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1. Intro_DBN16.pdf |
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Welcome toAdvanced Skills for Modern Radiation Therapy- RTT only - |
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Slide Number 21 |
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3. Patient preparation and positioning_MKA |
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Slide Number 1 |
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Patient Preparation and Positioning |
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Slide Number 3 |
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Slide Number 4 |
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Expectation management |
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Slide Number 6 |
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Slide Number 7 |
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Slide Number 8 |
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Pelvic patients: dietary protocol |
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Slide Number 10 |
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Prostate patients |
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Slide Number 12 |
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Slide Number 13 |
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Slide Number 14 |
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Slide Number 15 |
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Slide Number 16 |
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Slide Number 17 |
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Creating unfortunate differences |
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Example 1: Look for differences.. |
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Slide Number 20 |
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Slide Number 21 |
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Slide Number 22 |
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Slide Number 25 |
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Practical session |
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Slide Number 27 |
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Slide Number 28 |
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Slide Number 29 |
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Slide Number 30 |
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Slide Number 31 |
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Slide Number 32 |
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Slide Number 33 |
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Rectum patients |
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Slide Number 35 |
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Essential: education & compliance |
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Slide Number 37 |
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Slide Number 38 |
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Slide Number 39 |
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4. Josipovic Pre-treatment imaging |
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5. Delineation_SR |
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Slide Number 1 |
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Which are the 3 weakest points in our modern radiotherapy treatment chain? |
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Learning outcomes |
121 |
Delineation: one of the links in the treatment chain |
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Why is delineation important? |
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Do we need to improve? |
124 |
How can we answer that need ? |
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Did you know before this course that ESTRO provides a platform for hands on exercises on contouring? |
126 |
Inter-observer variability in contouring |
127 |
Does heterogeneity in RT matters? |
128 |
Hypoxia radioresistance |
129 |
Slide Number 12 |
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Slide Number 13 |
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Slide Number 14 |
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How to improve? |
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ICRU Guidelines (ICRU50): volume definition |
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Tumor Gross Volume: GTV |
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Tumor Gross Volume: GTV |
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Tumor Gross Volume: GTV |
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PET scans in delineation of lung cancer |
138 |
Tumor Gross Volume: GTV |
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Clinical Target Volume: CTV |
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CTV |
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Clinical Target Volume: CTV |
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GTV and CTV |
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Planning Target Volume: PTV |
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PTV |
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Irradiated Volume and Treated Volume: IRV and TV |
146 |
ICRU 50 |
147 |
ICRU 62 (in addition to ICRU 50) |
148 |
Set up Margin: SM |
149 |
What is the definition of the ITV? |
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What is the definition of the PTV? |
151 |
Slide Number 34 |
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Slide Number 35 |
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Contouring Guidelines |
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Contouring Guidelines |
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Contouring Guidelines |
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Contouring guidelines |
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Contouring guidelines |
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ESTRO guidelines |
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Thank you for you attention |
