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Special techniques

Introduction

Computerized radiation treatment planning systems are generally generic in nature in that they are capable of handling multiple treatment techniques for both external beam therapy and brachytherapy. However, complex procedures have evolved that require the use of specialized, stand-alone treatment planning computers. In addition, there are various clinical procedures that also require special consideration. Examples include:  total body irradiation (TBI) with photons; stereotactic radiosurgery with a linac or Gamma Knife; tomotherapy; intraoperative radiation therapy; electron beam arc therapy; and total skin electron irradiation (TSEI).

Important Principles

If a generic treatment planning system is to be used for a special technique then a unique commissioning program must be employed. Special measurements are required and an evaluation of the capabilities and limitations of that technique must be performed. For example, a total body irradiation procedure should be evaluated under the extended distance treatment that is used clinically to generate the appropriate large-field radiation data. Similarly, small field dosimetry must be performed with appropriately sized radiation detectors and evaluated for stereotactic radiosurgery. For techniques requiring specialized computer systems, a unique acceptance, commissioning and QA process will be required.

Introduction to References

The IAEA Radiation Oncology Physics Handbook provides a summary of special procedures in radiation therapy. Several AAPM reports provide guidance on total and half body photon irradiation, total skin electron therapy, stereotactic radiosurgery and stereotactic body radiation therapy.