Presentation AIM and Role of Radiotherapy.ppt

This presentation explains the aim and role of radiotherapy in cancer management. It covers the basic principles of radiation therapy, treatment objectives, and its importance in oncology practice. The material is designed for students, healthcare professionals, and anyone interested in medical physics and cancer treatment.

1. Radiation Protection inRadiation Protection in
RadiotherapyRadiotherapy
Part 1Part 1
Aim and Role of RadiotherapyAim and Role of Radiotherapy
Introductory LectureIntroductory Lecture
IAEA Training Material on Radiation Protection in Radiotherapy

2. Radiation Protection in Radiotherapy Part 1: Introductory lecture 2
RadiotherapyRadiotherapy
One of the main treatment One of the main treatment
modalities for cancer (often in modalities for cancer (often in
combination with chemotherapy and combination with chemotherapy and
surgery)surgery)
It is generally assumed that 50 to 60% It is generally assumed that 50 to 60%
of cancer patients will benefit from of cancer patients will benefit from
radiotherapyradiotherapy
Minor role in other diseasesMinor role in other diseases
Siemens Oncology

3. Radiation Protection in Radiotherapy Part 1: Introductory lecture 3
Objectives of the ModuleObjectives of the Module

To become familiar withTo become familiar with

the principles of radiotherapythe principles of radiotherapy

the role of radiotherapy in cancer the role of radiotherapy in cancer
managementmanagement

the cost effectiveness of radiotherapythe cost effectiveness of radiotherapy

To appreciate the importance of To appreciate the importance of
radiation dose in radiotherapyradiation dose in radiotherapy

4. Radiation Protection in Radiotherapy Part 1: Introductory lecture 4
Contents of the LectureContents of the Lecture
1.1.Cancer management and radiotherapyCancer management and radiotherapy
2.Approaches for dose delivery2.Approaches for dose delivery
External beam radiotherapyExternal beam radiotherapy
BrachytherapyBrachytherapy
3.3.Features of a radiotherapy departmentFeatures of a radiotherapy department
4.Self test at the end of the lecture4.Self test at the end of the lecture
””Quick test”Quick test”

5. Radiation Protection in Radiotherapy Part 1: Introductory lecture 5
Cancer incidence (WHO)Cancer incidence (WHO)

6. Radiation Protection in Radiotherapy Part 1: Introductory lecture 6
Major indications for radiotherapyMajor indications for radiotherapy

Head and neck cancersHead and neck cancers

Gynaecological cancers (Gynaecological cancers (e.g.e.g. Cervix) Cervix)

Prostate cancerProstate cancer

Other pelvic malignancies (rectum, bladder)Other pelvic malignancies (rectum, bladder)

Adjuvant breast treatmentAdjuvant breast treatment

Brain cancersBrain cancers

PalliationPalliation

7. Radiation Protection in Radiotherapy Part 1: Introductory lecture 7
ApproachesApproaches
Palliative radiotherapy to reduce pain Palliative radiotherapy to reduce pain
and address acute symptoms – and address acute symptoms – e.g.e.g.
bone metastasis, spinal cord bone metastasis, spinal cord
compression, ...compression, ...
Radical radiotherapy as primary Radical radiotherapy as primary
modality for cure – modality for cure – e.g.e.g. head and neck head and neck

Adjuvant treatment in conjunction with Adjuvant treatment in conjunction with
surgery – surgery – e.g.e.g. breast cancer breast cancer

8. Radiation Protection in Radiotherapy Part 1: Introductory lecture 8
AimAim

To kill To kill ALLALL viable viable
cancer cellscancer cells

To deliver as much To deliver as much
dose as possible to dose as possible to
the target while the target while
minimising the dose minimising the dose
to surrounding to surrounding
healthy tissueshealthy tissues
target
Patient
Critical
organs
Beam
directions

9. Radiation Protection in Radiotherapy Part 1: Introductory lecture 9
Prognostic FactorsPrognostic Factors

Cancer type and stageCancer type and stage

Patient performancePatient performance

Radiation doseRadiation dose

...... survival
time
Good prognosis
Bad prognosis

10. Radiation Protection in Radiotherapy Part 1: Introductory lecture 10
Prognostic FactorsPrognostic Factors

Cancer type and stageCancer type and stage

Patient performancePatient performance

Radiation doseRadiation dose

......
Accurate dose delivery
matters!

