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Oncology & Radiotherapy

Omid Urmia Radiotherapy Center Omid Urmia Radiotherapy Center is located in a calm and pleasant environment. In this center, using the most advanced radiotherapy devices in the world, in addition to advanced 3DCRT, IMRT and IGRT techniques, VMAT as the newest method of treating cancer of various organs such as prostate, head and neck, breast, gastrointestinal tract and so on are used. Omid Radiotherapy Center is the first center equipped with imaging system during CBCT treatment. Using this new and advanced system, it is possible to control tumor areas and vital tissues online at any time of treatment and significantly increases the accuracy of patients’ treatment. Not only equipment, but also experienced manpower is one of the basic principles for the effectiveness of treatment methods in Omid Radiotherapy Center in Urmia.
  • Modified Volume Arc Therapy (VMAT)
  • 3D Adaptive Radiotherapy (3DCRT)
  • Modified Intensive Radiation Therapy (IMRT)
  Modified Volume Arc Therapy (VMAT) Scientific and technological advances have led to the introduction of Arc Therapy with modified volume, which is the most efficient and latest method of cancer treatment technology using one or more beam arcs guided by online CT scan images. This method is known as IGRT. Electa Company, the innovator in providing new oncology and cancer treatment solutions by using the seventh generation of digital technology in medical accelerators, while introducing a complete treatment system for cancer patients, has introduced a new definition of accuracy, speed and control of treatment. Provides. Using this highly advanced system, which has been exploited for the first time in Iran at the Omid Radiology Center in Urmia, the patient is treated in the widest range of beam orientations in the shortest possible time and with the highest accuracy.   3D Adaptive Radiotherapy (3DCRT) Three-dimensional adaptive radiotherapy, unlike traditional two-dimensional therapies, is a method of treating cancer that uses advanced computers and software to accurately target the tumor. In fact, 3DCRT treatment is a complex process that begins with the creation of a three-dimensional set of data from healthy tumors and tissues. The set is then used to create 3D computer images and design complex maps so that the beam can be focused on the tumor and the surrounding tissues can be preserved.   Intensity Modulated Radiation Therapy (IMRT) Intensity Modulated Radiation Therapy (IMRT) is one of the most important advances in oncology in the last decade. Advances in computer technology as well as medical imaging have had a significant impact on the rapid development of IMRT therapy techniques.   In most malignant tumors, there is a direct relationship between the dose of prescribed radiation and the control of malignancy; However, healthy tissues around the tumor area prevent high doses of therapeutic radiation. In the IMRT technique in the radiotherapy ward of Omid Hospital in Urmia, by drawing the tumor volume more accurately, the damage to the surrounding healthy tissues is reduced and therefore by reducing the late complications and also increasing the tumor dose, the possibility of tumor control and survival increases.   Three dimensional treatment planning The first step in radiotherapy treatment design is the precise definition of the volume to be treated. For example, in the treatment of prostate cancer (in which the lymph nodes of the pelvis and prostate gland are irradiated) in the conventional method of radiotherapy (Conventional) using the characteristics of the pelvic bones, the site of radiotherapy is defined. A rectangular cube space is then formed using several beams that are mostly overlapping. This treatment technique is very simple and fast, but a large volume of the small intestine, rectum and bladder are exposed to radiation. Three dimensional treatment planning The first step in radiotherapy treatment design is the precise definition of the volume to be treated. For example, in the treatment of prostate cancer (in which the lymph nodes of the pelvis and prostate gland are irradiated) in the conventional method of radiotherapy (Conventional) using the characteristics of the pelvic bones, the site of radiotherapy is defined. A rectangular cube space is then formed using several beams that are mostly overlapping. This treatment technique is very simple and fast, but a large volume of the small intestine, rectum and bladder are exposed to radiation. With the advent of CT scan imaging in the field of radiotherapy, fundamental changes have been made in determining therapeutic volumes, tumor tissue, and healthy organs at risk. Using CT scan, the desired treatment volumes in each of the CT scan sections are carefully drawn and finally a three-dimensional view is created. Radiation therapy batches are then injected into this therapeutic volume using multi-leaf multi-layer conditioners, and the surrounding healthy tissues are largely protected. It should be noted that this protection of