1. Somvilai Mayurasakorn, MD. Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University Somvilai Mayurasakorn, MD. Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University

2. Helical Tomotherapy Smaller field widths, smaller pitches and higher modulation factors More conformal plans But increased treatment time !! Tomotherapy Planning Parameters

3. 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

4. Image matching

5. Dept. of Radiation Oncology M.D. Anderson Cancer Center Orlando

7. Helical Tomotherapy Dept. of Radiation Oncology M.D. Anderson Cancer Center Orlando

8. Helical Tomotherapy Palma et al. Cancer Treatment Reviews 2010;36 :393–399

9. Helical Tomotherapy

12. 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 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

13. Successful implementation of Tomotherapy Careful planning and effective teamwork Successful implementation of Tomotherapy Careful planning and effective teamwork Daily image guidance Positional correction Intensity-modulated delivery Daily image guidance Positional correction Intensity-modulated delivery Helical Tomotherapy

14. Tomotherapy Treatment Centers : Asia-Pacific South Korea – Incheon St. Marys Hospital, Catholic Medical Center – KangNam St Marys Hospital, Catholic University Hospital – Yonsei Cancer Center, Severance Hospital (2) – GangNam Severance Hospital – National Cancer Center – Catholic Medical Center, St.Vincents 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

15. 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 & Womens Hospital

17. Quality Depends on Number of Beams 1 Beam 5 Beams 11 Beams 17 Beams 25 Beams 51 Beams

18. Dose distribution for one patient of regular delivery A. 2.5-cm-field width (REG 2.5) B. 5-cm-field width (REG 5) doses are shown in Gy Dose distribution for one patient of regular delivery A. 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

19. 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 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

20. Gross Tumor Volume (GTV) GTV contour definition The primary tumor (GTV 1) A 1 cm peripherally enhancing lymph node (GTV2) GTV1 GTV2