This document provides information on 4D radiotherapy (4D-RT) techniques for accounting for respiratory motion during radiation treatment. It discusses 4D-RT imaging which involves acquiring multiple CT image sets over the breathing cycle to visualize anatomical changes. It also describes 4D treatment planning using these multi-phase CTs and 4D delivery which continuously delivers the treatment throughout the breathing cycle. Respiratory gating and tumor tracking techniques are summarized as methods to synchronize treatment with respiration to reduce motion effects. Clinical applications for 4D-RT include lung, breast, and liver tumors affected by respiratory motion.
SBRT versus Surgery in Early lung cancer : DebateRuchir Bhandari
This document discusses stereotactic body radiation therapy (SBRT) versus surgery for early stage non-small cell lung cancer (NSCLC). SBRT delivers a high dose of precision radiation to the tumor target in 1-5 fractions. Several studies have shown comparable survival and recurrence rates between lobectomy and sublobar resection for stage I lung cancer. SBRT has comparable or better local tumor control and survival rates than conventional radiation therapy for early stage NSCLC, with fewer side effects. While surgery may remain the standard of care, SBRT has emerged as a viable alternative to surgery for medically inoperable early stage NSCLC patients, with some studies investigating its use in operable patients as well.
This document provides an overview of image-guided radiation therapy (IGRT) for lung cancer. It discusses the role of IGRT in managing tumor motion through techniques like breath hold methods, free breathing with gating or tracking, and 4D imaging. Segmentation of the tumor and organs at risk on 4D CT scans is covered. Dose fractionation schedules and biological effective dose calculations for hypofractionated stereotactic body radiation therapy are reviewed. Toxicities, outcomes, and challenges of IGRT in lung cancer are also mentioned.
This presentation is intended to refer while doing planning of SBRT Prostate for all practical aspects from Simulation - contouring - planning - treatment. I am sure it will be very useful presentation for any radiation oncologist who are willing to start workflow of SBRT Prostate in the department of radiation oncology
1) Positron emission tomography (PET) has grown in prominence for medical imaging but suffers from several drawbacks including noisy attenuation maps from transmission scans, long scan durations, and lack of anatomical context.
2) The development of PET/CT scanners addressed these issues by using CT imaging for fast, low-noise attenuation correction mapping and by providing high-resolution anatomical images to fuse with PET images.
3) PET/CT scanners have significantly improved PET image quality and reduced scan times while also providing diagnostic CT imaging, improving patient scheduling and enabling accurate image fusion for improved diagnostic accuracy.
This document discusses treatment options for early stage lung cancer, including surgery, stereotactic body radiotherapy (SBRT), and other ablative modalities. It provides details on the types of surgical resection, factors affecting operability, and morbidity and quality of life outcomes following surgery. It also describes the historical use of radiotherapy, development of SBRT, studies investigating SBRT dose and fractionation schedules, and outcomes from SBRT clinical trials including local control and toxicity rates.
This document provides information on 4D radiotherapy (4D-RT) techniques for accounting for respiratory motion during radiation treatment. It discusses 4D-RT imaging which involves acquiring multiple CT image sets over the breathing cycle to visualize anatomical changes. It also describes 4D treatment planning using these multi-phase CTs and 4D delivery which continuously delivers the treatment throughout the breathing cycle. Respiratory gating and tumor tracking techniques are summarized as methods to synchronize treatment with respiration to reduce motion effects. Clinical applications for 4D-RT include lung, breast, and liver tumors affected by respiratory motion.
SBRT versus Surgery in Early lung cancer : DebateRuchir Bhandari
This document discusses stereotactic body radiation therapy (SBRT) versus surgery for early stage non-small cell lung cancer (NSCLC). SBRT delivers a high dose of precision radiation to the tumor target in 1-5 fractions. Several studies have shown comparable survival and recurrence rates between lobectomy and sublobar resection for stage I lung cancer. SBRT has comparable or better local tumor control and survival rates than conventional radiation therapy for early stage NSCLC, with fewer side effects. While surgery may remain the standard of care, SBRT has emerged as a viable alternative to surgery for medically inoperable early stage NSCLC patients, with some studies investigating its use in operable patients as well.
This document provides an overview of image-guided radiation therapy (IGRT) for lung cancer. It discusses the role of IGRT in managing tumor motion through techniques like breath hold methods, free breathing with gating or tracking, and 4D imaging. Segmentation of the tumor and organs at risk on 4D CT scans is covered. Dose fractionation schedules and biological effective dose calculations for hypofractionated stereotactic body radiation therapy are reviewed. Toxicities, outcomes, and challenges of IGRT in lung cancer are also mentioned.
This presentation is intended to refer while doing planning of SBRT Prostate for all practical aspects from Simulation - contouring - planning - treatment. I am sure it will be very useful presentation for any radiation oncologist who are willing to start workflow of SBRT Prostate in the department of radiation oncology
1) Positron emission tomography (PET) has grown in prominence for medical imaging but suffers from several drawbacks including noisy attenuation maps from transmission scans, long scan durations, and lack of anatomical context.
2) The development of PET/CT scanners addressed these issues by using CT imaging for fast, low-noise attenuation correction mapping and by providing high-resolution anatomical images to fuse with PET images.
3) PET/CT scanners have significantly improved PET image quality and reduced scan times while also providing diagnostic CT imaging, improving patient scheduling and enabling accurate image fusion for improved diagnostic accuracy.
