%/ 73% 35%/ 36% 32%/ 39% 72%/ 72% 81%/65%

27 27 References 1. Xia P. Optimization of intensity-modulated radiation therapy treatment planning. In: Chao K. Practical Essentials of Intensity Modulated Radiation Therapy. 2 nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005: Hall EJ, Wuu CS. Radiation induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys. 2003;56(1): doi: /s (03) Hermanto U, Frija EK, Lii MJ, Chang EL, Mahajan A, Woo SY. Intensity modulated radiotherapy (IMRT) and conventional three-dimensional conformal radiotherapy for high grade gliomas: does IMRT increase the integral dose to normal brain? Int J Radiat Oncol Biol Phys. 2007;67(4): doi: /j.irobp Marsh JC, Godbole R, Diaz AZ, et al. Sparing of the hippocampus, limbic circuit and neural stem cell compartment during partial brain radiotherapy for glioma: a dosimetric feasibility study. J Med Imaging Radiat Oncol. 2011;55(4): doi: /j x. 5. Stroom J, Heumen BJ. Limitations of planning organ at risk (PRV) concept. Int J. Radiat Oncology Biol. Phys. 2006;66(1) doi: /j.ijrobp Chan MF, Schupak K, Burman C, Chui CS, Ling CC. Comparison of intensity-modulated radiotherapy with three-dimensional conformal radiation therapy planning for glioblastoma multiforme. Med Dosim. 2003;28(4): doi: /j.meddos

Intensity modulated radiotherapy (IMRT) for treatment of post-operative high grade glioma in the right parietal region of brain

Intensity modulated radiotherapy (IMRT) for treatment of post-operative high grade glioma in the right parietal region of brain 1 Carol Boyd March Case Study March 11, 2013 Intensity modulated radiotherapy (IMRT) for treatment of post-operative high grade glioma in the right parietal region of brain History of Present Illness:

More information

Evaluation of Whole-Field and Split-Field Intensity Modulation Radiation Therapy (IMRT) Techniques in Head and Neck Cancer

Evaluation of Whole-Field and Split-Field Intensity Modulation Radiation Therapy (IMRT) Techniques in Head and Neck Cancer 1 Charles Poole April Case Study April 30, 2012 Evaluation of Whole-Field and Split-Field Intensity Modulation Radiation Therapy (IMRT) Techniques in Head and Neck Cancer Abstract: Introduction: This study

More information

Treatment Planning Evaluation of Volumetric Modulated Arc Therapy (VMAT) for Craniospinal Irradiation (CSI)

Treatment Planning Evaluation of Volumetric Modulated Arc Therapy (VMAT) for Craniospinal Irradiation (CSI) Treatment Planning Evaluation of Volumetric Modulated Arc Therapy (VMAT) for Craniospinal Irradiation (CSI) Tagreed AL-ALAWI Medical Physicist King Abdullah Medical City- Jeddah Aim 1. Simplify and standardize

More information

Advanced Technology Consortium (ATC) Credentialing Procedures for 3D Conformal Therapy Protocols 3D CRT Benchmark*

Advanced Technology Consortium (ATC) Credentialing Procedures for 3D Conformal Therapy Protocols 3D CRT Benchmark* Advanced Technology Consortium (ATC) Credentialing Procedures for 3D Conformal Therapy Protocols 3D CRT Benchmark* Purpose: To evaluate an institution s 3D treatment planning process and the institution

More information

A Comparison of IMRT and VMAT Technique for the Treatment of Rectal Cancer

A Comparison of IMRT and VMAT Technique for the Treatment of Rectal Cancer A Comparison of IMRT and VMAT Technique for the Treatment of Rectal Cancer Tony Kin Ming Lam Radiation Planner Dr Patricia Lindsay, Radiation Physicist Dr John Kim, Radiation Oncologist Dr Kim Ann Ung,

More information

Evaluation of Monaco treatment planning system for hypofractionated stereotactic volumetric arc radiotherapy of multiple brain metastases

Evaluation of Monaco treatment planning system for hypofractionated stereotactic volumetric arc radiotherapy of multiple brain metastases Evaluation of Monaco treatment planning system for hypofractionated stereotactic volumetric arc radiotherapy of multiple brain metastases CASE STUDY Institution: Odette Cancer Centre Location: Sunnybrook

More information

Comparing Study between Conventional and Conformal Planning Radiotherapy

Comparing Study between Conventional and Conformal Planning Radiotherapy Middle East Journal of Applied Sciences Volume : 06 Issue :04 Oct.-Dec. 2016 Pages: 660-670 Comparing Study between Conventional and Conformal Planning Radiotherapy 1 Aida Salama, 1 Sahar Awad, 2 Tamer

More information

Original Article. Teyyiba Kanwal, Muhammad Khalid, Syed Ijaz Hussain Shah, Khawar Nadeem

Original Article. Teyyiba Kanwal, Muhammad Khalid, Syed Ijaz Hussain Shah, Khawar Nadeem Original Article Treatment Planning Evaluation of Sliding Window and Multiple Static Segments Technique in Intensity Modulated Radiotherapy for Different Beam Directions Teyyiba Kanwal, Muhammad Khalid,

More information

3D Conformal Radiation Therapy for Mucinous Carcinoma of the Breast

3D Conformal Radiation Therapy for Mucinous Carcinoma of the Breast 1 Angela Kempen February Case Study February 22, 2012 3D Conformal Radiation Therapy for Mucinous Carcinoma of the Breast History of Present Illness: JE is a 45 year-old Caucasian female who underwent

More information

The objective of this lecture is to integrate our knowledge of the differences between 2D and 3D planning and apply the same to various clinical

