Patient

Flow in
Radio-
therapy

not necessarily a straight

forward process
Steps of RT Planning

Beam
Shaping
Block , MLC

Delineation of
Target & critical organs
Immobilization
 Linac( Linear Accelerator )
Machine
Cobalt -60 Machine
 Mould Room
Simulator / CT Simulator
Treatment Planning System/TPS
QA
Courtesy of N. Lee
mskcc /gm-ey 10
 Rotating
gantry
Diagnostic
X-ray tube

Radiation beam
defining system
Simulator couch
Image intensifier
Nucletron/Oldelft
and X-ray film
holder
 Marks on shell
Create relation
between patient
coordinates and
beam coordinates

Skin
markers
Tattoos
 CT Simulation
Moveable Laser
Lasers
Laser
Isocenter
Position

Laser

Isocenter

CT images
 Virtual Simulation
3D Model of
the patient
and the
Treatment
Devices
 Treatment disimulasikan
pada model pasien.

Treatment Planning
System (TPS) digunakan
:
Sumber radiasi data
Data pasien.
 3DCRT Process

Virtual Simulation
Image import,
deliniation TV, OAR

CT Simulator

Dose Planning
Record and Verify
Treatment System DVH
 Informasi densiti jaringan untuk
perhitungan dosis.
Proses pengambilan dan pengolahan data
secara cepat
Artefact yang dihasilkan dari internal
motion lebih sedikit.
Multi-Planar & rekonstruksi secara 3D
Dapat menghasilkan images dan orinetasi
pada bidang yang berlainan .
 Computer controlled
Mark patient (at the simulator)
Align the patient to the isocenter of the linac
Patient safety (collision avoidance)

2 1
3

1.collimator 2. gantry 3. couch

 patient positioning
patient security
automatic verification with online / off line
imaging
automatic verification of dose delivered
verification of intensity or collimator
modulation
Online cone beam CT image guided verification
and automatic reposition of treatment isocentre.

Initial matching Matching after repositioning

Courtesy of Ben Mijnheer

 All those planned and systematic actions
necessary to provide adequate confidence
that a product or process will satisfy given
requirements for quality [ISO 9000, 1994]
Those actions taken to assure that the system is
operating properly so the intended result will
be obtained. (daily, weekly, monthly, annual
machine checks, redundant measurements
and calculations machine calibration and
patient chart reviews - etc.)

Best possible treatment to the patient

Log book / Worksheet :
Daily
Weekly
Quarter
Annual
Situational
Test Result Data
Actions taken after QC test
 Most modern
brachytherapy is
delivered using
HDR
Reasons?
Outpatient
procedure
Optimization
possible

Part 11, lecture 1: Sources, techniques and

equipment 33
 Use of tweezers
Behind shielding
Short transport
ways

Part 11, lecture 1: Sources, techniques and

equipment 34
 Treatment of
superficial basal cell
carcinoma of the
upper chest and
lower neck
Part 11, lecture 1: Sources,
techniques and equipment 35
Use of lead shield reduces scatter to the patient
 Courtesy of
Mentor
Part 11, lecture 1: Sources,
techniques and equipment 37
 For calibration of
brachytherapy
sources

Brachytherapy
source

Part 2, lecture 2: Dosimetry and equipment 38

 Measurement jig
Film cassette for
autoradiograph

MDS Nordion

Nucletron
Part 11, lecture 1: Sources, techniques and
equipment 39