8/2/2012
II. Status and Challenges for New
Technologies
SEFM Perspective
Joan Roselló i Ferrando
Luis Brualla Gonzalez
Luis Núñez Martín
SURVEY FORMS
•Sent to all Spanish Radiotherapy Centers
•Sent to the head of the Radiophysics Departments
•Adressed to investigate the medical physics
•departments in radiotherapy
2
SURVEY FORMS
•Sent to all Spanish Radiotherapy Centers
•Sent to the head of the Radiophysics Departments
•Adressed to investigate the medical physics
•departments in radiotherapy
•Number of enquest:
92
•Number of answers:
64
•Survey questions on:
•1 Resources and activity
•2 IMRT
•3 IGRT
•4 Radiosurgery
•5 SBRT
3
1
8/2/2012
1 RESOURCES AND ACTIVITY
Personal
Equipment
4
Medical Physics human resources for Radiotherapy
Answer Options
Response
Average
Response
Total
Response
Count
Medical Physicists
3,16
196
62
Dosimetrists
2,29
142
62
answered question
skipped question
• Do not have Dosimetrists
• More Medical physicists than Dosimetrists
• Equal number of Medical Physicists that Dosimetrists
• More Dosimetrists than Medical Physicists
62
2
6
41
11
10
5
Average number of
patients treated per year
Total patients-60 centers:
63.375/60
Spanish population
(January 2011):
47.190.494
Average inhabitant/Linac
(First aproximation):
225.000
6
2
8/2/2012
Response Response
Average
Total
Answer Options
Total number of Linacs in the
Hospital
2,28
Response
Count
139
61
answered question
61
skipped question
3
Patients/Linac = 456
7
Number of linacs/Hospital
30
Number of Hospitals
25
20
15
10
5
0
1
2
3
4
5
Number of linacs
8
Do you use optimization techniques based on biological
criteria?
criteria?
Response Response
Percent
Count
Answer Options
Yes
14,5%
9
No
85,5%
53
Clarifications that it considers necessary
answered question
5
62
skipped question
2
9
3
8/2/2012
2 IMRT
10
Are IMRT treatments performed in your center?
Answer Options
Response Response
Percent
Count
78,0%
22,0%
Yes
No
Comment if you need
46
13
9
answered question
skipped question
59
5
11
Number of LINACS capable of IMRT whatever technique
Answer Options
Response Response Response
Average
Total
Count
1,51
89
59
Number of linacs with IMRT
answered question
skipped question
Of the 59 centers that replied there are 3 that have no linacs
capable of IMRT
59
5
12
4
8/2/2012
Number of patients per year treated with IMRT
Response Response Response
Count
Average Total
Answer Options
Number of patients/ year
(Whatever the technique
employed)
168,6
9.446
56
answered question
56
skipped question
8
13
Number of patiens/year treated with IMRT
Number of Hospitals
25
20
15
10
5
0
<=100 101-200
201-300
301-400 401-500 501-600
601-700 701-800
IMRT patients treated per year IMRT patients treated per year
14
Estimation the aproximate time of occupancy linac to treat a case of
IMRT
Answer Options
Under 20 minutes
Between 20 and 30 minutes
Between 30 and 45 minutes
Over 45 minutes
Comments
Response
Percent
Response
Count
43,8%
45,8%
8,3%
4,2%
21
22
4
2
13
answered question
skipped question
46
18
15
5
8/2/2012
Estimating the approximate average time of occupancy
of the LINAC to verify a case of IMRT.
IMRT.
Response Response
Percent
Count
Answer Options
26,5%
26,5%
20,4%
26,5%
Under 20 minutes
Between 20 and 30 minutes
Between 30 and 45 minutes
Over 45 minutes
Comments
answered question
skipped question
13
13
10
13
10
49
15
16
IMRT irradiation techniques commonly used (Several times in
the Hospital)
Response Response
Percent
Count
59,2%
29
44,9%
22
16,3%
8
2,0%
1
4,1%
2
2
answered question
49
skipped question
15
Answer Options
Step&Shoot
Sliding windows
Volumetric
Tomotherapy
Cyberknife
Other
17
% hospitals that have a particular technique
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Step&Shoot
Sliding windows
Volumétrica
Tomotherapy
Cyberknife
IMRT irradiation techniques commonly used
18
6
8/2/2012
Is there a selection criteria for treating patients with IMRT?