This document discusses treatment options for early stage lung cancer, including surgery, stereotactic body radiotherapy (SBRT), and other ablative modalities. It provides details on the types of surgical resection, factors affecting operability, and morbidity and quality of life outcomes following surgery. It also describes the historical use of radiotherapy, development of SBRT, studies investigating SBRT dose and fractionation schedules, and outcomes from SBRT clinical trials including local control and toxicity rates.
This document summarizes information on radiosurgery for lung cancer. It discusses stereotactic body radiation therapy (SBRT) as a technique that uses precisely targeted radiation to treat small or moderate lung tumors with a large dose per fraction. Studies show SBRT provides better local control and survival rates than conventional radiation for early stage lung cancer and results similar to surgery with less toxicity. For central tumors, lower SBRT doses are safer to reduce risks of excessive toxicity. SBRT is shown to be effective for tumors over 4 cm and in elderly patients.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: nuove possibilità di prevenzione e trattamento della tossicità acuta e tardiva
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.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Management dell’organ motion nei trattamenti stereo-RT e radiochirurgici: ruolo di fiducials e on-board imaging
Radiation pneumonitis is a common toxicity of lung SBRT. Risk factors include older age, poor lung function, and treatment of central rather than peripheral lesions. Dosimetric predictors include higher mean lung dose and lung volumes receiving higher doses. RP typically presents 2-3 months post-treatment as inflammation and edema, and is managed supportively with steroids. Late fibrosis can also occur. Esophageal toxicity risks increase with central lesions near the esophagus. Vascular injury to the aorta is rare but possible. Pneumothorax is a rare complication. Chest wall pain and rib fractures may occur near treatment sites. Skin toxicity risks are lower for lesions further from the chest wall and skin.
Stereotactic body radiation therapy (SBRT) is a form of high-precision radiotherapy that delivers large, precise radiation doses to tumors in just a few treatment sessions. Studies have shown SBRT provides excellent local tumor control of early stage non-small cell lung cancer comparable to surgery, with less invasive treatment. Ongoing and completed prospective studies continue to evaluate SBRT's long-term outcomes and toxicities compared to other standard treatments like surgery or conventional radiation therapy. SBRT is becoming an important treatment option for medically inoperable early stage lung cancer patients.
The document discusses adaptive radiation therapy and stereotactic body radiation therapy (SBRT) using Tomotherapy compared to using a LINAC with micro-multileaf collimator (MLC). It suggests that Tomotherapy may reduce treatment times for radiosurgery and SBRT and provide advantages such as avoiding invasive frames, allowing single scan setup, and facilitating dose accumulation.
Stereotactic body radiation therapy (SBRT) is a highly conformal form of radiation treatment that delivers a very high dose of radiation to an extracranial tumor target in only a few fractions. SBRT aims to ablate the tumor target using multiple, precisely aimed radiation beams that converge on the tumor. It provides an alternative to surgery for localized tumors, offering improved local tumor control compared to conventional radiation through dose escalation while sparing surrounding healthy tissues from damage. SBRT requires specialized equipment and planning to accurately deliver high radiation doses with minimal margins. Reported outcomes show it effectively controls tumors in the lung and liver with acceptable toxicity risks.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: effetti sul controllo tumorale e sulla tossicità (inclusa consequential late-toxicity)
SBRT is a precise form of radiation therapy that delivers very high ablative doses of radiation to tumors in a small number of fractions. It has become the standard of care for early stage non-small cell lung cancer (NSC LC) that is not surgically resectable. Key aspects of SBRT planning and delivery include delineating targets and organs at risk on imaging, determining appropriate dose and fractionation based on tumor location, using motion management strategies to account for tumor motion, precise daily image guidance, and ensuring dose constraints are met to minimize risks to critical structures like the spinal cord. SBRT provides superior local tumor control compared to conventional fractionation for early stage NSCLC with a favorable toxicity profile.
CHEST WALL TOXICITY IN SABR : PREDICTORS AND CONTOURING OF CHEST WALLVIMOJ JANARDANAN NAIR
This document summarizes the current evidence on chest wall toxicity from stereotactic ablative body radiotherapy (SABR). It finds that chest wall contouring should include a 2cm expansion from the lung edges and exclude other structures. Several studies found chest wall toxicity rates of 5-33% for severe chest pain and 2-21% for rib fractures. Larger volumes of the chest wall receiving higher doses, such as V30 >70cc, correlated with increased rates of grade 2 chest wall pain. Strategies to reduce toxicity include reducing the total tumor dose or increasing the number of fractions while maintaining tumor coverage and other constraints.
The document summarizes the experience of using stereotactic body radiation therapy (SBRT) and intensity modulated radiation therapy (IMRT) at SMC for lung cancer. Specifically:
- SBRT provided high local control (90%) and low toxicity for early stage lung cancer with few side effects. IMRT improved target coverage and spared normal tissues compared to 3D-CRT for locally advanced lung cancer.
- A study of 77 patients with stage IIIB N3+ lung cancer treated with chemoradiation found IMRT (used in 29 patients) achieved better lung sparing than 3D-CRT based on dosimetry, with similar treatment outcomes.
The document discusses the key steps in pre-SBRT workup including medical evaluation, tumor assessment, imaging, and motion management. It notes that patients with stage I lung cancer can be treated with surgery, sublobar resection, or SBRT depending on their risk level. For medically inoperable patients, imaging includes PET/CT and pathology confirmation if possible. Pulmonary function tests and cardiac evaluation are done. Tumor characteristics like size and location are assessed. During simulation, immobilization and respiratory motion management techniques like 4DCT are used to accurately define the tumor and organs at risk.
