This document discusses limiting radiation exposure from diagnostic imaging procedures like CT scans. It provides context about radiation dosage terms and compares the effective radiation dose of different medical imaging exams. While medical imaging only accounts for around 50% of radiation exposure in the US, it may be responsible for about 1% of cancer cases. The document examines balancing radiation risks, which are higher for younger patients and females, with clinical benefits on a case-by-case basis using the ALARA principle to keep radiation as low as reasonably possible. It analyzes the risks and benefits of 4DCT for imaging hyperfunctional parathyroid glands as an example.
Daily waiting time management for modern radiation oncology department in Ind...Kanhu Charan
This document discusses strategies for managing patient waiting times in radiation oncology departments. It notes that waiting times can impact patient satisfaction and treatment compliance. Various clinical factors can influence waiting times, such as individualized treatment protocols, patient performance status, use of immobilization devices or motion management techniques, organ site, and protocols for bladder and rectal filling. The conclusion recommends meticulous management of waiting times through clear communication and provisions to engage patients while waiting for treatment.
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
Protons Compared to Photons in Pediatric PatientsDanielle Buswell
Proton radiation therapy may reduce risks of late side effects compared to photon therapy for pediatric patients with medulloblastoma. Proton therapy decreases exit dose which can cause toxicities like heart problems, hearing loss, and neurocognitive deficits. Studies found proton therapy resulted in fewer neurocognitive deficits and lower risks of secondary cancers. While proton therapy may have better outcomes, its higher cost must be considered compared to photon therapy for each patient.
This document describes a cross-sectional nodal atlas intended to assist radiation oncologists in defining clinical target volumes in 3D radiation therapy planning. It outlines the lymphatic drainage patterns and locations of nodal stations on CT images of the head and neck, thorax, abdomen, pelvis. Key nodal stations are labeled on consecutive equidistant CT images with the goal of correlating these stations to their known spatial references to help delineate target volumes in 3D planning programs.
This study evaluated outcomes of 28 patients with intracranial meningiomas treated with hypofractionated radiosurgery. Most tumors were treated with 22.5-30 Gy delivered in 5 fractions. With a mean follow up of 32.6 months, the local tumor control rate was 100% with only one instance of marginal progression. Symptoms improved or resolved in over 66% of patients who originally presented with symptoms. Side effects occurred in 4 patients but the permanent morbidity rate was low at 3.5%. Hypofractionated radiosurgery provided high tumor control with a low risk of side effects, even for large tumors greater than 9 cm3.
This document is the abstract presentation from volume 149 of the Journal of the European Society for Radiotherapy and Oncology from August 2020. It was presented by Dr. A Premchand, a 2nd year DNB resident in Radiotherapy and Oncology. The journal covers original research and review articles relating to radiation oncology, including clinical radiotherapy, combined modality treatment, radiobiology, chemobiology, hyperthermia, tumor biology, and physical aspects of imaging, dosimetry and radiation therapy planning. It also includes papers on general oncology topics like chemotherapy, surgery and immunology. This issue features 2 reviews, 1 guideline, 1 meta-analysis, 4 clinical trials, 14 site specific articles,
El QUANTEC nos ayuda a los oncólogos radioterápicos a la hora de aprobar un tratamiento con sus tablas con "constraints" de los órganos de riesgo (los límites de dosis que pueden recibir los órganos sanos situados entorno al tumor que queremos tratar).
PD: Las tablas se encuentran en las páginas 15-17
Daily waiting time management for modern radiation oncology department in Ind...Kanhu Charan
This document discusses strategies for managing patient waiting times in radiation oncology departments. It notes that waiting times can impact patient satisfaction and treatment compliance. Various clinical factors can influence waiting times, such as individualized treatment protocols, patient performance status, use of immobilization devices or motion management techniques, organ site, and protocols for bladder and rectal filling. The conclusion recommends meticulous management of waiting times through clear communication and provisions to engage patients while waiting for treatment.
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
Protons Compared to Photons in Pediatric PatientsDanielle Buswell
Proton radiation therapy may reduce risks of late side effects compared to photon therapy for pediatric patients with medulloblastoma. Proton therapy decreases exit dose which can cause toxicities like heart problems, hearing loss, and neurocognitive deficits. Studies found proton therapy resulted in fewer neurocognitive deficits and lower risks of secondary cancers. While proton therapy may have better outcomes, its higher cost must be considered compared to photon therapy for each patient.
This document describes a cross-sectional nodal atlas intended to assist radiation oncologists in defining clinical target volumes in 3D radiation therapy planning. It outlines the lymphatic drainage patterns and locations of nodal stations on CT images of the head and neck, thorax, abdomen, pelvis. Key nodal stations are labeled on consecutive equidistant CT images with the goal of correlating these stations to their known spatial references to help delineate target volumes in 3D planning programs.
This study evaluated outcomes of 28 patients with intracranial meningiomas treated with hypofractionated radiosurgery. Most tumors were treated with 22.5-30 Gy delivered in 5 fractions. With a mean follow up of 32.6 months, the local tumor control rate was 100% with only one instance of marginal progression. Symptoms improved or resolved in over 66% of patients who originally presented with symptoms. Side effects occurred in 4 patients but the permanent morbidity rate was low at 3.5%. Hypofractionated radiosurgery provided high tumor control with a low risk of side effects, even for large tumors greater than 9 cm3.
