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Lombardo J, Castillo E, Castillo R, Miller R, Jones B, Miften M, Kavanagh B, Dicker A, Boyle C, Leiby B, Banks J, Simone NL, Movsas B, Grills I, Guerrero T, Rusthoven CG, Vinogradskiy Y. Prospective trial of Functional Lung Avoidance Radiation Therapy for Lung Cancer: Quality of Life Report. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00476-0. [PMID: 38614278 DOI: 10.1016/j.ijrobp.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE A novel form of lung function imaging has been developed that uses 4DCT data to generate lung ventilation images (4DCT-ventilation). Functional avoidance uses 4DCT-ventilation to reduce doses to functional lung with the aim of reducing pulmonary side-effects. A 4DCT-ventilation functional avoidance, phase II, multi-center clinical trial was completed. The purpose of this work is to quantify patient reported outcomes (PRO) changes for patients treated with functional avoidance and to determine which metrics are predictive of PRO changes. MATERIALS AND METHODS Patients with locally advanced lung cancer receiving curative intent radiotherapy were accrued. Each patient had a 4DCT-ventilation image generated using 4DCT data and image processing. PRO instruments included the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire, administered pre-treatment, 3, 6, and 12 months post-treatment. FACT-TOI (Trial Outcome Index) and the FACT-LCS (Lung Cancer Subscale) percentage of clinically meaningful declines (CMD) were determined. A linear mixed-effects model was used to determine which patient, clinical, dose, and dose-function metrics were predictive of PRO decline. RESULTS 59 patients completed baseline PRO surveys. 83% of patients had non-small-cell lung cancer, with 75% having stage III disease. The median dose was 60 Gy in 30 fractions. CMD FACT-TOI decline was 46.3%, 38.5%, and 26.8%, at 3, 6, and 12 months, respectively. CMD FACT-LCS decline was 33.3%, 33.3%, and 29.3%, at 3, 6, and 12 months, respectively. While an increase in most dose and dose-function parameters was associated with a modest decline in PROs, none of the results were significant (all p>0.053). CONCLUSION The current work provides an innovative combination of functional avoidance and PROs and is the first report of PROs for patients treated with prospective 4DCT-ventilation functional avoidance. Approximately 30% of patients had clinically significant decline in PROs at 12 months. The study provides additional data on outcomes with 4DCT-ventilation functional avoidance.
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Affiliation(s)
- Joseph Lombardo
- Thomas Jefferson University, Radiation Oncology, Philadelphia, USA
| | - Edward Castillo
- UT Austin, Department of Biomedical Engineering, Austin, USA
| | - Richard Castillo
- Emory University School of Medicine, Radiation Oncology, Atlanta, USA
| | - Ryan Miller
- Thomas Jefferson University, Radiation Oncology, Philadelphia, USA
| | - Bernard Jones
- University of Colorado, Radiation Oncology, Denver, USA
| | - Moyed Miften
- University of Colorado, Radiation Oncology, Denver, USA
| | | | - Adam Dicker
- Thomas Jefferson University, Radiation Oncology, Philadelphia, USA
| | - Cullen Boyle
- Thomas Jefferson University, Radiation Oncology, Philadelphia, USA
| | - Benjamin Leiby
- Thomas Jefferson University, Department of Pharmacology, Physiology, and Cancer Biology, Philadelphia, USA
| | - Joshua Banks
- Thomas Jefferson University, Department of Pharmacology, Physiology, and Cancer Biology, Philadelphia, USA
| | - Nicole L Simone
- Thomas Jefferson University, Radiation Oncology, Philadelphia, USA
| | - Benjamin Movsas
- Henry Ford Cancer Institute, Radiation Oncology, Detroit, USA
| | - Inga Grills
- Beaumont Health, Radiation Oncology, Royal Oak, USA
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Bayat F, Miller B, Park Y, Yu Z, Alexeev T, Thomas D, Stuhr K, Kavanagh B, Miften M, Altunbas C. 2D antiscatter grid and scatter sampling based CBCT method for online dose calculations during CBCT guided radiation therapy of pelvis. Med Phys 2024; 51:3053-3066. [PMID: 38043086 PMCID: PMC11008043 DOI: 10.1002/mp.16867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Online dose calculations before the delivery of radiation treatments have applications in dose delivery verification, online adaptation of treatment plans, and simulation-free treatment planning. While dose calculations by directly utilizing CBCT images are desired, dosimetric accuracy can be compromised due to relatively lower HU accuracy in CBCT images. PURPOSE In this work, we propose a novel CBCT imaging pipeline to enhance the accuracy of CBCT-based dose calculations in