Tokuda

Radiotherapy planning is a complex process, which consists of the following stages:

• Clinical biology planning
• Anatomic topography planning
• Dosage planning

Our department performs these mutually dependant activities to accurately plan our patients’ radiotherapy and cancer treatments:

Clinical biology planning, this process involves reviewing all the available patient data and test results to determine the most suitable type of radiotherapy treatment definitive, pre-operative, or post-operative or other.

Often, clinical biology planning begins with a patient case review by our clinical committee specialized to manage the treatment process for the specific cancer disease.  The clinical committee consists of specialists from different medical disciplines including a surgeon, radiotherapist, chemotherapist, pathologist, radiologist, and other specialists, whom decide which treatment methods to administer and for what duration.

Often, when selecting the best treatment plan for a given patient case additional tests are required to plan the most effective treatment. These additional tests can be prescribed by our  clinical committee, a physician, or the radiotherapist.

Cancers are dynamically developing diseases and consequently treatment plans are subject to change during the treatment process especially for cases in which cancerous cells spread. For cases in which the cancer state changes, our clinical commission could determine to post-phone or substitute radiotherapy with immediate surgical treatments, medication therapies, or symptom management treatments.


Anatomic topography planning involves preparing anatomical-topographic sections and/or a volumetric anatomical-topographic plan.

A master anatomical-topographic plan is prepared and the radiotherapy zones and required radiation dosages are precisely marked as well as the surrounding organs and tissues with the maximum allowable radiotherapy dosages to avoid damaging any sensitive tissues or organs.

The master plan is submitted to our medical physicist to create a dosage plan, in which the best dosage distribution, the number of fields, and the geometric parameters for each field are chosen and planned.

The patients’ body position is essential, which we take into account to assure comfort and reproducibility during the treatment process. The planning stage is finalized by marking the skin in the area to be treated with coordinates, which ensures the correct location and body position identification for the planned radiotherapy. In some cases depending on the radiotherapy location to ensure accuracy and precision, we prepare fixation devices and face masks to ensure the body position remains stationary during the treatment.   

For volumetric anatomical-topographic planning, the options for body positioning and location identification markings are the same as for single plane sections as described above. The difference between the two treatment approaches is that the irradiation volume to treatment zones is delivered to different sections and in a specific sequence at a distance less than 1 cm. This method significantly increases the accuracy, precision, and quality of the radiotherapy treatment. This type of radiotherapy planning is very effective to treat tumors, which are located close to sensitive organs or in difficult areas of the body with irregular shapes.

For each of our patients we prepare individualized anatomical-topographic plans per the following protocol:

Using our simulator or our scanner’s laser coordinate system (virtual scanner) the most appropriate body position is selected and the patient coordinates are marked upon the skin.

• The patient is placed in the selected body position into our spiral scanner, the scanner centers itself on patient’s marked coordinate system and the scanner resets itself.
• The chosen location is scanned at the prescribed section density.
• The gathered scan data is sent electronically to our planning system.
• The body contours are outlined and marked.
• The critical tissues and organs to be treated and surrounding tissues are outlined and marked.
• The specific volume areas to receive the radiotherapy are outlined and marked.
• The center of the coordinate system is marked as a reference point.
• The prepared volumetric plan as described above is sent electronically to the dosimeter equipment/software of our planning system. 

The Dosage Planning consists of the following:

• After preparing the volumetric dosage plan the treatment focal point is set, and this  center point must be calibrated with the center of the radiotherapy equipment coordinate system.
• We also offer treatment protocols in which a separate entry point or center is determined for each individual planned treatment field or area.
• A light projection check is conducted upon the skin coordinates on the treatment field.

• Upon necessity, for example if there are protective lead shields in the treatment field, we perform verification x-rays and Gamma-graphies, or we use our “beam eye view” monitoring system during the radiotherapy treatment to ensure precision and accuracy. 
• Upon necessity, we also conduct “in vivo” dosage monitoring internally or on the patient to verify the accuracy of the dosage plan and to determine the dosages to the treatment organs and tissues and surrounding tissues.