Effect of using different U/S probe Standoff materials in image geometry for interventional procedures : the example of prostate

PURPOSE: This study investigates the distortion of geometry of catheters and anatomy in acquired U/S images, caused by utilizing various stand-off materials for covering a transrectal bi-planar ultrasound probe in HDR and LDR prostate brachytherapy, biopsy and other interventional procedures. Furthermore, an evaluation of currently established water-bath based quality assurance (QA) procedures is presented. MATERIAL AND METHODS: Image acquisitions of an ultrasound QA setup were carried out at 5 MHz and 7 MHz. The U/S probe was covered by EA 4015 Silicone Standoff kit, or UA0059 Endocavity balloon filled either with water or one of the following: 40 ml of Endosgel(®), Instillagel(®), Ultraschall gel or Space OAR™ gel. The differences between images were recorded. Consequently, the dosimetric impact of the observed image distortion was investigated, using a tissue equivalent ultrasound prostate phantom - Model number 053 (CIRS Inc., Norfolk, VA, USA). RESULTS: By using the EA 4015 Silicone Standoff kit in normal water with sound speed of 1525 m/s, a 3 mm needle shift was observed. The expansion of objects appeared in radial direction. The shift deforms also the PTV (prostate in our case) and other organs at risk (OARs) in the same way leading to overestimation of volume and underestimation of the dose. On the other hand, Instillagel(®) and Space OAR™ "shrinks" objects in an ultrasound image for 0.65 mm and 0.40 mm, respectively. CONCLUSIONS: The use of EA 4015 Silicone Standoff kit for image acquisition, leads to erroneous contouring of PTV and OARs and reconstruction and placement of catheters, which results to incorrect dose calculation during prostate brachytherapy. Moreover, the reliability of QA procedures lies mostly in the right temperature of the water used for accurate simulation of real conditions of transrectal ultrasound imaging

First application of hemi-body electron beam irradiation for Kaposi sarcoma at the lower extremities

Kaposi’s sarcoma (KS) is a systemic neoplastic disease that can present cutaneous symptoms and is usually treated with a systematic approach due to its extent. Due to its radiosensitivity, radiotherapy is considered one of its main treatments, for palliation and local control of the skin and mucosal lesions. The aim of this paper was to report the first case of KS treated by hemi-body electron irradiation protocol in Greece. A fractionated 40 Gy hemi-body electron irradiation was prescribed to a 60-year-old male patient with KS at his legs. Dose uniformity was verified on a daily basis by thermo luminescence dosimetry (TLD). The treatment resulted to complete clinical response. Limited irradiation-derived side effects appeared. This is the first case ever to be treated with hemi-body electron irradiation protocol in Greece. To the best of our knowledge, this is also the first time that a single field hemi-body electron beam irradiation at a total skin electron beam (TSEB)-like configuration is reported to be used for KS

First treatment of mycosis fungoides by total skin electron beam (TSEB) therapy in Greece

BackgroundMycosis fungoides (MF), the most common subtype of cutaneous T-Cell Lymphoma (CTCL), is a rare chronic skin neoplasia. Total skin electron irradiation has been employed along with a variety of other topical or systemic treatments for MF management.AimTo report the first case treated by TSEB irradiation protocol in Greece.Materials and methodsA fractionated 36[[ce:hsp sp="0.25"/]]Gy total skin electron beam (TSEB) therapy was prescribed to a 65-years-old male patient with mycosis fungoides (MF), stage IIB, refractory to several treatments during a 20-year period. Dose uniform delivery was monitored by thermo-luminescence dosimetry.Results and discussionThe homogeneous skin dose distribution resulted in a complete clinical response. Limited, irradiation-oriented, side effects appeared.ConclusionsThe first TSEB irradiation prescription in Greek medical chronicles was proved effective in this case of tumor stage MF (T3-IIB), which had been refractory to several single or combination treatments

Study and development of methods for dosimetric verification of treatment plans in modern radiotherapy techniques

