Cancer Hospital In India
DEPARTMENT OF RADIATION ONCOLOGY

It is one of the largest radiation oncology departments in Asia with 6 Linear accelerators, High Dose rate Brachytherapy Unit, CT-Simulator and Digital Conventional Simulator etc. We are the first in this part of India to introduce Radiation Treatment through Linear Accelerators.

The department was started in the year 2000 with scientific support and consultation from New York Presbyterian Hospital-Weill Cornell Medical College, New York, USA under the supervision of renowned radiation oncologist Dr. Nori Dattatreyudu, Professor and Chair, Department of Radiation Oncology, New York Presbyterian Hospital and Professor and Chairman, Radiation Oncology & Director of the Cancer Center New York Hospital Queens.

The Department is managed by a dedicated and professionally competent team of Radiation Oncologists, Medical Physicists and Radiotherapy Technologists and Nursing Staff rendering Radiation therapy to 450-500 cancer patients everyday.

BIACH & RI as pioneer in Radiation therapy

  • Only center in India to have five Linear Accelerators with 4 capable of delivering IMRT (Intensity Modulated Radiotherapy).
  • Only center in India to have both RPM & ABC (Active Breath Coordinator) facilities for SBRT.
  • Started Cone beam CT based IGRT first time in India.
  • IGRT (Image Guided Radiotherapy) using Breath control system started first time at in India.
  • Philips big bore CT is first of its kind in India with 16 slices and 85 cm bore size.
  • First Stereotactic Body Radiotherapy (SBRT) for lung using ABC system in India.
  • Only Institute in India to have Lantis, ARIA and Mosaiq networks with 3 independent servers and one RT network.
  • First in India to use AIO (All In One) immobilization system for conformal therapy.
  • Two modern linear accelerators capable of doing IGRT/SBRT.
  • 5 modern 3D and 2 modern 4D planning systems for conformal radiotherapy.

Modern Radiotherapy simulation & imaging equipments

  • Discovery PET-CT(GE) for PET based Radiotherapy planning
  • Brilliance Big bore CT (Philips) dedicated to Radiotherapy
  • Acuity simulator for conventional RT planning (Varian Medical)
  • (GE) for MRI based Radiotherapy planning

Modern Radiotherapy treatment equipments

  • Novalis Tx linear accelerator (Varian Medical Systems)
  • Synergy linear accelerator (Elekta Medical)
  • Synergy platform linear accelerator (Elekta Medical)
  • Compact linear accelerator (Elekta Medical)
  • Varisource ix HDR Brachytherapy unit (Varian)

Radiation Therapy Services

  • Volumetric Modulated Arc Therapy (VMAT) using Rapid arc technology
  • Intensity Modulated Stereotactic Radio surgery (IM-SRS) / Stereotactic radio surgery (SRS)
  • Respiratory gated radiotherapy (RGRT) using RPM & ABC
  • Stereotactic Body Radiotherapy (SBRT) using RPM & ABC
  • Image guided radio therapy (IGRT)
  • Intensity Modulated radio therapy (IMRT)
  • 3-D Image Guided & 2D Brachytherapy (IGBT)
  • 3D Implant Brachytherapy
  • Conventional and virtual simulation

Services provided by the department:

Volumetric Modulate Arc Therapy (VMAT) using Rapid arc technology is a new and advanced form of intensity modulated radiotherapy which delivers precise treatment in shorter time. It is 5 to 8 times faster than conventional and helical IMRT techniques. Intrafractional patient setup errors can be effectively minimized when compared with other techniques which improve quality and comfort. Installed novalis Tx a very advanced linac machine for VMAT-rapid arc.

In this method gantry rotates 3600 around patient enabling very small beams with modulated intensity.Many treatments can be planned with one rotation of the machine; some complex treatments require multiple rotations.