the pelvis region. Our approach aims to improve the HU accuracy in CBCT images, thereby improving the overall accuracy of CBCT-based dose calculations prior to radiation treatment delivery. METHODS An in-house developed quantitative CBCT pipeline was implemented to address the CBCT raw data contamination problem. The pipeline combines algorithmic data correction strategies and 2D antiscatter grid-based scatter rejection to achieve high CT number accuracy. To evaluate the effect of the quantitative CBCT pipeline on CBCT-based dose calculations, phantoms mimicking pelvis anatomy were scanned using a linac-mounted CBCT system, and a gold standard multidetector CT used for treatment planning (pCT). A total of 20 intensity-modulated treatment plans were generated for five targets, using 6 and 10 MV flattening filter-free beams, and utilizing small and large pelvis phantom images. For each treatment plan, four different dose calculations were performed using pCT images and three CBCT imaging configurations: quantitative CBCT, clinical CBCT protocol, and a high-performance 1D antiscatter grid (1D ASG). Subsequently, dosimetric accuracy was evaluated for both targets and organs at risk as a function of patient size, target location, beam energy, and CBCT imaging configuration. RESULTS When compared to the gold-standard pCT, dosimetric errors in quantitative CBCT-based dose calculations were not significant across all phantom sizes, beam energies, and treatment sites. The largest error observed was 0.6% among all dose volume histogram metrics and evaluated dose calculations. In contrast, dosimetric errors reached up to 7% and 97% in clinical CBCT and high-performance ASG CBCT-based treatment plans, respectively. The largest dosimetric errors were observed in bony targets in the large phantom treated with 6 MV beams. The trends of dosimetric errors in organs at risk were similar to those observed in the targets. CONCLUSIONS The proposed quantitative CBCT pipeline has the potential to provide comparable dose calculation accuracy to the gold-standard planning CT in photon radiation therapy for the abdomen and pelvis. These robust dose calculations could eliminate the need for density overrides in CBCT images and enable direct utilization of CBCT images for dose delivery monitoring or online treatment plan adaptations before the delivery of radiation treatments.
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Affiliation(s)
- Farhang Bayat
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 Aurora, CO 80045
| | - Brian Miller
- Department of Radiation Oncology, The University of Arizona, College of Medicine, Tucson, AZ 85719
| | - Yeonok Park
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 Aurora, CO 80045
| | - Zhelin Yu
- Department of Computer Science and Engineering, University of Colorado Denver, 1200 Larimer Street, Denver, CO, 80204
| | - Timur Alexeev
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 Aurora, CO 80045
| | - David Thomas
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 Aurora, CO 80045
| | - Kelly Stuhr
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 Aurora, CO 80045
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 Aurora, CO 80045
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 Aurora, CO 80045
| | - Cem Altunbas
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 Aurora, CO 80045
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Bayat F, Miller B, Park Y, Yu Z, Alexeev T, Thomas D, Stuhr K, Kavanagh B, Miften M, Altunbas C. A 2D antiscatter grid and scatter sampling based CBCT method for online dose calculations during CBCT guided radiation therapy of pelvis. ArXiv 2023:arXiv:2310.07026v1. [PMID: 37873015 PMCID: PMC10593069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Online dose calculations before radiation treatment have applications in dose delivery verification, plan adaptation, and treatment planning. We propose a novel CBCT imaging pipeline to enhance accuracy. Our approach aims to improve HU accuracy in CBCT images for more precise dose calculations. A quantitative CBCT pipeline was implemented, combining data correction strategies and scatter rejection, achieving high CT number accuracy. We evaluated the pipeline's effect using pelvis anatomy phantoms and found that dosimetric errors in quantitative CBCT-based dose calculations were minimal. In contrast, clinical CBCT and high-performance ASG CBCT-based plans showed significant errors. The proposed quantitative CBCT pipeline offers comparable dose calculation accuracy to the gold-standard planning CT, eliminating the need for density overrides and enabling precise dose delivery monitoring or online plan adaptations in radiation therapy.
