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STATE OF THE ART RADIOTHERAPY EDUCATION DAYVenue: Stewart House, London
CPD: 5 CREDITS
10DECEMBER
2014
More information available soon at www.bir.org.uk
• Room1Primers for the non-specialistsSessionorganisedbyDrDavid
Wilson,ConsultantInterventional
MSKradiologist,OxfordUniversity
HospitalsNHSTrust
• Room2Radiation protectionSessionorganisedbyMrAndy
Rogers,HeadofRadiationPhysics,
NottinghamUniversityHospitals
NHSTrust
Save the date
• Room1Clinical hybrid imaging in oncologySessionorganisedbyDrGopinath
Gnanasegaran,Consultant
PhysicianinNuclearMedicine,
StThomas’Hospital
• Room2Musculoskeletal imagingSessionorganisedbyDrRichard
Wakefield,Consultantin
Rheumatology,StJames’s
UniversityHospital
Essentials for the radiology traineeSessionorganisedbyDrHardi
Madani,RadiologyRegistrar,
RoyalFreeLondonHospital,and
DrAusamiAbbas,Cardiothoracic
RadiologyPostCCTFellow,
UniversityHospitalAlberta
Day 2Day 1
BIR ANNUAL CONGRESS 20154–5 NOVEMBER
LONDON
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Save the date
Day 2
Welcomeandthankyouforcomingtoour‘Stateoftheartradiotherapyeducationday’organisedbytheBritishInstituteofRadiology.
Wewishyouaveryenjoyableandeducationalexperience.
Certificateofattendance
Thismeetinghasbeenawarded5RCRcategoryICPDcredits.
Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:
https://www.surveymonkey.com/s/Radiotherapyeducationday
BIR Annual Congress 2015: 4–5 November, London
We are most grateful to
for supporting this conference.
Please take the time to visit their exhibition stands to find out more about the services they offer.
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Programme
09:15 Registration and refreshments
09:40 Welcome and introduction MrsNicolaBlackler LeadDosimetristPlanningandTrials,DerrifordHospital
09:45 Setting up the treatment unit: intelligence-guided QC MrGeoffBudgell TeamLeaderforVerificationandDosimetry, TheChristieNHSFoundationTrust
10:15 Imaging in radiotherapy: current options available DrTimWood ClinicalScientist,HullandEastYorkshireHospitalsNHSTrust
10:45 Refreshments
11:15 Chemotherapy: principles and new developments DrMartinHighley ConsultantOncologist,PlymouthOncologyCentre,DerrifordHospital
11:40 Target volume definition MrJamieFairfoul HeadofRadiotherapyPlanning, PeterboroughandStamfordHospitalsNHSFoundationTrust
12:05 SABR gating and 4DCT MrAndrewPoynter ConsultantClinicalScientistandHeadofRadiotherapyPhysics, PeterboroughandStamfordHospitalsNHSFoundationTrust
12:30 Lunch
13:30 Basic and advanced treatment planning MsHayleyJames HeadofRadiotherapyPhysics,IpswichHospital
14:00 Verification of advanced treatment techniques MrGeoffBudgell TeamLeaderforVerificationandDosimetry, TheChristieNHSFoundationTrust
14:30 On set imaging: from 2D to 3D and beyond MrAndrewReilly ConsultantClinicalScientist,ClatterbridgeCancerCentre
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15:00 Refreshments
15:30 Radiobiologic modelling in gynaecologic cancer DrAlexandraStewart ConsultantClinicalOncologist, RoyalSurreyCountyHospitalNHSFoundationTrust
15:50 Flattening filter free (FFF) MrChrisWalker HeadofRadiotherapyPhysics,TheJamesCookUniversityHospital
16:10 Proton radiotherapy MrRichardAmos OperationalLeadforProtonBeamTherapyPhysics, UniversityCollegeLondonHospitalsNHSFoundationTrust
16:30 Questions
16:45 Close of event
_______________________________________________________________________
Certificate of attendance
Thismeetinghasbeenawarded5RCRcategoryICPDcredits.
Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:
https://www.surveymonkey.com/s/Radiotherapyeducationday
BIR Annual Congress 2015: 4–5 November, London
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Speaker profiles (where supplied)
Mr Richard AmosOperational Lead for Proton Beam Therapy Physics, University College London Hospitals NHS Foundation Trust
RichardAmosisOperationalLeadforProtonBeamTherapyPhysicsatUniversityCollegeLondon(UCL)HospitalsNHSFoundationTrustandHonorarySeniorLecturerattheDepartmentofMedicalPhysicsandBiomedicalEngineeringatUCL.Priortotakinguphiscurrentpositionin2013RichardgainedovertwelveyearsexperienceinprotonbeamtherapyphysicsatbothLomaLindaUniversityMedicalCenterandUniversityofTexasMDAndersonCancerCenterintheUSA.Hiscurrentresearchinterestisinthedevelopmentandclinicalimplementationofadvancedprotonbeamtherapy(PBT)technologyforthetreatmentofcancer.UCLHospitalsaredevelopingoneofthetwofirsthigh-energyPBTfacilitiesintheUKtoservejointlyasanationalPBTservice,duetocommencetreatmentin2018.RichardisaFellowoftheInstituteofPhysicsandEngineeringinMedicine,andservesonanumberofprofessionalcommitteesinboththeUKandUSA.
Mrs Nicola BlacklerLead Dosimetrist Planning and Trials, Derriford Hospital
NicolaBlacklerstartedworkingintheNHSin1989asatraineemedicalphysicstechnicianandonqualificationspecialisedinradiotherapyphysics.In2005sheachievedherMScinradiotherapystudiesandcurrentlyworksasHeadofTreatmentPlanningandMouldRoomwithintheDirectorateofHealthcareScienceandTechnologyatPlymouth.SheisnowthejointvicechairoftheBIRRadiotherapyandOncologySpecialInterestGroup.
Mr Geoff BudgellTeam Leader for Verification and Dosimetry, The Christie NHS Foundation Trust
GeoffBudgellisTeamLeaderforVerificationandDosimetryattheChristieNHSFoundationTrust.HespentfouryearsinaresearchroledevelopingIMRTinitsearlydays,includingthefirstdeliveryofIMRTintheUK,beforemovingintoamoreclinicalrole.
Geoff’sresearchinterestscentreonthedeliveryandverificationofmoderncomplexradiotherapytechniquesandtheadaptationofradiotherapyimagingsystemsforqualitycontrolandverificationpurposes.Heisparticularlykeenonputtingtheresultsofresearchtopracticalpurposeswhichhasresultedintheintroductionofnewandmoreefficientradiotherapyqualitycontrolmethods.
Morerecentlyhehasbeeninvolvedinsettinguptwosatellitecentres,introducinglarge-scaleuseofVMATattheChristie,settingupaQCprogramforFFFbeamsandisstartingtoworkonQAaspectsoftheMRlinac.
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Mr Jamie FairfoulHead of Radiotherapy Planning,Peterborough and Stamford Hospitals NHS Foundation Trust
JamieFairfoulisHeadofTreatmentPlanningatPeterboroughCityHospital,asmallbutverybusydepartmentwithextensiveexperienceofadvancedIMRTandIGRT.
Dr Martin HighleyConsultant Oncologist, Plymouth Oncology Centre, Derriford Hospital
MartinHighleyisaConsultantMedicalOncologistatDerrifordHospital,Plymouth,managingpatientswithmelanoma,renalcellcarcinoma,andovarianandtesticularcancers.HetrainedatGuysHospital,LondonandTheNorthernCentreforCancerTreatment,Newcastle.Hehasaninterestinthepharmacologyofanti-canceragents.
