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Lower risk of unwanted radiation thanks to new linear accelerator
In addition to surgery and drug therapy, radiotherapy is the third pillar in the treatment of cancer. Careful planning, preparation and monitoring of patients are essential to ensure that the radiation hits the tumour accurately. Surrounding healthy tissue should be largely spared to keep the side effects as low as possible. The team at the Clinic for Radiotherapy and Special Oncology at the Hannover Medical School (MHH) is now using a new linear accelerator with an innovative positioning and monitoring system with surface scanners. ‘The new technology offers a range of advantages,’ explains clinic director Prof. Dr. Hans Christiansen. ’The smallest movements within the treatment region are detected in real time, and radiation, for example, is only released when the target is in exactly the right place.’
Patients always in view
The surface scanner is equipped with several cameras and enables continuous monitoring with an unrestricted view. The patient surface is permanently monitored and checked throughout the entire irradiation phase. This allows patients to be precisely positioned and their correct position to be monitored from the outside during irradiation. The surface scanner thus provides a position check without additional radiation exposure. ‘During the ongoing irradiation, fewer control images with X-rays are required to check the exact positioning, thus reducing the additional radiation load in healthy tissue,’ explains Prof. Dr. Bremer, senior physician at the clinic.
Optimised heart protection through respiratory gating
With the new device, breathing phases can be precisely monitored. This enables the MHH team to irradiate patients in a targeted manner in a specific breathing position. This is particularly relevant for young patients with left-sided breast cancer, in whom the heart is close to the chest wall due to their individual anatomy. The aim is to keep the heart out of the radiation field. This is to prevent radiation damage that may not occur until several decades after radiotherapy. During a deep inhalation phase, the chest wall and heart move further apart. This moment is used for irradiation. ‘We were already able to observe breathing phases with the previous linear accelerator. The patients received verbal instructions on how to breathe. This is no longer necessary because the patients can control the duration of the individual radiation sessions themselves. With the new technology, breath-controlled radiation (breath gating) is optimised and thus better guarantees that the heart is maximally distant from the chest wall during radiation,’ explains Dr Anne Caroline Knöchelmann, senior physician at the clinic.
With respiratory gating, radiation is only delivered when the breast is in a position that is achieved by maximum inhalation, known as a deep inspiration breath hold (DIBH). The patient uses a specific breathing hold technique to navigate a ball into a kind of basket on a screen. When the patient has reached the optimum breathing depth, the ball lands in the basket and the patient can be irradiated. When the patient breathes out and the organs move closer together again, the radiation automatically stops.
‘I feel safe and in good hands’
‘I feel safe and in good hands with the device. The monitor gives me visual feedback on my breathing. I can control the ball with my breathing and determine how long I have to hold my breath,’ says a patient who has used the procedure. ’This gives me a feeling of control over the entire duration of the individual radiation fractions. At the beginning, I had some concerns about radiotherapy. However, the staff provided me with good information, so I was able to build up trust,’ she adds. ’I play the trumpet and am therefore able to hold my breath for a relatively long time. For me, this form of therapy is therefore just right.’
Individualised treatment planning required
In the Hannover region, this system is so far only established at the Clinic for Radiotherapy and Special Oncology at the MHH. Selected patients are already benefiting from breath gating, but the technology also places certain demands on them. As part of the individualised treatment planning, the treating physicians carefully examine which form of therapy is best suited. In the future, the monitored breathing technique could also be used for patients with lung cancer. An interdisciplinary team of medical physics experts (MPEs), physicians and medical technologists for radiology (MTRs) is working on the use of the new linear accelerator every day. A second linear accelerator will be equipped with the new technology in the coming year.
SERVICE
For further information, please contact Professor Dr Hans Christiansen, strahlentherapie@mh-hannover.de.
With a patient at the new linear accelerator: Professor Dr. Hans Christiansen, Christina Balk, medic ...
Copyright: Karin Kaiser/MHH
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