**Meet the editor**

Dr Gopishankar has more than fourteen years of teaching and working experience as Medical Physicist-cum-Radiological Safety Officer for the Departments of Neurosurgery and Radiation Oncology at All India Institute of Medical Sciences, New Delhi, India. His research interests are Gel Dosimetry, Radiochromic Film Dosimetry and its application on advanced radiotherapy

techniques like SRS/SRT, Intensity Modulated Radiotherapy (IMRT) and other advanced conformal treatments. He has several international presentations and publications. He is a life time member of UICC. He had done PhD in the field of Gel dosimetry for its application in Radiotherapy at his working institute. He also has done his Master's in Computer Application. He is at present member of several research projects and is involved in guiding PhD research scholars.

Contents

**Preface IX** 

Chapter 2 **STAT RAD:** 

S. Zimeras

Tomoki Kimura

**Part 2 Particle Therapy 67** 

Helmut Paul

Chapter 5 **Scanned Ion Beam Therapy** 

Chapter 1 **Stereotactic Body Radiotherapy** 

**Part 1 External Beam RT and New Practices 1** 

**for Pancreatic Adenocarcinoma:** 

**Set-Up Error Correction Using Internal Markers** 

Chi Lin, Shifeng Chen and Michael J. Baine

David Wilson, Ke Sheng, Wensha Yang, Ryan Jones, Neal Dunlap and Paul Read

Chapter 4 **Involved-Field Radiation Therapy (IF-RT)** 

Nami Saito and Christoph Bert

Su Youwu, Li Wuyuan, Xu Junkui, Mao Wang and Li Zongqiang

Chapter 3 **Segmentation Techniques of Anatomical Structures** 

**for Non-Small Cell Lung Cancer (NSCLC) 59** 

**of Moving Targets with Beam Tracking 69** 

Chapter 6 **Neutron Influence in Charged Particle Therapy 85** 

Chapter 7 **The Stopping Power of Matter for Positive Ions 113** 

**and Its Association with the Patient's Body Mass Index 3** 

**A Potential Real-Time Radiation Therapy Workflow 23** 

**with Application in Radiotherapy Treatment Planning 41** 

### Contents

#### **Preface XIII**


#### Chapter 2 **STAT RAD: A Potential Real-Time Radiation Therapy Workflow 23**  David Wilson, Ke Sheng, Wensha Yang, Ryan Jones, Neal Dunlap and Paul Read

	- **Part 2 Particle Therapy 67**

X Contents


Contents VII

Chapter 17 **Polymer Gel Dosimetry for Radiation Therapy 309** Senthil Kumar Dhiviyaraj Kalaiselven and James Jebaseelan Samuel Emmanvel Rajan

> **Image Noise and Improve Dose Resolution in X-Ray CT Based Normoxic Gel Dosimetry 327**