Ms Hayley JamesHead of Radiotherapy Physics, Ipswich Hospital
HayleyJameshasbeenaphysicistatIpswichHospitalsince1999,havingtrainedpreviouslyatSheffieldandthenworkedasaradiotherapyphysicistattheChristie.ShehasbeenHeadofRadiotherapyPhysicsatIpswichHospitalsince2010.Shehasalwayshadparticularinterestsinimplementingnewtechnologies,suchasIMRTandVMATandmorerecentlySABR,aswellasradiotherapyclinicaltrials.SheisamemberoftheNPLRadiationDosimetrySteeringGroup,IMPORTTrialManagementGroupandattendsRTTrialsQAmanagementgroupmeetings.
Mr Andrew ReillyConsultant Clinical Scientist, Clatterbridge Cancer Centre
AndrewReillyisaConsultantClinicalScientistintheradiotherapyphysicsdepartmentattheClatterbridgeCancerCentre.Hisprimaryroleistosupporttheclinicaluseanddevelopmentofradiotherapyimagingtechnologiesandworktowardsimprovedsystemsintegration.Hehasaparticularinterestinbridgingthegapbetweendifferentimagingdisciplinesandoptimisingimagingacrosstheradiotherapyprocess.HeisfounderoftheIQWorksproject,leadstheRadiotherapyImagingUserGroupandprovidedphysicssupportunderthenationalNRIGmentoringprogrammeforIGRTimplementation.AndrewservedasChairmanoftheBIRRadiation,PhysicsandDosimetryCommitteeuntil2009,wasamemberofBIRCouncilfrom2010to2013andrepresentstheBIRontheDHMedicalPhysicsExpertworkinggroup.
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Dr Alexandra StewartConsultant Clinical Oncologist, Royal Surrey County Hospital NHS Foundation Trust
AlexStewartwenttomedicalschoolatSouthamptonUniversity.ShedevelopedaninitialinterestinoncologyattheRoyalMarsdenHospitalworkingonprimarypreventionofbreastcancerstudiesintheProfessorialunit.ShethencommencedspecialistregistrartrainingatCharingCrossandtheHammersmithHospitalswhereamongstotherinterestsshegainedinitialexperienceinbrachytherapy.ShewasthenchosenforaprestigiousFellowshipattheBrighamandWomen’sHospital,HarvardUniversityinBostonwhereshecompletedayearofbrachytherapytrainingandayearofprostatecancerFellowshiponaNationalInstituteofHealthgrant.WhilstthereshewonanASCOmeritawardforaprostatecancerstudythatwassubsequentlypublishedintheJournalofClinicalOncology.
ShereturnedfromtheUSAtocompleteherspecialistregistrartrainingattheRoyalMarsdenHospitalwhereshecontinuedtopublishonspecialistradiotherapytechniquessuchasIMRTinlowerlimbsarcomas.OncompletingherspecialisttrainingshechosetoworkinGuildfordowingtotheexemplarybrachytherapydepartmenttheyhad.Alexhasnowdevelopedtheircervixbrachytherapyandaddedoesophagealandrectalbrachytherapytotheportfolio,oneoffewinternationalcentrestoperformthis.Alexhasastronginterestintheclinicalapplicationsofradiobiologyinbrachytherapyandhaswrittenthreetextbookchaptersonthissubject,inadditiontopublishedpapers.
Alexhaskeptherresearchlinksstrong,holdinganhonorarycontractattheUniversityofSurreyasaVisitingProfessor.SheisleadingastudyoncervixIMRTandanotherontheuseofPETscanninginearlycervixcancer.Sheisalsodevelopingimprovedimagingtechniquesincervixbrachytherapyandcollaboratingwiththeuniversityphysicsandengineeringdepartmentsininnovativeprojects.
SincestartingattheRoyalSurreyin2008,Alexhastakenakeeninterestinmanagement,takingontheroleofRadiotherapyLeadin2010andbecomingClinicalDirectorfortheOncology,MedicalPhysicsandNuclearMedicineDirectoratein2012.SheisnowClinicalLeadforOncology.
