Image Guided

Radiotherapy
Dr.Katta Charu Goutham Reddy
DNB Radiation Oncology
Yashoda Hospital,Hyderabad

Image Guided Radiotherapy

Image -guided radiation therapy (IGRT) may be defined as
a radiation therapy procedure that uses image guidance at
various stages of its process: patient data acquisition,
treatment planning, treatment simulation, patient setup,
and target localization before and during treatment.
In the present context, term IGRT to signifies radiotherapy
that uses image guidance procedures for target
localization before and during treatment.

Image Guidance Technologies

Portal
and
radiograp
hic
imagers
Megavolta
ge conebeam ct

In-room
CT
scanner

Kilo
voltage
conebeam CT

Helical
Tomothera
py

Ultrasoun
d

PORTAL IMAGERS
Modern accelerators are equipped with two kinds of imaging
systems:
(a) kilovoltage x-ray imager in which a conventional x-ray tube is
mounted on the gantry with an opposing flat-panel image detector and

(b) megavoltage (MV) electronic portal imaging device (EPID) with its
own flat-panel image detector.

The flat-panel image detector in both cases is a matrix of 256

256 solid state detectors consisting of amorphous silicon (aSi) photodiodes.

IN-ROOM CT SCANNER
An in-room CT scanner makes it possible to have the
capability of obtaining CT images before each treatment.
An in-room CT scanner is a conventional CT scanner on
rails that is housed in the treatment room and shares the
couch with the accelerator

Image Guided Adaptive

Radiotherapy
This information from In Room CT Images useful not only in
target localization prior to treatment, but also in
reconstructing dose distribution, which may be compared to
the reference treatment plan before each treatment or
periodically during the course of radiotherapy.
Frequent comparisons of these isodose plans enable one to
make setup corrections or modify treatment parameters to
minimize variations between the planned and the actual
treatment.

KILOVOLTAGE CONE-BEAM CT
The x-ray tube is mounted on a retractable arm at 90
degrees with respect to the central axis of the linear
accelerator beam.
The kilovoltage cone-beam computed tomography
(kVCBCT) involves acquiring planar projection images
from multiple directions as the gantry is rotated through
180 degrees or more.
Three-dimensional volumetric images are reconstructed
from these multiple radiographs by the computer, which
uses a filtered back-projection algorithm

MEGAVOLTAGE CONE BEAM

CT
Megavoltage cone-beam CT (MVCBCT) is made possible by the
use of a traditional EPID with the a-Si flat-panel detector.
The x-ray source in this case is the megavoltage therapy beam
of the accelerator.
Planar projection images are acquired from multiple directions
as the x-ray source and the detector rotate about the patient. As
in the kVCBCT, 3-D volumetric images are reconstructed by the
computer using a filtered back-projection algorithm.

KV vs MV
Merits of MV

Merits of KV

Less imaging artifacts

no need for extrapolating attenuation coefficients

more accurate calculation of imaging dose

does not require extensive modification of LA

Better contrast and spatial resolution

Better soft-tissue visibility at much lower doses

Ease of patient setup verification and correction
great flexibility in implementing the goals of IGRT

Helical Tomotherapy
Helical tomotherapy is an IMRT delivery technique that
combines features of a linear accelerator and a helical CT
scanner
MVCT images (typical scan dose in the range of 1 to 2
cGy) provide sufficient contrast for verifying the patients
position at the time of treatment

ULTRASOUND
3-D ultrasound data sets are generated through optical tracking of
free-handacquired 2-D ultrasound images.
The operator manipulates the ultrasound probe over the anatomic
region of interest to obtain 2-D images, which are automatically
transferred to a computer through a video link.
The position and angulation of the ultrasound probe are tracked by
an array of four infrared light-emitting diodes (IRLEDs). By coupling
the ultrasound probe position determined by IRLEDs with the
images acquired, a 3-D ultrasound image volume is reconstructed.