Features of new installed linac Trilogy At Dr Ziauddin Hospital Karachi

Features of Newly Installed Linac.
“Trilogy” at Dr. Ziauddin Hospital
Dept. of Radiation oncology

Overview
 Introduction
 Engineering
 Working principle
 Versatility
 High Tech. using Trilogy
 3DCRT, IMRT, VMAT, IGRT, SRS, Electrons
 Imaging Modalities
 MV imaging
 KV imaging
 Eclipse treatment planning system
 Planning algorithms
 Treatment Delivery process
 RV mode
 Online treatment verification
 Conclusion
 Take home message

Trilogy
Tri- means three
 Power, Precision, Versatility
 Power
 High dose rate,
 Dose rate gain
 Precision
 Repetition with accuracy
 Mechanical stability
 Tight is center alignments
 Versatility
 3DCRT, IMRT, VMAT, SRS
 Variety of electrons
 All In One, Best In One

Beautiful Engineering
Compact
Rapid on-board imaging
KV Arms
MV Imaging EPID
Imaging
Portal Dosimetry
Portal Dosimetry
Will discuss
120 MLC leaves
Virtual wedges
Enhanced Dynamic Wedges
Cone Beam CT

Working principle
 Same as the most of Linacs.
 Versatile dose rates
 100-600MU/mint
 Treatment time reduction
 1000MU/mint (SRS)
 Dose Rate stability
 Rapid Arc
 Dose rate
 Gantry speed
 Dynamic MLCs

Versatility
In terms Energies
 Photons
 6 and 16 MV, 6MV SRS
 Electrons
 6, 9, 12, 15, 18 and 22 Mev
In terms of treatment Modalities
 Electrons
 Photons
 IMRT, IGRT, VMAT,SRS
 Use of gating

3DCRT
 Forward planning
 Using asymmetric jaws
 MLC field shaping
 Enhanced dynamic wedges
High Tech. using Trilogy

IMRT
 Intensity Modulated Radiation Therapy
 Varying beam intensity
 Using dynamic MLCs
 Concept of inverse planning
 DVH formation
 Dose constraints
 Concave shape iso-dose lines
 Steep dose gradient near OAR
 What is the Magic
 Dynamic MLCs

IMRT pre treatment QA
 why?
 How?
 MLC fluence
 Dose fluence
 Calculated dose matrix
 Eclipse
 Measured Dose matrix
 Using EPID
 Portal dosimetry
 External Device
 2- D Array
 Map check
 Analysis

IMRT verification using EPID
 Portal Dosimetry
 Creation of verification plan
 Predicted dose (calculated dose)
 Predicted dose matrix
 Irradiation at linac
 Measured dose
 Measures dose matrix
 Comparison
 Pass or fail
 Why failure?
 Why we are doing all this?

Rapid Arc (VMAT)
 Volumetric Modulated Arc Therapy
Dynamic Arc Therapy
 Dynamic MLCs
 Variable dose rate
 Gantry speed variation
 Inverse planning
 Benefits
 Time efficient
 Better conformamity
 Drawbacks
 Needs stringent quality assurance
 Optimization is almost same
as that of IMRT

Treatment planning system(TPS)
 Brain of Radiotherapy
 Eclipse planning system
 Treatment planning algorithms
 PBC, AAA
 Best contouring tools
 Auto contouring
 Insightful Plan Evaluation
 Plan Revision

Treatment delivery path
 CT simulation
 BB’s placement
 TPS
 Contouring
 Planning
 Evaluation
 Approval
 RT chart, treatment
approval
 Time planner
 Console
 RV mode up
 Set up verification
 Treatment delivery

Treatment delivery
Treatment console
 4DICT, OBI,
 Patient mode up,
 Imaging modalities
 KV Imaging, MV imaging
cone beam CT
On Board Imaging
 Plan DRR Vs. Acquired Image
 Auto matching
 Manual matching
 Bony land marks
 External markings
16

Cone beam using OBI
Planning CT Vs. Acquired CT images
 Auto matching
 Shifting
 Plan revision
Off line review
 Matching
 Shifting
 Modifications
 instructions
17

OBI
 KV source
 KV detector
 Set up fields
 Matching with planed
DRRs
18

Real-time Position Management (RPM)
system
 Respiratory gating
 External cameras
 Synchronization
 Threshold
 Stable dose rate gain
19

Take Home Message
 “Any sufficiently advanced technology is indistinguishable
from magic”
 Technology
 Increases Therapeutic Ratio
 Team work
 In union there is strength
 Change is something which is permanent

Features of new installed linac Trilogy At Dr Ziauddin Hospital Karachi

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