Mr Chris WalkerHead of Radiotherapy Physics, The James Cook University Hospital
ChrisWalkerstartedhiscareerinmedicalphysicsin1987employedbytheRegionalMedicalPhysicsDepartmentasabasicgraderadiotherapyphysicistatNewcastleGeneralHospital.HeispresentlyaConsultantClinicalScientistandHeadofRadiotherapyPhysicsatTheJamesCookUniversityHospitalinMiddlesbrough.HehasawealthofexperiencebothintheUKandabroadinthedevelopmentanddeliveryofradiotherapyfromthegroundup.Hehasprovidedstrategicadviceandsupportathomeandoverseastohealthdepartments,radiotherapydepartmentsandprivatecompanies.In2011hewasformallyelectedaschairoftheNorthofEnglandCancerNetworkRadiotherapyCrossCuttingGroup(CCG),whichhasresponsibilityforthedevelopmentofcoordinated,cohesiveandintegratednetworkedcancerservicesforradiotherapy.AdditionallyheistheNorthEastsenaterepresentativeontheRadiotherapyClinicalReferenceGroup.
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Dr Tim WoodClinical Scientist, Hull and East Yorkshire Hospitals NHS Trust
TimWoodworksasaRadiationProtectionandDiagnosticImagingPhysicistintheRadiationPhysicsDepartment,HullandEastYorkshireHospitalsNHSTrust,andisalsoacurrentmemberoftheIPEMDiagnosticRadiologySpecialInterestGroup.Timiscurrentlyleadinganumberofprojectsinvestigatingthedevelopment,implementationandoptimisationofX-rayimagingtechniquesinradiotherapy.Otherinterestsincludethephysics,technologyandclinicalapplicationofCTanddigitalX-rayimaging,includingmammography.
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Abstracts (where supplied)
Setting up the treatment unit: intelligence-guided QCMr Geoff Budgell
Qualitycontrolisoftenconsideredadullnecessity,preferablylefttosomeoneelsetodo.Theaimofthistalkistodemonstratethat,ifyourbrainisengaged,QCcanbeinteresting.ItwillalsoshowhowQCneedstobeconstantlyadaptingtotheever-changingchallengesofradiotherapyincludingnewtechnologies(suchasIGRT,FFF,stereotactictreatmentsandMRlinacs)aswellason-goingclinicaldemandsontheservicesuchasextendedworkinghours,in vivodosimetryandpatient-specificverificationforcomplextreatments.
Thepresentationwilladdressthequestions:• HowdowedecidewhatQCtodo?• HowdowedecideontolerancesandfrequenciesforQCtests?• Dowehavetofollowreportsandrecommendations?• Whatdoyoudowhenimplementinganewtechniqueorpieceof
equipment?• WhoshoulddoQC?• WhattodowhenaQCtestisoutoftolerance?• WhenshouldQCbecarriedoutandhowdowecopewithincreasing
complexityofequipmentwithoutincreasingthetimetakenforQC?• HowdoesQCrelatetoclinicalpracticeandevidence?
Imaging in radiotherapy: current options availableDr Tim Wood
Imagingplaysafundamentalroleatallstagesofthepatientpathwayinastate-of-the-artradiotherapycentre,beittheinitialdiagnosis,treatmentplanningscansorverificationimaging.Forthisreason,theuseof‘imageguidedradiotherapy’shouldnowbeconsideredtobethestandardofcareforalltreatments,ratherthanalimitedspecialistapplication.However,therearemanyoptionsavailableforacquiringimagedatathatcaninformdecisionsregardinganindividualpatient’streatment,witheachmodalityhavingspecificadvantagesanddisadvantages.Itisthereforeimportanttounderstandhoweachimagingtechniqueworkstoensurethebestpossibleoutcomeforthepatient.
Thepurposeofthistalkistooutlinethevariousimagingoptionsthatarecurrentlyavailableinthestate-of-the-artradiotherapycentre.Theseinclude,butarenotlimitedto,CT,conebeamCT,PET–CT,MRIandultrasound.Abriefoverviewoftheprinciplesandbenefitsofeachtechniquewillbepresented,alongwitharangeofissuesthatshouldbeconsideredwhenimplementingthesetechnologies.