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Ghassemi N, Castillo R, Castillo E, Jones BL, Miften M, Kavanagh B, Werner-Wasik M, Miller R, Barta JA, Grills I, Leiby BE, Guerrero T, Rusthoven CG, Vinogradskiy Y. Evaluation of variables predicting PFT changes for lung cancer patients treated on a prospective 4DCT-ventilation functional avoidance clinical trial. Radiother Oncol 2023; 187:109821. [PMID: 37516361 PMCID: PMC10529225 DOI: 10.1016/j.radonc.2023.109821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Functional avoidance radiotherapy uses functional imaging to reduce pulmonary toxicity by designing radiotherapy plans that reduce doses to functional regions of the lung. A phase-II, multi-center, prospective study of 4DCT-ventilation functional avoidance was completed. Pre and post-treatment pulmonary function tests (PFTs) were acquired and assessed pulmonary function change. This study aims to evaluate which clinical, dose and dose-function factors predict PFT changes for patients treated with 4DCT-ventilation functional avoidance radiotherapy. MATERIALS AND METHODS 56 patients with locally advanced lung cancer receiving radiotherapy were accrued. PFTs were obtained at baseline and three months following radiotherapy and included forced expiratory volume in 1-second (FEV1), forced vital capacity (FVC), and FEV1/FVC. The ability of patient, clinical, dose (lung and heart), and dose-function metrics (metrics that combine dose and 4DCT-ventilation-based function) to predict PFT changes were evaluated using univariate and multivariate linear regression. RESULTS Univariate analysis showed that only dose-function metrics and the presence of chronic obstructive pulmonary disease (COPD) were significant (p<0.05) in predicting FEV1 decline. Multivariate analysis identified a combination of clinical (immunotherapy status, presence of thoracic comorbidities, smoking status, and age), along with lung dose, heart dose, and dose-function metrics in predicting FEV1 and FEV1/FVC changes. CONCLUSION The current work evaluated factors predicting PFT changes for patients treated in a prospective functional avoidance radiotherapy study. The data revealed that lung dose- function metrics could predict PFT changes, validating the significance of reducing the dose to the functional lung to mitigate the decline in pulmonary function and providing guidance for future clinical trials.
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Affiliation(s)
- Nader Ghassemi
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Richard Castillo
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Miller
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julie A Barta
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Benjamin E Leiby
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
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Miller R, Castillo R, Castillo E, Jones BL, Miften M, Kavanagh B, Lu B, Werner-Wasik M, Ghassemi N, Lombardo J, Barta J, Grills I, Rusthoven CG, Guerrero T, Vinogradskiy Y. Characterizing Pulmonary Function Test Changes for Patients With Lung Cancer Treated on a 2-Institution, 4-Dimensional Computed Tomography-Ventilation Functional Avoidance Prospective Clinical Trial. Adv Radiat Oncol 2023; 8:101133. [PMID: 36618762 PMCID: PMC9816902 DOI: 10.1016/j.adro.2022.101133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Four-dimensional computed tomography (4DCT)-ventilation-based functional avoidance uses 4DCT images to generate plans that avoid functional regions of the lung with the goal of reducing pulmonary toxic effects. A phase 2, multicenter, prospective study was completed to evaluate 4DCT-ventilation functional avoidance radiation therapy. The purpose of this study was to report the results for pretreatment to posttreatment pulmonary function test (PFT) changes for patients treated with functional avoidance radiation therapy. Methods and Materials Patients with locally advanced lung cancer receiving chemoradiation were accrued. Functional avoidance plans based on 4DCT-ventilation images were generated. PFTs were obtained at baseline and 3 months after chemoradiation. Differences for PFT metrics are reported, including diffusing capacity for carbon monoxide (DLCO), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). PFT metrics were compared for patients who did and did not experience grade 2 or higher pneumonitis. Results Fifty-six patients enrolled on the study had baseline and posttreatment PFTs evaluable for analysis. The mean change in DLCO, FEV1, and FVC was -11.6% ± 14.2%, -5.6% ± 16.9%, and -9.0% ± 20.1%, respectively. The mean change in DLCO was -15.4% ± 14.4% for patients with grade 2 or higher radiation pneumonitis and -10.8% ± 14.1% for patients with grade <2 radiation pneumonitis (P = .37). The mean change in FEV1 was -14.3% ± 22.1% for patients with grade 2 or higher radiation pneumonitis and -3.9% ± 15.4% for patients with grade <2 radiation pneumonitis (P = .09). Conclusions The current work is the first to quantitatively characterize PFT changes for patients with lung cancer treated on a prospective functional avoidance radiation therapy study. In comparison with patients treated with standard thoracic radiation planning, the data qualitatively show that functional avoidance resulted in less of a decline in DLCO and FEV1. The presented data can help elucidate the potential pulmonary function improvement with functional avoidance radiation therapy.
