Somvilai Mayurasakorn, MD.
Division of Therapeutic Radiology and Oncology,
Faculty of Medicine, Chiang Mai University
Helical Tomotherapy
Tomotherapy Planning Parameters
• Smaller field widths, smaller pitches and
higher modulation factors
More conformal plans
But increased treatment time !!
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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
Image matching
Dept. of Radiation Oncology M.D. Anderson Cancer Center Orlando
Dept. of Radiation Oncology M.D. Anderson Cancer Center Orlando
Helical Tomotherapy
Dept. of Radiation Oncology M.D. Anderson Cancer Center Orlando
Helical Tomotherapy
Palma et al. Cancer Treatment Reviews 2010;36 :393–399
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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
• Successful implementation of Tomotherapy
Careful planning and effective teamwork
Daily image guidance
Positional correction
Intensity-modulated delivery
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
Tomotherapy Treatment Centers in Asia-Pacific
•
Taiwan
–
–
–
–
–
–
–
•
•
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
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
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
–
–
–
–
•
•
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
Quality Depends on Number of Beams
COMING SOON
1 Beam
5 Beams
11 Beams
17 Beams
25 Beams
51 Beams
Helical Tomotherapy
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
STERZING et al. Int. J. Radiation Oncology Biol. Phys. 2010;76 (4):1266–1273
Helical Tomotherapy
• 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
Gross Tumor Volume (GTV)
GTV contour definition
GTV1
The primary tumor (GTV 1)
A 1 cm peripherally
enhancing lymph node
(GTV2)
GTV2