History of Radiotherapy & SRS
Angioma -
Non-malignant tumor of blood vessels or lymphatic vessels
Hairy nevus -
Benign tumor (birthmark)
Law of Bergonie and Tribondeau -
cells are most sensitive to radiation when they are immature, undifferentiated, and
rapidly dividing
Ex. gonads
Early measurement of x-rays -
Measure current or chemical/ionization effects
X-ray quality -
Superficial: 50-140 kVp
Ortho: 200-400 kVp
Megavoltage: above 1 MV
Paterson-Parker System -
Brachytherapy distribution
Manchester system delivers uniform dose to a plane or volume +/-10%.
Circular or planar configurations
Manchester system -
Anatomical points for cervical or uterine treatment are points A and B
Reduce dose to rectal and bladder points
Advantages of MV -
Better depth dose
Skin sparing
Less absorption in bone (good for treating through pelvis or ribs)
In LINAC head, photons need _____ and electrons need ______ -
flattening filter; scattering foils
Advantages of Linacs -
Greater efficiency and shorter length
Compact linac
Tighter energy control and greater stability
Coverage with fewer fields
Shorter Tx times
Greater skin sparing and greater penetration
Higher precision in Tx delivery; normal tissue sparing
1|Page
, Who combined internal and external techniques? -
Paris school
Gilbert H. Fletcher
What is a rectilinear scanner? -
It is a type of scintigraphy where you see a little more functionality fused with x-
ray
What is angiography used to for? -
Visualization of blood flow in the coronary arteries
Like in kidneys or brain
What is lymphangiography used for? -
Lymphoma, testicular and cervical cancer
What is ultrasound used for? -
Prostate, kidney, pelvic, and rectal cancer
What is a benefit of HDR remote afterloaders? -
Better safety--less exposure
Advantages of HDR brachytherapy over radium -
Much quicker
Less dwelling and catheter
Outpatient
Anatomically much more precise
Spare normal tissues
What Tx could be good for bilio pancreatic cancer? -
HDR Biliary
(T/F) The decision to use immobilization and which technique to use is evidence-based and
depends on the oncologist -
True
What are some changes in clinical practice since 1995? -
IGRT, gating, EMR, motion control, SBRT and hypo fractionation, BT for prostate
and breast, etc.
What are some goals for future clinical practice? -
More conformal dose (less Tx toxicity)
More effective (higher dose delivered safely)
Less Tx (more convenient, less financial toxicity)
More personalized-->functional PET, MRI
IG Tx (MR guided)
Adaptive RT
Oligometastatic disease
What is the workflow for Stereotactic Radio-surgery? -
Immobilization-->Imaging-->Treatment Planning-->Delivery
2|Page
Angioma -
Non-malignant tumor of blood vessels or lymphatic vessels
Hairy nevus -
Benign tumor (birthmark)
Law of Bergonie and Tribondeau -
cells are most sensitive to radiation when they are immature, undifferentiated, and
rapidly dividing
Ex. gonads
Early measurement of x-rays -
Measure current or chemical/ionization effects
X-ray quality -
Superficial: 50-140 kVp
Ortho: 200-400 kVp
Megavoltage: above 1 MV
Paterson-Parker System -
Brachytherapy distribution
Manchester system delivers uniform dose to a plane or volume +/-10%.
Circular or planar configurations
Manchester system -
Anatomical points for cervical or uterine treatment are points A and B
Reduce dose to rectal and bladder points
Advantages of MV -
Better depth dose
Skin sparing
Less absorption in bone (good for treating through pelvis or ribs)
In LINAC head, photons need _____ and electrons need ______ -
flattening filter; scattering foils
Advantages of Linacs -
Greater efficiency and shorter length
Compact linac
Tighter energy control and greater stability
Coverage with fewer fields
Shorter Tx times
Greater skin sparing and greater penetration
Higher precision in Tx delivery; normal tissue sparing
1|Page
, Who combined internal and external techniques? -
Paris school
Gilbert H. Fletcher
What is a rectilinear scanner? -
It is a type of scintigraphy where you see a little more functionality fused with x-
ray
What is angiography used to for? -
Visualization of blood flow in the coronary arteries
Like in kidneys or brain
What is lymphangiography used for? -
Lymphoma, testicular and cervical cancer
What is ultrasound used for? -
Prostate, kidney, pelvic, and rectal cancer
What is a benefit of HDR remote afterloaders? -
Better safety--less exposure
Advantages of HDR brachytherapy over radium -
Much quicker
Less dwelling and catheter
Outpatient
Anatomically much more precise
Spare normal tissues
What Tx could be good for bilio pancreatic cancer? -
HDR Biliary
(T/F) The decision to use immobilization and which technique to use is evidence-based and
depends on the oncologist -
True
What are some changes in clinical practice since 1995? -
IGRT, gating, EMR, motion control, SBRT and hypo fractionation, BT for prostate
and breast, etc.
What are some goals for future clinical practice? -
More conformal dose (less Tx toxicity)
More effective (higher dose delivered safely)
Less Tx (more convenient, less financial toxicity)
More personalized-->functional PET, MRI
IG Tx (MR guided)
Adaptive RT
Oligometastatic disease
What is the workflow for Stereotactic Radio-surgery? -
Immobilization-->Imaging-->Treatment Planning-->Delivery
2|Page
