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[Radiotherapy of glioblastoma: is shortening of the treatment time justifiable?].

Survival of glioblastoma patients can be double by postoperative radiation but nevertheless rarely exceeds one year. It is therefore desirable to minimize treatment time and hospitalisation. Aim of our study is to investigate the feasibility of a reduction of treatment time by accelerated fractionation. Out of 110 patients treated for glioblastoma from 1975 to 1988 in our institution postoperative radiation was performed in 79 patients using three different fractionation schedules: 60 Gy in six weeks, single fractions 2 Gy (n = 38), 35 Gy in two weeks, single fractions 3.5 Gy (n = 27), 45.5 Gy in 2.5 weeks, single fractions 3.5 Gy (n = 14). No statistically significant differences in both the mean overall and disease free survival were evaluated between the three groups. The larger fraction size was well tolerated and no relevant increase of early or late adverse reactions occurred. As the duration of treatment can be reduced from six to two weeks, this accelerated fractionation schedule seems to be a reasonable alternative to conventional fractionation.

Adult↗

Analysis of primate head irradiation with 55-MeV protons.

The distribution of the dose to the head of a primate phantom due to 55-MeV proton irradiation was calculated using a clinical radiotherapy treatment planning system, with anatomic definition through computerized tomography scans. Dose profiles, isodose distributions, and differential and integral dose-volume histograms are used to describe the probable proton dose to the brain of rhesus monkeys, irradiated over two decades ago, in which brain tumors have now developed. The dose analysis shows that 59% of the brain received a dose in excess of the reference surface dose, and that portions of the brain received doses greater than 300% of the reference surface dose. The regions of high dose are illustrated in isodose distributions. This information may be useful in evaluating potential tumor induction following radiation exposure.

Animals↗

[Optimizing target volume assessment in irradiation of intraocular melanomas with ruthenium applicators].

Radioactive applicators have been used for conservative therapy of melanomas in the vicinity of the nervus opticus and of melanomas of the ciliary body for a few years. The aim of optimal radiotherapy is to destroy all tumor cells and to protect the optic nerve and macula. Therefore, we calculated the dose distributions and isodoses for ruthenium applicators. Isodoses show underdosage or overdosage in the tumor area. We also present a calculation model with which it is possible to simulate selective shielding of activated parts of the applicator.

Brachytherapy↗

[A computer system for planning radiation therapy--the ROPLAN].

A computerized system of optimum plans of radiotherapy (computer SM 1420) was developed for the first time in the USSR. The ROPLAN system was adapted to a dosimetric design of irradiation sessions for all radiotherapy units, manufactured in the USSR, and provides for modes of initialization, design, storage and collection of data for all radiotherapeutic methods.

Humans↗

Integrated microscopic-macroscopic pharmacology of monoclonal antibody radioconjugates: the radiation dose distribution.

Accurate dosimetry is essential for the assessment of radioimmunotherapy. Most often studied to date has been the macroscopic dosimetry related to organ and tumor distribution of the radiolabeled antibody, but the question of microscopic dose heterogeneity is also important. To address the latter issue, we have taken an integrated approach to the pharmacology, taking into account whole-body distribution, transcapillary transport, percolation through the tumor interstitial space, antigen-antibody interaction, and antibody metabolism. The first step is to simulate the spatial antibody concentration profile in a tumor as a function of time after i.v. (e.g., bolus) injection, using reasonable values for the parameters involved. The second step is to calculate, also as a function of time, the absorbed radiation dose distribution resulting from each concentration profile. Parameter values for IgG pharmacology and a radiation point source function for 131I are used to explore the effect of antibody distribution profiles on absorbed dose in the tumor. The geometry simulated corresponds to a spherical nodule of densely packed tumor cells. Absorbed doses are calculated for radiation from a single nodule (e.g., a micrometastasis or prevascular primary tumor) and for a cubic lattice of such nodules (e.g., corresponding to nodular lymphoma). As noted in our previous studies, there is a "binding site barrier." Binding to antigen retards antibody percolation into the nodules; high antibody affinity tends to decrease percolation and give a higher absorbed dose near the surface of each nodule. Heterogeneous antibody distribution results in a heterogeneous absorbed dose. This is more apparent in the case of radiation from a single nodule than it is for radiation from within an array of nodules. Dehalogenation results in a lower absorbed dose over time, and the effect is more apparent at later times after injection. PERC-RAD, the computer program package developed for these analyses, provides a convenient and flexible way to assess the impact of macroscopic and microscopic parameters on the distribution of radioimmunoconjugates and on the consequent profile of absorbed radiation dose in tumors. This mathematical model and the general principles developed here can be applied as well to other radiolabeled biological ligands.