Response Response
Answer Options
Percent
Count
48,9%
23
Protocolized criteria
59,6%
28
Physician criteria dependent
9
Other
answered question
47
skipped question
17
19
Exists IMRT treatment protocol established by:
by:
Response Response
Answer Options
Percent
Count
81,3%
39
Locations
20,8%
10
Tumor type
10,4%
5
No protocol exists
5
Other (specify)
answered question
48
skipped question
16
20
Instrumental resources available for quality control verification of
IMRT planing
Response Response
Answer Options
Percent
Count
57,1%
28
EPID
67,3%
33
2D detector arrays
16,3%
8
3D cilindrical systems
14,3%
7
Radiografic films
83,7%
41
Radiochromic films
63,3%
31
Anthropomorfic phantoms
9
Other
answered question
49
skipped question
15
21
7
8/2/2012
Verification of treatment of patients with IMRT (Several times in the Hospital)
Answer Options
Response Percent
Response Count
89,8%
44
6,1%
3
4,1%
2
4,1%
2
Checks are performed for all patients treated with IMRT
Only checks are made for certain cases, pathologies or locations
Only perform checks on new cases not previously studied to have
enough statistics confirming the validity of the tecnique
Only a general check is made for the accelerators (with the frecuency
given by the quality control program)
Only IMRT specific controls in place (in addition to the quality control
program)
8,2%
4
RTPS controls are performed
38,8%
19
30,6%
15
Calculations made to confirm results
1
Other
22
answered question
skipped question
3
49
15
IGRT
23
Do you use IGRT techniques in your Hospital?
Answer Options
Yes
No
Comments
Response Response
Percent
Count
72,9%
27,1%
answered question
skipped question
43
16
12
59
5
24
8
8/2/2012
IGRT techniques used
Answer Options
Single planar image EPID
Plane image kV
Orthogonal plane images EPID
Orthogonal plane images kV
Reconstruction TC-kV
Reconstruction TC-MV
Ultrasound
Respiratoty gating
Tracking
Recognition of surfaces with structured light
Response
Percent
45,5%
25,0%
68,2%
45,5%
45,5%
18,2%
4,5%
18,2%
4,5%
2,3%
Response
Count
20
11
30
20
20
8
2
8
2
1
11
Other
answered question
skipped question
44
20
25
Are there criteria for selecting patients for treatment with IGRT?
Response
Response Count
Percent
78,6%
33
Protocolized
28,6%
12
Physician dependent
6
Other (specify)
answered question
42
skipped question
22
Answer Options
26
Protocol indication for use of IGRT
Answer Options
By locations
By type of tumors
there is no protocol
Other
Response Response
Percent
Count
66,7%
26
15,4%
6
17,9%
7
5
answered question
39
skipped question
25
27
9
8/2/2012
Instrumental resources for specific quality control , testing and
calibration of IGRT
Response Response
Answer Options
Percent
Count
41,7%
15
Phantom movements 2D
36,1%
13
Phantom movements 3D
22,2%
8
Radiografic film
52,8%
19
Radiocromic film
44,4%
16
Anthropomorphic phantom
9
Other
answered question
36
skipped question
28
28
Radiation dosimetry controls patients of IGRT
Response Response
Answer Options
Percent
Count
7,0%
3
In all patients
0,0%
0
between 50 - 100% of the patients
2,3%
1
Between 10 - 50 %
Is periodic quality control according to
60,5%
26
the CC protocol
32,6%
14
This verification is not
3
Other checking
answered question
43
skipped question
21
29
Number of LINACS capable of performing IGRT, whatever
technique is used.
Answer Options
Number
answered
question
skipped question
Response
Total
Response
Count
84
51
51
13
51
13
30
10
8/2/2012
Annual number of patients treated with IGRT techniques, whatever
this.
Answer Options
Response Response
Total
Count
Response Average
Number of patients
treated with IGRT
539,31
25.887
answered question
skipped question
48
48
16
48
16
31
Estimation of approximate occupation time of the accelerator to treat
a case with IGRT.
