Radiation Medicine Commons^™

Linac-Based Srs Treatments Slow Down Unnecessarily Due To Parked Leaf Optimization, Brian Loughery, Cory S. Knill, Raminder P. Sandhu, Lifeng Lin, Jian Liang

Conference Presentation Abstracts

Purpose: It was observed on a VersaHD that clinical SRS deliveries created in the Elements treatment planning system (TPS) slowed gantry rotation and dose rate to allow parked MLC leaves to move into position for use in an upcoming control point. Gantry rotation slowed suddenly, visibly backtracking to previous gantry angles. The purpose of this work is to study the effect of parked MLC positioning parameters in Elements on cranial SRS delivery speed and gantry motion on a VersaHD. Methods: To study the effect of parked MLC leaf positions on VersaHD deliverability, cranial SRS plans were generated with different TPS …

Comparison Of Vmat Beam Complexity With Different Mlc Collimator Rotation And Their Impact On Psqa Pass Rates, David T. To, Michael G. Snyder, Jian Liang

Conference Presentation Abstracts

Purpose: I t has been previously shown that utilizing a collimator angle of ±45° has demonstrated a reduction in MU and VMAT beam complexity. Studies have demonstrated this for VMAT prostate plans with small sample size. In this study we evaluate multiple collimator angles with a larger sample size and different treatment sites. Methods: A total of 17273 VMAT beams were evaluated with beam collimator rotations of 0°, ±5°, ±10°, ±15°, ±30°, ±45°, and ±90°. QA Gamma pass rates for our institution use a 3%/2mm criteria 10% threshold with 95% limit pass rate utilizing Sun Nuclear ArcCheck (helical diode array). …

Predicting Tumor Voxel Dose-Response Using Deep Learning On Serial Fdg-Pet Feedback Images, Shupeng Chen, Di Yan, An Qin, Rohan Deraniyagala, Daniel Krauss, Peter Chen, Craig Stevens

Conference Presentation Abstracts

Purpose: Tumor voxel dose-response matrix (DRM) can be assessed using a series of FDG-PET/CT feedback images acquired during radiotherapy. Predicting the tumor voxel DRM earlier is crucial for treatment adaptation. However, it is also challenging due to FDG fluctuation in tumor cells. This study investigated the feasibility of predicting DRM during early treatment weeks using deep learning (DL). Methods: FDG-PET images were acquired at the pretreatment (preTx), the 2nd and 4th weeks during chemo-radiotherapy (35×2Gy) from 50 head and neck patients. The reference value of tumor voxel DRM (DRMref), representing the average metabolic change ratio during the treatment, was determined …

Prospective Validation Of Diffusion-Weighted Mri As A Biomarker Of Tumor Response And Oncologic Outcomes In Head And Neck Cancer: Results From An Observational Biomarker Pre-Qualification Study, Abdallah S R Mohamed, Abdelrahman Abusaif, Renjie He, Kareem A Wahid, Vivian Salama, Sara Youssef, Brigid A Mcdonald, Mohamed Naser, Yao Ding, Travis C Salzillo, Moamen A Abobakr, Jihong Wang, Stephen Y Lai, Clifton D Fuller

Faculty, Staff and Student Publications

PURPOSE: To determine DWI parameters associated with tumor response and oncologic outcomes in head and neck (HNC) patients treated with radiotherapy (RT).

METHODS: HNC patients in a prospective study were included. Patients had MRIs pre-, mid-, and post-RT completion. We used T2-weighted sequences for tumor segmentation which were co-registered to respective DWIs for extraction of apparent diffusion coefficient (ADC) measurements. Treatment response was assessed at mid- and post-RT and was defined as: complete response (CR) vs. non-complete response (non-CR). The Mann-Whitney U test was used to compare ADC between CR and non-CR. Recursive partitioning analysis (RPA) was performed to identify …

A Comprehensive Investigation Of Linear Energy Transfer Optimization Effectiveness In Intensity-Modulated Proton Therapy Via Alternating Direction Method Of Multipliers (Impt Let-Admm), Q Fan, G Liu, Lewei Zhao, Xiaoqiang Li, Xuanfeng Ding, S Dai

