This document discusses the history and adoption of intensity-modulated radiation therapy (IMRT). It notes that IMRT was proposed over 40 years ago but was not widely implemented until the 1990s with the availability of commercial treatment planning systems. Two surveys from 2002 and 2004 found that adoption of IMRT in the United States grew rapidly, from 32% to 74% of radiation oncologists using it. While commonly available now, most centers only use IMRT to treat a subset of patients. The document reviews the types of cancer most commonly treated with IMRT and radiation oncologists' impressions of its effects.
This document summarizes the use of intensity-modulated radiation therapy (IMRT) for lung cancer. It discusses:
1) Types of IMRT including LINAC-based step-and-shoot, dynamic, and VMAT techniques as well as tomotherapy-based helical IMRT.
2) Retrospective studies show IMRT improves target coverage and reduces toxicity compared to 3DCRT, though results for organ at risks are mixed.
3) Prospective studies demonstrate the safety and efficacy of hypofractionated IMRT schedules.
4) Proton therapy may further improve sparing of organs at risk compared to photon-based IMRT techniques.
The document discusses intensity-modulated radiation therapy (IMRT) for head and neck cancers. It describes how IMRT improves target coverage and sparing of organs-at-risk like the parotid glands compared to conventional radiation therapy. Studies show IMRT reduces the risk of xerostomia and improves quality of life outcomes for patients.
Intensity modulated radiation therapy (IMRT) is an advanced form of 3D conformal radiation therapy that uses computer-controlled linear accelerators to modulate beam intensities within each beam's projection. This allows for higher radiation doses to be delivered to tumors while reducing doses to surrounding healthy tissues. Treatment planning for IMRT involves inverse planning where optimization software determines the optimal beam intensities to meet dose requirements. Intensity is modulated during treatment using multileaf collimators which shape the beam as it is delivered. IMRT has applications in treating many types of cancer as it improves target dose conformity and reduces doses to organs-at-risk compared to other radiation therapy techniques.
This document provides an overview of Intensity Modulated Radiotherapy (IMRT). It discusses the shift from conventional to conformal radiotherapy using improved imaging and planning techniques. IMRT allows customization of radiation dose distributions through non-uniform beam intensities achieved using dynamic multileaf collimators or compensators. The clinical implementation of IMRT requires treatment planning and delivery systems. IMRT offers advantages over conventional radiotherapy for many cancer types and its use has increased substantially in recent decades.
This document discusses the forward intensity-modulated radiation therapy (IMRT) technique known as field-in-field (FIF) for whole breast radiotherapy. It begins by explaining how FIF uses multiple subfields in addition to the main tangential fields to improve dose homogeneity throughout the breast. Studies show improved homogeneity decreases skin toxicities. The document then evaluates three FIF techniques - single pair of subfields, multiple pairs of subfields, and alternate subfields. It finds the alternate subfields technique provides the best dose distribution and target coverage while being less time-consuming than other techniques. Finally, the document discusses how FIF with lung blocks further reduces lung dose compared to physical wedges.
Intensity modulated radiotherapy (IMRT) uses computer-optimized radiation beam intensities to conform the high dose region to the tumor target while reducing exposure to surrounding normal tissues. Key aspects of IMRT planning include tumor and organ contouring, beam arrangement optimization to meet dose constraints, and quality assurance of treatment delivery. IMRT offers advantages over conventional radiotherapy such as superior dose distribution, better normal tissue sparing, and potential for dose escalation through its ability to sculpt high dose regions closely to irregularly shaped tumor volumes.
This document discusses motion management techniques for lung cancer radiotherapy. It begins by explaining why motion management is important, as standard CT scans do not fully capture lung tumor motion. It then describes 4DCT and other methods for assessing tumor motion, as well as techniques like ITV, gating, tracking and breath-holding to control for motion. Specific examples of tracking systems like ExacTrac and Cyberknife are provided. Overall, the document provides an overview of the challenges of lung tumor motion and different strategies used to manage it in radiation treatment planning and delivery.
This document summarizes the use of intensity-modulated radiation therapy (IMRT) for lung cancer. It discusses:
1) Types of IMRT including LINAC-based step-and-shoot, dynamic, and VMAT techniques as well as tomotherapy-based helical IMRT.
2) Retrospective studies show IMRT improves target coverage and reduces toxicity compared to 3DCRT, though results for organ at risks are mixed.
3) Prospective studies demonstrate the safety and efficacy of hypofractionated IMRT schedules.
4) Proton therapy may further improve sparing of organs at risk compared to photon-based IMRT techniques.
The document discusses intensity-modulated radiation therapy (IMRT) for head and neck cancers. It describes how IMRT improves target coverage and sparing of organs-at-risk like the parotid glands compared to conventional radiation therapy. Studies show IMRT reduces the risk of xerostomia and improves quality of life outcomes for patients.
Intensity modulated radiation therapy (IMRT) is an advanced form of 3D conformal radiation therapy that uses computer-controlled linear accelerators to modulate beam intensities within each beam's projection. This allows for higher radiation doses to be delivered to tumors while reducing doses to surrounding healthy tissues. Treatment planning for IMRT involves inverse planning where optimization software determines the optimal beam intensities to meet dose requirements. Intensity is modulated during treatment using multileaf collimators which shape the beam as it is delivered. IMRT has applications in treating many types of cancer as it improves target dose conformity and reduces doses to organs-at-risk compared to other radiation therapy techniques.
This document provides an overview of Intensity Modulated Radiotherapy (IMRT). It discusses the shift from conventional to conformal radiotherapy using improved imaging and planning techniques. IMRT allows customization of radiation dose distributions through non-uniform beam intensities achieved using dynamic multileaf collimators or compensators. The clinical implementation of IMRT requires treatment planning and delivery systems. IMRT offers advantages over conventional radiotherapy for many cancer types and its use has increased substantially in recent decades.
This document discusses the forward intensity-modulated radiation therapy (IMRT) technique known as field-in-field (FIF) for whole breast radiotherapy. It begins by explaining how FIF uses multiple subfields in addition to the main tangential fields to improve dose homogeneity throughout the breast. Studies show improved homogeneity decreases skin toxicities. The document then evaluates three FIF techniques - single pair of subfields, multiple pairs of subfields, and alternate subfields. It finds the alternate subfields technique provides the best dose distribution and target coverage while being less time-consuming than other techniques. Finally, the document discusses how FIF with lung blocks further reduces lung dose compared to physical wedges.
Intensity modulated radiotherapy (IMRT) uses computer-optimized radiation beam intensities to conform the high dose region to the tumor target while reducing exposure to surrounding normal tissues. Key aspects of IMRT planning include tumor and organ contouring, beam arrangement optimization to meet dose constraints, and quality assurance of treatment delivery. IMRT offers advantages over conventional radiotherapy such as superior dose distribution, better normal tissue sparing, and potential for dose escalation through its ability to sculpt high dose regions closely to irregularly shaped tumor volumes.
This document discusses motion management techniques for lung cancer radiotherapy. It begins by explaining why motion management is important, as standard CT scans do not fully capture lung tumor motion. It then describes 4DCT and other methods for assessing tumor motion, as well as techniques like ITV, gating, tracking and breath-holding to control for motion. Specific examples of tracking systems like ExacTrac and Cyberknife are provided. Overall, the document provides an overview of the challenges of lung tumor motion and different strategies used to manage it in radiation treatment planning and delivery.
