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BLK AV

Radiation Oncology

Introduction

Roentgen-BLK Radiation Oncology Centre has been designed to provide the most comprehensive and advanced radiation oncology care to cancer patients. The care is quality assured, personalized, and equivalent to the best available in the world. Caregivers at this centre are highly experienced in delivery of radiation therapy using the most advanced technology. Specially trained radiation oncologists are skilled in a wide range of standard and emerging treatments including conformal radiotherapy, intensity-modulated radiation therapy, stereotactic radiotherapy, image guided radiation therapy, gated radiation therapy, and high dose rate brachytherapy. In addition, a team of experienced medical physicists and radiation therapy technologists help in treatment planning and delivery. They work hard to help the patient and their families pass through their diagnosis and treatment plans. Each case is discussed with colleagues in other disciplines in a Tumor Board before starting the treatment.

At this centre the experience of the medical team blends with the latest technology resulting in better outcome for the patients.


Department Highlights

We are always refining radiation oncology treatment methods to deliver the highest-quality patient care possible. Our unmatched range of equipment includes the latest strategies to treat tumors aggressively, while reducing or eliminating some of the side effects that accompany radiation treatment. By using the most current treatment planning technology available to map tumors, our radiation oncologists can design treatments with pinpoint accuracy, ensuring that tumors get the most effective dose while healthy tissues and organs are spared. Treatment plans are created using the most advanced computing and imaging techniques. Radiation Oncologists, and Physicists have access to a complete array of devices to carefully administer radiation to target tissues while minimizing radiation exposure to uninvolved tissue.

The department is equipped with Trilogy TX linear accelerator, one of the best linear accelerator available in the world today, and Gammamed HDR brachytherapy machine.

Services and Treatments Offered

Trilogy TX Linear Accelerator –

  • Power
  • Precision
  • Versatility


The Trilogy TX system is the first in a new generation of cancer care systems. A versatile system optimized for multiple forms of treatment. The versatile Trilogy TX system delivers 3D conformal radiotherapy, IMRT, fractionated stereotactic radiation therapy, IGRT, and Gated Radiotherapy.

The on-board imager on the linear accelerator is an automated system for image-guided radiation therapy that provides high-resolution X-ray images to pinpoint tumor sites. The on-board imager is mounted on the treatment machine via robotically controlled arms that can be positioned for the best possible view of the tumor. The image detector shows exactly how a tumor will move during treatment due to breathing or other patient movements.

The power of Trilogy TX yields treatment times that are shorter, making the experience more comfortable for the patient. The precision of Trilogy TX allows you to spare healthy tissues to an extent that was unimaginable only a few years ago. The versatility of Trilogy TX enables treatment of a wide variety of patients using a single machine.

  • Choose from a broad range of external beam therapies, including 3D CRT, IMRT, IGRT or DART using the Trilogy TX system.
  • 2D and 3D KV image guidance for higher quality imaging at lower doses.
  • Full 360° range of treatment delivery angles with positional couch angles.
  • Stereotactic frame or frameless immobilization for patient positioning - treat any area of the body.
  • Real-time Position Management™ (RPM) system - for gating perfectly timed beam delivery with minimal margins.
  • Portal Dosimetry IMRT treatment delivery verification.
  • Dynamic high resolution MLC for exquisite beam sculpting.
  • Delivery verification and quality assurance in Argus Linac and Argus IMRT quality assurance software.


Clinical Benefits

  • Highest dose rate for shorter sessions.
  • Tight isocenter alignments on all three axes. Targets the smallest lesions.
  • Rapid on-board imaging. Reposition patients quickly and accurately.
  • Cone-Beam CT, fine tune patient set ups with ultra-precise CT scans.
     

Brachytherapy
Gammamed ix High Dose Rate brachytherapy unit In brachytherapy, the radiation source is placed within the tumor or in a cavity to deliver very high doses of radiation to the tumor tissue. It conforms the radiation dose to the size and shape of the target and limits side effects by sparing the surrounding healthy anatomy. Brachytherapy delivers high-intensity radiation directly into tumors through fine needles that are deployed from computer-controlled afterloaders that move the radiation source on a wire within the needle according to a prescribed treatment plan. Facility for temporary and permanent implants is available. Used in cancer of the cervix, prostate, breast, esophagus, lung, and soft tissue sarcomas. The total dose is delivered in a series of fractions, or treatment sessions. The treatment can be delivered in a few minutes as the system uses a high dose rate.