11. Radiation Protection in Radiotherapy Part 1: Introductory lecture 11
Dose Dose
responseresponse
100% response
means the tumour
is cured with
certainty (TCP) or
unacceptable normal
tissue damage (e.g.
paralysis) is
inevitable

12. Radiation Protection in Radiotherapy Part 1: Introductory lecture 12
Dose Dose
responseresponse
Therapeutic window:
Maximum probability
of Complication Free
Tumour Control

13. Radiation Protection in Radiotherapy Part 1: Introductory lecture 13
Dose should be accurateDose should be accurate
To target:To target:

5% too low - may result in clinically 5% too low - may result in clinically
detectable reduction in tumour control (detectable reduction in tumour control (e.g.e.g.
Head and neck cancer: 15%)Head and neck cancer: 15%)
To normal tissues:To normal tissues:
5% too high - may lead to significant 5% too high - may lead to significant
increase in normal tissue complication increase in normal tissue complication
probability = morbidity = unacceptable side probability = morbidity = unacceptable side
effectseffects

14. Radiation Protection in Radiotherapy Part 1: Introductory lecture 14
““Deviations from Prescribed Dose”Deviations from Prescribed Dose”

May involve severe or even fatal May involve severe or even fatal
consequences.consequences.

IAEA Basic Safety Standards (SS 115): IAEA Basic Safety Standards (SS 115):
”…require prompt investigation by ”…require prompt investigation by
licensees in the event of an accidental licensees in the event of an accidental
medical exposure…”medical exposure…”

15. Radiation Protection in Radiotherapy Part 1: Introductory lecture 15
Options for dose deliveryOptions for dose delivery

External beam radiotherapyExternal beam radiotherapy = dose is = dose is
delivered from outside the patient using delivered from outside the patient using
X Rays or gamma rays or high energy X Rays or gamma rays or high energy
electrons (refer to part 5 of the course)electrons (refer to part 5 of the course)

BrachytherapyBrachytherapy = dose delivered from = dose delivered from
radioactive sources implanted in the radioactive sources implanted in the
patient close to the target (brachys = patient close to the target (brachys =
Greek for short distance; refer to part 6 Greek for short distance; refer to part 6
of the course)of the course)

16. Radiation Protection in Radiotherapy Part 1: Introductory lecture 16
External beam radiotherapyExternal beam radiotherapy

17. Radiation Protection in Radiotherapy Part 1: Introductory lecture 17
External Beam RadiotherapyExternal Beam Radiotherapy

Typically fractionated - Typically fractionated - e.g.e.g. 30 daily fractions 30 daily fractions
of 2Gy up to a total dose of 60Gyof 2Gy up to a total dose of 60Gy

Superficial/orthovoltage photonsSuperficial/orthovoltage photons (50 to (50 to
400kVp) for skin or superficial lesions400kVp) for skin or superficial lesions
Megavoltage photonsMegavoltage photons (60-Co or linear (60-Co or linear
accelerators = linacs) for deeper lying accelerators = linacs) for deeper lying
tumours.tumours.

Megavoltage electronsMegavoltage electrons from linacs for more from linacs for more
superficial lesionssuperficial lesions

18. Radiation Protection in Radiotherapy Part 1: Introductory lecture 18
Superficial/orthovoltage unitSuperficial/orthovoltage unit

19. Radiation Protection in Radiotherapy Part 1: Introductory lecture 19
Modern Cobalt 60 unitModern Cobalt 60 unit

20. Radiation Protection in Radiotherapy Part 1: Introductory lecture 20
Linear accelerator with Linear accelerator with
electron coneelectron cone
Electron
applicator

21. Radiation Protection in Radiotherapy Part 1: Introductory lecture 21
BrachytherapyBrachytherapy
Interstitial implant for breast
radiotherapy
Intracavitary
gynecological implant