The objective of this lecture is to integrate our knowledge of the differences between 2D and 3D planning and apply the same to various clinical The objective of this lecture is to integrate our knowledge of the differences between 2D and 3D planning and apply the same to various clinical sites. The final aim will be to be able to make out these

More information

Measurement of Dose to Critical Structures Surrounding the Prostate from. Intensity-Modulated Radiation Therapy (IMRT) and Three Dimensional

Measurement of Dose to Critical Structures Surrounding the Prostate from. Intensity-Modulated Radiation Therapy (IMRT) and Three Dimensional Measurement of Dose to Critical Structures Surrounding the Prostate from Intensity-Modulated Radiation Therapy (IMRT) and Three Dimensional Conformal Radiation Therapy (3D-CRT); A Comparative Study Erik

More information

Efficient SIB-IMRT planning of head & neck patients with Pinnacle 3 -DMPO

Efficient SIB-IMRT planning of head & neck patients with Pinnacle 3 -DMPO Investigations and research Efficient SIB-IMRT planning of head & neck patients with Pinnacle 3 -DMPO M. Kunze-Busch P. van Kollenburg Department of Radiation Oncology, Radboud University Nijmegen Medical

More information

Defining Target Volumes and Organs at Risk: a common language

Defining Target Volumes and Organs at Risk: a common language Defining Target Volumes and Organs at Risk: a common language Eduardo Rosenblatt Section Head Applied Radiation Biology and Radiotherapy (ARBR) Section Division of Human Health IAEA Objective: To introduce

More information

A Dosimetric Comparison of Whole-Lung Treatment Techniques. in the Pediatric Population

A Dosimetric Comparison of Whole-Lung Treatment Techniques. in the Pediatric Population A Dosimetric Comparison of Whole-Lung Treatment Techniques in the Pediatric Population Corresponding Author: Christina L. Bosarge, B.S., R.T. (R) (T) Indiana University School of Medicine Department of

More information

To Reduce Hot Dose Spots in Craniospinal Irradiation: An IMRT Approach with Matching Beam Divergence

To Reduce Hot Dose Spots in Craniospinal Irradiation: An IMRT Approach with Matching Beam Divergence SCIENCE & TECHNOLOGY To Reduce Hot Dose Spots in Craniospinal Irradiation: An IMRT Approach with Matching Beam Divergence Alburuj R. Rahman*, Jian Z. Wang, Dr. Z. Huang, Dr. J. Montebello Department of

More information

THE TRANSITION FROM 2D TO 3D AND TO IMRT - RATIONALE AND CRITICAL ELEMENTS

THE TRANSITION FROM 2D TO 3D AND TO IMRT - RATIONALE AND CRITICAL ELEMENTS THE TRANSITION FROM 2D TO 3D AND TO IMRT - RATIONALE AND CRITICAL ELEMENTS ICTP SCHOOL ON MEDICAL PHYSICS FOR RADIATION THERAPY DOSIMETRY AND TREATMENT PLANNING FOR BASIC AND ADVANCED APPLICATIONS March

More information

IMRT - the physician s eye-view. Cinzia Iotti Department of Radiation Oncology S.Maria Nuova Hospital Reggio Emilia

IMRT - the physician s eye-view. Cinzia Iotti Department of Radiation Oncology S.Maria Nuova Hospital Reggio Emilia IMRT - the physician s eye-view Cinzia Iotti Department of Radiation Oncology S.Maria Nuova Hospital Reggio Emilia The goals of cancer therapy Local control Survival Functional status Quality of life Causes

More information

Radiotherapy techniques in brain tumors (2D, 3D CRT, IMRT) including craniospinal irradiation

Radiotherapy techniques in brain tumors (2D, 3D CRT, IMRT) including craniospinal irradiation Radiotherapy techniques in brain tumors (2D, 3D CRT, IMRT) including craniospinal irradiation Dr Anusheel Munshi Additional Director, Radiation Oncology, Fortis Memorial Research Institute, Gurgaon anusheel.munshi@fortishealthcare.com

More information

Hybrid VMAT/IMRT Approach to Traditional Cranio-Spinal Irradiation (CSI): A Case Study on Planning Techniques and Delivery

Hybrid VMAT/IMRT Approach to Traditional Cranio-Spinal Irradiation (CSI): A Case Study on Planning Techniques and Delivery Hybrid VMAT/IMRT Approach to Traditional Cranio-Spinal Irradiation (CSI): A Case Study on Planning Techniques and Delivery Catherine Cadieux, CMD June 13, 2017 The Ohio State University Comprehensive Cancer

More information

Treatment of exceptionally large prostate cancer patients with low-energy intensity-modulated photons

Treatment of exceptionally large prostate cancer patients with low-energy intensity-modulated photons JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 7, NUMBER 4, FALL 2006 Treatment of exceptionally large prostate cancer patients with low-energy intensity-modulated photons Mei Sun and Lijun Ma a University

More information

Ashley Pyfferoen, MS, CMD. Gundersen Health Systems La Crosse, WI

Ashley Pyfferoen, MS, CMD. Gundersen Health Systems La Crosse, WI Ashley Pyfferoen, MS, CMD Gundersen Health Systems La Crosse, WI 3 Radiation Oncologists 3 Physicists 2 Dosimetrists 9 Radiation Therapists o o o o o o o o o Brachial Plexus Anatomy Brachial Plexopathy

More information

Chapters from Clinical Oncology

Chapters from Clinical Oncology Chapters from Clinical Oncology Lecture notes University of Szeged Faculty of Medicine Department of Oncotherapy 2012. 1 RADIOTHERAPY Technical aspects Dr. Elemér Szil Introduction There are three possibilities

