Image Guided And Adaptive Radiation Therapy

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.

Image-Guided Radiation Therapy presents key image-guided radiation treatment (IGRT) technologies for external beam radiotherapy. The book explores the decades-long technological developments that have occurred in the realm of image-guided conformal, customized radiation treatment. Expert authors, all of whom have actively participated in the development or implementation of IGRT, imaging, and enabling technologies, share their first-hand experiences on the science, clinical uses, and impact of these technologies. They describe kilovoltage and megavoltage imaging as well as radiological, ultrasound, and optical technologies for determining and validating target and patient positioning. The book examines how anatomical and biological imaging using CT and PET has contributed to the understanding of target volume boundaries and biological behavior. It also explores such innovations as 4D PET/CT and digital tomosynthesis. Advancing patient care, this book focuses on a wealth of hybrid IGRT technologies and devices for coupled imaging and treatment inside the radiation treatment room. It thoroughly covers the modalities, software tools, and imaging treatment geometries that constitute IGRT.

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.

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.

Image Guided Radiation Therapy (IGRT) is a true revolution in the field of radiation oncology. IGRT provides the unprecedented means of conforming does to the shape of the target tissues in 3-dimensions reducing the risk of complications thereby improving the quality of life of irradiated patients. Moreover, IGRT provides the means to deliver higher than conventional doses thus improving the chance of cure in these patients. Despite its established benefits, several barriers exist to the widespread clinical implementation of IGRT. In the past, great concerns existed regarding the large capital outlay needed for both software and hardware. This barrier is less relevant today given the increased reimbursements possible with IGRT. Today, the most significant barrier is education. IGRT is a fundamentally new approach to both treatment planning and delivery. Adoption of the IGRT approach entails new ways of thinking in regard to patient selection, treatment planning and quality assurance measures. Unfortunately, apart from a few University-based short courses, limited resources are available for the physician and physicist interested in learning IGRT.

This book equips readers with detailed knowledge on the current status of image-guided radiotherapy with photons and particles and highlights issues that need to be addressed in order to further improve treatment outcomes. The opening chapters cover clinical and technical aspects of target volume definition using anatomic (computed tomography and magnetic resonance imaging; MRI) as well as functional (MRI and positron emission tomography) imaging. Up-to-date information is then provided on the full range of image-guided high-precision radiotherapy techniques, including IMRT/VMAT, stereotactic body radiation therapy, MR-guided linear accelerators, MR-guided brachytherapy, and particle therapy. The role of ultrasonography in image-guided radiotherapy is discussed, as are the available means for target volume demarcation and stabilization and adaptive radiation therapy. Finally, outcome evaluation is explored in depth, with a particular focus on the role of multimodality imaging in predicting tumor control and normal tissue toxicity. The authors are experts in different specialties and the book will be of high value for radiation oncologists, medical physicists, radiologists, nuclear medicine physicians, and radiation technicians.

Intensity-modulated radiation therapy (IMRT), one of the most important developments in radiation oncology in the past 25 years, involves technology to deliver radiation to tumors in the right location, quantity and time. Unavoidable irradiation of surrounding normal tissues is distributed so as to preserve their function. The achievements and future directions in the field are grouped in the three sections of the book, each suitable for supporting a teaching course. Part 1 contains topical reviews of the basic principles of IMRT, part 2 describes advanced techniques such as image-guided and biologically based approaches, and part 3 focuses on investigation of IMRT to improve outcome at various cancer sites.

This handbook provides a clinically relevant, succinct, and comprehensive overview of image-guided brachytherapy. Throughout the last decade, the utility of image guidance in brachytherapy has increased to enhance procedural development, treatment planning, and radiation delivery in an effort to optimize safety and clinical outcomes. Organized into two parts, the book discusses physics and radiobiology principles of brachytherapy as well as clinical applications of image-guided brachytherapy for various disease sites (central nervous system, eye, head and neck, breast, lung, gastrointestinal, genitourinary, gynecologic, sarcoma, and skin). It also describes the incorporation of imaging techniques such as CT, MRI, and ultrasound into brachytherapy procedures and planning. Featuring procedural and anesthesia care, extensive images, contouring examples, treatment planning techniques, and dosimetry for the comprehensive treatment for each disease site, Handbook of Image-Guided Brachytherapy is a valuable resource for practicing radiation oncologists, physicists, dosimetrists, residents, and medical students.