Principles and Practice of Radiation Therapy

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Presentation transcript:

Principles and Practice of Radiation Therapy Chapter 22 Conventional (Fluoroscopy-Based) Simulation Procedures Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Key Terms Simulation: The precise mockup of a patient treatment with radiographic documentation of the treatment portals in a one- or two-step process Localization: Defining the position and the extent of the tumor and anatomic structures by reference of surface marks; sometimes the second step of the simulation process Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Radiation Therapy Volumes Gross tumor volume (GTV): Gross palpable or visible tumor Clinical target volume (CTV): Gross palpable or visible tumor and surrounding volume of tissue that may contain subclinical or microscopic disease Planning target volume (PTV): Indicates the CTV plus margins for geometric uncertainties such as patient motion, beam penumbra, and treatment setup differences Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Simulation Acronyms AP CA, CAX Film/radiograph IFD LAO/LPO RAO/RPO POP Couch/table Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Simulation Acronyms ODI SAD SCD/SDD SFD SSD TSD TTH Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Isocentric Technique Example #1 A patient is treated to midplane on the 6-MV linear acclerator. The source-skin distance (SSD) reads out at 89 cm from the anterior. What is the patient’s innerfield distance (IFD)? Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Isocentric Technique Example #2 A patient measures 15 cm through the lateral aspect of his head. What will the SSD be for an isocentric setup using 100-cm SSD? Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Isocentric Technique Example #3 An abdominal tumor is located 9 cm from the anterior surface. What are the anterior and posterior SSDs for this isocenter placed in the middle of the tumor (IFD = 20 cm)? Treatment at 100 cm SSD Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Body Planes Transverse (axial) Coronal Sagittal Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Body Plane Radiographic Example Label the directional terms (anterior, posterior, superior, inferior, right, and left) Which body plane is represented? Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Radiation Oncology Process Diagnosis Consultation Simulation and treatment planning Treatment Patient follow-up Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Historical Perspective Radiology related Treatment planning on treatment unit Topographic anatomy and physiology Poor-quality films Treatment time used Fluoroscopy related Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Four Developments in Radiation Treatment Planning in the 1990s Virtual simulation was introduced. CT images on a conventional simulator were improved. Treatment planning computers were developed that could carry out three-dimensional treatment planning. Virtual simulator provided the ability to generate high-resolution digital reconstructed radiographs (DRRs). Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Simulation and Treatment Planning Conventional simulation Beam design/placement Determination of external contours CT simulation Patient marking Transfer of plan to marks on patient Treatment verification Confirmation of shields/multileaf collimator (MLC) Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. SSD/SAD Localization Source-skin distance (SSD) This approach positions a fixed treatment distance of 80 or 100 cm on the patient’s skin for each field. Source-axis distance (SAD) Also called the isocentric technique, it provides tumor localization in three dimensions, using an isocenter placed within the target volume. Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Conventional Simulation Procedure Presimulation plan Room preparation Explanation of procedure Patient positioning and immobilization Operation of simulator controls Setting field size parameters Exposure factors Radiographic exposure and image processing Documenting data Final procedures Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Contour Devices Definition Manual methods Solder wire Thermoplastic tube Plaster CT Examples Benefits Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Treatment Verification Overview Verification simulation “Part B” Imaging Changes Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Emergency Procedures Treatment related Spinal cord compression Excessive bleeding Obstruction Other Medical emergencies Cardiopulmonary resuscitation (CPR) Obstructed airway Anaphylactic shock Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.