Our section prides itself on setting the pace for cancer care in northern New England. We offer a full panoply of world class therapies, including stereotactic radiosurgery, stereotactic body radiation therapy, real-time target monitoring, gated radiation therapy, HDR and LDR applications across various body sites, a variety of treatments utilizing unsealed sources (e.g. Ra-223, I-131, Y-90), and cutting-edge image-guided radiation therapy technologies.
The section is equipped with 6 Varian megavoltage linear accelerators (4 with electron beam capability), 2 CT simulators, 19 treatment-planning workstations, HDR remote after-loading capability, and extensive brachytherapy expertise including Pd-103, Ir-192 (HDR & LDR), Y-90 (ibritumomab and microspheres), Sm-153, Ra-223, I-131, and Cs-131.
Advanced image-guidance is available through use of fiducial marker visualization, cone-beam CT scanning, 6-DOF computerized couch correction, VisionRT surface guided radiotherapy, gated beam treatments, and on-board real-time fluoroscopic beams-eye-view target tracking. Up through the end of 2018, we were the first and only provider in Vermont, Maine, and New Hampshire to offer the SpaceOAR® hydrogel technology for prostate cancer patients, and we currently maintain the largest experience with this technology in northern New England, having implanted several hundred cases.
The section has acquired an MRI-based linear accelerator for clinical use, one of the first dozen in the United States – Viewray’s MRIdian® linear accelerator. Installation was completed at the end of 2019, with clinical use treating patients started in January 2020. This new technology represents the very cutting edge of image-guided radiation therapy, opening entirely new vistas of research projects and clinical applications for the years ahead.
Innovative radiobiology applications include Velocity and MIM deformable registration and RBE formalism, HBO chambers, Cherenkov imaging of humans, EPR oximetry and dosimetry, and several animal-model technologies (e.g. a research accelerator, a KV animal irradiator, an advanced small animal imaging facility, and iron nano-particle therapy).
Beyond these technological resources, the section boasts outstanding human capital, both in terms of its core faculty and in terms of its strong affiliations across the Dartmouth campus. Research projects and partnerships extend across the basic sciences at Dartmouth Hitchcock Medical Center and Dartmouth College, into Dartmouth’s Thayer School of Engineering and Tuck School of Business, and as far as the Dartmouth Institute, the university’s health care policy think-tank.
External beam treatment and planning resources
- 6 Varian linear accelerators, X-ray energies 6, 10, and 18 MV All of the accelerators are equipped for IMRT and EPID (intensity modulated radiation therapy, electronic portal imaging) and VisionRT real time surface monitoring.
- 3 TrueBeam accelerators with real time fiducial marker tracking and 6DoF couches
- 1 Trilogy System with MLC and on-board imaging and access for research
- 1 2100 CD accelerator: OBI
- Stereotactic radiosurgery and stereotactic radiotherapy
- Total body irradiation for bone marrow transplant
- Total skin irradiation for mycosis fungoidies
- 1 GE CT scanner (16 slice big bore) with 4D image acquisition
- 1 Siemens CT scanner (128 slice big bore) with 4D and dual energy scanning.
- Eclipse treatment planning system to include GPU driven mulit-criteria optimization in 2019
- Velocity and MIM deformable image registration
- Gated lung treatments (4D)
- External beam partial breast irradiation
- World’s first clinical trials of Cherenkov emission imaging during radiotherapy
- World’s first FLASH delivery from a modified accelerator in normal treatment geometry.
Comprehensive brachytherapy services
- 3-D image guided implants (interstitial and intra-cavitary)
- Varian high dose rate remote afterloader
- Cs-131 and VariSeed prostate seed implant system including custom intra-operative planning
- Ra-223 therapy for bone metastasis
- Y-90 monoclonal antibody therapy for non-Hodgkin's lymphoma
- I-131 therapy for thyroid carcinoma
- Y-90 TheraSphere for liver cancer