This document is the abstract presentation from volume 149 of the Journal of the European Society for Radiotherapy and Oncology from August 2020. It was presented by Dr. A Premchand, a 2nd year DNB resident in Radiotherapy and Oncology. The journal covers original research and review articles relating to radiation oncology, including clinical radiotherapy, combined modality treatment, radiobiology, chemobiology, hyperthermia, tumor biology, and physical aspects of imaging, dosimetry and radiation therapy planning. It also includes papers on general oncology topics like chemotherapy, surgery and immunology. This issue features 2 reviews, 1 guideline, 1 meta-analysis, 4 clinical trials, 14 site specific articles,
El QUANTEC nos ayuda a los oncólogos radioterápicos a la hora de aprobar un tratamiento con sus tablas con "constraints" de los órganos de riesgo (los límites de dosis que pueden recibir los órganos sanos situados entorno al tumor que queremos tratar).
PD: Las tablas se encuentran en las páginas 15-17
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
CyberKnife: A New Option In the Treatment of Lung CancerKue Lee
This document summarizes the development and use of stereotactic body radiotherapy (SBRT) for early stage non-small cell lung cancer (NSCLC). It discusses how conventional radiation therapy had poor outcomes, but SBRT allows higher, more effective radiation doses to be delivered safely. Phase II data showed SBRT achieved high local control and 3-year survival rates for inoperable early stage NSCLC. Emerging data also suggests SBRT may be comparable to surgery for operable NSCLC, though more research is still needed to determine the optimal treatment approach. Overall, SBRT has significantly improved outcomes for early stage NSCLC compared to previous radiation techniques.
Evaluating Lung Nodules in an Endemic Region for CoccidioidomycosisKue Lee
This document summarizes a talk on evaluating lung nodules in a region where coccidioidomycosis is endemic. It discusses challenges in applying national guidelines locally. Radiological characteristics and clinical risk factors are used to evaluate nodules. A calculator was developed using these factors that better differentiates between coccidioidomycosis and lung cancer in nodules. Ongoing work includes refining the calculator, evaluating new tests like PCR for coccidioidomycosis, creating a tissue database, and assessing the impact of a lung nodule clinic.
The document summarizes several studies from the October 2010 issue of Radiology on various medical imaging techniques. It reports that digital tomosynthesis was found to have higher sensitivity than radiography in detecting lung lesions. It also discusses studies finding that some epidural hematomas may remain indolent without treatment, dual-energy CT can help differentiate contrast staining from hemorrhage, and screening CT may not be effective for early detection of ovarian cancer.
This document summarizes several studies on the risks of cancer from radiation exposure during medical imaging exams like CT scans and X-rays. Some key findings discussed are: 1) Studies have found small increased risks of leukemia and brain tumors from radiation exposure during childhood medical imaging; 2) Exposure to low doses of radiation from cardiac imaging after a heart attack was associated with a small increased risk of cancer; 3) One study estimated that CT scans in children could triple the risk of leukemia from doses over 50 mGy and triple the risk of brain tumors from doses over 60 mGy. However, the absolute risks were considered small.
Adjuvant Radiation Therapy in Early Cervical Cancer - EvidencesDr. Malhar Patel
Radiation therapy is one of the main line of management of carcinoma cervix.
This presentation is regarding evidences of adjuvant radiation therapy (post operative) in case of early carcinoma cervix.
The document discusses the increasing use of computed tomography (CT) scans and the resulting rise in medical radiation exposure. While CT scans provide important medical benefits, there is growing concern about the potential long-term health risks of radiation exposure, especially for pediatric patients. The literature review found that average radiation doses have doubled in some cases over the past decade and CT scans are now responsible for a significant portion of population radiation exposure from medical imaging. However, there is no system currently in place to track patients' cumulative lifetime radiation exposure from medical sources. The document examines various proposals to help minimize radiation doses from CT scans and optimize protocols while also exploring the feasibility of developing a standardized method for tracking and recording lifetime medical radiation exposure information.
Radiotherapy Risk Profiles & Its ManagementSubrata Roy
Due to the rapidly increasing complexity during the last years, comprehensive QA has become even more of an issue, including treatment planning software, information handling and treatment delivery. Obviously methods from clinical risk management (RM) can be well adapted and adopted for use in radiotherapy.
Understanding the complex process of radiotherapy requires many different kinds of expertise: it involves understanding principles of medical physics, radio biology, radiation safety, dose measurement and calculation, radiotherapy planning and simulation, and the interaction of radiotherapy with other treatment modalities, among others. Several different professional groups are needed to plan and deliver radiotherapy. The main professionals involved are radiation oncologists, radiation therapists and medical physicists. Each of these disciplines must work together through an integrated process to plan and deliver radiotherapy to patients
Optimal Treatment for Clinically Node Positive Prostate Cancer -A Brief Analy...Kanhu Charan
1. The document discusses the optimal treatment for clinically node positive prostate cancer, which is a controversial issue due to lack of randomized trial data.
2. It analyzes guidelines from the NCCN, results from the RTOG 85-31 trial, and studies from the national cancer database which all suggest that androgen deprivation therapy (ADT) plus radiation therapy provides better survival outcomes than ADT alone.
3. While most evidence comes from retrospective studies, the findings indicate that ADT plus radiation should be the standard treatment, and a randomized controlled trial is still needed to confirm potential survival benefits seen in previous analyses.
This document discusses the options and challenges for reirradiating recurrent brain tumors. It may be considered for gliomas or brain metastases if the prior radiation tolerance doses of critical structures like the optic pathways, brainstem and whole brain have not been exceeded. Differentiating tumor recurrence from treatment effects like necrosis or pseudoprogression is important prior to reirradiation. Short interval since prior radiation and large tumor volume predict poor outcomes. With smaller recurrences in favorable locations, reirradiation using techniques like stereotactic radiosurgery may be offered if the radiation interval is over 6 months. A multidisciplinary discussion weighing risks and benefits is needed for each case.
The management of painful bone metastases requires multidisciplinary care, with external beam radiation therapy (EBRT) providing relief that is effective and time efficient.
