Radiation Oncology Treatment Planning
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Treatment planning is an integral part of delivering radiation therapy. There are many technologies available to help radiation oncologists deliver radiation in the most effective, precise and accurate manner. Many of the radiation oncologists at Fox Chase helped develop these new technologies and have the most experience using these tools to plan radiation treatment.
Fox Chase Cancer Center houses the most advanced treatment planning technology available, including Calypso, High Intensity Focused Ultrasound (HIFU), MR Spectroscopy, Trilogy© Stereotactic System, 4-D CT Simulator, CT and MRI, CT-on-Rails, BAT® Ultrasound Guided Targeting and PET/CT.
Calypso® 4D Localization System
Working like a GPS system for the body, Calypso® is the world's first real-time tracking method available to locate and internally track prostate tumors during the delivery of radiation therapy - allowing for more precise and accurate radiation targeting. Before each treatment, Calypso finds the tiny electromagnetic sensors implanted in the prostate and prostate bed (called beacon transponders) and helps the technologist re-align the treatment plan.
In January 2007, Fox Chase became one of the two treatment centers in North America to use this FDA approved technology as part of prostate cancer treatment.
High Intensity Focused Ultrasound (HIFU)
High Intensity Focused Ultrasound (HIFU) is a technology that uses high energy sound waves to generate heat inside the body. This intense heat (hyperthermia) can destroy cancer cells alone or in conjunction with radiation. This heat can be narrowly focused on the tumor with great precision while sparing the normal surrounding tissue and organs.
MRI guidance for HIFU is the latest development in use at Fox Chase Cancer Center. The department of Radiation Oncology has a dedicated 1.5T MRI Scanner used to guide the sound waves. The sophisticated software system is able to shows the patient's tumor in real time during treatment. The MRI's image works with the software controlling the HIFU's targeting system, which ensures sub-millimeter accuracy.
Benefits of HIFU
- A new treatment option for some patients when radiation, surgery and chemotherapy can no longer be used
- Fast onset of pain relief
- Almost no side effects
- Uses clean ultrasound energy to heat the cancer cells
- Non-invasive treatment with no scarring, bleeding or risk of infection
- Outpatient procedure without hospital stay
Although HIFU is currently being used only to treat painful bone metastases, it may be used by Fox Chase physicians in the future to treat patients with breast, prostate, gynecologic and gastrointestinal (GI) cancers.
In December 2008, Fox Chase doctors performed the first HIFU (high intensity focused ultrasound) treatment at Fox Chase Cancer Center and only the 6th in the United States on a cancer patient.
Magnetic Resonance (MR) Spectroscopy
MR spectroscopy (also called MRS, functional MRI or fMRI) is used by radiation oncologists to more precisely tailor radiation treatment for appropriate patients with prostate and brain cancers. MR spectroscopy helps to identify the metabolic activity of the tumor, confirming the boundaries and bulky areas.
In October 2006, Fox Chase became the first treatment center in the region to use this technology for treatment planning.
Trilogy© Stereotactic System
Trilogy© Stereotactic System for Image-Guided Radiation Therapy (IGRT) and SRS is the world's premier image-guided system used to deliver all forms of external beam radiation, including IMRT and stereotactic radiosurgery. It automatically adjusts the treatment table position as needed and tailors treatment to phases in the pateint's breathing cycle. Radiation oncologists can generate CT images while the patient is on the treatment table using Trilogy's Conebeam CT. The images are used for Image-Guided Radiation Therapy and can confirm positioning.
Trilogy's linear accelerator (the machine that delivers the radiation) helps to shape the radiation beams to match the tumor, while Trilogy's on-board imaging capabilities help physicians accurately position patients for treatment.
In October 2006, Fox Chase became the first institution in the region to use Trilogy.
4-D CT Simulator
4-D CT Simulator is a CT, or "cat" scanner, with special software that measures patient motion, such as breathing or movements during rest. By planning radiation treatment around patient movement, doctors can treat smaller tumors with great accuracy. This is especially useful for lung, breast and some gastrointestinal cancers, where doctors can time the radiation to a special point in the breathing cycle to make the treatment more precise.
CT and MRI
Often used for diagnostic purposes, CT and MRI scans are also used in radiation treatment planning. These technologies offer a clear picture of the patient's body, which allows precision planning for treatments involving IMRT or 3-D CRT.
In 2001, Fox Chase Cancer Center was the first cancer center in the WORLD to use a dedicated MRI unit in the radiation oncology department specifically for routine radiation treatment planning.
CT-on-Rails is one of 3 techniques used to correct daily positioning of patients in order to provide precise delivery of radiation for men with prostate cancer. (The others are gold seeds and BAT.) CT-on-Rails is used in combination with IMRT for all high-risk patients who have had their prostate removed surgically in order to reduce their risk of recurrence.
CT-on-Rails is a CT scanner that slides on rails in the floor so the patient does not have to move between the time of the scan and treatment. It slides over the patient's treatment table and is later moved out of the way during treatment. A CT scan is performed immediately before each treatment and is then compared to the initial treatment planning CT scan to ensure accurate patient positioning, called a "CT-to-CT" matching approach.
Gold marker seeds are often used along with CT-on-Rails to treat patients with an intact prostate. The seeds are implanted before treatment and are used to help localize prostate position. Adjustments in position can then be made if necessary.
CT-on-Rails may also be used in conjunction with stereotactic radiosurgery for patients with brain tumors or those in the head and neck region. It also offers unique treatment applications, such as treating cancer that has spread to the spine and allows physicians to compare the imaging techniques to locate different targets or tumors.
In 2003, Fox Chase was the first hospital in the region to use CT-on-Rails technology.
BAT® (B-mode Acquisition and Targeting)
BAT® (B-mode Acquisition and Targeting) uses ultrasound guided targeting to benefit patients with prostate cancer. It is used before each daily treatment to direct the radiation because the position of the prostate may shift inside the body. BAT works with ultrasound guided targeting computer software to correct for small changes in the location of the prostate between treatments.
BAT technology was developed and first used at Fox Chase in 1999.
PET/CT combines PET scan (Positron Emission Tomography) with CT images to help physicians more precisely target the tumor with radiation. Fox Chase physicians integrate PET scan with treatment planning for patients with esophageal and rectal cancer.
Fox Chase was the first in the region to use PET/CT technology in 2002.
For more information about radiation oncology at Fox Chase Cancer Center or to make an appointment, call 1-888-FOX CHASE (1-888-369-2427).