4DCT driving improved lung radiotherapy outcomes at NCCI
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4D CT scanning provides improved target delineation and treatment alignment for lung radiotherapy by accounting for tumor motion throughout the respiratory cycle. Analysis of 4D CT scans from 20 patients at NCCI found that accounting for tumor motion increased planning target volumes by an average of 9.1-42.5% depending on tumor size. Studies have also shown 4D CT can reduce needed planning margins from 2mm down when using bony anatomy for alignment by better visualizing tumor position. NCCI now uses 4D CT along with IMRT and daily CBCT to precisely target tumors and minimize dose to healthy tissues, with the goal of reducing radiation pneumonitis complications.
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2) Imugene has completed a Phase 1 clinical trial of its lead HER-Vaxx vaccine in HER-2 positive breast cancer patients, and plans to begin a Phase 1b/2 gastric cancer trial in early 2016.
3) HER-Vaxx induces polyclonal antibody responses against HER-2, unlike monoclonal antibodies, and has the potential to provide long-lasting immunity through immune memory activation.
Tony seruga yolanda seruga
Tony seruga yolanda seruga business expert. Tony Seruga Yolanda Seruga hates scam and fraud and any kinds of ripoff. Tony Seruga a business i con knows pros and cons and has got very good reviews as he got the best review of internet marketer.In the early years, Tony Seruga started a professional lawn service, employing college kids to do the actual work when he was only 14 years old building revenues to over $12,000 per year by the time he was 17. Tony built his first computer from a kit in 1976 and started his first “online” business in the early 1980s, using AOL and Compuserve.
Tony is a serial entrepreneur, having personally started over 240 businesses and over 600 with business partners. Tony has mentored thousands upon thousands of business owners.
Tony has been an early stage investor and entrepreneur since 1987. Tony has over two decades of experience in the venture capital, technology and entertainment industries in a multitude of investing, operational and engineering roles acting as a key adviser. In addition to his investing efforts, Tony has been active with several non-profit organizations. Tony holds a Juris Doctorate, although he never chose to practice law, opting for buying and selling businesses and investing in those projects he felt had the best chance of success.
Tony was co-owner of half a dozen early search engines including three pay-per-click search engines and was an early angel investor and adviser to four different businesses that went on to become multi-billion dollar companies. As a business adviser, Tony’s past client roster included a number of household names and celebrities.
And while Tony enjoyed speaking at business and marketing events all over the world, his real passion is to empower entrepreneurs and business owners to create massive success. Tony loves to help people to understand specifically what it takes to build a successful business. He has a very successful background in venture capital, investing and marketing. He has spent two decades working with start-ups to major global brands increasing sales, productivity and overall success and is an innovator with a remarkable ability to determine and dictate success strategies that enable companies to seize global market opportunities.
For everyone that either wishes to start their own business, currently owns a business or would like to capitalize the entrepreneurial dream, Tony’s message will enlighten them with knowledge and actionable principles to turn that passion into success. Tony has an extensive background in starting businesses, commercial real estate development and building companies around the world. Over the past two decades, he has specialized in helping companies launch, grow and create exponential valuation in the marketplace.
For more info about Tony Seruga visit http://tonyserugatonyserugatonyseruga.blogspot.com/
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The document discusses combined chemoradiotherapy for non-small cell lung cancer (NSCLC). It describes the evolution of radiotherapy techniques from older 2D techniques to modern 3D conformal radiation and IMRT. Studies show combined chemoradiotherapy improves survival over radiotherapy alone or sequential chemotherapy and radiotherapy by reducing locoregional recurrence rates. However, concurrent chemoradiotherapy is associated with increased toxicity risks which must be balanced against survival benefits.
BALKAN MCO 2011 - E. Vrdoljak - Radiotherapy
This document discusses radiotherapy techniques for early breast cancer, including:
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1. The document discusses the standard treatment for locally advanced cervical cancer, which is concurrent chemoradiotherapy with cisplatin. Several randomized trials from the 1990s showed improved survival with this approach compared to radiotherapy alone.