Radiation therapy plays an evolving role in the treatment of lung cancer beyond just causing DNA double strand breaks.
1) Stereotactic body radiation therapy (SBRT) can provide curative treatment for early stage lung cancer with high local control rates.
2) For locally advanced lung cancer, dose escalation with conventional fractionation in RTOG 0617 did not improve overall survival, highlighting the importance of fractionation and sequencing with other therapies.
3) Radiation induces tumor cell death that can elicit anti-tumor immune responses, known as abscopal effects, especially when combined with immunotherapy like anti-CTLA4 and anti-PD1/PDL1 agents which play complementary roles.
Stereotactic body radiation therapy (SBRT) is an evolution of stereotactic radiosurgery that delivers high-dose radiation to tumors in fewer fractions than conventional radiotherapy. It requires extra-ordinary care due to the precision needed to target tumors while sparing surrounding tissues from damage. SBRT has shown efficacy in treating various tumor types including lung, liver, spine, pancreas and prostate cancers with acceptable toxicity risks when proper quality assurance procedures and motion management techniques are followed.
Radical brachytherapy for early stage external auditory canalKanhu Charan
1) Early stage squamous cell carcinoma of the external ear canal is rare and current treatment options like surgery can result in poor cosmesis or loss of function. 2) Brachytherapy provides a high dose to the target area while sparing surrounding organs but traditional applicators are costly. 3) The author proposes using a simple plastic earbud as a low-cost applicator for brachytherapy of the external ear canal. Dosimetry studies showed the earbud dimensions are comparable to catheter applicators and it can be stabilized using a stethoscope earpiece, providing a reproducible method of brachytherapy.
The use of high frequency radiation to shrink tumor cells and kill cancer cells is Radiation Oncology. Austin Journal of Radiation Oncology and Cancer is an open access, peer reviewed scholarly journal committed to publication of unique contributions concerned with the cancer and its therapy.
Austin Journal of Radiation Oncology and Cancer accepts original research articles, review articles, case reports, clinical images and rapid communication on all the aspects of radiation therapy and oncology.
This study assessed the diagnostic value of obtaining an additional upright kidney-ureter-bladder (KUB) radiograph during routine intravenous urography (IVU). Of 164 patients who underwent IVU with an additional upright KUB, the upright view provided diagnostic benefit in 72 patients (43.9%), identifying issues like nephroptosis, better filling of the collecting system, differentiation of phleboliths from stones, and evaluation of emptying. While newer modalities have advantages, upright positioning remains a simple way for IVU to provide unique diagnostic information by leveraging gravitational effects.
This document summarizes information on radiosurgery for lung cancer. It discusses stereotactic body radiation therapy (SBRT) as a technique that uses precisely targeted radiation to treat small or moderate lung tumors with a large dose per fraction. Studies show SBRT provides better local control and survival rates than conventional radiation for early stage lung cancer and results similar to surgery with less toxicity. For central tumors, lower SBRT doses are safer to reduce risks of excessive toxicity. SBRT is shown to be effective for tumors over 4 cm and in elderly patients.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: nuove possibilità di prevenzione e trattamento della tossicità acuta e tardiva
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.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Management dell’organ motion nei trattamenti stereo-RT e radiochirurgici: ruolo di fiducials e on-board imaging
Radiation pneumonitis is a common toxicity of lung SBRT. Risk factors include older age, poor lung function, and treatment of central rather than peripheral lesions. Dosimetric predictors include higher mean lung dose and lung volumes receiving higher doses. RP typically presents 2-3 months post-treatment as inflammation and edema, and is managed supportively with steroids. Late fibrosis can also occur. Esophageal toxicity risks increase with central lesions near the esophagus. Vascular injury to the aorta is rare but possible. Pneumothorax is a rare complication. Chest wall pain and rib fractures may occur near treatment sites. Skin toxicity risks are lower for lesions further from the chest wall and skin.
Stereotactic body radiation therapy (SBRT) is a form of high-precision radiotherapy that delivers large, precise radiation doses to tumors in just a few treatment sessions. Studies have shown SBRT provides excellent local tumor control of early stage non-small cell lung cancer comparable to surgery, with less invasive treatment. Ongoing and completed prospective studies continue to evaluate SBRT's long-term outcomes and toxicities compared to other standard treatments like surgery or conventional radiation therapy. SBRT is becoming an important treatment option for medically inoperable early stage lung cancer patients.
The document discusses adaptive radiation therapy and stereotactic body radiation therapy (SBRT) using Tomotherapy compared to using a LINAC with micro-multileaf collimator (MLC). It suggests that Tomotherapy may reduce treatment times for radiosurgery and SBRT and provide advantages such as avoiding invasive frames, allowing single scan setup, and facilitating dose accumulation.