161 |
Which are the 3 weakest points in our modern radiotherapy treatment chain? |
162 |
6. Forde_OAR Delineation 2016 |
163 |
11. Josipovic Image registration |
220 |
14. Josipovic Motion management |
261 |
15. Forde_Planning 2016 |
301 |
16. In-room imaging modalities_MK def 2003 |
356 |
Slide Number 1 |
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Content of the presentation |
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At the start of treatment |
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In fact…it’s just a snapshot |
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Why do we need imaging on the linac? |
360 |
Imaging modalities |
361 |
Ultrasound systems |
362 |
More recent developments |
363 |
Ultrasound system |
364 |
Electromagnetic tracking |
365 |
Electromagnetic tracking |
366 |
Electromagnetic tracking (GPS) |
367 |
Portal Imaging - physics |
368 |
Goals of PortaI Imaging |
369 |
Technical aspects of EPIDs |
370 |
Examples of portal images (open field) |
371 |
EPID – field images |
372 |
Electronic Portal Imaging |
373 |
2D kV imaging |
374 |
kV source moutend on linac |
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kV imaging: Cyberknife |
376 |
Slide Number 22 |
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Exac Trac® IGRT system |
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OBI kV imaging |
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kV imaging |
380 |
Cone beam CT |
381 |
CBCT Acquisition |
382 |
How does it work? |
383 |
Image registration: Defining the ROI |
384 |
Image registration: Defining the ROI |
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Image registration |
386 |
Image registration: bony anatomy |
387 |
Image registration: fiducial markers |
388 |
CBCT imaging |
389 |
MV-(CB)CT |
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MV-CT |
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Videosystems |
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Exac trac infrared |
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Surface scanning |
394 |
Infra red systems |
395 |
Slide Number 41 |
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Integrating MRI functionality with external beam radiotherapy |
397 |
Gantry design MRL: (MRI-Linac) |
398 |
MRIdian: MR Cobalt |
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MR linac |
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How accurate should the delivery be? |
401 |
17. Clinical rationale for IGRT_Jose Lopez_clean |
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Slide Number 1 |
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Learning Objectives (IGRT) |
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Wikipedia |
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Why do we need IGRT? |
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Slide Number 5 |
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Slide Number 6 |
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Slide Number 7 |
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Slide Number 8 |
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Slide Number 9 |
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Slide Number 10 |
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Slide Number 11 |
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Rationale for IGRT |
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Slide Number 13 |
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Imaging for treatment verification |
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Technologies available for IGRT |
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Technologies available for IGRT |
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Slide Number 17 |
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Slide Number 18 |
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Slide Number 19 |
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Rationale for IGRT |
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Slide Number 21 |
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Slide Number 22 |
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IGRT |
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Slide Number 24 |
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Slide Number 25 |
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Slide Number 26 |
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Sources for Clinical Rationale |
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Cites in Pubmed (2014-2016) |
429 |
Clinical trial, Phase III(compare new treatments with the standard) |
430 |
Clinical trial, Phase III |
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COST and TIME |
432 |
Clinical trial, Phase II (N = 74)(if a new treatment works well) |
433 |
Toxicity |
434 |
Phase II (Prostate) |
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Slide Number 35 |
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Slide Number 36 |
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Slide Number 37 |
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Prostate IGRT |
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Prostate IGRT |
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Clinical trial, Phase II (hepatocellular carcinoma ) |
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Clinical trial, Phase II (Sarcoma) |
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Clinical trial, Phase II (Lung) |
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Clinical trial, Phase II (oligometastases) |
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Clinical trial, Phase II (head and neck) |
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Slide Number 45 |
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Adaptive radiotherapy |
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FUTURE DIRECTIONS (phase III studies on-going) |
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FUTURE DIRECTIONS |
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IGRT confidence and knowledge |