22. Radiation Protection in Radiotherapy Part 1: Introductory lecture 22
BrachytherapyBrachytherapy
Implant of radioactive materials (Implant of radioactive materials (e.g.e.g.
137-Cs, 192-Ir) close to the target area137-Cs, 192-Ir) close to the target area
Intracavitary, interstitial and mould Intracavitary, interstitial and mould
surface applicationssurface applications
Low dose rate, LDR, (60Gy in about 5 Low dose rate, LDR, (60Gy in about 5
days) and high dose rate, HDR, days) and high dose rate, HDR,
(several fractions of several Gy in few (several fractions of several Gy in few
minutes each) applicationsminutes each) applications

23. Radiation Protection in Radiotherapy Part 1: Introductory lecture 23
Example for HDR BrachytherapyExample for HDR Brachytherapy

24. Radiation Protection in Radiotherapy Part 1: Introductory lecture 24
A radiotherapy department is A radiotherapy department is
part of a health systempart of a health system
Oncology
Radiotherapy
Department
Host hospital
National
Cancer System

25. Radiation Protection in Radiotherapy Part 1: Introductory lecture 25
…not necessarily a straightforward process
Patient Patient
Flow in Flow in
Radio-Radio-
therapytherapy

26. Radiation Protection in Radiotherapy Part 1: Introductory lecture 26
Patient flow in radiotherapyPatient flow in radiotherapy

Depends on:Depends on:

disease site and stagedisease site and stage

departmental protocolsdepartmental protocols

treating cliniciantreating clinician

resources availableresources available

27. Radiation Protection in Radiotherapy Part 1: Introductory lecture 27
Components of a Components of a
Radiotherapy DepartmentRadiotherapy Department

Diagnostic facilities (CT, MRI, …)Diagnostic facilities (CT, MRI, …)

Simulator (refer to part 5 of the course)Simulator (refer to part 5 of the course)

MouldroomMouldroom

Treatment planningTreatment planning

External beam treatment units (parts 5 and External beam treatment units (parts 5 and
10)10)

Brachytherapy equipment (part 6)Brachytherapy equipment (part 6)

Clinic rooms, beds, ...Clinic rooms, beds, ...

28. Radiation Protection in Radiotherapy Part 1: Introductory lecture 28
Layout of a DepartmentLayout of a Department

29. Radiation Protection in Radiotherapy Part 1: Introductory lecture 29
Layout of a DepartmentLayout of a Department
Two linac
bunkers
Offices
Physics &
workshops
Clinics
Simulator
Patient
waiting
Planning

30. Radiation Protection in Radiotherapy Part 1: Introductory lecture 30
Professionals in radiotherapyProfessionals in radiotherapy

Radiation oncologistsRadiation oncologists

Other cliniciansOther clinicians

Medical radiation physicistsMedical radiation physicists

Radiation therapistsRadiation therapists

Nursing staffNursing staff

Radiation safety officerRadiation safety officer

Information technology officerInformation technology officer

Administrative staffAdministrative staff

31. Radiation Protection in Radiotherapy Part 1: Introductory lecture 31
Features of RadiotherapyFeatures of Radiotherapy

High and potentially lethal absorbed High and potentially lethal absorbed
dose is required to cure cancerdose is required to cure cancer

High technology environmentHigh technology environment

Individualized treatment approachIndividualized treatment approach

Complex treatment set-upComplex treatment set-up

32. Radiation Protection in Radiotherapy Part 1: Introductory lecture 32
Features of RadiotherapyFeatures of Radiotherapy

High and potentially lethal absorbed dose High and potentially lethal absorbed dose
is required to cure canceris required to cure cancer

High technology environmentHigh technology environment

Individualized treatment approachIndividualized treatment approach

Complex treatment set-upComplex treatment set-up

Quality assurance, treatment verification Quality assurance, treatment verification
and radiation protection essentialand radiation protection essential

33. Radiation Protection in Radiotherapy Part 1: Introductory lecture 33
SummarySummary

Radiotherapy is an important cancer Radiotherapy is an important cancer
treatment modalitytreatment modality

Accuracy of dose delivery is essential Accuracy of dose delivery is essential
for good outcomesfor good outcomes

The complex and high tech environment The complex and high tech environment
requires attention to quality assurance requires attention to quality assurance
and radiation protectionand radiation protection

34. Radiation Protection in Radiotherapy Part 1: Introductory lecture 34
Any questions?Any questions?