1 / 25

Virtual Simulation in the Radiooncology Department of B-A-Z County Hospital Miskolc

Virtual Simulation in the Radiooncology Department of B-A-Z County Hospital Miskolc. Imre Geszti Certificated Clinical Radiophysicist Miskolc Hungary. Short History. Early ’60s Superficial Skin Therapy (Chaoul, Dermopan)

orsin
Download Presentation

Virtual Simulation in the Radiooncology Department of B-A-Z County Hospital Miskolc

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Virtual Simulation in the Radiooncology Department of B-A-Z County Hospital Miskolc Imre Geszti Certificated Clinical Radiophysicist Miskolc Hungary

  2. Short History • Early ’60s Superficial Skin Therapy (Chaoul, Dermopan) • 1974 Founded of the Department of Radiooncology, Teletherapy (Cs, Co therapy) • 1975 Brachytherapy (GUA) • 1977 National Therapy Planning Networking System • Transverse sectioning device • 1991 PC based therapy planning (van de Geijn) • 1994 Theratron 780c, Gammamed 12i (Gammadot TPS for brachytherapy) • 2002 Siemens Primus Dual Energy, digital linac machine, Siemens SimView NT conventional Simulator, real 3D CT based TPS (CMS XiO), connection to the hospital CT scanner via the network system • 2005-2007 Intracranial Stereotaxia (Brainlab) (ended by „politics”) • 2007 Siemens Oncor Impression linac, Siemens Somatom sensation Open CT Simulator (LAP Dorado laser system, Coherence Dosimetris Workstation) • 2008 2nd Oncor linac • 2014 ? IMRT, IGRT, (VMAT or RapidArc?), SRS, new Brachytarapy equipment, TPS

  3. Devices I. • Conventional RT Simulator • Siemens SimView NT (2002) • Image intensifier • DICOM Image server • Every Images are DICOM based

  4. Conventional RT Simulator Digitaly based imaging

  5. Devices II. • CT Simulator • Siemens SOMATOM Sensation Open (2007) • CT with flat table top • LAP Dorado Laser system • Coherence Dosimetrist (Virtual Simulator Software) workstation

  6. Siemens Somatom Sensation Open CT simulator, Coherence Dosimetrist ws LAP Dorado laser system

  7. Devices III. • For delineation, and verification • Coherence Oncologist • TPS • CMS XiO • Permedics Odyssey

  8. Virtual SimulationOlder methodology • Presimulation in conventional Simulator • Marking of the center of the region • Processing CT Images • In another department (not the same building) • Sending via network (advanced version) • Sending via CD-, DVD-ROM • 3D Therapy Planning system • Contouring • Planning • Processing of DRRs, hardcopy of isocentric plain • Simulation after the planning • Mark the sign of the „Isocenter” • Verification • Film • EPID

  9. Virtual SimulationNewer methodology I. • Pre- and postplanning processing in one step • Patient positioning • AP topogram (fix tube position) • Selecting the region • CT Imeges • Possible postprocessing (changing kernels or other processing details slice thickness etc.) • Sending the images

  10. Virtual Simulation Newer methodology II. • VSim software • Delineating (Skin, OAR, PTV) • Reference point managment • Other DICOM format images registration (fusion of images) (MRI, Diagnostic CT, PET etc.) • Virtual beam simulation • Room-, Beam eye view • Virtual machine • Without dose calculation

  11. Workflow diagram (CT Simulator) Patient registration Patient positioning Defining laser origin Region selction CT topogram Starting position CT scanning Image transfer Image import Ref. point marking Ref. Point management Skin Contouring Laser, table coordinates Marking on patient skin Other details, postprocesses

  12. CT-CT fusion Without contrast With contrast

  13. CT-MR fusion CT MR

  14. CT-PET fusion CT PET

  15. More spectacular fusion of PET and CT • Easier to find the correct place of tumor, and involved tissue volume

  16. Creation of the virtual beams

  17. Therapy planning preprocedure • Plan calculation (3D TPSs) • Parameter changing possibilities (comformalization of MLCs, selecting adequate beam energies, wedges etc.) • Making hardcopies (images of slices, plan parametres) • DRRs (paper based, and digitaly format) • Parametres for R&V (Lantis)

  18. Random error From inadequate positioning Changes of the patient weight From device (laser, table, light field etc.) Intended deviation Replace the reference point for better dose distribution For using different centre of treating volumes (whole breast vs. tumor bed) Deviations

  19. Verification I. • Optivue 500 Flat panels on Oncor Impression linacs (semiconductor based EPID) • Coherence Therapist workstations • Dedicated for both of the Oncor machines • Possibilities of Portal Imaging application • Fusion of digital format Portal or Verificational Image with DRRs • 3 directions (lat., long., vert.) eliminate deviations in 1 mm resolution

  20. Verification II. DRR with contours Portal Image (6MV X-ray EPID) Fused Images

  21. Verification III.Bony structure based Bony structure based registration

  22. Verification IV.Inplanted marker based Relative to inplanted markers Prostate case More precise if we can use some „Gold markers” Differencies relative to DRR it needs to adjust

  23. Important considerations • Accuracy of patient treatment • Precise lasers, • Table top (roll, tilt) • Rotating • Deflection • Patient fixation • Verification on Linacs • No soft tissue sensitivity (relative to bony structure) • No tissue moving or respiration tracking • So we believe we’ll have IGRT the near future • Human factor. What do they contour, where is the real tumor or tumor bed?

  24. Thank you for your attention Happy birthday for Prof. Matula

More Related