More information

The Physics of Oesophageal Cancer Radiotherapy

The Physics of Oesophageal Cancer Radiotherapy The Physics of Oesophageal Cancer Radiotherapy Dr. Philip Wai Radiotherapy Physics Royal Marsden Hospital 1 Contents Brief clinical introduction Imaging and Target definition Dose prescription & patient

More information

Reena Phurailatpam. Intensity Modulated Radiation Therapy of Medulloblastoma using Helical TomoTherapy: Initial Experience from planning to delivery

Reena Phurailatpam. Intensity Modulated Radiation Therapy of Medulloblastoma using Helical TomoTherapy: Initial Experience from planning to delivery Intensity Modulated Radiation Therapy of Medulloblastoma using Helical TomoTherapy: Initial Experience from planning to delivery Reena Phurailatpam Tejpal Gupta, Rakesh Jalali, Zubin Master, Bhooshan Zade,

More information

Chapter 2. Level II lymph nodes and radiation-induced xerostomia

Chapter 2. Level II lymph nodes and radiation-induced xerostomia Chapter 2 Level II lymph nodes and radiation-induced xerostomia This chapter has been published as: E. Astreinidou, H. Dehnad, C.H. Terhaard, and C.P Raaijmakers. 2004. Level II lymph nodes and radiation-induced

More information

A VMAT PLANNING SOLUTION FOR NECK CANCER PATIENTS USING THE PINNACLE 3 PLANNING SYSTEM *

A VMAT PLANNING SOLUTION FOR NECK CANCER PATIENTS USING THE PINNACLE 3 PLANNING SYSTEM * Romanian Reports in Physics, Vol. 66, No. 2, P. 401 410, 2014 A VMAT PLANNING SOLUTION FOR NECK CANCER PATIENTS USING THE PINNACLE 3 PLANNING SYSTEM * M. D. SUDITU 1,2, D. ADAM 1,2, R. POPA 1,2, V. CIOCALTEI

More information

Dosimetric Comparison of Intensity-Modulated Radiotherapy versus 3D Conformal Radiotherapy in Patients with Head and Neck Cancer

Dosimetric Comparison of Intensity-Modulated Radiotherapy versus 3D Conformal Radiotherapy in Patients with Head and Neck Cancer Dosimetric Comparison of Intensity-Modulated Radiotherapy versus 3D Conformal Radiotherapy in Patients with Head and Neck Cancer 1- Doaa M. AL Zayat. Ph.D of medical physics, Ayadi-Al Mostakbl Oncology

More information

Intensity Modulated Radiation Therapy (IMRT)

Intensity Modulated Radiation Therapy (IMRT) Intensity Modulated Radiation Therapy (IMRT) Policy Number: Original Effective Date: MM.05.006 03/09/2004 Line(s) of Business: Current Effective Date: HMO; PPO 06/24/2011 Section: Radiology Place(s) of

More information

Optimization of RapidArc for Head-and-Neck Radiotherapy. Jessica Emily Salazar. Department of Medical Physics Duke University.

Optimization of RapidArc for Head-and-Neck Radiotherapy. Jessica Emily Salazar. Department of Medical Physics Duke University. Optimization of RapidArc for Head-and-Neck Radiotherapy by Jessica Emily Salazar Department of Medical Physics Duke University Date: Approved: Shiva Das, Supervisor Ryan McMahon Robert Reiman Thesis submitted

More information

WHOLE-BRAIN RADIOTHERAPY WITH SIMULTANEOUS INTEGRATED BOOST TO MULTIPLE BRAIN METASTASES USING VOLUMETRIC MODULATED ARC THERAPY

WHOLE-BRAIN RADIOTHERAPY WITH SIMULTANEOUS INTEGRATED BOOST TO MULTIPLE BRAIN METASTASES USING VOLUMETRIC MODULATED ARC THERAPY doi:10.1016/j.ijrobp.2009.03.029 Int. J. Radiation Oncology Biol. Phys., Vol. 75, No. 1, pp. 253 259, 2009 Copyright Ó 2009 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/09/$ see front

More information

Additional Questions for Review 2D & 3D

Additional Questions for Review 2D & 3D Additional Questions for Review 2D & 3D 1. For a 4-field box technique, which of the following will deliver the lowest dose to the femoral heads? a. 100 SSD, equal dmax dose to all fields b. 100 SSD, equal

More information

Lung Spine Phantom. Guidelines for Planning and Irradiating the IROC Spine Phantom. MARCH 2014

Lung Spine Phantom. Guidelines for Planning and Irradiating the IROC Spine Phantom. MARCH 2014 Lung Spine Phantom Guidelines for Planning and Irradiating the IROC Spine Phantom. MARCH 2014 The study groups are requesting that each institution keep the phantom for no more than 2 week. During this

More information

Intensity Modulated Radiation Therapy (IMRT)

Intensity Modulated Radiation Therapy (IMRT) Intensity Modulated Radiation Therapy (IMRT) Policy Number: Original Effective Date: MM.05.006 03/09/2004 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 03/01/2015 Section: Radiology

More information

IROC Liver Phantom. Guidelines for Planning and Irradiating the IROC Liver Phantom. Revised July 2015

IROC Liver Phantom. Guidelines for Planning and Irradiating the IROC Liver Phantom. Revised July 2015 IROC Liver Phantom Guidelines for Planning and Irradiating the IROC Liver Phantom. Revised July 2015 The study groups are requests that each institution keep the phantom for no more than 2 weeks. During

More information

Planning Optimization of Conformal Radiotherapy Techniques for Meningioma Brain Tumors

