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'''The TomoTherapy platform''' is a helical radiation therapy delivery system that integrates a linear accelerator and CT technology.<ref>{{Cite journal |last=Welsh |first=James S. |last2=Patel |first2=Rakesh R. |last3=Ritter |first3=Mark A. |last4=Harari |first4=Paul M. |last5=Mackie |first5=T. Rockwell |last6=Mehta |first6=Minesh P. |date=2002-08-20 |title=Helical Tomotherapy: An Innovative Technology and Approach to Radiation Therapy |url=http://journals.sagepub.com/doi/10.1177/153303460200100413 |journal=Technology in Cancer Research & Treatment |language=en |volume=1 |issue=4 |pages=311–316 |doi=10.1177/153303460200100413 |issn=1533-0346}}</ref> It delivers accurate high-quality helical fan-beam image-guided, intensity-modulated radiation therapy (IG-IMRT) from multiple 360-degree rotations around the patient as the treatment table moves.<ref name=":0">{{Cite journal |last=Mackie |first=T. Rockwell |last2=Balog |first2=John |last3=Ruchala |first3=Ken |last4=Shepard |first4=Dave |last5=Aldridge |first5=Stacy |last6=Fitchard |first6=Ed |last7=Reckwerdt |first7=Paul |last8=Olivera |first8=Gustavo |last9=McNutt |first9=Todd |last10=Mehta |first10=Minesh |date=1999-01-01 |title=Tomotherapy |url=https://linkinghub.elsevier.com/retrieve/pii/S1053429699800587 |journal=Seminars in Radiation Oncology |language=en |volume=9 |issue=1 |pages=108–117 |doi=10.1016/S1053-4296(99)80058-7}}</ref> It enables accurate control of the radiation dose so it conforms precisely to the tumor and minimizes dose to healthy tissues.<ref>{{Cite journal |last=Chitapanarux |first=Imjai |last2=Nobnop |first2=Wannapha |last3=Tippanya |first3=Damrongsak |last4=Sripan |first4=Patumrat |last5=Chakrabandhu |first5=Somvilai |last6=Klunklin |first6=Pitchayaponne |last7=Onchan |first7=Wimrak |last8=Jia-Mahasap |first8=Bongkot |last9=Tharavichitkul |first9=Ekkasit |date=2019-01-31 |editor-last=Hutson |editor-first=Alan D. |title=Clinical outcomes and dosimetric study of hypofractionated Helical TomoTherapy in breast cancer patients |url=https://dx.plos.org/10.1371/journal.pone.0211578 |journal=PLOS ONE |language=en |volume=14 |issue=1 |pages=e0211578 |doi=10.1371/journal.pone.0211578 |issn=1932-6203}}</ref> The TomoTherapy platform is designed to deliver image-guided 3D conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and stereotactic radiosurgery (SRS).<ref>{{Cite journal |last=Engels |first=Benedikt |last2=De Ridder |first2=Mark |last3=Tournel |first3=Koen |last4=Sermeus |first4=Alexandra |last5=De Coninck |first5=Peter |last6=Verellen |first6=Dirk |last7=Storme |first7=Guy A. |date=2009-08-01 |title=Preoperative Helical Tomotherapy and Megavoltage Computed Tomography for Rectal Cancer: Impact on the Irradiated Volume of Small Bowel |url=https://linkinghub.elsevier.com/retrieve/pii/S0360301608036493 |journal=International Journal of Radiation Oncology*Biology*Physics |language=en |volume=74 |issue=5 |pages=1476–1480 |doi=10.1016/j.ijrobp.2008.10.017}}</ref><ref>{{Cite journal |last=De Bari |first=Berardino |last2=Lestrade |first2=Laëtitia |last3=Franzetti-Pellanda |first3=Alessandra |last4=Jumeau |first4=Raphael |last5=Biggiogero |first5=Maira |last6=Kountouri |first6=Melpomeni |last7=Matzinger |first7=Oscar |last8=Miralbell |first8=Raymond |last9=Bourhis |first9=Jean |last10=Ozsahin |first10=Mahmut |last11=Zilli |first11=Thomas |date=2018-04-01 |title=Modern intensity-modulated radiotherapy with image guidance allows low toxicity rates and good local control in chemoradiotherapy for anal cancer patients |url=http://link.springer.com/10.1007/s00432-018-2608-6 |journal=Journal of Cancer Research and Clinical Oncology |language=en |volume=144 |issue=4 |pages=781–789 |doi=10.1007/s00432-018-2608-6 |issn=0171-5216}}</ref><ref>{{Cite journal |last=Parisi |first=E. |last2=Romeo |first2=A. |last3=Sarnelli |first3=A. |last4=Ghigi |first4=G. |last5=Bellia |first5=S.R. |last6=Neri |first6=E. |last7=Micheletti |first7=S. |last8=Dipalma |first8=B. |last9=Arpa |first9=D. |last10=Furini |first10=G. |last11=Burgio |first11=M.A. |last12=Genestreti |first12=G. |last13=Gurioli |first13=C. |last14=Sanna |first14=S. |last15=Bovolato |first15=P. |date=2017-12-01 |title=High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment |url=https://linkinghub.elsevier.com/retrieve/pii/S1278321817303827 |journal=Cancer/Radiothérapie |language=en |volume=21 |issue=8 |pages=766–773 |doi=10.1016/j.canrad.2017.05.007}}</ref><ref>{{Cite journal |last=Saw |first=Cheng B. |last2=Gillette |first2=Carol |last3=Peters |first3=Christopher A. |last4=Koutcher |first4=Lawrence |date=2018-03-23 |title=Clinical implementation of radiosurgery using the Helical TomoTherapy unit |url=https://linkinghub.elsevier.com/retrieve/pii/S0958394717301152 |journal=Medical Dosimetry |language=en |volume=43 |issue=3 |pages=284–290 |doi=10.1016/j.meddos.2017.10.004}}</ref>
'''Tomotherapy''' is a [[radiation therapy]] modality,<ref name=handbook2007/><ref name=practice2012/><ref name=innovative2006/> in which the patient is scanned across a [[Radiation therapy#Intensity-modulated radiation therapy .28IMRT.29|modulated]] strip-beam, so that only one “slice” (Greek prefix “tomo-”) of the target is exposed at any one time by the [[linear accelerator]] (linac) beam. The three components distinctive to this modality are: (1) a [[collimator]] pair that defines the length of the strip, (2) a binary [[multileaf collimator]] whose leaves open and close during treatment to modulate the strip's intensity, and (3) a couch that scans the patient across the beam at a fixed speed during the treatment delivery.