In our study the efficacy of external beam irradiation in the palliation of bone metastasis-related symptoms is confirmed by this study, even with short treatments and single-dose administrations. This is important for both patient expectations and the necessity for improved resource allocation with reference to the territorial distribution and waiting lists of radiotherapy centers. The issue of their efficacy in combination with antiblastic drugs (Bisphosphonates drugs such as Zoledronic acid) and/or external beam irradiation(EBRT) remains open and will be clarified only with further randomized clinical trials.
1) The document discusses the case of a 38-year-old Hindu male patient from Visakhapatnam presenting with a 2x1cm ulcer on the right lateral border of his tongue.
2) It describes his medical history including a history of ill-fitting dentures and dying during an MRI evaluation due to an allergic reaction to contrast.
3) The oncologist discusses potential treatment options with the patient including radiation therapy to preserve his tongue and avoid surgery, as well as interviews with ENT specialists and a dentist.
Field of oncology has evolved since many decades! This presentation will demonstrate how oncology had evolved. Special focus is on current radiation oncology and surgical oncology practices along with principles of oncology.
34320294 jak inhibitors more than just glucocorticoids (1)EVELIN LÁZARO
This editorial discusses recent trials investigating immunomodulatory therapies for COVID-19. It finds that treatment with glucocorticoids (dexamethasone) and JAK inhibitors reduces mortality in hospitalized patients receiving supplemental oxygen or ventilation. Combining JAK inhibitors with glucocorticoids may widen the window of benefit compared to either treatment alone. The editorial concludes that anti-inflammatory therapies reduce mortality in COVID-19 patients with moderate to severe disease, and that JAK inhibitors are a particularly promising option due to their oral administration, safety profile, and potential for combination with glucocorticoids.
This study evaluated the management of pulmonary nodules between 8-20mm by 18 community pulmonology practices across the US. The researchers reviewed records of 377 patients and found:
1) The prevalence of lung cancer was 25% (n=94). Nearly half of patients (46%) underwent surveillance alone while 33% had a biopsy and 20% had surgery.
2) Predicted probability of malignancy models had good accuracy but invasive procedures were still common in low risk nodules and surgery was performed in 35% of benign nodules.
3) Adherence to guidelines for pulmonary nodule management may be lacking, as invasive sampling and surgery of low risk nodules remained common despite available
Objective: Lung cancer is the leading cause of cancer death in North America. Low-dose computed tomography screening can reduce lung cancer–specific mortality by 20%.
Intensity-modulated radiotherapy with simultaneous modulated accelerated boos...Enrique Moreno Gonzalez
To present our experience of intensity-modulated radiotherapy (IMRT) with simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC).
This document discusses stereotactic ablative radiotherapy (SABR) for early-stage lung cancer. It provides an overview of SABR as a technique and guidelines for its use. It also summarizes outcomes data from studies comparing SABR to surgery or conventional radiotherapy for early-stage lung cancer. Key findings include comparable local control with SABR compared to other options but superior quality of life. Toxicities are generally mild but increase for more central tumors or patients with comorbidities. Completely randomized trials are still needed to definitively guide treatment of early-stage lung cancer.
1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
This document provides an overview of the book "Image-guided Radiotherapy of Lung Cancer". It discusses how image-guided radiotherapy (IGRT) using techniques like PET/CT, 4D-CT, gated radiotherapy, IMRT and proton radiotherapy have introduced a new era for radiotherapy treatment of lung cancer. The book focuses on these novel IGRT approaches and provides recommendations on dose/fractionation, target volume delineation, treatment techniques and normal tissue tolerances. It aims to establish disease stage-specific guidelines to help radiation oncologists incorporate these advanced techniques into clinical practice for improved patient outcomes.
HLTHST382 Fa16-Individual Paper Assignment-Craig Peters-Draft 8Craig Peters
This document discusses the need for further research on radiation safety for adults undergoing medical imaging. It proposes a longitudinal study tracking the accumulated radiation exposure of 500,000 middle-aged adults over 15-20 years. Such a study could help close current gaps in understanding safe radiation levels. The document reviews existing literature showing that reducing tube current is effective for lowering patient radiation dose. However, thicker patients require higher radiation for adequate imaging. Cardiac CT in particular has increased and delivers significant radiation. Further research is needed to better understand safe radiation levels.
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
CyberKnife: A New Option In the Treatment of Lung CancerKue Lee
This document summarizes the development and use of stereotactic body radiotherapy (SBRT) for early stage non-small cell lung cancer (NSCLC). It discusses how conventional radiation therapy had poor outcomes, but SBRT allows higher, more effective radiation doses to be delivered safely. Phase II data showed SBRT achieved high local control and 3-year survival rates for inoperable early stage NSCLC. Emerging data also suggests SBRT may be comparable to surgery for operable NSCLC, though more research is still needed to determine the optimal treatment approach. Overall, SBRT has significantly improved outcomes for early stage NSCLC compared to previous radiation techniques.
Evaluating Lung Nodules in an Endemic Region for CoccidioidomycosisKue Lee
This document summarizes a talk on evaluating lung nodules in a region where coccidioidomycosis is endemic. It discusses challenges in applying national guidelines locally. Radiological characteristics and clinical risk factors are used to evaluate nodules. A calculator was developed using these factors that better differentiates between coccidioidomycosis and lung cancer in nodules. Ongoing work includes refining the calculator, evaluating new tests like PCR for coccidioidomycosis, creating a tissue database, and assessing the impact of a lung nodule clinic.
The document summarizes several studies from the October 2010 issue of Radiology on various medical imaging techniques. It reports that digital tomosynthesis was found to have higher sensitivity than radiography in detecting lung lesions. It also discusses studies finding that some epidural hematomas may remain indolent without treatment, dual-energy CT can help differentiate contrast staining from hemorrhage, and screening CT may not be effective for early detection of ovarian cancer.
