Real-Time RT Planning, Delivery in the Bronx

BRONX, New York—Montefiore Medical Center has opened a state-of-the-art Center for Radiation Therapy within walking distance of the Montefiore-Einstein Cancer Center. The new 15,000 square foot, two-story radiation therapy center is part of the burgeoning facilities located in the Morris Park campus, which services the approximately 1.25 million residents of the Bronx.

The radiation center is the first in New York to offer image-guided intensity modulated radiation therapy (IG-IMRT) via Varian Medical Systems' Trilogy system, which introduces a fourth dimension—time—into treatment planning and execution. The on-board imaging system incorporated into the Trilogy unit allows the radiologist to verify patient setup immediately prior to treatment. The system produces a three-dimensional (3D) movie loop of the tumor as it moves with the patient's breathing. Functional and metabolic information about tumor aggressiveness is integrated into images of tumor shape and size.

"For example," said Shalom Kalnicki, MD, chairman of the Department of Radiation Oncology at Montefiore, "the 3D motion of a lung tumor can be seen and analyzed in real time while the patient is breathing, allowing the radiation oncology team to produce a precise beam that closely follows the tumor's motion."

A respiratory gating system monitors respiratory motion during treatment delivery. "For cancers of organs that move with respiration, image-guided radiotherapy produces a beam that precisely follows tumor motion and sculpts highly focused radiation around it," he said.

At the core of the Trilogy system is a high-powered medical linear accelerator (see photo) that rotates around the patient to deliver radiation treatment from various angles and that incorporates a multileaf collimator to shape the radiation beam to match the 3D shape of the tumor.