Patient-specific quality assurance (PSQA) is integral to contemporary radiation therapy. Currently, the evaluation of the verification plans is being performed mainly with statistical methods, which could underestimate the clinical importance of the spotted differences, as per the literature. This work aims to present a novel method based on the difference of the isodose surfaces as a dose distribution comparison tool to connect acceptance tolerance to QA limitations (equipment capabilities) and transfer a more clinical approach in the analysis procedure. The distance of dose points from the isocenter can be used as a function to define the shape of an isodose surface. Isodose surface differences (ISD) are defined as the normalised differences of reference and evaluated surface histograms plotted against their corresponding isodose. Acceptance tolerances originate from actual QA tolerances, and they are presented in a clinically intuitive way. The ISD method was compared to the gamma index using intentionally erroneous VMAT and IMRT plans. Results revealed that the ISD method is sensitive to all errors induced in the plans. Discrepancies are presented per isodose, enabling the evaluation of the plan in two regions, which represent PTV and Normal Tissue. In conclusion, the ISD method is a meaningful, QA-related, registration-free, clinically oriented technique of dose evaluation during the verification process. This method can be used as a standalone or an auxiliary tool to the well-established evaluation procedures, overcoming significant limitations reported in the literature.Η διενέργεια επαλήθευσης των ακτινοθεραπευτικών πλάνων για κάθε ασθενή αποτελεί αναπόσπαστο μέρος της σύγχρονης ακτινοθεραπείας, λόγω της αυξημένης πολυπλοκότητάς της. Επί του παρόντος, η αξιολόγηση των πλάνων επαλήθευσης πραγματοποιείται κυρίως με στατιστικές μεθόδους. Σκοπός της παρούσας διατριβής είναι η ανάπτυξη μιας νέας μεθόδου σύγκρισης κατανομών δόσης, η οποία α) να παρέχει κλινικό περιεχόμενο στα αποτελέσματά της και β) να έχει όρια αποδοχής που να προκύπτουν από τις πραγματικές δυνατότητες του γραμμικού επιταχυντή. Η βασική ιδέα έγκειται στο γεγονός ότι το σχήμα κάθε ισοδοσιακής καμπύλης ή επιφανείας είναι εφικτό να παραμετροποιηθεί σε ιστόγραμμα χρησιμοποιώντας ως συνάρτηση μετατροπής την απόσταση των σημείων που την αποτελούν από το ισόκεντρο της θεραπείας. Με αυτό τον τρόπο, η πολύπλοκη σύγκριση στον τρισδιάστατο χώρο απλοποιείται με τη βοήθεια μέτρων ανομοιότητας ιστογραμμάτων. Ως «διαφορές ισοδοσιακών επιφανειών» ορίζονται οι κανονικοποιημένες διαφορές των ιστογραμμάτων των επιφανειών αναφοράς και αξιολόγησης συναρτήσει των αντίστοιχων ισοδοσιακών επιπέδων του πλάνου. Τα όρια αποδοχής πηγάζουν από τα όρια διασφάλισης ποιότητας του γραμμικού επιταχυντή, μεταβάλλονται ανάλογα με τη βάθμωση των περιοχών του πλάνου και παρουσιάζονται με κλινικά εύληπτο τρόπο. Η προτεινόμενη αυτή μέθοδος συγκρίθηκε με τον δείκτη γ χρησιμοποιώντας κατανομές δόσης VMAT και IMRT στις οποίες εισήχθησαν σκοπίμως λάθη αυξανόμενης σημαντικότητας. Τα αποτελέσματα έδειξαν ότι η προτεινόμενη μέθοδος είναι ευαίσθητη σε όλα τα σφάλματα που εμπεριέχονται στα πλάνα. Οι αποκλίσεις παρουσιάζονται ανά ισοδόσιακή επιτρέποντας την αξιολόγηση των πλάνων σε δύο περιοχές που αντιπροσωπεύουν την περιοχή υψηλής δόσης (στόχος) και τους φυσιολογικούς ιστούς. Συμπερασματικά, η προτεινόμενη μέθοδος «Διαφορών Ισοδοσιακών Επιφανειών» αποτελεί μια εύληπτη, σχετική με τα πρωτόκολλα διασφάλιση της ποιότητας, απαλλαγμένη από την ανάγκη αντιστοίχισης των κατανομών και κλινικά προσανατολισμένη τεχνική αξιολόγησης της δόσης ακτινοβολίας κατά τη διαδικασία επαλήθευσης ακτινοθεραπευτικών πλάνων. Η μέθοδος αυτή μπορεί να χρησιμοποιηθεί είτε ως αυτόνομο είτε ως επικουρικό εργαλείο στις καθιερωμένες διαδικασίες αξιολόγησης, ξεπερνώντας σημαντικούς περιορισμούς όπως αναφέρονται στη διεθνή βιβλιογραφία

Enhancing cancer patient's well-being and health status improvement following treatment using AI methods - project ONCORELIEF

ONCORELIEF improves post-treatment health status, well-being and follow-up care for cancer patients in order to meet their needs and allow for timely suggestions before these patients face increased therapeutic side-effects, emotional distress, or biobehavioural factors promoting cancer progression

Development of a composite index of quality of life and well-being (QoL/WB) for cancer patients and survivors in the context of the ONCORELIEF project

Background/rationale or Objectives/purpose: Healthcare professionals (HCPs) and industry need to be better aware of the unmet needs, expectations and preferences of cancer patients, survivors (CP&S) and their informal carers. The objective of this study, under the ONCORELIEF Project, was to develop a composite index of QoL/WB to be included in the decision making about risks and benefits of new health interventions for CP&S, in which the different scores will provide a set of metrics to allow HCPs and stakeholders to identify and monitor different levels of cancer patient’s QoL/WB, across their treatment and survivorship process