Technical Advances in radiotherapy for Lung (and liver) Cancerspa718
This document summarizes recent technical advances in radiotherapy for lung and liver cancer, including: 4DCT imaging to account for tumor motion; motion management techniques like gating and breath-holding; intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) to improve dose conformity; image-guided radiation therapy (IGRT) to reduce margins and enable adaptations; and proton therapy which may further reduce normal tissue dose due to its physical properties, though proton techniques are still evolving to address motion and anatomical changes. The document outlines the benefits and challenges of each technique through examples and studies.
Stereotactic body radiation therapy (SBRT) uses advanced technology to deliver high ablative doses of radiation to tumors in a precise manner. SBRT has been shown to be effective in treating various tumor types with acceptable toxicity. However, long term toxicity requires further study. New techniques aim to reduce treatment margins and account for organ motion to minimize dose to surrounding healthy tissues while ensuring accurate dose delivery to the tumor. SBRT shows promise but further prospective clinical trials are needed to fully evaluate efficacy and safety.
A short overview of Image Guided Radiotherapy process in Lung Cancer presented at TMC Kolkata circa 2016. Basic principles and concepts as well as examples are outlined.
2 d vs 3d planning in pelvic malignanciesAbhishek Soni
Three dimensional radiation treatment planning is superior to two dimensional planning for pelvic malignancies. 3D planning allows for a more accurate definition of the tumor and dose distribution, resulting in a more homogeneous dose to the target volume while better sparing nearby critical organs such as the bladder and rectum. Dose volume histograms based on 3D planning show improved target coverage and lower doses to organs at risk compared to 2D planning. Precise delineation of contours is important for effective 3D planning.
The CyberKnife is a frameless robotic radiosurgery system used to treat both benign and malignant tumors. It was invented in the 1990s and is manufactured by Accuray. It uses a compact linear accelerator mounted on a robotic arm to deliver radiation from many angles and can track tumor motion using X-ray imaging and respiratory tracking sensors. Treatment planning involves defining target volumes and constructing a correspondence model between internal fiducial markers and external sensors to track tumor position in real-time during delivery. The CyberKnife provides an alternative to frame-based radiosurgery and can fractionate treatment over multiple days.
This document provides an overview of intensity modulated radiotherapy (IMRT) including its process, physics, technological implementation, and sites of application. It discusses how IMRT is able to deliver varying radiation intensities within treatment fields using optimized beamlet weights to satisfy clinical objectives. The optimization process and various considerations for treatment planning such as objectives, beam placement, and multi-leaf collimator parameters are also covered at a high level.
A summary of recent innovations in radiation oncology focussing on the priniciples of different techniques and their application. An overview of clinical results has also been given
This document discusses radiotherapy planning and techniques for breast cancer treatment. It describes the iterative process of developing a treatment plan, which involves initial beam arrangement based on clinical experience, reviewing dose distributions, and modifying the plan based on parameters like isodose lines and dose-volume histograms. It also covers challenges like respiratory motion and setup uncertainties, and techniques to address these like deep inspiratory breath hold and respiratory gating. The goal is to deliver the prescribed radiation dose to the target while sparing surrounding healthy tissues as much as possible.
The document discusses standards for precision in radiation oncology, including definitions of target volumes and dose reporting levels according to International Commission on Radiation Units and Measurements (ICRU) reports. It notes unresolved issues for 3D conformal radiation therapy and intensity-modulated radiation therapy, such as margins between gross tumor and clinical target volumes. The document recommends that a new ICRU report is needed to address these modern radiotherapy techniques and provide common guidelines.
Future Developments In Radiation Therapy For Prostate Cancerfondas vakalis
This document discusses future developments in radiation therapy for prostate cancer. It summarizes that dose escalation improves disease control but can increase toxicity risks. Newer radiation techniques like IMRT, fiducial markers, on-board imaging, and protons may allow safer dose escalation by better sparing nearby organs. Further refinements include selective dose painting within the prostate using MRI/MRS imaging fusion to guide treatment. The document also reviews the history and ongoing improvements in brachytherapy techniques for localized prostate treatments.
This document summarizes radiotherapy techniques for treating tumors. It discusses the goals of maximizing dose to the tumor while minimizing dose to normal tissues. It then describes 3D conformal radiotherapy/IMRT which uses CT scans to delineate the tumor and organs at risk, plan the treatment using a treatment planning system, and implement the approved plan. IMRT is described as an advanced form of 3DCRT that allows for a higher conformity of dose to the tumor while better sparing critical structures. IGRT is also summarized as using image guidance to verify treatment setup and correct any errors before beginning the treatment.
1. The document discusses various aspects of intensity-modulated radiation therapy (IMRT) planning and delivery, including the use of inverse planning, optimization objectives and constraints, and different delivery methods like static field, dynamic field, tomotherapy, and VMAT.
2. It also discusses treatment volumes defined in ICRU 83 like gross tumor volume, clinical target volume, planning target volume, and organ-at-risk volumes. The document emphasizes using dose-volume histograms to specify dose rather than a single point.
3. Challenges with overlapping treatment volumes and the importance of evaluating the remaining volume at risk are also covered.
This document summarizes modern advances in radiation treatment for cancer. It discusses how radiation oncology aims to maximize radiation targeting of tumors while sparing surrounding healthy tissues. Key advances discussed include improved dose delivery techniques like IMRT and IMAT, more precise target definition using anatomical and functional imaging, and better target localization using image-guided radiation therapy and on-board imaging. The document also outlines potential future directions like dose escalation techniques like focal boosting, use of charged particle therapy, and stereotactic body radiotherapy.
The document discusses various aspects of radiation oncology and radiotherapy clinical trial design. It provides an overview of the evolution of radiation therapy techniques from the 1960s to present. It also covers important considerations for radiation oncology trials, including target volume delineation, dose schedules, quality assurance measures, and assessing toxicity. Multidisciplinary collaboration and factors influencing radiation sensitivity are also briefly discussed.
Imrt A New Treatment Method For Nasopharyngeal Cancerfondas vakalis
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.
1. Dr. Sheetal R Kashid presented on the use of IGRT for head and neck cancers and central nervous system tumors at TMH.
2. IGRT uses image guidance to precisely position patients and correct for setup errors, allowing for accurate radiation delivery while minimizing dose to surrounding healthy tissues.
3. At TMH, IGRT is performed using CBCT, EPID, and offline protocols to correct for systematic and random errors in head and neck and neuro-oncology patients.
The document discusses patient safety and image quality in x-ray imaging. It notes that ionizing radiation carries risks like carcinogenesis and outlines radiation doses from common medical imaging procedures. Maintaining adequate image quality while avoiding unnecessary radiation exposure requires justification of exams, optimization of protocols, and limiting patient doses. Key principles of radiation protection aim to balance image quality needs with radiation risks.
VMAT (Volumetric Modulated Arc Therapy) was first proposed in 1995 as a form of rotational IMRT. It involves delivering radiation therapy with the linear accelerator gantry rotating continuously around the patient. Intensity modulation is achieved through continuous movement of the MLC leaves as they shape the beam during rotation. VMAT can produce dose distributions similar to IMRT but with fewer monitor units and faster treatment times. Recent advances in treatment planning and linear accelerator control systems now allow for effective clinical implementation of VMAT with either single or multiple full arcs.
