Flipping Book- BTP
|
L1. Introduction to treatment planning_physicist perspective_Final upload 2015 |
8 |
|
Slide Number 1 |
8 |
|
Slide Number 2 |
9 |
|
Slide Number 3 |
10 |
|
Slide Number 4 |
11 |
|
Ionizing Radiation in Radiotherapy? |
12 |
|
Slide Number 6 |
13 |
|
Treatment Unit Head Design |
14 |
|
Photons and electrons |
15 |
|
Photon interaction with matter (atoms) |
16 |
|
Photon interaction with matter (water) |
17 |
|
Photon interaction with matter (water) |
18 |
|
Photon interaction with matter (water) |
19 |
|
Absorbed Dose – Gray [Gy] |
20 |
|
Absolute Dose - Linac |
21 |
|
Dose distribution in water (depth dose) |
22 |
|
Photon Intensity Attenuation- Inverse Square Law |
23 |
|
Depth dose (different engergy) |
24 |
|
Dose Distribution in Water (profiles) |
25 |
|
Dose Distribution in Water (profiles) |
26 |
|
Dose dependence (field size) |
27 |
|
For the given situation what will happen with the dose? |
28 |
|
Dose dependence (field size) |
29 |
|
Dose dependence (field size) |
30 |
|
Beam Modifications - Wedges |
31 |
|
Beam Modifications – Wegdes |
32 |
|
Dose Calculation Models |
33 |
|
Slide Number 27 |
34 |
|
Dose Calculation Accuracy |
35 |
|
Dose calculation models |
36 |
|
Treatment planning |
37 |
|
Treatment planning |
38 |
|
Treatment planning |
39 |
|
Treatment planning |
40 |
|
Slide Number 34 |
41 |
|
How do you plan ”more simple” cases (e.g. palliative and breast) at your department? |
42 |
|
Delineation of structures (3D) |
43 |
|
Evaluation of Dose (3D) |
44 |
|
Evaluation of Dose Volume Histograms |
45 |
|
Dose Volume Histogram |
46 |
|
Dose Volume (Area) Histogram |
47 |
|
Dose Volume (Area) Histogram |
48 |
|
Dose Volume (Area) Histogram |
49 |
|
Dose Volume Histogram |
50 |
|
Dose Volume Histogram |
51 |
|
Dose Volume Histogram |
52 |
|
Dose Volume Histogram |
53 |
|
Dose Volume Histogram |
54 |
|
Dose Volume Histogram |
55 |
|
Dose Volume Histogram |
56 |
|
Dose Volume Histogram |
57 |
|
Dose Volume Histogram |
58 |
|
Dose Volume Histogram |
59 |
|
Dose Volume Histogram |
60 |
|
Dose Volume Histogram |
61 |
|
Dose Volume Histogram |
62 |
|
Thank you for your attention |
63 |
|
L2. Introduction to BTP-oncologist persepctive-PK |
64 |
|
Introduction to Treatment Planning |
64 |
|
Principles of Radiotherapy |
65 |
|
Clinical Relevance of the Radiotherapy Plan |
66 |
|
Clinical Relevance |
67 |
|
Treatment Intent |
68 |
|
Treatment Intent |
69 |
|
Treatment Intent |
70 |
|
The Ideal Plan |
71 |
|
The Ideal Plan |
72 |
|
Typical DVH Prostate Radiotherapy |
73 |
|
The reality: Competing priorities |
74 |
|
Concept of Therapeutic Index |
75 |
|
Slide Number 13 |
76 |
|
Slide Number 14 |
77 |
|
Slide Number 15 |
78 |
|
Slide Number 16 |
79 |
|
Dose Volume Constraints |
80 |
|
Importance of Target Coverage |
81 |
|
Risks of Poor Target Coverage |
82 |
|
Importance of homogeneity [95-107%] |
83 |
|
Optic chiasm homogeneity |
84 |
|
Optic chiasm homogeneity |
85 |
|
Acute side effects of radiation |
86 |
|
Late Effects in Radiation Oncology |
87 |
|
L3. ICRU recommendations on Volume and Dose_DS |
88 |
|
ICRU |
88 |
|
Background |
89 |
|
Background |
90 |
|
Background |
91 |
|
Slide Number 5 |
92 |
|
Slide Number 7 |
93 |
|
Slide Number 8 |
94 |
|
Slide Number 9 |
95 |
|
Slide Number 10 |
96 |
|
Slide Number 12 |
97 |
|
Slide Number 13 |
98 |
|
Slide Number 14 |
99 |
|
Slide Number 15 |
100 |
|
Slide Number 16 |
