Helical tomotherapy targeting total bone marrow – First clinical experience at the University of Minnesota

Figures & data

Figure 1.  MVCT scan taken at the abdomen before treatment delivery. MVCT scan set was fused with treatment planning CT scan. The transverse sectional views are shown in (A) Tomo MVCT image and in (B) reference kVCT image. The fusion column (C) presents the kVCT in gray scale with the MVCT superimposed with a level of transparency in yellow. Similarly, the sagital sectional views and the coronal sectional views are shown in D, E, F and G, H, I respectively.

Table I.  Translational (in IEC Tx, Ty, Tz) shift at various anatomical sites for pre-treatment and post-treatment using MVCT-kVCT fusion.

	MVCT – kVCT fusion
	pre-treatment			post-treatment
Shifts (in mm)	Neck	Abdomen	Knee	Abdomen	knee
Lateral (IEC Tx)	5.54	−4.37	−3.67	−0.31	3.82
Longitudinal (IEC Ty)	8.62	3.03	4.76	−2.21	0.9
Vertical (IEC Tz)	8	−1.36	−2.38	0.4	0.72

Figure 2.  Sectional view of dose painting: (I) transverse, (II) sagital, (III) coronal view for upper part of the body, and (IV) transverse, (V) sagital, (VI) coronal view for lower part of the body; (VII) The dose volume histogram for PTV(A), liver(B), heart(C), eye(D), lungs(E), spleen(F), left kidney(G), right kidney(H), lens(I), scrotum(J), and (V) DVH for bony anatomy: Upper body PTV (A), thoracic bone(A1); bone of skull(A2); pelvic bone(A3); right extremities(A4) are shown in lower middle panel (VIII). Right lower panel (IX) shows DVH for lower body PTV (A’).

Table II.  Median dose in various organs for prescription dose (Rx) of 6 Gy.

	TMI dose		% dose
Anatomy	Median	STD	reduction
ptv (upper body)	6.14	0.29
ptv (lower body)	6.00	0.03
lungs	3.37	1.26	44
eyes	3.67	1.27	39
lens	2.01	0.59	67
right kidneys	2.32	1.56	62
left kidney	2.48	1.48	59
liver	4.17	1.22	31
heart	4.21	1.25	30
scrotum	0.71	0.15	88