Learningobjective:Acquireanunderstandingofthecurrentoptionsforimaginginradiotherapy,andtheadvantagesanddisadvantagesofeachtechnique.
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Chemotherapy: principles and new developmentsDr Martin Highley
Chemotherapeuticagentshavebeenusedtotreatcancersince1946.Theyactbyinterferingwithcelldivision,primarilybyaffectingDNAreplication.Theyareclassifiedintofivegroups;alkylatingagents,platinumcompounds,antimetabolites,topoisomeraseinteractingagentsandantimicrotubuleagents.Theinhibitionofrapidlydividingcellscanleadtothedevelopmentofparticulartoxicities,suchasbonemarrowsuppression,stomatitis,diarrhoeaandalopecia.Theuseofchemotherapeuticagentsneedstobebalancedagainsttheirtoxicities.
Chemotherapy,likeradiotherapy,isusedindifferentsetting—neoadjuvant(priortosurgery),adjuvant(aftersurgery)andinthetreatmentofmetastaticdisease.
Theassessmentofresponseisimportantwhenusinganti-cancertreatments,andtheRECISTcriteriaarewidelyemployedtoassessradiologicalresponse.Otherindicatorsoftheeffectivenessofchemotherapyarethesurvivalofpatientsandthetimetothedevelopmentofprogressivedisease.Theeffectonqualityoflifeisfrequentlyevaluated.Clinicaltrialsareasignificantaspectoftheuseanddevelopmentofsystemictreatments.
Systemictreatmenthaschangedimmenselyinthe21stcenturywiththeintroductionoftargetedtherapies.Thesecomprisetwomaingroups:thesmallmolecules,whichinhibitsignaltransduction,andtheimmunotherapies.
Learningobjective:Tounderstandthemechanismsofaction,clinicaluseandtoxicitiesoftheclassicalchemotherapeuticagentsandthenewertargetedagentsandimmunotherapies.
Target volume definitionMr Jamie Fairfoul
Goodtargetvolumedefinition(TVD)isthefoundationonwhichaccurateradiotherapyisbuilt.Withoutaccuratetargetoutlines,theprecisionaffordedbymodernIMRTandIGRTcannotbefullyutilised.AlthoughthistalkcannothopetocovertheintricaciesofTVDforallclinicalsites,itwillexplainthekeyprinciplesofgoodpracticethatshouldbeusedforallcontouring.
Learningobjectives:
• Accuracyincontouring •Whyisitimportant? •Impactontreatmentquality
• Optimisingyourmaterials/environment
• OptimalimagingforTVD
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• Useofmultimodalityimaging/imagefusion •Appropriatechoiceofimagingmodality •Accuracyofadditionalimagingtechniques •Assessingimageregistration
• Consistency:howdowemeasureitandhowdoweachieveit? •Whatisthecorrectanswer? •Theimportanceofoutliningprotocols?
Basic and advanced treatment planningMs Hayley James
Theradiotherapytreatmentplanningprocessdeterminesthemostappropriatewayofirradiatingapatienttomeettheclinicalrequirementsofthetreatment.Creatingoptimaltreatmentplansforagivenclinicalsitereliesonanumberofprocessesthatinclude:• Determinationofpatientpositionandsuitableimmobilisation• Accuratetargetvolumeandorganatrisklocalisationanddelineation• Determinationofsuitablebeamarrangements(forwardplanning)orthe
requireddoseanddosevolumeconstraints(inverseplanning)• Accuratedosemodellinganddosecomputationmethods• Evaluationofdosedistributions• Determinationoftherequiredtreatmentmachinesettingstodeliverthe
resultantplan
Thistalkwillconcentrateonthefundamentalsofforwardandinverseplanninginrelationto3Dconformalradiotherapy,IMRTandVMAT.Considerationwillbegiventobeamandfluenceshaping,planoptimisation,dosecalculationanddoseevaluation.Methodsofbeammodellinganddosecomputationwillalsobediscussed.