Novalis Tx includes Varian’s Trilogy linear accelerator and the new HD(High definition) 120 multileaf collimator, which offers very low ( 2.5 mm) leaf width at isocenter in the central 8 cm region and 5 mm in the 2x7 cm outer region giving excellent dosimetric results for any treatment plan.

Stereotactic Radio surgery is a non – invasive technique to deliver a single high dose of radiation to limited, well defined target volumes, while avoiding nearby normal tissue and critical structures. It is a potentially curative therapy in benign non –invasive tumors.

Though radiosurgery can be done using positively charged particles and gammaknife, linac based X-knife (Radiosurgery with high energy X-rays) became more popular because of many advantages as follows.

  • Dose distribution is equivalent to gamma knife.
  • There is a great flexibility in altering the pattern of beam delivery.
  • Field shaping is relatively easy to achieve.
  • Fractionated treatments are also possible (SRT) if required.
  • The cost is relatively low

BIACH & RI has most advanced linac based Radio surgery facility namely Brain lab supported Novalis Tx machine which makes the use of intensity modulation also for better conformity. With inbuilt micro MLC (High Definition MLC), it is capable of performing SRS (Stereotactic Radio surgery) / IMRS (Intensity Modulated Radio surgery) with the help of iplan Treatment planning system from Brain lab.

The greatest advantage of using Novalis supported radio surgery is the three dimensional volumetric verification (3D-3D matching) of reference and localized images using CBCT at any time before and during treatment. This 3Dimentional matching is not possible with other radio surgery delivery methods. This gives highest confidence on treatment delivery.

Radio surgeries are being successfully performed for different lesions using this ultra modern system. SRS is also being done using brain lab invasive frame.

Stereotactic Body radiotherapy (SBRT) can be done mainly for lung/liver cases using free breath and breath hold techniques. Basavatarakam has Real time Position Management (RPM) system and ABC (Active Breath Control) system for this purpose. Using 4D CT (4 Dimensional Computed Tomography) and RPM system SBRT can be executed in our novalis linear accelerator.

Active Breathing Control (ABC) which is available with synergy machine allows temporary and reproducible immobilization by monitoring the breath cycle and achieving a breath hold for a preset time at a pre determined lung volume level.

It is a very important delivery technique advancing rapidly in radiotherapy. Linear accelerators which have the facility for X-ray volume imaging are capable for doing this technique. Patient setup can be verified three dimensionally before the delivery of dose fraction. Therefore patient can be treated accurately by correcting these errors. Two ultra modern linear accelerators capable of doing IGRT namely elekta synergy and varian Novalis Tx are installed at the institute.

IMRT started in Basavatarakam in the year of 2005 and more than 5000 IMRT plans have been successfully completed till date and is a record number in India. This is the only institute in south india did this many IMRTs. 4 linear accelerators are IMRT capable.

Brachytherapy is the treatment method in which small sealed radioactive source is kept very close to (within the natural body cavities or implanted directly) the tumor. High dose rate brachytherapy (HDR) is a promising brachy treatment modality in which the treatment time is few minutes instead of few hours.

Varisource ix HDR Brachytherapy is a most advance unit with step size as less as 2 mm. Treatment planning conformity advantage is more with less step size. Around 10 brachytherapy cases per day are treated.

Treatment of cancer using gamma rays & x-rays from radioactive material placed at some distance away from the patient is called Tele therapy. Though Radioactive cobalt is the most popular and ideal source for this type of treatment, it is gradually replaced by the technologically advanced linear accelerators.

Linear accelerator is modern equipment which produces X-rays and electrons of different energies. Introduction of linacs changed the scenario of cancer therapy. We have six modern linear accelerators with Stereotactic Radiation Surgery -SRS, Stereotactic Radio Therapy – SRT, Intensity Modulated Radiation Therapy -IMRT, Image Guided Radiation Therapy -IGRT, Intensity Modulated Radiation Surgery -IMRS, with Rapid Arc facilities.