This study investigated generating improved 3D treatment plans for telecoabalt machines without MLC by using locally available materials like universal shielding blocks. The study aimed to see if plans similar to IMRT could be created on telecoabalt to help poor patients who cannot afford linear accelerator treatment but need advanced techniques. Two case studies are presented where improved 3D plans were created for telecoabalt that provided dose coverage and sparing of normal tissues comparable to IMRT plans. The conclusion is that 3DCRT/IMRT type plans are feasible on telecoabalt with careful planning using field-in-field techniques and custom shielding blocks.
This document discusses the principles and utility of 3D conformal radiation therapy (3DCRT). It begins by explaining the goals of radiotherapy to maximize dose to the tumor while minimizing dose to normal tissues. It then describes some disadvantages of conventional 2D planning, including lack of 3D visualization and irradiation of large normal tissue volumes. The document goes on to define 3DCRT as radiotherapy that closely conforms the high dose volume to the target while sparing critical tissues. It discusses the history and development of 3DCRT and provides details on target volume definition, treatment planning workflow including imaging, contouring, planning and evaluation.
Treatment Of Stage Iii Nsclc The Role Of Radiation Therapyfondas vakalis
1. Chemo-radiotherapy is the standard of care for stage III non-small cell lung cancer (NSCLC) based on randomized clinical trial outcomes, though local control and toxicity remain issues.
2. Advances in radiation therapy techniques like 3D conformal radiation therapy and intensity modulated radiation therapy may help improve local control and reduce toxicity by better sparing healthy tissues.
3. Patient-specific factors like tumor volume, nodal disease extent, co-morbidities, and dosimetry parameters should be considered to select optimal combined modality treatments and minimize risks.
This document discusses treatment approaches for locally advanced non-small cell lung cancer (NSCLC). It presents a case of stage IIIB NSCLC and reviews the history and evolution of combined modality therapy using chemotherapy and radiotherapy. Concurrent chemoradiotherapy is now the standard of care and research focuses on optimizing radiotherapy dose/fractionation and integrating targeted therapies and prophylactic cranial irradiation to further improve outcomes.
Technical Advances in radiotherapy for Lung (and liver) Cancerspa718
This document summarizes recent technical advances in radiotherapy for lung and liver cancer, including: 4DCT imaging to account for tumor motion; motion management techniques like gating and breath-holding; intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) to improve dose conformity; image-guided radiation therapy (IGRT) to reduce margins and enable adaptations; and proton therapy which may further reduce normal tissue dose due to its physical properties, though proton techniques are still evolving to address motion and anatomical changes. The document outlines the benefits and challenges of each technique through examples and studies.
Stereotactic body radiation therapy (SBRT) uses advanced technology to deliver high ablative doses of radiation to tumors in a precise manner. SBRT has been shown to be effective in treating various tumor types with acceptable toxicity. However, long term toxicity requires further study. New techniques aim to reduce treatment margins and account for organ motion to minimize dose to surrounding healthy tissues while ensuring accurate dose delivery to the tumor. SBRT shows promise but further prospective clinical trials are needed to fully evaluate efficacy and safety.
A short overview of Image Guided Radiotherapy process in Lung Cancer presented at TMC Kolkata circa 2016. Basic principles and concepts as well as examples are outlined.
2 d vs 3d planning in pelvic malignanciesAbhishek Soni
Three dimensional radiation treatment planning is superior to two dimensional planning for pelvic malignancies. 3D planning allows for a more accurate definition of the tumor and dose distribution, resulting in a more homogeneous dose to the target volume while better sparing nearby critical organs such as the bladder and rectum. Dose volume histograms based on 3D planning show improved target coverage and lower doses to organs at risk compared to 2D planning. Precise delineation of contours is important for effective 3D planning.
The CyberKnife is a frameless robotic radiosurgery system used to treat both benign and malignant tumors. It was invented in the 1990s and is manufactured by Accuray. It uses a compact linear accelerator mounted on a robotic arm to deliver radiation from many angles and can track tumor motion using X-ray imaging and respiratory tracking sensors. Treatment planning involves defining target volumes and constructing a correspondence model between internal fiducial markers and external sensors to track tumor position in real-time during delivery. The CyberKnife provides an alternative to frame-based radiosurgery and can fractionate treatment over multiple days.
This document provides an overview of intensity modulated radiotherapy (IMRT) including its process, physics, technological implementation, and sites of application. It discusses how IMRT is able to deliver varying radiation intensities within treatment fields using optimized beamlet weights to satisfy clinical objectives. The optimization process and various considerations for treatment planning such as objectives, beam placement, and multi-leaf collimator parameters are also covered at a high level.
A summary of recent innovations in radiation oncology focussing on the priniciples of different techniques and their application. An overview of clinical results has also been given
This document discusses radiotherapy planning and techniques for breast cancer treatment. It describes the iterative process of developing a treatment plan, which involves initial beam arrangement based on clinical experience, reviewing dose distributions, and modifying the plan based on parameters like isodose lines and dose-volume histograms. It also covers challenges like respiratory motion and setup uncertainties, and techniques to address these like deep inspiratory breath hold and respiratory gating. The goal is to deliver the prescribed radiation dose to the target while sparing surrounding healthy tissues as much as possible.
The document discusses standards for precision in radiation oncology, including definitions of target volumes and dose reporting levels according to International Commission on Radiation Units and Measurements (ICRU) reports. It notes unresolved issues for 3D conformal radiation therapy and intensity-modulated radiation therapy, such as margins between gross tumor and clinical target volumes. The document recommends that a new ICRU report is needed to address these modern radiotherapy techniques and provide common guidelines.
Future Developments In Radiation Therapy For Prostate Cancerfondas vakalis
This document discusses future developments in radiation therapy for prostate cancer. It summarizes that dose escalation improves disease control but can increase toxicity risks. Newer radiation techniques like IMRT, fiducial markers, on-board imaging, and protons may allow safer dose escalation by better sparing nearby organs. Further refinements include selective dose painting within the prostate using MRI/MRS imaging fusion to guide treatment. The document also reviews the history and ongoing improvements in brachytherapy techniques for localized prostate treatments.
This document summarizes radiotherapy techniques for treating tumors. It discusses the goals of maximizing dose to the tumor while minimizing dose to normal tissues. It then describes 3D conformal radiotherapy/IMRT which uses CT scans to delineate the tumor and organs at risk, plan the treatment using a treatment planning system, and implement the approved plan. IMRT is described as an advanced form of 3DCRT that allows for a higher conformity of dose to the tumor while better sparing critical structures. IGRT is also summarized as using image guidance to verify treatment setup and correct any errors before beginning the treatment.
1. The document discusses various aspects of intensity-modulated radiation therapy (IMRT) planning and delivery, including the use of inverse planning, optimization objectives and constraints, and different delivery methods like static field, dynamic field, tomotherapy, and VMAT.
2. It also discusses treatment volumes defined in ICRU 83 like gross tumor volume, clinical target volume, planning target volume, and organ-at-risk volumes. The document emphasizes using dose-volume histograms to specify dose rather than a single point.
3. Challenges with overlapping treatment volumes and the importance of evaluating the remaining volume at risk are also covered.