Verification of advanced treatment techniquesMr Geoff Budgell
Overthelastfewyears,theuseofadvancedradiotherapytechniquessuchasIMRT,VMATandSABRhasmushroomedintheUK.Theincreasedcomplexityofthetechniqueshasledtotheadoptionofpatient-specificverificationsonalargescale.Thistalkwillconsiderwhatverificationisactuallyfor,lookatthemeasurementoptionsavailableanddescribetheanalysismethodscommonlyused.Pitfallsinmakingandanalysingmeasurementswillbeidentifiedandadvicegivenonselectingtolerances.
Asnumbersincrease,andasadaptiveplanningbecomesaclinicalreality,manydepartmentsareaskingwhetherpatient-specificverificationsarerequiredforeverytreatmentplan.Thisquestionwillbeaddressed,identifyinghowwecansafelymoveawayfrompatient-specificmeasurementsandwhatsystemshavetobeinplacetoallowthistobecarriedout.
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On set imaging: from 2D to 3D and beyondMr Andrew Reilly
Treatmentplanningisonlythestartoftheradiotherapypatient’sjourney.Althoughagreatdealofeffortisexpendeddevelopingtheoptimumplantailoredtotheindividualpatient’scircumstances,itisimportantthattheplanbeconsistentlydeliveredasintendedoverthesubsequentcourseoftreatment:whetherduringasinglefractionorovermanyweeks.Verificationimagingatthepointoftreatmentisanimportanttoolforensuringsafeandconsistentradiotherapydeliveryovertime.
Thispresentationexplorestheimagingcapabilitiesofmodernradiotherapytreatmentunits,trackingtheevolutionfrom2DplanarMVandkVimagingthrough3Dcone-beamCT(CBCT)volumetricimaging,2D/3Dhybridimagingand4DCBCT.Advancedapplicationsbeyondbasicverificationimagingarealsoconsideredincludingstrategiesforplanadaptationandin vivo dosimetryusingelectronicportalimagingdevices(EPIDs).Thepotentialofemergingtechnologiessuchasimplantedradio-transpondersandreal-timetrackingisdiscussed.
Whenworkingwithstateofthearttechnology,andparticularlytechnologyinvolvingautomationandadvancedcomputersystems,itisimportanttomaintainfocusontheclinicalendpointandavoidbecomingdistractedbytheIT.Methodsforensuringtechnologyisutilisedaseffectivelyaspossibleareconsidered,includingoptimisationofimagingprotocols,peerreviewthroughmulti-centreauditandautomaticcalculationofsetuperrorsandmargins.
Radiobiologic modelling in gynaecologic cancerDr Alexandra Stewart
Historicallybrachytherapydosesweredevelopedempirically,changingdoses(durationofimplant)accordingtotumourresponse,earlyandlatetoxicity.Inthiswaylowdoserate(LDR)brachytherapydoseswereestablished.Doseprescriptionwasestablishedtofixedgeometricpointsinthe1930sandduetotheireffectivenesswerechangedverylittleforover70years.NormaltissuetoxicitywaspredictedbyusingICRUreferencepoints,againwithoutreferencetoactualorganlocation.
Theadventofhighdoserate(HDR)brachytherapyemphasisedtheimportanceofradiobiologyingynaecologiccancer,withuseofradiobiologicmodellingtoconvertdosesfromLDRtoHDRandtopredicttoxicity.Duetounavailabilityofradioactivesources,LDRusehasdeclinedandbeenreplacedbyHDRorpulsedbrachytherapy(PB).AgainradiobiologicmodellinghasbeencriticalinPBtodeterminewhatdosesarerequiredgivendurationofpulseandintervalbetweenpulses.
