scholarly journals Advanced Imaging Techniques for Radiotherapy Planning of Gliomas

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1063
Author(s):  
Antonella Castellano ◽  
Michele Bailo ◽  
Francesco Cicone ◽  
Luciano Carideo ◽  
Natale Quartuccio ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Imaging Modality ◽  
Imaging Techniques ◽  
Clinical Results ◽  
Target Volume ◽  
Radiotherapy Planning ◽  
Tumor Control ◽  
Current Standard ◽  
Volume Delineation ◽  
Hemodynamic Information

The accuracy of target delineation in radiation treatment (RT) planning of cerebral gliomas is crucial to achieve high tumor control, while minimizing treatment-related toxicity. Conventional magnetic resonance imaging (MRI), including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, represents the current standard imaging modality for target volume delineation of gliomas. However, conventional sequences have limited capability to discriminate treatment-related changes from viable tumors, owing to the low specificity of increased blood-brain barrier permeability and peritumoral edema. Advanced physiology-based MRI techniques, such as MR spectroscopy, diffusion MRI and perfusion MRI, have been developed for the biological characterization of gliomas and may circumvent these limitations, providing additional metabolic, structural, and hemodynamic information for treatment planning and monitoring. Radionuclide imaging techniques, such as positron emission tomography (PET) with amino acid radiopharmaceuticals, are also increasingly used in the workup of primary brain tumors, and their integration in RT planning is being evaluated in specialized centers. This review focuses on the basic principles and clinical results of advanced MRI and PET imaging techniques that have promise as a complement to RT planning of gliomas.

scholarly journals ACTIVE INVOLVEMENT OF RADIOLOGIST IN RADIATION ONCOLOGY PRACTICE

2021 ◽  
Vol 10 (4) ◽  
pp. 3199-3201
Author(s):  
Anurag A. Luharia
Keyword(s):  
Radiation Oncology ◽  
Normal Tissue ◽  
Radiation Treatment ◽  
Imaging Modality ◽  
Tumour Volume ◽  
Target Volume ◽  
Ct Images ◽  
Radiotherapy Planning ◽  
Internal Target Volume ◽  
Radiotherapy Treatment

Advancements in Radiation Oncology from conventional to 3D conformal radiotherapy treatment demands expertise in many steps of radiation planning, the horizon of radiologist is now expanded by many folds and made radiologist as a integral part of the Radiation Oncology Department. A critical aspect of radiotherapy treatment planning (RTP) is determining how to deliver the required radiation dosage to cancer cells while minimising the exposure to normal tissue for which the prerequisite is identification and accurate delineation of tumour volume as well as normal structure resulted in an increase in the therapeutic ratio by reducing complication associated with normal tissue and allowing for higher target dosage and better local control. In modern radiotherapy CT images are the standard set of imaging modality required for the radiotherapy planning along with it many other modalities like MRI, PET or DSA are used by superimposing on original CT images in order to contour or delineate the structures defined by International Commission on Radiation Units and Measurements in Reports 50, 62 and 71 (ICRU) for radiotherapy planning which comprise of Gross tumour volume, clinical target volume, planning target volume, irradiated volume, Internal target volume and the normal structures as Organ at risk. It is self-evident that the contribution of a radiologist with a thorough knowledge of the development of these new modalities is critical for optimising the potential of these novel modes of radiation treatment delivery.

scholarly journals Visualization of 4D-PET/CT, Target Volumes and Dose Distribution: Applications in Radiotherapy Planning

2014 ◽  
Author(s):  
Matthias Schlachter ◽  
Tobias Fechter ◽  
Ursula Nestle ◽  
Katja Bühler
Keyword(s):  
Dose Distribution ◽  
Visual Information ◽  
Radiation Treatment ◽  
Target Volume ◽  
Radiotherapy Planning ◽  
Medical Doctors ◽  
Visualization System ◽  
Volume Delineation ◽  
Pet Ct ◽  
Target Volumes

In radiation treatment (RT) planning medical doctors need to consider a variety of information sources for anatomical and functional target volume delineation. The validation and inspection of the defined target volumes and the resulting RT plan is a complex task, especially in the presence of moving target areas as it is the case for tumors of the chest and the upper abdomen. A 4D-PET/CT visualization system may become a helpful tool for validating RT plans. We define major requirements such a visualization system should fulfill to provide medical doctors with the necessary visual information to validate tumor delineations, and review the dose distribution of a RT plan. We present an implementation of such a system, and present qualitative results of its applications for a lung cancer patient.