101 |
|
Slide Number 17 |
102 |
|
Slide Number 18 |
103 |
|
Slide Number 19 |
104 |
|
Slide Number 20 |
105 |
|
Slide Number 23 |
106 |
|
Slide Number 24 |
107 |
|
Slide Number 25 |
108 |
|
Slide Number 26 |
109 |
|
Slide Number 27 |
110 |
|
Slide Number 28 |
111 |
|
Slide Number 29 |
112 |
|
Slide Number 30 |
113 |
|
Slide Number 31 |
114 |
|
Slide Number 33 |
115 |
|
Slide Number 34 |
116 |
|
Slide Number 36 |
117 |
|
Slide Number 37 |
118 |
|
Slide Number 38 |
119 |
|
Slide Number 39 |
120 |
|
Slide Number 40 |
121 |
|
Slide Number 41 |
122 |
|
Slide Number 42 |
123 |
|
Population Setup Errors |
124 |
|
Slide Number 44 |
125 |
|
Slide Number 46 |
126 |
|
Slide Number 47 |
127 |
|
Example IGRT |
128 |
|
Slide Number 49 |
129 |
|
Slide Number 50 |
130 |
|
Slide Number 52 |
131 |
|
Slide Number 53 |
132 |
|
Slide Number 55 |
133 |
|
Slide Number 56 |
134 |
|
Slide Number 57 |
135 |
|
Slide Number 58 |
136 |
|
Slide Number 59 |
137 |
|
Slide Number 60 |
138 |
|
Slide Number 61 |
139 |
|
Slide Number 64 |
140 |
|
Slide Number 65 |
141 |
|
Slide Number 67 |
142 |
|
Slide Number 68 |
143 |
|
Slide Number 69 |
144 |
|
Slide Number 70 |
145 |
|
Slide Number 73 |
146 |
|
Slide Number 75 |
147 |
|
Slide Number 76 |
148 |
|
Slide Number 77 |
149 |
|
ICRU recommendations on Dose |
150 |
|
Slide Number 79 |
151 |
|
Slide Number 80 |
152 |
|
Slide Number 81 |
153 |
|
Slide Number 83 |
154 |
|
Slide Number 84 |
155 |
|
Slide Number 88 |
156 |
|
Slide Number 89 |
157 |
|
Slide Number 90 |
158 |
|
Slide Number 92 |
159 |
|
Slide Number 93 |
160 |
|
Slide Number 94 |
161 |
|
Slide Number 95 |
162 |
|
Slide Number 96 |
163 |
|
Slide Number 97 |
164 |
|
L4. Treatment planning - tools and general principles part 1 |
165 |
|
Treatment Planning: Tools and General Principles |
165 |
|
Learning Outcomes |
166 |
|
Steps in the 3D Conformal Treatment Planning Process |
167 |
|
3D Conformal Treatment Planning |
168 |
|
Optimisation |
169 |
|
Fixed FSD vs. Isocentric Single Field |
170 |
|
Fixed FSD vs. Isocentric Dose Single Field |
171 |
|
Fixed Vs. Isocentric Single Field |
172 |
|
Fixed Vs. Isocentric Parallel Opposed |
173 |
|
Fixed Vs. Isocentric Parallel Opposed (Dose) |
174 |
|
Fixed Vs. Isocentric PO |
175 |
|
Gantry Angle |
176 |
|
Gantry Angle |
177 |
|
Collimator Angle |
178 |
|
Floor Angle |
179 |
|
Isocentre Placement |
180 |
|
Isocentre Placement 2 |
181 |
|
Energy Selection |
182 |
|
Energy Selection |
183 |
|
Slide Number 20 |
184 |
|
Question |
185 |
|
Penumbra |
186 |
|
Field Sizes |
187 |
|
Shaping fields to PTV only |
188 |
|
Shaping fields considering penumbra |
189 |
|
Wedges |
190 |
|
Wedging |
191 |
|
Why shape isodoses with wedges? |
192 |
|
Beam Weighting |
193 |
|
Dose Weighting |
194 |
|
Dose Weighting |
195 |
|
Bolus |
196 |
|
Effect of Bolus |
197 |
|
Scanning with bolus in situ |
198 |
|
Normalisation |
199 |
|
Normalisation |
200 |
|
Normalisation at isocentre |
201 |
|
Normalisation to a point |
202 |
|
Plan Evaluation: Isodoses |
203 |
|
Isodose distribution |
204 |
|
Plan evaluation |
205 |
|
Visual Assessment of Plan |
206 |
|
Target coverage inspection |
207 |
|
Organ at risk inspection |
208 |
|
Plan analysis:Dose Volume Histograms |
209 |
|
DVH |
210 |
|
Cumulative DVH |
211 |
|
Cumulative DVH |
212 |
|
Cumulative DVH |
213 |
|
What are dose volume constraints (DVCs?) |
214 |
|
How to read a dose volume constraint |