The three main principles of this modality are: (1) integrated daily CT imaging into the treatment process,<ref name=":1">{{Cite journal |last=Sheng |first=Ke |last2=Chow |first2=Jennifer |last3=Hunter |first3=Grant |last4=Larner |first4=James |last5=Read |first5=Paul |date=2008-12-01 |title=Is daily computed tomography image guidance necessary for nasal cavity and nasopharyngeal radiotherapy? An investigation based on helical tomotherapy |url=http://doi.wiley.com/10.1120/jacmp.v9i1.2686 |journal=Journal of Applied Clinical Medical Physics |language=en |volume=9 |issue=1 |pages=36–46 |doi=10.1120/jacmp.v9i1.2686}}</ref> (2), continuous delivery of radiation from multiple 360-degree rotations around the patient delivering thousands of precise beams with a binary multi-leaf collimator (MLC) enabling the ability of dose painting to maximize the dose to the target and minimize dose to organs at risk (OARs)<ref name=":0" /> (3) advanced dose-delivery capabilities enabling the delivery of image-guided intensity modulated radiation therapy.<ref name=":1" />

The TomoTherapy platform is capable of delivering radiation therapy helically also known as TomoHelical<sup>TM</sup> and at fixed-angles also known as TomoDirect<sup>TM</sup>.<ref>{{Cite journal |last=Dicuonzo |first=Samantha |last2=Patti |first2=Filippo |last3=Luraschi |first3=Rosa |last4=Frassoni |first4=Samuele |last5=Rojas |first5=Damaris Patricia |last6=Zaffaroni |first6=Mattia |last7=Morra |first7=Anna |last8=Gerardi |first8=Marianna Alessandra |last9=Zerella |first9=Maria Alessia |last10=Emiro |first10=Francesca |last11=Cattani |first11=Federica |last12=Bagnardi |first12=Vincenzo |last13=Fodor |first13=Cristiana Iuliana |last14=Veronesi |first14=Paolo |last15=Galimberti |first15=Viviana Enrica |date=2021-10-01 |title=Comparing TomoHelical and TomoDirect in postmastectomy hypofractionated radiotherapy after immediate breast reconstruction |url=https://linkinghub.elsevier.com/retrieve/pii/S1120179721003069 |journal=Physica Medica |language=en |volume=90 |pages=66–72 |doi=10.1016/j.ejmp.2021.09.007}}</ref> TomoHelical has the advantage of treating very long volumes without a need to abut fields in the longitudinal direction.<ref>{{Cite journal |last=Haraldsson |first=André |last2=Engellau |first2=Jacob |last3=Lenhoff |first3=Stig |last4=Engelholm |first4=Silke |last5=Bäck |first5=Sven |last6=Engström |first6=Per E. |date=2019-04 |title=Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy – A practical guide |url=https://linkinghub.elsevier.com/retrieve/pii/S1120179719300766 |journal=Physica Medica |language=en |volume=60 |pages=162–167 |doi=10.1016/j.ejmp.2019.03.032}}</ref> TomoDirect uses multiple static beams, each delivered from a separate fixed gantry angle, in which only the couch moves during beam delivery.<ref>{{Cite journal |last=Franco |first=Pierfrancesco |last2=Catuzzo |first2=Paola |last3=Cante |first3=Domenico |last4=La Porta |first4=Maria Rosa |last5=Sciacero |first5=Piera |last6=Girelli |first6=Giuseppe |last7=Borca |first7=Valeria Casanova |last8=Pasquino |first8=Massimo |last9=Numico |first9=Gianmauro |last10=Tofani |first10=Santi |last11=Meloni |first11=Teodoro |last12=Ricardi |first12=Umberto |last13=Ozzello |first13=Franca |date=2011-07 |title=TomoDirect: An efficient means to deliver radiation at static angles with tomotherapy |url=http://journals.sagepub.com/doi/10.1177/030089161109700414 |journal=Tumori Journal |language=en |volume=97 |issue=4 |pages=498–502 |doi=10.1177/030089161109700414 |issn=0300-8916}}</ref>


==General principles==
==General principles==


The TomoTherapy platform represented a significant advance in the radiation oncology field, specifically designed for integrated daily image-guidance with IMRT to help patients control their cancer.<ref>{{Cite journal |last=Welsh |first=James S. |date=2008-12 |title=Helical Tomotherapy: A Fascinating Technological Concept that has Matured into Clinical Reality |url=http://journals.sagepub.com/doi/10.1177/153303460800700601 |journal=Technology in Cancer Research & Treatment |language=en |volume=7 |issue=6 |pages=415–416 |doi=10.1177/153303460800700601 |issn=1533-0346}}</ref> First generations of the machine delivered megavoltage CT (MVCT) but the Radixact Treatment Delivery System, the latest-generation platform, expands the range of 3DCRT, IMRT, SBRT and SRS treatments with helical fan-beam kilovoltage CT (kVCT) also known as ClearRT™ imaging technology.<ref>{{Cite journal |last=Fusella |first=Marco |last2=Cavinato |first2=Samuele |last3=Germani |first3=Alessandra |last4=Paiusco |first4=Marta |last5=Pivato |first5=Nicola |last6=Rossato |first6=Marco Andrea |last7=Scott |first7=Anthony |last8=Scaggion |first8=Alessandro |date=2021-12 |title=Analysis of clinical patient-specific pre-treatment quality assurance with the new helical tomotherapy platform, following the AAPM TG-218 report |url=https://ro-journal.biomedcentral.com/articles/10.1186/s13014-021-01952-w |journal=Radiation Oncology |language=en |volume=16 |issue=1 |pages=226 |doi=10.1186/s13014-021-01952-w |issn=1748-717X}}</ref>
The treatment field's length is selectable. In static-jaw delivery, the field length remains constant during a treatment. In dynamic-jaw delivery, the field length changes so that it begins and ends at its minimum setting.


[[File:Tomotherapy nci-vol-4478-300.jpg|right|thumb|Patient undergoing tomotherapy, face and body covered, to prevent movement]]
[[File:Tomotherapy nci-vol-4478-300.jpg|right|thumb|Patient undergoing tomotherapy, face and body covered, to prevent movement]]


== The Radixact System ==
TomoTherapy treatment times vary compared to normal [[radiation therapy]] treatment times (tomotherapy treatment times can be as low as 6.5 minutes for common prostate treatment<ref name=ref09/>) but do add an additional 2&ndash;3 minutes for a daily CT. The daily CT is used to precisely place the radiation beam and allows the operator to modify the treatment should the patient's anatomy change due to weight loss or tumor shrinkage ([[image-guided radiation therapy]]).
The Radixact System provides a non-invasive option for the treatment of a wide range of cancerous and non-cancerous tumors throughout the body. The system can be used in combination with surgery, chemotherapy, and other medications.<ref>{{Cite journal |last=Masuda |first=Sakue |last2=Tsukiyama |first2=Toshitaka |last3=Minagawa |first3=Yumiko |last4=Koizumi |first4=Kazuya |last5=Kako |first5=Makoto |last6=Kinbara |first6=Takeshi |last7=Haruki |first7=Uojima |date=2022-03-16 |title=Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system: Two case reports and review of literature |url=https://www.wjgnet.com/2307-8960/full/v10/i8/2591.htm |journal=World Journal of Clinical Cases |volume=10 |issue=8 |pages=2591–2603 |doi=10.12998/wjcc.v10.i8.2591 |issn=2307-8960}}</ref><ref>{{Cite journal |last=Chen |first=Guang-Pei |last2=Tai |first2=An |last3=Puckett |first3=Lindsay |last4=Gore |first4=Elizabeth |last5=Lim |first5=Sara |last6=Keiper |first6=Timothy |last7=Johnstone |first7=Candice |last8=Shukla |first8=Monica |last9=Lawton |first9=Colleen |last10=Li |first10=X. Allen |date=2021-09 |title=Clinical Implementation and Initial Experience of Real-Time Motion Tracking With Jaws and Multileaf Collimator During Helical Tomotherapy Delivery |url=https://linkinghub.elsevier.com/retrieve/pii/S1879850021000473 |journal=Practical Radiation Oncology |language=en |volume=11 |issue=5 |pages=e486–e495 |doi=10.1016/j.prro.2021.01.010}}</ref>

There are few head-to-head comparisons of tomotherapy and other IMRT techniques, however there is some evidence that [[Radiation therapy#Volumetric modulated arc therapy (VMAT)|VMAT]] can provide faster treatment while tomotherapy is better able to spare surrounding healthy tissue while delivering a uniform dose.<ref name=vmat/><ref name=rao/><ref name=oliver/>

=== Helical delivery ===

In helical tomotherapy, the linac rotates on its gantry at a constant speed while the beam is delivered; so that from the patient's perspective, the shape traced out by the linac is helical.