A digital guardian angel app based on a patient- centered AI system to enhancing cancer patient's wellbeing and health status improvement following treatment

ONCORELIEF aims to validate in real-world settings the development of a patient-centered AI system which inputs, analyses and integrates big datasets from the biopsychosocial and environmental dimensions of patients with cancer, to improve post-treatment health status, increase the wellbeing and QoL, and assist the follow-up care of cancer patients. The AI system will generate an ongoing Wellbeing Index to capture the quality of life and well-being of cancer patients. A smart digital assistant (Guardian Angel) for smartphones will provide personalized support to cancer patients in post-treatment activities and tasks and suggest actions regarding the patients’ overall health-status and wellbeing index

Digitally assisted planning and monitoring of supportive recommendations in cancer patients

This publication presents a solution approach for digitally assisted planning and monitoring of supportive recommendations in cancer patients. This solution approach shall support patients in overcoming the after-effects of therapy effectively without extensive involvement of health professionals. Health professionals and patients are provided with a web application and a mobile application respectively, which use methods from mathematical decision support and artificial intelligence. This technological basis facilitates a closed-loop workflow for the cooperation of health professional and patient in oncological aftercare. The solution approach is illustrated for an exemplary case scenario of colorectal cancer

A hybrid artificial intelligence solution approach to aftercare for cancer patients

This publication presents a solution approach to oncological aftercare for cancer patients by means of artificial intelligence (AI) methods. This approach shall support patients in overcoming the after-effects of therapy effectively with suitable supportive actions and health-care professionals in goal-oriented planning of these actions. Different AI methods are used for analyzing patients’ needs for supportive actions depending on the available health data and for a monitoring of these actions. Decision support methods are used for effective planning of actions based on the AI results of analysis. The solution approach is realized in the form of a web application for health-care professionals, which allows for data analysis and planning of actions, and a mobile application for patients, which facilitates documentation and monitoring of supportive actions. In combination, they facilitate a closed-loop workflow for the effective cooperation of health-care professionals and cancer patients. The solution approach is illustrated for an exemplary case scenario of colorectal cancer

Digital Guardian Angel Supported by an Artificial Intelligence System to Improve Quality of Life, Well-being, and Health Outcomes of Patients With Cancer (ONCORELIEF): Protocol for a Single Arm Prospective Multicenter Pilot Study

BackgroundAccording to Europe’s Beating Cancer Plan, the number of cancer survivors is growing every year and is now estimated at over 12 million in Europe. A main objective of the European Commission is to ensure that cancer survivors can enjoy a high quality of life, underlining the role of digital technology and eHealth apps and tools to achieve this. ObjectiveThe main objective of this study is the development of a user-centered artificial intelligence system to facilitate the input and integration of patient-related biopsychosocial data to improve posttreatment quality of life, well-being, and health outcomes and examine the feasibility of this digitally assisted workflow in a real-life setting in patients with colorectal cancer and acute myeloid leukemia. MethodsA total of 60 patients with colorectal cancer and 30 patients with acute myeloid leukemia will be recruited from 2 clinical centers: Universitätsmedizin der Johannes Gutenberg-Universität Mainz (Mainz, Germany) and IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST, Italy). Psychosocial data (eg, emotional distress, fatigue, quality of life, subjective well-being, sleep problems, and appetite loss) will be collected by questionnaires via a smartphone app, and physiological data (eg, heart rate, skin temperature, and movement through step count) will be collected by a customizable smart wrist-worn sensor device. Each patient will be assessed every 2 weeks over their 3-month participation in the ONCORELIEF study. Inclusion criteria include patients with the diagnosis of acute myeloid leukemia or colorectal cancer, adult patients aged 18 years and older, life expectancy greater than 12 months, Eastern Cooperative Oncology Group performance status ≤2, and patients who have a smartphone and agree to use it for the purpose of the study. Exclusion criteria include patients with a reduced cognitive function (such as dementia) or technological illiteracy and other known active malignant neoplastic diseases (patients with a medical history of treated neoplastic disease are included). ResultsThe pilot study started on September 1, 2022. As of January 2023, we enrolled 33 patients with colorectal cancer and 7 patients with acute myeloid leukemia. As of January 2023, we have not yet started the data analysis. We expect to get all data in June 2023 and expect the results to be published in the second semester of 2023. ConclusionsWeb-based and mobile apps use methods from mathematical decision support and artificial intelligence through a closed-loop workflow that connects health professionals and patients. The ONCORELIEF system has the potential of continuously identifying, collecting, and processing data from diverse patient dimensions to offer health care recommendations, support patients with cancer to address their unmet needs, and optimize survivorship care. Trial RegistrationGerman Clinical Trials Register (DRKS) 00027808; https://drks.de/search/en/trial/DRKS00027808 International Registered Report Identifier (IRRID)DERR1-10.2196/4547