healthy tissues is not ideal in this treatment technique and when there is a need to use high doses of radiation therapy to control the tumor, there are many restrictions. This treatment technique, called conformal therapy, is used to treat most tumors in the body, such as the brain, head and neck, lungs, prostate, bladder, and so on. Reduction of complications with this treatment technique compared to the conventional method previously described has been proven in various studies. For example, in the treatment of prostate cancer, the long-term complications of the rectum have increased from 15% with conventional treatment to 5% with conformal treatment. It should be noted that the control of prostate cancer requires high doses (about 70-80 Gy), which is unacceptable and impossible with the treatment of 3D complications. Fortunately, the advanced IMRT technique presented in the radiological oncology department of Omid Hospital in Urmia has made this possible. Advanced IMRT treatment technique The advanced IMRT treatment technique is in fact a very advanced type of three-dimensional treatment, and especially in cases where the shape of the tumor area is very complex or convex and is adjacent to sensitive organs, the therapeutic value is doubled. The IMRT treatment technique has two major differences with the three-dimensional treatment method. It produces therapeutic rays with different intensities. Inverse Planning Treatment Design In the IMRT therapy technique, each radiation therapy batch is divided into hundreds of smaller beams of different intensities, resulting in a very complex distribution of different intensities throughout the treatment area. Therefore, in the desired treatment volume, at the same time as reducing the dose of radiation to healthy tissues, very high radiation dose can be prescribed to areas with tumor tissues. For example, in the case of prostate cancer, the lymph nodes reach high doses, but the bladder and intestines are well protected from radiation. The volume of the bladder, which receives a dose of more than 40 g, has been reduced by 20% using the three-dimensional treatment method, but the use of advanced IMRT technique has reduced this volume to more than 45%. This is a significant therapeutic advancement achieved using the IMRT technique. Benefits of Advanced IMRT Therapy Techniques:
  • Adaptation of therapeutic radiation to therapeutic volume increases, especially in convex therapeutic volumes.
  • With IMRT treatment technique, the intensity and amount of prescribed radiation can be changed in different parts of the irradiated volume.
  • The protection of healthy tissues around the tumor increases.
  • With IMRT treatment technique, higher doses can be applied to the desired treatment area, which will increase the efficiency of treatment.
  Essential IMRT treatment technique requirements:
  • The radiologist’s physician spends a great deal of time locating the tumor, treating volumes, and surrounding healthy organs.
  • The quality control system of the treatment should be very high.
  • Treatment design time increases.
  • Treatment time increases.
  Treatment design Advanced IMRT treatment technique One of the key features that sets IMRT apart from other treatments is the use of reverse treatment design using the most advanced treatment design systems. In this method, first the tumor dose and therapeutic volumes as well as the maximum tolerable dose of healthy tissues are given to the treatment design soft and this system creates the desired initial treatment plan by changing the beam intensity in the treated area. Each batch of radiation inside the patient’s body creates an initial dose distribution. With small changes in the intensity of these rays, the dose distribution changes. These dose changes should be repeated until an acceptable dose distribution is established in all healthy tissues in the beam pathway as well as the tumor. Therefore, treatment design in IMRT treatment technique is a longer process and requires advanced systems and software. In the radioconology department of Omid Hospital in Urmia, very advanced MONACO treatment design software is used.   Prescription dose of radiotherapy The radiologist determines the dose to be given to the tumor and at the same time determines the maximum tolerable dose to healthy tissues around the treatment area. In conventional treatment, due to the proximity of healthy and tumor tissues and to prevent unacceptable complications, the prescribed dose to the tumor is reduced. It is also often necessary to divide the treatment into different stages and use different combination fields for each stage. However, in the IMRT treatment technique, by determining the dose, different organs are exposed to radiation. A heterogeneous dose distribution is created within the desired treatment volume, which is called dose painting. This advanced treatment technique even makes it possible to deliver higher doses to high-risk areas simultaneously and treat the patient in one step. This intelligent technique is very effective in designing