While helical tomotherapy can treat very long volumes without a need to abut fields in the longitudinal direction, it does display a distinct artifact due to "thread effect"<ref name=thread2005/> when treating non-central tumors. Thread effect can be suppressed during planning through good pitch selection.

=== Fixed-angle delivery ===

Fixed-angle tomotherapy uses multiple tomotherapy beams, each delivered from a separate fixed gantry angle, in which only the couch moves during beam delivery. This is branded as TomoDirect, but has also been called topotherapy.<ref name=evaluation2006/>

The technology enables fixed beam treatments by moving the patient through the machine bore while maintaining specified beam angles.

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==Clinical considerations==

[[Lung cancer]], head and neck [[tumor]]s, [[breast cancer]], [[prostate cancer]], stereotactic [[radiosurgery]] (SRS) and [[stereotactic]] body radiotherapy (SBRT) are some examples of treatments commonly performed using tomotherapy.<ref name="srs1996"/><ref name=practical/><ref name=knife/>


=== ClearRT Helical Fan-beam kVCT Imaging ===
In general, radiation therapy (or radiotherapy) has developed with a strong reliance on homogeneity of dose throughout the tumor. Tomotherapy embodies the sequential delivery of radiation to different parts of the tumor which raises two important issues. First, this method is known as "field matching" and brings with it the possibility of a less-than-perfect match between two adjacent fields with a resultant hot and/or cold spot within the tumor. The second issue is that if the patient or tumor moves during this sequential delivery, then again, a hot or cold spot will result. The first problem is reduced by use of a helical motion, as in [[spiral computed tomography]].<ref name=tomohist/>
ClearRT imaging technology is used with the Radixact System to generate clear, high-fidelity images helping to improve the clarity of the tumor and surrounding healthy tissues to deliver a treatment plan with more confidence and precision.<ref>{{Cite web |title=First Patient Treatments on Radixact System with ClearRT Imaging |url=https://appliedradiationoncology.com/articles/first-patient-treatments-on-radixact-system-with-clearrt-imaging |access-date=2023-01-24 |website=appliedradiationoncology.com |language=en-us}}</ref> Improved image quality facilitates precise dose delivery that will enable medical care teams to make more informed decisions about all aspects of the patient’s treatment and improve the quality of care for almost any patient who would benefit from radiation therapy.<ref>{{Cite journal |last=Yang |first=Bin |last2=Geng |first2=Hui |last3=Chang |first3=Tien Yee Amy |last4=Tse |first4=Mei Yan |last5=Lam |first5=Wai Wang |last6=Huang |first6=Chen-Yu |last7=Wu |first7=Tungho |last8=Lau |first8=Ka Ki |last9=Cheung |first9=Kin Yin |last10=Chiu |first10=George |last11=Yu |first11=Siu Ki |date=2022-09 |title=Clinical implementation of kVCT-guided tomotherapy with ClearRT |url=https://link.springer.com/10.1007/s13246-022-01162-y |journal=Physical and Engineering Sciences in Medicine |language=en |volume=45 |issue=3 |pages=915–924 |doi=10.1007/s13246-022-01162-y |issn=2662-4729}}</ref>


=== Synchrony Technology ===
Some research has suggested tomotherapy provides more conformal treatment plans and decreased acute toxicity.<ref name=rectal/>
The Radixact System has the option of a real-time motion synchronization and adaption technology called Synchrony.<ref>{{Cite journal |last=Goddard |first=Lee |last2=Jeong |first2=Kyoungkeun |last3=Tomé |first3=Wolfgang A. |date=2022-02 |title=Commissioning and routine quality assurance of the Radixact Synchrony system |url=https://onlinelibrary.wiley.com/doi/10.1002/mp.15410 |journal=Medical Physics |language=en |volume=49 |issue=2 |pages=1181–1195 |doi=10.1002/mp.15410 |issn=0094-2405}}</ref> Synchrony technology is a collection of unique hardware and software technologies that enables personalized real-time adaptive delivery of radiation treatment to targets while they are in motion by synchronizing the treatment delivery beam position to the target location precisely and accurately during the delivery of a treatment fraction. If movement occurs during treatment as a result of internal or external body changes the delivery is adapted for that unique change in real-time.<ref>{{Cite journal |last=Ferris |first=William S. |last2=Kissick |first2=Michael W. |last3=Bayouth |first3=John E. |last4=Culberson |first4=Wesley S. |last5=Smilowitz |first5=Jennifer B. |date=2020-09 |title=Evaluation of radixact motion synchrony for 3D respiratory motion: Modeling accuracy and dosimetric fidelity |url=https://onlinelibrary.wiley.com/doi/10.1002/acm2.12978 |journal=Journal of Applied Clinical Medical Physics |language=en |volume=21 |issue=9 |pages=96–106 |doi=10.1002/acm2.12978 |issn=1526-9914 |pmc=PMC7497925 |pmid=32691973}}</ref>


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== History ==
Non-helical static beam techniques such as IMRT and TomoDirect are well suited to whole breast radiation therapy. These treatment modes avoid the low-dose integral [[wikt:splay|splay]] and long treatment times associated with helical approaches by confining dose delivery to [[tangential]] angles.<ref name=squires/><ref name=goddu/><ref name=Stovall08/>
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The TomoTherapy technique was developed in the early 1990s at the University of Wisconsin–Madison by Professor Thomas Rockwell Mackie and Paul Reckwerdt.<ref>{{Cite journal |last=Holmes |first=Timothy W. |last2=Hudes |first2=Richard |last3=Dziuba |first3=Sylwester |last4=Kazi |first4=Abdul |last5=Hall |first5=Mark |last6=Dawson |first6=Dana |date=2008-06-01 |title=Stereotactic Image-Guided Intensity Modulated Radiotherapy Using the HI-ART II Helical Tomotherapy System |url=https://www.meddos.org/article/S0958-3947(08)00041-1/abstract |journal=Medical Dosimetry |language=English |volume=33 |issue=2 |pages=135–148 |doi=10.1016/j.meddos.2008.02.006 |issn=0958-3947}}</ref> A small megavoltage X-ray source was mounted in a similar fashion to a CT X-ray source, and the geometry provided the opportunity to provide CT images of the body in the treatment setup position. Although original plans were to include kilovoltage CT imaging, early models use megavoltage energies. With this combination, the unit was one of the first devices capable of providing modern image-guided radiation therapy (IGRT).<ref>{{Cite journal |last=Mackie |first=T R |date=2006-07-07 |title=History of tomotherapy |url=https://iopscience.iop.org/article/10.1088/0031-9155/51/13/R24 |journal=Physics in Medicine and Biology |volume=51 |issue=13 |pages=R427–R453 |doi=10.1088/0031-9155/51/13/R24 |issn=0031-9155}}</ref>


