Provided that certain preliminary guidelines are followed, these protocols can reduce pathology test ordering in any pre-admission Service.

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Modern radiotherapy has advanced dramatically over the past decade and it is now possible to focus radiotherapy with extreme precision. This allows the radiation dose to be targeted to the area(s) of tumour while sparing adjacent normal tissues even in seemingly complicated and difficult parts of the body. The case report presented here will illustrate how it is possible to irradiate the entire scalp for extensive cutaneous T cell lymphoma while minimising radiotherapy to the underlying brain, orbits and other critical structures.

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minimize side effects, and can be planned relatively quickly. Delaying the start of radiotherapy because of a complicated treatment planning process does not make sense. For patients requiring palliative radiotherapy, specialized clinics have even been developed where treatment (with one or a few fractions of radiotherapy) is planned and administered on the same day that the consultation takes place 15 . Usually, fluoroscopic simulation and simple treatment approaches such as direct fields or parallel opposed fields are used in these clinics. However, are we utilizing the available radiotherapy scanning, planning, and treatment tools to the fullest extent possible in the palliative setting?We believe that, in certain situations, it is possible to use state-of-the-art ig-imrt approaches to deliver palliative radiotherapy in a safe, efficient, and effective manner without excessive wait times. It seems intuitive that, if radiotherapy could be focused more precisely, then it could be more effective and should lead to fewer side effects, because the tumour can be targeted more accurately and normal structures can be avoided. In the palliative setting, in which the goal tends to be delivery of low-to-moderate doses of radiation with minimal toxicity 13 , an ig-imrt approach would seem to be most appropriate. Here, we review our experience using ig-imrt on our helical TomoTherapy unit (TomoTherapy Incorporated, Madison, WI, U.S.A.) in the palliative setting. PATIENTS AND METHODSIn the spring of 2005, the Ottawa Hospital Cancer Centre installed a helical TomoTherapy unit (htu), and after a commissioning process that took 2 weeks, it started treating patients in September 2005. The htu was acquired mainly for research purposes, and many of the patients were on study protocols. However, having quickly realized the value and versatility of an ig-imrt approach, we began using it for selected palliative situations in which standard approaches might not be safe, and for unique situations in which palliative radiotherapy, although effective, would be difficult to administer. We subsequently created a protocol for scanning, planning, and treating ABSTRACTMany modern radiotherapy centers now have imageguided intensity-modulated radiotherapy (ig-imrt) tools available for clinical use, and the technique offers many options for patients requiring palliative radiotherapy. We describe a single-institution experience with ig-imrt for short-course palliative radiotherapy, highlighting the unique situations in which the technique can be most effectively used.