This document summarizes modern advances in radiation treatment for cancer. It discusses how radiation oncology aims to maximize radiation targeting of tumors while sparing surrounding healthy tissues. Key advances discussed include improved dose delivery techniques like IMRT and IMAT, more precise target definition using anatomical and functional imaging, and better target localization using image-guided radiation therapy and on-board imaging. The document also outlines potential future directions like dose escalation techniques like focal boosting, use of charged particle therapy, and stereotactic body radiotherapy.
The document discusses various aspects of radiation oncology and radiotherapy clinical trial design. It provides an overview of the evolution of radiation therapy techniques from the 1960s to present. It also covers important considerations for radiation oncology trials, including target volume delineation, dose schedules, quality assurance measures, and assessing toxicity. Multidisciplinary collaboration and factors influencing radiation sensitivity are also briefly discussed.
Imrt A New Treatment Method For Nasopharyngeal Cancerfondas vakalis
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.
1. Dr. Sheetal R Kashid presented on the use of IGRT for head and neck cancers and central nervous system tumors at TMH.
2. IGRT uses image guidance to precisely position patients and correct for setup errors, allowing for accurate radiation delivery while minimizing dose to surrounding healthy tissues.
3. At TMH, IGRT is performed using CBCT, EPID, and offline protocols to correct for systematic and random errors in head and neck and neuro-oncology patients.
The document discusses patient safety and image quality in x-ray imaging. It notes that ionizing radiation carries risks like carcinogenesis and outlines radiation doses from common medical imaging procedures. Maintaining adequate image quality while avoiding unnecessary radiation exposure requires justification of exams, optimization of protocols, and limiting patient doses. Key principles of radiation protection aim to balance image quality needs with radiation risks.
VMAT (Volumetric Modulated Arc Therapy) was first proposed in 1995 as a form of rotational IMRT. It involves delivering radiation therapy with the linear accelerator gantry rotating continuously around the patient. Intensity modulation is achieved through continuous movement of the MLC leaves as they shape the beam during rotation. VMAT can produce dose distributions similar to IMRT but with fewer monitor units and faster treatment times. Recent advances in treatment planning and linear accelerator control systems now allow for effective clinical implementation of VMAT with either single or multiple full arcs.
This study investigated generating improved 3D treatment plans for telecoabalt machines without MLC by using locally available materials like universal shielding blocks. The study aimed to see if plans similar to IMRT could be created on telecoabalt to help poor patients who cannot afford linear accelerator treatment but need advanced techniques. Two case studies are presented where improved 3D plans were created for telecoabalt that provided dose coverage and sparing of normal tissues comparable to IMRT plans. The conclusion is that 3DCRT/IMRT type plans are feasible on telecoabalt with careful planning using field-in-field techniques and custom shielding blocks.
This document discusses the principles and utility of 3D conformal radiation therapy (3DCRT). It begins by explaining the goals of radiotherapy to maximize dose to the tumor while minimizing dose to normal tissues. It then describes some disadvantages of conventional 2D planning, including lack of 3D visualization and irradiation of large normal tissue volumes. The document goes on to define 3DCRT as radiotherapy that closely conforms the high dose volume to the target while sparing critical tissues. It discusses the history and development of 3DCRT and provides details on target volume definition, treatment planning workflow including imaging, contouring, planning and evaluation.
Treatment Of Stage Iii Nsclc The Role Of Radiation Therapyfondas vakalis
1. Chemo-radiotherapy is the standard of care for stage III non-small cell lung cancer (NSCLC) based on randomized clinical trial outcomes, though local control and toxicity remain issues.
2. Advances in radiation therapy techniques like 3D conformal radiation therapy and intensity modulated radiation therapy may help improve local control and reduce toxicity by better sparing healthy tissues.
3. Patient-specific factors like tumor volume, nodal disease extent, co-morbidities, and dosimetry parameters should be considered to select optimal combined modality treatments and minimize risks.
This document discusses treatment approaches for locally advanced non-small cell lung cancer (NSCLC). It presents a case of stage IIIB NSCLC and reviews the history and evolution of combined modality therapy using chemotherapy and radiotherapy. Concurrent chemoradiotherapy is now the standard of care and research focuses on optimizing radiotherapy dose/fractionation and integrating targeted therapies and prophylactic cranial irradiation to further improve outcomes.
This document summarizes information about Hodgkin's and non-Hodgkin's lymphoma, including:
- Hodgkin's lymphoma accounts for about 30% of malignant lymphomas and is typically treated initially with ABVD chemotherapy plus radiation therapy. Non-Hodgkin's lymphoma is more common and heterogeneous.
- For advanced Hodgkin's lymphoma, BEACOPP chemotherapy is more effective than COPP/ABVD but also more toxic, increasing risks of infertility, premature menopause, and leukemia.
- Long-term survivors of Hodgkin's lymphoma face elevated risks of secondary cancers decades later due to effects of treatment.
This document discusses intensity-modulated radiotherapy (IMRT) and inverse planning. It describes the rationale for IMRT, including improving dose distribution to reduce normal tissue complications and improve quality of life. The document outlines the complex IMRT planning process, including structure segmentation, treatment optimization, and inverse planning using optimization algorithms to determine optimal beamlet weights. It also discusses key elements of inverse planning systems, such as dose calculation and optimization objectives and methods.
The document provides a list of locations and sights in Istanbul, Turkey, including amateur fisherman, Aya Sofia and Topkapi at Night, BuyukAda vapur Terminal, BuyukAda, Cankaya Palace-BuyukAda, Dolmabahce Mosque, Bosphorus Bridge, Istanbul - Bosphorus and Bridge, Military High School (Kuleli), Bosphorus Castle and Wall-(RumeliHisarı), Simit Seller, Sunset on HeybeliAda, VAPUR, and Yali on Bosphorus.
The Greek islands offer a beautiful vacation destination with over 200 islands dotting the Aegean Sea. Popular islands include Santorini known for its whitewashed cliffs and caldera views, as well as Mykonos with its charming windmills and beaches. Visitors can enjoy Greek culture, history, cuisine and relaxing beaches when traveling to the islands.
This document summarizes the arguments for proton therapy versus intensity-modulated radiation therapy (IMRT) for prostate cancer treatment. It discusses 1) clinical results from non-randomized studies showing similar toxicity but some dosimetric advantages for proton therapy, 2) the similar biology of proton and photon radiation but the potential for reduced neutron contamination and second cancers with proton therapy, and 3) dosimetric modeling showing the superior dose distributions and reduced doses to organs at risk that proton therapy can provide compared to IMRT. It concludes that while randomized data is still needed, proton therapy has the potential for improved toxicity outcomes compared to IMRT.
Varian is the leading provider of radiation therapy solutions with 60% of the global market share. To maintain its position amid increasing competition, Varian focuses on developing new precision treatment technologies like IMRT and IGRT. Recent products like RapidArc and the Novalis TX collaboration with BrainLab expand Varian's offerings and directly compete with solutions from Elekta, Siemens, and Accuray. Varian also invests in proton therapy to capitalize on its long-term advantages over other technologies and sustain growth over the next five years.
1) The document describes a conceptual journey through scales of size from 1 meter to billions of light years and back down to fractions of a nanometer.
2) It explores scales from the size of leaves to the size of galaxies and discusses what can be observed at each magnitude of size.