At BIACH&RI, treatment simulation with orthogonal fluoroscopy using conventional simulator is the standard practice, since a long time for treatment verification. It has the advantage to detect some movements of the patient during the process which helps to perform possible corrections to the planned beams. The department has a modern simulator facility namely Varian acuity digital simulator.

It is basically a CT unit with flat couch used for radiotherapy planning purpose and moving lasers. We have Philips big bore CT which is first of kind in India with 16 slice and 85 cm bore size.

In virtual simulation patient is required only at the time of CT scanning. Simulation can be done using CT slices and planning software without requirement of patient. The department has three virtual simulation stations (Focal –sim) for this purpose.

SRS is a non-invasive technique to deliver a single high dose of radiation to limited, well defined target volume while avoiding normal tissues and critical structures near to it. Modified high energy linear accelerators with micro multi leaf collimator facility (MLC) are the most versatile radiation producing machines for radio surgery. It is a linear accelerator based sophisticated method of delivering a high dose of radiation very precisely to a small volume of tissue. BIACH&RI has two different MLC based SRS facilities namely DIREX system and BRAIN LAB. For this iPlan and accsoft planning systems were used.

Three dimensional conformal radiation therapy (3D CRT) developed as a method of allowing higher dose to tumor, limiting dose to normal tissue, and improving local control and patient outcomes. Linear accelerators with multileaf collimator arrangements are capable of doing this technique (Four linacs have this facility).

Intensity modulated radiotherapy (IMRT) is a most sophisticated, advanced technique for the radiotherapy planning. In this method, intensity of each beam will be modulated in an optimal way to get the required distribution according to the prescription. Intensity modulated beams will be directed from different directions. It is an advanced 3D conformal radiotherapy. MLC based linear accelerators are required to deliver IMRT treatment. Four linear accelerators are, IMRT capable

It is a most important delivery technique advancing rapidly in radiotherapy. Linear accelerators which have the facility for X-ray volume imaging are capable for doing this technique. Patient setup can be verified three dimensionally before the delivery of dose fraction. Therefore patient can be treated accurately by correcting these errors. Two ultra modern linear accelerators are capable of doing IGRT Control.namely Elekta Synergy and Varian Novalis Tx. with Rapid Arc ( with Active Breath)

Active Breathing Control (ABC) based IGRT is mainly for lung/liver cancers. ABC allows temporary and reproducible immobilization by monitoring the breath cycle and achieving a breath hold for a preset time at a pre determined volume level.

Small sealed radioactive sources are kept very close to, within the natural body cavities or implanted directly into the tumor in this method. A small single stepping source will generate the required dose distribution by moving to different pre-planned positions. HDR brachytherapy solves the potential disadvantages of Low Dose Rate (LDR) brachytherapy method. Treatment time is only few minutes. Therefore no hospitalization is required. BIACH&RI has high end HDR brachytherapy unit Varisouce IX with 20 channels which uses Ir-192 source. With this machine, implants, Templates and all kind of intracavitary radiotherapy procedures are performed. It is the only centre with image guided brachytherapy with CT compatible applicators for treatment of cancer cervix.

Rapid arc technology is a new and advanced form of intensity modulated radiotherapy which delivers precise treatment in shorter time. It is many times (5 to 8 times) faster than conventional and helical IMRT techniques. Intrafractional patient setup errors can be effectively minimized when compared with other techniques which improves the quality and comfort. With Inbuilt micro MLC it is capable of performing IMRS also with the help of

Intrabeam, Intraoperative radiotherapy system was installed at our center in 2009 which is the first of its kind in India. With 50kev and 40microamps it is capable to treat all intraoperative tumors. Especially it is useful in intact breast cases. Other cases like brain, soft tissue, vagina, rectum etc. Can also be performed The main advantage of this instrument is that it is capable of delivering dose immediately after surgery. Instead of taking more than 25 fractions on linear accelerator, single fraction is sufficient and patient can be treated along with the surgery.