Conference Presentation Abstracts

Linear energy transfer (LET)-guided optimization in intensity-modulated proton therapy (IMPT) via alternating direction method of multipliers (ADMM) has the potential to improve its biological effectiveness (IMPTLET- ADMM), in which the LET distribution in target can be escalated, while the LET distribution in the organs at risk can be mitigated. This study aims to quantitatively investigate the effectiveness of LET optimization in IMPT via ADMM with different solvers in its iteration loop. Methods: The clinical dose-volume-histogram (DVH) constraint noted dose sub-problem and clinical LET -volume-histogram (LVH) constraint noted LET sub-problem are combined to generate a composite objective function, which is available …

Does Proton Arc Therapy Has Potential Clinical Benefits For Hepatocellular Carcinoma?, Peilin Liu, R Dalfsen, M Soukup, Shupeng Chen, Lewei Zhao, Z Wang, X S. Gao, Thomas Quinn, Craig Stevens, Rohan Deraniyagala, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To investigate the potential clinical benefits and dose-averaged Linear Energy Transfer (LETd) sparing, utilizing proton arc plan for Hepatocellular carcinoma (HCC) patients in comparison with Intensity Modulated Proton Therapy (IMPT). Methods: Ten HCC patients have been retrospectively selected. Two planning groups were created: Proton Arc plans using Monaco ver. 6 and the clinical IMPT plan. Both planning groups used the same robustness parameters. The prescription dose is 67.5 Gy (RBE) in 15 fractions/ 66 GyE in 10 fractions of the Clinical Target Volume (CTV) following clinical IMPT plan. Robustness evaluations were performed to ensure target dose coverage. Normal Tissue …

An Analytic Model Of The External Beam Dose Rate Effect On Immune Cells In Blood Dosimetry, Lewei Zhao, Peilin Liu, G Liu, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: Radiation therapy is a double-edged sword with regard to its immunomodulatory effect. It is critical to find how it is affected by dose rate. Thus, we developed an analytic model for calculating the number of immune cells receiving radiation. Methods: Suppose the blood is received radiation by constant dose rate. The blood is one-way flow without circulation in the radiation delivery at a constant velocity. Two kinds of lung treatment regimens were considered standard delivery 2Gy per fx total 30fx and hypo-fractionation SBRT 12 Gy per fx total 5 fx. Two different dose rates were simulated for standard treatment: …

Particle Arc Single-Isocenter Stereotactic Radiosurgery Of Multiple Brain Metastases, L Volz, S Mein, T Tessonnier, Peilin Liu, A Mairani, M Durante, Xuanfeng Ding, C Graeff, T Li

Conference Presentation Abstracts

Purpose: To develop spot-scanning proton (SPArc) and heavy ion (SHArc) arc therapy for single-isocenter stereotatic radiosurgery (SISRS) of multiple brain metastases (MBMs). First results achieved with dedicated planning infrastructure are compared to state-of-the -art volumetric modulated photon arc therapy (HA-VMAT). Methods: A multi-institutional collaboration was established to develop bespoke SPArc and SHArc SISRS infrastructure with available research and commercial treatment planning systems. Devised planning and delivery methods considered dedicated energy, spot, and multi-arc selection strategies. SPArc and SHArc (carbon and helium ions) plans were generated for MBM patients exhibiting 3-12 intracranial lesions with GTV volumes between 0.03ccm and 19.8ccm, at …

Investigate The Delivery Efficiency Improvement For Sparc Compared To Impt, Peilin Liu, B A. De Jong, S Chang, Lewei Zhao, G Liu, Craig Stevens, Rohan Deraniyagala, E W. Korevaar, J A. Langendijk, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To assess the efficiency improvement of SPArc compared to IMPT in proton clinical operation.Methods: A random clinical operation day at a proton therapy center with a two room system. Aa total of 10 Head & Neck cancer cases treated on Jan 6th, 2021were selected and SPArc plans were generated for all the cases with similar target coverage and dose constraints of organ at risk (OARs). 3% range uncertainties and 3mm setup uncertainties were applied for robust optimization. The log files of clinical IMPT were exported to calculate true treatment delivery time. The machine-specific delivery sequence model was utilized to …