215 |
|
Cumulative DVH |
216 |
|
Analysis using DVHs |
217 |
|
Dose volume constraints |
218 |
|
Which constraint is most important for normal tissue? |
219 |
|
Organs with high seriality |
220 |
|
Organs with architecture arranged in parallel |
221 |
|
Conclusion |
222 |
|
L5. Palliative PK |
223 |
|
Treatment Considerations for Palliative Radiotherapy |
223 |
|
Outline |
224 |
|
Common Indications |
225 |
|
Common Indications |
226 |
|
Treatment Goals |
227 |
|
Slide Number 6 |
228 |
|
Slide Number 7 |
229 |
|
Slide Number 8 |
230 |
|
Slide Number 9 |
231 |
|
Slide Number 10 |
232 |
|
Slide Number 11 |
233 |
|
Slide Number 12 |
234 |
|
Slide Number 13 |
235 |
|
Slide Number 14 |
236 |
|
Slide Number 15 |
237 |
|
Slide Number 16 |
238 |
|
Slide Number 17 |
239 |
|
Slide Number 18 |
240 |
|
Slide Number 19 |
241 |
|
Slide Number 20 |
242 |
|
Slide Number 21 |
243 |
|
Spinal Cord Compression |
244 |
|
Commonest sites of cord compression |
245 |
|
Presentation |
246 |
|
Slide Number 25 |
247 |
|
Slide Number 26 |
248 |
|
Slide Number 27 |
249 |
|
Whole Brain Radiotherapy |
250 |
|
WBRT |
251 |
|
Palliative Lung Case |
252 |
|
Palliative Lung Case |
253 |
|
Palliative Lung Case |
254 |
|
Slide Number 33 |
255 |
|
Slide Number 34 |
256 |
|
Slide Number 35 |
257 |
|
Take Home Messages |
258 |
|
L6. Introduction and IGRT for palliative treatment |
259 |
|
Slide Number 1 |
259 |
|
Content of the presentation |
260 |
|
Overview of IGRT lectures @ the BP course |
261 |
|
Overview of IGRT lectures @ the BP course |
262 |
|
Overview of IGRT lectures @ the BP course |
263 |
|
IGRT? I’m at a treatment planning course, right? |
264 |
|
What do people from the Linac want to know about the TP? |
265 |
|
How accurate should the delivery be? |
266 |
|
Position of critical points in TP |
267 |
|
How realistic in my TP? |
268 |
|
Is this realistic/achievable? |
269 |
|
Slide Number 12 |
270 |
|
IGRT in palliative treatment |
271 |
|
Imaging modalities |
272 |
|
Imaging modalities |
273 |
|
Portal Imaging - physics |
274 |
|
Goals of PortaI Imaging |
275 |
|
Technical aspects of EPIDs |
276 |
|
Examples of portal images |
277 |
|
EPID – field images |
278 |
|
Electronic Portal Imaging |
279 |
|
kV source moutend on linac |
280 |
|
kV imaging: Cyberknife |
281 |
|
Slide Number 24 |
282 |
|
Exac Trac® IGRT system |
283 |
|
Some images |
284 |
|
kV imaging |
285 |
|
Cone beam CT |
286 |
|
CBCT Acquisition |
287 |
|
How does it work? |
288 |
|
Image registration: Defining the ROI |
289 |
|
CBCT imaging |
290 |
|
Traditional TP in Palliative Radiotherapy |
291 |
|
Traditional TP in Palliative RT |
292 |
|
Traditional TP in Palliative RT |
293 |
|
SBRT for spinal cord compression |
294 |
|
SBRT for spinal cord compression |
295 |
|
SBRT for spinal cord compression |
296 |
|
Take home messages |
297 |
|
L7. Treatment Planning Pelvic Cancers_CG |
298 |
|
Slide Number 1 |
298 |
|
Treatment Planning for Pelvic Cancers |
299 |
|
Slide Number 3 |
300 |
|
Anatomy |
301 |
|
Overview |
302 |
|
Pelvic Cancers |
303 |
|
Pelvic Cancers |
304 |
|
Diagnostic Work-Up |
305 |
|
Cervical Cancer |
306 |
|
Slide Number 10 |
307 |
|
Anatomy |
308 |
|
Aetiology |
309 |
|
Pathology |
310 |
|
Management |
311 |
|
Slide Number 15 |
312 |
|
Cervix Radiotherapy |
313 |
|
RT in Cervix Cancer |
314 |
|
Cervix Radiotherapy |
315 |
|
Contouring: Key Publications |
316 |
|
