Image-Guided Radiotherapy – The Unsung Hero of Radiotherapy Development

Diagnostic Radionuclides Labeled on Biomimetic Nanoparticles for Enhanced Follow-Up Photothermal Therapy of Cancer

Imaging-guided local therapy is the most effective strategy to treat primary cancers in patients. However, the local therapeutic effect should be further improved under the premise of absence of induction of additional side effects. It would be meaningful to analyze the potential assistance of nuclear imaging to the follow-up treatments. In this study,cancer-targeted copper sulfide nanoparticles with ^99m Tc labeling (^99m Tc-M-CuS-PEG) are prepared using-cancer cell membranes as a synthesis reactor and applied for the potential single-photon emission computed tomography/photoacoustic imaging-guided and ^99m Tc-amplified photothermal therapy of cancer. Owing to the homologous targeting capability of the cancer cell membrane, M-CuS-PEG selectively accumulates in homologous tumor sites. After labeling with ^99m Tc, M-CuS-PEG with a high near-infrared light absorbance can realize bimodal imaging-guided photothermal therapy of cancer. Furthermore, the labeled ^99m Tc significantly enhances the cell uptake of M-CuS-PEG by inducing G2/M arrest of the cell cycle, further improving the photothermal antitumor effect, which is positively correlated with endocytosis of the photothermal conversion reagent. Therefore, a novel cancer-targeted theranostic nanoplatform is developed and it is revealed that the labeled ^99m Tc can not only guide but also amplify the subsequent therapy of cancer, providing a conceptual strategy for cancer theranostics with a high biosafety.

Adapting for Adaptive Radiotherapy (ART): The need to evolve our roles as Therapeutic Radiographers

OBJECTIVES

4D Adaptive Radiotherapy (4D-ART) has been stated as the future baseline standard-of-care for technical radiotherapy. Its goal is to optimise radiation dose received by 'adapting' to changes 'seen' in each individual patient, for each treatment delivery (fraction), throughout each treatment delivery. The drive for technological developments to achieve this is ongoing. To enhance the potential benefits, we should consider other aspects of the processes needed: How do changes in clinical practices and processes affect the role of the Therapeutic Radiographer? The aim is to raise the need to explore questions of Therapeutic Radiographers roles and responsibilities within 4D-ART.

KEY FINDINGS

Moving from using current predictive strategies (such as plan-of-the-day) to being able to dynamically adapt (real-time/4D-ART) for patient changes requires rapid clinical judgements to be made. The question becomes 'who makes these decisions'? Currently Therapeutic Radiographers maybe ideally placed for this. Dynamically adaptive radiotherapy requires Radiographers to have clinical decisions-making skills and authorities within the multi-professional team (MPT). It is not sufficient to train radiographers in the 'how' to use 4D-ART techniques and technologies; the ability to make good clinical judgments comes from understanding the principles supporting this concept by understanding the 'why'.

CONCLUSION

To support future service needs and ongoing developments within ART, Radiographer's roles need to adapt and evolve, as well as the way their role is perceived within the MPT. We need to provide Radiographers with the education required, abilities and authorities to act.

IMPLICATIONS FOR PRACTICE

Role revision is required to include greater responsibility for clinical decision making for implementing 4D-ART practices.