Research Article
No More Feet-first Supine: A Simplified Total Body Irradiation Planning and Delivery Using Single Head-first Supine CT Simulation and SGRT for Intra-fraction Motion Monitoring on Radixact Tomotherapy
Issue:
Volume 10, Issue 3, September 2025
Pages:
110-120
Received:
24 May 2025
Accepted:
16 June 2025
Published:
4 July 2025
Abstract: Introduction: Total Body Irradiation (TBI) remains a crucial preparatory regimen for hematopoietic stem cell transplantation. However, traditional techniques involve complex workflows requiring dual CT simulations-Head-First Supine (HFS) and Feet-First Supine (FFS)-which pose logistical, dosimetric, and patient comfort challenges. This study introduces a simplified TBI approach using a single HFS CT scan combined with Surface Guided Radiation Therapy (SGRT) for setup verification and intra-fraction motion monitoring on the Radixact® TomoTherapy system. Materials and Methods: From August 2024 to April 2025, five adult patients with hematologic malignancies scheduled for TBI were retrospectively analyzed. Each patient underwent a single HFS simulation scan on PET-CT with full-body coverage. Immobilization was achieved using a vacuum cushion and thermoplastic mask. Treatment planning was performed using Accuray Precision® version 3.5.0.2 on a single CT dataset. Two helical plans, one for the upper body and one for the lower body, were generated with a 14 cm overlap at the mid-thigh. Seven feathered Planning Target Volumes (PTVs) were created at the junction to ensure dose homogeneity. Surface Guided Radiation Therapy (SGRT) was used for initial setup and intra-fraction motion monitoring, while ClearRT-based kVCT imaging served as a secondary internal verification. Patient-specific quality assurance (PSQA) was conducted using Delta4 with 3%/3 mm gamma criteria, and junction dose validation was performed using ion chamber measurements. Results: SGRT enabled accurate patient setup for TBI, with mean translational errors ≤2 mm and rotational errors ≤0.6° when compared to kVCT verification. Real-time motion monitoring during treatment enabled automatic beam-holds with an average latency of 0.0038 seconds, ensuring precise delivery. Dosimetric results showed excellent target coverage (≥95% of the PTV receiving ≥95% of the prescribed dose) and homogeneous dose distribution. Smooth dose profiles were observed at plan junctions, and lung doses remained within safe limits (~1.7 Gy). Pre-treatment QA demonstrated high gamma pass rates across all body regions (mean ≥96.6%), confirming treatment accuracy. Discussion: This simple modified workflow utilizing a single HFS CT scan for full-body TBI on Radixact eliminates the need for patient repositioning and FFS imaging, thereby simplifying the planning and delivery process. Integration of SGRT provides non-ionizing, real-time monitoring, enhancing setup precision and intra-fraction control. The feathered PTV junction design effectively mitigated dose inhomogeneities. This method demonstrates not only dosimetric robustness but also improved workflow efficiency and patient comfort.
Abstract: Introduction: Total Body Irradiation (TBI) remains a crucial preparatory regimen for hematopoietic stem cell transplantation. However, traditional techniques involve complex workflows requiring dual CT simulations-Head-First Supine (HFS) and Feet-First Supine (FFS)-which pose logistical, dosimetric, and patient comfort challenges. This study introd...
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Research Article
Fear of Death and Preferred Place of Death Among Cancer Patients in Togo
Ablavi Adani-Ifè*
,
Kodjo Djagadou,
Mohaman Djibril
Issue:
Volume 10, Issue 3, September 2025
Pages:
121-126
Received:
2 June 2025
Accepted:
16 June 2025
Published:
7 July 2025
Abstract: Objective: Each year, many people die in Togo from advanced cancer. However, palliative care services are not well established in the country. Dying in the preferred place of death is considered an indicator of high-quality palliative care. This study aimed to explore perceptions of death and the preferred place of death among cancer patients to enhance the quality of end-of-life care. Methods: This was a hospital-based cross-sectional study conducted in the oncology unit of Sylvanus Olympio Teaching Hospital in Lomé from June to December 2022. Data was collected using a questionnaire administered to patients with advanced cancer. Results: A total of 81 patients participated in the study, including 47 women (58%) and 34 men (42%). The mean age of the patients was 53.3 years, with an age range from 28 to 77 years. The most common cancers were breast cancer (n=36; 44.4%), prostate cancer (n=11; 13.6%), and digestive cancers (n=11; 13.6%). One-third of the patients (n=27; 33.3%) expressed fear of dying, primarily fearing for their children and family (48.1%) and the suffering and pain associated with death (37%). The preferred place of death was home for 32.1% of cases (n= 26) and the hospital for 24.7% (n = 20). Thirty-five patients (43.2%) did not express a preference for their place of death. The patient’s end-of-life wishes included pain relief (n = 42; 51.8%) and meeting their spiritual needs (n = 30; 37%). Conclusion: This study provides insight into perceptions of death and end-of-life needs among cancer patients in our country. It will help improve their care and overall end-of-life experience.
Abstract: Objective: Each year, many people die in Togo from advanced cancer. However, palliative care services are not well established in the country. Dying in the preferred place of death is considered an indicator of high-quality palliative care. This study aimed to explore perceptions of death and the preferred place of death among cancer patients to en...
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