The first implementation of IMRT was the Corvus system developed by Nomos Corporation, with the first patient treated in April 1994.<ref>{{Cite journal |last=Mackie |first=T. Rockwell |last2=Balog |first2=John |last3=Ruchala |first3=Ken |last4=Shepard |first4=Dave |last5=Aldridge |first5=Stacy |last6=Fitchard |first6=Ed |last7=Reckwerdt |first7=Paul |last8=Olivera |first8=Gustavo |last9=McNutt |first9=Todd |last10=Mehta |first10=Minesh |date=1999-01-01 |title=Tomotherapy |url=https://www.sciencedirect.com/science/article/pii/S1053429699800587 |journal=Seminars in Radiation Oncology |series=Radiation Therapy Treatment Optimization |language=en |volume=9 |issue=1 |pages=108–117 |doi=10.1016/S1053-4296(99)80058-7 |issn=1053-4296}}</ref><ref>{{Cite journal |last=Woo |first=Shiao Y. |last2=Grant |first2=Walter H. |last3=Bellezza |first3=David |last4=Grossman |first4=Robert |last5=Gildenberg |first5=Philip |last6=Carpenter |first6=L. Steven |last7=Carol |first7=Mark |last8=Butler |first8=E. Brian |date=1996-06-01 |title=A comparison of intensity modulated conformal therapy with a conventional external beam stereotactic radiosurgery system for the treatment of single and multiple intracranial lesions |url=https://www.redjournal.org/article/S0360-3016(96)80023-X/abstract |journal=International Journal of Radiation Oncology, Biology, Physics |language=English |volume=35 |issue=3 |pages=593–597 |doi=10.1016/S0360-3016(96)80023-X |issn=0360-3016 |pmid=8655384}}</ref> This was the first commercial system for planning and delivering intensity modulated radiation therapy (IMRT). The original system, designed solely for use in the brain, incorporated a rigid skull-based fixation system to prevent patient motion between the delivery of each slice of radiation. But some users<ref>{{Cite journal |last=Squires |first=Matthew |last2=Hu |first2=Yunfei |last3=Byrne |first3=Mikel |last4=Archibald-Heeren |first4=Ben |last5=Cheers |first5=Sonja |last6=Bosco |first6=Bruno |last7=Teh |first7=Amy |last8=Fong |first8=Andrew |date=2017-12 |title=Static beam tomotherapy as an optimisation method in whole-breast radiation therapy (WBRT) |url=https://onlinelibrary.wiley.com/doi/10.1002/jmrs.232 |journal=Journal of Medical Radiation Sciences |language=en |volume=64 |issue=4 |pages=281–289 |doi=10.1002/jmrs.232 |pmc=PMC5715293 |pmid=28580762}}</ref> eschewed the fixation system and applied the technique to tumors in many different parts of the body.
This risk is accentuated in younger patients with early-stage breast cancer, where cure rates are high and life expectancy is substantial.<ref name=Stovall08/>


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At this time, the systems manufactured by Accuray (previously TomoTherapy Incorporated) are the primary TomoTherapy devices in use.
Static beam angle approaches aim to maximize the [[therapeutic ratio]] by ensuring that the tumor control probability (TCP) significantly outweighs the associated normal tissue complication probability (NTCP).<ref name=francocatuzzo/><ref name=francoricardi>{{Better source needed|reason=Removed previous source from predatory publisher|date=October 2021}}</ref><ref name=murai/>


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== Clinical Application ==
⚫
==History==
⚫
The tomotherapy technique was developed in the early 1990s at the [[University of Wisconsin–Madison]] by Professor [[Thomas Rockwell Mackie]] and Paul Reckwerdt.<ref name=hiart2008/> A small megavoltage x-ray source was mounted in a similar fashion to a CT x-ray source, and the geometry provided the opportunity to provide CT images of the body in the treatment setup position. Although original plans were to include kilovoltage CT imaging, current models use megavoltage energies. With this combination, the unit was one of the first devices capable of providing modern image-guided radiation therapy (IGRT).<ref name=tomohist/>


Radiation therapy is a treatment option for many types of tumors throughout the body.<ref>{{Cite book |title=Walter and Miller's Textbook of Radiotherapy: Radiation Physics, Therapy and Oncology |publisher=Churchill Livingstone |year=2002 |edition=Bomford, C.K., Kunkler, I.H. |location=6th (sixth) Revised |language=en}}</ref> Precise and accurate delivery of radiation to the tumor is key to killing cancerous cells while minimizing dose to healthy tissues. Accurate and precise delivery helps minimize irradiation of the healthy tissues surrounding tumors and potentially reduces the risk of side effects, which may lead to better quality of life for the patient both during and after treatment.<ref>{{Cite journal |last=Welsh |first=James S. |last2=Lock |first2=Michael |last3=Harari |first3=Paul M. |last4=Tomé |first4=Wolfgang A. |last5=Fowler |first5=Jack |last6=Mackie |first6=Thomas Rockwell |last7=Ritter |first7=Mark |last8=Kapatoes |first8=Jeff |last9=Forrest |first9=Lisa |last10=Chappell |first10=Richard |last11=Paliwal |first11=Bhudatt |last12=Mehta |first12=Minesh P. |date=2006-10 |title=Clinical Implementation of Adaptive Helical Tomotherapy: A Unique Approach to Image-Guided Intensity Modulated Radiotherapy |url=http://journals.sagepub.com/doi/10.1177/153303460600500503 |journal=Technology in Cancer Research & Treatment |language=en |volume=5 |issue=5 |pages=465–479 |doi=10.1177/153303460600500503 |issn=1533-0346}}</ref>
The first implementation of tomotherapy was the Corvus system developed by Nomos Corporation, with the first patient treated in April 1994.<ref name=seminars1999/><ref name=srs1996/> This was the first commercial system for planning and delivering intensity modulated radiation therapy (IMRT). The original system, designed solely for use in the brain, incorporated a rigid skull-based fixation system to prevent patient motion between the delivery of each slice of radiation. But some users <ref name=static2017/> eschewed the fixation system and applied the technique to tumors in many different parts of the body.


