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

      Affiliations

    • University of Cambridge Department of Oncology, Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
    • Corresponding Author InformationAuthor 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

      Affiliations

    • Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • J. Fairfoul

      Affiliations

    • Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • G.S.J. Tudor

      Affiliations

    • Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • A.C.F. Hoole

      Affiliations

    • Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • D.S. Routsis

      Affiliations

    • Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • J.C. Dean

      Affiliations

    • Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • R.D. Kirby

      Affiliations

    • Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • M. Cowen

      Affiliations

    • Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • S.G. Russell

      Affiliations

    • Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • Y.L. Rimmer

      Affiliations

    • Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
  • ,
  • S.J. Thomas

      Affiliations

    • Medical Physics Department, Addenbrooke's Hospital, Cambridge, UK

Received 9 December 2009 ,Revised 13 January 2010 ,Accepted 9 February 2010.

References 

  1. Intensity Modulated Radiation Therapy Collaborative Working Group. Intensity-modulated radiotherapy: current status and issues of interest. Int J Radiat Oncol Biol Phys. 2001;51:880–914
  2. International Atomic Energy Agency (IAEA) . Transition from 2-D radiotherapy to 3-D conformal and intensity modulated radiotherapy. Vienna: IAEA; 2008;
  3. Pow EH, Kwong DL, McMillan AS, et al. Xerostomia and quality of life after intensity-modulated radiotherapy vs conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys. 2006;66:981–991
  4. Xing L, Thorndyke B, Schreibmann E, et al. Overview of image-guided radiation therapy. Med Dosim. 2006;31(2):91–112
  5. Verellen D, Ridder MD, Linthout N, Tournel K, Soete G, Storme G. Innovations in image-guided radiotherapy. Nat Rev Cancer. 2007;7(12):949–960
  6. Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W. Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol. 2008;9(4):367–375
  7. Donovan E, Bleakley N, Denholm E, et al. Breast Technology Group Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007;82(3):254–264
  8. Nutting C, A'Hern R, Rogers MS, et al. on behalf of the PARSPORT Trial Management Group First results of a phase III multicenter randomized controlled trial of intensity modulated (IMRT) versus conventional radiotherapy (RT) in head and neck cancer (PARSPORT: ISRCTN48243537; CRUK/03/005). J Clin Oncol. 2009;27:(Suppl):abstract LBA6006
  9. Mackie TR, Olivera GH, Kapatoes JM, et al. Helical tomotherapy. In:  Palta P,  Mackie TR editor. Intensity-modulated radiation therapy: the state of the art. College Park, MD: American Association of Physicists in Medicine; 2003;p. 247–284
  10. Mackie TR. History of tomotherapy. Phys Med Biol. 2006;51(13):R427–453
  11. Welsh JS, Patel RR, Ritter MA, Harari PM, Mackie TR, Mehta MP. Helical tomotherapy: an innovative technology and approach to radiation therapy. Technol Cancer Res Treat. 2002;1(4):311–316
  12. Welsh JS, Lock M, Harari PM, et al. Clinical implementation of adaptive helical tomotherapy: a unique approach to image-guided intensity modulated radiotherapy. Technol Cancer Res Treat. 2006;5(5):465–479
  13. Yartsev S, Kron T, Van Dyk J. Tomotherapy as a tool in image-guided radiation therapy (IGRT): theoretical and technological aspects. Biomed Imaging Intervention J. 2007;3(1):e16
  14. IPEM Report no. 96 . Guidance for the clinical implementation of intensity modulated radiation therapy. London: Institute of Physics and Engineering in Medicine (IPEM); 2008;
  15. Whitton A, Warde P, Sharpe M, et al. Organisational standards for the delivery of intensity-modulated radiation therapy in Ontario. Clin Oncol (R Coll Radiol). 2009;21(3):192–203
  16. HMSO . The Ionising Radiation (Medical Exposures) Regulations 2000, as amended by the Ionising Radiation (Medical Exposures) (Amendments) Regulations 2006, SI 2006/2523. Available from:. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007957
