We have instituted routine dynamic Intensity Modulated Radiation Therapy (dIMRT). This is the most complex of IMRT treatments and requires considerable pre-treatment verification to ensure accurate execution. These treatments are delivered using our twin Clinac-21EX accelerators. A Hi-ART system (Tomotherapy Inc.) for delivering treatments via helical tomotherapy has been installed, accepted and is currently treating patients. This system provides ROB with cutting edge treatment technology to support future clinical trials. We have started a series of initiatives with our Nucletron High Dose-Rate Afterloader (HDR) , using a small, high intensity 192Ir source for interstitial and intercavitary brachytherapy. Our radiosurgery capability has been expanded with the acquisition of 3 new applicators with diameters of 5mm, 7.5mm and 10mm. A new Philips Brilliance 16 slice, large bore CT Simulator has received couch control upgrades. On-board imaging (OBI) has been installed on the newer Clinac-21EX. The final component of the Varian RPM Respiratory Gating system for providing gated radiation therapy has been acquired and we are awaiting delivery. Respiratory gating will improve targeting ability by compensating for regular respiratory motions during treatment.The Radionics SRS head frame system has been adapted to the Tomotherapy unit using a special support fabricated in-house. Procedures have been developed for patient simulation and treatment planning with this system. On-board imaging has been added to the newest Varian accelerator. This provides diagnostic quality images, which makes anatomical and fiducial matching much more accurate. This is especially useful for prostate patients. The RapidArc treatment delivery system has been installed on the newer Clinac-21EX and provides some degree of redundancy with the Tomotherapy Hi-ART unit as well as offering additional unique features. A new, all-carbon fiber patient couch top has also been installed on this machine. This improves the quality of both kV and MV images, resulting in improved localization of target areas. It also permits complex treatment techniques that had previously not been possible due to the attenuation and scatter of the steel supports of the old couch top. Treatment planning systems has been upgraded with the new adaptive planning software. A new volumetric Quality Assurance phantom has been procured and accepted for clinical use. This phantom contains 1386 diode detectors arranged in a helical pattern and is essential for the verification of complex treatment field sequences generated by both Tomotherapy and RapidArc. It also provides software for remapping the detector measurements onto patient image sets and compares them with treatment plan isodose volumes. It then generates a full statistical analysis of the planned versus measured volumetric dose distributions.We have acquired two state-of-the-art scanning water phantoms, one for CT and Tomotherapy and the second for general accelerator use. These should greatly facilitate data acquisition for annual quality assurance as well as for research purposes. We have also had funding approved for the replacement of our oldest linear accelerator with a new unit.
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