3) The document suggests that the laws of the universe remain consistent across all scales and ponders fundamental questions about humanity's place and understanding of the cosmos.
This document lists various brand names and product categories without context or details. It mentions brands like Lancôme, Nike, Burger King, and categories such as tobacco, sports, beverages, dental care, bags, and miscellaneous items along with some product names like Harry's Bread and window cleaner.
The document provides instructions for taking a photo using a monitor by sitting in front of it, looking directly at the lens, and pressing "TAKE PHOTO" without moving. It then claims this is a test of a new technology that converts monitors into cameras. Further instructions are given to move slightly left and smile for the photo before a message indicates the photo ability is fake and to get back to work.
Early Stage Nsclc The Role Of Chemotherapyfondas vakalis
- The document discusses the role of chemotherapy in early stage non-small cell lung cancer (NSCLC), including adjuvant and induction chemotherapy.
- Several studies on induction chemotherapy found it to be safe and feasible prior to surgery, with high rates of tumor response and similar postoperative complications compared to surgery alone. However, larger phase III studies are still ongoing.
- The optimal use of chemotherapy, whether adjuvant or induction, in early stage NSCLC remains unclear and requires completion of current clinical trials.
Eric Grohe es un artista que pinta murales hiperrealistas de gran escala directamente en paredes. Transforma paredes ordinarias en obras de arte tridimensionales mediante el uso de detalles finos y colores realistas. Eric trabaja solo en la mayoría de los proyectos, investigando y diseñando cada pieza desde cero.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
1) Intensity modulated radiation therapy (IMRT) is a technique that uses computer software to conform the radiation dose to the shape of the tumor, reducing dose to surrounding normal tissues and decreasing toxicity.
2) Numerous studies have shown IMRT provides better sparing of the small bowel, bladder, and rectum compared to conventional radiation for gynecologic cancers.
3) IMRT may allow dose escalation to high risk sites or involved nodes while maintaining normal tissue doses. Some studies have also investigated using IMRT as an alternative to brachytherapy boosts.
4) Clinical studies suggest IMRT results in low rates of acute gastrointestinal and genitourinary toxicity compared to conventional radiation for
This document discusses the integration of intensity-modulated radiation therapy (IMRT) and brachytherapy in the treatment of cervical cancer. It notes that while IMRT and brachytherapy were once seen as competing approaches, they can be integrated to provide comprehensive adaptive radiation treatment. Several studies demonstrate the tumor shrinkage observed during both external beam radiation and brachytherapy, allowing opportunities for treatment adaptation. Overcoming technical challenges like deformable image registration will be needed to enable daily adaptive IMRT integrated with adaptive brachytherapy planning based on imaging. This has the potential to further improve outcomes for cervical cancer patients.
Dr. Puneet Seth is a radiation oncologist who has worked in several hospitals in India implementing new radiotherapy techniques like IMRT and IGRT using Varian linear accelerators. He is now at BSR Cancer Hospital in Bhilai, Chhattisgarh where he plans to install a new unique Varian linear accelerator by end of 2012/2013 that will enable techniques like RapidArc and IGRT to treat cancer patients in the region. The new setup will help improve treatment planning and delivery compared to the existing older cobalt unit through features like the Millennium MLC and integrated CT simulation.
ERT is effective in treating thyroid cancer in adjuvant and salvage settings, but is underused due to fears of side effects. Newer RT techniques like IMRT and IGRT can help increase the benefits of ERT by reducing toxicity while maintaining tumor control.
Treatments of breast cancer in 2012: Where are we now? - Janice WalsheIrish Cancer Society
- The document discusses treatment approaches for breast cancer in 2012, including updates in diagnostics and therapies such as Oncotype DX testing, hormonal therapies, chemotherapy, and targeted therapies.
- It provides an overview of staging breast cancer and how factors like tumor size, lymph node involvement, and hormone receptor status influence treatment decisions.
- Testing such as Oncotype DX can help determine which early-stage, hormone receptor-positive, lymph node-negative breast cancer patients are likely to benefit from chemotherapy based on their recurrence score. This helps avoid unnecessary chemotherapy treatment and side effects.
This document discusses the risks of low-level radiation exposure from medical imaging procedures like CT scans. It notes that while there is no scientific consensus on radiation risks, international organizations assume the linear no-threshold model which states that any increase in radiation dose, no matter how small, results in an incremental increase in risk. The document outlines strategies that radiologists can employ to optimize CT protocols and reduce radiation doses for patients, such as using automatic exposure control, iterative reconstruction techniques, indication-based protocols, and monitoring doses at the patient and department levels. Radiologists are urged to take the lead in minimizing radiation exposures from medical imaging when it is clinically appropriate.
The document discusses considerations for larynx preservation approaches in treating head and neck cancers. It reviews milestones in the development of nonsurgical options, including the role of chemotherapy and radiation therapy. Two generations of larynx preservation trials are examined that evaluated induction chemotherapy followed by radiation therapy or concurrent chemoradiation, finding larynx preservation rates of 50-70% with equivalent survival outcomes to total laryngectomy. Ongoing questions remain around the most effective and least toxic treatment protocols.
ROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICSKanhu Charan
This document discusses soft tissue sarcomas. It begins by listing various histologic diagnoses of soft tissue sarcomas categorized by tissue of origin. It then discusses imaging with MRI and CT to evaluate tumors. Key points regarding surgery include performing limb-sparing over amputation when possible and obtaining negative margins of at least 2cm if no post-op radiation is planned. Adjuvant radiation improves local control but not necessarily survival. Pre-op radiation may increase wound complications compared to post-op.
This document discusses the use of radiosurgery, specifically CyberKnife, for gastrointestinal (GI) tumours. It provides an overview of common GI cancers such as liver, pancreatic and colorectal cancers. It then discusses various treatment options for these cancers including surgery, chemotherapy, radiotherapy, radiosurgery, stereotactic body radiation therapy and targeted therapies. It focuses on the use of CyberKnife for treatment of liver tumours such as hepatocellular carcinoma and liver metastases. Key benefits of CyberKnife highlighted are its precision, ability to track tumour motion, and delivery of high radiation doses in a short course of treatment.
Neoadjuvant therapy in colorectal carcinomaAnkita Singh
- Several studies have shown that neoadjuvant therapy decreases local recurrence rates in colorectal cancer when compared to surgery alone. One study showed a statistically significant decrease in local recurrence with the addition of chemotherapy to preoperative radiotherapy.
- Evidence indicates that long-course chemoradiotherapy, induction chemotherapy followed by long-course chemoradiotherapy, and short-course radiotherapy are the three accepted neoadjuvant approaches, with long-course chemoradiotherapy being the most commonly used currently. Short-course radiotherapy has also shown non-inferior oncologic outcomes compared to long-course chemoradiotherapy in some studies.
1) The document discusses optimal practice in radiation treatment for head and neck cancer in the 21st century, focusing on balancing treatment targets and sparing normal tissues using available technology and expertise.
2) It reviews treatment options and approaches for different stages of head and neck cancer, highlighting evidence that altered fractionation and chemoradiation can improve outcomes over standard radiation alone.
3) Challenges of implementing intensity-modulated radiation therapy (IMRT) for head and neck cancer are discussed, as well as examples of how IMRT can improve target coverage and tissue sparing compared to conventional techniques.
