Imaging Technology News 9/08

IGRT COMPARISON CHART Seeing and Treating Where the Tumor Is PARTICIPANTS Accuray Inc. By Fang-Fang Yin, professor and director of radiation physics, Duke University School of Medicine www.accuray.com BrainLAB www.brainlab.com W ith the development of 3D-CRT, IMRT, stereodue to respiration. tactic approaches and other advanced forms of There are a number of new IGRT tools available radiation therapy, imaging has become increastoday, and many are still evolving. There are room and ingly important in the field of radiation oncology. These gantry-mounted kV imaging systems, optical tracking more precise treatment modalities make it possible for us devices with 3D ultrasound reconstruction technology to plan and deliver very conformal radiation doses, in and respiratory gating systems used to synchronize imagkeeping with the main goal of radiation therapy, which is ing and dose delivery with a patient’s breathing cycle. to maximize the dose to the tumor volume and minimize The ideal IGRT system is one that can produce differthe dose to normal tissues. ent kinds of images just prior to treatment and then help However, the ability to shape dose distributions so preclinicians make use of those images in a clinically practical cisely resulted in a number of new challenges. To aim a very way. Clinicians will require online visualization of bony conformal beam at a tumor, the clinician must know exactanatomy, soft tissue — with or without implanted markers ly where it is during treat— and real-time tumor ment, or risk delivering too motion. Sophisticated softlittle dose to some part of the ware then compares the The ideal IGRT system is one that can protarget or too much to normal images with reference images duce different kinds of images just prior to healthy tissue. The variabilifrom earlier treatment planty of tumor position over a treatment and then help clinicians make use of ning, calculates the “delta,” or five-to six-week course of those images in a clinically practical way. how the patient must be treatment makes this prob— Fang-Fang Yin, moved in 3D so that the lematic. Even with the use of Duke University School of Medicine tumor lines up with the radiaimmobilization devices and tion beams, and instructs the alignment of the equipment treatment couch accordingly. with external marks on the patient’s skin, there is day-toIGRT has recently opened the door to true four dimenday variation in patient and tumor position. During treatsional (4D) radiation treatment. In addition to dealing with ment, there is the problem of intra-fraction motion due prithe three dimensions of space, radiation therapy techniques marily to respiration. also deal more effectively with the problem of tumor Traditionally, we have not had the means for exactly localmotion in time — the fourth dimension. Using 4D imaging, izing the target site each day, and so the standard of care was 4D simulation, 4D treatment planning, 4D treatment delivto treat a larger volume around the tumor, while holding ery and 4D verification, clinicians will be able to precisely doses low. This was a trade-off. Although research has determine the margin around the tumor and program the shown that tumor control is improved with higher doses, it technology to deliver treatment that adapts to the tumor was important not to exceed normal tissue tolerances. motion, keeping that margin constant. Ultimately, that is the path that IGRT has forged. For some tumor sites, such The advent of image-guided radiation therapy (IGRT) as the brain or the head and neck, IGRT will help shrink is changing the equation. Very simply, IGRT involves the margins by eliminating patient set-up uncertainties. For use of imaging tools to localize the area being treated, as tumors in the chest or abdomen where respiratory motion well as verify how treatment was delivered to the tumor. has a very big effect, IGRT presents a solution toward IGRT tools and techniques help clinicians deal with both overcoming this problem. patient positioning uncertainties and with tumor motion Editor’s Note: Due to space constraints, Imaging Technology News was not able to include all submitted product information in the printed version of this chart. However, all submitted information appears on our Web site at ITNonline.net. The “+” at the end of entries signifies more information is available online. Calypso Medical Technologies Inc. www.calypsomedical.com CIRS Inc. www.cirsinc.com CIVCO Medical Solutions www.civco.com Elekta Inc. www.elekta.com Integra Radionics www.integra-ls.com Modus Medical Devices Inc. www.modusmed.com Nucletron B.V. www.nucletron.com Philips Radiation Oncology Systems www.medical.philips.com Radiological Imaging Technology Inc. www.radimage.com Resonant Medical Inc. www.resonantmedical.com Siemens Medical Solutions www.usa.siemens.com/medical Standard Imaging Inc. www.standardimaging.com Sun Nuclear Corp. www.sunnuclear.com TheraView Technology www.theraviewusa.com TomoTherapy Inc. www.tomotherapy.com Varian Medical Systems www.varian.com The chart specifications were created by Reilly Communications Group in conjunction with industry experts, and published data were obtained from participating manufacturers. Comparison Chart Conducted by Reilly Communications Group Reilly Communications Group assumes no responsibility or liability for any errors or omissions in this chart. Open and fold out or remove for wall display Please direct all chart inquiries to: charts@rcgpubs.com ITNonline.net | September 2008 | ITN | 5 http://www.accuray.com http://www.brainlab.com http://www.calypsomedical.com http://www.cirsinc.com http://www.civco.com http://www.elekta.com http://www.integra-ls.com http://www.modusmed.com http://www.nucletron.com http://www.medical.philips.com http://www.radimage.com http://www.resonantmedical.com http://www.usa.siemens.com/medical http://www.standardimaging.com http://www.sunnuclear.com http://www.theraviewusa.com http://www.tomotherapy.com http://www.ITNonline.net http://www.varian.com http://www.ITNonline.net

Table of Contents Feed for the Digital Edition of Imaging Technology News 9/08

Imaging Technology News 9/08 Contents IGRT How IGRT Targets the Prostate ASTRO Oncology Information Management Systems (OIMS) Imaging Leading the Intense Race Against Cancer SBRT - The New Treatment of Choice Top IMRT/IGRT Centers to Watch Molecular Imaging: Ready for the Limelight CR or DR in the ER? Have You Hit the Glass Ceiling?

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