Para spinal tumors encircling the spinal cord imrt
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Para-spinal Tumors Encircling the Spinal Cord IMRT. Comparison of Several Target Definitions. SLICE 116 CTV Superior Brain stem and L & R eyes. Slice 104 CTV , Spinal cord L & R Parotid glands. Slice 83 Mid Volume CTV 3 – 5 mm separation between spinal cord and CTV.

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Para-spinal Tumors Encircling the Spinal Cord IMRT

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Para-spinal Tumors Encircling the Spinal Cord IMRT

Comparison of Several Target Definitions


SLICE 116

CTVSuperior

Brain stem and L & R eyes


Slice 104

CTV , Spinal cord

L & R Parotid glands


Slice 83 Mid Volume CTV

3 – 5 mm separation between spinal cord and CTV


Slice 63

Inferior CTV

13 mm Separation of spinal cord and CTV


Planning Volumes

CTV3mm Expansion63 Gy

Spinal Cord3mm Expansion43 Gy

Rt & Lt Eyes3mm Expansion3 Gy

Brain Stem3mm Expansion43Gy

Parotid Glands3mm Expansion30 Gy


Beam Arrangement


Beam Arrangement

Gantry0

Gantry 40

Gantry80

Gantry160

Gantry200

Gantry315


Basic Target Type


Dose Statistics

63 Gy

Target Type Basic


DVH 63 Gy

Target Type Basic

63 Gy @ ~76% Volume


Isodose Slice 104 Basic


Homogenous Target Type


Dose Statistics

63 Gy

Target Type Homogenous


DVH 63 Gy

Target Type Homogenous

63Gy @ ~46 % Volume


Isodose Slice 104 Homogenous


IMRS Target Type


Dose Statistics

63 Gy

Target Type IMRS

Emphasizes Conformality


DVH 63 Gy

Target Type IMRS

63Gy @ ~90% Volume


Isodose Slice 104 IMRS


Esophagus IMRT Sparing Kidneys and Spinal Cord


DVH 50.4Gy


IMRT 5 Field IMRT with Intensity Maps


Intensity Levels 10

Step Increment 1cm

MLC leaf 1cm


Step Increment

1cm step with 0.5cm MLC

0.5cm step with 0.5cm MLC

9991-959-08C


Intensity Level Comparison


Lung IMRT 60 Gy 5 Field 6 MV X-rays


Lung IMRT DVH


Large Field IMRT Plan with Dose Painting


Large Complex Treatment Volume

Long (~ 60 cm) volume needed 27 junctioned IMRT fields and

an 16 MeV electron field


IMRT plan avoiding spinal cord and kidneys

Superior Tumor Volumes


Treatment Volumes Lower Abdomen


Treatment Volume Change in Dose Nodal Volume


Treatment Volume Pelvis Superficial Nodes


Inferior Volumes Increase in Dose Using an Electron Field


ELECTRON BEAM CHARACTERISTICS


Location of (a)Flattening Filter and (b) Electron Scattering Foils


Isodose Curves for 7 and 18 Mev Electron Beams


Small Fields with Photon Component


12 Mev Beam at 00

12 Mev beam at 400


12 Mev Beam with Density Correction


AXILA TANGENTS & ELECTRON BOOST


Breast Boost Technique


9 Mev Electron Boost Posterior Neck Nodes


Interoperative Radiation Therapy

The benefit of IORT normal tissues are removed from

the treatment fields and the dose is delivered locally.

The enengy of the electron beams used is usually between

9-16 Mev.

The use in the country has been developed used at large

medical centers.


IORT Isodose Curve 15 Mev Electron Beam


ORIGINAL HARD DOCKING COX LL

STANDARD LINEAR ACCELERATOR


MGH

SOFT DOCKING

LASER SYSTEM IN

HEAD OF MACHINE


MOBETRON INTRA-OP ACCELERATOR


MOBETRON HARD DOCKING

Energies Available

4, 6, 9 & 12 Mev


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