Surgical (or Non-Surgical) Managment of Thyroid Cancer in the Era of "Over-Di...OSUCCC - James
This document discusses the rising rates of thyroid cancer diagnosis and treatment in the United States, and strategies to address the issue of potential over-diagnosis and over-treatment. It notes that while new thyroid cancer cases have tripled in recent decades, mortality rates have remained stable, suggesting many of these additional diagnoses are indolent cancers that do not require aggressive treatment. The document advocates for more conservative surgical management and observation for small, low-risk cancers. It also proposes renaming some indolent cancers and limiting unnecessary imaging to help reduce over-treatment. While these approaches could help address the problem of over-diagnosis, challenges remain in differentiating cancers requiring treatment from those that can be safely observed.
Whole body screening using CT involves risks and benefits that are debated. While it may detect some cancers early, many abnormalities detected may not be life-threatening. Following up on these abnormalities could lead to patient anxiety, additional testing with radiation exposure or other risks, and overdiagnosis of inconsequential findings. Current policies support targeted CT screening for certain high-risk individuals but do not recommend whole body screening for healthy asymptomatic people due to a lack of evidence for clear benefits outweighing the risks.
This document discusses care of cancer survivors and outlines the following key points in 3 sentences:
1) Approximately 3% of the population are cancer survivors, with many being elderly and having multiple comorbidities. 2) Both cancer-related and general medical needs must be addressed in cancer survivors, including surveillance for recurrence, late effects of treatment, and new primary cancers as well as screening and management of comorbidities. 3) The role of primary care physicians in providing ongoing care for cancer survivors along with survivorship care plans is reviewed.
The Epidemic of Thyroid Nodules: Which Should Undergo Fine Needle Aspiration?u.surgery
The document discusses thyroid nodules and guidelines for performing fine needle aspiration (FNA). It notes that while thyroid nodules are common, detected in up to 67% of ultrasound exams, only 5-15% of nodules are malignant. Sonographic features that increase the likelihood of malignancy include microcalcifications, irregular margins, hypoechogenicity, and intranodular flow. The document recommends FNA for nodules over 1 cm in size or if sonographic features suggest cancer risk. Strategic FNA based on risk factors aims to identify the minority of nodules that are cancer while avoiding unnecessary biopsies of predominantly benign nodules.
Novedades en Cardiopatía Isquémica en los principales congresos del año
24/11/15 18:00h - 20:00h Casa del Corazón, Madrid
Intervencionismo en Cardiopatía Isquémica
Dr. Iván Núñez Gil, Hospital Universitario Clínico San Carlos (Madrid)
The document discusses survey results from clinical investigators and practicing oncologists on their use of adjuvant chemotherapy regimens for breast cancer patients. The most common regimens used were anthracycline-containing regimens like AC for node-negative patients and TAC for node-positive patients. More clinicians were using taxane-containing regimens like AC followed by paclitaxel or docetaxel-cyclophosphamide over time. Most were also aware of and using genomic assays like Oncotype DX or MammaPrint to guide treatment decisions.
The document discusses survey results from clinical investigators and practicing oncologists on their use of adjuvant chemotherapy regimens for breast cancer patients. The most common regimens used were anthracycline-containing regimens like AC for node-negative patients and TAC for node-positive patients. More clinicians were using taxane-containing regimens like AC followed by paclitaxel or docetaxel-cyclophosphamide over time. Many clinicians had information on or used gene expression assays like Oncotype DX or MammaPrint to guide chemotherapy decisions.
This document discusses head and neck cancer and radiation therapy. It provides background information on head and neck cancers, noting they make up 6-9% of cancers and are more common in males. Risk factors include smoking, alcohol, HPV, and EBV. It then discusses the components of radiation therapy planning and delivery in detail, including patient preparation, positioning, volume definition, portal arrangement, dose and fractionation, plan acceptance, adding chemotherapy, and managing complications. The importance of a multidisciplinary team approach is also emphasized.
- Pathological examination of rectal cancer specimens after total mesorectal excision (TME) surgery or pre-operative chemoradiotherapy can provide important prognostic information and assess treatment response. This includes evaluating the circumferential resection margin (CRM) and quality of mesorectal excision.
- A close or positive CRM is a strong predictor of local recurrence. Pre-operative chemoradiotherapy can reduce but not eliminate CRM involvement. The plane of surgery and tumour characteristics also impact local recurrence risk.
- Assessing tumour regression grade after chemoradiotherapy allows prediction of survival and recurrence. A good regression grade correlates with improved outcomes.
This document discusses pancreatic cancer and its treatment. It begins by stating that pancreatic cancer is most commonly diagnosed as locally advanced or metastatic. It then discusses the role of surgery, chemotherapy, and radiation therapy in the treatment of pancreatic cancer. It notes that the majority of surgically treated patients will have a recurrence, with a median survival of 15-20 months. The value of adjuvant and neoadjuvant therapy is debated. The document summarizes several clinical trials investigating chemotherapy and chemoradiation as adjuvant treatment after surgery. It also discusses neoadjuvant therapy and its potential advantages over adjuvant therapy. Emerging strategies discussed include induction chemotherapy followed by localized chemoradiation or second line therapy. The document concludes by describing modern radiation
This document provides information on the evaluation and treatment of metastatic bone disease and spinal cord compression. It discusses:
1. Common sites of bone metastases from various primary cancers. Imaging tools to evaluate bone metastases like x-rays, bone scans, CT, PET, and MRI scans are described.
2. A multi-disciplinary treatment approach is recommended, including medical treatment, surgery, radiotherapy, radionuclides, chemotherapy, and hormonal therapy.
3. Details are provided on conventional and advanced radiation therapy techniques for treating bone metastases and spinal cord compression, including stereotactic radiosurgery. Overall pain relief rates, time to pain relief, and the benefits of combining surgery and radiation therapy are
This document discusses stereotactic body radiotherapy (SBRT) for early stage lung cancer patients who cannot undergo surgery. It describes how SBRT delivers a high radiation dose to the tumor in just 1-5 sessions. Studies show SBRT provides improved tumor control compared to conventional radiotherapy, with surprisingly low toxicity. Early investigations found 3-year tumor control rates of 60-80% with SBRT, similar to surgery. Larger prospective trials of SBRT for medically inoperable early stage lung cancer patients demonstrated 3-year local control of 90-98% and low risks of side effects. SBRT provides an effective non-invasive alternative to surgery for these high-risk patients.
Spinal cord compression bhf aos study day mar 2014 finalfondas vakalis
This document provides an overview of malignant spinal cord compression (MSCC). It begins with a clinical case of a 56-year-old man initially diagnosed with back pain who is later found to have prostate cancer with MSCC. The talk then covers the anatomy of the spinal cord, definition and incidence of MSCC, typical symptoms, investigations including MRI, and treatment options like surgery, radiotherapy, and steroids. Outcomes are discussed, with the median survival being 6 months. The document concludes by outlining the key priorities for implementing NICE guidance on MSCC, including early detection and treatment of suspected cases as emergencies.
The document discusses breast cancer treatment recommendations including:
- No radiation therapy is recommended for early stage DCIS or invasive breast cancer.
- A tumor bed boost is recommended for higher risk patients but large trials found no survival difference with or without a boost.
- Hypofractionated whole breast radiation has become a standard option based on trials showing no difference in survival outcomes compared to conventional fractionation.
