1. بسم الله الرحمن الرحيم
﴿و قل رب زدنى علماً﴾
صدق الله العظيم

2. Advanced Radiotherapy (RT)
Dr. Ahmed Al Far, M.D.
Professor of Radiation Oncology

3. Technical Aspects of Radiotherapy

4. Educational Objectives
By the end of this lecture you will be able to:
Describe how patients are referred for radiation oncology department.
Explain the stages of health care management for patients undergoing radiotherapy.
Demonstrate knowledge of the terms and concepts commonly used in radiotherapy practice.

5. Educational Objectives (cont.,)
Identify and describe parameters of radiotherapy prescription.
Discuss causes failure of radiotherapy.
Explain role of quality assurance program in preventing errors.
List characteristics of successful radical course of radiotherapy.

6. Outlines Stages leading to radiotherapy Radiotherapy process
Data in radiation oncology charts
Success or failure of radiotherapy

7. Stages Leading to Radiotherapy
Staging / investigations
Multidisciplinary Team
Symptoms/
Screening/
Referral
Diagnosis/ Primary surgery
surgery
or chemotherapy
Radiotherapy
Treatment
Radiotherapy
Planning

8. Clinical Evaluation (Path., stage,etc..)
Therapy Decisions
Multimodality therapy
Other modality
Radiotherapy
Identify tumor extent and sensitive organs
Decision about:
(a) Goal (cure/palliation)
(b) Modality (External Beam ± Brachytherapy)
Position, immobilization Patient data acquisition (CT, MRI, Simulator)
Flowchart for the process of RT
Treatment Planning Decision about: fields, dose, beam-modifiers
Treatment Simulation Radiographic verification of fields
Evaluation during therapy
Treatment
Follow-up

9. Data in Radiotherapy charts-1
Patient-related: age, gender, etc.
Diagnostic: clinical, pathological, TNM stage, previous treatment and concomitant medications.
Pretreatment: decision making/consent
Treatment technique: planning, simulation and delivery documentation
Acute-radiation side effects: kind and degree at weekly basis
On treatment patient education

10. Data in Radiotherapy charts-2
Tumor response to treatment
Impact of treatment on quality of life
Recommendations and compliance with follow-up
Recurrence, survival (with or without disease), and date and cause of death.

11. Causes of radiotherapy failure-1
Indicators:
Low tumor control rate,
High side effects
Causes:
Failure to deliver the prescribed dose
Failure to treat the intended volume of tissue

12. Causes of radiotherapy failure-2
Failure to deliver the prescribed dose:
Error in dose calculation or distribution
Wedge filter in wrong orientation or wrong field
Beam shaping block in wrong orientation or wrong field
Error in measurements of the patient's dimensions
Treatment machine malfunction (output)

13. Causes of radiotherapy failure-3
Failure to treat the intended volume of tissue:
Errors in determination target volume
Errors in localization of target volume
Errors in repositioning:
Field displacement,
Patient motion.
Role of quality assurance program.

14. Successful Radical Course of RT
Accurate localization of target volume (TV)
Effective patient immobilization
Uniformly high dose of radiation to the TV whilst sparing radiosensitive critical structures and normal tissues
Optimum dose/fractionation schedule
Accurate, consistent setting-up and execution of the treatment prescription.

15. Thank You