Top 10 Online Resources for Adaptive Radiotherapy Research
he most recent developments in the field of cancer treatment can be found in several online resources for adaptive radiotherapy research. These organizations include the Adaptive Intelligence Consortium, the Icon Group, and MR-Linacs. When it comes to enhancing patient outcomes, these sources are priceless.
Compared to traditional linac systems, MR-Linacs, or magnetic resonance imaging-guided radiation therapy, provide several benefits. These devices use continuous MRI to take many images per second, enabling medical professionals to customize radiation treatment schedules to each patient's unique anatomy. Patients can be comfortably seated throughout the procedure, making it almost painless. The radiation beams won't be felt by them at all.
The effectiveness of online customized radiation therapy was compared to reference treatment plans in the study. Although online adaptive radiotherapy aims to prevent plan erosion owing to tumor inter-fractional alterations, this kind of treatment is difficult due to the inherent restrictions of re-planning.
Clinical investigations have revealed that MR-Linacs have the potential to enhance the therapeutic ratio. However, to assess their benefits, additional clinical trials are necessary.
Online adaptive radiotherapy with CT guidance is gaining popularity. With this radiation therapy technique, the dose delivery can be more accurate. It provides online dosage computation, patient monitoring, and tumor and organ delineation. Through more accurate monitoring and on-the-fly adjustments for variations in patient anatomy, CT-guided treatment can also be used to reduce dose administration errors. However, scatter contamination and a constrained patient setup based on bony features are two drawbacks of contemporary CBCT.
Adaptive radiotherapy, called dose-dependent radiation (DART), modifies treatment parameters to achieve the best results by using information gathered from a patient's imaging on the day of treatment. This information, combined with a previously acquired IMRT dose fluence matrix, forms the basis of the treatment plan. The actual dosage distribution is then contrasted with the results, and deviations from the plan are computed in 1D, 2D, and volumetric forms. Target volumes and crucial structures also have dose-volume histograms calculated for them.
Although art is a promising technology, its application is constrained by the need for resource-intensive solutions. In one study, the viability and accuracy of Ethos, an artificial intelligence-driven CBCT-based solution, were assessed in 99 pelvic instances. A solution for quality control was also added.
One of the top places to go for research on adaptive radiation is the Adaptive Intelligence Consortium or AIC. They carry out pilot investigations, technological assessments, and clinical trials. Nearly 30 cancer centers across the world use their Ethos system. More than 30 abstracts for conferences in 2020 have been approved by the AIC.
The Varian Ethos is an AI-driven adaptive radiotherapy system that was recently released by Varian. This device uses an onboard cone beam CT to provide images and a treatment plan that is guided by artificial intelligence (AI). The plan can then be approved, modified, or rejected by the radiation oncologist. Ethos is made to modify a patient's treatment regimen if the tumor enlarges or contracts.
The workflow for online adaptive radiotherapy is a powerful technique that can improve the effectiveness of cancer therapies. It makes better use of proton radiation's conformal properties to maintain a dosage distribution that spares healthy tissue throughout the duration of therapy. It continuously adjusts to anatomical changes and inter-fractional movements, assisting medical professionals in giving cancer patients more tailored radiation therapy.
Icon, one of the top cancer treatment organizations in Australia, has opened locations in New Zealand and Mainland China as part of its global expansion. To develop research and enhance patient care, the organization has teamed with top business figures. It is in a unique position to use research to progress the field of cancer treatment because of its depth of technology and systems.
The lone Australian business, Icon Group, is ranked 47th on the Change the World List. People who are passionate, committed, and agile are rewarded by the organization dedicated to improving lives. Visit icongroup.com to find out more. And don't forget to subscribe to the newsletter.
In adaptive radiotherapy, a team of experts includes a medical physicist, radiation therapist, and physician. In a typical treatment session, a radiation therapist brings the patient into the treatment room, performs the initial setup, and acquires a volumetric MRI. In addition, the radiation therapist aligns the target in the workspace. A dosimetrist or physicist then becomes the adaptive planner. The adaptive planner then initiates a deformable-registration-based auto-contouring process. Critical structure contours are typically edited by the adaptive planner but are reviewed by the attending physician for final confirmation.
Radiation Therapy for Bladder Cancer: What's Next?
