1. Para-spinal Tumors Encircling the Spinal Cord IMRT Comparison of Several Target Definitions

2. SLICE 116 CTV Superior Brain stem and L & R eyes

3. Slice 104 CTV, Spinal cord L & R Parotid glands

4. Slice 83 Mid Volume CTV 3 – 5 mm separation between spinal cord and CTV

5. Slice 63 Inferior CTV 13 mm Separation of spinal cord and CTV

6. Planning Volumes CTV3mm Expansion63 Gy Spinal Cord3mm Expansion43 Gy Rt & Lt Eyes3mm Expansion3 Gy Brain Stem3mm Expansion43Gy Parotid Glands3mm Expansion30 Gy

7. Beam Arrangement

8. Gantry0 Gantry 40 Gantry80 Gantry160 Gantry200 Gantry315

9. Basic Target Type

10. Dose Statistics 63 Gy Target Type Basic

11. DVH 63 Gy Target Type Basic 63 Gy @ ~76% Volume

12. Isodose Slice 104 Basic

13. Homogenous Target Type

14. Dose Statistics 63 Gy Target Type Homogenous

15. DVH 63 Gy Target Type Homogenous 63Gy @ ~46 % Volume

16. Isodose Slice 104 Homogenous

17. IMRS Target Type

18. Dose Statistics 63 Gy Target Type IMRS Emphasizes Conformality

19. DVH 63 Gy Target Type IMRS 63Gy @ ~90% Volume

20. Isodose Slice 104 IMRS

21. Esophagus IMRT Sparing Kidneys and Spinal Cord

22. DVH 50.4Gy

23. IMRT 5 Field IMRT with Intensity Maps

24. Intensity Levels 10 Step Increment 1cm MLC leaf 1cm

25. Step Increment 9991-959-08C 1cm step with 0.5cm MLC 0.5cm step with 0.5cm MLC

26. Intensity Level Comparison

28. Lung IMRT 60 Gy 5 Field 6 MV X-rays

29. Lung IMRT DVH

30. Large Field IMRT Plan with Dose Painting

31. Large Complex Treatment Volume Long (~ 60 cm) volume needed 27 junctioned IMRT fields and an 16 MeV electron field

32. IMRT plan avoiding spinal cord and kidneys Superior Tumor Volumes

33. Treatment Volumes Lower Abdomen

34. Treatment Volume Change in Dose Nodal Volume

35. Treatment Volume Pelvis Superficial Nodes

36. Inferior Volumes Increase in Dose Using an Electron Field

37. ELECTRON BEAM CHARACTERISTICS

38. Location of (a)Flattening Filter and (b) Electron Scattering Foils

40. Isodose Curves for 7 and 18 Mev Electron Beams

41. Small Fields with Photon Component

42. 12 Mev Beam at 0 0 12 Mev beam at 40 0

43. 12 Mev Beam with Density Correction

46. AXILA TANGENTS & ELECTRON BOOST

47. Breast Boost Technique

48. 9 Mev Electron Boost Posterior Neck Nodes

49. Interoperative Radiation Therapy The benefit of IORT normal tissues are removed from the treatment fields and the dose is delivered locally. The enengy of the electron beams used is usually between 9-16 Mev. The use in the country has been developed used at large medical centers.

50. IORT Isodose Curve 15 Mev Electron Beam

51. ORIGINAL HARD DOCKING COX LL STANDARD LINEAR ACCELERATOR

52. MGH SOFT DOCKING LASER SYSTEM IN HEAD OF MACHINE

53. MOBETRON INTRA-OP ACCELERATOR

54. MOBETRON HARD DOCKING Energies Available 4, 6, 9 & 12 Mev