- Several trials investigated omitting axillary lymph node dissection or radiation with favorable results for select patient groups with low tumor burden.
This document discusses recent data on radiation therapy for prostate cancer. It begins by outlining the risk of prostate cancer development and mortality rates over time. It then examines risk stratification systems and treatment options for low, intermediate, and high risk disease. The document focuses on the benefits of dose escalation in radiation therapy, noting several studies that found higher radiation doses improved outcomes with acceptable toxicity when using newer techniques like IMRT. It also discusses hypofractionated regimens and image-guided radiation as ways to further improve the therapeutic ratio. In summary, this document reviews evidence that higher and more precisely delivered radiation doses can improve prostate cancer control while maintaining reasonable side effects.
The document discusses the benefits of meditation for reducing stress and anxiety. Regular meditation practice can help calm the mind and body by lowering heart rate and blood pressure. Studies have shown that meditating for just 10-20 minutes per day can have significant positive impacts on both mental and physical health over time.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like depression and anxiety.
This document summarizes a presentation on new perspectives on second-line therapy for non-small cell lung cancer (NSCLC). The presentation discusses current standards of care for second-line NSCLC, the unique needs of patients without targetable mutations, and emerging research findings. One study presented was the LUME-Lung 1 trial which found that the addition of the angiogenesis inhibitor nintedanib to docetaxel improved progression-free survival compared to placebo plus docetaxel in second-line NSCLC, with a significant overall survival benefit seen in the adenocarcinoma subgroup. Outstanding issues regarding biomarkers and the role of nintedanib in squamous cell carcinoma were discussed.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like depression and anxiety.
The document discusses the radiobiology behind dose fractionation in radiation therapy. It provides an overview of the linear quadratic model which describes how cell survival changes with dose and is used to determine biologically equivalent doses for different fractionation schedules. The model assumes equal effect per fraction but may not be accurate at high or low doses. Fractionation takes advantage of the four R's - repair, repopulation, redistribution, and reoxygenation - to better kill tumors while sparing normal tissues. The alpha/beta ratio indicates a tissue's sensitivity to fractionation and is used to estimate equivalent total doses for different fraction sizes.
The document discusses how tumor radiobiology may impact the move toward hypofractionation in radiation therapy. It reviews evidence that the classic linear-quadratic model does not fully capture tumor response at high radiation doses, and that other factors like vascular damage and immune effects become more important. Response heterogeneity between different tumor cell populations may also help explain why survival curves appear more linear at higher doses per fraction.
Rectal cancer treatment typically involves surgery. Local recurrence after conventional surgery occurs in 15-65% of cases on average. Long course preoperative chemoradiotherapy has been shown to reduce local recurrence rates compared to short course preoperative radiotherapy or radiotherapy alone. It increases local tumor control and survival rates with some toxicities but does not reduce colostomy rates. Preoperative chemoradiotherapy is superior to postoperative chemoradiotherapy in reducing local recurrence rates without affecting overall survival.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
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
14. Explain the concepts of current of injury, J point, and their significance
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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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3. “…further refining of delivery technology and the inverse planning
system, gaining clinical experience to address target definition and
dose inhomogeneity within the targets, and understanding the partial
volume effect on normal tissue tolerance are needed for IMRT to
excel in the treatment of head and neck cancer….”
4. Today
IMRT is no longer a “new” or “novel”
technology
IMRT has literally “grown up”
Pre-IMRT era seems like a long time
ago
5. IMRT
A major revolution in
our field
Fundamentally
changed the way we
plan and deliver
radiation therapy
6. IMRT Revolution
“There are no non-violent
revolutions…”
Malcolm X
Resulted in the upheaval of
the daily lives of all of us
(physicians and medical
physicists alike)
7. IMRT Revolution
Proposed over 40 years ago by
Takahashi in Japan
Takahashi et al. Acta Radiol 1965;242
1st attempted in the late 1960s by
Hellman and colleagues (JCRT)
Deemed infeasible due to excessive
planning and delivery times
8. IMRT Implementation
In mid-1990s, IMRT began to be used
at select academic centers
Not till the late 1990s with the
availability of commercial treatment
planning systems did IMRT start to
become widely available
Currently, 10 commercial planning
systems and 7 commercial delivery
systems
9. Commercial Planning Systems
BrainLAB (brainlab.com) BrainScan
CMS, Inc. (cmsrtp.com) Xio IMRT
Elekta (elekta.com) PrecisePlan
NOMOS (nasmedical.com) CORVUS
Philips (medical.philips.com) Pinnacle-PRO
Prowess Inc (prowess.com) Panther DAO
RAHD (rahd.com) 3D/Pro, Konrad
Siemens (siemens.com) Konrad
Tomotherapy (tomotherapy.com) Hi-Art
Varian (varian.com) Eclipse
Hamilton et al. Treatment Planning
IMRT: A Clinical Perspective. Mundt A, Roeske J (editors)
BC Decker, Toronto, 2005
10. Commercial Delivery Systems
brainlab.com
BrainLAB
elekta.com
Elekta
nasmedical.com
NOMOS
Southeastern Radiation
seradiation.com
Products
siemens.com
Siemens
tomotherapy.com
Tomotherapy
varian.com
Varian
Saw C, Ayyangar K, Krishna K, Wu A, Kalnicki S
Delivery Systems
IMRT: A Clinical Perspective. Mundt A, Roeske J (editors)
BC Decker, Toronto, 2005
12. IMRT Surveys
Two surveys performed to assess the
level of IMRT use in the United States
2002 Survey (450 Radiation Oncologists)
Mell LK, Roeske JC, Mundt AJ.
Cancer 2003;204-211
2004 Survey (500 Radiation Oncologists)
Mell LK, Mehrotra AK, Mundt AJ.
Cancer 2005;104:1296-1301
13. IMRT Surveys
Adoption was at first slow, but later
occurred at a very rapid rate
In the 2002 survey, 32% of radiation
oncologists were using IMRT
In the 2004 survey, this percentage
increased to 74%
14. Cumulative IMRT Adoption (USA)
100%
90%
80%
Percent of Physicians
70%
60%
50%
40%
30%
20%
10%
0%
1992 1995 1998 2001 2004*
*As of 8/04
Year
Mell LK, Mundt AJ. Survey of IMRT Use in the USA - 2004
American Radium Society Barcelona Spain 2005
15. IMRT Adoption
Initially only used at a few academic
institutions with home-grown systems
With advent of commercially available
planning systems, tremendous adoption
seen in private practice community
17. IMRT Utilization
Wide variety of sites are now being
treated
Top 3
Prostate, Head and Neck, CNS
In recent years, increasing interest in
other sites
Gynecology, GI, Breast
18. IMRT Practice Survey (2004)
Top Treated Sites
Site % __
Prostate 85%
Head and Neck 80%
CNS 64%
Gynecology 35%
Breast 28%
GI 26%
Sarcoma 20%
Lung 22%
Pediatrics 16%
Lymphoma 12%
Mell LK, Mundt AJ. Survey of IMRT Use in the USA- 2004
Cancer 2005;104:1296
19. IMRT Use
While commonly available, it is being
used to treat only a subset of patients at
most centers
Rarely used in a large percentage of
patients under treatment
20. IMRT Use
100%
Majority of IMRT 80%
users (73%) treat 60%
<1/4 of their
40%
patients with IMRT
20%
<5% use it in >1/2
of their current 0%
% Percentage
patients
<25% 25-50%
51-75% >75%
21. Clinical Impressions
2004 Survey asked clinical impressions
of IMRT users
Overwhelmingly favorable
Most only able to comment on acute
toxicity
Few could comment on chronic toxicity
or tumor control
22. Acute Toxicity
Most (87%) felt 50
acute toxicity was 45
similar or better 40
than conventional 35
30
RT 25
13% felt it was 20
worse (primarily in 15
head/neck cancer*) 10
5
*many of these also reported 0
↓acute toxicity in prostate pts Better Same Worse
23. Chronic Toxicity
55% could assess
chronic toxicity 80
70
Of these, great
majority (73%) felt 60
it was better than 50
standard RT 40
Only 1 felt it was 30
worse 20
10
No 2nd tumors
noted (even among 0
Better Same Worse
long-term users)
24. Tumor Control
60
47% could assess
tumor control 50
Of these, the 40
majority felt it was 30
superior or similar
20
None felt it was
worse 10
0
Better Same Worse
25. Future IMRT Use
IMRT use will continue to grow
Majority of current radiation oncology
residents are taught IMRT
Survey of Chief Residents at 77
programs → 87% hands on experience
>50% planned and treated >25 IMRT pts
Wide variety of tumor sites
Malik R, Mundt AJ et al.
