Radiology Commons^™

Mr-Linac Technology, Katherine Orellana

Radiologic Sciences

Purpose To examine the clinical advantages of magnetic resonance-guided linear accelerator (MR-Linac) technology in radiation therapy, with a focus on treatment accuracy, adaptive planning, and patient outcomes.

Method A literature review was conducted using peer-reviewed articles identified through The University of Texas MD Anderson Cancer Center Research Medical Library. Studies published between 2022 and 2026 were included if they addressed the clinical advantages of MR-Linac technology. Findings were synthesized using thematic analysis.

Results Three primary themes emerged: (a) superior soft-tissue visualization improved tumor delineation and treatment accuracy; (b) daily adaptive treatment planning and real-time tumor tracking enhanced precision by accounting …

Impact Of Mr-Linac Technology On Prostate Cancer Treatment Outcomes, Anhdiep P. Tran

Radiologic Sciences

Purpose To evaluate the impact of magnetic resonance-guided linear accelerator (MR-Linac) technology on treatment precision, clinical outcomes, and operational challenges in prostate cancer radiotherapy.

Method A systematic literature review was conducted using PubMed, Scopus, and Google Scholar to identify peer-reviewed studies published between 2018 and 2026. Eligible studies evaluated MR-Linac technology for prostate cancer and reported outcomes related to treatment precision, toxicity, workflow, and clinical effectiveness.

Results Three primary themes emerged: (a) improved treatment precision through superior soft tissue visualization, real-time target tracking, and adaptive radiotherapy; (b) improved clinical outcomes characterized by reduced radiation exposure to organs at risk, decreased …

Technical Development, Optimization, And Clinical Implementation Of Quantitative Magnetic Resonance Imaging Methods For Radiation Oncology, Lucas Mccullum

Dissertations and Theses (Open Access)

Magnetic resonance imaging (MRI) has gradually grown more important in the field of radiation oncology. This paradigm shift has grown from initial experiments with MRI of cancerous lesions in the early 1970s, to the integration of MRI images for radiation therapy treatment planning (i.e., MRI-Simulation) in the early 1980s, to the combined MRI linear accelerator (MR-Linac) becoming commercially available in 2018 which can simultaneously image a tumor and treat it with radiation. However, due to its novelty in radiation oncology, its full potential for the integration of quantitative MRI-based biomarkers has yet to be fully realized.

Therefore, this dissertation will …

Prostatic Urethral Length On Mri As A Predictor Of Late Genitourinary Toxicity After Prostate Cancer Radiation, Kyu Kim, Joseph Lee, Allison Hazy, Sayf Al-Katib, Hong Ye, Nathan Kolderman, Abhay Dhaliwal, Daniel Krauss, Thomas Quinn, Kimberly Marvin, Kiran R. Nandalur

Posters

Radiation therapy (RT) is a widely used treatment for prostate cancer.1 While effective, some patients develop late genitourinary (GU) toxicity, which can impact quality of life.2,4 Identifying pre-treatment factors that predict toxicity risk may help improve clinical decision-making. Recent studies suggest that prostatic urethral length (PUL) seen on MRI is associated with an increased risk of late GU toxicity.3 Understanding this relationship could enhance risk stratification before treatment.

Risk Analysis Of Radiosurgery For Vestibular Schwannoma: Systematic Review And Comparative Study Of 10-Year Outcomes, Kevin M. Guy, April A. Pace, Derek S. Tsang, Peter G. Volsky

Department of Otolaryngology (ENT) Faculty Publications

Background: Determine the benefit of stereotactic radiosurgery (SRS) compared to no treatment for sporadic vestibular schwannoma (VS) by calculating epidemiologic risk using 10-year data; apply the analysis to VS that have demonstrated linear growth.

Methods: PubMed, Google Scholar, Web of Science, and Cochrane Library are systematically reviewed for VS tumor control 10 years after SRS and compared to an historical cohort of untreated VS (primary risk analysis). Subgroups of VS limited by size and observed growth are compared to the untreated cohort (secondary analysis).