Published on: 09-06-2022
The MRE11, a protein crucial to the cellular response to DNA damage generated by radiation, will be one of the indicators of cancers studied in the future. The results may aid in the development of techniques to protect the bladder following radiation therapy. Because removing the bladder changes the rest of a person's life, this will help a lot of people.
Bladder cancer patients treated with intensity modulated radiation therapy (IMRT) had a clinical target volume (CTV) that included the tumor, bladder wall, pelvic arteries, and obturator lymph nodes. Non-isotropic margins were the term used to describe them. The first clinical target volume was around 15 cm in diameter at the tumor's core. A multileaf collimator was then used to sculpt the treatment field.
A substantial reduction or increase in bladder volume occurred while receiving therapy. This was crucial since the study's authors wanted to know if IMRT could cut down on the dosage of conventional chemoradiation. They compared CRT to IMRT in the treatment of 116 patients with muscle-invasive bladder cancer. Patients were called for follow-up evaluations after receiving therapy.
When dealing with cancer, one therapeutic option is radiation therapy. High-energy x-rays or other particles are used in radiation treatment to eradicate cancer cells. In most cases, the treatment plan will involve many sessions spread out over time. The procedure can be done either before or after surgery. Treatment aims to eliminate the possibility of the cancer returning or spreading.
Two hundred and seventy people participated in the research. The upper tract was affected in 28 cases, while the lower lot was affected in 232. Sixty-one of these patients were nephroureterectomy or TC veterans.
Advanced bladder cancer patients may benefit from intravenous chemotherapy. A medicinal medication is inserted by catheter into the bladder. You can administer this medication once a week or spread it out over a few weeks at a time. Draining the bladder may be necessary after therapy.
Chemotherapy is only one of several therapies that patients with bladder cancer undergo. Some intravenous treatments might last for up to six weeks. Patients may require booster therapies, such as immunotherapy or BCG, and maintenance therapy, even after the first treatment has been completed. If the cancer has spread from the bladder to other organs, surgery is often needed.
While intravenous chemotherapy may be administered during surgery, it is more commonly administered as an outpatient treatment. Patients are typically instructed to empty their bladders before the procedure to reduce the risk of bladder obstruction caused by foreign items. After the bladder has been emptied, the healthcare provider will put a sterile catheter into the urethra (the tube linking the bladder to the rest of the body) and inject the drugs via it. However, male patients may develop an involuntary reflex erection during the treatment; this side effect often subsides with deep breathing and distraction.
When diagnosing bladder cancer, MRI tumor definition is useful. T2-weighted spin-echo sequences and diffusion tensor imaging are only two of the imaging modalities utilized (DCE). The initial step is for the doctor to assess the tumor signal on the MRI. The size, form, and arrangement of the tumor may be ascertained with its help.
While MRI is helpful in defining tumors, it should not be used in place of other diagnostic procedures. Examples include the fact that transurethral resection biopsy is still the gold standard for diagnosing tumor size. Cancer can be diagnosed with a variety of techniques, including magnetic resonance imaging (MRI), computed tomography (CT), urography (CTU), and cystoscopy.
A polypoid mass is seen on the bladder MRI, located on the left side of the trigone. T2-weighted SE reveals a hyposignal in this mass, with disruption of the trigone wall and the surrounding fatty space. The tumor has spread to muscle and fat, but it has not reached the ureter.
Patients with bladder cancer may benefit from radiation that targets only the affected area of the bladder. With a reduced radiation dosage, healthy tissue can be left surrounding the tumor. Further, both the dose to healthy tissues and the amount of radiation that accidentally reaches nearby lymph nodes are reduced using image-guided radiotherapy. However, there is no proof that this method improves local control or survival, so it is not suited for many patients.
Treatment options for bladder cancer include radiation treatment, chemotherapy, or both. These medications are often administered intravenously or orally. The medications are administered systemically to increase their chances of killing cancer cells outside the bladder. Treatment cycles might run for a few months, and episodes are broadcast in cycles.
Adaptive Radiotherapy Strategies
Published On: 08-22-2022
Recent advances in adaptive radiotherapy strategies have allowed clinicians to reduce the dose to the ipsilateral parotid gland and correct morphological variations in tumours. However, these techniques remain labour and resource intensive. Here, we review some of the most important considerations when selecting an adaptive radiotherapy strategy. Adaptive radiotherapy strategies are not for every patient. They may be best suited for patients with specific types of tumours.