Stereotactic body radiation therapy (SBRT) is a highly conformal form of radiation treatment that delivers a very high dose of radiation to an extracranial tumor target in only a few fractions. SBRT aims to ablate the tumor target using multiple, precisely aimed radiation beams that converge on the tumor. It provides an alternative to surgery for localized tumors, offering improved local tumor control compared to conventional radiation through dose escalation while sparing surrounding healthy tissues from damage. SBRT requires specialized equipment and planning to accurately deliver high radiation doses with minimal margins. Reported outcomes show it effectively controls tumors in the lung and liver with acceptable toxicity risks.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: effetti sul controllo tumorale e sulla tossicità (inclusa consequential late-toxicity)
SBRT is a precise form of radiation therapy that delivers very high ablative doses of radiation to tumors in a small number of fractions. It has become the standard of care for early stage non-small cell lung cancer (NSC LC) that is not surgically resectable. Key aspects of SBRT planning and delivery include delineating targets and organs at risk on imaging, determining appropriate dose and fractionation based on tumor location, using motion management strategies to account for tumor motion, precise daily image guidance, and ensuring dose constraints are met to minimize risks to critical structures like the spinal cord. SBRT provides superior local tumor control compared to conventional fractionation for early stage NSCLC with a favorable toxicity profile.
CHEST WALL TOXICITY IN SABR : PREDICTORS AND CONTOURING OF CHEST WALLVIMOJ JANARDANAN NAIR
This document summarizes the current evidence on chest wall toxicity from stereotactic ablative body radiotherapy (SABR). It finds that chest wall contouring should include a 2cm expansion from the lung edges and exclude other structures. Several studies found chest wall toxicity rates of 5-33% for severe chest pain and 2-21% for rib fractures. Larger volumes of the chest wall receiving higher doses, such as V30 >70cc, correlated with increased rates of grade 2 chest wall pain. Strategies to reduce toxicity include reducing the total tumor dose or increasing the number of fractions while maintaining tumor coverage and other constraints.
The document summarizes the experience of using stereotactic body radiation therapy (SBRT) and intensity modulated radiation therapy (IMRT) at SMC for lung cancer. Specifically:
- SBRT provided high local control (90%) and low toxicity for early stage lung cancer with few side effects. IMRT improved target coverage and spared normal tissues compared to 3D-CRT for locally advanced lung cancer.
- A study of 77 patients with stage IIIB N3+ lung cancer treated with chemoradiation found IMRT (used in 29 patients) achieved better lung sparing than 3D-CRT based on dosimetry, with similar treatment outcomes.
The document discusses the key steps in pre-SBRT workup including medical evaluation, tumor assessment, imaging, and motion management. It notes that patients with stage I lung cancer can be treated with surgery, sublobar resection, or SBRT depending on their risk level. For medically inoperable patients, imaging includes PET/CT and pathology confirmation if possible. Pulmonary function tests and cardiac evaluation are done. Tumor characteristics like size and location are assessed. During simulation, immobilization and respiratory motion management techniques like 4DCT are used to accurately define the tumor and organs at risk.
Radiation therapy plays an evolving role in the treatment of lung cancer beyond just causing DNA double strand breaks.
1) Stereotactic body radiation therapy (SBRT) can provide curative treatment for early stage lung cancer with high local control rates.
2) For locally advanced lung cancer, dose escalation with conventional fractionation in RTOG 0617 did not improve overall survival, highlighting the importance of fractionation and sequencing with other therapies.
3) Radiation induces tumor cell death that can elicit anti-tumor immune responses, known as abscopal effects, especially when combined with immunotherapy like anti-CTLA4 and anti-PD1/PDL1 agents which play complementary roles.
Stereotactic body radiation therapy (SBRT) is an evolution of stereotactic radiosurgery that delivers high-dose radiation to tumors in fewer fractions than conventional radiotherapy. It requires extra-ordinary care due to the precision needed to target tumors while sparing surrounding tissues from damage. SBRT has shown efficacy in treating various tumor types including lung, liver, spine, pancreas and prostate cancers with acceptable toxicity risks when proper quality assurance procedures and motion management techniques are followed.
Radical brachytherapy for early stage external auditory canalKanhu Charan
1) Early stage squamous cell carcinoma of the external ear canal is rare and current treatment options like surgery can result in poor cosmesis or loss of function. 2) Brachytherapy provides a high dose to the target area while sparing surrounding organs but traditional applicators are costly. 3) The author proposes using a simple plastic earbud as a low-cost applicator for brachytherapy of the external ear canal. Dosimetry studies showed the earbud dimensions are comparable to catheter applicators and it can be stabilized using a stethoscope earpiece, providing a reproducible method of brachytherapy.
The use of high frequency radiation to shrink tumor cells and kill cancer cells is Radiation Oncology. Austin Journal of Radiation Oncology and Cancer is an open access, peer reviewed scholarly journal committed to publication of unique contributions concerned with the cancer and its therapy.
Austin Journal of Radiation Oncology and Cancer accepts original research articles, review articles, case reports, clinical images and rapid communication on all the aspects of radiation therapy and oncology.
This study assessed the diagnostic value of obtaining an additional upright kidney-ureter-bladder (KUB) radiograph during routine intravenous urography (IVU). Of 164 patients who underwent IVU with an additional upright KUB, the upright view provided diagnostic benefit in 72 patients (43.9%), identifying issues like nephroptosis, better filling of the collecting system, differentiation of phleboliths from stones, and evaluation of emptying. While newer modalities have advantages, upright positioning remains a simple way for IVU to provide unique diagnostic information by leveraging gravitational effects.
Respiratory motion affects tumor sites in the thorax and abdomen. With conventional radiotherapy, respiratory motion can distort the target volume, increase the apparent tumor size, and increase normal tissue irradiation. 4D radiotherapy explicitly accounts for temporal changes in anatomy during imaging, planning, and treatment delivery. It involves acquiring 4D CT images over different breathing phases, creating treatment plans for each phase, and continuously delivering the plans throughout the breathing cycle to better target the tumor and spare healthy tissue.
