Clinical Radiation Physics Service

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We have instituted routine dynamic Intensity Modulated Radiation Therapy (dIMRT). This is the most complex of IMRT treatments and requires considerable pre-treatment verification to ensure accurate execution. These treatments are delivered using our twin Clinac-21EX accelerators. A Hi-ART system (Tomotherapy Inc.) for delivering treatments via helical tomotherapy has been installed, accepted and is currently treating patients. This system provides ROB with cutting edge treatment technology to support future clinical trials. We have started a series of initiatives with our Nucletron High Dose-Rate Afterloader (HDR) using a small, high intensity 192Ir source for interstitial and intercavitary brachytherapy. The oldest Clinac-21EX accelerator has been replaced with a new machine is a state-of-the-art Varian TrueBeam STX. This accelerator will be equipped with the new high definition multi-leaf collimator with leaf widths as thin as 2.5 mm. This will render it capable of performing frameless stereotactic radiosurgery (SRS), although a set of circular collimators with diameters ranging from 4mm to 25mm and an SRS planning module are included in the acquisition. The patient couch also provides 6 Degrees-of-Freedom (6DOF) to greatly improve positioning accuracy by permitting corrections for pitch, roll and yaw, in addition to the traditional longitudinal, lateral and vertical position adjustments. This machine includes the Edge Extracranial SABR Package that will permit the unit to deliver frameless stereotactic body radiation therapy (SBRT) using advanced motion management based on radiofrequency local positioning using implanted fiducial transponders and infrared cameras. The revised Edge package includes a Calypso radiofrequency positioning system, utilizing implantable fiducial transducers and real-time tracking capability. ROB is in the process of acquiring a second TrueBeam STX unit to replace its RapidArc Clinac-21EX.