Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
PET/CT Link Between Radiation Therapy and Planning BY: JONATHAN BALDWIN, BSRT, CNMT, RT(CT) & GARRETT WINTERS, BSRT, RT(T) Introduction — What is Radiation Therapy — Immobilization Techniques — What is Radiation Therapy Planning — PET/CT Equipment Needs For Planning — PET/CT Protocol Changes — Drawbacks of PET/CT Planning What is Radiation Therapy? What is CT Simulation — Foundation of radiation therapy process ¡ ¡ Information gathered from the simulation process determines how the patient will be treated Determines patient position ÷ Simulating the daily treatment setup — Area scanned is determined by physician — Images acquired are sent to dosimetry How do we reproduce setups? — Flat Table top ¡ Uncomfortable ¡ Carbon Fiber ¡ Identical to the tx rm tabletop — Lap Laser system — Three point setup 1. Anterior Mark 2. Lateral Marks — Immobilization devices What are immobilization devices? Why do we need immobilization devices? — What about internal organ motion? ¡ Respiratory Gating What happens during the planning process? — Prescription-Physician ¡ Total dose-Physician ¡ Dosing RestraintsPhysician/Dosimetrist — Contouring ¡ Treatment volumes-Physician ÷ ¡ GTV, CTV, PTV Normal Tissues-Dosimetrist — Forward Planning ¡ Algorithm Based ¡ Determines the best beam arrangement ¡ DVH Why is simulation so important? & What does PET bring to the table? Benefits of Planning in PET/CT — Benefits to Radiation Therapy ¡ Decrease Tumor Margins ¡ Physiologic Information ¡ Treatment Regimen Change — Benefits to the PET/CT Department ¡ Increased Productivity ¡ Increased Revenue Benefits of Planning in PET/CT — Benefits to the Patient ¡ Smaller Treatment Fields ¡ Treatment of Tumors Missed by CT ¡ Increased Effectiveness of Treatment ¡ Treatment Regimen Changes Accomplishing PET/CT Planning — PET/CT Technologist must: ¡ Accommodate the Needs of the Radiation Therapy Department ÷ Communication is Key ¡ Thorough Patient Education ¡ Minor Changes to common Protocols PET/CT Protocol Changes — General F-18 FDG Protocol ¡ Injection, 60-90 min localization, PET/CT Scan — PET/CT Planning Protocol Changes PET/CT Protocol Changes — Localization Time/Coordination ¡ Communicate Injection/Scan Times ¡ Patient Use the Restroom Early ¡ Allow 10-15 Minutes For Proper Set Up ÷ ¡ ¡ Multiple Scout Scans Possible Have Bed/Equipment Prepared Consistency on Subsequent Studies PET/CT Protocol Changes — Positioning Changes ¡ RTX Requires Special Positioning For Different Pathology ¡ Reproducible Positions — Contrast Use ¡ Many Pathologies May Require the Use of Contrast Media ÷ ¡ Compensate for Attenuation IV, Rectal, Bladder, and Esophageal Contrast PET/CT Protocol Changes — Patient Preparation ¡ Explain the Procedure!! ¡ Some Patients will Require Sedative ¡ Remove Immobilization Devices ASAP — Laser Landmark Adjustments ¡ External Laser System ¡ Adjust Starting Locations Accordingly Disadvantages To PET/CT Planning — Cross Departmental Communication — Time To Complete — Scanner Bore Size — Diabetic Patients Nasopharyngeal Cancer — Less than 1 case/100,000 — In 2013 2,900 cases in US — Bimodal age distribution ¡ 15-24 yo ¡ 55-65 yo — Early stage survival rate ¡ 80%-90% — Late Stage survival rate ¡ 50%-70% Adapted from: radiopaedia.org NSCLC — Most common type of lung cancer ¡ 224,210 new cases in 2014 ¡ 159,260 deaths — Leading cause of cancer related death ¡ 27% — Cancer of the elderly ¡ 2/3rd are 65 or older ¡ Avg. age of 70 Adapted from: www.lung.org Wrap Up — What is radiation therapy — What is radiation planning — What are immobilization devices, and how are they implemented — Benefits of PET/CT radiation planning — Protocol differences with PET/CT planning — Draw backs to radiation planning PET/CT Questions