Session 3 - Treatment Simulation in RT.pptx

Simulation

1. Pre- CT Imaging Practice in Radiation Oncology Radiography has been a standard for imaging. X-ray Machine was maneuvered around the Patient Films were processed Films evaluated and marked

2. X-RAY vs Computed Tomography

3. Generating Image

4. Improved Treatment Plans

5. The First Step in the Radiation Treatment Preparation. It is non-diagnostic CT scan of the treatment area . The Objective is to Identify Region of Interest the pertains to the disease. And Create a Reproducible Setup A CT Simulation is normally performed  AFTER the patient has been consulted by a physician     In many cases Pathology and diagnostic imaging has indicated the presence of malignant disease. What is a CT simulation?

6. Who is involved in the CT simulation process? Radiation Therapist Dosimetrist  Radiation Oncologist Physicist 

7. What are the Benefits of CT Simulation Positioning  Set-up reproducibility  Tumor Localization  Contours 

8. Patient Preparation and Communication. All Documentation and Clinical Assessment ready. Have all equipment setup and ready before patient arrival. Explain to your patient How long will the procedure be. Provide comfort and assurance. Having a cooperative patient is essential to the process.

9. Marking the Skin for Setup

10. HOW IS A CT SIMULATION  WORKFLOW COMPLETED

11. Setting Up Parameter Revising Treatment Console Enter Patients Information. Selecting Protocols. Confirming Patient Orientation. Adjusting Setting.

12. Preliminary Scan Scout Images Anatomy to be Scanned Depth of Scan

13. CT SIMULATION IMAGES  CT Simulation scan (axial) will be reconstructed to view images in other orientations, such as:  Sagittal  Coronal  The CT Simulation scan will be used to create DRR's. ( Digitally Reconstructed Radiograph)

14. IMMBOLIZATION DEVICES VAC LOC Create a rigid and secure support around the patient when a vacuum is drawn through a self-sealing quick-release valve. Vacuum Compressors are used to draw a vacuum through Vac-Loc cushions.

15. IMMBOLIZATION DEVICES Alpha Cradle A custom made immobilization device made with plastic bag and foam.

16. IMMBOLIZATION DEVICES AQUA PLAST MASK  an easy to use, rigid thermoplastic with minimal shrinkage.

17. IMMBOLIZATION DEVICES MOLD CARE Wedges

18. Head and Neck/Brain Simulation HEAD & NECK TWO scans for H&N Arms on their sides Mold the aqua- plast mask Knee wedge for comfort BRAIN NO tattoos for Brain setups One scan only for  whole Brain  Arms on their sides Mold the aqua- plast mask Knee wedge for comfort

19. Head and Neck/Brain Setups

20. Breast Setups

21. Prone Breast Setups Only one scan Both arms up  6-8 tattoos total (back, dorsal & breast tattoos Knee wedge under ankles

22. Supine Breast or Chest Only one scan One or both arm up  5-7 tattoos total (breast & doral tattoos) Mold care, vac-loc, Or Device Knee wedge under knees

23. Breast setups

24. Chest/Abdomen Simulation

25. Chest Setups Position the Patient as straight and comfortable as possible Aling the head to a semi extended position

26. 4D GATING Gating is a system that tracks a patient's normal respiratory cycle with an infrared camera and chest/abdomen marker. The system is coordinated to only deliver radiation when the tumor is in the treatment field. Typically used for: breast, lung, liver and SBRT 2 tattoos are done for box placement

27. 4D Gating The patient is first imaged on the CT Simulator while tracking the movement of the lightweight chest/abdomen marker with the infrared camera. Images are analyzed using Siemens' 4D software to accurately determine tumor motion.

28. Pelvis Simulation Anal, Rectum & Prostate Hands on chest holding ring Universal wedge, Molds, or vacloc Typically sim is done with empty rectum and full bladder 4 tattoos done GYN & Brachytherapy  Arms above head holding poles  Wingboard and a squared pillow vacloc Some may be position frog legged Catheter placed during sim for full and empty bladder scans 4 tattoos done For brachytherapy sim is only done to see placement of vaginal cylinder, tandem and ovoid or seeds

29. PELVIS SETUPS Anal, Rectum & Prostate Hands on chest holding ring  Universal wedge, Molds, or  vacloc Typically sim is done with empty rectum and full bladder 4 tattoos done 

30. Brachytherapy CT GYN & Brachytherapy  ​ Arms above head holding poles  ​ Wingboard and a squared pillow ​ vacloc ​ Some may be position frog legged ​ Catheter placed during sim for full and empty bladder scans ​ For brachytherapy sim is only done to see placement of vaginal cylinder, tandem and ovoid or seed

31. EXTREMITIES SIMULATIONS

32. Simulation Completed Images are uploaded Physician outlines Structures (Contouring) A Physicist or Dosimetrist Designs a plan for treatment.

33. Final Remarks CT SIM is a Golden Tool and pivotal Process in providing safe accurate and reproducible Radiation Therapy.