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      Tomotherapy – a different way of dose delivery in radiotherapy

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          Abstract

          Aim of the study

          Helical tomotherapy is one of the methods of radiotherapy. This method enables treatment implementation for a wide spectrum of clinical cases. The vast array of therapeutic uses of helical tomotherapy results directly from the method of dose delivery, which is significantly different from the classic method developed for conventional linear accelerators. The paper discusses the method of dose delivery by a tomotherapy machine. Moreover, an analysis and presentation of treatment plans was performed in order to show the therapeutic possibilities of the applied technology. Dose distributions were obtained for anaplastic medulloblastoma, multifocal metastases to brain, vulva cancer, tongue cancer, metastases to bones, and advanced skin cancer. Tomotherapy treatment plans were compared with conventional linear accelerator plans.

          Results

          Following the comparative analysis of tomotherapy and conventional linear accelerator plans, in each case we obtained the increase in dose distribution conformity manifested in greater homogeneity of doses in the radiation target area for anaplastic medulloblastoma, multifocal metastases to brain, vulva cancer, metastases to bones, and advanced skin cancer, and the reduction of doses in organs at risk (OAR) for anaplastic medulloblastoma, vulva cancer, tongue cancer, and advanced skin cancer. The time of treatment delivery in the case of a tomotherapy machine is comparable to the implementation of the plan prepared in intensity-modulated radiotherapy (IMRT) technique for a conventional linear accelerator. In the case of tomotherapy the application of a fractional dose was carried out in each case during one working period of the machine. For a conventional linear accelerator the total value of the fractional dose in the case of anaplastic medulloblastoma and metastases to bones was delivered using several treatment plans, for which a change of set-up was necessary during a fraction.

          Conclusion

          The obtained results confirm that tomotherapy offers the possibility to obtain precise treatment plans together with the simplification of the therapeutic system.

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          Most cited references44

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          Volumetric modulated arc therapy: IMRT in a single gantry arc.

          Karl-Otto Bischoff (2007)
          In this work a novel plan optimization platform is presented where treatment is delivered efficiently and accurately in a single dynamically modulated arc. Improvements in patient care achieved through image-guided positioning and plan adaptation have resulted in an increase in overall treatment times. Intensity-modulated radiation therapy (IMRT) has also increased treatment time by requiring a larger number of beam directions, increased monitor units (MU), and, in the case of tomotherapy, a slice-by-slice delivery. In order to maintain a similar level of patient throughput it will be necessary to increase the efficiency of treatment delivery. The solution proposed here is a novel aperture-based algorithm for treatment plan optimization where dose is delivered during a single gantry arc of up to 360 deg. The technique is similar to tomotherapy in that a full 360 deg of beam directions are available for optimization but is fundamentally different in that the entire dose volume is delivered in a single source rotation. The new technique is referred to as volumetric modulated arc therapy (VMAT). Multileaf collimator (MLC) leaf motion and number of MU per degree of gantry rotation is restricted during the optimization so that gantry rotation speed, leaf translation speed, and dose rate maxima do not excessively limit the delivery efficiency. During planning, investigators model continuous gantry motion by a coarse sampling of static gantry positions and fluence maps or MLC aperture shapes. The technique presented here is unique in that gantry and MLC position sampling is progressively increased throughout the optimization. Using the full gantry range will theoretically provide increased flexibility in generating highly conformal treatment plans. In practice, the additional flexibility is somewhat negated by the additional constraints placed on the amount of MLC leaf motion between gantry samples. A series of studies are performed that characterize the relationship between gantry and MLC sampling, dose modeling accuracy, and optimization time. Results show that gantry angle and MLC sample spacing as low as 1 deg and 0.5 cm, respectively, is desirable for accurate dose modeling. It is also shown that reducing the sample spacing dramatically reduces the ability of the optimization to arrive at a solution. The competing benefits of having small and large sample spacing are mutually realized using the progressive sampling technique described here. Preliminary results show that plans generated with VMAT optimization exhibit dose distributions equivalent or superior to static gantry IMRT. Timing studies have shown that the VMAT technique is well suited for on-line verification and adaptation with delivery times that are reduced to approximately 1.5-3 min for a 200 cGy fraction.
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            History of tomotherapy.