Planning Optimization of Conformal Radiotherapy Techniques for Meningioma Brain Tumors Med. J. Cairo Univ., Vol. 80, No. 1, June: 213-221, 2012 www.medicaljournalofcairouniversity.com Planning Optimization of Conformal Radiotherapy Techniques for Meningioma Brain Tumors AIDA SALAMA, Ph.D.*;

More information

Protocol. Intensity-Modulated Radiation Therapy (IMRT): Central Nervous System Tumors

Protocol. Intensity-Modulated Radiation Therapy (IMRT): Central Nervous System Tumors Intensity-Modulated Radiation Therapy (IMRT): Central Nervous (80159) Medical Benefit Effective Date: 03/01/14 Next Review Date: 03/15 Preauthorization No Review Dates: 07/12, 07/13, 03/14 The following

More information

Silvia Pella, PhD, DABR Brian Doozan, MS South Florida Radiation Oncology Florida Atlantic University Advanced Radiation Physics Boca Raton, Florida

Silvia Pella, PhD, DABR Brian Doozan, MS South Florida Radiation Oncology Florida Atlantic University Advanced Radiation Physics Boca Raton, Florida American Association of Medical Dosimetrists 2015 Silvia Pella, PhD, DABR Brian Doozan, MS South Florida Radiation Oncology Florida Atlantic University Advanced Radiation Physics Boca Raton, Florida Most

More information

Institute of Oncology & Radiobiology. Havana, Cuba. INOR

Institute of Oncology & Radiobiology. Havana, Cuba. INOR Institute of Oncology & Radiobiology. Havana, Cuba. INOR 1 Transition from 2-D 2 D to 3-D 3 D conformal radiotherapy in high grade gliomas: : our experience in Cuba Chon. I, MD - Chi. D, MD - Alert.J,

More information

Role of adaptive radiation therapy for pediatric patients with diffuse pontine glioma

Role of adaptive radiation therapy for pediatric patients with diffuse pontine glioma JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 12, NUMBER 2, spring 2011 Role of adaptive radiation therapy for pediatric patients with diffuse pontine glioma Chris Beltran, a Saumya Sharma, and Thomas

More information

Dosimetric Analysis of 3DCRT or IMRT with Vaginal-cuff Brachytherapy (VCB) for Gynaecological Cancer

Dosimetric Analysis of 3DCRT or IMRT with Vaginal-cuff Brachytherapy (VCB) for Gynaecological Cancer Dosimetric Analysis of 3DCRT or IMRT with Vaginal-cuff Brachytherapy (VCB) for Gynaecological Cancer Tan Chek Wee 15 06 2016 National University Cancer Institute, Singapore Clinical Care Education Research

More information

Editorial Process: Submission:11/14/2017 Acceptance:07/31/2018

Editorial Process: Submission:11/14/2017 Acceptance:07/31/2018 DOI:10.22034/APJCP.2018.19.9.2499 Dosimetric Comparison of SIB IMRT vs SIB VMAT in Gliomas RESEARCH ARTICLE Editorial Process: Submission:11/14/2017 Acceptance:07/31/2018 Dosimetric Comparison and Feasibility

More information

Evaluation of the Dynamic Arc-Therapy in Comparison to Conformal Radiation Therapy in Radiotherapy Patients

Evaluation of the Dynamic Arc-Therapy in Comparison to Conformal Radiation Therapy in Radiotherapy Patients Evaluation of the Dynamic Arc-Therapy in Comparison to Conformal Radiation Therapy in Radiotherapy Patients Aliaa Mahmoud (1,4), Ehab M. Attalla (2,3), M..S. El-Nagdy (4), Gihan Kamel (4) (1) Radiation

More information

International Multispecialty Journal of Health (IMJH) ISSN: [ ] [Vol-3, Issue-9, September- 2017]

International Multispecialty Journal of Health (IMJH) ISSN: [ ] [Vol-3, Issue-9, September- 2017] Dosimetric evaluation of carcinoma nasopharynx using Volumetric Modulated Arc Therapy (VMAT): An institutional experience from Western India Dr. Upendra Nandwana 1, Dr. Shuchita Pathak 2, Dr. TP Soni 3,

More information

SBRT fundamentals. Outline 8/2/2012. Stereotactic Body Radiation Therapy Quality Assurance Educational Session

SBRT fundamentals. Outline 8/2/2012. Stereotactic Body Radiation Therapy Quality Assurance Educational Session Stereotactic Body Radiation Therapy Quality Assurance Educational Session J Perks PhD, UC Davis Medical Center, Sacramento CA SBRT fundamentals Extra-cranial treatments Single or small number (2-5) of

More information

A TREATMENT PLANNING STUDY COMPARING VMAT WITH 3D CONFORMAL RADIOTHERAPY FOR PROSTATE CANCER USING PINNACLE PLANNING SYSTEM *

A TREATMENT PLANNING STUDY COMPARING VMAT WITH 3D CONFORMAL RADIOTHERAPY FOR PROSTATE CANCER USING PINNACLE PLANNING SYSTEM * Romanian Reports in Physics, Vol. 66, No. 2, P. 394 400, 2014 A TREATMENT PLANNING STUDY COMPARING VMAT WITH 3D CONFORMAL RADIOTHERAPY FOR PROSTATE CANCER USING PINNACLE PLANNING SYSTEM * D. ADAM 1,2,

More information

Potential benefits of intensity-modulated proton therapy in head and neck cancer van de Water, Tara Arpana

Potential benefits of intensity-modulated proton therapy in head and neck cancer van de Water, Tara Arpana University of Groningen Potential benefits of intensity-modulated proton therapy in head and neck cancer van de Water, Tara Arpana IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's