Components* of CTV-T |
317 |
|
Slide Number 21 |
318 |
|
Slide Number 22 |
319 |
|
Target Volume Delineation |
320 |
|
Nodal Margins |
321 |
|
Slide Number 25 |
322 |
|
Slide Number 26 |
323 |
|
Slide Number 27 |
324 |
|
Slide Number 28 |
325 |
|
Radical Cervix Radiotherapy |
326 |
|
Dose |
327 |
|
Uterus |
328 |
|
Epidemiology |
329 |
|
Anatomy |
330 |
|
Management: Stage I-III |
331 |
|
Stage I |
332 |
|
Stage II |
333 |
|
Stage III |
334 |
|
Stage IV |
335 |
|
Adjuvant Radiotherapy |
336 |
|
Stage I: controversial Treatment following surgery for adenocarcinoma |
337 |
|
Adjuvant Therapy: Stage II/III |
338 |
|
Post-Op Endometrial RT Contouring |
339 |
|
Dose |
340 |
|
Role of IMRT in Gynae Cancers |
341 |
|
Rectal Cancer |
342 |
|
Slide Number 46 |
343 |
|
Slide Number 47 |
344 |
|
Rectum Anatomy |
345 |
|
Pathology |
346 |
|
Slide Number 50 |
347 |
|
Spread |
348 |
|
Pelvic Lymph Nodes |
349 |
|
Total Mesorectal Excision (TME) |
350 |
|
Management – localised |
351 |
|
Aims of Additional Therapy |
352 |
|
Pre-Operative Radiotherapy |
353 |
|
Pre-Operative RT in Rectal Cancer |
354 |
|
Positioning/Immobilisation |
355 |
|
Rectum Pre-Op Radiotherapy Planning |
356 |
|
Slide Number 60 |
357 |
|
Slide Number 61 |
358 |
|
Slide Number 62 |
359 |
|
Anal Cancer |
360 |
|
Epidemiology |
361 |
|
Invasive Cancer |
362 |
|
Spread - lymphatic |
363 |
|
Management |
364 |
|
Management (>T2 N0) |
365 |
|
Radiotherapy Technique |
366 |
|
Target Volume Definition |
367 |
|
Phase I |
368 |
|
Target Volume Definition |
369 |
|
Phase II |
370 |
|
More Advanced Cancers |
371 |
|
Slide Number 75 |
372 |
|
Slide Number 76 |
373 |
|
Toxicity - Early |
374 |
|
Female Pelvic RT Toxicity - Late |
375 |
|
Male Pelvic RT Toxicity - Late |
376 |
|
Summary |
377 |
|
Treatment Planning for Pelvic Cancers |
378 |
|
L8. Prostate PK |
379 |
|
Treatment Considerations for Prostate Cancer |
379 |
|
Outline |
380 |
|
Slide Number 3 |
381 |
|
Anatomy |
382 |
|
Slide Number 5 |
383 |
|
Slide Number 6 |
384 |
|
Slide Number 7 |
385 |
|
Slide Number 8 |
386 |
|
Slide Number 9 |
387 |
|
Slide Number 10 |
388 |
|
Slide Number 11 |
389 |
|
Organs at Risk |
390 |
|
Slide Number 13 |
391 |
|
Slide Number 14 |
392 |
|
Slide Number 15 |
393 |
|
Slide Number 16 |
394 |
|
Slide Number 17 |
395 |
|
Patient Immobilisation |
396 |
|
Delineations |
397 |
|
Slide Number 20 |
398 |
|
Variation in Contouring |
399 |
|
Delineations |
400 |
|
Slide Number 23 |
401 |
|
Organ Motion |
402 |
|
Slide Number 25 |
403 |
|
Slide Number 26 |
404 |
|
Impact of Rectal Distension |
405 |
|
Slide Number 28 |
406 |
|
Strategies to address with Organ Motion |
407 |
|
Slide Number 30 |
408 |
|
Slide Number 31 |
409 |
|
Fiducial Markers |
410 |
|
Take home message |
411 |
|
L9. Contouring session Pelvis_DP |
412 |
|
Slide Number 1 |
412 |
|
Contouring Session 1: Pelvis |
413 |
|
Anatomical Definition: Rectum |
414 |
|
Anatomical Definition: Bladder |
415 |
|
Anatomical Definition: Bladder |
416 |
|
Contouring Guidelines |
417 |
|
Contouring Guidelines and Atlas |
418 |
|
RTOG Guidelines: Rectum |
419 |
|
RTOG guidelines: Bladder |
420 |
|
Start of rectum |
421 |
|
Rectum |
422 |
|
Prostate Apex |
423 |
|
Rectum |
424 |
|
Rectum |
425 |
|
QUANTEC SegmentationRectum |
426 |
|
QUANTEC Papers |
427 |
|
L10. IGRT and margin determination for pelvic treatment_MK |
428 |
|
Slide Number 1 |
428 |
|
Content of the presentation |