A. Jirasek, S. S. Kale, G. K. Rath Sanjay Thulkar, V. Subramani, S. Senthil Kumaran and R. K. Bisht

**Throughout the Radiation Therapy Treatment Pathway 341** 

Chapter 18 **Digital Filtering Techniques to Reduce** 

**Part 7 Enhancing Patient Care in RT 339** 

Chapter 19 **Information and Support for Patients** 

Michelle Leech and Mary Coffey

N. Gopishankar, S. Vivekanandhan,

	- **Part 6 Emerging Dosimeters and New QA Practices 189**

#### **Part 7 Enhancing Patient Care in RT 339**

VI Contents

**Part 3 Brachytherapy and** 

Chapter 8 **Prostate Seed Brachytherapy –** 

Masataka Sawaki

Chapter 11 **Enhancing Therapeutic Radiation**

Kelley Salem and Apollina Goel

Chapter 12 **Radiation Therapy and Skin Cancer 207**

Chapter 13 **Critical Normal Tissue and Radiation Injury:** 

Mineur Laurent, Jaegle Enric, Pourel Nicolas and Garcia Robin

Chapter 14 **The Cytoprotective Effect of Amifostine** 

Chapter 15 **Abscopal Effect of Radiation Therapy:** 

Chapter 16 **Quality Assurance (QA) for Kilovoltage** 

Joerg Lehmann and Stanley Skubic

Kenshiro Shiraishi

**The Stomach 249**

Bruce Libby, Matthew D. Orton, Haidy Lee, Mark E. Smolkin,

**Intraoperative Radiation Treatments 133**

Stanley H. Benedict and Bernard F. Schneider

Chapter 9 **Intra-Operative Radiotherapy with Electron Beam 145**  Ernesto Lamanna, Alessandro Gallo, Filippo Russo, Rosa Brancaccio, Antonella Soriani and Lidia Strigari

Chapter 10 **Intraoperative Radiotherapy for Early Breast Cancer 169** 

**Part 4 Scope of Radiation Therapy for Specific Diseases 179**

**Responses in Multiple Myeloma 181** 

Jonathan D. Tward, Christopher J. Anker, David K. Gaffney and Glen M. Bowen

**Against Radiation Induced Toxicity 257**  Vassilis E. Kouloulias and John R. Kouvaris

**Part 6 Emerging Dosimeters and New QA Practices 189**

**Current Concepts and Future Applications 275**

**Cone Beam Computed Tomography (CBCT) 291** 

**Part 5 Radiation Induced Effects and Overcoming Strategies 247**

**Methods to Improve Implant Characteristics 135** 

Chapter 19 **Information and Support for Patients Throughout the Radiation Therapy Treatment Pathway 341**  Michelle Leech and Mary Coffey

Preface

*Cherish the help of men of skill, Who ward and safe-guard you from ill*. **Thiruvalluvar (An Indian Poet)** 

Cancer is a dreadful disease that confiscates million of people's life every year. It has created trepidation in the human minds for significant amount of time. General perception about cancer is it often leads to death. A large number of cancer patients today can expect to recover from this increasingly treatable illness. This achievement is due to significant advances over the last 50 years in the technology for treating cancer with radiation. While radiation therapy technology has progressed considerably in the last half-century, the basic goal of such treatment is unchanged: To target and kill cancer cells while exposing the surrounding healthy tissue to as little as possible. Radiation therapy kills cancer cells by damaging their DNA either directly or indirectly by creating free radicals within the cells that can in turn damage the DNA. Radiation may be delivered by a higher energy radiation generating equipments to shrink tumors and kill cancer cells. Does radiation therapy kill only cancer cells? The

answer is no. It can also damage normal cells leading to side effects as well.

How far has radiation therapy technology progressed and how is the future of radiation therapy. Does this treatment modality for cancer have any role in treating tumors which usually prefer other treatments? All answers for these questions are found in this book entitled "**Modern Practices in Radiation Therapy**". This book contains 19 exceptional chapters contributed by renowned world-class radiotherapy professionals and researchers who have overwhelming knowledge in this field. To make this more interesting, all the chapters were further grouped into sections so that the readers could pursue their specific subjects of interest in radiation treatment.

**Section I** entitled "**External Beam RT and New Practices**" brings together chapters related to external beam radiotherapy which is defined as the methodology for treating tumors with radiation generation equipments like linear accelerators, cobalt units, etc. In recent times a remarkable advancement has happened in this treatment technique. This section groups chapters discussing relatively new type of external beam radiation therapy delivery system such as Stereotactic Body Radiotherapy

### Preface

*Cherish the help of men of skill, Who ward and safe-guard you from ill*. **Thiruvalluvar (An Indian Poet)** 

Cancer is a dreadful disease that confiscates million of people's life every year. It has created trepidation in the human minds for significant amount of time. General perception about cancer is it often leads to death. A large number of cancer patients today can expect to recover from this increasingly treatable illness. This achievement is due to significant advances over the last 50 years in the technology for treating cancer with radiation. While radiation therapy technology has progressed considerably in the last half-century, the basic goal of such treatment is unchanged: To target and kill cancer cells while exposing the surrounding healthy tissue to as little as possible. Radiation therapy kills cancer cells by damaging their DNA either directly or indirectly by creating free radicals within the cells that can in turn damage the DNA. Radiation may be delivered by a higher energy radiation generating equipments to shrink tumors and kill cancer cells. Does radiation therapy kill only cancer cells? The answer is no. It can also damage normal cells leading to side effects as well.