Response
Percent
Response
Count
Less than 20 minutes
67,4%
29
Between 20 and 30 minutes
34,9%
15
Between 30 and 45 minutes
4,7%
2
Over 45 minutes
0,0%
0
Answer Options
7
comment
4
7
answered question
43
43
skipped question
21
32
21
RADIOSURGERY
33
11
8/2/2012
Do you perform radiosurgery treatments at your hospital?
Response Response
Percent
Count
Answer Options
Yes
38,6%
22
No
61,4%
35
4
Comments
answered question
57
skipped question
7
34
Number of units with a capacity of radiosurgery
Answer Options
Response Average
Response Response
Total
Count
,84
Number
27
22
answered question
answered question
22
skipped question
skipped question
42
35
Number of patienes/year treated with radiosurgery
7
Number of hospitals
6
5
4
3
2
1
0
1
2
Less than 20 21- 40
3
41- 60
4
61- 80
5
81- 100
6
Over 100
36
12
8/2/2012
Number of patients treated with Radiosurgery/
Radiosurgery/ year (single sesion)
sesion)
Response Response Response
Answer Options
Average
Total
Count
43
942
22
Numero
29
answered question
35
skipped question
37
Estimation of approximate occupation time Linac for a case of
Radiosurgery VERIFY.
Response
Response
Answer Options
Percent
Count
50,0%
11
Less than 20 minutes
Between 20 and 30 minutes
22,7%
5
Between 30 and 45 minutes
18,2%
4
9,1%
2
3
Over 45 minutes
Coments
answered question
skipped question
22
42
38
Radiosurgery techniques commonly used (there may be multiple answers)
Response
Answer Options
Percent
50,0%
Cones colimation
26,9%
Multileaf collimation (thickness sheet 10 to 5 mm)
50,0%
Micro multileaf collimation micro (thickness less than 5 mm)
50,0%
IGRT
61,5%
Invasive fixation frame
65,4%
Thermoplastic mask fixation
50,0%
3D conformal planning
42,3%
IMRT planning
3,8%
Gammaknife
26,9%
Linac dedicated to radiosurgery
0,0%
Tomoterapia
7,7%
Cyberknike
Another distinctive feature of the technique and instrumentation used
Response Count
13
7
13
13
16
17
13
11
1
7
0
2
3
answered question
skipped question
26
38
39
13
8/2/2012
Are there criteria for selecting patients for treatment with
Radiosurgery
Response Response
Percent
Count
Answer Options
73,9%
26,1%
Protocolized
Physician dependent
Other (specify)
17
6
2
answered question
skipped question
23
41
40
Protocol indication for use of Radiosurgery
Response
Percent
Answer Options
By locations
By type of tumors
there is no protocol
Other
Response
Count
34,8%
8
60,9%
14
4,3%
1
1
answered question
23
skipped question
41
41
5 STEREOTATIC BODY
RADIOTHERAPY
SBRT
42
14
8/2/2012
Does SBRT treatments performed in your center?.
Respons Respons
e Percent e Count
Answer Options
38,2%
61,8%
Yes
No
Comment if you need
21
34
4
answered question
skipped question
55
9
43
Number of patients treated with SBRT / year
Response Response Response
Average
Total
Count
Answer Options
37,96
Number
987
21
answered question
21
skipped question
38
44
16
14
12
Hospitals
10
8
6
4
2
0
1
2
Less than
20 21- 40
3
41- 60
61- 480
81- 5100
6
Over
100
Number of patients treated with SBRT / year
45
15
8/2/2012
SBRT technique used (there may be multiple answers)
Answer Options
Cones colimation
Multileaf collimation (thickness sheet 10 to 5
mm)
Micro multileaf collimation micro (thickness
less than 5 mm)
IGRT (any technique)
Invasive fixation frame
Thermoplastic mask fixation
3D conformal planning
IMRT planning
Linac dedicated to SBRT
Tomoterapia
Cyberknike
Another distinctive feature of the technique and
instrumentation used
Response
Percent
12,5%
Response
Count
3
75,0%
18
29,2%
7
83,3%
0,0%
37,5%
70,8%
70,8%
25,0%
4,2%
8,3%
20
0
9
17
17
6
1
2
2
answered question
skipped question
24
46
40
Are there criteria for selecting patients for treatment with SBRT
Response Response
Percent
Count
Answer Options
65,2%
34,8%
Protocolized
Physician dependent
Other (specify)
15
8
3
answered question
skipped question
23
41
47
Protocol indication for use of SBRT
Answer Options
By locations
By type of tumors
there is no protocol
Other
Response
Percent
71,4%
23,8%
4,8%
Response
Count
15
5
1
2
answered question
21
skipped question
43
48
16
8/2/2012
Conclusions:
•Radiotherapy is strongly dependent on technology and this is evolving
constantly.
