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Is tomotherapy the future of IMRT?

Department of Medical Physics, Hull and East Yorkshire NHS Trust and Post Graduate Medical Institute, University of Hull and Princess Royal Hospital, Saltshouse Road, Kingston Upon Hull HU8 9HE, UK

View larger version (125K): [in a new window]   Figure 1. The helical tomotherapy treatment unit.

View larger version (39K): [in a new window]   Figure 2. The treatment arcs are delivered in a spiral, or helical, manner in the fashion now familiar on spiral CT. This has removed the need for manual translation of the patient as in the ground-breaking serial tomotherapy (NOMOS) treatment methodology.

View larger version (18K): [in a new window]   Figure 3. Schematic of the beam-line, illustrating the integration of the therapy Linac with the MVCT detectors. MLC, multileaf collimator.

View larger version (78K): [in a new window]   Figure 4. A mega voltage CT image obtained on the tomotherapy is shown on the left and a kV CT planning image on the right. The former does not suffer with the dental-filling artefacts present in the planning data set. Though the MVCT is intended as a verification tool for image guidance it is clear that other benefits may be apparent for planning. We also note that sufficient soft tissue contrast is present to demonstrate the position of the parotid glands in the MVCT.

View larger version (53K): [in a new window]   Figure 5. (a) An oesophagus treatment, the isodose levels given in the key or in units of Gy. This treatment took 12 min 24 s to deliver. Courtesy of Dr D Cho of the Southeast Regional cancer Centre in Tallahassee, Florida, USA. (b) The cumulative dose–volume histogram obtained for the treatment whose isodose distribution is shown in (a). The colours of the curves relate to the structures shown in the images.

View larger version (81K): [in a new window]   Figure 6. A sagittal reconstruction from the MVCT verification data set is shown in the top left box and the corresponding image from the planning data set underneath. The tinted blocks in the "checker-board" show the MVCT data. Once again the aberrations in the kV image due to prosthesis are not evident in the MV image. This figure was kindly provided by Dr Chester Ramsey III of the Thompson Cancer Survival Centre, Knoxville, Tennessee, USA.

View larger version (44K): [in a new window]   Figure 7. The adaptive radiotherapy process map as defined by Mackie. The importance of an integrated volumetric imaging system in the treatment system is apparent from this diagram.

View larger version (75K): [in a new window]   Figure 8. High dose gradients that can be formed at structure interfaces due to the high number of beamlets etc. This treatment took 4 min 47 s to deliver. Courtesy of Dr D Cho of the Southeast Regional Cancer Centre in Tallahassee, Florida, USA.

View larger version (71K): [in a new window]   Figure 9. A planning study of a total marrow irradiation protocol. In this simulation the bones are the planning target volumes and the soft tissues of the body are designated as the organs at risk. Courtesy of Dr T Schultheiss of the City of Hope Comprehensive Cancer Centre, California, USA.