How far has radiation therapy technology progressed and how is the future of radiation therapy. Does this treatment modality for cancer have any role in treating tumors which usually prefer other treatments? All answers for these questions are found in this book entitled "**Modern Practices in Radiation Therapy**". This book contains 19 exceptional chapters contributed by renowned world-class radiotherapy professionals and researchers who have overwhelming knowledge in this field. To make this more interesting, all the chapters were further grouped into sections so that the readers could pursue their specific subjects of interest in radiation treatment.

**Section I** entitled "**External Beam RT and New Practices**" brings together chapters related to external beam radiotherapy which is defined as the methodology for treating tumors with radiation generation equipments like linear accelerators, cobalt units, etc. In recent times a remarkable advancement has happened in this treatment technique. This section groups chapters discussing relatively new type of external beam radiation therapy delivery system such as Stereotactic Body Radiotherapy

#### X Preface

(SBRT), Involved-Field Radiation Therapy (IF-RT), a rapid clinical work flow STAT RAD using tomotherapy system and in addition it discusses about segmentation techniques of anatomical structures for planning in External beam RT which is also useful in Brachytherapy planning as well.

Preface XI

**Gopishankar Natanasabapathi** 

India

Gamma Knife Unit, Neurosciences Centre,

All India Institute of Medical Sciences, New Delhi,

In 2008, there were an estimated 12.7 million cases of cancer diagnosed and 7.6 million deaths from cancer around the world. Cancer survival tends to be poorer in developing countries, most likely because of combination of a late stage at diagnosis and limited access to timely and standard treatment. A considerable proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing methods for early detection and treatment. Emergence of advanced technologies is giving hope to more patients in recent times due to fewer side effects. It is expected that search for the origin and treatment of this disease will continue over the next quarter century in much the same manner as it has, by adding more complexity to scientific literature that is already complex almost beyond measure. Main goal of this book "**Modern Practices in Radiation Therapy**" is to provide contemporary knowledge and serve as a stepping

stone for treating cancer patients efficiently in future.

**Section II** entitled "**Particle Therapy**" has blended chapters pertinent to treatment modalities such as ion beam therapy. Main advantage of this technique is that it provides supreme dose conformity. Chapter 5 discusses about beam tracking system for moving targets treatment using ion beam therapy. Chapter 6 is about influence of neutron in charged particle therapy. Chapter 7 enumerates stopping power data which is determines the characteristics of ion beam therapy.

**Section III** entitled "**Brachytherapy and Intraoperative Radiation Treatments**" has unified chapters related to delivery of radiation locally to the tumor with rapid dose fall-off in the surrounding normal tissue. New technical developments in brachytherapy such as transperineal seed implantation and Intra-operative radiotherapy, is discussed in this section.

**Section IV** entitled "**Scope of Radiation Therapy for Specific Diseases**" contains two chapters; first one reveals the recent advances in the treatment of multiple myeloma (MM) such as targeted radiotherapy. Second chapter of this section mentions about underutilized radiation therapy modality for skin cancer which could be effective treatment for this disease if proper communication is established between the dermatologist's and radiation oncologist's.

**Section V** entitled "**Radiation Induced Effects and Overcoming Strategies**" congregates chapters discussing complications associated with radiation treatment and methods to protect normal tissue from radiation damage. There is one chapter in this section which reveals facts about anti-tumor effect at a non irradiated location in patients.