Results: Twenty-four studies of 4,079 SRS-treated VS exhibited tumor control in 90.93% (87.0%-100%; SD 4.1%), while …

Financial Toxicity In Breast Cancer Patients Receiving Regional Nodal Irradiation: Variation By Cancer Subtype, Grace L Smith, Benjamin D Smith, Chi-Fang Wu, Simona F Shaitelman, Mariana Chavez-Macgregor, Rashmi Murthy, Kelsey Kaiser, Kimberly S Ku, Julia J Shi, Sanjay S Shete, Ying-Shiuan Chen, Robert J Volk, Sharon H Giordano, Ya-Chen T Shih, Karen E Hoffman

Faculty, Staff and Student Publications

BACKGROUND: We evaluated sociodemographic and clinical predictors of financial toxicity (FT) among patients with breast cancer with higher risk clinical factors warranting regional nodal irradiation (RNI).

METHODS: Among 183 participants in a clinical trial of conventional vs. hypofractionated treatment with RNI, 125 (68 %) completed a pilot survey of FT measured using the validated Economic Strain and Resilience in Cancer (ENRICh) instrument, scored from 0 (minimal) to 10 (severe) FT. Associations with predictors were evaluated using Pearson correlation coefficients and Kruskal Wallis, Mann-Whitney U, and Jonckheere-Terpstra tests. Predictors of severe FT (ENRICh≥5) were tested using multivariable logistic regression with odds …

Improving Radiotherapy In Immunosuppressive Microenvironments By Targeting Complement Receptor C5ar1, Callum Beach, David Maclean, Dominika Majorova, Stavros Melemenidis, Dhanya K Nambiar, Ryan K Kim, Gabriel N Valbuena, Silvia Guglietta, Carsten Krieg, Mahnaz Darvish-Damavandi, Tatsuya Suwa, Alistair Easton, Lily Vs Hillson, Ashley K Mcculloch, Ross K Mcmahon, Kathryn Pennel, Joanne Edwards, Sean M O'Cathail, Campbell S Roxburgh, Enric Domingo, Eui Jung Moon, Dadi Jiang, Yanyan Jiang, Qingyang Zhang, Albert C Koong, Trent M Woodruff, Edward E Graves, Tim Maughan, Simon Ja Buczacki, Manuel Stucki, Quynh-Thu Le, Simon J Leedham, Amato J Giaccia, Monica M Olcina

Faculty, Staff and Student Publications

An immunosuppressive microenvironment causes poor tumor T cell infiltration and is associated with reduced patient overall survival in colorectal cancer. How to improve treatment responses in these tumors is still a challenge. Using an integrated screening approach to identify cancer-specific vulnerabilities, we identified complement receptor C5aR1 as a druggable target, which when inhibited improved radiotherapy, even in tumors displaying immunosuppressive features and poor CD8+ T cell infiltration. While C5aR1 is well-known for its role in the immune compartment, we found that C5aR1 is also robustly expressed on malignant epithelial cells, highlighting potential tumor cell-specific functions. C5aR1 targeting resulted in increased …

Primary Tumor Site For Localized Merkel Cell Carcinoma Drives Different Management Strategies Without Impacting Oncologic Outcomes, Samuel Cass, Brandon Cope, Andrew J Bishop, Yi-Ju Chiang, B Ashleigh Guadagnolo, Ahsan Farooqi, William Morrison, Russell G Witt, Riyad N H Seervai, Adam S Garden, Clifton D Fuller, Ryan P Goepfert, Merrick Ross, Jeffrey E Gershenwald, Michael Wong, Phyu P Aung, Emily Z Keung, Devarati Mitra

Faculty, Staff and Student Publications

BACKGROUND AND PURPOSE: Clinically localized Merkel cell carcinoma (MCC) has been associated with high rates of disease relapse. This study examines how primary tumor anatomic site drives patterns of care and outcomes in a large cohort treated in the contemporary era.

MATERIALS AND METHODS: Patterns of care and associated outcomes were evaluated for clinically Stage I-II MCC patients treated at our institution with adjuvant radiation therapy (RT) to the primary site and/or regional nodal basin as a component of their curative intent therapy between 2014-2021.

RESULTS: Of 80 patients who met inclusion criteria, the primary tumor anatomic site was head …

Quantitative Longitudinal Mapping Of Radiation-Treated Prostate Cancer Using Mr Fingerprinting With Radial Acquisition And Subspace Reconstruction, Victoria Y Yu, Ricardo Otazo, Can Wu, Ergys Subashi, Manuel Baumann, Peter Koken, Mariya Doneva, Peter Mazurkewitz, Daniel Shasha, Michael Zelefsky, Laura Cervino, Ouri Cohen

