ICTP/UNITS-AOUP

Alejandro Coloma

February 10, 2017

1 Introduction
1.1 Radiotherapy
The Azienda Ospedallero Universitaria Pisana has part of its facilities in the Santa Chiara
hospital, where the Medical Physics department is located. In this hospital there are two
Linear Accelerators, one Varian DHX and one old Primus that currently is out of order.
In another friend hospital in Pisa there is one Varian True Beam. Another radiotherapy
techniques performed in Santa Chiara are: Brachytherapy and Intra Operative Radiation
Therapy.

1.2 Other areas

The Medical Physics department also is strongly involved in the following areas:
1. Nuclear Medicine
2. Radiation Protection (personal dosimetry laboratory)
3. Diagnostic Radiology, MRI

2 Radiotherapy Planning
There are three different Treatment Planing Systems (TPS) used in the radiotherapy planing
section, additionally there is the software FocalSim, that can be used for contouring structures
in the CT sets and then exporting them to the desired TPS.

2.1 Eclipse
This TPS is mainly used for VMAT (RapidArc) planning, its suitable for small fields and it
has been commissioned only for 6 MV photon beams without wedges. In this TPS we find
the following workspaces:
1. Select patient data
2. Registration: for image co-registration, such as CT with contras, MRI, etc.
3. Contouring: similar to what can be done with FocalSim.
4. Field set-up: creation of plans with their corresponding beam arrangements.
5. Plan evaluation: allows comparison between two or more plans, through their isodose
maps in the three planes (transversal, sagital and coronal) and though their DVHs.
Its interesting to explore the possibilities of performing RapidArc treatments in suitable
breast treatments, following literature procedures.
Patient specific QA is performed by comparing the 2D dose distribution map calculated
in a phantom that reproduces the dose deposition in the EPID produced by the irradiation
with the same patient field arrangement of the approved plan.

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2.2 XiO
This TPS has been commissioned in Santa Chiara Hospital for use with photon beams with
energy of 6 MV and 15 MV with wedges. In this department its widely used for breast and
palliative treatments, almost all of them with static fields, but there is also the option to use
IMRT in this TPS.

2.3 Oncentra
Similar to XiO, commissioned only for static fields with 6 MV and 15 MV. In my opinion
this TPS has better interface than XiO, its very simple, complete and easy to learn how
to use. Its not commissioned for electron beams although some measurements have been
made; the dosimetric information has to be managed and sent to the vendor to complete the
commissioning. In general this is a very interesting problem to be solved.

2.4 Oncentra for Brachytherapy

3D planing mainly for endocavitary treatments are performed, but also contact brachytherapy
for superficial tumors is performed.

2.5 DosimetryCheck
The Medical Physics department has the license to use Dosimetry Check which is a quality
control software that uses the x-ray radiation fields that are measured with the electronic
portal imaging devices (EPID) and provides a theoretical calculation of the dose and dose
distribution using the patient specific CT. Then this reconstructed dose is compared to the
plan dose from the TPS Eclipse.

3 Linear accelerator
The department has a Varian DHX linear accelerator, 6 and 15 MV equipped with an EPID
and a OBI to perform ConeBeamCT.

3.1 Daily QA
Daily QA consists in output measurements of: energy, CAX, symmetry, flatness for 6 and 15
MV, using the QuickCheck equipment. Also a set of images are acquired in Cine mode for
further analysis.

3.2 IORT
Its performed in a dedicated accelerator Novac7 in the Senologia building, with small size
(diameter 10 cm) electron beams of 3,5,7 and 9 MeV. This modality is used for irradiation
of breast cancer during the surgery. Interesting aspects of this technique are the dosimetry
considerations because of the very high dose rate beam and its radiobiology characterization.