49
Conclusions:
•Radiotherapy is strongly dependent on technology and this is evolving
constantly.
• The ultimate goal of incorporating new technologies in the field of
radiotherapy is to deliver a superior or optimal dose of radiation to tumor
cells, without increasing the dose to normal tissue, resulting in a gain in
therapeutic results.
50
Conclusions:
•Radiotherapy is strongly dependent on technology and this is evolving
constantly.
• The ultimate goal of incorporating new technologies in the field of
radiotherapy is to deliver a superior or optimal dose of radiation to tumor
cells, without increasing the dose to normal tissue, resulting in a gain in
therapeutic results.
•The current situation of our country in relation to the incorporation of high
technology is slow growing, although it is difficult to draw clear
conclusions from the available surveys.
•.
51
17
8/2/2012
Conclusions:
•Radiotherapy is strongly dependent on technology and this is evolving
constantly.
• The ultimate goal of incorporating new technologies in the field of
radiotherapy is to deliver a superior or optimal dose of radiation to tumor
cells, without increasing the dose to normal tissue, resulting in a gain in
therapeutic results.
•The current situation of our country in relation to the incorporation of high
technology is slow growing, although it is difficult to draw clear
conclusions from the available surveys.
•. The incorporation of high technology in radiation therapy requires an
adequate investment plan, maintenance, staff and time.
52
Conclusions:
•Radiotherapy is strongly dependent on technology and this is evolving
constantly.
• The ultimate goal of incorporating new technologies in the field of
radiotherapy is to deliver a superior or optimal dose of radiation to tumor
cells, without increasing the dose to normal tissue, resulting in a gain in
therapeutic results.
•The current situation of our country in relation to the incorporation of high
technology is slow growing, although it is difficult to draw clear
conclusions from the available surveys.
•. The incorporation of high technology in radiation therapy requires an
adequate investment plan, maintenance, staff and time .
•The potential benefits of dose escalation, increased local control and
reduced toxicity are evident, even they can originate new indications for
treatment with radiation oncology situations.
53
Conclusions:
•Radiotherapy is strongly dependent on technology and this is evolving
constantly.
• The ultimate goal of incorporating new technologies in the field of
radiotherapy is to deliver a superior or optimal dose of radiation to tumor
cells, without increasing the dose to normal tissue, resulting in a gain in
therapeutic results.
•The current situation of our country in relation to the incorporation of high
technology is slow growing, although it is difficult to draw clear
conclusions from the available surveys.
•. The incorporation of high technology in radiation therapy requires an
adequate investment plan, maintenance, staff and time.
•The potential benefits of dose escalation, increased local control and
reduced toxicity are evident, even they can originate new indications for
treatment with radiation oncology situations.
•As a result of all this effort a high precision and safe radiotherapy which
irradiates high doses is actually present in my country.
54
18
8/2/2012
Conclusions:
•Radiotherapy is strongly dependent on technology and this is evolving
constantly.
• The ultimate goal of incorporating new technologies in the field of
radiotherapy is to deliver a superior or optimal dose of radiation to tumor
cells, without increasing the dose to normal tissue, resulting in a gain in
therapeutic results.
•The current situation of our country in relation to the incorporation of high
technology is slow growing, although it is difficult to draw clear
conclusions from the available surveys.
•. The incorporation of high technology in radiation therapy requires an
adequate investment plan, maintenance, staff and time.
•The potential benefits of dose escalation, increased local control and
reduced toxicity are evident, even they can originate new indications for
treatment with radiation oncology situations.
•As a result of all this effort a high precision and safe radiotherapy which
irradiates high doses is actually present in my country.
•This situation can be lost if there isn´t a continuous investment the next
55
years.
Thanks for your attention
56
19