Faculty, Staff and Student Publications

MR fingerprinting (MRF) enables fast multiparametric quantitative imaging with a single acquisition and has been shown to improve diagnosis of prostate cancer. However, most prostate MRF studies were performed with spiral acquisitions that are sensitive to B0 inhomogeneities and consequent blurring. In this work, a radial MRF acquisition with a novel subspace reconstruction technique was developed to enable fast T1/T2 mapping in the prostate in under 4 min. The subspace reconstruction exploits the extensive temporal correlations in the MRF dictionary to pre-compute a low dimensional space for the solution and thus reduce the number of radial spokes to accelerate the …

Auto-Segmentation In Pancreatic And Liver Radiation Therapy, Cenji Yu

Dissertations and Theses (Open Access)

Background

Gastrointestinal cancers exhibit a high mortality rate compared to other cancer types. Among these, pancreatic cancer ranks as the fourth leading cause of cancer-related deaths worldwide. The five-year survival rate remains alarmingly low at a mere 9%. Hepatocellular carcinoma (HCC), another aggressive form of cancer, is rapidly becoming the primary cause of cancer-related deaths in the United States. The treatment of both liver cancer and pancreatic cancer heavily relies on a multidisciplinary approach. Innovative treatment strategies involving dose-escalated regimens, such as stereotactic body radiation therapy (SBRT), are emerging as an important pillar of the management of liver and pancreatic …

Improving Dose-Response Correlations For Locally Advanced Nsclc Patients Treated With Imrt Or Pspt, Yulun He

Dissertations and Theses (Open Access)

The standard of care for locally advanced non-small cell lung cancer (NSCLC) is concurrent chemo-radiotherapy. Despite recent advancements in radiation delivery methods, the median survival time of NSCLC patients remains below 28 months. Higher tumor dose has been found to increase survival but also a higher rate of radiation pneumonitis (RP) that affects breathing capability. In fear of such toxicity, less-aggressive treatment plans are often clinically preferred, leading to metastasis and recurrence. Therefore, accurate RP prediction is crucial to ensure tumor coverage to improve treatment outcome. Current models have associated RP with increased dose but with limited accuracy as they …

Radiation Therapy For Retroperitoneal Sarcomas: A Strass-Ful Situation, Ahsan S Farooqi, B Ashleigh Guadagnolo, Devarati Mitra, Andrew J Bishop

Faculty, Staff and Student Publications

Locoregional recurrence (LRR) is the predominant pattern of relapse and often the cause of death in patients with retroperitoneal sarcomas (RPS). As a result, reducing LRR is a critical objective for RPS patients. However, unlike soft tissue sarcomas (STS) of the superficial trunk and extremity where the benefits of radiation therapy (RT) are well-established, the role of RT in the retroperitoneum remains controversial. Historically, preoperative or postoperative RT, either alone or in combination with intraoperative radiation (IORT), was commonly justified for RPS based on extrapolation from the superficial trunk and extremity STS literature. However, long-awaited results were recently published from …

Prediction Of Rapid Early Progression And Survival Risk With Pre-Radiation Mri In Who Grade 4 Glioma Patients, Walia Farzana, Mustafa M. Basree, Norou Diawara, Zeina Shboul, Sagel Dubey, Marie M. Lockheart, Mohamed Hamza, Joshua D. Palmer, Khan Iftekharuddin

Electrical & Computer Engineering Faculty Publications

Rapid early progression (REP) has been defined as increased nodular enhancement at the border of the resection cavity, the appearance of new lesions outside the resection cavity, or increased enhancement of the residual disease after surgery and before radiation. Patients with REP have worse survival compared to patients without REP (non-REP). Therefore, a reliable method for differentiating REP from non-REP is hypothesized to assist in personlized treatment planning. A potential approach is to use the radiomics and fractal texture features extracted from brain tumors to characterize morphological and physiological properties. We propose a random sampling-based ensemble classification model. The proposed …

Radiation Therapy For Older Women With Early Breast Cancer: An Unnecessary Hardship, Lauren E. Shawver

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM; PRIME II investigators. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial [published correction appears in Lancet Oncol. 2015 Mar;16(3):e105]. Lancet Oncol. 2015;16(3):266-273. https://doi.org/10.1016/S1470-2045(14)71221-5

for an older patient seeking treatment for Stage 1 Ductal Breast Carcinoma

Financial Toxicity Tumor Board: A Multi-Disciplinary Team Activity Required In Low And Middle-Income Countries (Lmic), Ahmed Nadeem Abbasi, Sohail Rasool, Laraib Khan

Department of Radiation Oncology

No abstract provided.