More information

IROC Lung Phantom 3D CRT / IMRT. Guidelines for Planning and Irradiating the IROC Lung Phantom. Revised Dec 2015

IROC Lung Phantom 3D CRT / IMRT. Guidelines for Planning and Irradiating the IROC Lung Phantom. Revised Dec 2015 IROC Lung Phantom 3D CRT / IMRT Guidelines for Planning and Irradiating the IROC Lung Phantom. Revised Dec 2015 The IROC requests that each institution keep the phantom for no more than 2 weeks. During

More information

Head and Neck Treatment Planning: A Comparative Review of Static Field IMRT RapidArc TomoTherapy HD. Barbara Agrimson, BS RT(T)(R), CMD

Head and Neck Treatment Planning: A Comparative Review of Static Field IMRT RapidArc TomoTherapy HD. Barbara Agrimson, BS RT(T)(R), CMD Head and Neck Treatment Planning: A Comparative Review of Static Field IMRT RapidArc TomoTherapy HD Barbara Agrimson, BS RT(T)(R), CMD Disclaimer This presentation will mention equipment by trade name.

More information

Reducing excess radiation from portal imaging of pediatric brain tumors

Reducing excess radiation from portal imaging of pediatric brain tumors JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 14, NUMBER 5, 2013 Reducing excess radiation from portal imaging of pediatric brain tumors Moses Tam, 1 Maya Mathew, 1 Christine J. Hitchen, 1 Ashwatha

More information

Feasibility of the partial-single arc technique in RapidArc planning for prostate cancer treatment

Feasibility of the partial-single arc technique in RapidArc planning for prostate cancer treatment Chinese Journal of Cancer Original Article Feasibility of the partial-single arc technique in RapidArc planning for prostate cancer treatment Suresh Rana 1 and ChihYao Cheng 2 Abstract The volumetric modulated

More information

IMRT Planning Basics AAMD Student Webinar

IMRT Planning Basics AAMD Student Webinar IMRT Planning Basics AAMD Student Webinar March 12, 2014 Karen Chin Snyder, MS Senior Associate Physicist Department of Radiation Oncology Disclosures The presenter has received speaker honoraria from

More information

Alexandria University Faculty of Medicine. Alexandria Journal of Medicine.

Alexandria University Faculty of Medicine. Alexandria Journal of Medicine. Alexandria Journal of Medicine (2013) 49, 379 384 Alexandria University Faculty of Medicine Alexandria Journal of Medicine www.sciencedirect.com ORIGINAL ARTICLE Three dimensional conformal postoperative

More information

A treatment planning study comparing Elekta VMAT and fixed field IMRT using the varian treatment planning system eclipse

A treatment planning study comparing Elekta VMAT and fixed field IMRT using the varian treatment planning system eclipse Peters et al. Radiation Oncology 2014, 9:153 RESEARCH Open Access A treatment planning study comparing Elekta VMAT and fixed field IMRT using the varian treatment planning system eclipse Samuel Peters

More information

Statistical Analysis and Volumetric Dose for Organ at Risk of Prostate Cancer

Statistical Analysis and Volumetric Dose for Organ at Risk of Prostate Cancer The African Review of Physics (2013) 8:0063 477 Statistical Analysis and Volumetric Dose for Organ at Risk of Prostate Cancer F. Assaoui¹,*, A. Bazine² and T. Kebdani³ ¹ Medical Physics Unit, Radiotherapy

More information

PEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING

PEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING PEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING ANATOMY ANATOMY CONT ANATOMY CONT. ANATOMY CONT. EYE OF A CHILD Normal tissue tolerance doses (in conventional #) TD 5/5 TD 50/5 Endpoint Gy Gy Optic nerve

More information

Address for Correspondence: Department of Medical Physics, Khwaja Yunus Ali University, Enayetpur, Sirajgonj ,

Address for Correspondence: Department of Medical Physics, Khwaja Yunus Ali University, Enayetpur, Sirajgonj , ORIGINAL ARTICLE Dosimetric Comparison of Different 3DCRT Techniques in Left Breast Cancer Radiotherapy Planning Abdus Sattar Mollah 1 and Meher Niger Sharmin 2 1 Department of Medical Physics, KhwajaYunus

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Head and Neck File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_head_and_neck

More information

REVISITING ICRU VOLUME DEFINITIONS. Eduardo Rosenblatt Vienna, Austria

REVISITING ICRU VOLUME DEFINITIONS. Eduardo Rosenblatt Vienna, Austria REVISITING ICRU VOLUME DEFINITIONS Eduardo Rosenblatt Vienna, Austria Objective: To introduce target volumes and organ at risk concepts as defined by ICRU. 3D-CRT is the standard There was a need for a

More information

Comparison of high and low energy treatment plans by evaluating the dose on the surrounding normal structures in conventional radiotherapy

Comparison of high and low energy treatment plans by evaluating the dose on the surrounding normal structures in conventional radiotherapy Turkish Journal of Cancer Volume 37, No. 2, 2007 59 Comparison of high and low energy treatment plans by evaluating the dose on the surrounding normal structures in conventional radiotherapy MUHAMMAD BASIM

More information

Intensity Modulated Radiation Therapy for Squamous Cell Carcinoma of the Penis

Intensity Modulated Radiation Therapy for Squamous Cell Carcinoma of the Penis 1 Louise Francis September Case Study September 23, 2011 Intensity Modulated Radiation Therapy for Squamous Cell Carcinoma of the Penis History of Present Illness: JM is a 56 year-old African American