This document summarizes several studies on the risks of cancer from radiation exposure during medical imaging exams like CT scans and X-rays. Some key findings discussed are: 1) Studies have found small increased risks of leukemia and brain tumors from radiation exposure during childhood medical imaging; 2) Exposure to low doses of radiation from cardiac imaging after a heart attack was associated with a small increased risk of cancer; 3) One study estimated that CT scans in children could triple the risk of leukemia from doses over 50 mGy and triple the risk of brain tumors from doses over 60 mGy. However, the absolute risks were considered small.
Adjuvant Radiation Therapy in Early Cervical Cancer - EvidencesDr. Malhar Patel
Radiation therapy is one of the main line of management of carcinoma cervix.
This presentation is regarding evidences of adjuvant radiation therapy (post operative) in case of early carcinoma cervix.
The document discusses the increasing use of computed tomography (CT) scans and the resulting rise in medical radiation exposure. While CT scans provide important medical benefits, there is growing concern about the potential long-term health risks of radiation exposure, especially for pediatric patients. The literature review found that average radiation doses have doubled in some cases over the past decade and CT scans are now responsible for a significant portion of population radiation exposure from medical imaging. However, there is no system currently in place to track patients' cumulative lifetime radiation exposure from medical sources. The document examines various proposals to help minimize radiation doses from CT scans and optimize protocols while also exploring the feasibility of developing a standardized method for tracking and recording lifetime medical radiation exposure information.
Radiotherapy Risk Profiles & Its ManagementSubrata Roy
Due to the rapidly increasing complexity during the last years, comprehensive QA has become even more of an issue, including treatment planning software, information handling and treatment delivery. Obviously methods from clinical risk management (RM) can be well adapted and adopted for use in radiotherapy.
Understanding the complex process of radiotherapy requires many different kinds of expertise: it involves understanding principles of medical physics, radio biology, radiation safety, dose measurement and calculation, radiotherapy planning and simulation, and the interaction of radiotherapy with other treatment modalities, among others. Several different professional groups are needed to plan and deliver radiotherapy. The main professionals involved are radiation oncologists, radiation therapists and medical physicists. Each of these disciplines must work together through an integrated process to plan and deliver radiotherapy to patients
Optimal Treatment for Clinically Node Positive Prostate Cancer -A Brief Analy...Kanhu Charan
1. The document discusses the optimal treatment for clinically node positive prostate cancer, which is a controversial issue due to lack of randomized trial data.
2. It analyzes guidelines from the NCCN, results from the RTOG 85-31 trial, and studies from the national cancer database which all suggest that androgen deprivation therapy (ADT) plus radiation therapy provides better survival outcomes than ADT alone.
3. While most evidence comes from retrospective studies, the findings indicate that ADT plus radiation should be the standard treatment, and a randomized controlled trial is still needed to confirm potential survival benefits seen in previous analyses.
This document discusses the options and challenges for reirradiating recurrent brain tumors. It may be considered for gliomas or brain metastases if the prior radiation tolerance doses of critical structures like the optic pathways, brainstem and whole brain have not been exceeded. Differentiating tumor recurrence from treatment effects like necrosis or pseudoprogression is important prior to reirradiation. Short interval since prior radiation and large tumor volume predict poor outcomes. With smaller recurrences in favorable locations, reirradiation using techniques like stereotactic radiosurgery may be offered if the radiation interval is over 6 months. A multidisciplinary discussion weighing risks and benefits is needed for each case.
The management of painful bone metastases requires multidisciplinary care, with external beam radiation therapy (EBRT) providing relief that is effective and time efficient.
In our study the efficacy of external beam irradiation in the palliation of bone metastasis-related symptoms is confirmed by this study, even with short treatments and single-dose administrations. This is important for both patient expectations and the necessity for improved resource allocation with reference to the territorial distribution and waiting lists of radiotherapy centers. The issue of their efficacy in combination with antiblastic drugs (Bisphosphonates drugs such as Zoledronic acid) and/or external beam irradiation(EBRT) remains open and will be clarified only with further randomized clinical trials.
1) The document discusses the case of a 38-year-old Hindu male patient from Visakhapatnam presenting with a 2x1cm ulcer on the right lateral border of his tongue.
2) It describes his medical history including a history of ill-fitting dentures and dying during an MRI evaluation due to an allergic reaction to contrast.
3) The oncologist discusses potential treatment options with the patient including radiation therapy to preserve his tongue and avoid surgery, as well as interviews with ENT specialists and a dentist.
Field of oncology has evolved since many decades! This presentation will demonstrate how oncology had evolved. Special focus is on current radiation oncology and surgical oncology practices along with principles of oncology.
34320294 jak inhibitors more than just glucocorticoids (1)EVELIN LÁZARO
This editorial discusses recent trials investigating immunomodulatory therapies for COVID-19. It finds that treatment with glucocorticoids (dexamethasone) and JAK inhibitors reduces mortality in hospitalized patients receiving supplemental oxygen or ventilation. Combining JAK inhibitors with glucocorticoids may widen the window of benefit compared to either treatment alone. The editorial concludes that anti-inflammatory therapies reduce mortality in COVID-19 patients with moderate to severe disease, and that JAK inhibitors are a particularly promising option due to their oral administration, safety profile, and potential for combination with glucocorticoids.
This study evaluated the management of pulmonary nodules between 8-20mm by 18 community pulmonology practices across the US. The researchers reviewed records of 377 patients and found:
1) The prevalence of lung cancer was 25% (n=94). Nearly half of patients (46%) underwent surveillance alone while 33% had a biopsy and 20% had surgery.