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Affiliation(s)
- Ryan Miller
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Richard Castillo
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Edward Castillo
- Department of Biomedical Engineering, University of Texas at Austin, Austin, Texas
| | - Bernard L. Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bo Lu
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nader Ghassemi
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joseph Lombardo
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julie Barta
- Department of Thoracic Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Chad G. Rusthoven
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Bayat F, Elsayed Eldib M, Kavanagh B, Miften M, Altunbas C. Concurrent kilovoltage CBCT imaging and megavoltage beam delivery: suppression of cross-scatter with 2D antiscatter grids and grid-based scatter sampling. Phys Med Biol 2022; 67:10.1088/1361-6560/ac8268. [PMID: 35853441 PMCID: PMC9378529 DOI: 10.1088/1361-6560/ac8268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022]
Abstract
Objective. The concept of using kilovoltage (kV) and megavoltage (MV) beams concurrently has potential applications in cone beam computed tomography (CBCT) guided radiation therapy, such as single breath hold scans, metal artifact reduction, and simultaneous imaging during MV treatment delivery. However, MV cross-scatter generated during MV beam delivery degrades CBCT image quality. To address this, a 2D antiscatter grid and a cross-scatter correction method were investigated in the context of high dose MV treatment delivery.Approach. A 3D printed, tungsten 2D antiscatter grid prototype was utilized in kV CBCT scans to reduce MV cross-scatter fluence during concurrent MV beam delivery. Remaining cross-scatter in projections was corrected by using the 2D grid itself as a cross-scatter intensity sampling device, referred to as grid-based scatter sampling (GSS). To test this approach, kV CBCT acquisitions were performed while delivering 6 and 10 MV beams, mimicking high dose rate treatment delivery scenarios. kV and MV beam deliveries were not synchronized to eliminate MV beam delivery interruption. MV cross-scatter suppression performance of the proposed approach was evaluated in projections and CBCT images of phantoms.Main results. 2D grid reduced the intensity of MV cross-scatter in kV projections by a factor of 3 on the average, when compared to conventional antiscatter grid. Remaining cross scatter as measured by the GSS method was within 7% of measured reference intensity values, and subsequently corrected. CBCT image quality was improved substantially during concurrent kV-MV beam delivery. Median Hounsfield Unit (HU) inaccuracy was up to 182 HU without our methods, and it was reduced to a median 6.5 HU with our 2D grid and scatter correction approach. Our methods provided a factor of 2-6 improvement in contrast-to-noise ratio.Significance. This investigation demonstrates the utility of 2D antiscatter grids and grid-based scatter sampling in suppressing MV cross-scatter. Our approach successfully minimized the effects of MV cross-scatter in concurrent kV CBCT imaging and high dose MV treatment delivery scenarios. Hence, robust MV cross-scatter suppression is potentially feasible without MV beam delivery interruption or compromising kV image acquisition rate.
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Affiliation(s)
- Farhang Bayat
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Mohamed Elsayed Eldib
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Cem Altunbas
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Liu J, Chen YJ, Williams TM, Fields E, Kavanagh B, Shah C, Royce T, Ladbury C, Amini A, Glaser S. Evaluation of Radiation Oncologist And Trainee Opinions on Residency Expansion, Possible Actions, and Training Program Accreditation Changes in the United States. Int J Radiat Oncol Biol Phys 2022; 114:16-20. [PMID: 35595159 DOI: 10.1016/j.ijrobp.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To sample U.S. radiation oncologist and trainee opinions regarding residency expansion, what action(s) should be taken to limit residency supply, if any, and the proposed Accreditation Council for Graduate Medical Education (ACGME) changes. MATERIALS AND METHODS An online survey was distributed to 1048 attending radiation oncologists by email and ∼800 residents through their program coordinators. The survey asked respondents to rank how strongly they agreed with certain statements regarding residency supply, possible solutions to address any perceived oversupply, and the proposed ACGME changes on a 1-10 disagreement-to-agreement scale. The 16% response rate yielded 294 responses for analysis. RESULTS Of the respondents, 90 (30%) were residents, and 204 (70%) were attendings, of whom 117 (57%) were academic, and 87 (43%) were non-academic. 86% agreed that there is a residency oversupply issue, and 91% agreed that actions should be taken to limit residency expansion. On chi-square test, residents and attendings were similarly likely to agree that there is a residency oversupply issue (93% and 89%, p=0.27), although residents were more likely to agree that this oversupply should be acted upon compared to attendings (100% and 88%, p<0.01). Regarding possible solutions, respondents were most likely to agree that further expansion should be limited (90%), program requirements should be made more stringent (76%), and the use of the Supplemental Offer and Acceptance Program should be limited (SOAP) (69%). Proposed ACGME changes that respondents were most likely to agree with included requiring that programs have modern image guidance, stereotactic radiotherapy, and brachytherapy techniques (98%) and have 4+ faculty members and maintain a faculty-to-resident ratio of >1.5:1 (86%). Case log minimums most supported to be increased were 4 uterus (65%) and 11 postmastectomy breast (61%) simulations. CONCLUSIONS The majority of respondents agree that there is a residency oversupply issue and that actions should be taken to limit residency expansion and make program requirements more stringent.
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Affiliation(s)
- Jason Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Yi-Jen Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Terence M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Emma Fields
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado Hospital, Aurora, Colorado
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland, Ohio
| | - Trevor Royce
- Department of Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina; Flatiron Health, New York City, New York
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California.
