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Image Guidance in

Radiotherapy

DR. SANDEEP AGARWAL

Senior Consultant,

Department of Radiation Oncology

Galaxy Cancer Institute,

Pushpanjali Crosslay Hospital,

W-3, Sector 1, Vaishali, Ghaziabad, Delhi NCR

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CANCER BURDEN

1 crore new cases/year globally(2000) 50% of

these are in developing countries

2 crores new cases/year globally(2020) 70%

of these will be in developing countries

8 lacs new cases in India, 25 lacs at one

point of time, 5.5 lacs death due to cancer

70% of cancer patients will requireradiotherapy in their course of disease

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CANCER BURDEN

The most common cancer in males are Carcinoma Lung

Head & Neck

Stomach

The most common cancer in females are Carcinoma cervix

carcinoma breast

carcinoma ovary

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TREATMENTAPP

ROACH

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Radiation Surgery

Chemotherapy

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CANCER:ROLE OFRADIOTHERAPY

Plays important role in overall management

Logistic utility models show that RT is single or

combined in >70% of all patients

Radiation as a single modality can be curativebut for larger tumors the dose required is very

high therefore it is usually combined withsurgery or chemotherapy

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CHALLENGESCHALLENGES--RADIATIONPROCTITISRADIATIONPROCTITIS

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CHALLENGESCHALLENGES--RADIATIONCYSTITISRADIATIONCYSTITIS

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CHALLENGESCHALLENGES--RADIATIONMUCOSITISRADIATIONMUCOSITIS

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CHALLENGESCHALLENGES--RADIATIONSKIN BURNSRADIATIONSKIN BURNS

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CHALLENGESCHALLENGES--RADIATIONRADIATIONBRAINNECROSISBRAINNECROSIS

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CHALLENGESCHALLENGES--RADIATIONALOPECIARADIATIONALOPECIA

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CHALLENGESCHALLENGES--RADIATIONRADIATIONOSTEONECROSISOSTEONECROSIS

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CHALLENGESCHALLENGES--RADIATIONRADIATIONOSTEONECROSISOSTEONECROSIS

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CHALLENGESCHALLENGES--RADIATIONRADIATIONPNEUMONITISPNEUMONITIS

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IMRT

Intensity Modulated Radiotherapy is newer

technique in radiotherapy where the intensity of

the beam is changed during the treatment so

that certain areas get lesser/more doses to givemaximum doses to the tumor and minimal doses

to the normal tissues

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INTENSITYMODULATIONOF THE BEAM

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2D CRTNO IMRT

In the interior of the shaped field

the doses are homogeneous

IMRT

In the interior of the shaped

field the doses are

heterogeneous

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CARCINOMAHYPOPHARYNX60Gy

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CARCINOMAHYPOPHARYNX 66Gy

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POST IMRT

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CARCINOMA BREASTCARCINOMA BREAST

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Conventional Tangents

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IMRT FOR PROSTATE

concave shaped distribution

Enables Dose Escalation

Better patient compliance

Better patient compliance

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2D2D 3DCRT3DCRT IMRTIMRT

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IMAGE GUIDANCE IN RT

Availability of image guidance on treatment table

enhances the correctness of delivering radiation

on target

2D image guidance

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IMAGE GUIDED RADIOTHERAPYIN VARIOUSCANCERS

IGRT is required in conditions where critical

organs are very close to the tumor

IMRT+IGRT is used when there is negligible

distance between the tumor and surrounding

normal tissues

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CARCINOMANASALCAVITY-2D PLAN

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CARCINOMANASALCAVITY-3D PLAN

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CARCINOMANASALCAVITY-IMRTPLAN

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CARCINOMANASALCAVITY-IGRTPLAN

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CARCINOMANASAL CAVITY-IMRT-IGRTPLAN

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RESPONSETO TREATMENT

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CARCINOMA URINARY

BLADD

ER

79 yrs old male diagnosed as having carcinoma

Urinary Bladder with symptoms of hematuria and

thickening in lateral wall of urinary bladder

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CARCINOMA GALL BLADDER

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65 year old lady diagnosed as having

Carcinoma gall bladder with extensive liver

metastasis. She was explained poorprognosis and was started on Palliative

Cisplatinum + Gemcitabine and showed very

good response. She was taken up for IGRT

to residual disease for extended palliation

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