More information

3D Conformal Radiation Therapy for Invasive Ductal Carcinoma of the Left Breast

3D Conformal Radiation Therapy for Invasive Ductal Carcinoma of the Left Breast 1 Angela Kempen April Case Study April 30, 2012 3D Conformal Radiation Therapy for Invasive Ductal Carcinoma of the Left Breast History of Present Illness: KT is a 64 year-old patient who detected a palpable

More information

Conventional (2D) Versus Conformal (3D) Techniques in Radiotherapy for Malignant Pediatric Tumors: Dosimetric Perspectives

Conventional (2D) Versus Conformal (3D) Techniques in Radiotherapy for Malignant Pediatric Tumors: Dosimetric Perspectives Journal of the Egyptian Nat. Cancer Inst., Vol. 2,. 3, December: 39-34, 29 Conventional (2D) Versus Conformal (3D) Techniques in Radiotherapy for Malignant Pediatric Tumors: Dosimetric Perspectives NESREEN

More information

I. Conventional External Beam Teletherapy including 3-D Conformal Teletherapy A. Tumor Mapping and Clinical Treatment Planning

I. Conventional External Beam Teletherapy including 3-D Conformal Teletherapy A. Tumor Mapping and Clinical Treatment Planning National Imaging Associates, Inc. Clinical guidelines RADIATION ONCOLOGY INCLUDING INTENSITY MODULATED RADIATION THERAPY (IMRT) CPT4 Codes: Refer to pages 21-22 LCD ID Number: L34652 J 5 = IA, KS, MO,

More information

BLADDER RADIOTHERAPY PLANNING DOCUMENT

BLADDER RADIOTHERAPY PLANNING DOCUMENT A 2X2 FACTORIAL RANDOMISED PHASE III STUDY COMPARING STANDARD VERSUS REDUCED VOLUME RADIOTHERAPY WITH AND WITHOUT SYNCHRONOUS CHEMOTHERAPY IN MUSCLE INVASIVE BLADDER CANCER (ISRCTN 68324339) BLADDER RADIOTHERAPY

More information

Radiation Therapy for Metastatic Non-Small Cell Lung Carcinoma of the Right Hip

Radiation Therapy for Metastatic Non-Small Cell Lung Carcinoma of the Right Hip Angela Kempen June Case Study June 15 th, 2012 Radiation Therapy for Metastatic Non-Small Cell Lung Carcinoma of the Right Hip History of Present Illness: HT is a 66 year-old Caucasian male who was diagnosed

More information

UNIVERSITY OF WISCONSIN-LA CROSSE Graduate Studies

UNIVERSITY OF WISCONSIN-LA CROSSE Graduate Studies UNIVERSITY OF WISCONSIN-LA CROSSE Graduate Studies A SINGLE INSTITUTION S EXPERIENCE IN DEVELOPING A PURPOSEFUL AND EFFICIENT OFF-LINE TECHNIQUE FOR ADAPTIVE RADIOTHERAPY IN A CLINICAL ENVIRONMENT A Research

More information

Grid Treatment of Left Upper Lobe Lung Mass History of Present Illness: Past Medical History:

Grid Treatment of Left Upper Lobe Lung Mass History of Present Illness: Past Medical History: 1 Ellie Hawk Clinical Practicum I Case Study II April 19, 2015 Grid Treatment of Left Upper Lobe Lung Mass History of Present Illness: The patient is a 79 year-old white gentleman who was diagnosed with

More information

Spatially Fractionated GRID Therapy: A Case Study Abstract: Introduction: Case Description: Conclusion: Key Words Introduction

Spatially Fractionated GRID Therapy: A Case Study Abstract: Introduction: Case Description: Conclusion: Key Words Introduction 1 Spatially Fractionated GRID Therapy: A Case Study Authors: Maggie Stauffer, B.S., Ellie Hawk, B.S., R.T.(R), Nishele Lenards, M.S., CMD, R.T.(R)(T), FAAMD, Ashley Hunzeker, M.S., CMD Abstract: Introduction:

More information

A STUDY OF PLANNING DOSE CONSTRAINTS FOR TREATMENT OF NASOPHARYNGEAL CARCINOMA USING A COMMERCIAL INVERSE TREATMENT PLANNING SYSTEM

A STUDY OF PLANNING DOSE CONSTRAINTS FOR TREATMENT OF NASOPHARYNGEAL CARCINOMA USING A COMMERCIAL INVERSE TREATMENT PLANNING SYSTEM doi:10.1016/j.ijrobp.2004.02.040 Int. J. Radiation Oncology Biol. Phys., Vol. 59, No. 3, pp. 886 896, 2004 Copyright 2004 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/04/$ see front

More information

Role of Belly Board Device in the Age of Intensity Modulated Radiotherapy for Pelvic Irradiation

Role of Belly Board Device in the Age of Intensity Modulated Radiotherapy for Pelvic Irradiation Role of Belly Board Device in the Age of Intensity Modulated Radiotherapy for Pelvic Irradiation 2017 AAMD 42 nd Annual Meeting Neil C. Estabrook, MD 6 / 14 / 2017 7/5/2017 1 Conflicts of Interest None

More information

Treatment Planning for Lung. Kristi Hendrickson, PhD, DABR University of Washington Dept. of Radiation Oncology

Treatment Planning for Lung. Kristi Hendrickson, PhD, DABR University of Washington Dept. of Radiation Oncology Treatment Planning for Lung Kristi Hendrickson, PhD, DABR University of Washington Dept. of Radiation Oncology Outline of Presentation Dosimetric planning strategies for SBRT lung Delivery techniques Examples