Adaptive radiotherapy is a promising new way to treat cancer since it uses novel technologies to improve tumour control. Two examples of this technology are a Luo Qin-Lang and an online ART strategy. These techniques aim to correct morphological variations by altering the treatment plan according to changes in the imaging feedback loop. Adaptive radiotherapy has been discussed conceptually for several years, but its integration into routine care has been limited due to technical limitations.
A hybrid radiation therapy method combining intensity-based image registration with mechanics-based tissue modelling can correct geometric variations induced by tumour regression or anatomical deformation. The hybrid treatment strategy reduces the target margins accordingly. The technique is also able to compensate for variations in internal organs. It also reduces the risk of post-treatment toxicity due to tumour regression. The method also eliminates the geometric uncertainty caused by intrafraction.
The new ART technique reduces the dose to the ipsilateral parotid by at least half compared to standard WBRT. Using 3D computed tomography, the mass of the parotid is visible anteriorly to the right ear. The brainstem is also outlined to assess the dose to the brainstem.
The reductions in GTV were insignificant and not associated with CTN (contrast-to-noise ratio). For some patients, detectable changes in CTN were observed. In most patients, significant anatomical changes were observed; the degree of anatomical change was very patient-specific. For example, in a representative case, shrinkages of the GTV and OAR contours can be observed between the first and last fractions. On the MVCT of the previous trace, the dose distribution of the ipsilateral parotid was approximately 50% lower than that of the contralateral parotid gland.
There are currently two significant challenges in the application of ART. First, the accuracy of the dose calculation is often suboptimal. This is due in part to the difficulty of acquiring reliable dose measurements. Second, the radiation dose is often insufficient to induce the desired tumour response. However, ART has been shown to improve tumour control in most patients. In addition, it may be too expensive to administer ART to every patient. To address this challenge, a new method has been developed that uses deep learning and recurrent neural networks.
This approach has many potential benefits for patients with advanced lung cancer. First, it may predict which patients will benefit from ART. A mid-treatment ventilation-SPECT scan, also known as V-SPECT, may help predict which patients will benefit from ART. Yuan et al. performed a prospective study using this method in patients with Stage I-III NSCLC. They defined the lung regions by classification. Region A was characterized by tumour; region B was characterized by reduced lung function, and part C was classified as usual.
Adaptive radiation therapy, or ART, was first developed in the 1990s and used a closed-loop treatment planning approach. In an ART treatment plan, the patient's anatomy and dose to organs at risk are constantly monitored and incorporated early in the treatment. Adaptive radiotherapy also contains multimodality imaging, dose summation, and quality assurance. Several studies have been conducted to determine the benefits of Adaptive Radiotherapy and the effectiveness of a given treatment plan. However, adaptive radiotherapy strategies still require substantial resources and labour.
The AAPM Task Group Report 218 discusses several techniques for IMRT QA and recommends action limits for 90% g passing rates and tolerance limits of 3%(global)/2 mm. In addition, the report's authors suggest that a 10% threshold is appropriate for both methods. However, further research is needed to identify optimal radiation techniques for different patient populations. The researchers also recommend evaluating the optimal clinical schedule and daily imaging technologies.
Image-guided radiotherapy systems have limitations.
Published on: 08/02/2022
Although image-guided radiation treatment is a highly accurate method of treating cancer, it has several disadvantages. One of these is the potential for tumors to migrate while being treated. Tumors can migrate as a result of a patient's breathing and other natural activities. As a result, this method isn't always as precise as it could be. Dynamic Targeting(r) IGRT, a Varian Medical Systems system, is specifically used by Advocate Health Care to help deliver a more accurate therapy.
Real-time adaptive conformal radiation systems are a new advancement in cancer treatment (RTACCS). A doctor can use RTACCS to arrange radiation therapy based on the pelvic or torso mobility of a patient. These new techniques make it possible to deliver radiation with greater accuracy, which lowers the likelihood of recurrence and toxicity. These systems can target more tumors with fewer fractions, which can assist shorten the overall treatment duration in addition to enabling more precise dosage distribution.
Choosing the right type of treatment for a patient's particular tumor is the first step in creating such a system. Five elements make up real-time adaptive conformal radiation systems: the patient, the treatment volume, the physicist, and the equipment. The objective is to minimize dosages to healthy organs in order to optimize patient response. They are therefore more effective than standard CT-based radiation therapy. The majority of patients, the researchers discovered, are ineligible for ART because their tumor size has changed.