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The document discusses key concepts in radiobiology relevant for radiotherapy. It defines important treatment volumes including the gross tumour volume (GTV), clinical target volume (CTV), planning target volume (PTV), treated volume (TV), irradiated volume (IV), and organs at risk (OARs). It also describes biological factors that influence radiation effects on tissues, known as the "5 Rs": repair, repopulation, reoxygenation, redistribution, and radiosensitivity. Fractionated radiotherapy takes advantage of these factors to maximize tumor cell kill while minimizing damage to normal tissues.
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Respiratory Gating with IMRT
Respiratory gating with intensity-modulated radiation therapy (IMRT) allows for higher doses to be delivered to the tumor target while reducing side effects to normal tissues. It works by synchronizing beam delivery to specific phases of the respiratory cycle using external markers or internal fiducials implanted in or near the tumor. This leads to smaller planning target volumes and sharper dose gradients compared to conventional radiation therapy that does not account for tumor motion. Respiratory gating requires consistent breathing patterns from patients and continuous monitoring during treatment. It is effective for tumors in organs that move significantly during respiration like lung, liver and pancreas.
The immune checkpoint landscape in 2015: combination therapy
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4D Radiotherapy
4D radiotherapy aims to account for tumor motion during radiation therapy by acquiring CT images over multiple phases of the breathing cycle (4D CT imaging) and using this information for treatment planning and delivery. It allows for more accurate targeting of tumors in organs affected by respiratory motion like the lungs. While 4D radiotherapy provides advantages over existing motion management techniques, there are still technological challenges and limitations like complexity, treatment time, and residual motion. Future work includes addressing these issues and further integrating 4D techniques with other advances in radiation oncology.
Cancer immunotherapy
Immunotherapy is a type of cancer treatment that uses components of the immune system to fight cancer. There are several types of immunotherapy including passive immunotherapy using monoclonal antibodies that target tumor antigens, active immunotherapies using cytokines, cancer vaccines, and cell-based therapies. Monoclonal antibodies can directly kill cancer cells, block proteins that help cancer grow, or be linked to chemotherapy drugs. Cancer vaccines work by boosting the immune system against tumor antigens. Adoptive immunotherapy transfers modified immune cells to the body to attack cancer. Immunotherapy has shown success in treating various cancer types and continues to be improved and developed further.
The immunotherapy of cancer: past, present & the next frontier
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Amgen Cowen and Company 37th Annual Health Care Conference Presentation
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Similar to 4DCT driving improved lung radiotherapy outcomes at NCCI
Novel rt in sarc2017
Radiotherapy techniques have advanced for treating sarcoma, including more precise tumor delineation using MRI fusion and CT atlases. Treatment planning has improved with IMRT, VMAT and IGRT allowing higher doses to the tumor while sparing normal tissues. Combining radiotherapy with chemotherapy in trials showed increased local control and survival. Alternative particle therapies like protons and carbon ions may further enhance local control rates for certain sarcomas. Ongoing research aims to enhance radiotherapy response through anti-angiogenesis agents and modulating DNA damage response pathways.
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1. The document discusses locally advanced breast cancer and the role of radiotherapy. It outlines the anatomy, target volumes, organs at risk and response assessment using tools like MRI.
2. Postmastectomy radiotherapy can reduce the risk of local recurrence by 72% and increase survival rates. The risk of local recurrence is higher with larger tumor size and more positive lymph nodes.
3. The use of neoadjuvant chemotherapy and radiotherapy after mastectomy further reduces the risk of local-regional recurrence compared to no radiotherapy, especially in patients with more advanced clinical stage.
Head & neck cancer
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IMRT is a new treatment method for nasopharyngeal cancer that has the potential to improve local control, especially for T3 and T4 tumors, reduce post-irradiation complications, and reduce the rate of distant metastasis. A study of 13 NPC patients treated with IMRT found that it resulted in reduced acute reactions and improved dosimetry compared to conventional radiotherapy. Further research is needed to optimize target definition and dose distribution in IMRT for NPC.