2) Predicted probability of malignancy models had good accuracy but invasive procedures were still common in low risk nodules and surgery was performed in 35% of benign nodules.
3) Adherence to guidelines for pulmonary nodule management may be lacking, as invasive sampling and surgery of low risk nodules remained common despite available
Objective: Lung cancer is the leading cause of cancer death in North America. Low-dose computed tomography screening can reduce lung cancer–specific mortality by 20%.
Intensity-modulated radiotherapy with simultaneous modulated accelerated boos...Enrique Moreno Gonzalez
To present our experience of intensity-modulated radiotherapy (IMRT) with simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC).
This document discusses stereotactic ablative radiotherapy (SABR) for early-stage lung cancer. It provides an overview of SABR as a technique and guidelines for its use. It also summarizes outcomes data from studies comparing SABR to surgery or conventional radiotherapy for early-stage lung cancer. Key findings include comparable local control with SABR compared to other options but superior quality of life. Toxicities are generally mild but increase for more central tumors or patients with comorbidities. Completely randomized trials are still needed to definitively guide treatment of early-stage lung cancer.
1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
This document provides an overview of the book "Image-guided Radiotherapy of Lung Cancer". It discusses how image-guided radiotherapy (IGRT) using techniques like PET/CT, 4D-CT, gated radiotherapy, IMRT and proton radiotherapy have introduced a new era for radiotherapy treatment of lung cancer. The book focuses on these novel IGRT approaches and provides recommendations on dose/fractionation, target volume delineation, treatment techniques and normal tissue tolerances. It aims to establish disease stage-specific guidelines to help radiation oncologists incorporate these advanced techniques into clinical practice for improved patient outcomes.
HLTHST382 Fa16-Individual Paper Assignment-Craig Peters-Draft 8Craig Peters
This document discusses the need for further research on radiation safety for adults undergoing medical imaging. It proposes a longitudinal study tracking the accumulated radiation exposure of 500,000 middle-aged adults over 15-20 years. Such a study could help close current gaps in understanding safe radiation levels. The document reviews existing literature showing that reducing tube current is effective for lowering patient radiation dose. However, thicker patients require higher radiation for adequate imaging. Cardiac CT in particular has increased and delivers significant radiation. Further research is needed to better understand safe radiation levels.
1) Radiation therapy has a questionable role in treating primary renal cell carcinoma (RCC) but is commonly used to palliatively treat brain and other metastatic lesions.
2) Stereotactic body radiation therapy (SBRT) enables high doses of radiation to tumors while sparing normal tissues and has shown promise for treating primary or metastatic RCC, with local control rates of 90-98% in studies.
3) While some studies found adjuvant radiation after surgery reduced local recurrence in advanced RCC, prospective randomized trials found no survival benefit and increased toxicity, so radiation is not routinely recommended after surgery.
The document provides updates from various departments at the Kimmel Cancer Center. It announces new treatments for prostate cancer including high intensity focused ultrasound. It highlights advances in areas like radiation oncology, integrative medicine, and stem cell research. It recognizes support from donors and announces new rankings for cancer care.
Researchers at Norris Cotton Cancer Center have, for the first time, used Cherenkov emissions to visualize radiation beams as they enter and exit a patient's body during cancer treatment. In a trial with a breast cancer patient, images showed a hot spot in the underarm area, allowing physicians to prevent overdosing. This technique provides real-time information about radiation dosage and location with minimal added time to treatments. The goal is to help optimize treatments and avoid misadministration of radiation. A pilot study with 12 patients is nearing completion.
Essentials of radiation therapy and cancer immunotherapy by Dr. Basil TumainiBasil Tumaini
Radiation therapy uses high-energy radiation to treat cancer and control its symptoms. It works by damaging DNA in cancer cells and preventing them from reproducing. The radiation oncology team includes radiation oncologists, medical physicists, dosimetrists, radiation therapists and nurses. Treatment involves simulation, planning and delivery, with the goal of maximizing dose to the tumor while minimizing it to healthy tissues. External beam radiation uses linear accelerators to deliver photon or particle beams in precise fractions over weeks, while brachytherapy places radioactive sources directly in or near tumors. New techniques like IMRT and SBRT further improve targeting accuracy.
Recent advances in the diagnosis and treatment of thyroid cancerHealthXn
This document summarizes recent advances in the diagnosis and treatment of thyroid cancer by Professor Steven Boyages. It discusses the rising incidence of thyroid cancer in recent decades, which may be due to increased medical surveillance and technology. It describes a study that examined pathways to diagnosis for thyroid cancer patients in New South Wales, finding most were serendipitous discoveries. Factors like tumor size influenced diagnosis pathways. Minimally invasive thyroidectomy techniques and strategies for radioiodine ablation in low-risk thyroid cancer, including using recombinant human thyrotropin and lower radiation doses, are also summarized. Treatment of radioiodine-resistant thyroid cancer is an ongoing challenge.
Alain Toledano : Small Breast Cancers Radiotherapy : Locoregional Treatments ...breastcancerupdatecongress
This document provides guidance on the use of accelerated partial breast irradiation (APBI) based on published evidence and expert consensus. It proposes three patient groups: 1) "suitable" patients for whom APBI outside of trials is acceptable, 2) "cautionary" patients for whom APBI should only be considered in trials, and 3) "unsuitable" patients for whom APBI is not recommended. While APBI may be an option for select patients, whole breast irradiation remains the established standard treatment with longer-term data demonstrating effectiveness and safety. Patients choosing APBI should understand it is not as established as whole breast irradiation.