429 |
|
Margin determination |
430 |
|
Errors in the radiotherapy chain |
431 |
|
Errors and Margins |
432 |
|
The delineation error is a random error |
433 |
|
Organ motion is a: |
434 |
|
Errors in the radiotherapy chain (McKenzie et al., BIR 2003) |
435 |
|
How to solve the problem? |
436 |
|
Margin for prostate RT |
437 |
|
Offline/Online bony anatomy matching |
438 |
|
Offline/Online bony anatomy matching |
439 |
|
Offline marker registration using fiducial markers |
440 |
|
Problem/challenge |
441 |
|
Fiducial markers |
442 |
|
Fiducial markers: offline |
443 |
|
Fiducial markers: offline |
444 |
|
Online fiducial marker registration |
445 |
|
Food for thought! |
446 |
|
Would you like to treat a patient like this offline? |
447 |
|
Food for thought! |
448 |
|
Would you like to treat a patient like this offline? |
449 |
|
Online Position Verification |
450 |
|
Offline vs Online |
451 |
|
Online Position Verification |
452 |
|
Online marker registration using CBCT |
453 |
|
ConeBeam CT: soft tissue information |
454 |
|
Many ways to Rome! |
455 |
|
(Adaptive) strategies |
456 |
|
Other physiological motion |
457 |
|
Bladder strategy 1 |
458 |
|
Strategy 2: Plan of the day |
459 |
|
Solving visibility problems |
460 |
|
Slide Number 34 |
461 |
|
“Predictable” random changes |
462 |
|
Plan of the day |
463 |
|
Slide Number 37 |
464 |
|
L11. Treatment planning tools and general principles part 2 |
465 |
|
Treatment Planning: Tools and General Principles Part 2. |
465 |
|
Learning Outcomes |
466 |
|
Inhomogeneities |
467 |
|
Inhomogeneities |
468 |
|
Effect of Lung (Pencil Beam Algorithm) |
469 |
|
Effect of Lung (Pencil Beam Algorithm) |
470 |
|
Effect of Lung |
471 |
|
Inhomogeneities |
472 |
|
How does the TPS compute dose in inhomogeneities? |
473 |
|
Dose Calculation Algorithm Review |
474 |
|
Dose Calculation Algorithm Review |
475 |
|
Pencil Beam |
476 |
|
Collapsed Cone |
477 |
|
Pencil Beam Algorithm |
478 |
|
Collapsed Cone Algorithm |
479 |
|
Slide Number 16 |
480 |
|
Slide Number 17 |
481 |
|
Comparison of Pencil Beam and Collapsed Cone |
482 |
|
Segmented Fields |
483 |
|
Use of segmented fields |
484 |
|
Breast Plan before segments (Note hot areas) |
485 |
|
How to create segmented fields in a chest wall case |
486 |
|
Lateral Segment indicating location of MLCs |
487 |
|
Result - Settings |
488 |
|
New Distribution |
489 |
|
Balanced Weights |
490 |
|
Hole in Dose |
491 |
|
Modified MLC |
492 |
|
Result |
493 |
|
Final Dose at Central Axis |
494 |
|
Final Dose at Superior End |
495 |
|
Final Dose at Inferior End |
496 |
|
Inverse Planning |
497 |
|
Why use IMRT? |
498 |
|
Dosimetric merits of IMRT |
499 |
|
Straight Lats and IMRT Plan |
500 |
|
3DCRT vs. IMRT |
501 |
|
3DCRT vs. IMRT |
502 |
|
Inverse Planning |
503 |
|
Inverse Planning |
504 |
|
Inverse Planning |
505 |
|
Advantages: Inverse Planning |
506 |
|
Advantages of Inverse Planning |
507 |
|
Conclusion |
508 |
|
L12. Treatment Planning Breast Cancer_CG |
509 |
|
Slide Number 1 |
509 |
|
Treatment Planning for Breast Cancer |
510 |
|
Overview |
511 |
|
Diagnostic Work-Up |
512 |
|
Pattern of Spread |
513 |
|
Local Management |
514 |
|
Breast Conserving Surgery (BCS) |
515 |
|
Consider mastectomy… |
516 |
|
BCS and WBI |
517 |
|
Rationale for Partial Breast Irradiation |
518 |
|
Accelerated PBI Methods |
519 |
|
2-Dimensional Whole Breast Irradiation |