Stereotactic body radiotherapy
Stereotactic body radiotherapy (SBRT) delivers high-dose radiation to tumors in a small number of fractions using high precision. For prostate SBRT, the target and organs at risk are contoured on planning CT. A dose of 35-38Gy in 5 fractions is used as primary treatment for low risk prostate cancer. Rigid image guidance and intrafraction monitoring are important to minimize setup errors. ExacTrac X-ray positioning co-registers X-rays with digitally reconstructed radiographs and corrects for rotational and translational deviations, achieving sub-millimeter accuracy. This allows safe dose escalation for prostate SBRT.
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This document discusses radiation oncology and radiotherapy for cervical cancer. It begins with an overview of radiation oncology and its use of particles like photons, neutrons, protons and heavy ions to treat cancer. It then focuses on radiotherapy for cervical cancer, describing the different treatment modalities used like external beam radiation therapy and brachytherapy. It also discusses the importance of delineating target volumes accurately on imaging like CT and MRI for treatment planning and conformal radiation therapy.
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This document discusses the use of breast MRI in evaluating response to neoadjuvant chemotherapy. MRI can provide both morphological and functional information about tumors. Studies show DCE-MRI and DWI-MRI may help assess response after 1-2 cycles of chemotherapy, with changes in tumor size, kinetic parameters and ADC values predicting pathological complete or near-complete response. Larger prospective trials are still needed to standardize MRI methods and thresholds to determine if changes on MRI could guide modifications to chemotherapy regimens for non-responders. Overall, MRI shows potential as a predictive marker and non-invasive method for monitoring early response to neoadjuvant breast cancer treatment.Brain metastasis
Brain metastasis is a common complication of systemic cancers. Stereotactic radiosurgery (SRS) is an effective treatment modality for patients with a limited number of brain metastases and good performance status. SRS provides high local tumor control rates comparable to surgery but is non-invasive. While SRS alone risks new metastases developing elsewhere in the brain, combining SRS with whole brain radiation therapy improves local and distant brain control but increases risks of cognitive decline. Patient prognosis depends on factors like performance status, number and size of metastases, and control of the primary cancer.
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IMRT and 3 DCRT in cervical Cancers - Principles, Uses, Methods and Planning. A short summary of results of contemporary series are also provided.
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General Principles and Practical Points in Target Delineation: Esophageal Cancer
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1. IMRT allows delivering different dose levels to multiple tumor targets simultaneously.
2. Advanced MRI techniques like DCE and T2 mapping can help better identify diseased sites and define boost targets for IMRT planning.
3. The presenter is working to incorporate MRI data like functional MRI into the radiotherapy planning process to help optimize dose distribution and improve patient outcomes.
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The document presents a method for generating pseudoCT images from MRI data alone using machine learning. Random forest regression is used to predict electron density values from MRI features. The predicted pseudoCT images are then evaluated by comparing dose distributions and radiological depths to the reference CT. Results show pseudoCTs have better agreement with the reference CT than using tissue substitution phantoms. Further improvements are still needed but this work establishes a full MRI-only radiotherapy workflow for ion beam therapy planning.
AN ANALYSIS OF THE BENEFITS AND ADVANTAGES TO SRT
1) Stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT), and stereotactic body radiotherapy (SBRT) use focused radiation beams and precise targeting to deliver high doses of radiation to small, well-defined tumors with minimal damage to surrounding healthy tissue.
2) Studies have found stereo treatments improve survival rates for certain brain tumors compared to traditional treatments and offer an effective non-invasive option for inoperable lung tumors.
3) The advantages of stereo treatments include targeting small tumors with high radiation doses using fewer treatment sessions, resulting in reduced side effects and improved quality of life for patients.
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This document summarizes 4 abstracts from the AROICON 2018 conference:
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2. The second abstract involves developing a Python script to evaluate treatment plan robustness using both physical and radiobiological parameters for proton pencil beam scanning. The script allowed quick evaluation of perturbed dose distributions.
