Gated Radiotherapy Development and its Expansion

One of the most important challenges in treatment of patients with cancerous tumors of chest and abdominal areas is organ movement. The delivery of treatment radiation doses to tumor tissue is a challenging matter while protecting healthy and radio sensitive tissues. Since the movement of organs due to respiration causes a discrepancy in the middle of planned and delivered dose distributions. The moderation in the fatalistic effect of intra-fractional target travel on the radiation therapy correctness is necessary for cutting-edge methods of motion remote monitoring and cancerous growth irradiancy. Tracking respiratory milling and implementation of breath-hold techniques by respiratory gating systems have been used for compensation of respiratory motion negative effects. Therefore, these systems help us to deliver precise treatments and also protect healthy and critical organs. It seems aspiration should be kept under observation all over treatment period employing tracking seed markers (e.g. fiducials), skin surface scanners (e.g. camera and laser monitoring systems) and aspiration detectors (e.g. spirometers). However, these systems are not readily available for most radiotherapy centers around the word. It is believed that providing and expanding the required equipment, gated radiotherapy will be a routine technique for treatment of chest and abdominal tumors in all clinical radiotherapy centers in the world by considering benefits of respiratory gating techniques in increasing efficiency of patient treatment in the near future.This review explains the different technologies and systems as well as some strategies available for motion management in radiotherapy centers.

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Recent advances in Surface Guided Radiation Therapy

Radiation Oncology ◽

10.1186/s13014-020-01629-w ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 2

Author(s):

P. Freislederer ◽

M. Kügele ◽

M. Öllers ◽

A. Swinnen ◽

T.-O. Sauer ◽

...

Keyword(s):

Quality Assurance ◽

Radiation Therapy ◽

Imaging Technique ◽

Patient Treatment ◽

Quality Assurance Program ◽

Breath Hold ◽

Breast Irradiation ◽

Clinical Practices ◽

Motion Management ◽

Wide Range

Abstract The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques. SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments. The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations. Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests. Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition). This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.

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Motion management within two respiratory-gating windows: feasibility study of dual quasi-breath-hold technique in gated medical procedures

Physics in Medicine and Biology ◽

10.1088/0031-9155/59/21/6583 ◽

2014 ◽

Vol 59 (21) ◽

pp. 6583-6594 ◽

Cited By ~ 7

Author(s):

Taeho Kim ◽

Siyong Kim ◽

Yang-Kyun Park ◽

Kaylin K Youn ◽

Paul Keall ◽

...

Keyword(s):

Feasibility Study ◽

Respiratory Gating ◽

Breath Hold ◽

Medical Procedures ◽

Motion Management

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Respiratory Gating for Radiotherapy: Main Technical Aspects and Clinical Benefits

ISRN Pulmonology ◽

10.1155/2013/519602 ◽

2013 ◽

Vol 2013 ◽

pp. 1-13 ◽

Cited By ~ 20

Author(s):

Philippe Giraud ◽

Annie Houle

Keyword(s):

Respiratory Motion ◽

Liver Tumors ◽

Organs At Risk ◽

Respiratory Gating ◽

Breath Hold ◽

Complication Rates ◽

Abdominal Compression ◽

Breathing Motion ◽

Gated Radiotherapy ◽

Respiratory Movements

Respiratory-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast, and liver tumors. An increased conformality of irradiation fields leading to decreased complication rates of organs at risk is expected. Five main strategies are used to reduce respiratory motion effects: integration of respiratory movements into treatment planning, forced shallow breathing with abdominal compression, breath-hold techniques, respiratory gating techniques, and tracking techniques. Measurements of respiratory movements can be performed either in a representative sample of the general population, or directly on the patient before irradiation. Reduction of breathing motion can be achieved by using either abdominal compression, breath-hold techniques, or respiratory gating techniques. Abdominal compression can be used to reduce diaphragmatic excursions. Breath-hold can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily breath-holds. Respiratory gating techniques use external devices to predict the phase of the breathing cycle while the patient breathes freely. Another approach is tumor-tracking technique, which consists of a real-time localization of a constantly moving tumor. This work describes these different strategies and gives an overview of the literature.

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Not all biases are bad: equitable and inequitable biases in machine learning and radiology

Insights into Imaging ◽

10.1186/s13244-020-00955-7 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Mirjam Pot ◽

Nathalie Kieusseyan ◽

Barbara Prainsack

Keyword(s):

Machine Learning ◽

Human Error ◽

Technical Problem ◽

Social Dimension ◽

Patient Treatment ◽

Technical Solution ◽

Negative Effects ◽

Different Types ◽

Human Decision

AbstractThe application of machine learning (ML) technologies in medicine generally but also in radiology more specifically is hoped to improve clinical processes and the provision of healthcare. A central motivation in this regard is to advance patient treatment by reducing human error and increasing the accuracy of prognosis, diagnosis and therapy decisions. There is, however, also increasing awareness about bias in ML technologies and its potentially harmful consequences. Biases refer to systematic distortions of datasets, algorithms, or human decision making. These systematic distortions are understood to have negative effects on the quality of an outcome in terms of accuracy, fairness, or transparency. But biases are not only a technical problem that requires a technical solution. Because they often also have a social dimension, the ‘distorted’ outcomes they yield often have implications for equity. This paper assesses different types of biases that can emerge within applications of ML in radiology, and discusses in what cases such biases are problematic. Drawing upon theories of equity in healthcare, we argue that while some biases are harmful and should be acted upon, others might be unproblematic and even desirable—exactly because they can contribute to overcome inequities.

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