520 |
|
2-D Whole Breast Irradiation |
521 |
|
Slide Number 14 |
522 |
|
IMRT in breast cancer: data accumulating |
523 |
|
Loco-regional Nodes |
524 |
|
Supra-Clavicular RT |
525 |
|
Axillary RT |
526 |
|
Internal Mammary RT |
527 |
|
Post-Mastectomy RT |
528 |
|
Cardiac Toxicity |
529 |
|
Compensating for Respiratory Motion |
530 |
|
Conclusions |
531 |
|
Summary |
532 |
|
Treatment Planning for Breast Cancer |
533 |
|
L13. Introduction to breast workshop_DS |
534 |
|
Introduction to the practical treatment planning workshop on Breast |
534 |
|
Cases |
535 |
|
Breast 1 |
536 |
|
Breast 2 |
537 |
|
Overall aim |
538 |
|
Dose Volume Constraints |
539 |
|
Expectations |
540 |
|
Follow the Guidelines |
541 |
|
Questions |
542 |
|
Questions |
543 |
|
DVC - Check points |
544 |
|
Slide Number 12 |
545 |
|
L14. IGRT for breast MKA |
546 |
|
Slide Number 1 |
546 |
|
IGRT for breast cancer |
547 |
|
Content of the presentation |
548 |
|
Delineation |
549 |
|
Common target volumes |
550 |
|
Target volume delineation - variability |
551 |
|
Slide Number 7 |
552 |
|
Target volume delineation - variability |
553 |
|
Multiple modalities |
554 |
|
Use of fiducials |
555 |
|
Treatment planning |
556 |
|
Treatment planning – Typical beam set-up |
557 |
|
Treatment planning – Typical beam set-up |
558 |
|
Slide Number 14 |
559 |
|
Slide Number 15 |
560 |
|
Margins |
561 |
|
Margins |
562 |
|
Unsufficient margins? |
563 |
|
Margins |
564 |
|
Margins |
565 |
|
Epi vs CBCT |
566 |
|
Treatment – EPID versus CBCT verification |
567 |
|
Image quality EPID & CBCT |
568 |
|
Coordinates (LR, AP, CC versus U, V) |
569 |
|
Correlation in the U – direction |
570 |
|
Correlation in the V – direction |
571 |
|
Results |
572 |
|
Summary |
573 |
|
Anatomical changes |
574 |
|
Seroma changes |
575 |
|
Seroma changes |
576 |
|
Seroma changes |
577 |
|
Seroma changes |
578 |
|
Changes in breast shape |
579 |
|
Average difference (treatment planning) |
580 |
|
Slide Number 36 |
581 |
|
SD of average distances (all) |
582 |
|
Breathhold technique |
583 |
|
Slide Number 39 |
584 |
|
Essential: education & compliance |
585 |
|
Take home messages |
586 |
|
L15. Treatment Planning Thoracic Cancers_CG |
587 |
|
Slide Number 1 |
587 |
|
Treatment Planning for Thoracic Cancers |
588 |
|
Overview |
589 |
|
Thoracic Cancers |
590 |
|
Slide Number 5 |
591 |
|
Diagnostic Work-Up |
592 |
|
Oesophagus and OG Junction |
593 |
|
Slide Number 8 |
594 |
|
Surgical outcome by stage |
595 |
|
Slide Number 10 |
596 |
|
Multimodality treatment for localised disease |
597 |
|
Definitive Chemoradiation |
598 |
|
CROSS Pre-Op CRT study |
599 |
|
Slide Number 14 |
600 |
|
Post operative radiotherapy |
601 |
|
Positioning and Immobilisation |
602 |
|
Slide Number 17 |
603 |
|
Slide Number 18 |
604 |
|
Toxicity |
605 |
|
Lung |
606 |
|
Slide Number 21 |
607 |
|
Slide Number 22 |
608 |
|
NSCLC: Pattern of Spread |
609 |
|
Radical EBRT-NSCLC |
610 |
|
Radical EBRT- NSCLC |
611 |
|
Volume Definition / Delineation |
612 |
|
CT Window Settings |
613 |
|
Volume Definition / Delineation |
614 |
|
Slide Number 29 |
615 |
|
Slide Number 30 |
616 |
|
Radical EBRT |
617 |
|
Radical EBRT |
618 |
|
Slide Number 33 |
619 |
|
Lung Tumour Motion (cm) |
620 |
|
ICRU 83: 4D Volume delineation Process |
621 |
|
Organ motion |
622 |
|
Radical EBRT- NSCLC |
623 |
|
Radical EBRT: Planning Technique |
624 |
|