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.
WEBINAR: The Four Ws of Preclinical Small Animal Imaging; What, When, Where &...Scintica Instrumentation
We will begin this 3-part preclinical imaging learning mini-series with this 60-minute webinar in which we will highlight five important preclinical imaging modalities including optical imaging, high frequency ultrasound, MRI, PET/CT, and fluorescence in vivo endomicroscopy. We will give a brief technical overview of each modality and discuss how an image is acquired. We will then review the strengths and weaknesses of each technology and provide some insight on when to use one over the other by highlighting some example images acquired on preclinical systems offered by Scintica Instrumentation.
Topics discussed in this webinar include:
The need for preclinical imaging
Technical overview: Optical, High Frequency Ultrasound, MRI, PET/CT, and Fluorescence in vivo Endomicroscopy
When each modality should be used
Different types of preclinical imaging applications
Multiplex imaging
This study aimed to reduce hospital stay through improved pre-operative workup by analyzing data from patients undergoing orthopedic, laparoscopic, and spine surgeries. The results showed that completing pre-op tests and optimization according to guidelines was associated with shorter hospital stays. For example, patients who had pre-op workup done as outpatients rather than inpatients had shorter stays. The study recommended standardizing pre-op processes and investigations according to surgery type and patient risk to further reduce hospital costs and free up beds.
Introducing VESPIR: a new open-source software to investigate CT ventilation ...Cancer Institute NSW
VESPIR is an open-source toolkit for analyzing computed tomography ventilation imaging (CTVI) from 4DCT scans. It performs deformable image registration on inhale and exhale phases to quantify lung volume and density changes, generating CT-derived ventilation maps. Studies using VESPIR have found voxel-wise correlations as high as 0.80 between CTVI and nuclear medicine ventilation imaging like Gallium-68 PET scans. VESPIR validates CTVI across multiple sites and imaging modalities. It requires only a Windows laptop with MATLAB and the free Plastimatch deformable registration software. Researchers can contact the authors to obtain VESPIR and explore CTVI at their own clinics.
4D-CBCT (Symmetry) - a useful tool to verify and treat traditional ITV withou...Dr. Malhar Patel
4D-CBCT is latest software gadget in field of radiation oncology. It will calculate breathing movement during treatment of lung cancer and help in delineate the target better.
This presentation will convince you that even if you do not have 4D-CT simulation, you can confidently use 4D-CBCT at optimal level.
This study compared heart dose and positional reproducibility between supine voluntary deep-inspiratory breath-hold (VBH) technique and free-breathing prone technique for left breast radiotherapy in women with breast volumes over 750 cm3. 34 patients underwent planning CT scans and radiotherapy treatment plans using both techniques, with randomization to one technique for the first half of treatment and the other for the second half. Mean heart and left anterior descending coronary artery doses were significantly lower with VBH compared to prone. VBH also showed better positional reproducibility than prone based on imaging. The study concluded that for larger-breasted women, the supine VBH technique provided superior cardiac sparing and reproducibility compared to free-breathing prone positioning.
Dosimetric Consequences of Intrafraction Variation of Tumor Motion in Lung St...semualkaira
The purpose of this study was to investigate the target dose discrepancy caused by intrafraction variation during Stereotactic Body Radiotherapy (SBRT) for lung cancer. Intensity-Modulated Radiation Therapy (IMRT) plans were designed based on Average Computed Tomography (AVG CT) utilizing the Planning Target Volume (PTV) surrounding the 65% and 85% prescription isodoses in both phantom and patient cases
Dosimetric Consequences of Intrafraction Variation of Tumor Motion in Lung St...semualkaira
The purpose of this study was to investigate the target dose discrepancy caused by intrafraction variation during Stereotactic Body Radiotherapy (SBRT) for lung cancer. Intensity-Modulated Radiation Therapy (IMRT) plans were designed based on Average Computed Tomography (AVG CT) utilizing the Planning Target Volume (PTV) surrounding the 65% and 85% prescription isodoses in both phantom and patient cases. Intrafraction variation was simulated by shifting the nominal plan isocenter along six directions from 0.5 mm to 4.5 mm with a 1-mm step size to produce a series of perturbed plans. The dose discrepancy between the initial plan and the perturbed plans was calculated as the percentage of the initial plan
Dosimetric Consequences of Intrafraction Variation of Tumor Motion in Lung St...semualkaira
The purpose of this study was to investigate the target dose discrepancy caused by intrafraction variation during Stereotactic Body Radiotherapy (SBRT) for lung cancer. Intensity-Modulated Radiation Therapy (IMRT) plans were designed based on Average Computed Tomography (AVG CT) utilizing the Planning Target Volume (PTV) surrounding the 65% and 85% prescription isodoses in both phantom and patient cases. Intrafraction variation was simulated by shifting the nominal plan isocenter along six directions from 0.5 mm to 4.5 mm with a 1-mm step size to produce a series of perturbed plans. The dose discrepancy between the initial plan and the perturbed plans was calculated as the percentage of the initial plan. Dose indices, including D99 and D95 for Internal Target Volume (ITV) and Gross Tumor Volume (GTV), were adopted as endpoint samples. The mean dose discrepancy was calculated under the 3-dimensional space distribution. In this study, we found that intrafraction motion can lead to serious dose degradation of the target and ITV in lung SBRT, especially during SBRT with PTV surrounding the lower isodose line. This phenomenon was compromised when 3-dimensional space distribution was considered. This result may provide a prospective reference for target dose degradation due to intrafraction motion during lung SBRT treatment.