Precision Radiotherapy: Tailoring Treatment for Individualised Cancer Care.pptxDr. Rituparna Biswas
Precision radiotherapy, also known as precision radiation therapy or targeted radiotherapy, is a cutting-edge approach in the field of radiation oncology that aims to deliver highly focused and accurate doses of radiation to cancerous cells while minimizing damage to surrounding healthy tissues.
Personalized medicine in radiation oncology aims to individualize radiotherapy treatment through better imaging, genetics, and biomarkers. Newer radiotherapy techniques like IMRT and IGRT allow for more precise targeting of tumors while minimizing dose to normal tissues. Biomarkers can help characterize tumor hypoxia, proliferation, and a patient's inherent radiosensitivity at the genetic level. Radiogenomics research seeks genetic polymorphisms associated with radiation response and side effects. The goal is to predict treatment outcomes and tailor radiotherapy for each patient's unique biology and genetics.
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 provides guidance for physicians on appropriate use of medical imaging for common clinical
presentations. It discusses when CT, MRI, ultrasound or other modalities are most useful for evaluating abdominal
pain, chest pain, headache and other issues. The goal is to promote efficient and radiation-limiting use of imaging
to aid accurate diagnosis while avoiding unnecessary exposure or costs. Imaging choice depends on clinical
findings, but CT and MRI may help identify conditions like appendicitis, aneurysms, infections or tumors causing
abdominal, chest or neurological symptoms.
Role of diffusion weighted magnetic resonance imaging inshubhamoygantait
This document outlines a study examining the role of diffusion weighted magnetic resonance imaging (DWI) in evaluating prostate cancer. The study aims to evaluate suspected prostate cancer cases with DWI and correlate findings with histology. It also aims to compare DWI findings to T2-weighted imaging (T2WI) findings and their combination to see if the multiparametric approach increases cancer detection sensitivity and specificity. The study involves imaging and histological analysis of 100 patients with suspected prostate cancer using 1.5T MRI with endorectal and surface coils. Statistical analysis will correlate imaging findings with histology and stage cancer based on imaging and pathology.
Begoña Caballero-'La visión computacional se encuentra con la medicina'Fundación Ramón Areces
El 14 de noviembre de 2016, la Fundación Ramón Areces organizó un Simposio Internacional sobre tecnología aplicada al mundo de la medicina de la mano del Instituto Tecnológico de Massachusetts (MIT) y de la Fundación mVision. Este encuentro llevó por título 'La visión computacional se encuentra con la medicina'. Durante esta jornada, se analizó el impacto que están teniendo las nuevas técnicas de imagen en alta resolución para el diagnóstico de todo tipo de enfermedades.
Advances of Radiation Oncology in CancManagement: Vision for Role of Theranos...CrimsonpublishersCancer
Significant computational and technological advances in radiation therapy have enhanced our ability to more accurately plan and deliver increasing doses of radiation therapy to limited target volumes in many patients with cancer. Recent developments on magnetic resonance on-line imaging and use of implanted markers allow more precise on-time tumor localization with lower doses delivered to surrounding organs at risk leading to less treatment morbidity. Biological markers and molecular imaging (theranostics) will add new dimensions and precision to radiation therapy techniques. Nanoparticles are promising tools in therapeutic programs. Further research in efficacy, safety, cost utility (value) and institution of robust quality assurance programs will be necessary to optimize these contributions in clinical practice.
1) Stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT), and stereotactic body radiotherapy (SBRT) use focused radiation beams and precise targeting to deliver high doses of radiation to small, well-defined tumors with minimal damage to surrounding healthy tissue.
2) Studies have found stereo treatments improve survival rates for certain brain tumors compared to traditional treatments and offer an effective non-invasive option for inoperable lung tumors.
3) The advantages of stereo treatments include targeting small tumors with high radiation doses using fewer treatment sessions, resulting in reduced side effects and improved quality of life for patients.
Ionizing radiation makes invasive cardiology procedures such as coronary angiography, percutaneous coronary intervention (PCI), and electrophysiologic diagnostics and therapeutics possible .
Radiation risks can be thought of as deterministic (effects after exceeding certain threshold, e.g., skin burns) or stochastic (a risk of an outcome is proportional to the dose received, e.g., malignancy or teratogenicity) .
Reducing the radiation exposure in the cardiac catheterization laboratory is important, especially as procedures are becoming more complex .
Study on Physicians Request for Computed Tomography Examinations for Patients...IRJESJOURNAL
Background and objectives: There is a lot controversy about the use of Computed tomography (CT) for patients with minor head injury. We aimed to determine the practice of guiding rules for the safety of radiation and increasing awareness of physicians about risks of ionizing radiation and find out the reasons of emergency doctors for sending head injury patients to CT scan exams. Materials and Methods: A descriptive questionnaire in the Emergency Department (ED) based study was performed to assess physicians' knowledge of radiation doses received from radiological treatments and knowledge about Clinic Decision Support rules (CDS). The questionnaire consisted of 26 questions distributed to physicians working in the emergency department in six hospitals in East Java. Finally, the data collected have been analyzed by some tests using SPSS version 15 and Smart PLS. Results: In this study 44 participants had taken part. The percentage of general knowledge and awareness that shows the response of people who work in the emergency departments was total 44 respondents, by percent 6.8% of the respondents had passably knowledge, awareness and 84.1% they were having a good knowledge and awareness and 9.1% the respondents had very good knowledge and awareness. That means almost of respondents have good knowledge and awareness. To find out if an indicator is forming a construct (latent variables) testing the convergent validity of the measurement model with a reflexive indicator assessed based on the correlation between the item score to construct scores were calculated with the help of software Smart PLS. Size reflexive considered valid if the individual has a correlation (loading) to construct (latent variables) to be measured ≥ 0.5 or the value of t-statistics should ≥1.96 (test two tailed) at a significance level of α = 0.05. If one of the indicators has a leading value <0.5,><1.96, then the indicator should be discarded (dropped) because it indicates that the indicators are not good enough to measure the construct in right. The positive influence between general knowledge and awareness against to knowledge about radiation doses can be interpreted that the better general knowledge and awareness, then it will be followed by an increase in their knowledge about radiation doses. And vice versa, the worse general knowledge and awareness, then this will decrease their knowledge about radiation doses too. Conclusion: The present study has illustrated that the level of awareness and knowledge physicians who deal with ionizing radiation in CT scan units are adequate overall. There is a good influence between the diligence in applying the principles of guidance and rules stipulated by the nuclear energy in Indonesia by physicians to adjust the use of CT in the emergency department, the majority of participants who have a good awareness & knowledge, there are some of them do not have enough knowledge.