Slide Number 39 |
625 |
|
3DCRT vs. IMRT |
626 |
|
Potential Role of IMRT |
627 |
|
Radical Conventional Radiotherapy |
628 |
|
Summary |
629 |
|
Treatment Planning for Thoracic Cancers |
630 |
|
L16. Contouring Session Thorax_DP |
631 |
|
Slide Number 1 |
631 |
|
Contouring Case 2 Thorax |
632 |
|
Anatomical Definition: Heart |
633 |
|
Heart Delineation Issues |
634 |
|
Contouring Guidelines |
635 |
|
Whole heart and pericardium |
636 |
|
Feng: Cardiac Atlas |
637 |
|
Feng: Cardiac Atlas |
638 |
|
RTOG: Atlas for breast cancer |
639 |
|
RTOG atlas for breast cancer |
640 |
|
Quantec: Heart |
641 |
|
QUANTEC Heart Segmentation |
642 |
|
QUANTEC Heart segmentation |
643 |
|
Anatomical Definition: Thoracic Oesophagus |
644 |
|
Contouring Guidelines: Oesophagus |
645 |
|
QUANTEC Oesophagus Segmentation |
646 |
|
Contouring Guidelines |
647 |
|
Contouring Guidelines: Oesophagus RT1106 |
648 |
|
Contouring Atlas: Oesophagus |
649 |
|
Start of Oesophagus |
650 |
|
End of Oesophagus |
651 |
|
Oesophagus |
652 |
|
Oesophagus |
653 |
|
Oesophagus |
654 |
|
Oesophagus |
655 |
|
Oesophagus |
656 |
|
L17. Optimizing the treatment volume in_MK |
657 |
|
Slide Number 1 |
657 |
|
Content of the presentation |
658 |
|
Radiotherapy is an effective but toxic treatment |
659 |
|
Systematic approach |
660 |
|
GTV/CTV definition |
661 |
|
GTV/CTV |
662 |
|
Positron Emission Tomography |
663 |
|
Delineation variation: CT versus CT + PET |
664 |
|
ITV= IM + CTV |
665 |
|
Minimizing the impact of respiration |
666 |
|
Motion encompassing ITV |
667 |
|
Gating |
668 |
|
Gating |
669 |
|
Mid ventilation |
670 |
|
Mid ventilation |
671 |
|
PTV=ITV+SM (Set-up margin) |
672 |
|
Set-up margin |
673 |
|
Where to register on? |
674 |
|
Be aware of the OAR: Critical isodose |
675 |
|
How do you register? |
676 |
|
When do you image? |
677 |
|
Example: prostate |
678 |
|
Special attention to: anatomical changes |
679 |
|
Slide Number 24 |
680 |
|
Weekly 3D imaging is mandatory! |
681 |
|
And what about TP? |
682 |
|
Conformity index (CI) |
683 |
|
From low to high conformity |
684 |
|
CRT vs IMRT or VMAT |
685 |
|
Small reductions in CTV-PTV margin |
686 |
|
PTV 5 cm diameter5mm CTV-PTV margin reductionWhat will be the % volume reduction? |
687 |
|
Is it worth the effort? YES! |
688 |
|
Where to start? |
689 |
|
M=2.5*Σ+0.7*σ |
690 |
|
Errors summed in quadratic |
691 |
|
What happens? |
692 |
|
Conclusions |
693 |
|
L18. Head & Neck PK Lisbon |
694 |
|
Treatment Planning Considerations in Head and Neck Cancer |
694 |
|
General Overview |
695 |
|
General Overview |
696 |
|
Introduction |
697 |
|
General Overview |
698 |
|
Aetiology |
699 |
|
Nasopharyngeal cancer and Epstein-Barr virus |
700 |
|
Oropharyngeal Cancer and Human Papilloma Virus |
701 |
|
General Overview |
702 |
|
Oral Cavity Subsites |
703 |
|
Oral Tongue Tumour |
704 |
|
Oral Cavity Tumours |
705 |
|
Cancer Retromolar Trigone |
706 |
|
Oropharynx Subsites |
707 |
|
Tonsillar Cancer |
708 |
|
Soft Palate Cancer |
709 |
|
Larynx Subsites |
710 |
|
Vocal Cord Anatomy |
711 |
|
Vocal Cord Tumour |
712 |
|
Hypopharynx Subsites |
713 |
|
Pyriform Sinus Cancer |
714 |
|
Nasopharynx Subsites |
715 |
|
Signs & Symptoms |
716 |
|
General Overview |
717 |
|
Work Up |
718 |
|
Work Up |
719 |
|
Imaging: CT / MRI / PET |
720 |
|
CT Neck - Lymphadenopathy |
721 |
|
MRI – Primary Tumour |
722 |
|
PET/CT |
723 |
|
