Para spinal tumors encircling the spinal cord imrt
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Para-spinal Tumors Encircling the Spinal Cord IMRT PowerPoint PPT Presentation


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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

Para-spinal Tumors Encircling the Spinal Cord IMRT

Comparison of Several Target Definitions


Para spinal tumors encircling the spinal cord imrt

SLICE 116

CTVSuperior

Brain stem and L & R eyes


Para spinal tumors encircling the spinal cord imrt

Slice 104

CTV , Spinal cord

L & R Parotid glands


Para spinal tumors encircling the spinal cord imrt

Slice 83 Mid Volume CTV

3 – 5 mm separation between spinal cord and CTV


Para spinal tumors encircling the spinal cord imrt

Slice 63

Inferior CTV

13 mm Separation of spinal cord and CTV


Planning volumes

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


Para spinal tumors encircling the spinal cord imrt

Beam Arrangement

Gantry0

Gantry 40

Gantry80

Gantry160

Gantry200

Gantry315


Basic target type

Basic Target Type


Para spinal tumors encircling the spinal cord imrt

Dose Statistics

63 Gy

Target Type Basic


Para spinal tumors encircling the spinal cord imrt

DVH 63 Gy

Target Type Basic

63 Gy @ ~76% Volume


Isodose slice 104 basic

Isodose Slice 104 Basic


Homogenous target type

Homogenous Target Type


Para spinal tumors encircling the spinal cord imrt

Dose Statistics

63 Gy

Target Type Homogenous


Para spinal tumors encircling the spinal cord imrt

DVH 63 Gy

Target Type Homogenous

63Gy @ ~46 % Volume


Isodose slice 104 homogenous

Isodose Slice 104 Homogenous


Imrs target type

IMRS Target Type


Para spinal tumors encircling the spinal cord imrt

Dose Statistics

63 Gy

Target Type IMRS

Emphasizes Conformality


Para spinal tumors encircling the spinal cord imrt

DVH 63 Gy

Target Type IMRS

63Gy @ ~90% Volume


Isodose slice 104 imrs

Isodose Slice 104 IMRS


Para spinal tumors encircling the spinal cord imrt

Esophagus IMRT Sparing Kidneys and Spinal Cord


Para spinal tumors encircling the spinal cord imrt

DVH 50.4Gy


Para spinal tumors encircling the spinal cord imrt

IMRT 5 Field IMRT with Intensity Maps


Para spinal tumors encircling the spinal cord imrt

Intensity Levels 10

Step Increment 1cm

MLC leaf 1cm


Step increment

Step Increment

1cm step with 0.5cm MLC

0.5cm step with 0.5cm MLC

9991-959-08C


Para spinal tumors encircling the spinal cord imrt

Intensity Level Comparison


Para spinal tumors encircling the spinal cord imrt

Lung IMRT 60 Gy 5 Field 6 MV X-rays


Para spinal tumors encircling the spinal cord imrt

Lung IMRT DVH


Para spinal tumors encircling the spinal cord imrt

Large Field IMRT Plan with Dose Painting


Para spinal tumors encircling the spinal cord imrt

Large Complex Treatment Volume

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

an 16 MeV electron field


Para spinal tumors encircling the spinal cord imrt

IMRT plan avoiding spinal cord and kidneys

Superior Tumor Volumes


Para spinal tumors encircling the spinal cord imrt

Treatment Volumes Lower Abdomen


Para spinal tumors encircling the spinal cord imrt

Treatment Volume Change in Dose Nodal Volume


Para spinal tumors encircling the spinal cord imrt

Treatment Volume Pelvis Superficial Nodes


Para spinal tumors encircling the spinal cord imrt

Inferior Volumes Increase in Dose Using an Electron Field


Electron beam characteristics

ELECTRON BEAM CHARACTERISTICS


Para spinal tumors encircling the spinal cord imrt

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


Para spinal tumors encircling the spinal cord imrt

Isodose Curves for 7 and 18 Mev Electron Beams


Para spinal tumors encircling the spinal cord imrt

Small Fields with Photon Component


Para spinal tumors encircling the spinal cord imrt

12 Mev Beam at 00

12 Mev beam at 400


Para spinal tumors encircling the spinal cord imrt

12 Mev Beam with Density Correction


Para spinal tumors encircling the spinal cord imrt

AXILA TANGENTS & ELECTRON BOOST


Para spinal tumors encircling the spinal cord imrt

Breast Boost Technique


Para spinal tumors encircling the spinal cord imrt

9 Mev Electron Boost Posterior Neck Nodes


Para spinal tumors encircling the spinal cord imrt

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.


Para spinal tumors encircling the spinal cord imrt

IORT Isodose Curve 15 Mev Electron Beam


Para spinal tumors encircling the spinal cord imrt

ORIGINAL HARD DOCKING COX LL

STANDARD LINEAR ACCELERATOR


Para spinal tumors encircling the spinal cord imrt

MGH

SOFT DOCKING

LASER SYSTEM IN

HEAD OF MACHINE


Para spinal tumors encircling the spinal cord imrt

MOBETRON INTRA-OP ACCELERATOR


Para spinal tumors encircling the spinal cord imrt

MOBETRON HARD DOCKING

Energies Available

4, 6, 9 & 12 Mev


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