and delivering high doses to tumor areas and reducing treatment length and increasing treatment efficiency. The primary tumor receives a dose of 66 Gy (red). At the same time, the lymph nodes that are at risk for microscopic involvement receive a lower dose (ie, 50 g). The spinal cord and brainstem adjacent to the primary tumor receive a maximum dose of 46 Gy. The salivary glands are highly sensitive to radiation and receive a dose of about 24 g (blue); Because doses higher than 25-30 g cause permanent dry mouth for the patient, which is very uncomfortable. In tumors of the oropharyngeal region, if the treatment is two-dimensional (Conventional) or three-dimensional (Conformal), both parotid glands must be placed in the treatment area and receive a high dose. However, by using the advanced IMRT technique, the necessary doses can be delivered to the patient in one step and the parotid on the opposite side of the treatment area can be preserved and dry mouth can be prevented. This will increase the quality of life of patients in the radiotherapy ward of Omid Urmia Hospital. How to perform IMRT treatment technique Advanced IMRT treatment technique can be performed in several ways. The two most common and important methods that use multi-layer or multi-fiber air conditioning (MLC) are: Segmental IMRT and Dynamic IMRT. The first multifiller was built in 1948 for three-dimensional treatment with an accelerator. This multifilament was made of tungsten removable fibers and could protect parts of the treatment area. The fibers are usually 5-10 mm wide in opposite pairs, which are computer-controlled and protect normal tissues by adapting to the irregular shape of the tumor. Multifill is an essential tool for performing IMRT therapy technique.     SEGMENT MLC This treatment method is directly derived from the three-dimensional radiotherapy method. Thus, the beam in the treatment field is made in several different ways by MLC (segment) and the intensity of the beam in each treatment field is determined by the sum of these segments. When a segment is in position, therapeutic radiation is prescribed and after the radiation is completed until the next segment is formed, the radiation is stopped. This method is called STEP AND SHOOT treatment.   DYNAMIC MLC In this method, unlike the previous method, the fibers (MLC) during the treatment of a field, are continuously moving with computer control and the desired beam intensity is created at any point with the speed of movement and distance of fibers. Dynamic treatment method is better than SEGMENT method in terms of dose distribution and adaptation to tumor shape.   The role of imaging in advanced IMRT treatment technique Determining the exact location of the tumor is important for any type of radiotherapy, but because in the advanced IMRT treatment technique the margin around the tumor area is considered very close to the tumor to reduce complications, the volume of treatment is more important. CT scan is the standard method for locating a tumor, but its main limitation is that it can not always accurately determine the extent of the tumor. Other diagnostic methods are needed for this purpose. For example, MRI imaging is used for the pelvic, head, neck and brain areas. Also, the use of functional imaging techniques such as PET and MRS provides other valuable information for accurate tumor determination, which is used for the IMRT technique, but due to space limitations, these methods are usually used in conformity with CT scans in treatment design. they take. Using the image fusion technique, the patient’s MRI, CT scan and PET scan images are matched, which helps to more accurately determine the location of the tumor. This method is especially used in the treatment of tumors of the head, neck and brain. For example, brain tumors can be clearly seen on MRI, but CT scans are not able to determine the exact extent of the tumor. For this purpose, the boundaries of the tumor are determined and plotted on MRI and automatically transferred to CT scan images, after which the treatment design is performed.   Tumor and patient movement During the course of radiotherapy, it is important to ensure that the tumor is completely covered. Tumor movements within the body and the patient’s own movements should be considered in the treatment design. For this purpose, safe margins around the tumor are considered. If this margin is inappropriate, the tumor may not receive enough radiation or the surrounding healthy tissue may be further damaged. Because in the advanced IMRT treatment technique, the prescribed dose adapts to the dimensions of the treatment volume and minimizes radiation to surrounding healthy organs, dose reduction occurs very quickly outside of the treatment volume. Therefore, tumor and patient movements are very important in IMRT therapy technique. For this purpose, in the radiotherapy ward of Omid Hospital in Urmia, a lot of attention is paid to restricting movements and also reproducing the patient.   