Gynaecologicbrachytherapyhasnowdevelopedfrompointdosingtovolumebasedprescription.Thisallowsradiobiologytobeusedtoaccuratelydetermine
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thedosesadministeredtotumourandnormaltissuesandhasresultedingreaterratesoflocalcontrolandthuscurewithlowerlatetoxicity.Thispresentationwillexaminebasicradiobiologicprinciplesandshowhowtheyhavebeenusedtodevelopmoderngynaecologicbrachytherapy.
Flattening filter free (FFF)Mr Chris Walker
Thispresentationexplorestheclinicalimplementationofflatteningfilterfree(FFF)technologyinMiddlesbroughwiththeElektalinearaccelerator.DelegateswillgetaninsightintowhatisrequiredtoconvertaconventionallinactoutiliseFFFtechnology.TheElektaimplementationphilosophywillbecontrastedwiththatofVarianandthedifferencebetweenclinicalbeamsofthesamenotionalenergyfromthetwomanufacturerswillbeexplained.Radiationsafetywillbediscussedinrelationtothesignificantlyhigherinstantaneousdoseratesachievedwiththeseradiationbeams.
OnceFFFhasbeenenabledthecommissioningprocesswillbeexploredwithparticularemphasisontheabsolutedosecalibrationmethodology.ThisisofparticularimportanceaspresentlyaUKcodeofpracticeforreferencedosimetryonthesebeamsisstillunderdevelopment.Inordertoconfirmthelongtermvalidityofthecommissioningprocessbaselinequalitycontrolparameterswereestablishedandwillbedemonstratedinthispresentation.
Throughoutthepresentationthepotentialadvantagesofthistechnologyintheclinicalenvironmentwillbediscussedincludingthereductionofheadscatterandtheenhanceddoserate.ExamplesofclinicalplanswillbepresentedwithdosedistributionsforSABRfornon-small-celllungcancer,hypofractionatedprostatetreatmentsandintracranialstereotactictreatmentsforbrainmetastasis.Dataontreatmentdeliverytimeswillalsobeprovidedtodemonstratetheintrinsicefficiencyofthistechnology.Finallytheimpactthatthistechnologypotentiallyexhibitsintreatmentofleftsidedbreastcancer,underdeepinspirationbreathholdwillbedemonstrated.
Proton radiotherapyMr Richard Amos
Protonradiotherapypotentiallyoffersclinicaladvantagesoverconventionalradiotherapyowingtothephysicalcharacteristicsofchargedparticleinteraction.Asprotonstraversepatientanatomytheyloseenergy,slowingdownandbecomingmoredenselyionisingastheyapproachtheirend-of-range,atwhichpointtheystop.Thismanifestsintodosedepositionasafunctionofdepththatincreasestoamaximum,theBraggpeak,towardstheirend-of-range,withnodosebeyond.BychoosingprotonbeamsofinitialenergysuchthattheBraggpeakregionisdeliveredatthedepthoftheclinicaltargetvolume(CTV),thetherapeuticdosecanberealizedwithreduceddosetosurroundinghealthytissuecomparedwiththatdeliveredbyphotons.Reduceddosetosurroundingtissueoffersthepotentialforreducedacutetoxicityandsecondarycancerrisk.
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Currentstate-of-the-arttechnologicalrequirementsfortheprovisionofprotonradiotherapyarelargescaleandexpensive.Despitethis,however,thepromiseofaclinicaladvantagehasledtoarapidgrowthinavailabilityofprotonbeamfacilitiesworldwideinrecentyears,andsuchtechnologywillsoonbeavailableinEnglandforNHSpatientsindicatedforprotons.
Theeducationalaimsofthispresentationaretointroducetheaudiencetothefundamentalcharacteristicsofclinicalprotonbeams;todescribethetechnologyandlayoutofatypicalprotonfacility;toprovideexamplesofdeliveredtreatments;andtosummarisetheUKprojecttodate.
Thelearningobjectivewillbeanunderstandingoftherationaleforprotonradiotherapy;thetechnologicalrequirements;andfutureofprotonradiotherapyintheUK.
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