  17. Mayles WPM, Lake R, McKenzie A, et al. Physics aspects of quality control in radiotherapy. IPEM Report no. 81. York: Institute of Physics and Engineering in Medicine (IPEM); 1999;
  18. Fenwick JD, Tome WA, Jaradat HA, et al. Quality assurance of a helical tomotherapy machine. Phys Med Biol. 2004;49(13):2933–2953
  19. Balog J, Holmes T, Vaden R. Helical tomotherapy dynamic quality assurance. Med Phys. 2006;33:3939–3950
  20. Sarkar V, Lin L, Shi C, Papanikolaou N. Quality assurance of the multileaf collimator with helical tomotherapy: design and implementation. Med Phys. 2007;34(7):2949–2956
  21. Broggi S, Cattaneoa GM, Molinellia S, et al. Results of a two-year quality control program for a helical tomotherapy unit. Radiother Oncol. 2008;86:231–241
  22. Gibbons JP, Smith K, Cheek D, Rosen I. Independent calculation of dose from a helical TomoTherapy unit. J Appl Clin Med Phys. 2009;10(1):103–119
  23. Zhao YL, Mackenzie M, Kirkby C, Fallone BG. Monte Carlo evaluation of a treatment planning system for helical tomotherapy in an anthropomorphic heterogeneous phantom and for clinical treatment plans. Med Phys. 2008;35(12):5366–5374
  24. Rimmer YL, Burnet NG, Routsis DS, et al. Practical issues in the implementation of image-guided radiotherapy for the treatment of prostate cancer within a UK department. Clin Oncol. 2008;20(1):22–30
  25. Dean JC, Routsis DS. Training Needs of Radiographers for Implementing TomoTherapy in NHS Practice. J Radiother Practice (in press).
  26. Beavis AW, Phillips R, Ward JW. Radiotherapy training tools for yesterday's future. Imaging Oncol. 2007;30–35
  27. Rimmer YL. The implementation and optimisation of image-guided radiotherapy in prostate cancer. MD thesis, University of East Anglia, 2009.
  28. de Crevoisier R, Tucker SL, Dong L, et al. Increased risk of biochemical and local failure in patients with distended rectum on the planning CT for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2005;62(4):965–973
  29. Ghilezan M, Yan D, Liang J, Jaffray D, Wong J, Martinez A. Online image-guided intensity-modulated radiotherapy for prostate cancer: how much improvement can we expect? a theoretical assessment of clinical benefits and potential dose escalation by improving precision and accuracy of radiation delivery. Int J Radiat Oncol Biol Phys. 2004;60(5):1602–1610
  30. Kupelian PA, Langen KM, Zeidan OA, et al. Daily variations in delivered doses in patients treated with radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2006;66(3):876–882
  31. Kupelian PA, Willoughby TR, Reddy CA, Klein EA, Mahadevan A. Impact of image guidance on outcomes after external beam radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70(4):1146–1150
  32. Cozzarini C, Fiorino C, Di Muzio N, et al. Significant reduction of acute toxicity following pelvic irradiation with helical tomotherapy in patients with localized prostate cancer. Radiother Oncol. 2007;84(2):164–170
  33. Zelefsky MJ, Levin EJ, Hunt M, et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70(4):1124–1129
  34. Viani GA, Stefano EJ, Afonso SL. Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys. 2009;74(5):1405–1418
  35. Cahlon O, Hunt M, Zelefsky MJ. Intensity-modulated radiation therapy: supportive data for prostate cancer. Semin Radiat Oncol. 2008;18(1):48–57
  36. Clark CH, Bidmead AM, Mubata CD, Harrington KJ, Nutting CM. Intensity-modulated radiotherapy improves target coverage, spinal cord sparing and allows dose escalation in patients with locally advanced cancer of the larynx. Radiother Oncol. 2004;70(2):189–198
  37. Sterzing F, Schubert K, Sroka-Perez G, Kalz J, Debus J, Herfarth K. Helical tomotherapy. Experiences of the first 150 patients in Heidelberg. Strahlenther Onkol. 2008;184(1):8–14
  38. Thomas SJ, Hoole AC. The effect of optimization on surface dose in intensity modulated radiotherapy (IMRT). Phys Med Biol. 2004;49(21):4919–4928
  39. Thilmann C, Grosser KH, Rhein B, Zabel A, Wannenmacher M, Debus J. Virtual bolus for inversion radiotherapy planning in intensity-modulated radiotherapy of breast carcinoma within the scope of adjuvant therapy. Strahlenther Onkol. 2002;178(3):139–146