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Vinogradskiy Y, Castillo R, Castillo E, Schubert L, Jones BL, Faught A, Gaspar LE, Kwak J, Bowles DW, Waxweiler T, Dougherty JM, Gao D, Stevens C, Miften M, Kavanagh B, Grills I, Rusthoven CG, Guerrero T. Results of a Multi-Institutional Phase 2 Clinical Trial for 4DCT-Ventilation Functional Avoidance Thoracic Radiation Therapy. Int J Radiat Oncol Biol Phys 2022; 112:986-995. [PMID: 34767934 PMCID: PMC8863640 DOI: 10.1016/j.ijrobp.2021.10.147] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/07/2021] [Accepted: 10/22/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Radiation pneumonitis remains a major limitation in the radiation therapy treatment of patients with lung cancer. Functional avoidance radiation therapy uses functional imaging to reduce pulmonary toxic effects by designing radiation therapy plans that reduce doses to functional regions of the lung. Lung functional imaging has been developed that uses 4-dimensional computed tomography (4DCT) imaging to calculate 4DCT-based lung ventilation (4DCT-ventilation). A phase 2 multicenter study was initiated to evaluate 4DCT-ventilation functional avoidance radiation therapy. The study hypothesis was that functional avoidance radiation therapy could reduce the rate of grade ≥2 radiation pneumonitis to 12% compared with a 25% historical rate, with the trial being positive if ≤16.4% of patients experienced grade ≥2 pneumonitis. METHODS AND MATERIALS Lung cancer patients receiving curative-intent radiation therapy (prescription doses of 45-75 Gy) and chemotherapy were accrued. Patient 4DCT scans were used to generate 4DCT-ventilation images. The 4DCT-ventilation images were used to generate functional avoidance plans that reduced doses to functional portions of the lung while delivering the prescribed tumor dose. Pneumonitis was evaluated by a clinician at 3, 6, and 12 months after radiation therapy. RESULTS Sixty-seven evaluable patients were accrued between April 2015 and December 2019. The median prescription dose was 60 Gy (range, 45-66 Gy) delivered in 30 fractions (range, 15-33 fractions). The average reduction in the functional volume of lung receiving ≥20 Gy with functional avoidance was 3.5% (range, 0%-12.8%). The median follow-up was 312 days. The rate of grade ≥2 radiation pneumonitis was 10 of 67 patients (14.9%; 95% upper CI, 24.0%), meeting the phase 2 criteria. CONCLUSIONS 4DCT-ventilation offers an imaging modality that is convenient and provides functional imaging without an extra procedure necessary. This first report of a multicenter study of 4DCT-ventilation functional avoidance radiation therapy provided data showing that the trial met phase 2 criteria and that evaluation in a phase 3 study is warranted.
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Affiliation(s)
- Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado; Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Richard Castillo
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Austin Faught
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Laurie E Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer Kwak
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel W Bowles
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Timothy Waxweiler
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Dexiang Gao
- Departments of Pediatrics and Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, Colorado
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
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Das IJ, Dawes SL, Dominello MM, Kavanagh B, Miyamoto CT, Pawlicki T, Santanam L, Vinogradskiy Y, Yeung AR. Quality and Safety Considerations in Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy: An ASTRO Safety White Paper Update. Pract Radiat Oncol 2022; 12:e253-e268. [DOI: 10.1016/j.prro.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
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10
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Hubbard A, Mantz C, Mohideen N, Hartsell W, Thaker NG, Orio P, Yashar C, Kavadi V, Kavanagh B, Adler D. Radiation Oncology's Place in Payment Reform: ASTRO Advocates for a Place at the Table. JCO Oncol Pract 2021; 17:777-781. [PMID: 34524836 DOI: 10.1200/op.21.00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In its current form, the Radiation Oncology Model (RO Model) prioritizes payment cuts over true value-based payment transformation. With significant modifications to the payment methodology, the reporting requirements, and recognition of the unique challenges faced by disadvantaged populations, the RO Model can protect patient access to care, preserve the physician-patient decision-making process, and ensure the delivery of high-quality, efficient radiation therapy treatment. The American Society for Radiation Oncology has spent several years advocating for a meaningful alternative payment model for radiation oncology and continues to push The Center for Medicare and Medicaid Innovation for changes to the RO Model that will recognize these key outcomes.