Antibodies, Monoclonal↗

Random search algorithm (RONSC) for optimization of radiation therapy with both physical and biological end points and constraints.

A new algorithm for the optimization of 3-dimensional radiotherapy plans is presented. The RONSC algorithm (Random Optimization with Non-linear Score functions and Constraints) is based on the idea of random search in the space of feasible solutions. RONSC takes advantage of some specific properties of the dose distribution and derivable information such as dose-volume histograms and calculated estimates of tumor control and normal tissue complication probabilities. The performance of the algorithm for clinical and test cases is discussed and compared with the performance of the simulated annealing algorithm, which is also based on the idea of random search.

Algorithms↗

High-performance computing in radiation cancer treatment.

In 1989 a consortium of the Radiation Oncology and Computer Science Departments at the University of North Carolina, BellSouth Corporation, GTE, and the MCNC was formed in response to the high-speed network initiative proposed by the National Science Foundation and the Defense Advanced Research Projects Agency. One of the purposes of this effort has been to demonstrate that applications exist that require gigabit per second networks. Our consortium, known as VISTAnet, proposed to use real-time radiation therapy treatment planning as the application that would require the use of a gigabit network. The plan was to develop a system that could rapidly calculate and display a three-dimensional radiation dose distribution for any configuration of radiation beams. The gigabit network would be used to tie the dose calculations done with the Cray Y-MP at the Research Triangle to the graphics engine at the Department of Computer Science (Pixel-Planes 5) and the medical workstation at Radiation Oncology. The system would then provide the radiation physician with the capability of considering hundreds of potential treatment plans, instead of the usual two or three, with the goal of arriving at a highly optimized plan within a few minutes.

Computer Communication Networks↗

Computer-aided medical decision making in radiotherapy.

Radiotherapy departments are becoming sophisticated in working with computers for isodose computations, treatment machine verifications and administrative and medical records. The next step lies in computer-assisted medical decision making. The logic for a patient's diagnostic work-up and treatment protocol can be stored in a computer. It can then be used as an aid in making the diagnosis, in prescribing the treatment and for quality control. For patients who fit established protocols the computer can select and list treatment using the logic of that protocol. Such a system has been implemented for the postoperative radiotherapy of breast cancer on a trial basis. Its potential usefulness is illustrated by results in 25 consecutive patients. Physician acceptance and costs of the program are under investigation.

Breast Neoplasms↗

Bayesian statistics: a guided tour.

An overview of Bayesian statistical decision theory is presented in the tutorial spirit. A section on fundamental principles is followed by selected applications of the Bayesian approach to parameter estimation, pattern recognition, image processing, computer-aided medical diagnosis, optimal diagnostic test selection, and radiotherapy treatment planning.

Decision Making↗

Investigating the potential of three-dimensional treatment planning.

3-D treatment planning has received a great deal of attention in the radiation therapy community over the last several years. This new technology makes use of the continuous improvements in computer hardware and graphics capabilities, along with major improvements in treatment planning software, to provide a fully three dimensional simulation of the patient, radiation beams, and dose distributions which are used for radiation therapy of various cancers. With these capabilities, the physician and treatment planner may now optimize the radiation beams used to treat the patient much more effectively than in the past, when only a limited description of the patient, beams, and doses was available. This paper describes several of the new capabilities of these 3-D planning systems, some research studies which are currently being performed to evaluate the usefulness of the new technology, and finally some of the costs associated with its implementation.

Computer Simulation↗

[Ultrasound in tumor diagnostics and treatment planning (author's transl)].

The fundamental requirements of irradiation planning are discussed delimitating the minimum and maximum demands of planning. Different possibilities to represent the topographic relations within the irradiation plane of the patient's cross-section are described. The computer-assisted system for irradiation planning, installed at our hospital by means of MAT construction, is discussed. A pathway is shown which leads to individual treatment planning and considers dosimetrically the actual conditions of the patient who will undergo radiation therapy. The possibilities and limits of ultrasonic cross-sectional imaging are demonstrated.

Diagnosis, Computer-Assisted↗

An interactive beam-weight optimization tool for three-dimensional radiotherapy treatment planning.

A computer software tool has been developed to aid the treatment planner in selecting beam weights for three-dimensional radiotherapy treatment planning. The program consists of a feasibility search algorithm embedded in an interactive, user-friendly driving program. The feasibility search algorithm is based on the iterative relaxation algorithm of Cimmino [La Ricerca Scientifica, Vol. I, pp. 326-333 (1938)] as applied to the radiotherapy inverse problem by Altschuler et al. [Med. Phys. 13, 590 (1986)]. Relative importances of structures based upon clinical considerations can be incorporated into the algorithm. In order to speed convergence, the relaxation parameter is made to vary, with its value based upon a measure of deviation from feasibility. The interactive driving program is designed so that the treatment planner can make reasonable judgments regarding the acceptability of a plan in the event that the dose constraints yield no feasible solution. An example of the use of this program applied to a problem in three-dimensional radiotherapy treatment planning is illustrated.

