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IMAGE GUIDED RADIO-THERAPY

Image guided radiotherapy (IGRT) is a type of conformal radiotherapy. Conformal radiotherapy can shape the radiotherapy beams around the area of the cancer.

Image Guided Radio-Therapy (IGRT) in India

Image Guided Radiation Therapy is a technique which involves the frequent use of diagnostic imaging to view the location, extent and size of the tumor during the course of the radiation therapy. This not only enhances accuracy and precision of the treatment, but also plays a critical role in the post therapy management of the patient.

Image-Guided Radiation Therapy (IGRT) is one of the latest and cutting-edge innovations in radiation therapy and management of cancers. The therapy involves integration of treatment and imaging capabilities into a single machine, which makes it simpler and more effective in the management of cancers and tumors. This technology also increases the accuracy with which the tumor cells can be specifically targets, whilst reducing the damage on the surrounding tissues.

Radiation oncologists use image guided radiation therapy, or IGRT, to help better deliver the radiation to the cancer since tumors can move between treatments due to differences in organ filling or movements while breathing. IGRT involves conformal radiation treatment guided by imaging, such as CT, ultrasound or X-rays, taken in the treatment room just before the patient is given the radiation treatment on a daily basis.

How does IMRT work?

IMRT represents an evolution of radiation technology, from standard to 3D to IMRT. The evolution in technology offers the possibility of better cure rates with fewer side effects.

  • Standard radiation involved starting with plain x-rays of the pelvis. Lines were hand drawn on each x-ray film to make "radiation fields". Lead blocks were then created which matched the hand drawings. Usually, four radiation beams were used, entering the body from the front, back, and both sides.

  • 3D-conformal radiation involved starting with a CT scan. The prostate, rectum, and bladder were circled on a computer screen which showed the CT images. Any number of radiation beams could be used, and the computer shaped the beams to precisely match the contour of the prostate. Beams could be angled so that they missed most of the bladder and rectum, but passed through the prostate.

  • IMRT is even more computer intensive than 3D. Every beam is broken down into tiny "beamlets", and each beamlet can be given a different dose. This results in beams with different intensities across their surfaces. Multiple beams are used for each treatment. Although the beams are all different in shape and intensity profiles, once they all converge on the prostate you are left with a high dose covering the prostate gland, and a lower dose hitting the normal tissues, such as rectum and bladder.


Image Guided Radiation Therapy

Image Guided Radiation Therapy is a technique which involves the frequent use of diagnostic imaging to view the location, extent and size of the tumor during the course of the radiation therapy. This not only enhances accuracy and precision of the treatment, but also plays a critical role in the post therapy management of the patient.

In the Image Guided Radiation Therapy, the machine that delivers the radiation dose (i.e. linear accelerator) is linked to any diagnostic imaging equipment like a Computed Tomography (CT scan) Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET scan) or simply an X-ray, via a computer program, which facilitates the physician to view the tumor before, during and after the irradiation. This allows the radiation specialist to make necessary corrections and adjustments during the patient's exposure to the radiation doses.

Who can Undergo Image Guided Radio-Therapy (IGRT)

Breast cancer

is usually diagnosed in early stages and in many cases of breast cancer, the breast can be preserved. In preservation of the breast, the cosmesis should be maintained. The radiotherapy of the breast involves the irradiation of the whole breast and higher dose to the tumour bed. But at the same time the lung and the heart are also irradiated.

Since these patients are going to be the long term survivors, the late toxicities of radiation need to be minimised. Lungs and heart being mobile organs, Image Guided Radio-Therapy ( IGRT) can be solution to overcome their mobility.

Prostate Cancer

Prostrate Cancer can be treated very well with high dose of radiation. Since prostrate is surrounded by two critical organs, the rectum and the urinary bladder, radiation becomes a critical issue. Also, position of the prostrate varies with the bladder filling and to an extent, distension of the rectum. With Image Guided Radio-Therapy ( IGRT), these volumes can be reduced, so that a higher dose of radiation is delivered to the tumour and minimising the dose to bladder and rectum.

Brain tumors

The brain is enclosed in the compact cranial cavity and brain does not move on its own within this cavity, but the irradiation volumes are very prone for set-up errors and this is very risky. The movements of neck and chin can alter the position of targets within the cranial sphere to a large extent. The margins of the treatment volumes are kept very tight to save the normal brain and other critical structures and the gradient between the high dose and low dose at the periphery of tumour volume is very sharp. These errors can be minimised with Image Guided Radio-Therapy ( IGRT).

Lung Cancer

Statistics say that more 60% of the times, lung cancer is detected in advanced stages, when the in which radiotherapy and chemotherapy is the standard of care. To achieve the outcome of radiation therapy with minimal side- effects, it is imperative to administer a radical dose of radiation to the tumor. Since lungs move with respiration, higher volume of radiation is given so as to not miss out the tumor, thus irradiating the normal lung. Image Guided Radio-Therapy ( IGRT) is advantageous in such cases to save the healthy tissues in the lung.


Benefits of Image Guided Radio-Therapy

  • Image Guided Radio-Therapy ( IGRT) treatment is beneficial in administering the radiation on the exact location of different types of tumours including that of lung, prostate, liver, pancreas, breast, brain, head and neck.

  • The radiation beam can be imaged and administered at the tumor center in the real time.

  • By controlling breathing, a lung cancer patient can reduce movement, there by, helping radiation to be more accurately targeted.

  • Least possibility of error as the correct amount of radiation dose can be administered to the exact location of the tumour.

  • Minimal side effects as the amount of radiation for significant/normal organs can be reduced.

  • More accurate treatment as real time imaging can be done.

Note: Treatment Options/Results may vary from patient to patient depending on their medical condition.

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