Fiducial Markers Allow Accurate And Reproducible Delivery Of Liver Stereotactic Body Radiation Therapy, Marina Moskalenko, Bernard L. Jones, Adam Mueller, Shirley Lewis, Jay C. Shiao, Sara J. Zakem, Tyler P. Robin, Karyn A. Goodman

Department of Radiation Oncology Faculty Papers

Fiducial markers are utilized for image guided radiotherapy (IGRT) alignment during the delivery of liver stereotactic body radiosurgery (SBRT). There are limited data demonstrating the impact of matching fiducials on the accuracy of liver SBRT. This study quantifies the benefit of fiducial-based alignment and improvements in inter-observer reliability. Nineteen patients with 24 liver lesions were treated with SBRT. Target localization was performed using fiducial markers on cone-beam computed tomography (CBCT). Each CBCT procedure was retrospectively realigned to match both the liver edge and fiducial markers. The shifts were recorded by seven independent observers. Inter-observer variability was analyzed by calculating the …

Comparison Of Clinical And Radiographic Efficacy Of Particles Versus Nbca/Onyx In Middle Meningeal Artery Embolization For Chronic Subdural Hematoma, Jane Khalife, Mohamed Salem, Victoria Wong Murray, Allen Karimov, Brian Jankowitz, Jan Karl Burkhardt, Hamza Shaikh, Daniel Tonetti, Pratit Patel, Tudor Jovin, Ajith Thomas

Rowan-Virtua Research Day

Different embolic materials are utilized in MMA embolization of chronic subdural hematoma per operators’ discretion. We aim to compare the clinical and radiographic efficacy of different embolic materials in a pooled retrospective cohort of two US centers.

Clinical Outcomes Of Immunotherapy Continued Beyond Radiographic Disease Progression In Older Adult Patients With Advanced Non-Small Cell Lung Cancer, Eric K Singhi, Frank Mott, Michelle Worst, Cheuk Hong Leung, J Jack Lee, Brett Carter, Carolyn J Presley, John V Heymach, Mehmet Altan

Faculty, Staff and Student Publications

Immunotherapy is an effective and generally well-tolerated treatment strategy for older adult patients (aged ≥70 years) with advanced non-small cell lung cancer (NSCLC). Unfortunately, most patients who receive immunotherapy eventually exhibit disease progression during treatment. The present study reports on a subset of older adult patients with advanced NSCLC who could effectively continue immunotherapy beyond radiographic disease progression due to perceived clinical benefit. Local consolidative radiotherapy may be used in select older adult patients to prolong the duration of immunotherapy they receive, with a particular consideration of their preexisting co-morbidities, performance status and tolerance of potential toxicities associated with combined …

Tumor Locations Impact On Cardiac Toxicity In Women That Received Partial Breast Irradiation, Sara Diltz, Muayad Almahariq, Joshua Dilworth

Posters

Accelerated partial breast irradiation (APBI) is an appropriate modality for select women with low-risk breast cancer. While APBI delivers radiation dose to a smaller volume of breast tissue compared to whole breast irradiation, dose to the heart and coronary vessels may be relatively high, depending on the proximity of the treatment device to these structures. The primary goal of this study is to determine if the risk of adverse cardiac events depends on tumor location in women receiving APBI.

High Dose Rate Brachytherapy Monotherapy Versus External Beam Radiotherapy With Hdr Brachytherapy Boost For Unfavorable Intermediate Prostate Cancer Patients, Doyle Lang, Benjamin Willen, Daniel J. Krauss, Sirisha R. Nandalur

Posters

Prostate cancer is the most common male malignancy by incidence in the world. Treatment differs by the patient’s risk stratification. For the treatment of unfavorable intermediate-risk prostate cancer, external beam radiotherapy with high-dose-rate brachytherapy boost was the accepted treatment but high-dose-rate brachytherapy as monotherapy has been proposed as a potentially viable treatment option. External beam radiotherapy treatment involves shooting high-energy photons or particle radiation through normal healthy tissue to hit the tumor directly. High-dose-rate brachytherapy involves inserting radioactive seeds into the tumor. Studies are needed to compare toxicity profiles and relative outcomes between the two treatment options.