More information

NIA MAGELLAN HEALTH RADIATION ONCOLOGY CODING STANDARD. Dosimetry Planning

NIA MAGELLAN HEALTH RADIATION ONCOLOGY CODING STANDARD. Dosimetry Planning NIA MAGELLAN HEALTH RADIATION ONCOLOGY CODING STANDARD Dosimetry Planning CPT Codes: 77295, 77300, 77301, 77306, 77307, 77321, 77316, 77317, 77318, 77331, 77399 Original Date: April, 2011 Last Reviewed

More information

Description. Section: Therapy Effective Date: July 15, 2015 Subsection: Original Policy Date: September 13, 2012 Subject: Page: 1 of 10

Description. Section: Therapy Effective Date: July 15, 2015 Subsection: Original Policy Date: September 13, 2012 Subject: Page: 1 of 10 Last Review Status/Date: June 2015 Page: 1 of 10 Description Radiotherapy (RT) is an integral component in the treatment of many brain tumors, both benign and malignant. Intensity-modulated radiation therapy

More information

Int J Clin Exp Med 2015;8(9): /ISSN: /IJCEM Gang Zhou, Yanze Sun, Jianjun Qian, Ye Tian, Xueguan Lu

Int J Clin Exp Med 2015;8(9): /ISSN: /IJCEM Gang Zhou, Yanze Sun, Jianjun Qian, Ye Tian, Xueguan Lu Int J Clin Exp Med 2015;8(9):15975-15982 www.ijcem.com /ISSN:1940-5901/IJCEM0009616 Original Article The dosimetric comparison of the radiotherapeutic plans between composite and synchronous approaches

More information

Case Study. Institution Farrer Park Hospital

Case Study. Institution Farrer Park Hospital Case Study Single isocenter high definition dynamic radiosurgery (HDRS) for multiple brain metastases HDRS with Monaco, Versa HD and HexaPOD allows multiple brain metastases treatment within standard 15-minute

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of the Chest File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_the_chest

More information

IMRT QUESTIONNAIRE. Address: Physicist: Research Associate: Dosimetrist: Responsible Radiation Oncologist(s)

IMRT QUESTIONNAIRE. Address: Physicist:   Research Associate:   Dosimetrist:   Responsible Radiation Oncologist(s) IMRT QUESTIONNAIRE Institution: Date: / / Address: Physicist: e-mail: Telephone: Fax: Research Associate: email: Telephone: Fax: Dosimetrist: email: Telephone: Fax: Responsible Radiation Oncologist(s)

More information

First, how does radiation work?

First, how does radiation work? Hello, I am Prajnan Das, Faculty Member in the Department of Radiation Oncology at The University of Texas MD Anderson Cancer Center. We are going to talk today about some of the basic principles regarding

More information

Dose escalation for NSCLC using conformal RT: 3D and IMRT. Hasan Murshed

Dose escalation for NSCLC using conformal RT: 3D and IMRT. Hasan Murshed Dose escalation for NSCLC using conformal RT: 3D and IMRT. Hasan Murshed Take home message Preliminary data shows CRT technique in NSCLC allows dose escalation to an unprecedented level maintaining cancer

More information

Page 1. Helical (Spiral) Tomotherapy. UW Helical Tomotherapy Unit. Helical (Spiral) Tomotherapy. MVCT of an Anesthetized Dog with a Sinus Tumor

Page 1. Helical (Spiral) Tomotherapy. UW Helical Tomotherapy Unit. Helical (Spiral) Tomotherapy. MVCT of an Anesthetized Dog with a Sinus Tumor Helical (Spiral) Tomotherapy Novel Clinical Applications of IMRT Linac Ring Gantry CT Detector X-Ray Fan Beam Binary Multileaf Collimator Binary MLC Leaves James S Welsh, MS, MD Department of Human Oncology

More information

CBCT of the patient in the treatment position has gained wider applications for setup verification during radiotherapy.

CBCT of the patient in the treatment position has gained wider applications for setup verification during radiotherapy. Gülcihan CÖDEL Introduction The aim of this study is to evaluate the changes in bladder doses during the volumetric modulated arc therapy (VMAT) treatment of prostate cancer patients using weekly cone

More information

CURRICULUM OUTLINE FOR TRANSITIONING FROM 2-D RT TO 3-D CRT AND IMRT

CURRICULUM OUTLINE FOR TRANSITIONING FROM 2-D RT TO 3-D CRT AND IMRT CURRICULUM OUTLINE FOR TRANSITIONING FROM 2-D RT TO 3-D CRT AND IMRT Purpose The purpose of this curriculum outline is to provide a framework for multidisciplinary training for radiation oncologists, medical

More information

The Effects of DIBH on Liver Dose during Right-Breast Treatments: A Case Study Abstract: Introduction: Case Description: Conclusion: Introduction

The Effects of DIBH on Liver Dose during Right-Breast Treatments: A Case Study Abstract: Introduction: Case Description: Conclusion: Introduction 1 The Effects of DIBH on Liver Dose during Right-Breast Treatments: A Case Study Megan E. Sullivan, B.S., R.T.(T)., Patrick A. Melby, B.S. Ashley Hunzeker, M.S., CMD, Nishele Lenards, M.S., CMD, R.T. (R)(T),

More information

The Effects of DIBH on Liver Dose during Right-Breast Treatments Introduction

The Effects of DIBH on Liver Dose during Right-Breast Treatments Introduction 1 The Effects of DIBH on Liver Dose during Right-Breast Treatments Megan E. Sullivan B.S.R.T.(T)., Patrick A. Melby, B.S. Ashley Hunzeker, M.S., CMD, Nishele Lenards, M.S., CMD Medical Dosimetry Program