Prone Versus Supine Position For Breast Cancer Treatment, Alexis Wychock

Student Research Poster Presentations 2022

This project explains the two most common positions to treat breast cancer: prone and supine. Radiation therapy, breast cancer, complications of radiation therapy to the breast, and the new set-up for prone positioning called Crawl Couch are also discussed on the poster. Breast cancer is the second most common cancer in women in the United States. Men can also develop breast cancer, but it is less common. Supine is performed utilizing deep inspiration breath hold and the prone is completed using free breathing. Prone and supine are the two positions used but some researchers found a better way to treat …

The Potential Of Biology-Guided Radiation Therapy In Thoracic Cancer: A Preliminary Treatment Planning Study, Steven N Seyedin, Rostem Bassalow, Osama R Mawlawi, Lehendrick M Turner, Roshal R Patel, Samuel R Mazin, Oluwaseyi M Oderinde, Yevgen Voronenko, Cody A Wages, Peter D Olcott, Joe Y Chang, Peter A Balter, James W Welsh

Faculty, Staff and Student Publications

PURPOSE: We investigated the feasibility of biology-guided radiotherapy (BgRT), a technique that utilizes real-time positron emission imaging to minimize tumor motion uncertainties, to spare nearby organs at risk.

METHODS: Volumetric modulated arc therapy (VMAT), intensity-modulated proton (IMPT) therapy, and BgRT plans were created for a paratracheal node recurrence (case 1; 60 Gy in 10 fractions) and a primary peripheral left upper lobe adenocarcinoma (case 2; 50 Gy in four fractions).

RESULTS: For case 1, BgRT produced lower bronchus V40 values compared to VMAT and IMPT. For case 2, total lung V20 was lower in the BgRT case compared to VMAT …

A Comparison Between Rectal Dose In Prostate Radiotherapy Patients Treated With Spaceoar Hydrogel Present Versus Patients Treated Without Spaceoar Hydrogel., David Desano

Masters Projects

Introduction: External beam radiation therapy is a common treatment option for prostate cancer patients with localized disease. Radiation-induced side effects associated with the rectum can impact a patient’s ability to complete treatment or affect the quality of life years after radiation treatment. Spaceoar hydrogel has been developed to reduce radiation dose to nearby pelvis structures, and therefore decreasing potential side effects.

Methods: A total of 20 patients who received definitive radiation therapy to the prostate and seminal vesicles were selected and placed into 2 groups (10 spaceoar, 10 non-spaceoar). The individuals’ age ranged from 60 to 79 years old with …

Adjuvant Therapy In Adrenocortical Carcinoma: Reflections And Future Directions, Sara Bedrose, Marilyne Daher, Lina Altameemi, Mouhammed Amir Habra

Faculty, Staff and Students Publications

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with high risk of recurrence despite macroscopically complete surgical resection. The main predictors of ACC recurrence include advanced disease stage, incomplete surgical resection, cortisol production, certain genetic alterations, and high proliferation rate (Ki-67 proliferation index). Mitotane has been the mainstay adjuvant therapy of ACC. However, the use of mitotane is based on retrospective and occasionally conflicting evidence. As mitotane levels can take a few months before reaching therapeutic levels, there is an emerging practice of combining platinum-based chemotherapy with mitotane in the adjuvant setting. Retrospective data indicate that radiotherapy is an …

The Impact Of Serum Glucose, Anti-Diabetic Agents, And Statin Usage In Non-Small Cell Lung Cancer Patients Treated With Definitive Chemoradiation, Nick A. Iarrobino, Beant S. Gill, Mark E. Bernard, Rainer J. Klement, Maria Werner-Wasik, Colin E. Champ

Radiation Medicine Faculty Publications

Introduction: Epidemiologic data indicate diabetes confers an augmented risk of lung cancer development, yet the relationship between hyperglycemia, metabolic agents, and prognosis is unclear. We analyzed the impact of hyperglycemia, anti-diabetic agents, and statins on outcomes in non-small cell lung cancer (NSCLC) patients undergoing chemoradiation.

