22- IGRT - Lecture # 22 (Ch. 25) Image-Guided Radiation...

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Image-Guided Radiation Therapy (IGRT) Tarun K. Podder, PhD, DABR Department of Radiation Oncology Brody School of Medicine Leo Jenkins Cancer Center East Carolina University March 07, 2011 Lecture # 22 (Ch. 25)
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What is IGRT? • Initial simulation • Patient data acquisition • Treatment planning • Treatment simulation • Patient setup Target localization before and during Tx In broader sense, IGRT is defined as a RT procedure that uses image-guidance at various stages of its process:
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What is IGRT? However, common/popular concept/understanding of IGRT is- RT that uses image guidance procedures for target localization just before and during treatment ” !!!
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What is IGRT? • patient setup and anatomy • shapes and volumes of treatment target • organ at risk • surrounding normal tissues Image-guidance procedures uses imaging technology to identify and correct problems arising from inter- and intra-fractional variations in -
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Image Guidance Technologies for IGRT • In-room imaging systems – CT on the rail – Calypso EM system – X-ray system – etc…. . • Imaging systems directly mounted on the linacs ( on-board imagers – OBI ) kV x-ray MV x-ray with EPID CBCT etc… Increased conformal RT (3DCRT IMRT IMPT) requires very accurate localization/ visualization of targets/OARs before and during Tx.
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Image Guidance Technologies for IGRT 1. Portal and Radiographic Imagers 2. In-room CT Scanner 3. On-board kV Cone-Beam CT 4. MV Cone-Beam CT 5. Helical Tomotherapy 6. Ultrasound 7. Fluoroscopy (ExacTrac, Cyberknife) 8. MRI (Renaissance system) 9. Electromagnetic (Calypso system) Real-time tumor tracking
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Image Guidance Technologies for IGRT 1. Portal and Radiographic Imagers a) Conventional Port Films with MV beam b) kV X-ray imager: conventional x-ray tube is mounted on the gantry with an opposing flat-panel detector c) MV electronic portal imager (EPID) with its own flat-panel detector kV imagers has better contrast Neither of them is sufficiently good for visualizing soft-tissue targets Quite useful in determining target position in relation to bony landmark or radio-opaque marker
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Image Guidance Technologies for IGRT 1. Portal and Radiographic Imagers Conventional Port Films Image quality – very high energy (10Mv or higher, large source, large patient thickness, poor radiographic technique (single emulsion is better) Viewing is delayed – time required for processing Impractical – port films before each treatment Solution – electronic portal imaging
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Image Guidance Technologies for IGRT Electronic Portal Imaging Device (EPID) Video camera is interfaced with a computer using frame-grabber board for digitizing video image to produce a digital final image. A compact EPID system has matrix of
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22- IGRT - Lecture # 22 (Ch. 25) Image-Guided Radiation...

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