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IGRT confidence and knowledge |
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CONCLUSIONS: Why IGRT? |
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Slide Number 52 |
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19. Prostate_Jose Lopez |
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Slide Number 1 |
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Outline of Talk |
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Slide Number 3 |
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Lymph nodemetastasized prostate cancer |
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Lymph nodemetastasized prostate cancer |
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Lymph nodemetastasized prostate cancer |
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Lymph nodemetastasized prostate cancer |
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Lymph nodemetastasized prostate cancer |
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Lymph nodemetastasized prostate cancer |
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Slide Number 10 |
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Slide Number 11 |
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Slide Number 12 |
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Slide Number 13 |
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Slide Number 14 |
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Case 1: patient with stage N+ (D1) disease |
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Case 1: patient with stage N+ (D1) disease |
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Case 1: patient with stage N+ (D1) disease |
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Slide Number 18 |
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Slide Number 19 |
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Prostate |
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Slide Number 21 |
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Slide Number 22 |
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PTV (prostate gland+5mm margin) |
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Seminal vesicles planning volume (orange) |
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Pelvic lymph nodes planning volume(prophylactic [purple], positive [red]) |
478 |
Slide Number 26 |
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Slide Number 27 |
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20. Josipovic Prostate physicists perspective |
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21. Prostate_MK |
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IGRT for prostate cancer: RTT perspective |
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Content |
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Offline/Online bony anatomy matching |
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Offline/Online bony anatomy matching |
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Offline marker registration using fiducial markers |
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Problem/challenge |
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Fiducial markers |
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Fiducial markers: offline |
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Fiducial markers: offline |
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Online fiducial marker registration |
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Food for thought! |
510 |
Food for thought! |
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Online Position Verification |
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Offline vs Online |
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Online Position Verification |
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Online marker registration using CBCT |
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ConeBeam CT: soft tissue information |
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Many ways to Rome! |
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The N1 case |
518 |
Option 1: solved by margins (AMC) |
519 |
Option 2: Adaptive procedure |
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Bladder: Focal adaptive margin strategy |
521 |
Thank you for your attention! |
522 |
22. 2016_Cervix_SR |
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Slide Number 1 |
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Cervix cancer diagnosis OMS (2002) |
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Patient History |
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Slide Number 5 |
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Slide Number 6 |
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Slide Number 7 |
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Slide Number 8 |
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Slide Number 9 |
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Slide Number 10 |
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Slide Number 11 |
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Slide Number 12 |
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Slide Number 13 |
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Heterogeneity in contouring target volumes besides the use of guidelines |
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Quite good homogeneity in some OAR contouring |
536 |
But it’s not always the case! |
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Upper and lower limits are a source of heterogeneity in contouring as well |
538 |
24. Cervix_DBN16_RdJ |
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Slide Number 1 |
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CervixART Planselection |
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Slide Number 3 |
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Slide Number 4 |
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Slide Number 5 |
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Slide Number 6 |