**Section VI** entitled "**Emerging Dosimeters and New QA Practices**" focuses on topics which are essential to determine and enhance the quality of the radiation equipment for patient treatment. With the introduction of new technology into the field of radiation oncology, a need arises to have a quality assurance program that is customized to these newer treatment modalities. The goal of a QA program for radiotherapy equipment is to assure that the machine characteristics do not deviate significantly from their baseline values acquired at the time of acceptance and commissioning. In early times radiation measurements were restricted to point measurements or two dimensional measurements. Advanced treatment techniques exhibit more complex radiation patterns which are characterized with steep dose gradients.

**Section VII** entitled "**Enhancing Patient Care in RT**" contains a single chapter about communication which is the key factor for providing better patient care. How it influences cancer patients is well discussed in this section.

In 2008, there were an estimated 12.7 million cases of cancer diagnosed and 7.6 million deaths from cancer around the world. Cancer survival tends to be poorer in developing countries, most likely because of combination of a late stage at diagnosis and limited access to timely and standard treatment. A considerable proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing methods for early detection and treatment. Emergence of advanced technologies is giving hope to more patients in recent times due to fewer side effects. It is expected that search for the origin and treatment of this disease will continue over the next quarter century in much the same manner as it has, by adding more complexity to scientific literature that is already complex almost beyond measure. Main goal of this book "**Modern Practices in Radiation Therapy**" is to provide contemporary knowledge and serve as a stepping stone for treating cancer patients efficiently in future.

X Preface

useful in Brachytherapy planning as well.

radiotherapy, is discussed in this section.

dermatologist's and radiation oncologist's.

patterns which are characterized with steep dose gradients.

influences cancer patients is well discussed in this section.

patients.

is determines the characteristics of ion beam therapy.

(SBRT), Involved-Field Radiation Therapy (IF-RT), a rapid clinical work flow STAT RAD using tomotherapy system and in addition it discusses about segmentation techniques of anatomical structures for planning in External beam RT which is also

**Section II** entitled "**Particle Therapy**" has blended chapters pertinent to treatment modalities such as ion beam therapy. Main advantage of this technique is that it provides supreme dose conformity. Chapter 5 discusses about beam tracking system for moving targets treatment using ion beam therapy. Chapter 6 is about influence of neutron in charged particle therapy. Chapter 7 enumerates stopping power data which

**Section III** entitled "**Brachytherapy and Intraoperative Radiation Treatments**" has unified chapters related to delivery of radiation locally to the tumor with rapid dose fall-off in the surrounding normal tissue. New technical developments in brachytherapy such as transperineal seed implantation and Intra-operative

**Section IV** entitled "**Scope of Radiation Therapy for Specific Diseases**" contains two chapters; first one reveals the recent advances in the treatment of multiple myeloma (MM) such as targeted radiotherapy. Second chapter of this section mentions about underutilized radiation therapy modality for skin cancer which could be effective treatment for this disease if proper communication is established between the

**Section V** entitled "**Radiation Induced Effects and Overcoming Strategies**" congregates chapters discussing complications associated with radiation treatment and methods to protect normal tissue from radiation damage. There is one chapter in this section which reveals facts about anti-tumor effect at a non irradiated location in

**Section VI** entitled "**Emerging Dosimeters and New QA Practices**" focuses on topics which are essential to determine and enhance the quality of the radiation equipment for patient treatment. With the introduction of new technology into the field of radiation oncology, a need arises to have a quality assurance program that is customized to these newer treatment modalities. The goal of a QA program for radiotherapy equipment is to assure that the machine characteristics do not deviate significantly from their baseline values acquired at the time of acceptance and commissioning. In early times radiation measurements were restricted to point measurements or two dimensional measurements. Advanced treatment techniques exhibit more complex radiation

**Section VII** entitled "**Enhancing Patient Care in RT**" contains a single chapter about communication which is the key factor for providing better patient care. How it

#### **Gopishankar Natanasabapathi**

Gamma Knife Unit, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India

**Part 1** 

**External Beam RT and New Practices**