Helical delivery allows precise irradiation to complex volumes and long volumes without the use of junctions, which is particularly useful in cerebral spinal irradiation, total body irradiation and total marrow irradiation.<ref>{{Cite journal |last=Lee |first=Joongyo |last2=Kim |first2=Euidam |last3=Kim |first3=Nalee |last4=Byun |first4=Hwa Kyung |last5=Suh |first5=Chang-Ok |last6=Chung |first6=Yoonsun |last7=Yoon |first7=Hong In |date=2021-03-17 |title=Practical aspects of the application of helical tomotherapy for craniospinal irradiation |url=https://www.nature.com/articles/s41598-021-85574-y |journal=Scientific Reports |language=en |volume=11 |issue=1 |pages=6120 |doi=10.1038/s41598-021-85574-y |issn=2045-2322}}</ref><ref>{{Cite journal |last=Paix |first=Adrien |last2=Antoni |first2=Delphine |last3=Waissi |first3=Waisse |last4=Ledoux |first4=Marie-Pierre |last5=Bilger |first5=Karin |last6=Fornecker |first6=Luc |last7=Noel |first7=Georges |date=2018-03 |title=Total body irradiation in allogeneic bone marrow transplantation conditioning regimens: A review |url=https://linkinghub.elsevier.com/retrieve/pii/S1040842817303268 |journal=Critical Reviews in Oncology/Hematology |language=en |volume=123 |pages=138–148 |doi=10.1016/j.critrevonc.2018.01.011}}</ref><ref>{{Cite journal |last=Haraldsson |first=André |last2=Engellau |first2=Jacob |last3=Lenhoff |first3=Stig |last4=Engelholm |first4=Silke |last5=Bäck |first5=Sven |last6=Engström |first6=Per E. |date=2019-04 |title=Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy – A practical guide |url=https://linkinghub.elsevier.com/retrieve/pii/S1120179719300766 |journal=Physica Medica |language=en |volume=60 |pages=162–167 |doi=10.1016/j.ejmp.2019.03.032}}</ref> Fixed-angle techniques such as TomoDirect are well suited to whole breast radiation therapy<ref>{{Cite journal |last=Lee |first=Hyo Chun |last2=Kim |first2=Sung Hwan |last3=Suh |first3=Young Jin |last4=Chung |first4=Mi Joo |last5=Kang |first5=Dae Gyu |last6=Choi |first6=Hyun Joo |last7=Lee |first7=Jong Hoon |date=2014-12 |title=A prospective cohort study on postoperative radiotherapy with TomoDirect using simultaneous integrated boost technique in early breast cancer |url=https://ro-journal.biomedcentral.com/articles/10.1186/s13014-014-0244-0 |journal=Radiation Oncology |language=en |volume=9 |issue=1 |pages=244 |doi=10.1186/s13014-014-0244-0 |issn=1748-717X}}</ref>. This treatment mode confines dose delivery to [[tangential]] angles, minimizing dose to healthy tissues. Synchrony technology enables more precise treatments in the use of high-dose [[radiosurgery]] (SRS) and [[Stereotactic radiation therapy|stereotactic body radiotherapy (SBRT)]].<ref>{{Cite journal |last=Chen |first=Yi-Xing |last2=Zhuang |first2=Yuan |last3=Yang |first3=Ping |last4=Fan |first4=Jia |last5=Zhou |first5=Jian |last6=Hu |first6=Yong |last7=Zhu |first7=Wen-Chao |last8=Sun |first8=Jing |last9=Zeng |first9=Zhao-Chong |date=2020-01-01 |title=Helical IMRT-Based Stereotactic Body Radiation Therapy Using an Abdominal Compression Technique and Modified Fractionation Regimen for Small Hepatocellular Carcinoma |url=http://journals.sagepub.com/doi/10.1177/1533033820937002 |journal=Technology in Cancer Research & Treatment |language=en |volume=19 |pages=153303382093700 |doi=10.1177/1533033820937002 |issn=1533-0346}}</ref><ref>{{Cite journal |last=Barra |first=Salvina |last2=Agostinelli |first2=Stefano |last3=Vagge |first3=Stefano |last4=Giannelli |first4=Flavio |last5=Siccardi |first5=Desiderio |last6=Garelli |first6=Stefania |last7=Aloi |first7=Deborah |last8=Belgioia |first8=Liliana |last9=Bosetti |first9=Davide |last10=Zeverino |first10=Michele |last11=Corvò |first11=Renzo |date=2015-12 |title=Radiosurgery with Helical Tomotherapy: Outcomes for Patients with One or Multifocal Brain Metastasis |url=http://journals.sagepub.com/doi/10.7785/tcrt.2012.500427 |journal=Technology in Cancer Research & Treatment |language=en |volume=14 |issue=6 |pages=693–699 |doi=10.7785/tcrt.2012.500427 |issn=1533-0346}}</ref>
⚫
At this time, the systems manufactured by Accuray (previously TomoTherapy Inc.) are the primary tomotherapy devices in use.


In general, radiation therapy (or radiotherapy) has developed with a strong reliance on homogeneous dose throughout the tumor.<ref>{{Cite journal |last=Sun |first=Wenzhao |last2=Zhang |first2=Jun |last3=Wang |first3=Yixuan |last4=Chen |first4=Meining |last5=Wang |first5=Jianli |last6=Chen |first6=Li |last7=Lu |first7=Lixia |last8=Deng |first8=Xiaowu |date=2022-01 |title=Comparison of Absolute Dose Achievable Between Helical Tomotherapy and RapidArc in Total Dura Mater Irradiation for Child Cancer |url=http://journals.sagepub.com/doi/10.1177/15330338211072680 |journal=Technology in Cancer Research & Treatment |language=en |volume=21 |pages=153303382110726 |doi=10.1177/15330338211072680 |issn=1533-0346}}</ref> The TomoTherapy platform enables sequential delivery of radiation to different parts of the tumor, negating the use of field matching in long treatment volumes and reducing hot and/or cold spots within the tumor.<ref>{{Cite journal |last=Gruen |first=Arne |last2=Ebell |first2=Wolfram |last3=Wlodarczyk |first3=Waldemar |last4=Neumann |first4=Oliver |last5=Kuehl |first5=Joern Sven |last6=Stromberger |first6=Carmen |last7=Budach |first7=Volker |last8=Marnitz |first8=Simone |date=2013-12 |title=Total Body Irradiation (TBI) using Helical Tomotherapy in children and young adults undergoing stem cell transplantation |url=https://ro-journal.biomedcentral.com/articles/10.1186/1748-717X-8-92 |journal=Radiation Oncology |language=en |volume=8 |issue=1 |pages=92 |doi=10.1186/1748-717X-8-92 |issn=1748-717X}}</ref> It is an advanced treatment platform that conforms dose tightly to the tumor whilst minimizing dose to healthy tissues.<ref>{{Cite journal |last=Figlia |first=Vanessa |last2=Mazzola |first2=Rosario |last3=Cuccia |first3=Francesco |last4=Alongi |first4=Filippo |last5=Mortellaro |first5=Gianluca |last6=Cespuglio |first6=Daniela |last7=Cucchiara |first7=Teresa |last8=Iacoviello |first8=Giuseppina |last9=Valenti |first9=Vito |last10=Molino |first10=Massimo |last11=Verderame |first11=Francesco |last12=Matranga |first12=Domenica |last13=Casto |first13=Antonio Lo |last14=Ferrera |first14=Giuseppe |date=2018-06 |title=Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience |url=http://link.springer.com/10.1007/s11547-018-0858-7 |journal=La radiologia medica |language=en |volume=123 |issue=6 |pages=406–414 |doi=10.1007/s11547-018-0858-7 |issn=0033-8362}}</ref>
===Mobile tomotherapy===
Due to their internal shielding and small footprint, TomoTherapy Hi-Art and TomoTherapy TomoHD treatment machines were the only high energy radiotherapy treatment machines used in relocatable radiotherapy treatment suites. Two different types of suites were available: TomoMobile developed by TomoTherapy Inc. which was a moveable truck; and Pioneer, developed by UK-based Oncology Systems Limited. The latter was developed to meet the requirements of UK and European transport law requirements and was a contained unit placed on a concrete pad, delivering radiotherapy treatments in less than five weeks.<ref name=ontheroad/><ref name=relocatable/>