РАДИОЛОГИЯ: журнал British Journal of Radiology - British Institute of Radiol...oncoportal.net
This document summarizes the key topics discussed at the 2005 President's Conference on "Technology in Imaging and Radiotherapy". The conference highlighted advances in medical imaging technologies like CT and their impact on clinical practice and workflow. Presentations covered improvements in CT scanner design allowing faster, lower dose scans over wider areas. Applications of newer cardiac CT and particle therapy techniques were also discussed. The conference emphasized that while technology enables better outcomes, optimized implementation through improved workflows is also needed to increase productivity and efficiency in medicine.
This study investigated the clinical efficacy and safety of uniportal video-assisted thoracoscopic bronchial sleeve lobectomy (BSL) in 5 patients with central lung cancer. The results found that the BSL procedure was successfully completed in all 5 patients without severe complications. Key findings included an average operation time of 254 minutes, average blood loss of 116 ml, average hospital stay of 9.2 days, and no postoperative recurrence or metastasis during follow-up periods ranging from 3-19 months. The study concluded that uniportal video-assisted thoracoscopic BSL is a safe and minimally invasive treatment for central lung cancer.
Journal Presentation on article Comparative efficacy of different combination...Shubham Jain
Journal Presentation on article Comparative efficacy of different combinations of acapella, active cycle of breathing technique, and external diaphragmatic pacing in perioperative patients with lung cancer
PET GUIDED TARGET CONTOURING GUIDELINES.pptxGaurav Jaswal
PET/CT can improve the accuracy of target volume delineation for radiation therapy planning in three key ways:
1) PET/CT may help avoid geographic misses and better guide target volume definition compared to CT alone.
2) Functional imaging with PET tracers like 18FDG can facilitate identification of biologically relevant tumor sub-volumes that may benefit from dose escalation.
3) PET provides tumor characterization that can enable adaptive radiotherapy and other personalized treatment strategies when used before and during treatment.
However, while promising, issues remain unresolved and widespread clinical adoption is not yet recommended until prospective studies validate the benefits.
Pulmonary rehabilitation has been shown to benefit patients with lung cancer in several ways:
1) Pre-operative pulmonary rehabilitation programs, lasting 4 weeks or longer, have demonstrated improvements in cardiorespiratory fitness and functional capacity as well as reductions in post-operative pulmonary complications.
2) Exercise training, including both aerobic and strength training, is a core component of pulmonary rehabilitation and has been shown to improve peak oxygen consumption, walking distance, and muscle strength both before and after lung cancer surgery.
3) In addition to exercise, pulmonary rehabilitation includes education on lung expansion techniques, breathing exercises, and smoking cessation, all of which can reduce post-operative risks when implemented before surgery.
This document provides an overview of PET/MRI technology, including its current and future status. It discusses:
1. The history and evolution of PET and MRI from the 1960s onwards, leading to the development of simultaneous PET/MRI systems in the late 1990s.
2. Examples of whole-body PET/MRI images from 2011 demonstrating the technique's ability to provide molecular and anatomical data.
3. The paradigm shift brought by PET/MRI's ability to provide integrated information on structure, function and tissue environment for applications in oncology, neurology and other areas.
4. Future directions for PET/MRI including 'whole body mapping' to characterize metastatic disease, improved data analysis techniques, and
Cervical screening – taking care of your health flipchart (Farsi)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Farsi women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Khmer)Cancer Institute NSW
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The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women from different cultural backgrounds, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
This document provides information for users of a flipchart about cervical cancer screening. It discusses topics like what cervical cancer is, its causes, prevention methods, who should get screened and how often, the screening procedure, possible results, and where to find more information. The flipchart is intended to help bilingual health workers educate community members from different cultural backgrounds about cervical cancer screening.
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Innovations conference 2014 dr john kipritidis can we use ventilation imaging to measure predict and reduce pulmonary function loss
1.
2. Can we use Ventilation Imaging to measure, predict and reduce
pulmonary function loss in lung cancer radiotherapy?
SYDNEY MEDICAL SCHOOL
John Kipritidis, CINSW Early Career Fellow
Radiation Physics Laboratory
UNIVERSITY OF SYDNEY
Innovations in Cancer Treatment and Care Conference
October 17th 2014
3. Acknowledgements
Nepean Cancer Care Centre
Dr Fiona Hegi-Johnson
Dr Roland Yeghiaian-Alvandi
Jeffrey Barber
Dr Chuong Bui
Katrina West
Kylie Unicomb
Peter MacCallum Cancer Centre
Prof. Michael Hofman.
Dr Shankar Siva
Jason Callahan
Prof. Rodney Hicks
Contributing authors:
University of Sydney
Prof Paul Keall
Dr John Kipritidis
Dr Enid Eslick
Andy Shieh
Virginia Commonwealth Univ.
Jeffrey Williamson, Ph.D.
Geoffrey Hugo, Ph.D.
Elisabeth Weiss, Ph.D.
Special thanks:
University of Sydney
Dr Ricky O’Brien
Benjamin Cooper
Royal North Shore Hospital
Dr Dale Bailey
Dr Jeremy Booth
Disclosure
Supported by a Cancer Institute NSW Early Career Fellowship, NHMRC Australia Fellowship,
NHMRC project grant 1034060 and NIH/NCI P01CA116602.
4. (i) Why is ventilation imaging important in lung
cancer radiotherapy?