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Slide Number 7 |
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Slide Number 8 |
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Slide Number 9 |
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Slide Number 10 |
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Slide Number 11 |
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Slide Number 12 |
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Slide Number 13 |
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Slide Number 14 |
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Question |
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Observer study setup |
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Patient 1 |
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Patient 2 |
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Slide Number 19 |
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Result |
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Slide Number 21 |
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Slide Number 22 |
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Slide Number 23 |
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Slide Number 24 |
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Slide Number 25 |
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Slide Number 26 |
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Slide Number 27 |
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Slide Number 28 |
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Slide Number 29 |
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Slide Number 30 |
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Slide Number 31 |
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Slide Number 32 |
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Slide Number 33 |
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Slide Number 34 |
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Slide Number 35 |
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Slide Number 36 |
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Slide Number 37 |
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Slide Number 38 |
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25. Lung_Jose Lopez |
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Slide Number 1 |
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Slide Number 2 |
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Outline of Talk |
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Introduction |
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Introduction |
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Slide Number 6 |
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Slide Number 7 |
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Recent Trials Addressing Management of Oligometastatic NSCLC |
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Slide Number 9 |
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STEREOTACTIC ABLATIVE RADIOTHERAPY DELIVERED BY HELICAL TOMOTHERAPY FOR EXTRACRANEAL OLIGOMETASTASIS |
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STEREOTACTIC ABLATIVE RADIOTHERAPY DELIVERED BY HELICAL TOMOTHERAPY FOR EXTRACRANEAL OLIGOMETASTASIS |
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Slide Number 12 |
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Slide Number 13 |
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Slide Number 14 |
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Slide Number 15 |
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Slide Number 16 |
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Slide Number 17 |
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Slide Number 18 |
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Case 1: Oligorecurrence of lung cancer |
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Slide Number 20 |
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Slide Number 21 |
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Slide Number 22 |
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Motion artifacts are commonly seen with thoracic CT images |
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Motion artifacts |
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Tumor movement |
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Slide Number 26 |
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Slide Number 27 |
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Slide Number 28 |
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26. Josipovic Lung physicists perspective |
606 |
27. Lung_MK |
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Lung SBRT on the linac |
626 |
Key features SBRT |
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What do we have to manage? |
628 |
Intra fraction motion: amplitude |
629 |
Inter fraction motion: baseline shift |
630 |
Baseline shift |
631 |
Slide Number 7 |
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Slide Number 8 |
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Managing intra fraction motion |
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Management of baseline shifts |
635 |
Option 1: NKI/ELEKTA solution |
636 |
Option 1: NKI/ELEKTA solution |
637 |
Option 2: critical isodose |
638 |
Option 3: homemade excel sheet |
639 |
Reference CT: OAR ROI (Clipbox) |
640 |
Reference CT: Tumor ROI (Mask) |
641 |
Step 1: image registration on OAR |
642 |
Step 2: image registration on tumor |
643 |
Verify the registration |
644 |
Slide Number 20 |
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Convert to correction |
646 |
Registration data in overview tab |
647 |
Fill in data in excel sheet |
648 |
Perform table correction and 2nd CBCT |
649 |
Fill in data of 2nd CBCT in excel sheet |
650 |
Starting treatment? |
651 |
Slide Number 27 |
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Thank you for your attention! |
653 |
28. Breast_2SR_clean |
654 |
Slide Number 1 |
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Clinical case |
