Practical Aspects of Implementation of Helical Tomotherapy for Intensity-modulated and Image-guided Radiotherapy

Burnet, N.G.; Adams, E.J.; Fairfoul, J.; Tudor, G.S.J.; Hoole, A.C.F.; Routsis, D.S.; Dean, J.C.; Kirby, R.D.; Cowen, M.; Russell, S.G.; Rimmer, Y.L.; Thomas, S.J.

doi:10.1016/j.clon.2010.02.003

« Previous Next »Clinical Oncology
Volume 22, Issue 4 , Pages 294-312, May 2010

Practical Aspects of Implementation of Helical Tomotherapy for Intensity-modulated and Image-guided Radiotherapy

N.G. Burnet
- University of Cambridge Department of Oncology, Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
- Author for correspondence: N.G. Burnet, University of Cambridge Department of Oncology, Oncology Centre (Box 193 - R4), Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
E.J. Adams
- Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
J. Fairfoul
- Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
G.S.J. Tudor
- Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
A.C.F. Hoole
- Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
D.S. Routsis
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
J.C. Dean
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
R.D. Kirby
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
M. Cowen
- Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
S.G. Russell
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
Y.L. Rimmer
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
S.J. Thomas
- Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK

Received 9 December 2009; received in revised form 13 January 2010; accepted 9 February 2010.

Abstract

Aims

Image-guided radiotherapy (IGRT) and intensity-modulated radiotherapy (IMRT) represent two important technical developments that will probably improve patient outcome. Helical tomotherapy, provided by the TomoTherapy HiArt™ system, provides an elegant integrated solution providing both technologies, although others are available. Here we report our experience of clinical implementation of daily online IGRT and IMRT using helical tomotherapy.

Materials and methods

Methods were needed to select patients who would probably benefit. Machine-specific commissioning, a quality assurance programme and patient-specific delivery quality assurance were also needed. The planning target volume dose was prescribed as the median dose, with the added criterion that the 95% isodose should cover 99% of the target volume. Although back-up plans, for delivery on conventional linear accelerators, were initially prepared, this practice was abandoned because they were used very rarely.

Results

In the first 12 months, 114 patients were accepted for treatment, and 3343 fractions delivered. New starts averaged 2.6 per week, with an average of 17.5 fractions treated per day, and the total number capped at 22. This has subsequently been raised to 24. Of the first 100 patients, 96 were treated with radical intent. Five were considered to have been untreatable on our standard equipment. IGRT is radiographer led and all patients were imaged daily, with positional correction made before treatment, using an action level of 1mm. A formal training programme was developed and implemented before installation. The in-room time fell significantly during the year, reflecting increasing experience and a software upgrade. More recently, after a couch upgrade in April 2009, the mean in-room time fell to 18.6min.

Conclusions

Successful implementation of tomotherapy was the result of careful planning and effective teamwork. Treatment, including daily image guidance, positional correction and intensity-modulated delivery, is fast and efficient, and can be integrated into routine service. This should encourage the adoption of these technologies.

Key words: Helical tomotherapy, image-guided intensity-modulated radiotherapy