Stereotactic body radiotherapy for treatment of liver metastasis

В данной работе было изучено методологию планирования VMAT. Роль предварительной обработки топометрии, планирования лечения, планов контроля качества, и доставки лечения пяти пациентам с метастазами в печени в Томском Областном Онкологическом Центре.In this work was study the planning methodology of VMAT. the role of pre-treatment topometry, treatment planning, quality control plans, and delivery of treatment to five patients with liver metastases in the Tomsk Regional Oncology Center

Stereotactic body radiotherapy for treatment of liver metastasis

В данной работе было изучено методологию планирования VMAT. Роль предварительной обработки топометрии, планирования лечения, планов контроля качества, и доставки лечения пяти пациентам с метастазами в печени в Томском Областном Онкологическом Центре.In this work was study the planning methodology of VMAT. the role of pre-treatment topometry, treatment planning, quality control plans, and delivery of treatment to five patients with liver metastases in the Tomsk Regional Oncology Center

Stereotactic body radiation therapy for abdominal oligometastases: a biological and clinical review

Advances in imaging and biological targeting have led to the development of stereotactic body radiation therapy (SBRT) as an alternative treatment of extracranial oligometastases. New radiobiological concepts, such as ceramide-induced endothelial apoptosis after hypofractionated high-dose SBRT, and the identification of patients with oligometastatic disease by microRNA expression may yet lead to further developments. Key factors in SBRT are delivery of a high dose per fraction, proper patient positioning, target localisation, and management of breathing–related motion. Our review addresses the radiation doses and schedules used to treat liver, abdominal lymph node (LN) and adrenal gland oligometastases and treatment outcomes. Reported local control (LC) rates for liver and abdominal LN oligometastases are high (median 2-year actuarial LC: 61 -100% for liver oligometastases; 4-year actuarial LC: 68% in a study of abdominal LN oligometastases). Early toxicity is low-to-moderate; late adverse effects are rare. SBRT of adrenal gland oligometastases shows promising results in the case of isolated lesions. In conclusion, properly conducted SBRT procedures are a safe and effective treatment option for abdominal oligometastases

Evaluation of three presets for four-dimensional cone beam CT in lung radiotherapy verification by visual grading analysis.

Objective To evaluate three image acquisition presets for four-dimensional cone beam CT (CBCT) to identify an optimal preset for lung tumour image quality while minimizing dose and acquisition time.Methods Nine patients undergoing radical conventionally fractionated radiotherapy for lung cancer had verification CBCTs acquired using three presets: Preset 1 on Day 1 (11 mGy dose, 240 s acquisition time), Preset 2 on Day 2 (9 mGy dose, 133 s acquisition time) and Preset 3 on Day 3 (9 mGy dose, 67 s acquisition time). The clarity of the tumour and other thoracic structures, and the acceptability of the match, were retrospectively graded by visual grading analysis (VGA). Logistic regression was used to identify the most appropriate preset and any factors that might influence the result.Results Presets 1 and 2 met a clinical requirement of 75% of structures to be rated "Clear" or above and 75% of matches to be rated "Acceptable" or above. Clarity is significantly affected by preset, patient, observer and structure. Match acceptability is significantly affected by preset.Conclusion The application of VGA in this initial study enabled a provisional selection of an optimal preset (Preset 2) to be made.Advances in knowledge This was the first application of VGA to the investigation of presets for CBCT

Non-Invasive Imaging for the Assessment of Cardiac Dose and Function Following Focused External Beam Irradiation

Technological advances in imaging and radiotherapy have led to significant improvement in the survival rate of breast cancer patients. However, a larger proportion of patients are now exhibiting the less understood, latent effects of incidental cardiac irradiation that occurs during left-sided breast radiotherapy. Here, we examine the utility of four-dimensional computed tomography (4D-CT) for the accurate assessment of cardiac dose; and a hybrid positron emission tomography (PET) magnetic resonance imaging (MRI) system to longitudinally study radiation-induced cardiac effects in a canine model. Using 4D-CT and deformable dose accumulation, we assessed the variation caused by breathing motion in the estimated dose to the heart, left-ventricle, and left anterior descending artery (LAD) of left-sided breast cancer patients. The LAD showed substantial variation in dose due to breathing. In light of this, we suggest the use of 4D-CT and dose accumulation for future clinical studies looking at the relationship between LAD dose and cardiac toxicity. Although symptoms of cardiac dysfunction may not manifest clinically for 10-15 years post radiation, PET-MRI can potentially identify earlier changes in cardiac inflammation and perfusion that are typically asymptomatic. Using PET-MRI, the progression of radiation-induced cardiac toxicity was assessed in a large animal model. Five canines were imaged using 13N-ammonia and 18F-fluorodeoxyglucose (FDG) PET-MRI to assess changes in myocardial perfusion and inflammation, respectively. All subjects were imaged at baseline, 1 week, 4 weeks, 3 months, 6 months, and 12 months after focused cardiac irradiation. To the best of our knowledge PET has not been previously used to assess cardiac perfusion following irradiation. The delivered dose to the heart, left ventricle, LAD, and left circumflex artery were comparable to what has been observed during breast radiotherapy. Relative to baseline, a transient increase in myocardial perfusion was observed followed by a gradual return to baseline. However, a persistent increase in FDG uptake was observed throughout the entire left ventricle, including both irradiated and less-irradiated portions of the heart. In light of these findings, we suggest the use of this imaging approach for future human studies to assess mitigation strategies aimed at minimizing cardiac exposure and long-term toxicity subsequent to left-sided breast irradiation

