- Toshiba Large Bore CT Simulation
- Conventional X-Ray Simulation
- Varian 21EX Dual Energy Linear Accelerators
- Photon (X-Ray) Irradiation
- Electron Irradiation
- On Board KV Imaging (OBI)
- Cone Beam Computerized Tomography (CBCT)
- MOSAIQ Record and Verify System
Toshiba Large Bore 16 slice CT Scanner
The Toshiba Aquillion Large bore CT scanner is a 16 slice CT scanner with a 90 cm physical bore. Currently this is the largest CT bore in Boston. With the large bore CT the Beth Israel Deaconess Medical Center (BIDMC) has the ability to scan our patients in the same position as their treatment position. This leads to a more carefully prepared radiation therapy plan and treatment delivery. In addition, this large bore allows for the simulation of larger patients.
Conventional X-Ray Simulation
The department has a VARIAN XIMATRON fluoroscopic simulator. This 2D simulator is used to determine the position of the patient for subsequent treatment delivery on the treatment machines. After the position of the treatment fields are determined , the patient is tattooed to indicate the position of these treatment fields on the patient.
Varian 21EX Dual Energy Linear Accelerators
The department of radiation oncology currently has 2 linear accelerators on the main campus. One is a Varian 21EX single energy
LINAC. It delivers a 6 MV x-ray beam. It is equipped with an Amorphous Silicon Portal Imager (aSi-PV), and a Millenium Multileaf collimator. It has the ability to deliver IMRT as well as IGRT. The other LINAC is a Varian 21EX dual energy LINAC. It delivers a 6 MV and a 10 MV x-ray beam as well as 4, 6, 8, 10, and 12 MeV electron beams. It is equipped with a Amorphous Silicon Portal Imager (aSi-PV), and a Millenium Multileaf collimator. This LINAC is fully IGRT capable with KV Onboard imagers and Cone beam CT. The LINAC communicates with the MOSAIQ record and verify system through the 4D Treatment Console. It has the ability to deliver IMRT as well as IGRT. The latest technology available for radiation therapy treatment delivery is On Board Imaging, or OBI, and Cone Beam Computerized Tomography, or CBCT.
On Board Imaging (OBI)
On Board Imaging is a 2D planar imaging modality that utilizes KV x-rays to obtain the x-ray images. Images obtained using this energy x-rays results in a very clear and crisp, diagnostic quality x-ray image. These KV x-rays can be obtained any time prior, during, or after each treatment. They can be used to compare the patient's position on the treatment couch to that of the patient's position during the simulation. It allows for a very accurate, day by day positioning of the patient so as to ensure precise targeting of the radiation to the tumor.
Cone Beam Computerized Tomography (CBCT): Cone Beam Computerized Tomography is a technology that allows for the acquisition of a full volumetric CT scan any time during the treatment delivery. CBCT can be used to obtain a more accurate, three dimensional positioning of the patient. Other uses include the evaluation of the size and position of the tumor over the course of therapy. For certain diseases, it is common for the tumor to shrink, and therefore change its relative position with in the body as a reaction to treatment. Properly delivered radiation dose to the tumor can have the effect of shrinking the tumor. CBCT can be used to assess the degree of this volume change and be used to determine if the radiation plan needs to be altered to accommodate this change. Another benefit to the large bore CT scanner is that it has a large physical scan field of view. Other scanners have to interpolate patient CT data at larger field sizes where as the Toshiba large bore can supply actual CT patient data at these extreme field sizes. This results in a more accurate determination of the patient's internal anatomy.
MOSAIQ Record and Verify System
The entire process of planning the patient's courses of treatment is managed by the IMPAC MOSAIQ record and verify system. MOSAIC is a software system that is used to register, document, and quality assure the patients courses of treatment. MOSAIQ also acts as the patient's image and radiation plan archive making accessible to the treatment team all of the patient's information. Once of the most critical features of the MOSAIQ system is its ability to ensure that each radiation field that is to be delivered is correct. Prior to the irradiation of any given beam, MOSAIQ checks that the patient is correct as well as the all of the parameters involved in the actual delivery of the radiation beams. MOSAIQ also manages all of the patient's images including the on treatment KV OBI and CBCT images. The image management side of MOSAIQ allows for all images, whether generated in the simulator, treatment planning, or on the treatment machine to be reviewed and approved, remotely if necessary, by any ad all of the professional team members, including the physicians. This remote review and approve feature if invaluable in the setting of a busy clinic such as the BIDMC.
CyberKnife is a robotic radiation delivery system that has the ability to deliver very focused beams of radiation to the tumor. The CyberKnife is unique in that it can deliver hundreds of small, highly focus beams of radiation. The CyberKnife facility at the BIDMC is the latest in the CyberKnife technology.
Large Bore CT Simulation
Once it has been decided that radiation therapy is the suitable course of treatment, the first step in the process of planning your therapy is the CT-Simulation. The CT simulation therapists will setup you up on the CT table in the approximate position you will be in during your treatment. Then a CT scan of the area of your body that it to receive treatment will be taken. After the scan is processes it is sent to the simulation software suite for further analysis. In this phase the patient CT data is utilized to determine the anatomical volumes needed to prepare a comprehensive radiation treatment plan. In addition, the direction of the treatment fields will be defined. Once this is done, small ink based tattoos will be placed on the patient to indicate the location of the planned radiation fields. This completes the simulation process.
The Beth Israel Deaconess Medical Center's department of Radiation Oncology offers many different treatment modalities to treat cancer and other benign diseases.