44 Results: TVE values were 5.1 and 2.8mm for Hipfix and alpha cradle systems respectively. TVE associated with alpha cradle was significantly less than Hipfix system. The CC axis in Hipfix attained greatest large (23.6%) and serious (7.9%) set-up errors. The calculated CTV to PTV margin was 8.3, 1.9 and 2.3mm for Hipfix, and 2.1, 3.4 and 1.8mm for alpha cradle in CC, ML and AP axes respectively. Alpha cradle was significantly better than Hipfix in terms of reproducibility, especially in the CC axis. 15.10. Information System empowerment in Radiotherapy Presenter: Wing Yiu Joseph Lee, Hong Kong Sanatorium & Hospital Author: Lee Wing Yiu, Joseph Introduction: In the development of modern radiotherapy, it is highly dependent on computers to control sophisticated electronic equipment for advance treatment deliveries. We now come to an age of computerized radiotherapy. This computerization trend not only limited to machine controls but covers whole department. Nowadays radiotherapy centers would normally ‘equip’ with a hospital information system, a billing system, a scheduling system, and one or a few treatment delivery systems. We put our eyes on the development trend to perform an integration power of those systems with the help of streamlining and simplifying procedures so as to increase efficiency and most importantly: to improve patient safety. There are areas which can fulfill patient’s satisfaction during their journey in the radiotherapy department such as improving the clinical service quality, productivity and safety in planning and treatment stations. With this vision, this paper aims to get a comprehensive view in radiotherapy departments in order to develop a better understanding of the clinical demand and service development by utilizing our huge patient data volume in radiotherapy centers through identifying and improving the clinical process for integration with the good support of Information Technology (IT). Methods: This paper intends to grasp the insight of the clinical workflow management and re-engineering clinical process in radiation therapy department through illustrating different IT integrations, which are available through related journals and personal. Results: The clinical workflow and multi system integration in radiotherapy service has been improved with the help of IT technology. Clinical systems integration will be commenced in order to provide good quality service and beneficial to clinical working environment of radiation therapists together with the multi-disciplinary teams. 15.11. A Clinical Pathway of a Patient with Breast Cancer Presenter: Annika Inkinen, The Central Hospital of Central Finland Author: Annika Inkinen Introduction: This is a report on a clinical pathway of a breast cancer patient in the radiation therapy ward. The report was done as a school assignment during a practical training period in the spring 2013. The practical training was completed in the Radiation Therapy Ward in The Central Hospital of Central Finland. During 2013 there were 797 cancer patients given radiation therapy and 174 (22%) of them were breast cancer patients. The cancer patient followed in this report is a 56-year-old earlier healthy woman. At the end of the year 2012 a 9mm ductal carcinoma with a lymphatic vessel invasion was found in a routine mammogram screening .The tumor was grade 2. Lumpectomy was an option because the cancer was in a relatively small part of one breast. Surgery was a success and the scars healed well. Hormonal therapy and radiation therapy were offered as adjuvant therapy. The 8 week long radiation therapy period included the first appointment with an oncologist, virtual simulation using a specialized CT scanner and an interview held by a radiographer charting patient’s mental, social and physical condition. Also two appointments with a psychiatric nurse, one meeting with a social welfare supervisor and two more visits to the oncologist were needed. The total radiation dose of 50 Gy was divided into 25 fractions. FIMRT technique was used and one fraction was given in two fields. Methods:The breast cancer patients clinical bathway was observed by author. Results: The biggest problems during the radiation therapy treatments were mental. The patient suffered from depression and sleeping problems and could not work during the treatment period even though she wanted to. Physically the radiation therapy was endured well. 15.12. Experienced benefits of CyberKnife® Robotic Radiosurgery System in Kuopio, Finland Presenter: Kati Tolonen, Kuopio University Hospital, Finland Authors: Kati Tolonen, Aija Juutilainen Introduction: In this study the use of the CyberKnife® Robotic Radiosurgery System (Accuray Inc., Sunnyvale, USA) of our Cancer Center is presented. CyberKnife® (CK) is a stereotactic radiotherapy system based on robotic technology. With CK it is possible to treat both benign and malignant tumours anywhere in the body. CK in Kuopio, Finland is the first and so far the only one in the Nordic countries. The majority of treatment targets treated with CK in our department are prostate, brain and lung tumours. Generally all the treatments are either radiosurgical (neurosurgical targets) or hypofractionated. Our Cancer Center works in close collaboration with the Kuopio NeuroCenter. Most of the cranial targets are treated radiosurgically with a single fraction. Prostate and lung cancers are treated with a hypofractionation scheme with five times 7.25 Gy and three times 18 Gy, respectively. CK unit is equipped with two orthogonal X-ray imaging devices for automated image guidance throughout radiotherapy treatment delivery. The tracking method is determined by the target: bony structures, tumour volume or fiducials. For example gold fiducials are utilised to track the prostate motion before and during the dose delivery. Targets moving with respiration are treated with Synchrony® system, in where the real time breathing pattern is recorded and the corresponding breathing cycle is accounted by the robot itself at time of treatment delivery. The online tracking methods allow reduction of treatment margins and high doses of radiation can be utilised safely. Equally important for reducing margins is the system´s sub-millimetre accuracy being down to 0.3 mm. Methods: Data for this study were collected from patient databases, personnel experiences and on-going studies in Cancer Center and Kuopio NeuroCenter. This data covered all the patients treated with CK in Kuopio. Results and conclusions: With CyberKnife it is emphasised that treatments are comfortable for patients: there is no need for extracranial frames due to intrafractional online tracking. Use of hypofractionation makes the treatments more convenient for the patients reducing the total treatment course. For example, for prostate cancer patients the course is reduced from 38 fractions to 5 fractions. In conclusion CK is a cost effective method in treating patients non-invasively. 15.13. Investigation of patient setup errors in different body regions using MVCT imaging in Helical Tomotherapy Presenter: Ka Fai Cheng, Hong Kong Sanatorium & Hospital Authors: Vincent Wu, George Chiu Introduction: The goal of radiotherapy is to maximize tumor control and minimize complications in the surrounding normal tissues. Modern radiotherapy techniques provide highly conformal dose distributions to target volumes while sparing adjacent normal tissues with steep dose gradients. The success of these advanced radiotherapy techniques depends very much on the setup accuracy of daily treatment delivery. Investigation of setup accuracy can be done by analyzing daily setup errors. Through investigating and analyzing the setup errors in daily radiotherapy treatments, this study aims to provide reference information in deciding optimal planning target margin in radiotherapy of tumors of different body regions. Systematic error, random error and 3D vector mean which calculated from recorded daily setup errors, are common parameters in studies of setup accuracy. Systematic error is the mean deviations between mean irradiation geometry in the fractionated treatment and the geometry in the treatment plan. Random errors are the fraction-to-fraction variations around the systematic mean. 3D vector is the magnitude of the displacement of the treatment position from the reference position. In this study, daily setup errors were detected by pretreatment megavoltage computed tomography (MVCT) by Tomotherapy machine. MVCT can provide 3-dimensional (3D) images for treatment verification. This daily assessment of setup errors of patient can provides large amount of detail set up data and so a more reliable result in assessing set up accuracy. Methods: 5556 tomotherapy daily treatment fractions’ set up data from 270 patients were collected. Based on the pretreatment MVCT, setup corrections were recorded. Systematic errors, random errors, 3D vector means and CTV-PTV margins were calculated. Conclusions/results: Translation systematic and random errors were ranged from 0.8-1.4mm for cranium, 1.0-1.7mm for H&N, 1.5-3.5mm for
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