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Planning > Adaptive RT > Flashcards

Adaptive RT Flashcards

1
Q

What is ART?

A
  • technique aims to customise each patients treatment plan to patient-speicific variation by evaluating systematic and random variation
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2
Q

What are the time points for ART?

A
  • offline: between fractions
  • online: immediatley before fraction
  • in real time: during fraction
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3
Q

What are the patient positioning ART?

A
  • patient re-setup
  • change in setup instruction
  • change to immobilisation device
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4
Q

What are the IGRT ART?

A
  • image taken prior to treatment to assess change in patient position and adapt couch position
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5
Q

What are the organ motion detection systems?

A
  • elekta symmetry (4DCT)
  • iGuide (patient movement)
  • exactrac (floor rotations)
  • varian RPM (breathing)
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6
Q

What is a limitation of IRGT?

A
  • image guidance in isolation can not correct for non-ridig changes
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7
Q

What is an adantage of IGRT?

A
  • provides righ 3D information which can be used for adaptive planning intervention
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8
Q

What is deformable image registration?

A
  • finding geometrical correspondence between imaging data sets that differ in time, space and modality
  • used in ART workflow due to efficiency in adapting contours required for re-planning
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9
Q

What is the clinical problem with bladder organ motion?

A
  • bladder is mobile, hollow and can change size, shape and position significantly during treatment
  • require large margins (2-3cm) which increase dose to OAR especially small bowel
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10
Q

What is the bladder ART?

A
  • daily pre-treatment CBCT
  • chose plan of the day (small medium and large)
  • do offline adaptive PTV based on frist 5#
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11
Q

What is the cinical problem with prostate?

A
  • size, shape and position is highly dependent on bladder and bowel
  • can lead to over and under dosing of OAR and PTV
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12
Q

What is the online and offline ART for prostate?

A
  • online: direct beam apeture modification so field shape of prostate and SV definition
  • offline: delivered dose and organ variation accounted for and plan adapted for reamining fractions
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13
Q

What is the clinical problem with lung?

A
  • outoe is poor and require dose escaltion but limited due to respiratory motion
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14
Q

What ate the ART for lung?

A
  • pre treatment: 4DCT for mean size, shape and trajectory
  • breahting control during treatment
  • gating
  • tumour tracking
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15
Q

What is gating?

A
  • allows treatment device to periodically turn off and on depending on stage of breathing cycle
  • RPM or ABC
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16
Q

What is tumour tracking?

A
  • dynamically shifts dose to follow tumour position during free breathing
17
Q

What is the clinical problem with H & N?

A
  • patients undergo significant anatomic change during treatment which has impact on dose distribuition
  • weight loss, change in PTV and OA, oedema
18
Q

What is the position variation ART for H & N?

A
  • image feedback
  • quatify dosimetric error from setup error and adapt each fraction by taking into account dose accumulated over entire course and adjust prescription accordingly
19
Q

What is the anatomical variation for H & N?

A
  • parotid shift medially and decrease in size

- magnitude of effect depends on location to high dose region and OAR

20
Q

What are the limitations of ART?

A
  • patient specific margins: depends on no. of initial observations
  • plan of the day: mutliply planning and staff training intensive
  • extensive re-contouning required
  • variation in opinion on which patient need ART
  • variation in opinion on timing of ART
  • resource and time intensive: workflow
21
Q

What is the use of FDG-PET imaging for lung?

A
  • may allow predication of tumout response or radiation induced lung toxcitity
  • eary detection of non-responding patient can decrease cost and toxcitity for patient
  • can adapt plan based on which area of lung is most functioning and aviod dose to that area
22
Q

What are the 4 steps for tumour tracking?

A
  1. identify tumour position in real-time
  2. anticipate tumour motion to allow for time delays in beam reponse
  3. reposition the beam
  4. adapt dosimetry to allow for changing lung volumes and critical OAR and critical stucture location during the breathing cycle

Planning (8 decks)

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