PET/CT: Sagittal,Coronal + Axial Views |
724 |
|
PET/CT : Axial Views |
725 |
|
Patterns of Spread |
726 |
|
Work Up |
727 |
|
Histology |
728 |
|
General Overview |
729 |
|
T stage generally...... |
730 |
|
T stage .....but the exceptions |
731 |
|
N Stage(apart from nasopharynx) |
732 |
|
Lymph Node Levels |
733 |
|
Lymph Node Levels |
734 |
|
General Overview |
735 |
|
Management: MDM |
736 |
|
General Principles of Treatment |
737 |
|
What LN Levels to treat in the neck? |
738 |
|
Pre Radiotherapy ProcessDental Review Extractions + Oral Hygiene |
739 |
|
Pre Radiotherapy ProcessOral Stents |
740 |
|
Pre Radiotherapy ProcessDietician + SALT Review |
741 |
|
Pre Radiotherapy ProcessPercutaneous Endoscopic Gastrostomy |
742 |
|
Pre-Radiotherapy ProcessMedical Oncology Consult |
743 |
|
RT Treatment PlanningPatient Positioning |
744 |
|
RT Treatment PlanningOrfit |
745 |
|
RT Treatment PlanningTechniques |
746 |
|
RT Dose |
747 |
|
IMRT Dose |
748 |
|
RT Treatment Planning3D Planning CT |
749 |
|
RT Treatment Planning CTV – Lymph nodes |
750 |
|
RT Treatment Planning 3D Planning CT |
751 |
|
5 Field Beam arrangement and isodose distribution for well-lateralised target - parotid |
752 |
|
3D Radiotherapy Plan – Unilateral RTAllows treatment of one side of neck, sparing of spinal cord and contralateral parotid |
753 |
|
Slide Number 61 |
754 |
|
IMRTReducing parotid dose in Tonsillar Cancer |
755 |
|
Dose Volume HistogramShows dose received by different volumes of tissues |
756 |
|
OARs |
757 |
|
On Treatment Imaging |
758 |
|
General Overview |
759 |
|
RT Toxicity |
760 |
|
Reactions Depend On: |
761 |
|
Early Effects |
762 |
|
Skin Reaction |
763 |
|
Mucositis |
764 |
|
Xerostomia |
765 |
|
Late Effects |
766 |
|
The end |
767 |
|
L19. Treatment planning for Head and Neck_DS |
768 |
|
Treatment planning for Head and Neck |
768 |
|
The challenge with HN treatment planning |
769 |
|
Many dose levels |
770 |
|
High dose |
771 |
|
Many critical structures (OAR) |
772 |
|
Slide Number 6 |
773 |
|
Compromises between dose to target and OAR |
774 |
|
OAR priorities |
775 |
|
OAR priorities |
776 |
|
OAR priorities |
777 |
|
OAR priorities |
778 |
|
DAHANCA |
779 |
|
Delineation |
780 |
|
Conventional 3DCRT |
781 |
|
Reference Point |
782 |
|
Outlining Contour |
783 |
|
Outlining Contour – Remove fiducials |
784 |
|
Contrast and Artefacts |
785 |
|
Slide Number 19 |
786 |
|
Slide Number 20 |
787 |
|
Slide Number 21 |
788 |
|
Isocentre Placement |
789 |
|
Isocentre Placement 2 |
790 |
|
Glottis T1 - delineation |
791 |
|
Glottis T1 - isocenter |
792 |
|
Glottis T1 – treatment fields |
793 |
|
Glottis T1 – dose distribution |
794 |
|
Beam Arrangements |
795 |
|
Posterior Oblique Beam (RPO) |
796 |
|
RPO beam close to eyes |
797 |
|
Collimator / Floor Angles |
798 |
|
Anterior Oblique Beam (RAO) |
799 |
|
Lateral Beam (RLO) |
800 |
|
Calculation Points |
801 |
|
Dose Weighting |
802 |
|
First Distribution |
803 |
|
Increased Wedges |
804 |
|
Segments on RLO field |
805 |
|
Distribution After Segments |
806 |
|
Summary |
807 |
|
Inverse treatment planning (IMRT/VMAT) |
808 |
|
Standard invers planlægning |
809 |
|
Standard invers planlægning |
810 |
|
Standard invers planlægning |
811 |
|
Conventional 3DCRT compared to IMRT |
812 |
|
Straight Lats and IMRT Plan |
813 |
|
Straight Lats and IMRT Plan |
814 |
|
Thank you for your attention |
815 |