Adaptive Radiation Therapy

Modern medical imaging and radiation therapy technologies are so complex and computer driven that it is difficult for physicians and technologists to know exactly what is happening at the point-of-care. Medical physicists responsible for filling this gap in knowledge must stay abreast of the latest advances at the intersection of medical imaging and radiation therapy. This book provides medical physicists and radiation oncologists current and relevant information on Adaptive Radiation Therapy (ART), a state-of-the-art approach that uses a feedback process to account for patient-specific anatomic and/or biological changes, thus delivering highly individualized radiation therapy for cancer patients. The book should also benefit medical dosimetrists and radiation therapists. Adaptive Radiation Therapy describes technological and methodological advances in the field of ART, as well as initial clinical experiences using ART for selected anatomic sites. Divided into three sections (radiobiological basis, current technologies, and clinical applications), the book covers: Morphological and biological biomarkers for patient-specific planning Design and optimization of treatment plans Delivery of IMRT and IGRT intervention methodologies of ART Management of intrafraction variations, particularly with respiratory motion Quality assurance needed to ensure the safe delivery of ART ART applications in several common cancer types / anatomic sites The technology and methodology for ART have advanced significantly in the last few years and accumulated clinical data have demonstrated the need for ART in clinical settings, assisted by the wide application of intensity modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT). This book shows the real potential for supplying every patient with individualized radiation therapy that is maximally accurate and precise.

This book provides detailed, state-of-the-art information and guidelines on the latest developments, innovations, and clinical procedures in image-guided and adaptive radiation therapy. The first section discusses key methodological and technological issues in image-guided and adaptive radiation therapy, including use of implanted fiducial markers, management of respiratory motion, image-guided stereotactic radiosurgery and stereotactic body radiation therapy, three-dimensional conformal brachytherapy, target definition and localization, and PET/CT and biologically conformal radiation therapy. The second section provides practical clinical information on image-guided adaptive radiation therapy for cancers at all common anatomic sites and for pediatric cancers. The third section offers practical guidelines for establishing an effective image-guided adaptive radiation therapy program.

External-beam radiotherapy has long been challenged by the simple fact that patients can (and do) move during the delivery of radiation. Recent advances in imaging and beam delivery technologies have made the solution—adapting delivery to natural movement—a practical reality. Adaptive Motion Compensation in Radiotherapy provides the first detailed treatment of online interventional techniques for motion compensation radiotherapy. This authoritative book discusses: Each of the contributing elements of a motion-adaptive system, including target detection and tracking, beam adaptation, and patient realignment Treatment planning issues that arise when the patient and internal target are mobile Integrated motion-adaptive systems in clinical use or at advanced stages of development System control functions essential to any therapy device operating in a near-autonomous manner with limited human interaction Necessary motion-detection methodology, repositioning techniques, and approaches to interpreting and responding to target movement data in real time Medical therapy with external beams of radiation began as a two-dimensional technology in a three-dimensional world. However, in all but a limited number of scenarios, movement introduces the fourth dimension of time to the treatment problem. Motion-adaptive radiation therapy represents a truly four-dimensional solution to an inherently four-dimensional problem. From these chapters, readers will gain not only an understanding of the technical aspects and capabilities of motion adaptation but also practical clinical insights into planning and carrying out various types of motion-adaptive radiotherapy treatment.

Images from CT, MRI, PET, and other medical instrumentation have become central to the radiotherapy process in the past two decades, thus requiring medical physicists, clinicians, dosimetrists, radiation therapists, and trainees to integrate and segment these images efficiently and accurately in a clinical environment. Image Processing in Radiation Therapy presents an up-to-date, detailed treatment of techniques and algorithms for the registration, segmentation, reconstruction, and evaluation of imaging data. It describes how these tools are used in radiation planning, treatment delivery, and outcomes assessment. The book spans deformable registration, segmentation, and image reconstruction and shows how to incorporate these practices in radiation therapy. The first section explores image processing in adaptive radiotherapy, online monitoring and tracking, dose accumulation, and accuracy assessment. The second section describes the mathematical approach to deformable registration. The book presents similarity metrics used for registration techniques, discussing their effectiveness and applicability in radiation therapy. It also evaluates parametric and nonparametric image registration techniques and their applications in radiation therapy processes. The third section assesses the efficiency, robustness, and breadth of application of image segmentation approaches, including atlas-based, level set, and registration-based techniques. The fourth section focuses on advanced imaging techniques for radiotherapy, such as 3D image reconstruction and image registration using a graphics processor unit. With contributions from an international group of renowned authors, this book provides a comprehensive description of image segmentation and registration, in-room imaging, and advanced reconstruction techniques. Through many practical examples, it illustrates the clinical rationale and implementation of the techniques.

Successful clinical use of intensity-modulated radiation therapy (IMRT) represents a significant advance in radiation oncology. Because IMRT can deliver high-dose radiation to a target with a reduced dose to the surrounding organs, it can improve the local control rate and reduce toxicities associated with radiation therapy. Since IMRT began being used in the mid-1990s, a large volume of clinical evidence of the advantages of IMRT has been collected. However, treatment planning and quality assurance (QA) of IMRT are complicated and difficult for the clinician and the medical physicist. This book, by authors renowned for their expertise in their fields, provides cumulative clinical evidence and appropriate techniques for IMRT for the clinician and the physicist. Part I deals with the foundations and techniques, history, principles, QA, treatment planning, radiobiology and related aspects of IMRT. Part II covers clinical applications with several case studies, describing contouring and dose distribution with clinical results along with descriptions of indications and a review of clinical evidence for each tumor site. The information presented in this book serves as a valuable resource for the practicing clinician and physicist.

External-beam radiotherapy has long been challenged by the simple fact that patients can (and do) move during the delivery of radiation. Recent advances in imaging and beam delivery technologies have made the solution—adapting delivery to natural movement—a practical reality. Adaptive Motion Compensation in Radiotherapy provides the first detailed treatment of online interventional techniques for motion compensation radiotherapy. This authoritative book discusses: Each of the contributing elements of a motion-adaptive system, including target detection and tracking, beam adaptation, and patient realignment Treatment planning issues that arise when the patient and internal target are mobile Integrated motion-adaptive systems in clinical use or at advanced stages of development System control functions essential to any therapy device operating in a near-autonomous manner with limited human interaction Necessary motion-detection methodology, repositioning techniques, and approaches to interpreting and responding to target movement data in real time Medical therapy with external beams of radiation began as a two-dimensional technology in a three-dimensional world. However, in all but a limited number of scenarios, movement introduces the fourth dimension of time to the treatment problem. Motion-adaptive radiation therapy represents a truly four-dimensional solution to an inherently four-dimensional problem. From these chapters, readers will gain not only an understanding of the technical aspects and capabilities of motion adaptation but also practical clinical insights into planning and carrying out various types of motion-adaptive radiotherapy treatment.

Details technology associated with radiation oncology, emphasizing design of all equipment allied with radiation treatment. Describes procedures required to implement equipment in clinical service, covering needs assessment, purchase, acceptance, and commissioning, and explains quality assurance issues. Also addresses less common and evolving technologies. For medical physicists and radiation oncologists, as well as radiation therapists, dosimetrists, and engineering technologists. Includes bandw medical images and photos of equipment. Paper edition (unseen), $145.95. Annotation copyrighted by Book News, Inc., Portland, OR