The use of imaging to direct treatment is emphasized by the current radiation therapy paradigm. However, port films, anatomic surface markers, and radiologic correlation are used in conventional radiation approaches to plan treatment. Contrarily, advanced imaging methods gather three-dimensional (3D) structural and biologic data and enable exact therapy planning. Unfortunately, this strategy may actually make more issues than it resolves. Therefore, prior to using image-guided radiation, it is crucial to recognize its limits.
Despite being a key area of interest for the radiation oncology community, image-guided radiotherapy systems are still in their infancy. Robust registration and precise autosegmentation remain major obstacles. Additionally, the design of a patient's treatment must take into consideration interfractional changes in respiratory motion. In addition, respiratory-correlated imaging, which links target motion with breathing, has to be improved in image-guided radiation therapy.
Systems for image-guided radiation have many benefits. The technique can be used to account for variations in internal anatomy that may happen during a treatment, reducing the quantity of radiation a patient must get. Denis Keefe, one of those patients, received treatment with this method and is presently a participant in a clinical trial. He had a little tumor, but congestive heart failure was affecting him.
Using image-guided radiation equipment, clinicians may make their treatment plans more precise. By improving the targeted area's precision, the treatment volume can be decreased and the treatment schedule can be compressed. Because of better tumor management, patients may also have reduced toxicity after radiation. Clinical trials can also benefit from these new technologies. Additionally, images can enhance how data from upcoming studies are interpreted. This kind of imaging technology has revolutionized the treatment of cancer.
To give doses to malignancies, image-guided radiation therapy (IGRT) is used. Since it can lower the safety margin and enable frameless radiosurgery of lung and brain cancers, this method is excellent for treating head and neck tumors. Although CBCT-based guidance has some drawbacks, it is a good alternative for treating head and neck cancers. Although less effective for treating abdominal malignancies due to its motion-insensitive nature, breath-hold technology nevertheless makes this conceivable.
MRI guidance on linac has a number of advantages in addition to providing tumor-specific dosages. First off, the requirement for implanted markers is removed by the constant visualization of the tumor during beam delivery. Second, it lessens the danger of excessive doses reaching vital tissues near to the tumor. Third, MRI guiding on linac offers better tumor coverage. Any SBRT application must have the system.
Use of Advanced Imaging and Hypofractionation to Improve Radiation Therapy
Published On: 06/09/2022
According to Dattoli Cancer Center, the use of advanced imaging and hypofractionation to refine the delivery of radiation therapy is a promising option. Traditionally, radiation therapy has focused on treating large areas of the body with a high dose, including invisible tumors. Conformal radiation therapy, on the other hand, tailors the distribution of dose to the shape of the tumor. Several breakthroughs in computer science and imaging made it possible to optimize the radiation field according to the target shape, and the use of a multileaf collimator technology in the 1980s and 1990s was a major step forward.
Researchers have discovered that ultra-high dose rates deliver iso-effective ability to kill tumors, a biological phenomenon known as the FLASH Effect. Several animal studies and the first human treatment demonstrate this phenomenon and consistently demonstrate lower toxicity to surrounding healthy tissue. Because of the impressive results, many researchers are turning to clinical trials. Mobetron, an advanced radiotherapy machine, can deliver dose rates over five thousand times higher than conventional radiotherapy. With electron energies up to six and nine MeV, it can produce field sizes as large as 10cm.
Dattoli Cancer Center explains, research on technology-driven radiotherapy has been a major driving force in making this treatment method more efficient, more effective, and more affordable. However, it is difficult to identify what technology will lead to better outcomes and more patient-friendly treatments. This is a critical time to make a difference. The use of hyperfractionation and advanced imaging to improve radiation therapy can significantly increase the efficiency of treatment.
Proton-minibeam radiotherapy has been used to reduce the side effects associated with conventional radiation therapy. This therapy takes advantage of spatial fractionation in normal tissue, allowing small beams to be widely spread in the surrounding normal tissue, while ensuring that the tumor receives a homogenous dose. This approach was developed in collaboration with a radiation oncologist. Further studies have addressed normal tissue sparing and tumor control. Several preclinical studies have been conducted to optimize proton-minibeam radiation therapy.