Technical illustration of Volumetric arc conformal radiotherapy planning in a case of paratesticular sarcoma

2021 ◽  
pp. 1-6
Author(s):  
Anil Gupta ◽  
Rambha Pandey ◽  
Seema Sharma ◽  
Vivek Ghosh ◽  
Ekta Dhamija ◽  
...  
Keyword(s):  
Organs At Risk ◽  
Target Volume ◽  
Radiotherapy Planning ◽  
Current Evidence ◽  
Lower Grade ◽  
Malignant Tumours ◽  
Target Volume Delineation ◽  
Volume Delineation ◽  
Delivery Technique ◽  
Technical Illustration

Abstract Introduction: Paratesticular sarcoma are extremely rare malignant tumours. Unlike other sites, they tend to be lower grade and have higher propensity of lymphatic spread. They tend to fail locally and occasionally in the regional lymph nodes. In the absence of target volume delineation guidelines and technical illustration of conformal planning, we have made an attempt to illustrate conformal planning methodology and define target volume based on current evidence in a case of paratesticular sarcoma. Methods: We are presenting a case of 62-year-old male who presented with 15-cm scrotal swelling and underwent high inguinal orchidectomy with ligation of spermatic cord. Histopathology presented a well-differentiated leiomyosarcoma of epididymis. Post-operative radiotherapy target volume included the tumour bed, ipsilateral inguinal nodes and lower pelvic nodes as the clinical target volume. Conclusion: Adjuvant radiotherapy using advanced delivery technique such as volumetric arc technique can provide good dose distribution with good sparing of organs at risk. The downside of conformal radiation delivery is that it is a resource-intensive and has no established target volume delineation guidelines.

scholarly journals Clinical Results of Fibroblast Activation Protein (FAP) Specific PET and Implications for Radiotherapy Planning: Systematic Review

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2629
Author(s):  
Paul Windisch ◽  
Daniel R. Zwahlen ◽  
Stefan A. Koerber ◽  
Frederik L. Giesel ◽  
Jürgen Debus ◽  
...  
Keyword(s):  
Systematic Review ◽  
Small Molecules ◽  
Imaging Modality ◽  
Clinical Results ◽  
Fibroblast Activation Protein ◽  
Emission Tomography ◽  
Radiotherapy Planning ◽  
Limited Data ◽  
Fibroblast Activation ◽  
Positron Emission

Small molecules targeting fibroblast activation protein (FAP) have emerged as a new group of tracers for positron emission tomography (PET) in 2018. The purpose of this systematic review is therefore to summarize the evidence that has been gathered to date in patients and to discuss its possible implications for radiotherapy planning. The MEDLINE database was searched for the use of FAP-specific PET in cancer patients and the records were screened according to PRISMA guidelines. Nineteen studies were included. While dedicated analyses of FAP-specific PET for radiotherapy planning were available for glioblastoma, head and neck cancers, lung cancer, and tumors of the lower gastrointestinal tract, there is still very limited data for several epidemiologically significant cancers. In conclusion, FAP-specific PET represents a promising imaging modality for radiotherapy planning that warrants further research.

FDG-PET/CT imaging for staging and definition of tumor volumes in radiation treatment planning in non-small cell lung cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7574-7574 ◽  
Author(s):  
Y. Xu ◽  
S. Ma ◽  
D. Yu ◽  
J. Wang ◽  
L. Zhang ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Fdg Pet ◽  
Radiation Treatment ◽  
Target Volume ◽  
Ct Images ◽  
Planning System ◽  
Treatment Planning System ◽  
Volume Delineation ◽  
Pet Ct ◽  
Fdg Pet Ct

7574 Background: 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) /computed tomography (CT) has a potential improvement for staging and radiation treatment (RT) planning of various tumor sites. But from a clinical standpoint, the open questions are essentially the following: to what extent does PET/CT change the target volume? Can PET/CT reduce inter-observer variability in target volume delineation? We analyzed the use of FDG-PET/ CT images for staging and evaluated the impact of FDG- PET/CT on the radiotherapy volume delineation compared with CT in patients with non-small cell lung cancer (NSCLC) candidates for radiotherapy. Intraobserver variation in delineating tumor volumes was also observed. Methods: Twenty-three patients with stage I-III NSCLC were enrolled in this pilot study and were treated with fractionated RT based therapy with or without chemotherapy. FDG-PET/CT scans were acquired within 2 weeks prior to RT. PET and CT data sets were sent to the treatment planning system Pinnacle through compact disc. The CT and PET images were subsequently fused by means of a dedicated radiation treatment planning system. Gross Tumor Volume (GTV) was contoured by four radiation oncologists respectively on CT (CT-GTV) and PET/CT images (PET/CT-GTV). The resulting volumes were analyzed and compared. Results: For the first phase, two radiation oncologists outlined together the contours achieving a final consensus. Based on PET/CT, changes in TNM categories occurred in 8/23 cases (35%). Radiation targeting with fused FDG-PET and CT images resulted in alterations in radiation therapy planning in 12/20 patients (60%) by comparison with CT targeting. The most prominent changes in GTV have been observed in cases with atelectasis. For the second phase was four intraobserver variation in delineating tumor volumes. The mean ratio of largest to smallest CT-based GTV was 2.31 (range 1.01–5.96). The addition of the PET data reduced the mean ratio to 1.46 (range 1.12–2.27). Conclusions: PET/CT fusion images could have a potential impact on both tumor staging and treatment planning. Implementing matched PET/CT reduced observer variation in delineating tumor volumes significantly with respect to CT only. [Table: see text]

