Tomotherapy at the London Regional Cancer Program, Canada


Discussions with Tomotherapy Incorporated and the London Regional Cancer Program regarding the installation and physics evaluation a Helical Tomotherapy unit began in 1998, building on a long-standing collaborative relationship between LRCP investigators and Tomotherapy inventor Dr. Rock Mackie. These discussions culminated in commitment by LRCP to purchase one of the first 3 beta test unitsyet to be manufactured. In doing so, London became a leader in adopting this technology very early along with Madison, Wisconsin and Edmonton, Alberta. Funding was obtained through private donations and Cancer Care Ontario.


In 2002 the LRCP received a Tomotherapy treatment planning workstation and comparative dosimetry/planning studies commenced. The tomotherapy protype (Beta) unit arrived in December 2002 and was used for commissioning, quality assurance, dosimetry and MVCT Physics research during 2003. The Beta unit was replaced with a clinical unit in early 2004 and commissioning for clinical applications began in the spring of 2004.


Installation and Commissioning

The current tomotherapy HiArt unit was installed on May 25, 2004. Dr. Tomas Kron (medical physicist) was instrumental in the organized and relatively smooth installation, acceptance and commissioning of the unit. Subsequently, Dr. Slav Yartsev has become the physicist in charge of the Thomotherapy Unit and Jim Allin provides local engineering support. Jerry Battista, Jake Van Dyk and Glenn Bauman lead the collaborative tomotherapy research program that most often involves radiation oncologists and medical physicists.

Clinical Implementation

The tomotherapy treatment process has been streamlined and now works very well. Since 2004 the majority of our patients have been enrolled in clinical trials evaluating the performance of the unit and exploring novel treatments with tomotherapy. Clinical results are available through the following publications: 'A Prospective Evaluation of Helical Tomotherapy' and 'Simultaneous Infield Boost With Helical Tomotherapy for Patients With 1 to 3 Brain Metastases'. Currrent clinical trials include hypofractionated image guided treatments for prostate cancer and image-guided radiotherapy for CNS tumors.

Tomotherapy Research

Research with HT has been enabled through peer-reviewed funding by the Ontario Institute of Cancer Research, and the Ontario Research Fund (ORF/ORDCF) and the Canadian Cancer Society Research Institute (CCSRI).


Selected References

1: Rodrigues G, Yartsev S, Yaremko B, Perera F, Dar AR, Hammond A, Lock M, Yu E,
Ash R, Caudrelier JM, Khuntia D, Bailey L, Bauman G. Phase I Trial of
Simultaneous In-Field Boost With Helical Tomotherapy for Patients With One to
Three Brain Metastases. Int J Radiat Oncol Biol Phys. 2010 Jul 31. [Epub ahead of
print] PubMed PMID: 20675078.

2: Kim B, Chen J, Kron T, Battista J. Feasibility study of multi-pass
respiratory-gated helical tomotherapy of a moving target via binary MLC closure.
Phys Med Biol. 2010 Nov 21;55(22):6673-94. Epub 2010 Oct 28. PubMed PMID:

3: Martin S, Yartsev S. KVCT, MVCT, and hybrid CT image studies--treatment
planning and dose delivery equivalence on helical tomotherapy. Med Phys. 2010
Jun;37(6):2847-54. PubMed PMID: 20632596.

4: Beldjoudi G, Yartsev S, Bauman G, Battista J, Van Dyk J. Schedule for CT image
guidance in treating prostate cancer with helical tomotherapy. Br J Radiol. 2010
Mar;83(987):241-51. Epub 2009 Jun 8. PubMed PMID: 19505966.

5: Schirm M, Yartsev S, Bauman G, Battista J, Van Dyk J. Consistency check of
planned adaptive option on helical tomotherapy. Technol Cancer Res Treat. 2008
Dec;7(6):425-32. PubMed PMID: 19044321.

6: Woodford C, Yartsev S, Dar AR, Bauman G, Van Dyk J. Adaptive radiotherapy
planning on decreasing gross tumor volumes as seen on megavoltage computed
tomography images. Int J Radiat Oncol Biol Phys. 2007 Nov 15;69(4):1316-22.
PubMed PMID: 17967322.

7: Bauman G, Yartsev S, Rodrigues G, Lewis C, Venkatesan VM, Yu E, Hammond A,
Perera F, Ash R, Dar AR, Lock M, Baily L, Coad T, Trenka K, Warr B, Kron T,
Battista J, Van Dyk J. A prospective evaluation of helical tomotherapy. Int J
Radiat Oncol Biol Phys. 2007 Jun 1;68(2):632-41. Epub 2007 Feb 22. PubMed PMID:

8: Song WY, Chiu B, Bauman GS, Lock M, Rodrigues G, Ash R, Lewis C, Fenster A,
Battista JJ, Van Dyk J. Prostate contouring uncertainty in megavoltage computed
tomography images acquired with a helical tomotherapy unit during image-guided
radiation therapy. Int J Radiat Oncol Biol Phys. 2006 Jun 1;65(2):595-607. PubMed
PMID: 16690441.

9: Kron T, Yartsev S, Mackie TR. Verification dosimetry during treatment for
helical tomotherapy using radiographic film. Australas Phys Eng Sci Med. 2005
Dec;28(4):232-7. PubMed PMID: 16506620.

10: Yartsev S, Kron T, Cozzi L, Fogliata A, Bauman G. Tomotherapy planning of
small brain tumours. Radiother Oncol. 2005 Jan;74(1):49-52. PubMed PMID:

11: Gladwish A, Kron T, McNiven A, Bauman G, Van Dyk J. Asymmetric fan beams
(AFB) for improvement of the craniocaudal dose distribution in helical
tomotherapy delivery. Med Phys. 2004 Sep;31(9):2443-8. PubMed PMID: 15487723.

12: Kron T, Grigorov G, Yu E, Yartsev S, Chen JZ, Wong E, Rodrigues G, Trenka K,
Coad T, Bauman G, Van Dyk J. Planning evaluation of radiotherapy for complex lung
cancer cases using helical tomotherapy. Phys Med Biol. 2004 Aug
21;49(16):3675-90. PubMed PMID: 15446797.

13: McNiven A, Kron T. Interpolation and extrapolation of dose measurements with
different detector sizes to improve the spatial resolution of radiotherapy
dosimetry as demonstrated for helical tomotherapy. Phys Med Biol. 2004 Aug
21;49(16):3665-74. PubMed PMID: 15446796.

14: Moiseenko V, Mulligan M, Kron T. Radiation quality of a tomotherapy photon
fan beam. Health Phys. 2004 Aug;87(2):166-70. PubMed PMID: 15257217.

15: Grigorov G, Kron T, Wong E, Chen J, Sollazzo J, Rodrigues G. Optimization of
helical tomotherapy treatment plans for prostate cancer. Phys Med Biol. 2003 Jul
7;48(13):1933-43. PubMed PMID: 12884926.