Radiotherapy Planning Department

 

 

 

 

 

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The Radiotherapy Planning Department has evolved from the Treatment Planning Unit which operated at the Institute of Oncology in Gliwice since 1991 year.  Over the years, the following radiotherapy techniques have been implemented in the Department: dynamic treatment techniques (IMRT, RapidArc), radiosurgery, respiratory gating, IGRT, robotic tracking, vascular and real time brachytherapy.

The Radiotherapy Planning Department provides comprehensive preparation for patients scheduled to undergo radiotherapy and brachytherapy.

The Department is responsible for the following steps:

• Patient positioning and immobilization, depending on the type of therapy,
• CT and MR scanning for treatment planning,
• Definition of geometric irradiation conditions, including organ and tumor contours,
• Individual dose and radiation time calculations based on CT scans (MR and/or PET image fusion),
• Preparation of individual blocks and other treatment fields accessories,
• Treatment fields simulation and contours,
• Definition of therapeutic sessions in the computerized management system,
• Verification of treatment plans using biomedical accelerators and QA procedures.

The treatment planning includes all the technical procedures, patient positioning and IT processes needed for the patient to start radiotherapy.

Treatment planning is based on the primary image set of computer tomography (CT) performed individually for each patient.  CT and MR scans are used for the planning since they provide information about tissue densities used to calculate the radiation dose distribution in the patient’s body and to determine the irradiation time.

The Radiotherapy Planning Department has two types of scanners:  CT and magnetic resonance (MR) to carry out patient imaging for treatment planning and to mark areas to be protected.  Modern treatment planning systems allow for fusion of different imaging sources. The image data from the CT and MR can also be registered with positron emission tomography (PET), which can improve the localization and size definition of the irradiation target.

In order to plan radiotherapy, the irradiated target and the surrounding healthy organs are contoured on the CT images.  Subsequently, the required radiation doses to the target and the maximum acceptable doses for the healthy organs are specified by the oncologist.  Planning includes selecting the beam energy, beam sizes and arrangement (teleradiotherapy) or source placement, the stop positions and time (brachytherapy) as well as consecutive dose optimization attempts.

Contouring and dose computation are generated in the advanced computer treatment planning system.  All the treatment planning systems used by the Department allow for calculating the three-dimensional dose distribution.  The calculations are performed for all the latest technologies, performed on various contemporary biomedical accelerators, such as Linacs, CyberKnife and Tomotherapy as well as delivered by HDR machines.

After selecting the optimal dose distribution and the best plan approval, a simulation of the plan is carried out.  The simulation consists in outlining the geometrical conditions of the plan, i.e. reference points, treatment field lines on the mask or the patient’s body.  The procedure is performed on the so-called simulator equipped with an X-ray tube and imaging system.  Radiographic images of the treated region are also taken.

The last step in the treatment planning process is plan checking prior to treatment delivery. During this step, an independent dose calculation is made, the conformity of the prescribed dose with the planned one is checked, and verification plans for dosimetry are generated.

The planned daily and total doses are transferred to the data management system.  Moreover, all planning images of the patient and the X-ray images registered during the simulation are saved in the database.  The system includes all patient data and graphics; controls the delivered dose; provides the history of the treatment and any necessary changes or breakpoints in the treatment.  The management system is administered by the staff of the Radiotherapy Planning Department.

The Radiotherapy Planning Department conducts R&D work on developing and introducing the following into clinical practice:

• New irradiation techniques in radiotherapy and brachytherapy,
• Proprietary software for radiobiological dose calculations using mathematical modeling and clinical data,
• Treatment planning support programs,
• Computer algorithms used to ensure high quality radiotherapy.

The overall planning course is prepared by the dosimetrists and medical physicists working for the Radiotherapy and Brachytherapy Planning Department.  Its employees also actively participate in research work carried out at the Institute.  They attend both Polish and international conferences on radiotherapy, brachytherapy, and medical physics, raising their professional qualifications and improving knowledge of treatment planning.  The Department employees are also authors and co-authors of numerous papers and posters.

The Department participates in the education of young doctors and physicists, organizing training courses and conducting classes on treatment planning problems.

The Radiotherapy Planning Department consists of the following Units:

• QA and IT Unit,
• Dose Calculation Unit,
• Patient Preparation Unit,