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Optimising the clinical use of tomotherapy

Petersson, Kristoffer LU (2014)
Abstract (Swedish)
Popular Abstract in Swedish

En av tre svenskar drabbas av cancer. Hälften av de som behandlas för sin cancer får strålbehandling som en del av sin behandling. Teknikutvecklingen gör att strålbehandling kan levereras på mer och mer avancerade sätt. Det är dock svårt att veta vilka patienter som verkligen gynnas av behandling med en avancerad teknik och i så fall med vilken typ av avancerad teknik.

Hur ska nya strålbehandlingstekniker implementeras i kliniken så att de kan nyttjas på ett optimalt sätt?

Hur kan vi säkerställa att våra patienter får behandling med den bästa behandlingstekniken som finns att tillgå och dessutom att tekniken används på ett optimalt sätt för behandling av den enskilda... (More)
Popular Abstract in Swedish

En av tre svenskar drabbas av cancer. Hälften av de som behandlas för sin cancer får strålbehandling som en del av sin behandling. Teknikutvecklingen gör att strålbehandling kan levereras på mer och mer avancerade sätt. Det är dock svårt att veta vilka patienter som verkligen gynnas av behandling med en avancerad teknik och i så fall med vilken typ av avancerad teknik.

Hur ska nya strålbehandlingstekniker implementeras i kliniken så att de kan nyttjas på ett optimalt sätt?

Hur kan vi säkerställa att våra patienter får behandling med den bästa behandlingstekniken som finns att tillgå och dessutom att tekniken används på ett optimalt sätt för behandling av den enskilda patienten?

Hur kan vi säkerställa att vår patient får en väldigt bra behandling även om vår utrustning för att leverera den avancerade strålbehandlingen av någon anledning inte skulle vara tillgänglig, dvs. hur ska vi undvika att patienten tvingas till ett behandlingsuppehåll? Ett sådant kan vara katastrofalt för utgången av behandlingen och därmed patientens liv!

I det arbete som presenteras i denna avhandling så beskrivs metoder som kan användas för att bemöta dessa frågeställningar. Metoderna är applicerade på en specifik strålbehandlingsteknik, nämligen tomoterapi.

Om de metoder som presenterats används vid den kliniska introduktion av nya tekniker för strålbehandling så ökar chansen att varje enskild patient får den bästa möjliga behandling som finns att tillgå. Vidare forskning kommer förhoppningsvis leda till att vi verkligen kan säkerställa detta. (Less)
Abstract
Radiotherapy is one of the major tools for treating cancer. Through research and technical development radiotherapy is becoming more advanced with new treatment techniques emerging. In the work presented in this thesis, well-known methods have been used, or modified for use, and new methods have been introduced in order to optimise the clinical use of an advanced radiotherapy treatment technique, specifically tomotherapy.

In the presented work, tools used for fallback planning are evaluated. Methods are developed for the commissioning of them, evaluating the quality of the treatment plans (describes how patients are to be treated) they produce, and measurements are performed to ensure that the resulting treatments can be... (More)
Radiotherapy is one of the major tools for treating cancer. Through research and technical development radiotherapy is becoming more advanced with new treatment techniques emerging. In the work presented in this thesis, well-known methods have been used, or modified for use, and new methods have been introduced in order to optimise the clinical use of an advanced radiotherapy treatment technique, specifically tomotherapy.

In the presented work, tools used for fallback planning are evaluated. Methods are developed for the commissioning of them, evaluating the quality of the treatment plans (describes how patients are to be treated) they produce, and measurements are performed to ensure that the resulting treatments can be accurately delivered to the patients. These could assure an uninterrupted patient treatment with specialised treatment techniques. The results show that fallback planning is useful as it in many cases prevents a prolongation of the treatment which can have clinically significant impact. It should be an important time-saving complement, especially for clinics with a single specialised treatment unit such as tomotherapy, as they are more affected by its downtime.

A method called clinical grading analysis (CGA) is presented as a way of comparing radiotherapy treatment plans. A CGA study takes advantage of the radiation oncologists’ clinical assessments to identify the clinical relevant differences between treatment plans. These subjective assessments are quantified in a CGA study, and used to decide which patients have a clinical benefit from treatment with one or the other of the advanced treatment techniques available to them. The results indicate that a CGA study provides a supporting framework for decision making regarding treatment techniques which helps to ensure a more optimal use of the clinic’s advanced treatment resources.

Beam commissioning, plan quality assessment, and treatment deliverability measurements are important when introducing new techniques into the clinic. However, the work presented in this thesis shows that despite performing such investigations thoroughly, unexpected treatment side effects might occur. Hence, patient follow-up is of utmost importance when introducing new treatment techniques as it enables treatment adjustment to optimise the treatment outcome. (Less)
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author
supervisor
opponent
  • PD-MER (Privat-Docent and Senior Lecturer) Moekli, Raphaël, Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland.
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Radiotherapy, IMRT, Implementation, Optimisation
pages
158 pages
publisher
Lund University, Division of Medical Radiation Physics
defense location
Lecture hall, 3rd floor in the radiotherapy building at Skåne University Hospital, Klinikgatan 5, Lund.
defense date
2014-02-14 13:00
ISBN
978-91-7473-804-9
language
English
LU publication?
yes
id
7f2df2de-2d9a-4ab4-a843-5fa473ec2d81 (old id 4249320)
date added to LUP
2014-02-10 14:36:48
date last changed
2016-09-19 08:45:10
@misc{7f2df2de-2d9a-4ab4-a843-5fa473ec2d81,
  abstract     = {Radiotherapy is one of the major tools for treating cancer. Through research and technical development radiotherapy is becoming more advanced with new treatment techniques emerging. In the work presented in this thesis, well-known methods have been used, or modified for use, and new methods have been introduced in order to optimise the clinical use of an advanced radiotherapy treatment technique, specifically tomotherapy.<br/><br>
In the presented work, tools used for fallback planning are evaluated. Methods are developed for the commissioning of them, evaluating the quality of the treatment plans (describes how patients are to be treated) they produce, and measurements are performed to ensure that the resulting treatments can be accurately delivered to the patients. These could assure an uninterrupted patient treatment with specialised treatment techniques. The results show that fallback planning is useful as it in many cases prevents a prolongation of the treatment which can have clinically significant impact. It should be an important time-saving complement, especially for clinics with a single specialised treatment unit such as tomotherapy, as they are more affected by its downtime. <br/><br>
A method called clinical grading analysis (CGA) is presented as a way of comparing radiotherapy treatment plans. A CGA study takes advantage of the radiation oncologists’ clinical assessments to identify the clinical relevant differences between treatment plans. These subjective assessments are quantified in a CGA study, and used to decide which patients have a clinical benefit from treatment with one or the other of the advanced treatment techniques available to them. The results indicate that a CGA study provides a supporting framework for decision making regarding treatment techniques which helps to ensure a more optimal use of the clinic’s advanced treatment resources. <br/><br>
Beam commissioning, plan quality assessment, and treatment deliverability measurements are important when introducing new techniques into the clinic. However, the work presented in this thesis shows that despite performing such investigations thoroughly, unexpected treatment side effects might occur. Hence, patient follow-up is of utmost importance when introducing new treatment techniques as it enables treatment adjustment to optimise the treatment outcome.},
  author       = {Petersson, Kristoffer},
  isbn         = {978-91-7473-804-9},
  keyword      = {Radiotherapy,IMRT,Implementation,Optimisation},
  language     = {eng},
  pages        = {158},
  publisher    = {ARRAY(0x9687638)},
  title        = {Optimising the clinical use of tomotherapy},
  year         = {2014},
}