Imaging-guided radiotherapy Tumor movement between sessions and days of radiotherapy treatment is important for many tumors because it can cause errors in the geometry of the treatment. Many studies on the treatment of prostate cancer have shown that this organ can move up to about 2 cm between radiotherapy sessions. The amount of movement also depends on how full and empty the rectum is. Imaging-guided radiotherapy can improve the geometric accuracy of patients’ treatment by adjusting the treatment fields to the daily position of the treatment volume. Today, electronic portal imaging (EPID) devices are used for 2D imaging in radiotherapy. The development of CBCT linear accelerators is a very promising approach in imaging-guided radiotherapy. Infinity Linear Accelerator The radiology department of Omid Hospital in Urmia is the only linear accelerator with unique CT scan (CBCT) capability in the country. Using the CBCT system, before each radiotherapy session, three-dimensional images of the patient’s condition can be taken and the position of the treatment volume and surrounding healthy organs can be corrected. This highly advanced system has provided the possibility of very accurate IMRT treatment in the radiological oncology department of Omid Hospital in Urmia.   Clinic Summary of the performance report of the Charity Association for aiding to the Cancerous Patients of West Azerbaijan   Charity Association for Support of Cancer Patients of West Azerbaijan Province (Omid) is a non-governmental organization that was established in 1990 due to the widespread prevalence of cancer, economic and cultural deprivation and lack of medical facilities in the region to solve medical, material and spiritual problems. It is an important problem and now, in the twenty-seventh year of its activity, with the help of public assistance, it has succeeded in providing decent services in the fields of treatment, assistance and prevention of cancer. Omid Research and Treatment Center is one of the achievements of the members and supporters of this association, the first phase of which since 1996, has succeeded in providing services to a large number of patients in the province, neighboring provinces and clients from neighboring countries such as Iraq, Turkey, Armenia And Azerbaijan. Fortunately, this association was selected as one of the top non-governmental organizations in the field of cancer in the conference of World Cancer Day, which was held in February 2013 in Tehran, and received a plaque of honor and a statue of UNESCO. Also, Omid Charity Association is the first non-governmental organization in the field of cancer in the country that has succeeded in receiving the standard certificate of ISO 9001: 2008 quality management system from DAS Company and UKAS Accreditation Organization and has succeeded in receiving the statue of honor. It was one of the five sample hospitals in the country in the International Congress on Hospital Construction in 1396 and …   The parts of the association’s performance in various fields of treatment, support and culture are mentioned: Construction of the first phase of Omid Research and Treatment Center with an infrastructure of about 3000 square meters, including:
  1. Radiotherapy department equipped with three accelerators
  2. Intracavitary radiotherapy
  3. Specialized sections of medical physics
  4. Setting up the MLC software and hardware system in the radiotherapy ward of Omid Medical Center with the aim of increasing the accuracy of radiotherapy treatment of patients.
  5. With the benefit of experienced personnel and medical specialists, this center is the only specialized radiotherapy charity center in the region, and is considered by many doctors and cancer patients and their families in the west and northwest of the country. Establishment of a third high-energy accelerator, which is unique in the country
  Devices available in Omid Charity Radiotherapy Rehearsal ELEKTA SYNERGY Year of purchase 2017 and year of launch 2018 Device Description:
  1. The first radiotherapy device was a cobalt device that was used in this complex until 2010 and after that new devices were replaced.
  2. Synergy device made by the British company Elktay (high energy accelerator device) with photon and electron energies, which is a much better method of treating cancer with this device than other devices. This device is rare compared to other devices in the northwest of the country and treats with much less complications, higher speed and much more accuracy using different energies in advanced and modern methods such as IMRT and VMAT. The therapeutic capacity of the synergy device is twice as much as other devices and can respond to 60 patients daily. At present, this device is not available in the province and the northwest of the country and even in the country it is one of the most unique methods of cancer treatment.
  3. Saginava brachycherapy device Launched in 1396
For the treatment of tumors of the uterus, cervix, esophagus and colorectal tumors of skin tumors
  1. MultiEnergy linac siemens, year of purchase and launch 1396
single linac siemens, year of purchase and launch 1390