Survey of Resident Education in IMRT
Technol Cancer Res Treat 2005;4:303-309
26. Disease Sites Treated
Resident Survey
Site %
Head and Neck 92%
Prostate 81%
CNS Tumors 56%
Pediatrics 38%
Gynecology 24%
Recurrent/Palliative 24%
Breast 21%
GI 21%
Lung 15%
Lymphoma 7%
29. Reasons for Adopting IMRT
Normal Gain
Tissue Escalate Competitive Remain
Advantage Competitive
Sparing Dose
100
90
92%
80
89%
70
60
50
Research
40
30 38%
36%
Other*
20
10
10%
0
1 2 3 4 5 6
*”…don’t all boys love new toys?”
30. Motivations
Financial reasons are common
New billing codes added in 2001 making
reimbursement 4 times conventional
In 2004, reimbursement rates revised
down to 2.8 times conventional RT
31. Financial Motivations
Led some physicians to make false
claims about IMRT
Internet is full of such misinformation
Review of IMRT websites → 42% have
false and/or misleading information
(including many academic sites!)
Schomas D, Mell LK, Mundt AJ.
IMRT and the Internet: Evaluation of Content and
Quality of Patient-Oriented Information
Cancer 2004;101:412-20
32. Example Statements
Conventional prostate RT can leave the patient
impotent and incontinent…IMRT dramatically
decreases these problems
IMRT is a kindler and gentler treatment because it
leaves healthy tissues alone
IMRT beams intersect on the tumor by turning
corners
The promise of IMRT lies in its ability to focus
treatment only on the tumor
34. Less Cynical View
Improves sparing of normal tissues,
reducing the risk of acute and chronic
sequelae → Improving patient quality of
life
Improves ability to dose escalate high
risk patients, cover of difficult targets
and even safely re-irradiate patients →
Improving tumor control
35. And Importantly…..
IMRT rests on an
ever growing foundation
of convincing clinical
data
36. IMRT Literature
Initially devoted exclusively to physics
issues, e.g. tongue and groove effect,
QA, etc.
Clinical studies have become
increasingly common in recent years
39. 0
20
40
60
80
100
120
140
160
180
200
H ea d/N
e ck
P ro s ta t
e
B re a s t
C NS
G yn e
L un g
GI
P ed s
S ar co m
IMRT Clinical Studies
a
O th e r
40. IMRT Outcome Studies
100
90
80
70
60
50
40
30
20
10
0
er
S
k
st
I
e
ds
te
G
ec
yn
CN
ea
th
ta
Pe
/N
G
os
O
Br
ad
Pr
He
41. Clinical Studies
160
140
120
100
80
60
40
20
0
'96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06
Larger series
Early Small Series
Longer follow-up
Very limited follow-up
Wide variety of disease
Mostly prostate and
sites
head/neck
42. Every Red J now has IMRT outcome studies
Mackley et al.
IMRT for pituitary adenomas: preliminary report of the Cleveland
Clinic Experience
Daly et al.
IMRT for malignancies of the nasal cavity and paranasal sinuses
Bossi et al.
IMRT for preoperative posterior abdominal wall irradiation of
Retroperitoneal liposarcomas
43. Lessons from the Literature
A number of reports highlight various
issues/problems/toxicities in IMRT
patients
Such reports improve the quality and
delivery of IMRT
Teach us how to do IMRT and how not
to do it
44. Mundens et al. (MD Anderson)
Radiation Injury to the liver after IMRT in patients
with mesothelioma: An unusual CT appearance
AJR 2005;184:1091-5
Lee N et al. (UCSF)
Skin toxicity due to IMRT for head/neck cancer
Int J Radiat Oncol Biol Phys 2002;53:630-7
Uy et al. (Baylor)
IMRT for meningioma
Int J Radiat Oncol Biol Phys 2002;53:1265-7
De Neve W et al.
Lethal pneumonitis in a phase I study of chemotherapy
And IMRT for lung cancer
Radiother Oncol 2005
47. IMRT Studies
Prospective cooperative group trials
evaluating IMRT are now appearing
Most importantly, Phase III clinical trials
are being undertaken
49. “IMRT Era”
Truly an exciting time for IMRT
Becoming standard in many disease sites
Also being used in ever more
sophisticated ways
50. IMRT will become
increasingly common
in the treatment
recurrent disease
Stephanie Milker-Zabel (Heidelberg)
IMRT for Recurrent Spinal Metastasis
IMRT: A Clinical Perspective BC Decker 2005
51. Electron IMRT
Isodose distribution of
a parotid cancer planned
with electron IMRT
↑conformity and sparing
of underlying tissues
Song Y, Boyer A, Xing L et al. (Stanford)
Modulated Electron Radiation Therapy
IMRT: A Clinical Perspective BC Decker 2005
52. “Repair” of Unacceptable Brachytherapy
Prostate Implants
Original Brachy IMRT Brachy + IMRT
Li XA, Wang JZ (U Maryland)
Repair of Unacceptable Implants
IMRT: A Clinical Perspective BC Decker 2005
53. Replacement of Brachytherapy
Cervical Cancer
Applicator-Guided
HDR
IMRT
Low DA (Washington U)
Applicator-Guided IMRT
IMRT: A Clinical Perspective BC Decker 2005
54. Accelerated
Concomitant Boost IMRT
Breast Cancer
Whole breast: 40.5 in 2.7 Gy
fractions per day
Lumpectomy Site: 48 Gy in
3.2 Gy fractions per day
Tot al time = 3 weeks (15 fx)
Eugene Lief, Silvia Formenti (NYU)
Accelerated Concomitant Boost IMRT
IMRT: A Clinical Perspective BC Decker 2005
55. Proton IMRT
IM-proton plan in
a 10 year old girl with
a lumbar chordoma
Lomax A
Intensity Modulated Proton Therapy
IMRT: A Clinical Perspective BC Decker 2005