Radiation Oncology relies on imaging to accurately stage cancer, localize the target area and plan treatment. Until recently conventional simulation could not accurately integrate the information available from diagnostic CT for treatment planning and simulation. The recent introduction of CT based simulation and planning allows a higher degree of accuracy in target localization and treatment planning.

The introduction of a CT simulator at TSRCC allowed us to re-evaluate our planning techniques. One of the techniques we evaluated was craniospinal fields irradiation. Planning craniospinal axis irradiation fields has conventionally been time-consuming, resource intensive, stressful for patients and staff and did not fully utilize the imaging technology available for localization of target and critical structures.

CT-simulation of this technique demonstrates many of the advantages of this technology. Field placement and junctioning directly on soft tissue MPRs is more accurate and individualized than using standard bony landmarks. Exit beam verification is fast and visual. Critical structures such as eyes and cribriform plate are clearly outlined in a beam’s eye view for shield placement. Furthermore, the time a patient must remain immobilized for CT data acquisition is typically less than 20 minutes, which is significantly shorter than the 60 to 90 minutes required for conventional simulation?

Recently trained health care professionals have come to expect the computer to be part of their ongoing education. The trend in education has been for visual-based learning tools to replace text-based teaching. Technical concepts can be clearly demonstrated using multi-media presentations. CT-simulation is a technology that is highly visual. For this exciting new technology, teaching with real-time demonstrations and graphical images is particularly effective.

At our Centre, a CD-ROM was produced describing our CT-simulation technique for craniospinal axis irradiation fields, which is compared to our previous conventional method. The goal of this project was to provide a detailed and informative tutorial for radiotherapy professionals. Graphical images, real-life video segments and computer animations (real-time screen captures) from the virtual simulation workstation are used in the CD. The program is structured into four major sections; a general introduction, a step-by-step description of conventional simulation, followed by the same for CT-simulation, and concluding with a comparison section. In the final section, the user can compare and contrast the impact of CT-simulation on the patient, the radiation therapists, the radiation oncologists, beam placement, junction determination, as well as on target and critical structure localization.

To augment the CD, we included the narration text in a cover booklet. The CD-ROM is used to teach residents at TSRCC and Radiation Technologists at the Mitchner Institute.

• Copies of the CD-ROM were distributed at the AcQsim users meeting and mailed to the head of medical physics and pediatric radiation oncologist in the Regional Cancer Centres in Ontario. An evaluation form was included with the CD.
• A total of 70 responses were obtained.
• Number of completed evaluation forms = 68
• Results of the responses to an evaluation questionnaire; Other Topics you would like to see in this format?
• 40/68 (59%) wanted all complicated techniques in that format
• Suggested topics: Prostate implant (6), Breast technique (4), Three or four breast fields (10), Mantle (3), Head & Neck (3), Stereotactic Radiosurgery (2), 3D Conformal RT (1), IMRT, Esophagus, Lung Cancer, Asymmetric jaw half field, MRI fusion for CNS, Volume definition for nodal irradiation

• The CD-ROM format was well received.
• There was a high level of satisfaction.
• Majority would recommend it to others.
• High demand for similar educational CD-ROM.

• Importance of a good storyboard.
• Selection of appropriate multimedia to illustrate difficult concepts.
• Value of pre-testing before the final production.

BENEFIT TO PARTICIPANTS ATTENDING SESSION:

• Compares conventional and CT based technique
• Demonstrates that new technology improves treatment technique and is more accurate
• Evaluation of the CD by users demonstrated its effectiveness as a teaching resource and a need for similar educational CD ROMS for complex procedures.

Dr C. Danjoux MD FRCPC
Toronto Sunnybrook Regional Cancer Centre
2075 Bayview Ave
Toronto M4N 3M5
Ontario. Canada
Phone: 416 480 4998
Fax: 416 480 6002
Email: cyril.danjoux@tsrcc.on.ca

CO-AUTHORS:
Katherine Mah, Sharan Manship, Marlene Cardoso, Nadiya Makhani, and Katharina Sixel
Toronto Sunnybrook Regional Cancer Centre 2075 Bayview Ave
Toronto M4N 3M5
Ontario. Canada