==See also==
==See also==

Revision as of 11:47, 24 January 2023

Tomotherapy
Tomotherapy Hi Art machine
Other namesHelical tomotherapy
Specialtyoncology

The TomoTherapy platform is a helical radiation therapy delivery system that integrates a linear accelerator and CT technology.[1] It delivers accurate high-quality helical fan-beam image-guided, intensity-modulated radiation therapy (IG-IMRT) from multiple 360-degree rotations around the patient as the treatment table moves.[2] It enables accurate control of the radiation dose so it conforms precisely to the tumor and minimizes dose to healthy tissues.[3] The TomoTherapy platform is designed to deliver image-guided 3D conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and stereotactic radiosurgery (SRS).[4][5][6][7]

The three main principles of this modality are: (1) integrated daily CT imaging into the treatment process,[8] (2), continuous delivery of radiation from multiple 360-degree rotations around the patient delivering thousands of precise beams with a binary multi-leaf collimator (MLC) enabling the ability of dose painting to maximize the dose to the target and minimize dose to organs at risk (OARs)[2] (3) advanced dose-delivery capabilities enabling the delivery of image-guided intensity modulated radiation therapy.[8]

The TomoTherapy platform is capable of delivering radiation therapy helically also known as TomoHelicalTM and at fixed-angles also known as TomoDirectTM.[9] TomoHelical has the advantage of treating very long volumes without a need to abut fields in the longitudinal direction.[10] TomoDirect uses multiple static beams, each delivered from a separate fixed gantry angle, in which only the couch moves during beam delivery.[11]

General principles

The TomoTherapy platform represented a significant advance in the radiation oncology field, specifically designed for integrated daily image-guidance with IMRT to help patients control their cancer.[12] First generations of the machine delivered megavoltage CT (MVCT) but the Radixact Treatment Delivery System, the latest-generation platform, expands the range of 3DCRT, IMRT, SBRT and SRS treatments with helical fan-beam kilovoltage CT (kVCT) also known as ClearRT™ imaging technology.[13]

Patient undergoing tomotherapy, face and body covered, to prevent movement

The Radixact System

The Radixact System provides a non-invasive option for the treatment of a wide range of cancerous and non-cancerous tumors throughout the body. The system can be used in combination with surgery, chemotherapy, and other medications.[14][15]

ClearRT Helical Fan-beam kVCT Imaging

ClearRT imaging technology is used with the Radixact System to generate clear, high-fidelity images helping to improve the clarity of the tumor and surrounding healthy tissues to deliver a treatment plan with more confidence and precision.[16] Improved image quality facilitates precise dose delivery that will enable medical care teams to make more informed decisions about all aspects of the patient’s treatment and improve the quality of care for almost any patient who would benefit from radiation therapy.[17]

Synchrony Technology

The Radixact System has the option of a real-time motion synchronization and adaption technology called Synchrony.[18] Synchrony technology is a collection of unique hardware and software technologies that enables personalized real-time adaptive delivery of radiation treatment to targets while they are in motion by synchronizing the treatment delivery beam position to the target location precisely and accurately during the delivery of a treatment fraction. If movement occurs during treatment as a result of internal or external body changes the delivery is adapted for that unique change in real-time.[19]

History

The TomoTherapy technique was developed in the early 1990s at the University of Wisconsin–Madison by Professor Thomas Rockwell Mackie and Paul Reckwerdt.[20] A small megavoltage X-ray source was mounted in a similar fashion to a CT X-ray source, and the geometry provided the opportunity to provide CT images of the body in the treatment setup position. Although original plans were to include kilovoltage CT imaging, early models use megavoltage energies. With this combination, the unit was one of the first devices capable of providing modern image-guided radiation therapy (IGRT).[21]

The first implementation of IMRT was the Corvus system developed by Nomos Corporation, with the first patient treated in April 1994.[22][23] This was the first commercial system for planning and delivering intensity modulated radiation therapy (IMRT). The original system, designed solely for use in the brain, incorporated a rigid skull-based fixation system to prevent patient motion between the delivery of each slice of radiation. But some users[24] eschewed the fixation system and applied the technique to tumors in many different parts of the body.

At this time, the systems manufactured by Accuray (previously TomoTherapy Incorporated) are the primary TomoTherapy devices in use.

Clinical Application

Radiation therapy is a treatment option for many types of tumors throughout the body.[25] Precise and accurate delivery of radiation to the tumor is key to killing cancerous cells while minimizing dose to healthy tissues. Accurate and precise delivery helps minimize irradiation of the healthy tissues surrounding tumors and potentially reduces the risk of side effects, which may lead to better quality of life for the patient both during and after treatment.[26]

Helical delivery allows precise irradiation to complex volumes and long volumes without the use of junctions, which is particularly useful in cerebral spinal irradiation, total body irradiation and total marrow irradiation.[27][28][29] Fixed-angle techniques such as TomoDirect are well suited to whole breast radiation therapy[30]. This treatment mode confines dose delivery to tangential angles, minimizing dose to healthy tissues. Synchrony technology enables more precise treatments in the use of high-dose radiosurgery (SRS) and stereotactic body radiotherapy (SBRT).[31][32]

In general, radiation therapy (or radiotherapy) has developed with a strong reliance on homogeneous dose throughout the tumor.[33] The TomoTherapy platform enables sequential delivery of radiation to different parts of the tumor, negating the use of field matching in long treatment volumes and reducing hot and/or cold spots within the tumor.[34] It is an advanced treatment platform that conforms dose tightly to the tumor whilst minimizing dose to healthy tissues.[35]