› 10-30% of lung cancer radiotherapy patients experience radiation-induced lung toxicity (RILT)
› Functionally weighted dose-volume metrics can outperform standard dose-volume metrics as
a predictor of RILT;
c.f. Hoover et al. 2014. J Med Imaging Radiat Oncol 58 (2)
› Functional image-guided treatment planning requires functional imaging! `Gold standard' is
SPECT ventilation / perfusion.
4
Technegas SPECT Galligas PET
Peter MacCallum Cancer Centre
Nepean Cancer Care Centre
5. (ii) Innovative ventilation imaging using 4D-CT
› “CT-ventilation imaging” models regional air volume change in terms of regional lung volume
(or intensity) changes during the breathing cycle.
c.f. Guerrero et al. (IJROBP 2005)
5
(i) Acquire 4D-CT (ii) Deformable image registration (iii) Quantify volume/intensity
4DCT data courtesy of
Nepean Cancer Care Centre
change
high
low
Ventilation
Main advantages:
High accessibility
High resolution (same as CT)
No-extra cost in scan time / imaging dose (just image processing!)
6. (iii) How could CT-ventilation be practice-changing?
› CT-ventilation will allow greater access to functional image guided radiotherapy treatment planning, with
the potential to reduce functionally-weighted mean lung dose by 2-5 Gy.
Yamamoto et al. 2011
IJROBP 79 (1)
› In-room 4D cone beam CT could maximise sparing of functional
lung by enabling adaptive functional image guidance:
7. (iv) How is CT-ventilation being validated?
We are aiming to validate CT-ventilation imaging across multiple modalities:
Modalities 4D-CT 4D-CBCT SPECT V/Q 4D-PET V/Q PFTs
4D-CT VCU VCU NCCC
PMCC
RNSH
RNSH
NCCC
BH-CT RNSH RNSH RNSH
4D-CBCT VCU VCU NCCC NCCC
LEGEND Under-way
Happening
soon
Not
yet
• NCCC = Nepean Cancer Care Centre (Ongoing QA study)
• RNSH = Royal North Shore Hospital (Ongoing prospective trial)
• PMCC = Peter MacCallum Cancer Centre (Ongoing prospective trial)
• VCU = Virginia Commonwealth University (Existing database from earlier study)
8. 8
high
low
Ventilation
Patient 7 (Best case)
4D-CT ventilation:
MC
rVHU
Std
PET ventilation: VPET
(iv) How is CT-ventilation being validated?
› 12-patient comparison* using baseline Galligas 4D-PET/CT scans.
› Strongest voxel-wise correlation with nuclear medicine ventilation imaging (so far!)
*Kipritidis et al. Med Phys 2014 41(1)
12 patients:
Data courtesy of Peter MacCallum Cancer Centre
(Melbourne, VIC Australia)
9. (iv) How is CT-ventilation being validated?
9
› Comparing daily 4D-CBCT ventilation images to baseline Q-SPECT in lung SBRT patients:
› Ongoing QA study; comparison of functional changes underway.
Data courtesy of Nepean Cancer Care Centre
(Penrith, NSW Australia)
high
low
Ventilation
4D-CBCT ventilation:
SPECT perfusion:
5 patients:
10. (iv) How is CT-ventilation being validated?
10
• Comparing CT ventilation to Technegas V-SPECT:
CT ventilation Technegas V-SPECT
(HU based)
Data courtesy of Nepean Cancer Care Centre
(Penrith, NSW Australia)
11. (iv) How is CT-ventilation being validated?
Author Reference
modality
Subjects Dice similarity Voxel-wise
correlation
Fuld et al.
(J Apply Physiol 2008)
Xe-CT 4 sheep ~ 0.81
(Small ROIs)
Reinhardt / Ding et al.
(Med. Image Anal.
2008)
Xe-CT 5 sheep ~ 0.85
(Small ROIs)
Yamamoto et al.
(IWPIA 2010)
SPECT V/Q 1 patient ~ 0.18/0.48
(Whole lung)
Castillo et al.
(PMB 2010)
SPECT V 7 patients 0.30-0.35
(low function)
~
Castillo et al.
(PMB 2012)
SPECT Q 10 patients 0.78
(low function)
~
Mathew et al.
(Med. Phys. 2012)
3He-MRI 11 patients 0.86-0.88
(good function)
~
Kipritidis, Siva et al. Ga 4D PET/CT 12 patients 0.38-0.68
(low function)
0.22-0.76
(Whole lung)
Hegi-Johnson et al. SPECT V/Q 30 patients
(goal)
TBA TBA
Eslick et al. Ga PET/CT 30 patients
(goal)
TBA TBA
12. (v) New technologies, new questions
12
4D-CBCT patient study:
o 19 locally advanced NSCLC patients received daily 4D-CBCTs over 4-6 weeks
o We generated 56 interfraction pairs (Week 1 vs. Weeks 2, 4 and 6).
o Main question: How does ventilation change during radiotherapy treatment?
13. 100
101
102
103
104
105
106
107
108
109
• 4D-CBCT ventilation images can exhibit a wide range of changes
(both positive and negative!) during treatment.
110
111
112
114
115
116
117
118
119
First day
Week 2
Week 4
Week 6
• Adaptive functional image guidance is important as poor-functioning
First day
Week 2
Week 4
Week 6
Scan
Ventilation increase
Transient change
Stable
Ventilation decrease
Highly variable
lung can re-ventilate.
14. (v) New technologies, new questions
14
• Patients breathe differently from day-to-day (and breath-to-breath!)
