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Treatment Planning
Trilogy© Stereotactic System for IGRT and SRS is the world's premier image-guided system that is capable of delivering all forms of external beam radiation, including IMRT and stereotactic radiosurgery (see SRS). It automatically adjusts the treatment table position as needed and tailors treatment to phases in the pateint's breathing cycle.
The Trilogy System has recently been upgraded with a new software program providing even greater accuracy. Conebeam CT allows radiation oncologists to generate CT images while the patient is on the treatment table. These are used to guide treatment (IGRT) and allow doctors to confirm positioning.
Trilogy's linear accelerator (the machine that delivers the radiation) contours the radiation beams to match the shape of the tumor, while Trilogy's on-board imaging capabilities allow physicians to accurately position patients for treatment.
In October 2006, Fox Chase became the first institution in the region to use Trilogy.
4-D CT Simulator is a CT or "cat" scanner with special software. During a 4-D CT scan, data is collected in discreet packets of time that are correlated with patient motion such as breathing. This allows doctors to "gate" or plan radiation treatment around your breathing or other motions your body makes at rest. This is especially useful when treating lung cancer where doctors can time the radiation to a special point in the breathing cycle to make the treatment more accurate. By utilizing the 4-D CT scanner, doctors are able to treat smaller tumors with great accuracy. The 4-D CT simulator is primarily used for patients with lung cancer, breast cancer and some gastrointestinal cancers.
CT and MRI scans, typically thought of as a diagnostic tool, are also used in radiation treatment planning. These technologies offer doctors a clear picture of your body allowing precision planning for treatments involving IMRT or 3-D CRT.
In 2001, Fox Chase Cancer Center was the first cancer center in the WORLD to use a dedicated MRI unit in the radiation oncology department specifically for routine radiation treatment planning.
CT-on-Rails, gold seeds and ultrasound-guided targeting (BAT) are all techniques that allow corrections in daily positioning to assure accurate delivery of radiation for men with prostate cancer. It is used in combination with IMRT for all patients who have had their prostate removed surgically. A key study showed that radiation after surgery for high-risk prostate cancer reduces the risk of recurrence. CT-on-Rails is a CT scanner that slides on rails in the floor so the patient doesn't have to move between the time of the scan and treatment. It slides over the patient's treatment table and then is pushed out of the way during treatment. Using the CT-on-Rails, a CT-scan is performed immediately before each treatment. That scan is compared to the initial treatment planning CT-scan to ensure the patient's positioning is accurate. This is called a "CT-to-CT" matching approach. BAT may also be used.
The CT-on-Rails is also used for some patients with an intact prostate in conjunction with gold marker seeds. These seeds are implanted before treatment and are used to help localize prostate position and make adjustments in position as necessary to help with the precision of the treatment. This approach is also used for cranial and extracranial (other sites outside of the head) stereotactic radiosurgery. It also offers unique treatment applications, such as treating cancer that has spread to the spine and allows physicians to compare the imaging techniques to locate different targets. In 2003, Fox Chase was the first in the region to use this technology.
A linear accelerator and in-room CT-on-Rails are housed together in a treatment room and are used for both imaging and radiation treatment. This ensures precise positioning before treatment begins each day. It also offers unique treatment applications, such as treating cancer that has spread to the spine and allows physicians to compare the imaging techniques to locate different targets.
Ultrasound Guided Targeting (BAT®) — B-mode Acquisition and Targeting benefits patients with prostate cancer. It may be used everyday before treatment to direct radiation treatment. The position of the prostate may shift inside the body. BAT technology allows the computer to correct for small changes in the location of the prostate between treatments. BAT Ultrasound, gold seeds and Calypso Beacons all are techniques to correct for prostate motion. Your physician will advise you on which is best in your case.
This technology was developed and first used at Fox Chase in 1999.
PET/CT combines PET scan (Positron Emission Tomography) with CT images to help physicians more precisely target the tumor with radiation. At Fox Chase, physicians integrate PET scan with treatment planning for patients with esophageal and rectal cancer.
Fox Chase was the first in the region to use PET/CT technology in 2002.
For more information about radiation oncology at Fox Chase Cancer Center or to make an appointment, call 1-888-FOX CHASE (1-888-369-2427).