Study on Physicians Request for Computed Tomography Examinations for Patients...
Limiting the risks
1. Limiting the risks of radiation
exposure in diagnostic imaging
Preston Ray,a
Thinh Vu, MD,b
Minerva Romero, MD, MPH,a
and Nancy D. Perrier, MD, FACS,a
Houston, TX
From the Departments of Surgical Oncologya
and Neuroradiology,b
The University of Texas M.D. Anderson
Cancer Center, Houston, TX
THIS REPORT BY THE JOHNS HOPKINS’ GROUP discusses
the development that multiphase computed to-
mography (CT) as becoming a favored imaging
modality for complex parathyroid localization.1
The article cites delineation of hyperfunctioning
parathyroid tissue from other structures by relating
density on unenhanced CT to the rapidity of
enhancement following contrast injection. The
‘‘fourth dimension’’ (4D) of perfusion over time
has excellent predictive power for localization.
The additional ‘‘washout phase’’ has been cited
to increase reader confidence. In this article, Nour-
eldine et al recommend eliminating $1 aspects of
serial scans to decrease the effective radiation
dosing. We support decreasing radiation exposure
to the patient using an informative and respon-
sible risk–benefit strategy.
To understand the risk, a basic knowledge of
radiation dosage terms is needed. Effective dose is a
probabilistic estimate of the total amount of radia-
tion absorbed at different doses by the tissues
exposed (Table I).2
Measured in Sieverts (Sv)
and used mainly to evaluate radiation risks in pa-
tients, effective doses are difficult to calculate
because they depend largely on estimating ab-
sorbed doses from CT.2
Although estimating effec-
tive dose has many limitations, such as not being
specific to patient size or gender, it is commonly
used for medical imaging examinations involving
radiation. Exposure is the ionization produced in
a specific volume of air as radiation waves strip
electrons from air molecules.2
Absorbed dose is
the amount of energy absorbed per unit of mass
in a particular tissue, measured in grays (Gy).2
Although the radiation used in diagnostic im-
aging accounts for <50% of all radiation exposure
in the United States,3
a 2004 study suggested that
medical exposure might be responsible for
approximately 1% of the cancer in the United
States.4
However, it is difficult to isolate radiation-
induced cancers (1/1,000 per 10-mSv effective
dose) that are superimposed on the normal back-
ground risk for other cancers (approximately
40% of the population will be diagnosed as having
cancer at some point in their lives).5
Table II lists
the approximate effective doses for various forms
of radiation exposure. Some form of radiation,
including radioactive materials and ultraviolet
rays, is believed to play a role in #10% of all cases
of invasive cancer.6
A 2009 study brought medical radiation expo-
sure risks into the spotlight. In 2007, an estimated
72 million CTs were performed in the United
States---nearly 200,000 CT per day, or >2 scans per
second.4
Essentially, the issue of radiation expo-
sure narrows down to 2 overarching questions:
How can risk be minimized, and how much is
too much exposure? With awareness, clinicians
can make informed decisions about this risk–
benefit ratio pertaining to diagnostic imaging
involving radiation.7
Avoiding low-quality imaging
reduces the need for repetitive scanning. Accord-
ing to the principle of ALARA (as low as reason-
ably achievable), the absorbed dose should be
the lowest needed for a good image.8
The Image
Gently and Image Wisely campaigns represent
many professional organizations working to reduce
the use of medical radiation in children and
adults, respectively. Predicting radiation risk for in-
dividual patients is difficult because the risk de-
pends on the patient’s size, gender, age, and
targeted organs. The risk is greater for young pa-
tients than for older patients because young pa-
tients have longer to live with the absorbed dose
and their tissues are more sensitive to radiation
10.1016/j.surg.2014.08.002
Accepted for publication August 22, 2014.
Reprint requests: Nancy D. Perrier, MD, FACS, The University of
Texas M.D. Anderson Cancer Center, 1400 Pressler Dr., Unit
1484, Houston, TX 77030. E-mail: NPerrier@mdanderson.org.
Surgery 2014;156:1297-9.
0039-6060/$ - see front matter
Ó 2014 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.surg.2014.08.085
SURGERY 1297
2. damage. In addition, the sensitivity of the targeted
organ has a significant impact on the effective
dose, depending on the concentration of mito-
chondria and the frequency of mitosis. The risk
can be greater for females than for males if breast
tissue is exposed to radiation. Because of these
variations in risk, specific protocols cannot be
developed, and treating clinicians must treat each
patient according to the patient’s needs.