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Affiliation(s)
- Anne Hubbard
- American Society for Radiation Oncology, Arlington, VA
| | | | | | | | | | - Peter Orio
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | - Dave Adler
- American Society for Radiation Oncology, Arlington, VA
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11
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Kavanagh B, Perkmann M, Phillips N. Collective identity and the limits of innovation: a review and research agenda. Innovation 2021. [DOI: 10.1080/14479338.2020.1742127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Brian Kavanagh
- King’s College London, Department of Digital Humanities, King’s College, London, England, United Kingdom
| | - Markus Perkmann
- Imperial College Business School, South Kensington Campus, London, England, United Kingdom
| | - Nelson Phillips
- Imperial College Business School, South Kensington Campus, London, England, United Kingdom
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12
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Thomas DH, Schubert LK, Vinogradskiy Y, Nath S, Kavanagh B, Miften M, Jones B. Technical Note: Deep Learning approach for automatic detection and identification of patient positioning devices for radiation therapy. Med Phys 2020; 47:5061-5069. [DOI: 10.1002/mp.14338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- David H. Thomas
- Department of Radiation Oncology University of Colorado Aurora CO USA
| | - Leah K. Schubert
- Department of Radiation Oncology University of Colorado Aurora CO USA
| | | | - Sameer Nath
- Department of Radiation Oncology University of Colorado Aurora CO USA
| | - Brian Kavanagh
- Department of Radiation Oncology University of Colorado Aurora CO USA
| | - Moyed Miften
- Department of Radiation Oncology University of Colorado Aurora CO USA
| | - Bernard Jones
- Department of Radiation Oncology University of Colorado Aurora CO USA
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13
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Thomas DH, Miller B, Rabinovitch R, Milgrom S, Kavanagh B, Diot Q, Miften M, Schubert LK. Integration of automation into an existing clinical workflow to improve efficiency and reduce errors in the manual treatment planning process for total body irradiation (TBI). J Appl Clin Med Phys 2020; 21:100-106. [PMID: 32426947 PMCID: PMC7386186 DOI: 10.1002/acm2.12894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose To identify causes of error, and present the concept of an automated technique that improves efficiency and helps to reduce transcription and manual data entry errors in the treatment planning of total body irradiation (TBI). Methods Analysis of incidents submitted to incident learning system (ILS) was performed to identify potential avenues for improvement by implementation of automation of the manual treatment planning process for total body irradiation (TBI). Following this analysis, it became obvious that while the individual components of the TBI treatment planning process were well implemented, the manual ‘bridging’ of the components (transcribing data, manual data entry etc.) were leading to high potential for error. A C#‐based plug‐in treatment planning script was developed to remove the manual parts of the treatment planning workflow that were contributing to increased risk. Results Here we present an example of the implementation of “Glue” programming, combining treatment planning C# scripts with existing spreadsheet calculation worksheets. Prior to the implementation of automation, 35 incident reports related to the TBI treatment process were submitted to the ILS over a 6‐year period, with an average of 1.4 ± 1.7 reports submitted per quarter. While no incidents reached patients, reports ranged from minor documentation issues to potential for mistreatment if not caught before delivery. Since the implementation of automated treatment planning and documentation, treatment planning time per patient, including documentation, has been reduced; from an average of 45 min pre‐automation to <20 min post‐automation. Conclusions Manual treatment planning techniques may be well validated, but they are time‐intensive and have potential for error. Often the barrier to automating these techniques becomes the time required to “re‐code” existing solutions in unfamiliar computer languages. We present the workflow here as a proof of concept that automation may help to improve clinical efficiency and safety for special procedures.
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Affiliation(s)
- David H Thomas
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Brian Miller
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Rachel Rabinovitch
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Sarah Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Leah K Schubert
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
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14
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Vinogradskiy Y, Diot Q, Jones B, Castillo R, Castillo E, Kwak J, Bowles D, Grills I, Myziuk N, Guerrero T, Stevens C, Schefter T, Gaspar LE, Kavanagh B, Miften M, Rusthoven C. Evaluating Positron Emission Tomography-Based Functional Imaging Changes in the Heart After Chemo-Radiation for Patients With Lung Cancer. Int J Radiat Oncol Biol Phys 2020; 106:1063-1070. [PMID: 31983558 DOI: 10.1016/j.ijrobp.2019.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Studies have noted a link between radiation dose to the heart and overall survival (OS) for patients with lung cancer treated with chemoradiation. The purpose of this study was to characterize pre- to posttreatment cardiac metabolic changes using fluorodeoxyglucose/positron emission tomography (FDG-PET) images and to evaluate whether changes in cardiac metabolism predict for OS. METHODS AND MATERIALS Thirty-nine patients enrolled in a functional avoidance prospective study who had undergone pre- and postchemoradiation FDG-PET imaging were evaluated. For each patient, the pretreatment and posttreatment PET/CTs were rigidly registered to the planning CT, dose, and structure set. PET-based metabolic dose-response was assessed by comparing pretreatment to posttreatment mean standardized uptake values (SUVmean) in the heart as a function of dose-bin. OS analysis was performed by comparing SUVmean changes for patients who were alive or had died at last follow-up and by using a multivariate model to assess whether pre- to posttreatment SUVmean changes were a predictor of OS. RESULTS The dose-response curve revealed increasing changes in SUV as a function of cardiac dose with an average SUVmean increase of 1.7% per 10 Gy. Patients were followed for a median of 437 days (range, 201-1131 days). SUVmean change was significantly predictive of OS on multivariate analysis with a hazard ratio of 0.541 (95% confidence intervals, 0.312-0.937). Patients alive at follow-up had an average increase of 17.2% in cardiac SUVmean while patients that died had an average decrease in SUVmean decrease of 13.5% (P = .048). CONCLUSIONS Our data demonstrated that posttreatment SUV changes in the heart were significant indicators of dose-response and predictors of OS. The present work is hypothesis generating and must be validated in an independent cohort. If validated, our data show the potential for cardiac metabolic changes to be an early predictor for clinical outcomes.
