Tomotherapy


 

What Is Tomotherapy?

Tomotherapy is the latest state-of-the art method of delivering Intensity modulated radiation beams directed precisely to the tumor and saving normal healthy tissue surrounding the tumor. The accuracy and precision of the treatment delivery process is unparalleled compared to conventional radiotherapy machines.

Accuracy

For accurate patient set-up and positioning, Tomo CT images play a critical role. With every treatment fraction, we can see where the anatomy is, compared to where it’s supposed to be, and based on accurate, consistent 3D image pixel locations relative to the treatment beam. Then, with automated image registration, we can quickly determine any required adjustment, precisely apply the offsets and treat accurately.

tomo1

The green area is the Tomo CT image and the gray area is the planning CT.  With the automated image registration, we can easily match to its accurate position.

Precision

Conventional radiation therapy machines deliver a wide beam of radiation from only a few angles. The Tomotherapy treatment system uses its unique CT scanner design to deliver radiation continuously from all angles around the patient. And, it features patented beam-modulating technology that divides a single beam into many smaller, narrow “beamlets.” More angles and more precise modulation result in dose distributions that conform to tumors like never before. This, in turn, minimizes damage to surrounding healthy tissue.

Along with integrated CT guidance, two fundamental differences enhance the precision of a Tomotherapy approach:

  • A ring gantry design for helical delivery
  • A superior binary multi-leaf collimator
    (MLC) for beam shaping and modulation

tomo_2

As the ring gantry rotates in simultaneous motion to the couch, helical fan-beam IMRT is continuously delivered from all angles around the patient.The width of the fan-beam projected to the axis is 40 cm, and the maximum length the couch can transport the patient is 160 cm.This means very large volumes can be treated in a single, simple set-up. In fact, it is possible to treat anywhere within
a cylindrical volume 40 cm in diameter by 160 cm long. Even larger diameter volumes can be treated with a reduced number of beams. Typically, tens of thousands of beamlets are included in a precisely-optimized Tomotherapy system treatment fraction. A single beamlet corresponds to the radiation
emitted through an open leaf of the Tomo MLC with the gantry at any given angle, during any given rotation.

The Imaging Advantage

The Tomotherapy treatment system looks like a CT scanner because it is a CT scanner. It lets clinicians efficiently acquire 3D CTimages of every patient, every day. With these images, clinicians can check the size, shape and location of tumors before each treatment. Then they can compare that day’s image with the one used for planning, to make sure that radiation will be directed to where it should be. Importantly, daily CT images can also be used to analyze and, if necessary, modify — a patient’s treatment at any point during the treatment
course. Revolutionary, not evolutionary.

Less Complication

Conventional radiation therapy machines deliver a wide beam of radiation from only a few angles. The Tomotherapy treatment system uses its unique CT scanner design to deliver radiation continuously from all angles around the patient. And, it features Intensity modulating technology that divides a single beam into many smaller, narrow “beamlets.” More angles and more precise modulation result in dose distributions that conform to tumors like never before. This, in turn, minimizes damage to surrounding healthy tissue and minimizes
healthy tissue complications.

IMRT and Stereotactic Radiotherapy

All Tomotherapy treatments are IMRT treatments and some are precise stereotactic radiation therapy. The Tomotherapy system offers fast and precise stereotactic radiation therapy, from planning to verification to delivery. Whether the case is simple or complex, our CT-guided helical IMRT is always the natural choice. Our stereotactic radiation therapy allows us to achieve excellent dose conformality—even with highly irregular targets—and rapid dose falloff outside each target volume. All on the same plan. Treat multiple targets in a single delivery sequence with a single setup and no isocenter shifts. Our tools use actual patient anatomy to localize the target at treatment time, reducing the
need for invasive frames and eliminating the need for specialized external targeting equipment.

Clinical Sites

Tomo Stereotactic treatments can be for Small brain lesions, Multiple metastases treated simultaneously, Gliomas adjacent to the brain stem, vertebral metastasis to spare the spine.

tomo_3    tomo_4

A new paradigm for stereotactic targeting and positioning

With  Tomotherapy System, patient positioning occurs via 3D CT images as seen on planning scans and pre-treatment mega-voltage CT scans. This means actual patient anatomy is used in place of a surrogate stereotactic coordinate system to localize the target at treatment time. Furthermore, CT guidance allows soft-tissue, even the tumor itself, to be used in the process of aligning the target according to the plan.

Non-Invasive Immobilization

Can be used for single and multiple fraction intracranial treatments. With CT-based localization, the role of the immobilization device is just to keep the patient still while on the treatment table. It does not act as the basis for a stereotactic coordinate system – a task that traditionally requires invasive fixation for single fraction treatments. As well as improving patient comfort, this means planning scans, treatment planning, and quality assurance can be performed over several days, for both single and multiple fraction treatments.


  • Ali R. Lakhani Ali R. Lakhani, M.D.
  • Arvind Kumar Arvind Kumar, M.D.
  • Ellen J. Gustafson Ellen J. Gustafson, M.D.
  • Jason J. Suh Jason J. Suh, M.D.
  • Kulumani M.Sivarajan Kulumani M.Sivarajan, M.D.
  • Nafisa Burhani Nafisa Burhani, M.D.
  • Nicholas Galanopoulos Nicholas Galanopoulos, M.D.
  • Ommar Hla Ommar Hla, M.D.
  • Patrick McGinnis Patrick McGinnis, M.D.
  • Sanjiv S. Modi Sanjiv S. Modi, M.D.
  • Sarode K.Pundaleeka Sarode K.Pundaleeka, M.D.
  • Silviya Velinova Silviya Velinova, M.D.
  • Virag Dandekar Virag Dandekar, M.D.
  • Worood Abboud Worood Abboud, M.D.

JOHA FOUNDATION
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