  40. International Commission on Radiation Units and Measurements. Prescribing, recording and reporting photon beam therapy (supplement to ICRU Report 50). ICRU Report 62. Bethesda, MD, ICRU.
  41. International Commission on Radiation Units and Measurements . Prescribing, recording and reporting electron beam therapy. ICRU Report 71. J ICRU. 2004;4(1):25–37
  42. Nguyen TB, Hoole AC, Burnet NG, Thomas SJ. Dose-volume population histogram: a new tool for evaluating plans whilst considering geometrical uncertainties. Phys Med Biol. 2009;54(4):935–947
  43. Kissick MW, Fenwick J, James JA, et al. The helical tomotherapy thread effect. Med Phys. 2005;32(5):1414–1423
  44. Thomas SJ. Capacity and demand models for radiotherapy treatment machines. Clin Oncol. 2003;15:353–358
  45. Hendry JH, Bentzen SM, Dale RG, et al. A modelled comparison of the effects of using different ways to compensate for missed treatment days in radiotherapy. Clin Oncol (R Coll Radiol). 1996;8(5):297–307
  46. Burnet NG, Benson RJ, Williams MV, Peacock JH. Improving cancer outcomes through radiotherapy. Lack of UK radiotherapy resources prejudices cancer outcomes. Br Med J. 2000;320(7229):198–199
  47. Royal College of Radiologists . The timely delivery of radical radiotherapy: standards and guidelines for the management of unscheduled treatment interruptions. 3rd ed.. London: Royal College of Radiologists; 2008;
  48. Burnet NG, Routsis DS, Murrell P, et al. A tool to measure radiotherapy complexity and workload: derivation from the Basic Treatment Equivalent (BTE) concept. Clin Oncol. 2001;13:14–23
  49. Clark B, Montgomery L, Fox G, et al. Implementation and workflow for a clinical tomotherapy unit. Radiother Oncol. 2006;80(Suppl. 1):S55
  50. Bauman G, Yartsev S, Rodrigues G, et al. A prospective evaluation of helical tomotherapy. Int J Radiat Oncol Biol Phys. 2007;68(2):632–641
  51. Bijdekerke P, Verellen D, Tournel K, et al. TomoTherapy: implications on daily workload and scheduling patients. Radiother Oncol. 2008;86(2):224–230
  52. McNair HA, Francis G, Balyckyi J. Clinical implementation of dynamic intensity-modulated radiotherapy: radiographers' perspectives. Br J Radiol. 2004;77(918):493–498
  53. Adams EJ, Convery DJ, Cosgrove VP, et al. Clinical implementation of dynamic and step-and-shoot IMRT to treat prostate cancer with high risk of pelvic lymph node involvement. Radiother Oncol. 2004;70(1):1–10
  54. Houghton F, Benson RJ, Tudor GS, et al. An assessment of action levels in imaging strategies in head and neck cancer using TomoTherapy. Are our margins adequate in the absence of image guidance?. Clin Oncol. 2009;21:720–727
  55. Royal College of Radiologists , Society and College of Radiographers , Institute of Physics and Engineering in Medicine . On target: ensuring geometric accuracy in radiotherapy. London: Royal College of Radiologists; 2008;
  56. British Institute of Radiology . Geometric uncertainties in radiotherapy – defining the planning target volume. London: British Institute of Radiology; 2003;
  57. Beldjoudi G, Yartsev S, Battista JJ, Van Dyk J. Optimisation du processus d'imagerie de haute énergie (MVCT) pour la tomothérapie hélicoïdale des cancers de la prostate (Optimization of MVCT imaging schedule in prostate cancer treatment using helical tomotherapy), Cancer Radiother. 2008;12(5):316–322
  58. Den RB, Doemer A. Kubicek G, et al. Daily image guidance with cone-beam computed tomography for head-and-neck cancer intensity-modulated radiotherapy: a prospective study. Int J Radiat Oncol Biol Phys in press, doi:10.1016/j.ijrobp.2009.03.05g.
  59. Zeidan OA, Langen KM, Meeks SL, et al. Evaluation of image-guidance protocols in the treatment of head and neck cancers. Int J Radiat Oncol Biol Phys. 2007;67(3):670–677
  60. Li XA, Qi XS, Pitterle M, et al. Interfractional variations in patient setup and anatomic change assessed by daily computed tomography. Int J Radiat Oncol Biol Phys. 2007;68(2):581–591
  61. Kupelian PA, Lee C, Langen KM, et al. Evaluation of image-guidance strategies in the treatment of localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70(4):1151–1157