655 |
Mammograms + US |
656 |
Angio mammography |
657 |
Breast MRI |
658 |
Clinical case |
659 |
Therapeutic strategy: Which radiotherapy? |
660 |
Slide Number 8 |
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Slide Number 9 |
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Partial breast irradiation indication guidelines |
663 |
Intraoperative Partial breast versus whole breast irradiation |
664 |
Slide Number 12 |
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EBRT allows for conformal treatment |
666 |
Slide Number 14 |
667 |
PAPBI: first résults |
668 |
Dosimetry |
669 |
Dosimetry |
670 |
Dosimetric comparision between APBI |
671 |
Re-positionning control |
672 |
Heart Toxicity |
673 |
Cardiac risk is increased by cardiovascular risk factors |
674 |
Improved heart sparing by breath hold |
675 |
How to improve heart sparing? |
676 |
30. Breast RTT Perspective 2016 |
678 |
32. Forde_Varian CBCT 2016 |
705 |
33. WorkshopImageRegistrationElekta_DBN16 |
771 |
‘steps’of registration @AMC |
771 |
Reference settings – 1x |
772 |
Image registration and evaluation |
773 |
Image registration and evaluation |
774 |
Image registration and evaluation |
775 |
Symantics @Elekta |
776 |
Slide Number 7 |
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Slide Number 8 |
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Slide Number 9 |
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Algorithms @Elekta |
780 |
Algorithms |
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Slide Number 12 |
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Slide Number 13 |
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Bone and seed algoritme |
784 |
Bone and seed algoritme |
785 |
Algoritmes |
786 |
Cons:Local minima: specifically a problem for small regions of interest depending on cost function |
787 |
Slide Number 18 |
788 |
Slide Number 19 |
789 |
CRP @Elekta |
790 |
Correction Reference Point |
791 |
Correction Reference Point |
792 |
Correction Reference Point |
793 |
Correction Reference Point |
794 |
Correction Reference Point |
795 |
Slide Number 26 |
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Slide Number 27 |
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Slide Number 28 |
798 |
34. Head&neck_SR |
799 |
Slide Number 1 |
799 |
Changing traditional scenario in H&N cancer |
800 |
Patient history |
801 |
Clinical examination |
802 |
Slide Number 5 |
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Slide Number 6 |
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Slide Number 7 |
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Slide Number 8 |
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Slide Number 9 |
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Slide Number 10 |
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Slide Number 11 |
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Slide Number 12 |
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Slide Number 13 |
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Slide Number 14 |
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Slide Number 15 |
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Slide Number 16 |
814 |
Slide Number 17 |
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Slide Number 18 |
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Slide Number 19 |
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Slide Number 20 |
818 |
Slide Number 21 |
819 |
Slide Number 22 |
820 |
Contouring guidelines |
821 |
Case used for H&N Falcon online WS |
822 |
36. Forde_H and N RTT Perspective 2016 |
824 |
37. Brain_Jose Lopez |
844 |
Slide Number 1 |
844 |
Outline of Talk |
845 |
Pearls |
846 |
Inmovilization |
847 |
Planning images |
848 |
Slide Number 6 |
849 |
Slide Number 7 |
850 |
Slide Number 8 |
851 |
Slide Number 9 |
852 |
Slide Number 10 |
853 |
Technologies |
854 |
Slide Number 12 |
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Slide Number 13 |
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Slide Number 14 |
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Slide Number 15 |
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Slide Number 16 |
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Slide Number 17 |
860 |
Slide Number 18 |
861 |
BRAGG PEAK |
862 |
Slide Number 20 |
863 |
Slide Number 21 |
864 |
PTC |
865 |
Slide Number 23 |
866 |
Case 1: patient with teratoid rhabdoid tumor |
867 |
Slide Number 25 |
868 |
Mass at the fourth ventricle |
869 |
Slide Number 27 |
870 |
Slide Number 28 |
871 |
Slide Number 29 |
872 |
PTV (surgical bed + 5 mm margin) |
873 |
PTV |
874 |
Slide Number 32 |
875 |
Slide Number 33 |
876 |
38. Josipovic Brain physicists perspective |
877 |
39. Brain_DBN16_RdJ |
898 |
Slide Number 1 |
898 |
Brain |
899 |
Slide Number 3 |
900 |
Slide Number 4 |
901 |
Slide Number 5 |
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Slide Number 6 |
903 |
Slide Number 7 |
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Slide Number 8 |
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Slide Number 9 |
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Slide Number 10 |
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Slide Number 11 |
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Slide Number 12 |
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Slide Number 13 |
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Slide Number 14 |
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Slide Number 15 |
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Slide Number 16 |
913 |
Slide Number 17 |
914 |
Slide Number 18 |
915 |
Slide Number 19 |
916 |
Slide Number 20 |
917 |
Slide Number 21 |
918 |
40. agnella2_clean |
919 |
Health Literacy and Cancer |
919 |
Slide Number 2 |
920 |
Slide Number 3 |
921 |
What is Literacy? |
922 |
Background |
923 |
Slide Number 6 |
924 |
Example |
925 |
Consequences of Low Health Literacy |
926 |
Health Literacy Model |
927 |
Factors that Influence HL level |
928 |
Tools to measure HL |
929 |
The Newest Vital Sign-Test of Functional HL |
930 |