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CT Dose Issues.pptx on the factors to be considered on radiation protection
summary, mobile radiography allows for the diagnostic imaging of patients who are unable to be seen in the X-ray examination room. Therefore, mobile X-ray equipment is useful for patients who have difficulty with movement. However, staff are exposed to scattered radiation from the patient, and can receive potentially harmful radiation doses during radiography. The protection of staff is of utmost importance; therefore, we investigated the occupational radiation doses received by RTs, particularly eye doses, using phantom measurements. RTs can be located close to a patient (i.e., the source of scattered radiation) during mobile radiography. As eye doses can be significant, protective measures are essential for RTs. Protective aprons are important for protecting RTs, as is increasing the distance from the radiation source (i.e., the patient). Lead glasses may also be necessary for protecting the eyes of RTs. To reduce RT radiation exposure, RTs should remain distant from the patient if possible. However, because this distance may hinder verification of the patient’s condition, RTs sometimes work in close proximity to patients. This is a patient phantom study. In future, the data may need validation by comparison with personal RT dosimeter records. It is important to evaluate the radiation doses delivered to RTs during mobile radiography, as well as the scattered radiation distribution, to ensure adequate protection. Further comparison studies may be needed using the Monte Carlo method.
radiographers and nurses have a responsibility to ensure that no one is within the radiation field during the X-ray exposure of the patient. This is achieved by informing all persons in the immediate area that an X-ray exposure is about to be made and asking them to stand a safe distance from the radiation field area.
Shielding
Placing a barrier of lead or concrete between the radiation source and an individual provides protection from X-radiation (Jones and Taylor, 2006; Ehrlich and Coakes, 2017). During mobile radiography, anyone assisting in an examination and staying in the radiation field should wear a lead-rubber apron or stand behind a mobile lead screen. Generally, walls in special care units where ionising radiation is used are designed to contain the radiation produced by the mobile X-ray tube within a set of criteria and limits determined by relevant legislation (Hart et al, 2002).
Radiation protection during mobile radiography
Nurses' understanding and adherence to radiation protection control measures during mobile radiography is of paramount importance in protecting patients, themselves and members of the public visiting the ward/unit. However, some research studies have found limited awareness and non-adherence to radiation protection control measures among nurses during mobile radiography (Anim-Sampong et al, 2015; Luntsi et al, 2016; Azimi et al, 2018). This can be attributed to a lack of radiation protection awareness programmes for nurses working
UMC St Radboud, Innovatieve imaging biedt grote kansen voor betere iagnostiek...
1. The document discusses using innovative medical imaging techniques to improve prostate cancer diagnosis, treatment, and research through translational research.
2. Multi-modality MRI, MR-guided biopsies, advanced contrast agents, and computer-assisted analysis can help determine cancer aggression, improve detection and localization, aid staging and detection of metastases.
3. Collaboration between clinicians and researchers has potential to develop personalized treatment and screening to optimize outcomes.
Stereotactic Radiosurgery for Lung Cancer
Robert Sinha, M.D., Radiation Oncologist .Western Radiation Oncology - Dorothy Schneider Cancer Center - 2013 Mills-Peninsula Health Services Cancer Symposium
Random and systematic errors 25.10.12
This document provides definitions and examples of random and systematic errors that can occur during the radiotherapy treatment process. It discusses various sources of errors including patient setup, organ motion, and target deformation. Methods for managing errors such as offline and online correction techniques, immobilization devices, and image-guidance are presented. The importance of distinguishing between random and systematic errors when establishing appropriate planning target volume margins is also emphasized.
Role of RT in oropharynx ca 2013 june
This document discusses the role of radiation therapy (RT) in oropharynx cancer treatment. It notes that a multidisciplinary approach is optimal. For early stage disease, RT alone may be sufficient, while for advanced stages concurrent chemoradiation (CCRT) provides better control and survival than RT alone. Data from one center shows comparable outcomes for CCRT versus surgery plus RT. Advanced RT techniques like IMRT can lower toxicity compared to 3D conformal RT. Adaptive RT using parameters like tumor volume reduction may help predict outcomes. Future areas of refinement include improved imaging and de-intensified strategies guided by prognostic factors.