Implementation and efficacy of a large-scale radiation oncology case-based peer-review quality program across a multinational cancer network.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 1-1
Author(s):  
Ethan B. Ludmir ◽  
Karen E. Hoffman ◽  
Anuja Jhingran ◽  
Mee-Chung Puscilla Ip ◽  
Seth D. Frey ◽  
...  
Keyword(s):  
Peer Review ◽  
Radiation Oncology ◽  
Large Scale ◽  
Radiation Treatment ◽  
Target Volume ◽  
National Standards ◽  
Case Volume ◽  
Target Volume Delineation ◽  
Volume Delineation ◽  
Cancer Network

1 Background: With rapid community expansion of academic cancer centers, ensuring high-quality delivery of care across all affiliated network sites is critical. Here we report the results of a radiation oncology peer-review system implemented across a large multinational cancer network. Methods: Weekly radiation oncology peer-review conferences were held between network centers and the main campus of a major cancer system; results of standardized peer-review for each case were recorded. Peer-review resulted in each case being scored as concordant or nonconcordant on initial review; nonconcordance was based on institutional guidelines, national standards, and/or expert opinion. Results: Between 2014 and 2018, 28,730 patient radiation treatment plans underwent peer-review at 10 network centers. The peer-review case volume increased over this study period, from 1,420 cases in 2014 to 9,112 in 2018, concomitant with network expansion. Examining cases reviewed in 2018 (N = 9,112), the most-commonly reviewed cases by disease site were breast (28.9%), head and neck (HN; 13.9%), and lung (12.6%). Of all cases in 2018, 452 (5.0%) were deemed nonconcordant. Higher nonconcordance rates were noted for HN cases (14.0%), and lower rates for lung cases (2.3%; p < 0.001). Of nonconcordant HN cases, the majority (69.5%) were deemed nonconcordant based on target volume delineation. Of nonconcordant breast cases, most (67.1%) were nonconcordant based on radiation field design. For centers added to the network during the study period, we observed a significant decrease in the nonconcordance rate over time after joining the network (average annual decrease of 5.4% in nonconcordant cases; p < 0.001). Conclusions: These data demonstrate the feasibility and efficacy of a large-scale multinational cancer network radiation oncology weekly peer-review program. Nonconcordance rates were highest for HN cases, primarily due to target volume delineation. With improved nonconcordance rates for newly-added network centers, these results offer the promise of improving the quality of radiotherapy delivery across an extensive cancer network with a major academic center as the nucleus.

Evaluation of Hybrid PET/MRI for Gross Tumor Volume (GTV) Delineation in Liver Cancer Radiotherapy

2020 ◽  
Author(s):  
Yan-Nan Zhang ◽  
Xin Lu ◽  
Zhen-Guo Lu ◽  
Li-Ping Fu ◽  
Jun Zhao ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Liver Cancer ◽  
Gross Tumor Volume ◽  
Tumor Volume ◽  
Target Volume ◽  
Biological Data ◽  
Radiotherapy Planning ◽  
Dice Similarity Coefficient ◽  
Volume Delineation ◽  
Positron Emission

Abstract Background: Hybrid 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) has been increasingly incorporated into the practice of radiation oncologists since it contains both anatomical and biological data and may bring about personalized radiation plans for each patient. The objective of this study was to evaluate the feasibility of gross tumor volume (GTV) delineation from hybrid PET/MRI compared with that from current-practice MRI during radiotherapy planning in patients with liver cancer. Methods: Twelve patients (eighteen lesions) with liver cancer were enrolled in this study. We chose one of the most popular delineating methods—the visual method—in this study, and three physicians delineated the target volume of each lesion from MRI, PET, and hybrid PET/MRI images. The difference and correlation of GTV values obtained by MRI, PET and hybrid PET/MRI were subjected to statistical analysis. In addition, the Dice similarity coefficient (DSC) was calculated to assess the spatial overlap. GTV-MRI was set as a reference. Results: Most GTV-PET/MRI (83%) and 50% of GTV-PET were larger than the reference GTV-MRI. Statistical analysis revealed that GTV-PET/MRI (p=0.021) diverged statistically significantly from the reference GTV-MRI. In contrast, GTV-PET (p=0.266) was not significantly different from GTV-MRI. GTV-PET (r=0.991, p<0.001) and GTV-PET/MRI (r=0.997, p<0.001) were significantly related to GTV-MRI. The average DSC value between GTV-MRI and GTV-PET was 0.45 (range 0–0.90) and that between GTV-MRI and GTV-PET/MRI was 0.76 (range 0.43–0.90). Conclusions: With the database used, PET/MRI-based target volume delineation for liver cancer is feasible. The larger GTV-PET/MRI may allow adequate irradiation of the diseased tissue and improved treatment effect.

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