• Intrafraction changes can sometimes exceed interfraction changes.
• Careful normalisation of serial images is required.
4D-CBCTs courtesy Virginia Commonwealth Univ.
(Richmond, VA USA)
15. Take home messages
› CT-ventilation imaging: a potentially practice-changing technology enabling (adaptive)
functional image guidance in radiotherapy treatment planning.
15
› Australian researchers are driving world-first validation studies across multiple imaging
modalities.
› In-room ventilation imaging: innovative technology driving new questions.
16. Thanks for listening!
SYDNEY MEDICAL SCHOOL
Radiation Physics Laboratory
UNIVERSITY OF SYDNEY
John Kipritidis, CINSW Early Career Fellow
john.kipritidis@sydney.edu.au
Editor's Notes
Hi everyone, Im John Kipritidis from the University of Sydney. We’re investigating an innovative new technology, CT ventilation imaging, to measure lung function, predice and potentially even reduce lung function loss in radiotherapy.
As usual there are many people to thank..
The main clinical driver to look at ventilation imaging in lung cancer radiotherapy is that 10-30% of patients can experience some form of radiation-induced lung toxicity (RILT), the effects of which can range from merely radiographic, to debilitating shortness of breath requiring hospitalization.
There is increasing evidence that RILT correlates with the mean-lung dose, but even more strongly with functionally-weighted dose-volume metrics (e.g. fV20).
This drives the study of functional image-guided treatment planning, aiming to minimize the irradiation of healthy lung.
This necessitates functional lung imaging; the clinical Gold standard methods are ventilation / perfusion imaging using single-photon emission CT (SPECT), and positron emission tomography (PET).
So then, what if we could quantify lung function using respiration-correlated, four-dimensional (or `4D’) CT? In many centres in Australia, 4D-CT is the standard of care for respiratory motion management in lung cancer radiotherapy, most patients will get a 4D-CT scan.
`CT-ventilation imaging’ is an innovative technique using the following steps,
(i) First a 4D-CT is acquired,
(ii) Second, Using deformable image registration, we then quantify the regional lung volume change, or tissue density changes between exhale and inhale.
(iii) This information is used to model regional air-volume changes in the lung, a surrogate for ventilation.
What’s exciting about CT-ventilation is that it offers the potential of high accessibility, high resolution and requiring no extra-cost in scan time or imaging dose (<10 minutes of image processing!)
Recent planning studies have shown that that CT-ventilation has the potential to reduce healthy lung dose by 2-5 Gy (modality-dependent).
A challenge is that lung function can change during treatment; particularly for patients undergoing longer treatments – due to tumor growth or regression.
By combining CT-ventilation with in-room 4D cone beam CT, we could achieve adaptive functional image guidance to maximise the dose-savings for healthy lung.
So what are we doing to validate this new technology?
We are correlating baseline CT-ventilation, either 4D-CT breath hold CT or 4D cone beam CT, to other modalities including Technegas ventilation SPECT, respiratory gated Galligas PET as well as pulmonary function tests.
This is all patient imaging data, some resulting from QA studies collecting 4D imaging, others are prospective clinical trials.
You may be wondering why, in some cases I’m comparing a modality against itself; this is referring to multiple timepoint data, and I’ll get onto that shortly.
-At Nepean hospital in Sydney, Dr Fiona Hegi-Johnson is also looking at ventilation / perfusion V-SPECT for stereotactic lung patients. Technegas SPECT is similar to PET-Galligas except that it uses technetium instead of gallium.
- The main novelty of this study is in collecting multiple 4D-cone beam CTs for every treatment fraction; we are in the progress of correlating changes in CBCT VIs during treatment, with changes in pre/post treatment SPECT imaging.
-In this example we’re comparing CT-ventilation to Technegas V-SPECT. Technegas SPECT is similar to PET-Galligas except that it uses technetium instead of gallium.
- We investigated 19 locally advanced NSCLC patients undergoing lung cancer radiation therapy. Each patient received multiple 4D cone beam scans over 4-6 weeks of treatment.
We collated 215 4D cone beam ventilation images (or Vis) including 78 intrafraction pairs (referring to pre/post fraction 4D-CBCTs on the same day), and 56 interfraction pairs (comparing the first week of treatment to each of Weeks 2, 4 and 6).
We determine if..
Here are the interfraction ventilation images. For each patient we have four scans; Week 1, 2, 4 and 6. All the VIs were deformably registered to the corresponding planning CT, cropped to a common region of imaged lung, and normalized based on the 10th and 90th functional percentiles of contralateral lung.
What we see is that patients show all sorts of different kinds of functional changes; some patients exhibit a ventilation increase, another shows a decrease, one shows what looks like a transient change. Yet others seems stable, and others quite variable.
The same patient can also exhibit varying levels of breathing effort from scan-to-scan, leading to varying levels of deformation. To account for this, we normalize ventilation images by the relatively `healthy’ lung which is contralateral or opposite to the primary tumour..
So what does this all mean?
- The take-home messages are that:
Patients can exhibit both +ve and –ve ventilation changes throughout treatment highlighting the need for adaptive functional avoidance using techniques such as 4D cone beam ventilation.
At this stage, 4D-cone beam ventilation could be useful for detecting large changes in function. About ½ of interfraction ventilation variability may be due to mis-registration of changing anatomy.
With better 4D-cone beam image quality, and more reliable registration of large anatomic changes, perhaps the sensitivity of this technique can be improved.