- Volumetric Modulated ARC Therapy (VMAT)
- Intensity-Modulated Radiation Therapy (IMRT)
- Image-Guided radiation therapy (IGRT)
- 3D Conformal Radiation Therapy (3DCRT)
- Conventional Radiation Therapy
- External Beam RT
- Immobilization and Mould Room
- HDR Brachytherapy
- Fully networked department with data and image server
- Dr. Aarti Kaul Patel
- Dr. S.P. Shrivastava
- Dr. Rajendra Kumar Aanjne
- Mr. Atul Kumar Tiwari
- Mr. Pradeep Sharma
- Mr. Durgesh Ptidar
- Mrs. Mrinalini
- Mr. Anand Patel
- Mrs. Nancy
Intensity Modulated Radiation Therapy (IMRT)
Intensity modulated radiation therapy (IMRT) is based on variation in the intensity of radiation dose within different parts of a radiation field. This allows complex shaping of radiation fields including concavities. High quality radiation delivery for IMRT has to be complemented with specialized treatment planning. Inverse planning approach is used for IMRT treatment planning that permits limiting the radiation dose to the organs at risk near the radiation target.
There are many details that affect the quality of IMRT. CHRC has the highest quality IMRT because of following reasons
- Multi-leaf collimator allowing fine shaping of RT fields
- Highest quality treatment planning system with multiple workstations, fully networked RT department with image and data servers
- Team of senior consultants, physicists and technicians
- High quality IMRT quality assurance with digital portal dosimetry
3D Conformal Radiation Therapy (3DCRT)
Conforming radiation field to the target area and avoiding normal surrounding tissues is capable using multi-leaf collimators and used for planning techniques. 3DCRT is a radiation technique that occupies a place between standard or conventional RT and IMRT. It is useful in many body areas when IMRT is not necessary but standard radiation includes lot of normal tissues and limits the delivery of higher doses of radiation. The 3DCRT at Choithram is able to deliver a much higher quality of treatment because of the presence of multi-leaf collimator.
Conventional Radiation Therapy
Conventional radiation therapy is used for cases where advanced techniques of radiation are not required. While not comparable to 3DCRT/IMRT/IGRT, conventional RT is of a very high quality. Planning for conventional RT is also done based on CT scanning of the tumour and normal tissues. Further, immobilization of the patient using thermoplastic mask system and other accessories improves the results of conventional RT. Linear accelerator-based conventional RT is significantly superior to conventional RT based on cobalt tele-therapy units. The damage to skin and superficial tissues is minimized in the linear accelerator-based RT. CHRC also has the capability for irradiation of blood products, which is used in some patients with haematological diseases. Electron beam irradiation is useful for treatment of some superficial lesions and giving radiation boost doses to some targets.
Brachytherapy Brachytherapy or internal delivery of radiation therapy is an essential technique of RT that makes a radiation facility complete. Brachytherapy allows high radiation doses to be delivered within the tumour without the radiation passing through normal tissues. Brachytherapy is critical in achieving high cure rates in gynaecological cancers such as cancer of cervix and cancer of uterine body (endometrium). In addition, it is used for prostate cancer, breast cancer, esophageal cancer, head and neck cancers, soft tissue sarcomas, skin cancers, bronchial tumors, hepatobiliary tumours, brain tumours, etc. Based on the route of application, Brachytherapy is divided into intracavitary, intraluminal, interstitial, surface mould, etc.
CHRC has the highest quality brachytherapy delivery capability because of the following reasons:
- 30 channel Brachytherapy machine
- Widest range of Brachytherapy applicators
- Capability for image-guided Brachytherapy delivery
- Inverse planning Brachytherapy capability
External Beam RT
Choithram Hospital is equipped with an IMRT-capable, single linear accelerator from Siemens Primus, Germany. The highlights of the system are:
Multiple Electrons – 3 Mev to 14 Mev
Photon Energy 4 MV, 6 MV and 15 V (Elekta Synergy)
- Photon energy 6 MV (SIEMENS PRIMUS)
- Multiple electron energies (5 MeV to 14 MeV)
- Amorphous silicon-based digital portal imaging device (EPID)
- Multi-leaf collimator
- Completely computerized record and verification system
- Advanced treatment planning system (TPS) for inverse planning using advanced algorithms, multiple planning workstations for rapid workflow management, multiple contouring stations with advanced contouring capabilities
- Cone beam CT
Immobilization and Mould Room
Since radiation treatment is delivered in a divided/fractionated plan, it is critical to ensure that the same area of the body receives the radiation with a high degree of accuracy. High quality mould room facilities and immobilization are essential to ensure this. Choithram’s Institute of Radiation Oncology has invested in the best mould room and immobilization technology.
Custom fit vacuum cushion system: Vacuum cushions (Vacloc) ensure rigid yet comfortable support to the patient to minimize deformation of body while lying on the treatment table. A custom cushion is prepared for the patient at the beginning of treatment and is used for each treatment session.
Thermoplastic mask system: Thermoplastic masks (Orfit) from the global pioneers in the field are used in addition to the vacuum cushion system to prevent patient movement. Together, the two make for a near perfect immobilization solution. Custom masks are also prepared for the patient at the start of the treatment and used during each treatment session.
Foam rests for head, neck, arms, knees etc: To ensure patient comfort while making him immobile, comfortable foam rests are used for each patient.
40-slice CT scanner from Siemens Medical Systems is used for CT based simulation of all patients treated at CHRC Institute of Radiation Oncology. Moving lasers are installed in the CT room for accurate positioning and simulation of the cancer treatment. High quality thin slice imaging with contrast is used to ensure the best possible visualization of the tumour and normal tissues. CT based simulation is supplemented by 1.5 Tesla high quality MRI when considered necessary. MRI is especially useful in radiation treatment of brain tumours. High end virtual simulation software from Oncentra Treatment Planning Systems is used for contouring of the tumour and normal tissues in 3D. Advanced options like beams eye view etc are available in the system for high quality treatment planning.
Quality assurance of the equipment and quality checking of all treatment plans is mandatory for all radiation treatment. High quality equipment helps in ensuring that patients get the planned treatment without any toxicity Institute of Radiation Oncology, Choithram Hospital and Research Centre has invested in the highest quality of QA equipment from PTW of Germany. The equipment consists of
HDR Brachytherapy High Dose Rate Brachytherapy systems are the de facto standard for internal radiation or Brachytherapy. Based on a small radiation source (Iridium 192) driven by computer control, these systems offer the convenience of fast and highly optimized treatment of a large variety of tumours while reducing the dose to normal tissues.
Choithram’s Institute of Radiation Oncology has commissioned a thirty channel remote after-loading HDR brachytherapy unit from Nucletron BV of Netherlands, the world leader in Brachytherapy systems. Combined with 3D and inverse planning capabilities, wide range of CT and MR compatible applicators, the system is capable of Image-Guided Brachytherapy, the most advanced form of Brachytherapy available today.