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CT simulation for radiotherapy treatment planning

E G A Aird, MSc, PhD, FIPEM 1 and J Conway, BSc, PhD, MIPEM 2

1 Medical Physics Department, Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex HA6 2RN and 2 Department of Radiotherapy Physics, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK



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  		Figure 1. Schematic of CT simulator and associated systems. DRR, digitally reconstructed radiograph; EPI, electronic portal imaging; PET, positron emmission tomography; RTP, radiotherapy treatment planning.

 


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  		Figure 2. Large bore (85 cm physical aperture) oncology CT scanner showing breast patient positioning (photo reproduced by permission of Phillips Medical Systems).

 


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  		Figure 3. Localization: a suitable "patient origin" (isocentre) is marked as the centre of the purple triangle (mark-up). These coordinates are sent to the laser system and the patient marked. All plan isocentres are related to this mark in terms of "shift coordinates".

 


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  		Figure 4. Verification: the "shift coordinates" represent the relationship between the isocentre and the "patient marked origin" to be used for treatment setup. All field digitally reconstructed radiographs are exported for portal verification on the linear accelerator.

 


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  		Figure 5. (a) Virtual simulation planning of tangential breast fields. Collimator and table angle to provide matching borders are obtained from multiple window views.

 


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  		Figure 5. (b) Virtual verification of a carcinoma of the tongue. The purple triangle represents the plane containing the "patient origin" reference point from which the position of the isocentre gives the "shift coordinates".

 


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  		Figure 5. (c) Localization of a chest lesion using virtual fluoroscopy. Anteroposterior and lateral virtual radiographs (digitally reconstructed radiographs) show the isocentre in simulator and CT views.

 




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