Ateneo - UPO

The course provides TSRM (radiation therapy technologist) students with the theoretical and methodological knowledge of special techniques in external beam radiotherapy and of the systems used for treatment planning and plan verification, with particular focus on MR-guided adaptive radiotherapy. The following topics are covered:
1. The radiotherapy process and the treatment chain Phases of the patient pathway: simulation, contouring, planning, verification, delivery. The role of the radiation therapist in the different phases and integration within the multidisciplinary team.
2. Treatment Planning Systems (TPS) TPS architecture; imaging for treatment planning (simulation CT, MRI and PET co-registration); dose calculation algorithms (convolution/superposition, Monte Carlo); prescription, dose-volume constraints and plan evaluation through DVHs; record-and-verify systems and data flow within the department.
3. Intensity-modulated techniques Step-and-shoot and sliding-window IMRT; VMAT: principles, inverse planning, plan optimization.
4. Image-Guided Radiotherapy (IGRT) On-board imaging systems (EPID, CBCT, in-room imaging); positioning correction strategies; ICRU margins and volumes; organ motion management (4D-CT, respiratory gating, breath-hold, tracking).
5. Stereotactic radiotherapy Intracranial SRS and SBRT: technological requirements, dedicated immobilization systems, small-field dosimetry, geometric accuracy and treatment workflow.
6. Adaptive radiotherapy and the MR-Linac Rationale for offline and online adaptive radiotherapy; hybrid MR-accelerator systems: technological features, magnetic field effects on dose distribution; Adapt to Position and Adapt to Shape online adaptive workflows; intra-fraction MR imaging and patient management in the MR environment; the role of the radiation therapist in the adaptive workflow.
7. Plan verification and patient safety Principles of patient-specific quality assurance (measurements with detector arrays, independent dose calculation); pre-treatment checks; risk management and errors in the radiotherapy process

The teaching material consists of:
lecture slides;
texts and slides available on the IAEA website at http://www-naweb.iaea.org/nahu/DMRP/slides.html

1. Knowledge and understanding The student will acquire knowledge of the physical and technological principles of special techniques in radiotherapy (IMRT/VMAT, intracranial and body stereotactic radiotherapy, IGRT, online adaptive radiotherapy on MR-Linac) and of treatment planning systems (TPS), with particular reference to dose calculation algorithms, hybrid systems integrating magnetic resonance imaging with the linear accelerator, and tools for the dosimetric verification of treatment plans.2. Applying knowledge and understanding The student will be able to apply the acquired knowledge to the technical phases of the radiotherapy pathway: simulation, set-up and positioning verification through on-board imaging, operational management of adaptive workflows on the MR-Linac (Adapt to Position and Adapt to Shape), and support to treatment plan quality assurance procedures.3. Making judgements The student will be able to assess the consistency between the treatment plan and the anatomy of the day, recognize relevant positioning or anatomical deviations, and identify situations requiring the involvement of the radiation oncologist or the medical physicist, thus contributing to patient safety.4. Communication skills The student will be able to communicate clearly and effectively with the patient, fostering their cooperation during procedures, and to interact using appropriate technical language within the multidisciplinary team, properly documenting the activities performed.5. Learning skills The student will develop the ability to independently keep up to date with the technological evolution of the field, with particular attention to emerging radiotherapy techniques such as MR-guided online adaptive radiotherapy and innovative artificial intelligence-based applications integrated into clinical workflows, through the critical appraisal of guidelines and scientific literature.

Basic Knowledge of radiation physics

20 hours of face-to-face lectures

not available

Written examination with open-ended questions on the topics included in the course syllabus

1) Course introduction: Radiotherapy equipment.Operating principles of linear accelerators, interaction of radiation with matter and biological effects of radiation. Introduction to external beam radiotherapy with photons and electrons. Special equipment and an overview of hadron therapy.

2) Radiotherapy treatment planning:workflows, fundamentals of clinical dosimetry. Prescription, volume definition and reporting according to ICRU 83. 3D conformal radiotherapy. Forward planning in conformal radiotherapy, methods for dose distribution optimization, methods for treatment plan quality evaluation.

3) Intensity-modulated radiotherapy:clinical and dosimetric rationale, delivery modalities, quality assurance. IMRT/VMAT treatment planning: physical and biological cost functions for dose distribution optimization in inverse planning. Clinical examples, treatment plan quality evaluation. Dosimetric challenges of intensity-modulated treatments, metrics and methods for patient-specific quality assurance.

4) Intracranial stereotactic radiotherapy: clinical and dosimetric rationale, treatment modalities, applications. Stereotactic treatment planning, frame-based and frameless localization systems, workflow and quality assurance. Stereotactic body radiotherapy (SBRT): clinical and dosimetric rationale, treatment modalities, applications. Management of geometric uncertainties due to organ motion in SBRT, treatment verification systems and quality assurance.

5) Image-guided radiotherapy (IGRT):clinical and dosimetric rationale for the management of geometric uncertainties in radiotherapy treatment. 2D (EPID, kV), 3D (CBCT) and integrated-MR IGRT systems. Inter- and intra-fraction treatment verification: clinical workflow and examples. Overview of image-guided adaptive radiotherapy: offline and online workflows. Examples of MR-guided online adaptive radiotherapy with the MR-Linac.

The student will learn the physical and technological principles of special techniques in radiotherapy (IMRT/VMAT, intracranial and body stereotactic radiotherapy, IGRT, online adaptive radiotherapy on MR-Linac) and of treatment planning systems (TPS), with particular reference to dose calculation algorithms, hybrid systems integrating magnetic resonance imaging with the linear accelerator, and tools for the dosimetric verification of treatment plans.The student will be able to apply the acquired knowledge to the technical phases of the radiotherapy pathway: simulation, set-up and positioning verification through on-board imaging, operational management of adaptive workflows on the MR-Linac (Adapt to Position and Adapt to Shape), and support to treatment plan quality assurance procedures.