Method and Materials: In total, data from 170 patients with stage III NSCLC treated at the University of Pittsburgh Medical Center between 2001 and 2014 were obtained for analysis. Kaplan-Meier survival analysis was used to estimate time-to-event for overall survival (OS), disease-free survival, distant metastasis (DM), and loco-regional control (LRC). Blood glucose values (n …

Development Of 3d-Printed Patient Specific Bolus For Clinical Use In To Tal Scalp Irradiation, Garrett Baltz

Dissertations and Theses (Open Access)

Total scalp irradiation (TSI) is a specialized radiation therapy technique that aims to deliver a uniform dose to the entire scalp. Original electron-based TSI techniques had limited homogeneity due to hot and cold spots created at field junctions due to the multiple matched fields that were required to treat the entire scalp. The transition to photon volumetric-modulated arc therapy based TSI techniques has improved homogeneity, to the point where non-conformal bolus is now a limiting factor. Bolus is required to build-up full dose to the scalp surface in total scalp irradiation. Creating bolus that is conformal to the scalp is …

Dosimetric Impact Of A Tumor Treating Fields Device For Glioblastoma Patients Undergoing Simultaneous Radiation Therapy, Taoran Li, Gaurav Shukla, Cheng Peng, Virginia Lockamy, Haisong Lui, Wenyin Shi

Department of Radiation Oncology Faculty Papers

Purpose: A recent randomized phase III clinical trial in patients with glioblastoma demonstrated the efficacy of tumor treating fields (TTFields), in which alternating electric fields are applied via transducer arrays to a patient's scalp. This treatment, when added to standard of care therapy, was shown to increase overall survival from 16 to 20.9 months. These results have generated significant interest in incorporating the use of TTFields during postoperative concurrent chemoradiation. However, the dosimetric impact of high-density electrodes on the scalp, within the radiation field, is unknown. Methods: The dosimetric impact of TTFields electrodes in the radiation field was quantified in …

Emerging Therapies For Stage Iii Non-Small Cell Lung Cancer: Stereotactic Body Radiation Therapy And Immunotherapy, Sameera S. Kumar, Kristin A. Higgins, Ronald C. Mcgarry

Radiation Medicine Faculty Publications

The current standard of care for locally advanced non-small cell lung cancer (NSCLC) includes radiation, chemotherapy, and surgery in certain individualized cases. In unresectable NSCLC, chemoradiation has been the standard of care for the past three decades. Local and distant failure remains high in this group of patients, so dose escalation has been studied in both single institution and national clinical trials. Though initial studies showed a benefit to dose escalation, phase III studies examining dose escalation using standard fractionation or hyperfractionation have failed to show a benefit. Over the last 17 years, stereotactic body radiation therapy (SBRT) has shown …

From Survival To Survivorship: Late Side Effects Become An Issue In High-Grade Glioma., Yaacov R Lawrence, Wenyin Shi, Adam P Dicker

Department of Radiation Oncology Faculty Papers

“For many patients, controlling neurological symptoms, preventing cognitive dysfunction and maintaining functional independence are just as important as prolonging survival.”

Thoracic Radiotherapy Treatment Planning With Cine Pet/Ct, Adam C. Riegel

Dissertations and Theses (Open Access)

Purpose: Respiratory motion causes substantial uncertainty in radiotherapy treatment planning. Four-dimensional computed tomography (4D-CT) is a useful tool to image tumor motion during normal respiration. Treatment margins can be reduced by targeting the motion path of the tumor. The expense and complexity of 4D-CT, however, may be cost-prohibitive at some facilities. We developed an image processing technique to produce images from cine CT that contain significant motion information without 4D-CT. The purpose of this work was to compare cine CT and 4D-CT for the purposes of target delineation and dose calculation, and to explore the role of PET in target …

A Phase Ii Study Of Acute Toxicity For Celebrex(Tm) (Celecoxib) And Chemoradiation In Patients With Locally Advanced Cervical Cancer: Primary Endpoint Analysis Of Rtog 0128, David K. Gaffney, Kathryn Winter, Adam P. Dicker, Brigitte Miller, Patricia J. Eifel, Janice Ryu, Vilija Avizonis, Mitch Fromm, Kathryn Greven

Department of Radiation Oncology Faculty Papers

Purpose: To determine treatment-related acute toxicity rates in patients with locally advanced cervical cancer treated by oral celecoxib, i.v. cisplatin and 5-FU, and concurrent pelvic radiation therapy.

Methods and Materials: Eligible patients on this RTOG Phase I-II study for advanced cervix cancer included FIGO Stage IIB-IVA or patients with FIGO Stage IB through IIA with biopsy proven pelvic node metastases ortumor size >5 cm. Patients were treated with pelvic radiotherapy and brachytherapy. Celecoxib was prescribed at 400 mg twice daily beginning on day 1 for 1 year. Cisplatin (75 mg/m2) and 5-FU (1g/m2 for 4 days) were administered every 3 …