Methods and Techniques in Radiotherapy I

Base Knowledge

Knowledge acquired in the curricular units of Medical Image an Radiotherapy Technology, Radiobiology and Equipment and instrumentation in Medical Imaging and Radiotherapy

Teaching Methodologies

This is a Curricular Unit (CU) central to the training of future graduates, in which content will be taught on the techniques of external radiotherapy and brachytherapy treatment available in a radiotherapy service.

The teaching methodologies described above, in theoretical terms, aim to introduce new core subjects of the Degree and consolidate contents taught in previous CUs. The use of the expository-active method calls for the use of multimedia contents as an aid to the exhibition. The participation of students will be encouraged in order to understand the content taught.

The theoretical-practical aspect will appeal to the reasoning elaborated in relation to the contents of the UC, in this sense it will appeal to the simulation in class of clinical problems/examples aimed at raising technical-professional awareness in Medical Imaging and Radiotherapy. Practical integration of simulated environments for clinical reasoning and humanization with feedback.

Use of simulation software, virtual reality, or augmented reality, with funding from the INNOV2CARE program.

Learning Results

The student must acquire knowledge about:

– Types of treatment

– Techniques of External Radiotherapy and Brachytherapy, used for treatments with Ionizing Radiation, allowing for their understanding and identification.

The student must acquire skills to:

– Recognize treatment techniques regarding their therapeutic indication

– Identify, choose and build adequate positioning and immobilization means for each situation, taking into account the patient’s technique, pathology and physical condition. Know the radiation sources used in each technique and their main applications and areas of action.

The student must acquire skills to:

– Use, apply and reproduce treatment techniques and protocols

– Use the appropriate positioning and immobilization means

– Use treatment verification systems

– Apply the concepts of radioprotection to the patient and the professional

Program

Evolution of Radiotherapy and Fundamental Concepts

Modalities of Radiotherapy: EXTERNAL and BQRT

External Radiotherapy Techniques:

– 3D-3DCRT Conformal

– Intensity Modulated Radiotherapy (IMRT)/VMAT

– Image-Guided – IGRT


– Stereotactic Cranial RT – SRS

– Stereotactic Body RT – SBRT


– Adaptive Radiotherapy

– Surface-Guided Radiotherapy (SGRT)

 

Brachytherapy
 HDR, LDR, interstitial, intracavitary and endoluminal

Special therapies with protons, Cyberknife, Tomotherapy, GammaKnife, MRlinac

Intraoperative Radiotherapy


Control of internal organ mobility (gating, active breathing control, diaphragm compression and tracking system)


 

Humanisation of Radiotherapy Care

Understanding the fragility, anxiety and physical/psychological needs of cancer patients

Communication and empathy strategies during positioning and treatment.

The centrality of the human being in radiotherapy practice.

 

Sustainability in Radiotherapy

Energy consumption in complex equipment (accelerators, tomographs, MRI-Linac).

Practices to reduce waste and energy consumption.

Sustainable management of radioactive materials and waste.

Digital simulation and innovative technologies

 

Theoretical/Practical Classes:


1. Planning CT (Lasers, tattoos, positioning accessories, immobilisations and acquisition protocols by pathology/anatomical location)


2. Use of simulation software (Innov2Care).

3. Linear accelerators (imaging modalities for verification: EPID and Portal imaging; CBCT; Imaging protocols: Online/offline matching)

4. Irradiation techniques (3DCRT and IMRT/VMAT)

5. After loading in BQT

6. SBRT with abdominal compression

7. Tomotherapy unit; MRI Linac

8. Gammaknife and Cyberknife units

9. Follow-up consultations and side effects (toxicities)

10 – Artificial Intelligence in Radiotherapy: automatic contouring, adaptive planning and positioning verification.

 

Curricular Unit Teachers

Maria João Taborda Serrano Gomes da Cunha Cura Mariano

Internship(s)

NAO

Bibliography

Secondary Bibliographie:

Boustani, Grapin, Laurent, Apetoh und Mirjolet. (2019). Das 6. R der Radiobiologie: Reaktivierung der Anti-Tumor-Immunantwort. Cancers, 11(6), 860. https://doi.org/10.3390/cancers11060860

Europäische Kommission. Veröffentlichungen zum Strahlenschutz (EURATOM)

Generaldirektion Gesundheit. Normen für Strahlenschutz und Sicherheit in der Strahlentherapie

Heinzerling, J. H., Hampton, C. J., Robinson, M., Bright, M., Moeller, B. J., Ruiz, J., Prabhu, R., Burri, S. H., & Foster, R. D. (2020). Einsatz der oberflächengeführten Strahlentherapie in Kombination mit IGRT zur Überwachung der Positionierung und der Bewegungen während der Behandlung bei der stereotaktischen Körperstrahlentherapie von Lunge und Bauchraum. Journal of Applied Clinical Medical Physics, 21(5), 48–55. https://doi.org/10.1002/acm2.12852

Internationale Atomenergie-Organisation (IAEO). (o. J.). Strahlentherapie. Human Health Campus. Abgerufen am 26. Juli 2023 von https://humanhealth.iaea.org/HHW/MedicalPhysics/Radiotherapy/

Lahmi, L., Mamzer, M.-F., Burgun, A., Durdux, C., & Bibault, J.-E. (2022). Ethische Aspekte der künstlichen Intelligenz in der Radioonkologie. Seminare in Radioonkologie, 32(4), 442–448. https://doi.org/10.1016/j.semradonc.2022.06.013

Leech, M., Coffey, M., Mast, M., Moura, F., Osztavics, A., Pasini, D. und Vaandering, A. (2017). ESTRO ACROP-Richtlinien für die Positionierung, Immobilisierung und Positionsüberprüfung von Kopf- und Halspatienten für Strahlentherapeuten. Technische Innovationen und Patientenunterstützung in der Radioonkologie, 1, 1–7. https://doi.org/10.1016/j.tipsro.2016.12.001

Mast, M., & Perryck, S. (2022). Einführung in: Oberflächengeführte Strahlentherapie (SGRT). Technische Innovationen und Patientenunterstützung in der Radioonkologie, 22, 37–38. https://doi.org/10.1016/j.tipsro.2022.04.004

Moore, K., Agur, A. M. R., & Dalley, A. F. (2024). Anatomia Orientada para a Clínica (N. GUANABARA, Ed.; 9a). NOVA GUANABARA.

Perez & Brady’s Principles and Practice of Radiation Oncology (Perez und Bradys Prinzipien und Praxis der Strahlentherapie) 7. Auflage (2018)

Khan, FM (2020). The Physics of Radiation Therapy. 6. Auflage, Lippincott Williams & Wilkins.

 

Zhao, W., Shen, L., Islam, M. T., Qin, W., Zhang, Z., Liang, X., Zhang, G., Xu, S., & Li, X. (2021). Künstliche Intelligenz in der bildgesteuerten Strahlentherapie: eine Übersicht über die Lokalisierung von Behandlungszielen. Quantitative Bildgebung in Medizin und Chirurgie, 11(12), 4881–4894. https://doi.org/10.21037/qims-21-199