Slide Number 14 |
931 |
Slide Number 15 |
932 |
Same for all countries? |
933 |
European Health Literacy Project-HLS-EU 2009-2012 |
934 |
European Health Literacy Project-HLS-EU 2009-2012 |
935 |
HLS-EU ModelDomains and dimensions of Health Literacy |
936 |
Slide Number 21 |
937 |
Health Literacy and Cancer |
938 |
HL and Radiotherapy |
939 |
HL and Radiotherapy |
940 |
HL and Radiotherapy –Ireland? |
941 |
HL and Radiotherapy –Ireland? |
942 |
Slide Number 27 |
943 |
Slide Number 28 |
944 |
What are the signs? |
945 |
Slide Number 30 |
946 |
Can we give information better? |
947 |
Slide Number 32 |
948 |
Plain Language |
949 |
How can we check understanding? |
950 |
Slide Number 35 |
951 |
Current Study |
952 |
Research Aims |
953 |
Slide Number 44 |
954 |
Take home message |
955 |
Slide Number 47 |
956 |
41. Implementing and managing IGRT_MK |
957 |
Slide Number 1 |
957 |
The Aim of the presentation |
958 |
Protocol implementation |
959 |
Preparation phase |
960 |
Preparation phase: Investigate! |
961 |
Slide Number 6 |
962 |
Planning/protocol writing phase |
963 |
Implementation Phase |
964 |
Well described and well defined tasks |
965 |
Anatomical changes |
966 |
Slide Number 11 |
967 |
Slide Number 12 |
968 |
Slide Number 13 |
969 |
Atelectases |
970 |
Slide Number 15 |
971 |
Tumor regression |
972 |
Tumor shift |
973 |
Slide Number 18 |
974 |
Rare changes |
975 |
Rare changes |
976 |
Change in lymphocele |
977 |
Weight loss |
978 |
Slide Number 23 |
979 |
Cardiac changes |
980 |
Slide Number 25 |
981 |
Summary |
982 |
How to deal with changing anatomy?* |
983 |
The protocol… |
984 |
Implementation Phase |
985 |
Plan of the day |
986 |
Slide Number 31 |
987 |
Demo database ART blaas |
988 |
Implementation Phase |
989 |
Evaluation phase |
990 |
Bladder ART: Safety-net plan selection |
991 |
Conclusions |
992 |
Slide Number 37 |
993 |
John Kotter’s 8 steps of change |
994 |
Thank you for your attention! |
995 |
42. WhoIsDoingWhat_DBN16_RdJ |
996 |
Who is doing what in Radiation Therapy |
996 |
Slide Number 2 |
997 |
Survey |
998 |
Survey |
999 |
1. Indication of treatment |
1000 |
1. Indication of treatment |
1001 |
2. Pre-treatment Imaging |
1002 |
2. Pre treatment Imaging |
1003 |
3. Delineation: Target Volume |
1004 |
3. Delineation Target Volume |
1005 |
3. Delineation: Organs at Risk |
1006 |
3. Delineation Organs at Risk |
1007 |
4. Treatment Planning |
1008 |
4. Treatment Planning |
1009 |
5. Treatment Delivery |
1010 |
5. Treatment Delivery |
1011 |
6a. Image Guidance: Acquisition |
1012 |
6a. Image guidance: Acquisition |
1013 |
6b. Image Guidance: Registration |
1014 |
6b. Image Guidance: Registration |
1015 |
6c. Image Guidance: Evaluation |
1016 |
6c. Image Guidance: Evaluation |
1017 |
Who is doing what? |
1018 |
RTT training / Education |
1019 |
Training & Education |
1020 |
RTT training / Education |
1021 |
Slide Number 27 |
1022 |
Slide Number 28 |
1023 |
Slide Number 29 |
1024 |
Slide Number 30 |
1025 |
IGRT |
1026 |
IGRT modalities: 2D MV |
1027 |
IGRT modalities: 2D kV |
1028 |
IGRT modalities: 3D kV |
1029 |
IGRT modalities: 3D MV |
1030 |
IGRT protocols are |
1031 |
IGRT |
1032 |
IGRT |
1033 |
IGRT |
1034 |
IGRT |
1035 |
Who is doing ART? |
1036 |
Summary |
1037 |
Questions & Discussion |
1038 |
43. Safety issues and prospective risk analysis_MK |
1039 |
HFMEA – Martijn Kamphuis |
1039 |
Introduction |
1040 |
Failure Modes and Effects Analysis (FMEA) |
1041 |
FMEA project |
1042 |
FMEA project |
1043 |
Process Mapping |
1044 |
Slide Number 7 |
1045 |
FMEA project |
1046 |
Team |
1047 |
FMEA project |
1048 |
Steps in a FMEA Process |
1049 |
FMEA |
1050 |
FMEA project |
1051 |
Risk Priority Number (RPN) |
1052 |
Example RT Process: Ford et al, 2009 |
1053 |
Slide Number 16 |
1054 |
Example: Step _x_ in Process: Field Placement |
1055 |
Example: Step _x_ in Process: Field Placement |
1056 |
FMEA: putting it all together |
1057 |
The Workshop (50 minutes) |
1058 |
Process map: Online 3D portal imaging |
1059 |
Feedback session |
1060 |
Conclusions |
1061 |
Thank you for your attention! |
1062 |
45. Incident management |
1063 |
46. WorkshopPS_DBN16_RdJ |
1097 |
Slide Number 1 |
1097 |
Workshop on Plan Selection |
1098 |
Slide Number 3 |
1099 |
Slide Number 4 |
1100 |
Slide Number 5 |
1101 |
Plan selection - cervix |
1102 |
Plan selection - rectum |
1103 |
Geometrical uncertainties rectum |
1104 |
Plan selection - rectum |
1105 |
Plan selection – rectum |
1106 |
Plan selection – rectum |
1107 |
Plan selection – rectum |
1108 |
Plan selection – rectum |
1109 |
Design of the study |
1110 |
Design of the study |
1111 |
Workflow registration and selection |
1112 |
Workflow registration and selection |
1113 |
Workflow registration and selection |
1114 |
Workflow registration and selection |
1115 |
Outcome of the study |
1116 |
Outcome of the study |
1117 |
Outcome of the study |
1118 |
Implementation - conclusion |
1119 |
Clinical protocol |
1120 |
Mosaiq |
1121 |
Administration at Linac |
1122 |
Safety net |
1123 |
Slide Number 28 |
1124 |
Slide Number 29 |
1125 |
Slide Number 30 |
1126 |
Slide Number 31 |
1127 |
Slide Number 32 |
1128 |
Slide Number 33 |
1129 |
Slide Number 34 |
1130 |
Slide Number 35 |
1131 |
ART bladder patient 1 / CBCT 1 |
1132 |
ART bladder patient 1 / CBCT 2 |
1133 |
ART bladder patient 1 / CBCT 3 |
1134 |
ART bladder patient 2 / CBCT 1 |
1135 |
ART bladder patient 2 / CBCT 2 |
1136 |
ART bladder patient 2 / CBCT 3 |
1137 |
Slide Number 42 |
1138 |
Slide Number 43 |
1139 |
Slide Number 44 |
1140 |
Slide Number 45 |
1141 |
Slide Number 46 |
1142 |
Slide Number 47 |
1143 |
Slide Number 48 |
1144 |
Slide Number 49 |
1145 |
ART cervix patient 1 / CBCT 1 |
1146 |
ART cervix patient 1 / CBCT 2 |
1147 |
ART cervix patient 1 / CBCT 3 |
1148 |
ART cervix patient 1 / CBCT 4 |
1149 |
ART cervix patient 2 / CBCT 1 |
1150 |
ART cervix patient 2 / CBCT 2 |
1151 |
ART cervix patient 3 / CBCT 3 |
1152 |
Slide Number 57 |
1153 |
Slide Number 58 |
1154 |
Slide Number 59 |
1155 |
Slide Number 60 |
1156 |
Slide Number 61 |
1157 |
Slide Number 62 |
1158 |
47. AE Reporting and Role of RTT 2016 |
1159 |