See also

References

  1. ^ Welsh, James S.; Patel, Rakesh R.; Ritter, Mark A.; Harari, Paul M.; Mackie, T. Rockwell; Mehta, Minesh P. (2002-08-20). "Helical Tomotherapy: An Innovative Technology and Approach to Radiation Therapy". Technology in Cancer Research & Treatment. 1 (4): 311–316. doi:10.1177/153303460200100413. ISSN 1533-0346.
  2. ^ a b Mackie, T. Rockwell; Balog, John; Ruchala, Ken; Shepard, Dave; Aldridge, Stacy; Fitchard, Ed; Reckwerdt, Paul; Olivera, Gustavo; McNutt, Todd; Mehta, Minesh (1999-01-01). "Tomotherapy". Seminars in Radiation Oncology. 9 (1): 108–117. doi:10.1016/S1053-4296(99)80058-7.
  3. ^ Chitapanarux, Imjai; Nobnop, Wannapha; Tippanya, Damrongsak; Sripan, Patumrat; Chakrabandhu, Somvilai; Klunklin, Pitchayaponne; Onchan, Wimrak; Jia-Mahasap, Bongkot; Tharavichitkul, Ekkasit (2019-01-31). Hutson, Alan D. (ed.). "Clinical outcomes and dosimetric study of hypofractionated Helical TomoTherapy in breast cancer patients". PLOS ONE. 14 (1): e0211578. doi:10.1371/journal.pone.0211578. ISSN 1932-6203.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  4. ^ Engels, Benedikt; De Ridder, Mark; Tournel, Koen; Sermeus, Alexandra; De Coninck, Peter; Verellen, Dirk; Storme, Guy A. (2009-08-01). "Preoperative Helical Tomotherapy and Megavoltage Computed Tomography for Rectal Cancer: Impact on the Irradiated Volume of Small Bowel". International Journal of Radiation Oncology*Biology*Physics. 74 (5): 1476–1480. doi:10.1016/j.ijrobp.2008.10.017.
  5. ^ De Bari, Berardino; Lestrade, Laëtitia; Franzetti-Pellanda, Alessandra; Jumeau, Raphael; Biggiogero, Maira; Kountouri, Melpomeni; Matzinger, Oscar; Miralbell, Raymond; Bourhis, Jean; Ozsahin, Mahmut; Zilli, Thomas (2018-04-01). "Modern intensity-modulated radiotherapy with image guidance allows low toxicity rates and good local control in chemoradiotherapy for anal cancer patients". Journal of Cancer Research and Clinical Oncology. 144 (4): 781–789. doi:10.1007/s00432-018-2608-6. ISSN 0171-5216.
  6. ^ Parisi, E.; Romeo, A.; Sarnelli, A.; Ghigi, G.; Bellia, S.R.; Neri, E.; Micheletti, S.; Dipalma, B.; Arpa, D.; Furini, G.; Burgio, M.A.; Genestreti, G.; Gurioli, C.; Sanna, S.; Bovolato, P. (2017-12-01). "High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment". Cancer/Radiothérapie. 21 (8): 766–773. doi:10.1016/j.canrad.2017.05.007.
  7. ^ Saw, Cheng B.; Gillette, Carol; Peters, Christopher A.; Koutcher, Lawrence (2018-03-23). "Clinical implementation of radiosurgery using the Helical TomoTherapy unit". Medical Dosimetry. 43 (3): 284–290. doi:10.1016/j.meddos.2017.10.004.
  8. ^ a b Sheng, Ke; Chow, Jennifer; Hunter, Grant; Larner, James; Read, Paul (2008-12-01). "Is daily computed tomography image guidance necessary for nasal cavity and nasopharyngeal radiotherapy? An investigation based on helical tomotherapy". Journal of Applied Clinical Medical Physics. 9 (1): 36–46. doi:10.1120/jacmp.v9i1.2686.
  9. ^ Dicuonzo, Samantha; Patti, Filippo; Luraschi, Rosa; Frassoni, Samuele; Rojas, Damaris Patricia; Zaffaroni, Mattia; Morra, Anna; Gerardi, Marianna Alessandra; Zerella, Maria Alessia; Emiro, Francesca; Cattani, Federica; Bagnardi, Vincenzo; Fodor, Cristiana Iuliana; Veronesi, Paolo; Galimberti, Viviana Enrica (2021-10-01). "Comparing TomoHelical and TomoDirect in postmastectomy hypofractionated radiotherapy after immediate breast reconstruction". Physica Medica. 90: 66–72. doi:10.1016/j.ejmp.2021.09.007.
  10. ^ Haraldsson, André; Engellau, Jacob; Lenhoff, Stig; Engelholm, Silke; Bäck, Sven; Engström, Per E. (2019-04). "Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy – A practical guide". Physica Medica. 60: 162–167. doi:10.1016/j.ejmp.2019.03.032. {{cite journal}}: Check date values in: |date= (help)
  11. ^ Franco, Pierfrancesco; Catuzzo, Paola; Cante, Domenico; La Porta, Maria Rosa; Sciacero, Piera; Girelli, Giuseppe; Borca, Valeria Casanova; Pasquino, Massimo; Numico, Gianmauro; Tofani, Santi; Meloni, Teodoro; Ricardi, Umberto; Ozzello, Franca (2011-07). "TomoDirect: An efficient means to deliver radiation at static angles with tomotherapy". Tumori Journal. 97 (4): 498–502. doi:10.1177/030089161109700414. ISSN 0300-8916. {{cite journal}}: Check date values in: |date= (help)
  12. ^ Welsh, James S. (2008-12). "Helical Tomotherapy: A Fascinating Technological Concept that has Matured into Clinical Reality". Technology in Cancer Research & Treatment. 7 (6): 415–416. doi:10.1177/153303460800700601. ISSN 1533-0346. {{cite journal}}: Check date values in: |date= (help)
  13. ^ Fusella, Marco; Cavinato, Samuele; Germani, Alessandra; Paiusco, Marta; Pivato, Nicola; Rossato, Marco Andrea; Scott, Anthony; Scaggion, Alessandro (2021-12). "Analysis of clinical patient-specific pre-treatment quality assurance with the new helical tomotherapy platform, following the AAPM TG-218 report". Radiation Oncology. 16 (1): 226. doi:10.1186/s13014-021-01952-w. ISSN 1748-717X. {{cite journal}}: Check date values in: |date= (help)CS1 maint: unflagged free DOI (link)
  14. ^ Masuda, Sakue; Tsukiyama, Toshitaka; Minagawa, Yumiko; Koizumi, Kazuya; Kako, Makoto; Kinbara, Takeshi; Haruki, Uojima (2022-03-16). "Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system: Two case reports and review of literature". World Journal of Clinical Cases. 10 (8): 2591–2603. doi:10.12998/wjcc.v10.i8.2591. ISSN 2307-8960.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  15. ^ Chen, Guang-Pei; Tai, An; Puckett, Lindsay; Gore, Elizabeth; Lim, Sara; Keiper, Timothy; Johnstone, Candice; Shukla, Monica; Lawton, Colleen; Li, X. Allen (2021-09). "Clinical Implementation and Initial Experience of Real-Time Motion Tracking With Jaws and Multileaf Collimator During Helical Tomotherapy Delivery". Practical Radiation Oncology. 11 (5): e486–e495. doi:10.1016/j.prro.2021.01.010. {{cite journal}}: Check date values in: |date= (help)
  16. ^ "First Patient Treatments on Radixact System with ClearRT Imaging". appliedradiationoncology.com. Retrieved 2023-01-24.
  17. ^ Yang, Bin; Geng, Hui; Chang, Tien Yee Amy; Tse, Mei Yan; Lam, Wai Wang; Huang, Chen-Yu; Wu, Tungho; Lau, Ka Ki; Cheung, Kin Yin; Chiu, George; Yu, Siu Ki (2022-09). "Clinical implementation of kVCT-guided tomotherapy with ClearRT". Physical and Engineering Sciences in Medicine. 45 (3): 915–924. doi:10.1007/s13246-022-01162-y. ISSN 2662-4729. {{cite journal}}: Check date values in: |date= (help)