Available Radiation Therapy Techniques

  • 3D Conformal Radiation Therapy (3DCRT)
  • Intensity Modulated Radiation Therapy (IMRT)
  • Image Guided Radiation Therapy (IGRT)
  • Stereotactic Radiation Therapy (SRT)
  • Respiratory Gating
  • Digital Portal Imaging
  • Virtual Simulation of Radiation Therapy with CT Scan/MRI
  • High Dose Rate Brachytherapy (HDRBT)


Intensity Modulated Radiation Therapy (IMRT)
A type of 3-dimensional conformal radiotherapy that focuses multiple radiation beams directly on the tumor itself. Beam intensities vary, so that the highest possible doses can be used to destroy cancerous tissue keeping the dose to the critical normal tissues to the minimum. This results in very low complication rate following extended radiotherapy treatments. Proper positioning of the patient is crucial to the success of IMRT. Radiation oncologists use special planning software to determine the most accurate treatment

Image Guided Radiation Therapy (IGRT)
When the radiation oncologists plan highly specialized treatments like 3 dimensional conformal radiotherapy (3DCRT) or intensity modulated radiotherapy (IMRT), they keep the margins around the tumor very tight in order to reduce dose to the surrounding normal tissues. However, there is a possibility of the treatment field to shift on either side by a few millimeters everyday and also the organ in which the tumor arises may not be in the same position daily (most organs move a few millimeters or more in all directions). Therefore the doctor will take into account the above situations and give bigger margins around the tumor, thus including more surrounding normal tissues thereby defeating the purpose of highly precise treatments like IMRT.

If IGRT facility is available on treatment machine, doctor can take very tight margins, since the treatment fields and organ position will be verified by image guidance everyday before treatment delivery and adjustments made for field and organ shift on a daily basis before delivery of radiation. Thus IGRT helps in reducing the side effects dramatically in patients and is the ultimate in precision radiation therapy.

Stereotactic Radiation Therapy (SRT)

Several radiation beams are precisely aimed to converge upon a small tumor. The patient lies on a couch that rotates 180 degrees for maximum targeting, without harming surrounding tissues. This technique is used to treat brain tumors and other intracranial cancers. It can also be used to treat tumors outside the skull.

CT Simulation
CT (computed tomography) scanning for simulating radiation treatments for each individual patient is used in all treatment plannings. These simulations are used to test various treatment fields and devices used to immobilize the patient during therapy. Data from the CT simulator ensures that patients get the appropriate dose of radiation before treatment begins. Each patient will undergo a CT scan (CT Simulation) for planning of radiotherapy procedure. Treatment planning based on CT scans is the most accurate method available in the world today. Some patients may require MRI scan along with CT scans, where the CT and MRI images are fused for treatment planning. Facility is also available for fusing data obtained from PET scan for the purposes of treatment planning.

Digital Portal Imaging
Allows for real-time viewing of radiotherapy images, which helps oncologists position the patient by tracking their movements, and to design blocks for protecting healthy tissue. Images can be viewed one at a time, superimposed, or in a movie loop for optimum treatment planning.

High Dose Rate Brachytherapy
Used in cancer of the cervix, prostate, breast, esophagus, lung, and soft tissue sarcomas. The total dose is delivered in a series of fractions, or treatment sessions. The treatment can be delivered in a few minutes as the system uses a high dose rate.

A New Use For Brachytherapy: Breast Conservation
HDR brachytherapy is now also used to treat breast cancer. Today, many women with breast cancer are successfully treated with local surgery (lumpectomy), followed by a five-week course of daily external beam radiation to the whole breast. HDR brachytherapy is being used as a way of delivering breast radiation therapy, which involves treating the area around a lumpectomy with a highly localized dose of radiation over a period of about three to five days. This method of treatment as an addition to external beam radiation delivers a very high dose to tumor site resulting into high local control and at the same time gives excellent cosmesis and negligible radiation dose to the underlying lung and heart.

 

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