More information

IMRT - Intensity Modulated Radiotherapy

IMRT - Intensity Modulated Radiotherapy IMRT - Intensity Modulated Radiotherapy Advanced product in the RT technology Aims to deliver radiation more precisely to the tumor, while relatively limiting dose to the surrounding normal tissues 7 position

More information

Research Article An IMRT/VMAT Technique for Nonsmall Cell Lung Cancer

Research Article An IMRT/VMAT Technique for Nonsmall Cell Lung Cancer Hindawi Publishing Corporation BioMed Research International Volume 2015, Article ID 613060, 7 pages http://dx.doi.org/10.1155/2015/613060 Research Article An IMRT/VMAT Technique for Nonsmall Cell Lung

More information

Implementation of advanced RT Techniques

Implementation of advanced RT Techniques Implementation of advanced RT Techniques Tibor Major, PhD National Institute of Oncology Budapest, Hungary 2. Kongres radiološke tehnologije, Vukovar, 23-25. September 2016. Current RT equipments at NIO,

More information

Potential systematic uncertainties in IGRT when FBCT reference images are used for pancreatic tumors

Potential systematic uncertainties in IGRT when FBCT reference images are used for pancreatic tumors JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 16, NUMBER 3, 2015 Potential systematic uncertainties in IGRT when FBCT reference images are used for pancreatic tumors Ahmad Amoush, May Abdel-Wahab,

More information

PRIOR AUTHORIZATION Prior authorization is recommended and obtained via the online tool for participating providers.

PRIOR AUTHORIZATION Prior authorization is recommended and obtained via the online tool for participating providers. Medical Coverage Policy Intensity-Modulated Radiotherapy: Central Nervous System Tumors EFFECTIVE DATE: 02 15 2016 POLICY LAST UPDATED: 09 05 2017 OVERVIEW Radiotherapy (RT) is an integral component in

More information

RPC Liver Phantom Highly Conformal Stereotactic Body Radiation Therapy

RPC Liver Phantom Highly Conformal Stereotactic Body Radiation Therapy RPC Liver Phantom Highly Conformal Stereotactic Body Radiation Therapy Guidelines for Planning and Irradiating the RPC Liver Phantom. Revised Dec 2005 Credentialing for this protocol requires four steps:

More information

Tangent field technique of TomoDirect improves dose distribution for whole-breast irradiation

Tangent field technique of TomoDirect improves dose distribution for whole-breast irradiation JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 16, NUMBER 3, 2015 Tangent field technique of TomoDirect improves dose distribution for whole-breast irradiation Harumitsu Hashimoto, 1,3a Motoko Omura,

More information

A dosimetric evaluation of VMAT for the treatment of non-small cell lung cancer

A dosimetric evaluation of VMAT for the treatment of non-small cell lung cancer JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 14, NUMBER 1, 2013 A dosimetric evaluation of VMAT for the treatment of non-small cell lung cancer Caitlin E. Merrow, a Iris Z. Wang, Matthew B. Podgorsak

More information

Intensity Modulated Radiation Therapy (IMRT): Central Nervous System Tumors. Original Policy Date

Intensity Modulated Radiation Therapy (IMRT): Central Nervous System Tumors. Original Policy Date MP 8.01.36 Intensity Modulated Radiation Therapy (IMRT): Central Nervous System Tumors Medical Policy Section Therapy Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Created with literature

More information

IGRT Solution for the Living Patient and the Dynamic Treatment Problem

IGRT Solution for the Living Patient and the Dynamic Treatment Problem IGRT Solution for the Living Patient and the Dynamic Treatment Problem Lei Dong, Ph.D. Associate Professor Dept. of Radiation Physics University of Texas M. D. Anderson Cancer Center Houston, Texas Learning

More information

Protocol of Radiotherapy for Breast Cancer

Protocol of Radiotherapy for Breast Cancer 107 年 12 月修訂 Protocol of Radiotherapy for Breast Cancer Indication of radiotherapy Indications for Post-Mastectomy Radiotherapy (1) Axillary lymph node 4 positive (2) Axillary lymph node 1-3 positive:

More information

Dosimetric advantage of using 6 MV over 15 MV photons in conformal therapy of lung cancer: Monte Carlo studies in patient geometries

Dosimetric advantage of using 6 MV over 15 MV photons in conformal therapy of lung cancer: Monte Carlo studies in patient geometries JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 3, NUMBER 1, WINTER 2002 Dosimetric advantage of using 6 MV over 15 MV photons in conformal therapy of lung cancer: Monte Carlo studies in patient geometries

More information

A Smart Setup for Craniospinal Irradiation

A Smart Setup for Craniospinal Irradiation Original Article PROGRESS in MEDICAL PHYSICS Vol. 24, No. 4, December, 2013 http://dx.doi.org/10.14316/pmp.2013.24.4.230 A Smart Setup for Craniospinal Irradiation Jennifer L. Peterson*, Laura A. Vallow*,

More information

Comparison of bulk electron density and voxel-based electron density treatment planning

Comparison of bulk electron density and voxel-based electron density treatment planning JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 12, NUMBER 4, fall 2011 Comparison of bulk electron density and voxel-based electron density treatment planning Aliaksandr Karotki, 1a Katherine Mah,

More information

New Technologies for the Radiotherapy of Prostate Cancer

New Technologies for the Radiotherapy of Prostate Cancer Prostate Cancer Meyer JL (ed): IMRT, IGRT, SBRT Advances in the Treatment Planning and Delivery of Radiotherapy. Front Radiat Ther Oncol. Basel, Karger, 27, vol. 4, pp 315 337 New Technologies for the

More information