  18. ^ Goddard, Lee; Jeong, Kyoungkeun; Tomé, Wolfgang A. (2022-02). "Commissioning and routine quality assurance of the Radixact Synchrony system". Medical Physics. 49 (2): 1181–1195. doi:10.1002/mp.15410. ISSN 0094-2405. {{cite journal}}: Check date values in: |date= (help)
  19. ^ Ferris, William S.; Kissick, Michael W.; Bayouth, John E.; Culberson, Wesley S.; Smilowitz, Jennifer B. (2020-09). "Evaluation of radixact motion synchrony for 3D respiratory motion: Modeling accuracy and dosimetric fidelity". Journal of Applied Clinical Medical Physics. 21 (9): 96–106. doi:10.1002/acm2.12978. ISSN 1526-9914. PMC 7497925. PMID 32691973. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  20. ^ Holmes, Timothy W.; Hudes, Richard; Dziuba, Sylwester; Kazi, Abdul; Hall, Mark; Dawson, Dana (2008-06-01). "Stereotactic Image-Guided Intensity Modulated Radiotherapy Using the HI-ART II Helical Tomotherapy System". Medical Dosimetry. 33 (2): 135–148. doi:10.1016/j.meddos.2008.02.006. ISSN 0958-3947.
  21. ^ Mackie, T R (2006-07-07). "History of tomotherapy". Physics in Medicine and Biology. 51 (13): R427–R453. doi:10.1088/0031-9155/51/13/R24. ISSN 0031-9155.
  22. ^ Mackie, T. Rockwell; Balog, John; Ruchala, Ken; Shepard, Dave; Aldridge, Stacy; Fitchard, Ed; Reckwerdt, Paul; Olivera, Gustavo; McNutt, Todd; Mehta, Minesh (1999-01-01). "Tomotherapy". Seminars in Radiation Oncology. Radiation Therapy Treatment Optimization. 9 (1): 108–117. doi:10.1016/S1053-4296(99)80058-7. ISSN 1053-4296.
  23. ^ Woo, Shiao Y.; Grant, Walter H.; Bellezza, David; Grossman, Robert; Gildenberg, Philip; Carpenter, L. Steven; Carol, Mark; Butler, E. Brian (1996-06-01). "A comparison of intensity modulated conformal therapy with a conventional external beam stereotactic radiosurgery system for the treatment of single and multiple intracranial lesions". International Journal of Radiation Oncology, Biology, Physics. 35 (3): 593–597. doi:10.1016/S0360-3016(96)80023-X. ISSN 0360-3016. PMID 8655384.
  24. ^ Squires, Matthew; Hu, Yunfei; Byrne, Mikel; Archibald-Heeren, Ben; Cheers, Sonja; Bosco, Bruno; Teh, Amy; Fong, Andrew (2017-12). "Static beam tomotherapy as an optimisation method in whole-breast radiation therapy (WBRT)". Journal of Medical Radiation Sciences. 64 (4): 281–289. doi:10.1002/jmrs.232. PMC 5715293. PMID 28580762. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  25. ^ Walter and Miller's Textbook of Radiotherapy: Radiation Physics, Therapy and Oncology (Bomford, C.K., Kunkler, I.H. ed.). 6th (sixth) Revised: Churchill Livingstone. 2002.{{cite book}}: CS1 maint: location (link)
  26. ^ Welsh, James S.; Lock, Michael; Harari, Paul M.; Tomé, Wolfgang A.; Fowler, Jack; Mackie, Thomas Rockwell; Ritter, Mark; Kapatoes, Jeff; Forrest, Lisa; Chappell, Richard; Paliwal, Bhudatt; Mehta, Minesh P. (2006-10). "Clinical Implementation of Adaptive Helical Tomotherapy: A Unique Approach to Image-Guided Intensity Modulated Radiotherapy". Technology in Cancer Research & Treatment. 5 (5): 465–479. doi:10.1177/153303460600500503. ISSN 1533-0346. {{cite journal}}: Check date values in: |date= (help)
  27. ^ Lee, Joongyo; Kim, Euidam; Kim, Nalee; Byun, Hwa Kyung; Suh, Chang-Ok; Chung, Yoonsun; Yoon, Hong In (2021-03-17). "Practical aspects of the application of helical tomotherapy for craniospinal irradiation". Scientific Reports. 11 (1): 6120. doi:10.1038/s41598-021-85574-y. ISSN 2045-2322.
  28. ^ Paix, Adrien; Antoni, Delphine; Waissi, Waisse; Ledoux, Marie-Pierre; Bilger, Karin; Fornecker, Luc; Noel, Georges (2018-03). "Total body irradiation in allogeneic bone marrow transplantation conditioning regimens: A review". Critical Reviews in Oncology/Hematology. 123: 138–148. doi:10.1016/j.critrevonc.2018.01.011. {{cite journal}}: Check date values in: |date= (help)
  29. ^ Haraldsson, André; Engellau, Jacob; Lenhoff, Stig; Engelholm, Silke; Bäck, Sven; Engström, Per E. (2019-04). "Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy – A practical guide". Physica Medica. 60: 162–167. doi:10.1016/j.ejmp.2019.03.032. {{cite journal}}: Check date values in: |date= (help)
  30. ^ Lee, Hyo Chun; Kim, Sung Hwan; Suh, Young Jin; Chung, Mi Joo; Kang, Dae Gyu; Choi, Hyun Joo; Lee, Jong Hoon (2014-12). "A prospective cohort study on postoperative radiotherapy with TomoDirect using simultaneous integrated boost technique in early breast cancer". Radiation Oncology. 9 (1): 244. doi:10.1186/s13014-014-0244-0. ISSN 1748-717X. {{cite journal}}: Check date values in: |date= (help)CS1 maint: unflagged free DOI (link)
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  33. ^ Sun, Wenzhao; Zhang, Jun; Wang, Yixuan; Chen, Meining; Wang, Jianli; Chen, Li; Lu, Lixia; Deng, Xiaowu (2022-01). "Comparison of Absolute Dose Achievable Between Helical Tomotherapy and RapidArc in Total Dura Mater Irradiation for Child Cancer". Technology in Cancer Research & Treatment. 21: 153303382110726. doi:10.1177/15330338211072680. ISSN 1533-0346. {{cite journal}}: Check date values in: |date= (help)
  34. ^ Gruen, Arne; Ebell, Wolfram; Wlodarczyk, Waldemar; Neumann, Oliver; Kuehl, Joern Sven; Stromberger, Carmen; Budach, Volker; Marnitz, Simone (2013-12). "Total Body Irradiation (TBI) using Helical Tomotherapy in children and young adults undergoing stem cell transplantation". Radiation Oncology. 8 (1): 92. doi:10.1186/1748-717X-8-92. ISSN 1748-717X. {{cite journal}}: Check date values in: |date= (help)CS1 maint: unflagged free DOI (link)
  35. ^ Figlia, Vanessa; Mazzola, Rosario; Cuccia, Francesco; Alongi, Filippo; Mortellaro, Gianluca; Cespuglio, Daniela; Cucchiara, Teresa; Iacoviello, Giuseppina; Valenti, Vito; Molino, Massimo; Verderame, Francesco; Matranga, Domenica; Casto, Antonio Lo; Ferrera, Giuseppe (2018-06). "Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience". La radiologia medica. 123 (6): 406–414. doi:10.1007/s11547-018-0858-7. ISSN 0033-8362. {{cite journal}}: Check date values in: |date= (help)

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External links

Scholia has a profile for Tomotherapy (Q174387).
Retrieved from "https://en.wikipedia.org/w/index.php?title=Tomotherapy&oldid=1135394059"