Algorithms↗

[Technical aspects of proton irradiation of intraocular tumors].

The paper is concerned with the description of some technical aspects of irradiation of intraocular melanomas of the preequatorial and retroequatorial localizations with a proton beam on a synchrotron at the Institute of Theoretical and Experimental Physics. Potentialities of a program of design of irradiation of intraocular tumors were considered. The parameters of an optimized plan of irradiation were determined by analysis of computer-simulated dose topographic and anatomic situations at different variants of irradiation. Reproducibility of an optimized plan of irradiation was no worse than 1 mm.

Eye Neoplasms↗

Computer-assisted 3D-reconstruction and statistics of the limbic system. 1. Computer-assisted 3D-reconstruction of the hippocampal formation, the fornix, and the mamillary bodies.

The hippocampal formation of eight perfusion-fixed human brains was examined using new methods according to stereotactic and morphometric principles (macrovibratome and computer-aided 3D reconstruction). The reconstructions form part of a neuroanatomical reference system (NeuRef). This reference system allows for 3D visualisation of the brain and its components on a computer graphic workstation, as well as for the presentation of the union set based on a neuroanatomical structure taken from this sample of brains. This retrievable knowledge of neurofunctional systems is important for the preoperative planning of neurosurgeons and the adjustment of radiotherapy.

Adult↗

New methods of imaging in diagnostic radiology Sylvanus Thompson Memorial Lecture.

A brief history of the recent developments in computer-assisted tomography (CAT) is presented. The development of whole-body scanners from the basic brain scanner, the trend towards higher-speed scanners using multiple detectors in a fan-type geometry, and some of the unsolved problems related to CAT scanners are discussed, as well as the potential use of whole-body scanning in radiotherapy treatment planning and in radiobiology. A review of recent developments in electrostatic imaging is presented and a new method of imaging called ionography is described in detail. It is shown how a single exposure can be used to produce a number of copies, each with a different amount of edge contrast, under the control of the radiologist. Further, it is shown how this can be done using a closed system so that the ionography chamber never needs to be opened. Some of the recent commercial developments in this field are described. It is suggested that in the future radiology departments may be replaced by departments of imaging, which will include all ways of obtaining diagnostic information and where such a department would be problem oriented rather than technique oriented. The need for basic scientific support by a medical physics and engineering group in such a department is emphasized.

Electrons↗

True three-dimensional dose computations for megavoltage x-ray therapy: a role for the superposition principle.

The objective of radiation therapy is to concentrate a prescribed radiation dose accurately within a target volume in the patient. Major advances in imaging technology have greatly improved our ability to plan radiation treatments in three dimensions (3D) and to verify the treatment geometrically, but there is a concomitant need to improve dosimetric accuracy. It has been recommended that radiation doses should be computed with an accuracy of 3% within the target volume and in radiosensitive normal tissues. We review the rationale behind this recommendation, and describe a new generation of 3D dose algorithms which are capable of achieving this goal. A true 3D dose calculation tracks primary and scattered radiations in 3D space while accounting for tissue inhomogeneities. In the past, dose distributions have been computed in a 2D transverse slice with the assumption that the anatomy of the patient dose not change abruptly in nearby slices. We demonstrate the importance of computing 3D scatter contributions to dose from photons and electrons correctly, and show the magnitude of dose errors caused by using traditional 2D methods. The Monte Carlo technique is the most general and rigorous approach since individual primary and secondary particle tracks are simulated. However, this approach is too time-consuming for clinical treatment planning. We review an approach that is based on the superposition principle and achieves a reasonable compromise between the speed of computation and accuracy in dose. In this approach, dose deposition is separated into two steps. Firstly, the attenuation of incident photons interacting in the absorber is computed to determine the total energy released in the material (TERMA). This quantity is treated as an impulse at each irradiated point. Secondly, the transport of energy by scattered photons and electrons is described by a point dose spread kernel. The dose distribution is the superposition of the kernels, weighted by the magnitude of the TERMA impulse for all interaction sites. In this review, we demonstrate the capabilities of the superposition method, particularly for situations of charged particle disequilibrium, and we report on the progress made by several research groups in adapting this method to clinical treatment planning. In the future, the superposition method will have a significant role in dose optimization for conformal irradiation techniques because of its close correspondence to image reconstruction by filtered back-projection.

Image Processing, Computer-Assisted↗