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Imrt A New Treatment Method For Nasopharyngeal Cancer
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Esophageal cancer practical target delineation 2013 may
CT Dose Issues.pptx on the factors to be considered on radiation protection
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UMC St Radboud, Innovatieve imaging biedt grote kansen voor betere iagnostiek...
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Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Osteoporosis is an increasing cause of morbidity among the elderly.
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Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
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ABDOMINAL TRAUMA in pediatrics part one.
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Dehradun #ℂall #gIRLS Oyo Hotel 8107221448 #ℂall #gIRL in Dehradun
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4DCT driving improved lung radiotherapy outcomes at NCCI
- 2. 4 Dimensional CT Driving Improved Lung Radiotherapy Outcomes at NCCI G Livingston, L Connors, A Fonseca, V Connors, P Dwyer and A Last
- 3. North Coast Cancer Institute • 3 Departments • 6 Linear Accelerators • 7 Radiation Oncologists. • 12 Physicists • 55ish Radiation Therapists (including specialty roles – Thoracic RT) • ≈ 2000 Tx per annum
- 4. What’s the problem with Conventional CT? • Tumour Distortions = poor visualisation the tumour • Poor information regarding motion = cannot be sure where or if it moves • Target Delineation errors = less appropriate target size • Less accurate treatment alignment. = rely on bony surrogates.
- 5. Video of RSD phantom
- 8. 4DCT solution • Low-pitched CT scan which images each slice of the patient throughout each phase of the respiratory cycle to produce a series of respiratory phase correlated 3DCT scans. • 4th dimension is respiratory phase.
- 10. CT Data
- 13. Amplitude 3D PTV average 4D PTV average Change (%) Small (0-5mm) n = 12 309cc 281cc 9.1% Medium (5-10mm) n = 7 194cc 213cc 9.8% Large (>1cm) n = 1 167cc 238cc 42.5% PTV Size comparison (n=20)
- 14. Improved Treatment Alignment JAN-JAKOB SONKE, PH.D., JOOS LEBESQUE, PH.D., M.D., AND MARCEL VAN HERK, PH.D. VARIABILITY OF FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY PATIENT MODELS Int. J. Radiation Oncology Biol. Phys., Vol. 70, No. 2, pp. 590–598, 2008
- 15. Improved Treatment Alignment JAN-JAKOB SONKE, PH.D., JOOS LEBESQUE, PH.D., M.D., AND MARCEL VAN HERK, PH.D. VARIABILITY OF FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY PATIENT MODELS Int. J. Radiation Oncology Biol. Phys., Vol. 70, No. 2, pp. 590–598, 2008 Bony alignment: additional 2mm margin surrounding the Target. Neilson T, Hansen V, Westberg J, Hansen O, Brink C. A DUAL CENTRE STUDY OF SETUP ACCURACY FRO THORACIC PATIENTS BASED ON CONE-BEAM CT DATA. Radiother Oncol Vol. 102, pp. 281–286, 2012
- 16. SABR (Stereotactic Ablative Body Radiotherapy) - very high doses (>100Gy RBE) - very few fractions (1-5#) - very small margins (GTV/ITV + 5mm - high precision (Planning and Treatment - highly dependent on 4D imaging
- 17. Locally Advanced NSCLC Grade 2+ Radiation Pneumonitis ~ 30% (including 1-2% fatal). Palma et al 2013 (2012) NCCI implemented 4DCT + IMRT + Daily CBCT as the standard. - Maximising accuracy of RT - Minimising dose to healthy lung, oesophagus and heart
- 19. Thank You thank you to Andrew Last, Pat Dwyer, Lisa Connors, Amara Fonseca, Vanessa Connors and the NCCI Team