  62. Forrest LJ, Mackie TR, Ruchala K, et al. The utility of megavoltage computed tomography images from a helical tomotherapy system for setup verification purposes. Int J Radiat Oncol Biol Phys. 2004;60(5):1639–1644
  63. Song WY, Chiu B, Bauman GS, et al. Prostate contouring uncertainty in megavoltage computed tomography images acquired with a helical tomotherapy unit during image-guided radiation therapy. Int J Radiat Oncol Biol Phys. 2006;65(2):595–607
  64. Mackie TR, Kapatoes J, Ruchala K, et al. Image guidance for precise conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2003;56(1):89–105
  65. Bortfeld T, Webb S. Single-Arc IMRT?. Phys Med Biol. 2009;54(1):N9–N20
  66. Sheng K, Molloy JA, Read PW. Intensity-modulated radiation therapy (IMRT) dosimetry of the head and neck: a comparison of treatment plans using linear accelerator-based IMRT and helical tomotherapy. Int J Radiat Oncol Biol Phys. 2006;65(3):917–923
  67. Chen AM, Jennelle RL, Sreeraman R, et al. Initial clinical experience with helical tomotherapy for head and neck cancer. Head Neck. 2009;31(12):1571–1578
  68. Kupelian PA, Langen KM, Willoughby TR, Zeidan OA, Meeks SL. Image-guided radiotherapy for localized prostate cancer: treating a moving target. Semin Radiat Oncol. 2008;18(1):58–66
  69. Fiorino C, Dell'Oca I, Pierelli A, et al. Significant improvement in normal tissue sparing and target coverage for head and neck cancer by means of helical tomotherapy. Radiother Oncol. 2006;78(3):276–282
  70. Ahmed M, Hansen VN, Harrington KJ, Nutting CM. Reducing the risk of xerostomia and mandibular osteoradionecrosis: the potential benefits of intensity modulated radiotherapy in advanced oral cavity carcinoma. Med Dosim. 2009;34(3):217–224
  71. Galvin JM, Ezzell G, Eisbrauch A, et al. American Society for Therapeutic Radiology and Oncology; American Association of Physicists in Medicine Implementing IMRT in clinical practice: a joint document of the American Society for Therapeutic Radiology and Oncology and the American Association of Physicists in Medicine. Int J Radiat Oncol Biol Phys. 2004;58(5):1616–1634
  72. Barnett GC, Wilkinson J, Moody AM, et al. A randomised controlled trial of forward-planned radiotherapy (IMRT) for early breast cancer: baseline characteristics and dosimetry results. Radiother Oncol. 2009;92(1):34–41
  73. Mundt AJ, Mell LK, Roeske JC. Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys. 2003;56(5):1354–1360
  74. Chao KS, Majhail N, Huang CJ, et al. Intensity-modulated radiation therapy reduces late salivary toxicity without compromising tumor control in patients with oropharyngeal carcinoma: a comparison with conventional techniques. Radiother Oncol. 2001;61(3):275–280
  75. Duthoy W, Boterberg T, Claus F, et al. Postoperative intensity-modulated radiotherapy in sinonasal carcinoma: clinical results in 39 patients. Cancer. 2005;104(1):71–82
  76. Dearnaley DP, Sydes MR, Graham JD, et al. RT01 collaborators Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2007;8(6):475–487
  77. Huang E, Teh BS, Strother DR, et al. Intensity-modulated radiation therapy for pediatric medulloblastoma: early report on the reduction of ototoxicity. Int J Radiat Oncol Biol Phys. 2002;52(3):599–605
  78. Dearnaley DP, Khoo VS, Norman AR, et al. Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial. Lancet. 1999;353(9149):267–272
  79. Ting JY, Scarbrough TJ. Intensity-modulated radiation therapy and image-guided radiation therapy: small clinic implementation. Hematol Oncol Clin North Am. 2006;20(1):63–86
  80. National Radiotherapy Advisory Group Report to Ministers . Radiotherapy: developing a world class service for England. Available from http://www.cancerimprovement.nhs.uk/documents/radiotherapy/NRAG_0507.pdf2007;
  81. Thomas SD, Mackenzie M, Rogers DWO, Fallone BG. A Monte Carlo derived TG-51 equivalent calibration for helical Tomotherapy. Med Phys. 2005;32(5):1346–1353
  82. Duane S, Nicholas D, Palmans H, et al. Dosimetry audit for tomotherapy using alanine/EPR. Med Phys. 2006;33(6):2093–2094
  83. Alfonso R, Andreo P, Capote R, et al. A new formalism for reference dosimetry of small and nonstandard fields. Med Phys. 2008;35(11):5179–5186

PII: S0936-6555(10)00049-X

doi: 10.1016/j.clon.2010.02.003

Clinical Oncology
Volume 22, Issue 4 , Pages 294-312 , May 2010