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