Outcomes Of Locally Advanced Lung Cancer Patients Treated With 60 Gy Vs. 70 Gy, Batoul Nasser, Muyad Almahariq, Inga Grills

Posters

The standard form of treatment for locally advanced lung cancer is to prescribe the conventional dose of 60 Gy radiation therapy (RT) concurrently with chemotherapy. However, five-year overall survival is still less than 20%. These outcomes remain poor due to both distant and local regional recurrence. The literature suggests that local regional control and overall survival is strongly associated with doses of radiotherapy that are higher than 60 Gy. However, when escalating radiation dose was prescribed exceeding 70 Gy, the overall survival rates plateaued. The primary goal of this study is to determine if there is a marked difference in …

Dose To The Left Anterior Descending Artery Correlates With Cardiac Events After Irradiation For Breast Cancer, Brittany Silverman, Andrew Zureick, Vincent Grzywacz, Muayad Almahariq, Aleksander Vayntraub, Joshua Dilworth

Posters

Although global heart dose has been associated with late cardiac toxic effects in patients who received radiation therapy for breast cancer, data detailing the clinical significance of cardiac substructure dosimetry are limited. We investigated whether dose to the left anterior descending artery (LAD) correlates with adverse cardiac events.

Influence Of Pretreatment Magnetic Resonance Imaging On Local Therapy Decisions For Intermediate-Risk Prostate Cancer Patients, Christian Skowronski, Andrew Shanholtzer, Brent Yelton, Muayad Almahariq, Daniel Krauss

Posters

Prostate cancer has the third highest incidence rate and is the second leading cause of cancer death for men in the United States. Magnetic resonance imaging (MRI) provides superior soft tissue delineation serving as a valuable tool for both diagnosis and treatment planning. With minimal data regarding utility on diagnosis and treatment planning for intermediate-risk prostate cancer, the National Comprehensive Cancer Network’s guidelines indicate MRI as optional in intermediate-risk prostate cancer evaluation. This project aims to elucidate whether MRI affects radiation treatment decisions for intermediate-risk prostate cancer.

Impact Of Structured Reporting Template On The Quality Of Hrct Radiology Reports For Interstitial Lung Disease, Han G. Ngo, Girish B. Nair, Sayf Al-Katib

Posters

This QI study compared the completeness of HRCT radiology reports before and after the implementation of a disease-specific structured reporting template for suspected cases of interstitial lung disease (ILD).

The Safe And Effective Clinical Deployment Of Artificial Intelligence To Ols, Kelly Nealon

Dissertations and Theses (Open Access)

18 million new cancer cases are diagnosed each year. Roughly half of these patients will be treated with radiation therapy, a complex technique that requires an interdisciplinary team of clinical staff and expensive equipment to be delivered safely. Cancer centers in Low- and Middle-Income Countries (LMIC) have an especially difficult time meeting the demands of radiation therapy as the complexity of treatment techniques increase, with only 37% of patients in these regions having access to the care they need. Artificial Intelligence (AI) based tools are being developed to simplify the treatment planning and quality assurance processes to increase the number …

Optimal Circulatory Arrest Temperature For Aortic Hemiarch Replacement With Antegrade Brain Perfusion, Laura Seese, Edward P Chen, Vinay Badhwar, Dylan Thibault, Robert H Habib, Jeffrey P Jacobs, Vinod Thourani, Faisal Bakaeen, Sean O'Brien, Oliver K Jawitz, Brittany Zwischenberger, Thomas G Gleason, Ibrahim Sultan, Arman Kilic, Joseph S Coselli, Lars G Svensson, Joanna Chikwe, Danny Chu

Faculty, Staff and Students Publications

Objective: This study sought to identify the optimal temperature for moderate hypothermic circulatory arrest in patients undergoing elective hemiarch replacement with antegrade brain perfusion.

Methods: The Society of Thoracic Surgeons adult cardiac surgery database was queried for elective hemiarch replacements using antegrade brain perfusion for aneurysmal disease (2014-2019). Generalized estimating equations and restricted cubic splines were used to determine the risk-adjusted relationships between temperature as a continuous variable and outcomes.

Results: Elective hemiarch replacement with antegrade brain perfusion occurred in 3898 patients at 374 centers with a median nadir temperature of 24.9°C (first quartile, third quartile = 22.0°C, 27.5°C) and …