Strategies for Reducing the Impact of Tumour Motion During Helical Tomotherapy

Tumour motion presents a significant limitation for effective radiotherapy of lung cancer, and more specifically for helical tomotherapy. The simultaneous and continuous movements of tomotherapy subsystems (gantry, couch, and binary multi-leaf collimator) can lead to inaccurate dose delivery, when combined with tumour motion. In this thesis, we have investigated the impact of tumour motion and strategies to reduce the resulting dose discrepancies for helical tomotherapy, through computer simulations and film measurements performed in a dynamic body phantom. Three distinctively different types of dose discrepancies have been isolated: dose rounding, dose rippling, and the intensity-modulated radiation therapy (IMRT) asynchronization effect. Each effect was shown to be affected by different combinations of tumour motion and treatment parameters. In clinical practice using a conventional fractionation scheme, the dose rounding effect remains the major concern, which can be compensated by assigning a larger treatment margin around the tumour volume. For hypofractionation schemes, the IMRT asynchronization effect can become an additional concern by introducing dose discrepancies inside the target volume, necessitating the use of a motion management technique. Two new motion management techniques have thus been developed for helical tomotherapy: loose helical tomotherapy with breath-holding and multi-pass respiratory gating. Both methods require the treatment couch to be reset to its starting position to repeat the entire helical treatment, until nearly all planned dose is delivered. For sinusoidal target motion, employing multi-pass respiratory gating was shown to reduce the dose deviation inside the target volume from 14% to 2% for a single fraction, using 4 gated passes. For non-sinusoidal tumour motion causing a dose deviation of 6% within the tumour volume, the required number of passes to keep the dose deviation below 1% was approximately 4 passes for 30 fractions and 5 passes for 3 fractions, demonstrating the feasibility of the multi-pass respiratory gating approach. Clinical implementation of the multi-pass respiratory gating technique would require a number of electronic control and communication modifications to the existing tomotherapy machine, which would lead to significant improvements in the dose distributions delivered for lung tomotherapy treatments – especially for patients exhibiting large tumour motion who are treated with hypofractionation schemes

Spatio-Temporal Modeling Of Anatomic Motion For Radiation Therapy

In radiation therapy, it is imperative to deliver high doses of radiation to the tumor while reducing radiation to the healthy tissue. Respiratory motion is the most significant source of errors during treatment. Therefore, it is essential to accurately model respiratory motion for precise and effective radiation delivery. Many approaches exist to account for respiratory motion, such as controlled breath hold and respiratory gating, and they have been relatively successful. They still present many drawbacks. Thus, research has been expanded to tumor tracking. The overall goal of 4D-CT is to predict tumor motion in real time, and this work attempts to move in that direction. The following work addresses both the temporal and the spatial aspects of four-dimensional CT reconstruction. The aims of the paper are to (1) estimate the temporal parameters of 4D models for anatomy deformation using a novel neural network approach and (2) to use intelligently chosen non-uniform, non-separable splines to improve the spatial resolution of the deformation models in image registration

On the investigation of a novel x-ray imaging techniques in radiation oncology

Radiation therapy is indicated for nearly 50% of cancer patients in Australia. Radiation therapy requires accurate delivery of ionising radiation to the neoplastic tissue and pre-treatment in situ x-ray imaging plays an important role in meeting treatment accuracy requirements. Four dimensional cone-beam computed tomography (4D CBCT) is one such pre-treatment imaging technique that can help to visualise tumour target motion due to breathing at the time of radiation treatment delivery. Measuring and characterising the target motion can help to ensure highly accurate therapeutic x-ray beam delivery. In this thesis, a novel pre-treatment x-ray imaging technique, called Respiratory Triggered 4D cone-beam Computed Tomography (RT 4D CBCT), is conceived and investigated. Specifically, the aim of this work is to progress the 4D CBCT imaging technology by investigating the use of a patient’s breathing signal to improve and optimise the use of imaging radiation in 4D CBCT to facilitate the accurate delivery of radiation therapy. These investigations are presented in three main studies: 1. Introduction to the concept of respiratory triggered four dimensional conebeam computed tomography. 2. A simulation study exploring the behaviour of RT 4D CBCT using patientmeasured respiratory data. 3. The experimental realisation of RT 4D CBCT working in a real-time acquisitions setting. The major finding from this work is that RT 4D CBCT can provide target motion information with a 50% reduction in the x-ray imaging dose applied to the patient

UWOMJ Volume 83, No 1, Winter 2014

Schulich School of Medicine & Dentistry Rural and Remote Medicine Cover of issue reads Winter 2014 - Inside Table of Contents page reads Spring 2014https://ir.lib.uwo.ca/uwomj/1067/thumbnail.jp