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Affiliation(s)
- Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard Castillo
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Jennifer Kwak
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Bowles
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Nicholas Myziuk
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Tracey Schefter
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Laurie E Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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15
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Sheehan JP, Grills I, Chiang VL, Dong H, Berg A, Warnick RE, Kondziolka D, Kavanagh B. Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry. J Neurosurg 2019; 131:1848-1854. [DOI: 10.3171/2018.8.jns181599] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEStereotactic radiosurgery (SRS) is increasingly used for the treatment of brain metastasis. To date, most studies have focused on survival, radiological response, or surrogate quality endpoints such as Karnofsky Performance Scale status or neurocognitive indices. The current study prospectively evaluated pre-procedural factors impacting quality of life in brain metastasis patients undergoing SRS.METHODSUsing a national, cloud-based platform, patients undergoing SRS for brain metastasis were accrued to the registry. Quality of life prior to SRS was assessed using the 5-level EQ-5D (EQ5D-L) validated tool; additionally, patient and treatment attributes were collected. Patient quality of life was assessed as part of routine follow-up after SRS. Factors predicting a difference in the aggregate EQ5D-L score or the subscores were evaluated. Pre-SRS covariates impacting changes in EQ5D-L were statistically evaluated. Statistical analyses were conducted using multivariate linear regression models.RESULTSEQ5D-L results were available for 116 patients. EQ5D-L improvement (average of 0.387) was noted in patients treated with earlier SRS (p = 0.000175). Worsening overall EQ5D-L (average of 0.052 per lesion) was associated with an increased number of brain metastases at the time of initial presentation (p = 0.0399). Male sex predicted a risk of worsening (average of 0.347) of the pain and discomfort subscore at last follow-up (p = 0.004205). Baseline subscores of pain/discomfort were not correlated with pain/discomfort subscores at follow-up (p = 0.604), whereas baseline subscores of anxiety/depression were strongly positively correlated with the anxiety/depression follow-up subscores (p = 0.0039).CONCLUSIONSAfter SRS, quality of life was likely to improve in patients treated early with SRS and worsen in those with a greater number of brain metastases. Sex differences appear to exist regarding pain and discomfort worsening after SRS. Those with high levels of anxiety and depression at SRS may benefit from medical treatment as this particular quality of life factor generally remains unchanged after SRS.
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Affiliation(s)
- Jason P. Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Inga Grills
- 5Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Veronica L. Chiang
- 3Department of Neurological Surgery, Yale University, New Haven, Connecticut
| | - Huamei Dong
- 2Penn State Medical Center, Hershey, Pennsylvania
| | - Arthur Berg
- 2Penn State Medical Center, Hershey, Pennsylvania
| | | | - Douglas Kondziolka
- 4Department of Neurological Surgery, New York University, New York, New York
| | - Brian Kavanagh
- 6Department of Radiation Oncology, University of Colorado, Denver, Colorado; and
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16
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Altunbas C, Alexeev T, Miften M, Kavanagh B. Effect of grid geometry on the transmission properties of 2D grids for flat detectors in CBCT. Phys Med Biol 2019; 64:225006. [PMID: 31585444 DOI: 10.1088/1361-6560/ab4af4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To suppress scatter in cone beam computed tomography (CBCT), two-dimensional antiscatter grids (2D grid) have been recently proposed. In this work, we developed several grid prototypes with higher grid ratios and smaller grid pitches than previous designs, and quantified their primary and scatter transmission properties in the context of CBCT for radiation therapy. Three focused 2D grid prototypes were developed with grid ratios at 12 and 16, and grid pitches at 2 and 3 mm. Their scatter transmission properties were measured between 80-140 kVp, and benchmarked against a high performance radiographic grid (1D grid) using a Varian TrueBeam CBCT system. The effect of source-grid misalignment on the primary transmission and the improvement in contrast-to-noise ratio (CNR) were also evaluated. Changing the grid pitch from two to three mm increased the average primary transmission from 84% to 89%. Maximum scatter-to-primary ratio (SPR) with grid ratio of 12 was 0.3, and increasing the grid ratio to 16 reduced SPR by 30%. A 10 mm misalignment in 2D grid position led to a 6%-8% reduction in average primary transmission, and reduction was more pronounced for the higher grid ratio. 2D grids provided up to factor of seven lower SPR and 21% better primary transmission than the 1D grid, and their scatter transmission exhibited lower energy dependence. While 2D grids provided up to factor of 2.3 higher CNR improvement, a significant variation in CNR improvement was not observed among different grid pitch and ratios. In summary, grid ratio of 16 and grid pitch of 2 mm can keep SPRs below 0.2 even in high scatter conditions, while keeping primary transmission fractions above 80%, key benefits of the investigated 2D grids in improving image quality of CBCT. However, such grids require precise alignment in source-grid geometry during CBCT acquisitions. This study also implies that 2D grids can provide substantially better scatter suppression and primary transmission than high-performance 1D grids currently available.
