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Virtual Simulation in the Radiooncology Department of B-A-Z County Hospital Miskolc Imre Geszti Certificated Clinical Radiophysicist Miskolc Hungary.

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Presentation on theme: "Virtual Simulation in the Radiooncology Department of B-A-Z County Hospital Miskolc Imre Geszti Certificated Clinical Radiophysicist Miskolc Hungary."— Presentation transcript:

1 Virtual Simulation in the Radiooncology Department of B-A-Z County Hospital Miskolc Imre Geszti Certificated Clinical Radiophysicist Miskolc Hungary

2 Short History Early ’60s Superficial Skin Therapy (Chaoul, Dermopan) 1974 Founded of the Department of Radiooncology, Teletherapy (Cs, Co therapy) 1975 Brachytherapy (GUA) 1977 National Therapy Planning Networking System –Transverse sectioning device 1991 PC based therapy planning (van de Geijn) 1994 Theratron 780c, Gammamed 12i (Gammadot TPS for brachytherapy) 2002 Siemens Primus Dual Energy, digital linac machine, Siemens SimView NT conventional Simulator, real 3D CT based TPS (CMS XiO), connection to the hospital CT scanner via the network system –2005-2007 Intracranial Stereotaxia (Brainlab) (ended by „politics”) 2007 Siemens Oncor Impression linac, Siemens Somatom sensation Open CT Simulator (LAP Dorado laser system, Coherence Dosimetris Workstation) 2008 2nd Oncor linac 2014 ? IMRT, IGRT, (VMAT or RapidArc?), SRS, new Brachytarapy equipment, TPS

3 Devices I. Conventional RT Simulator –Siemens SimView NT (2002) –Image intensifier DICOM Image server Every Images are DICOM based

4 Digitaly based imaging Conventional RT Simulator

5 Devices II. CT Simulator Siemens SOMATOM Sensation Open (2007) –CT with flat table top –LAP Dorado Laser system –Coherence Dosimetrist (Virtual Simulator Software) workstation

6 Siemens Somatom Sensation Open CT simulator, Coherence Dosimetrist ws LAP Dorado laser system

7 Devices III. For delineation, and verification –Coherence Oncologist TPS –CMS XiO –Permedics Odyssey

8 Virtual Simulation Older methodology Presimulation in conventional Simulator –Marking of the center of the region Processing CT Images –In another department (not the same building) –Sending via network (advanced version) –Sending via CD-, DVD-ROM 3D Therapy Planning system Contouring Planning Processing of DRRs, hardcopy of isocentric plain Simulation after the planning –Mark the sign of the „Isocenter” Verification –Film –EPID

9 Virtual Simulation Newer methodology I. Pre- and postplanning processing in one step Patient positioning AP topogram (fix tube position) Selecting the region CT Imeges Possible postprocessing (changing kernels or other processing details slice thickness etc.) Sending the images

10 Virtual Simulation Newer methodology II. VSim software –Delineating (Skin, OAR, PTV) –Reference point managment –Other DICOM format images registration (fusion of images) (MRI, Diagnostic CT, PET etc.) Virtual beam simulation Room-, Beam eye view Virtual machine Without dose calculation

11 Workflow diagram (CT Simulator) Patient registrationPatient positioningDefining laser origin Starting positionCT topogramRegion selction CT scanning Ref. Point managementRef. point marking Image transfer Image import Skin Contouring Laser, table coordinatesMarking on patient skinOther details, postprocesses

12

13 CT-CT fusion Without contrastWith contrast

14 CT-MR fusion CTMR

15 CT-PET fusion CTPET

16 More spectacular fusion of PET and CT Easier to find the correct place of tumor, and involved tissue volume

17 Creation of the virtual beams

18 Therapy planning preprocedure Plan calculation (3D TPSs) Parameter changing possibilities (comformalization of MLCs, selecting adequate beam energies, wedges etc.) Making hardcopies (images of slices, plan parametres) DRRs (paper based, and digitaly format) Parametres for R&V (Lantis)

19 Deviations Random error –From inadequate positioning –Changes of the patient weight –From device (laser, table, light field etc.) Intended deviation –Replace the reference point for better dose distribution –For using different centre of treating volumes (whole breast vs. tumor bed)

20 Verification I. Optivue 500 Flat panels on Oncor Impression linacs (semiconductor based EPID) Coherence Therapist workstations –Dedicated for both of the Oncor machines –Possibilities of Portal Imaging application –Fusion of digital format Portal or Verificational Image with DRRs –3 directions (lat., long., vert.) eliminate deviations in 1 mm resolution

21 Verification II. DRR with contoursPortal Image (6MV X-ray EPID) Fused Images

22 Verification III. Bony structure based Bony structure based registration

23 Verification IV. Inplanted marker based Relative to inplanted markers Prostate case More precise if we can use some „Gold markers” Differencies relative to DRR it needs to adjust

24 Important considerations Accuracy of patient treatment –Precise lasers, –Table top (roll, tilt) Rotating Deflection –Patient fixation Verification on Linacs –No soft tissue sensitivity (relative to bony structure) –No tissue moving or respiration tracking So we believe we’ll have IGRT the near future Human factor. What do they contour, where is the real tumor or tumor bed?

25 Thank you for your attention Happy birthday for Prof. Matula


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