Radiation Therapy Technology & Tools
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Radiation Oncology at Fox Chase Cancer Center
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These tools are critical for precise delivery of high-dose radiation. The Fox Chase ream uses them to plan/tailor radiation treatment and to localize (locate daily) the tumor target. (Some tools may be familiar because some of the technology, such as a CT, is also used in the diagnosis of cancer).
Extensive Planning Tools for More Precise Treatment
Calypso® is brand new 4-dimensional monitoring technology to localize and track the prostate throughout treatment, allowing for more precise and accurate radiation targeting. During radiation treatment, doctors work hard to protect healthy tissues near the tumor from receiving radiation. Sometimes though, the location of the cancer moves during treatment, even if the patient is set up perfectly. This is usually caused by internal organ motion that can not be controlled by the patient or physician. For men receiving treatment for prostate cancer, the most common side effects occur when the nearby normal organs (the bladder) receive small amounts of radiation causing urinary, rectal (rectum) and sexual side effects (penile base tissues).
Calypso 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.
Since gaining FDA approval, Calypso 4D Localization System offers doctors assistance to objectively determine a tumor's location with great accuracy and continuously monitor its position throughout treatment. Miniature electromagnetic sensors (similar to seeds), called Beacon® transponders, are implanted into the prostate during treatment planning to continuously monitor position and motion of the organ in real-time. Before each treatment, Calypso® finds the beacons and helps the technologist re-align the treatment plan. Unlike other treatment planning tools, Calypso offers "real time tracking" which helps improve the accuracy of delivering radiation. If the prostate moves out of the targeting range during treatment, the system signals the therapists so that an adjustment may be made.
In January 2007, Fox Chase became the first treatment center in the region to use this technology for treatment planning.
High Intensity Focused Ultrasound (HIFU) is a new technology allows sound waves to generate heat, which can destroy cancer cells alone and in conjunction with radiation. HIFU allows high levels of ultrasound energy to create intense heat. The sound waves are narrowly focused on the tumor with great precision while sparing the normal surrounding organs/structures. Heat (hyperthermia) has been used for many years and there is a large published experience in the US and Europe; however, in the past, technology limited hyperthermia to superficial (shallow) tumors.
HIFU was introduced to treat patients with bone metastases, but will eventually allow Fox Chase physicians to treat deep tumors in the pelvis and elsewhere for the first time. HIFU works like a magnifying glass intensifying and focusing the sun's light on a specific point. HIFU's energy has physical properties that allow the beam to avoid harming tissues in the entry and exit pathways. The HIFU capability can be manipulated by the focusing devices, the temperature of the energy and the exposure time. Currently, HIFU is FDA approved for use in treating benign uterine fibroids. At Fox Chase, researchers will study the use of HIFU for prostate, gynecologic and gastrointestinal (GI) cancers.
Fox Chase was the first treatment center in the region to validate this technology with MRI for oncology.
1.5T MRI scanner is used at Fox Chase in conjunction with HIFU to guide the hyperthermia (sound waves). A sophisticated software system allows the visualization of the patient's tumor in real time during treatment. The MRI's image interfaces with the software controlling the HIFU's targeting system. The coupling of these technologies ensures sub-millimeter accuracy.
MR spectroscopy (also called MRS, functional MRI or fMRI) is used along with 1.5T MRI in the Department of Radiation Oncology by radiation oncologists to further tailor radiation treatment, specifically now for certain prostate cancer and brain cancers. MR spectroscopy is helpful in identifying the metabolic activity of the tumor, confirming the boundaries and bulky areas. MR spectroscopy brings a new capability to treatment planning and allows more precise tailoring of radiation treatment.
In October 2006, Fox Chase became the first treatment center in the region to use this technology for treatment planning.
CyberKnife Technology with Fox Chase Skill in Pennsylvania
Stereotactic Radiosurgery (SRS) and Stereotactic Radiotherapy (SRT) offer physicians the opportunity to deliver large doses of radiation to very small areas by aiming an X-ray or gamma-ray at a target or tumor. Radiation can be precisely delivered to its target while preserving more healthy tissue than with conventional external beam therapy.More
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.