            T R Mackie (2006)
            Tomotherapy is the delivery of intensity modulated radiation therapy using rotational delivery of a fan beam in the manner of a CT scanner. In helical tomotherapy the couch and gantry are in continuous motion akin to a helical CT scanner. Helical tomotherapy is inherently capable of acquiring CT images of the patient in treatment position and using this information for image guidance. This review documents technological advancements of the field concentrating on the conceptual beginnings through to its first clinical implementation. The history of helical tomotherapy is also a story of technology migration from academic research to a university-industrial partnership, and finally to commercialization and widespread clinical use.
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              Optimization of stationary and moving beam radiation therapy techniques.

              A Brahme (1988)
              A new approach is suggested for the optimization of stationary and more general moving beam type of irradiations. The method reverses the order of conventional treatment planning as it derives the optimum incident beam dose distributions from the desired dose distribution in the target volume. It is therefore deterministic and largely avoids the trial and error approach often applied in treatment planning of today. Based on the approximate spatial invariance of the convergent beam point irradiation dose distribution, the desired dose distribution in the target volume is analyzed in terms of the optimum density of such point irradiations. Since each point irradiation distribution is optimal for the irradiation of a given point and due to the linearity of individual energy depositions or absorbed dose contributions, the resultant point irradiation density will also generate the best possible irradiation of an extended target volume when the maximum absorbed dose at a certain distance from the target should be minimized. The optimum shape of the incident beam for each position of the gantry is obtained simply by inverse back projection of the point irradiation density on the position of the radiation source for that orientation of the incident beam.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Contemp Oncol (Pozn)
                Journal ID (iso-abbrev): Contemp Oncol (Pozn)
                Journal ID (publisher-id): WO
                Title: Contemporary Oncology
                Publisher: Termedia Publishing House
                ISSN (Print): 1428-2526
                ISSN (Electronic): 1897-4309
                Publication date (Electronic): 29 February 2012
                Publication date (Print): 2012
                Volume: 16
                Issue: 1
                Pages: 16-25
                Affiliations
                [1 ]Department of Electroradiology, Poznan University of Medical Sciences, Poland
                [2 ]Department of Medical Physics, Greater Poland Cancer Centre, Poznań, Poland
                [3 ]Department of Radiotherapy II, Greater Poland Cancer Centre, Poznań, Poland
                [4 ]Second Radiotherapy Ward, Greater Poland Cancer Centre, Poznań, Poland
                [5 ]Third Radiotherapy Ward, Greater Poland Cancer Centre, Poznań, Poland
                [6 ]Department of Radiotherapy I, Greater Poland Cancer Centre, Poznań, Poland
                [7 ]Gynaecological Radiotherapy Ward, Greater Poland Cancer Centre, Poznań, Poland
                Author notes
                Address for correspondence: Tomasz Piotrowski PhD, Zakład Fizyki Medycznej, Wielkopolskie Centrum Onkologii, ul. Garbary 15, 61-866 Poznań. tel. +48 61 885 07 63. e-mail: tomasz.piotrowski@ 123456me.com
                Article
                Publisher ID: 18249
                DOI: 10.5114/wo.2012.27332
                PMC ID: 3687380
                PubMed ID: 23788850
                SO-VID: 241070a4-010c-41c7-8d13-34c8a3659a59
                Copyright © Copyright © 2012 Termedia
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 March 2011
                Date revision received : 21 September 2011
                Date accepted : 18 January 2012
                Categories
                Subject: Original Paper

                Keywords: helical tomotherapy,imrt,treatment planning,evaluation of the dose distribution
                Data availability:
                Keywords: helical tomotherapy, imrt, treatment planning, evaluation of the dose distribution

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