Four-dimensional CT (4DCT) for imaging hyper-
functional parathyroid glands represents a good
example of the need to carefully assess the balance
between risks and benefits. The dose absorbed by
the parathyroid is 57.5 times higher (92 vs 1.6 mGy)
on average with 4DCT than with sestamibi scan-
ning.9
Therefore, 4DCT must be used with caution.9
However, a conservatively estimated absorbed dose
of 27 mSv received in a 4-stage 4DCTexaminationin-
creases a patient’s annual cancer risk by only
0.019%.10
Given the very small risk, this particular
scenario has a favorable risk–benefit ratio.10
Reducing the 4DCT examination from 4 stages to
3 would diminish the effective dose to approxi-
mately 21 mSv without lowering the examination’s
accuracy.11
Reducing the examination to 2 stages,
however, would drastically lower the likelihood of
accurately localizing the abnormality.11,12
Overall,
the potential benefits of quality 4DCT scanning to
localize a parathyroid disease can outweigh the risks.
The safety of each patient ultimately rests on
their clinician’s educated assessment of those risks.
Clinicians should ensure that all diagnostic imag-
ing examinations are of high quality and need not
be repeated. As endocrine surgeons, we can help
our referring physicians by encouraging them to
allow us to order scans based on quality and
necessity of ‘‘roadmapping’’ the case, not for
diagnostic purposes. We can help our patients by
being knowledgeable about radiation risks so that
we can effectively inform a patient with sporadic
primary hyperparathyroidism that the risks of
performing a good, quality, diagnostic 4DCT ex-
amination are minimal compared with the benefits
of localizing an adenoma. The importance of
accurate localization to help facilitate cure and
eliminate future studies can ensure that diagnostic
imaging procedures do not needlessly compromise
patient safety.
REFERENCES
1. Noureldine SI, Aygun N, Walden MJ, Hassoon A, Gujar SK,
Tufano RP. Multiphase computed tomography for localiza-
tion of parathyroid disease in patients with primary hyper-
parathyroidism: How many phases do we really need?
Surgery 2014;156:1300-7.
2. McNitt-Gray MF. AAPM/RSNA physics tutorial for residents:
topics in CT. Radiation dose in CT. Radiographics 2002;22:
1541-53.
3. National Council on Radiation Protection & Measurements.
Report no. 160: ionizing radiation exposure of the popula-
tion of the United States. Bethesda: National Council on
Radiation Protection & Measurements; 2009.
4. Berrington de Gonzalez A, Mahesh M, Kim KP, Bhargavan
M, Lewis R, Mettler F, et al. Projected cancer risks from
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5. Amis ES Jr, Butler PF, Applegate KE, Birnbaum SB, Brate-
man LF, Hevezi JM, et al. American College of Radiology.
Table I. Typical effective radiation doses from
common diagnostic imaging examinations13
Examination
Typical effective
dose (mSv)
Range
(5th–95th
percentile)
95th/5th
percentile
ratio
Ultrasound 0.0 — —
X-ray
Skull 0.03 0.012–0.06 5.0
Chest 0.02 0.008–0.037 4.6
Abdomen 0.7 0.26–1.4 5.4
Pelvis 0.7 0.3–1.3 4.3
CT
Head 2.0 0.9–3.0 3.3
Chest 8.0 2.4–16.0 6.7
Abdomen 10.0 4.0–18.0 4.5
Pelvis 10.0 4.0–18.0 4.5
Table II. Levels of radiation for various types of
exposure from diagnostic imaging examinations13
Exposure
Approximate
effective
dose (mSv)
Radiation
equivalent
Ultrasonography 0.0 —
Working as an
international flight
attendant for 1 y
(600 flights)
4 2 head CT scans
Natural background
radiation (1 y)
2.4 120 chest x-rays
Chest x-ray 0.02 3 international
flights
CT
Head 2.0 100 chest x-rays
Chest 8.0 4 head CT scans
Abdomen 10.0 4.2 y of natural
background
radiation
4DCT (4-stage) 27.0 8 y of natural
background
radiation
CT, Computed tomography.
Surgery
December 2014
1298 Ray et al
3. American College of Radiology white paper on radiation
dose in medicine. J Am Coll Radiol 2007;4:272-84.
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Tharakan ST, Lai OS, et al. Cancer is a preventable disease
that requires major lifestyle changes. Pharm Res 2008;25:
2097-116.
7. Redberg RF. Cancer risks and radiation exposure from
computed tomographic scans: how can we be sure that
the benefits outweigh the risks? Arch Intern Med 2009;
169:2049-50.
8. Brateman L. Radiation safety considerations for diagnostic
radiology personnel. Radiographics 1999;19:1037-55.
9. Mahajan A, Starker LF, Ghita M, Udelsman R, Brink JA,
Carling T. Parathyroid four-dimensional computed tomog-
raphy: evaluation of radiation dose exposure during preop-
erative localization of parathyroid tumors in primary
hyperparathyroidism. World J Surg 2012;36:1335-9.
10. Hunter GJ, Schellingerhout D, Vu TH, Perrier ND, Hamberg
LM. Accuracy of four-dimensional CT for the localization of
abnormal parathyroid glands in patients with primary hyper-
parathyroidism. Radiology 2012;264:789-95.
11. Kelly HR, Hamberg LM, Hunter GJ. 4D-CT for preoperative
localization of abnormal parathyroid glands in patients with
hyperparathyroidism: accuracy and ability to stratify pa-
tients by unilateral versus bilateral disease in surgery-naive
and re-exploration patients. AJNR Am J Neuroradiol 2014;
35:176-81.
12. Hunter GJ, Ginat DT, Kelly HR, Halpern EF, Hamberg LM.
Discriminating parathyroid adenoma from local mimics by
using inherent tissue attenuation and vascular information
obtained with four-dimensional CT: formulation of a
multinomial logistic regression model. Radiology 2014;
270:168-75.
13. Wall BF, Hart D. Revised radiation doses for typical X-ray
examinations. Report on a recent review of doses to patients
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National Radiological Protection Board. Br J Radiol 1997;
70:437-9.
Surgery
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