Radiation Oncology

Batra Hospital was the first private healthcare setup to offer the radiation facility in Delhi way back in 1987. Our journey started with Cobalt machine which was very soon replaced by linear accelerator. Radiation oncology is a branch of medicine where technological innovations play a major role. Batra cancer centre has evolved from first private setup to one of the best private cancer setup with all modern facilities.

Radiation facilities

1. LINEAR ACCELERATOR (6 & 15 MV and Electron Beam)
A Siemens Mevatron dual energy Linear Accelerator, a versatile, technologically advanced machine is in operation in this department. On one hand it has highly penetrating PHOTON BEAMS to treat deep seated tumours while on the other hand, it is equipped with 6 energies of ELECTRONS (5, 7, 8, 10, 12, 14 MeV) to treat superficial tumours while protecting the underlying organs completely.

2. LINEAR ACCELERATOR (6 & 15 MV and Electron Beam)
The Varian Clinac 2100 C linear accelerator is state of the art medical accelerator in the world. This linear accelerator is having dual photon energies 6 X and 15 X, with five high electron energies 6,9,12,16 & 20 MeV. Clinac 2100 C is having dose rate variation which starts from 100 MU / minute to 400 MU / minute. This machine is equipped with 80 leaves MLC, which is able to shape the treating beam so that each and every type of tumor can be treated and at the same time dose to the normal organs can be avoided. It is having precise isocentre alignments of gantry, couch, collimator which gives stable and accurate positioning of patient in relation to tumor. All the above capabilities are combined with integrated multileaf collimation and electronic portal imaging system, which enable clinicians to perform the most advanced computer-driven intensity Modulated radiation therapy (IMRT) treatments as well as conventional radiation therapy techniques.

3. INTENSITY MODULATED RADIATION THERAPY (IMRT)
A recent technique which is used to deliver higher dose of radiation therapy with utmost accuracy to improve the cure rate of various forms of cancers. It is a computer controlled delivery of radiation therapy to maximize the radiation dose while keeping radiation dose to the normal organs with the tolerance level. It is available only in very few select centers across the country and is especially useful in the management of head & neck cancer and prostate cancer. We are using the dynamic MLC for IMRT which is one of the most sophisticated and accurate technique to treat tumors and spare all the critical structures surrounding the tumor thus enabling us to reduce the long term side effects of radiation. We are among the few centers who are well experienced to practice this technique. Batra hospital has many international publications with regard to intensity modulated radiotherapy (please refer to publication sections).

4. CT SIMULATOR:
Siemens SOMATOM Sensation Open is a third generation 20 slice CT simulator with a wider than usual gantry available in diagnostic CT's. The SOMATOM delivers superior image quality for planning. The goal of simulation is the localization of the tumor (3D perspective) where the sensitive structures are and to provide anatomy necessary for accurate dose computations.

Virtual Simulation of radiotherapy treatment planning replaces the real simulator with a virtual one, and uses the 3D CT data information of a patient, including the external patient's skin marks instead of a real patient body. The advances in computer graphics have stimulated the development of virtual simulator systems that allows clinician to make choices including the number of treatment beams used and their energy, orientation, shape.

5. ECLIPSE:
The Varian eclipse treatment planning system is a powerful computer system that combines advanced graphics with lightning fast dose calculations. The advantage of eclipse treatment planning is that it is completely integrated with other equipments. The system communicates with the IMPAC record and verify (RV) system and Varian Clinac 2100 C linear accelerator. It provides treatment planning capabilities for simple radiation treatment, for 3D-conformal radiation therapy (3DCRT) as well as for highly complex and most sophisticated technology like Intensity Modulated Radiotherapy using dynamic MLC's. In addition, the eclipse system is able to utilize and fuse either CT, MRI or PET scan data for accurate target delineation and precision radiotherapy. The eclipse system performs complicated calculations very fast such that a complex Intensity Modulated Radiotherapy treatment plans can be generated in as little as 20 minutes, compared to the 3 to 4 hours calculation time by the system previously used. The combination of the eclipse treatment planning and the Varian linear accelerator with 80-leaf multileaf collimation (MLC) results in one of the finest and most accurate treatment delivery systems available to patients anywhere in this area of the country.

6. BRACHYTHERAPY AND THE CONCEPT OF ORGAN PRESERVATION :
Latest generation Computer Controlled Remote After loading System HDR (MICROSELECTRON) is in operation in the department to provide state of art Brachytherapy facilities. It has a high dose rate delivery system and the treatment is completed in minutes. The hospital is equipped with full fledged facilities for Brachytherapy i.e. intracavitary, intraluminal and interstitial radiation. This technique, which involves insertion of radioactive sources into tumor tissue allows conservation of body parts such as breast, tongue, cheek affected by cancer and limbs affected by Sarcomas.

7. Quality Assurance & Dosimetry
The centre is equipped with a Scanditronix & wellhofer RFA. This is the versatile 2D radiation field analyzer for commissioning, acceptance, testing and regular Quality Assurance (QA) of Linacs. QA in any radiation department is the most crucial part in overall treatment of the patients especially when modern sophisticated techniques are used like IMRT. Our QA program got published in international journal (please refer to publications section).

8. Publications

1. At 26th National Conference of AROI November 2004 Ludhiana. Intensity modulated radiation therapy for head and neck cancer: Our experience in achieving dosimetric parameters. K. Chufal, S. Nangia, A. Tyagi, V. Arivazhagan, P. Srinivas, D. Ghosh

2. Nangia S, Chufal KS, Arivazhagan V, Srinivas P, Tyagi A, and Ghosh D. Compensator-based intensity-modulated radiotherapy in head and neck cancer: our experience in achieving dosimetric parameters and their clinical correlation. Clinical oncology (Royal College of Radiologists (Great Britain)) 18(6):485-92, 2006 Aug .

3. Intensity Modulated Radiotherapy Using Compensators for Head And Neck Cancer Patients: Impact of Dosimetric Parameters on Clinical Outcome International Journal of Radiation OncologyBiologyPhysics, Volume 66, Issue 3, Pages S453-S454. K. Chufal, S. Nangia, A. Tyagi, V. Arivazhagan, P. Srinivas, D. Ghosh.

4. CHUFAL KS , Nangia S Aggression and innovation rather than palliation. Radiother Oncol. 2008;89:123.

5. A Tyagi, S Nangia, K Chufal, M Mishra, D Ghosh, and MP Singh. Quality Assurance and Dosimetric Analysis of Intensity Modulated Radiotherapy Using Compensators for Head and Neck Cancers. Med. Phys. Volume 35, Issue 6, pp. 2763-2763 (June 2008).

6. NANGIA S , Chufal KS, Tyagi A, Bhatnagar A, et al. Selective Nodal Irradiation for Head and Neck Cancer Using Intensity-Modulated Radiotherapy: Application of RTOG Consensus Guidelines in Routine Clinical Practice. Int J Radiat Oncol Biol Phys. 2009.

For more details, please visit our site http://www.radiotherapy.in/mssd/