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Affiliation(s)
- Cem Altunbas
- Author to whom correspondence should be addressed
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17
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Behbahani RA, Diot Q, Kavanagh B, Serkova NJ, Miften M, Westerly DC. Electromagnetic wave propagation in a fast pulse line ion accelerator. Med Phys 2019; 46:5714-5721. [PMID: 31622500 DOI: 10.1002/mp.13875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The pulse line ion accelerator (PLIA) is a low-cost accelerator concept originally designed to accelerate heavy ions. Our group has been investigating the use of PLIA to accelerate light ions and believe a multi-stage PLIA could be useful for short half-life PET isotope production. The goal of this work was to develop a single prototype fast PLIA structure and demonstrate electromagnetic wave propagation using a high-voltage pulser. MATERIALS AND METHODS A 1.6 m fast PLIA structure (wave speed > 107 m/s) was constructed along with a high-voltage, sinusoidal pulse generator. The latter uses capacitive voltage doubling and spark gap switching. A step-up transformer couples voltage from the pulser to the PLIA coil. Voltage measurements on the coil were made in air using a high-voltage resistive probe, while capacitive probes placed along the length of the PLIA were used to measure wave propagation with the PLIA structure filled with transformer oil. RESULTS Voltage measurements acquired on the primary and secondary coils of the transformer coupler in air demonstrated a peak-to-peak voltage step-up of 4.2 relative to the pulser DC charging voltage. The maximum voltage time-rate-of-change on the PLIA coil was 0.76 × 1013 V/s. Capacitive probe measurements indicated voltage oscillations on the PLIA coil with half-period equal to 43 ± 0.9 ns and wave speed (with oil) of 1.2 × 107 m/s. Average and peak accelerating gradients were conservatively estimated to be 0.44 and 0.60 MV/m, respectively, with a charging voltage of 55 kV. Wave propagation was demonstrated at these gradients without flashover at a vacuum pressure of 9 × 10-6 Torr. Submerging the pulser in oil would allow for charging voltages up to 150 kV and produce accelerating gradients >1.2 MV/m. CONCLUSIONS Use of a multi-stage, fast PLIA for light ion acceleration could provide a low-cost complement to cyclotrons for the production of short half-life isotopes used for PET imaging, including carbon-11, nitrogen-13, oxygen-15, and fluorine-18.
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Affiliation(s)
- Reza A Behbahani
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Natalie J Serkova
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - David C Westerly
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
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18
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Alexeev T, Kavanagh B, Miften M, Altunbas C. A novel total variation based ring artifact suppression method for CBCT imaging with two-dimensional antiscatter grids. Med Phys 2019; 46:2181-2193. [PMID: 30802970 DOI: 10.1002/mp.13456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Two-dimensional antiscatter grids (2DASG) for cone beam computed tomography (CBCT) is a new area of research to reduce scatter intensity, and consequently improve CBCT image quality. One of the challenges in implementation of 2DASGs is their septa shadows that are impinged on the projections. If these artifacts are not corrected, they may lead to ring artifacts in CBCT images. In this work, we present a novel method to suppress ring artifacts in FPD-based CBCT images. METHODS Briefly, our method first detects the locations of 2DASG's septa shadows in projections and then, reduces projection pixel values in septa shadows iteratively until a residual-based convergence criterion is met. To suppress the 2DASG's septa shadows, we developed a total variation minimization (TVM) formulation, referred to as adaptive-diffusive total variation minimization (adTVM), where the diffusivity regularization parameter was adaptively adjusted during each iteration based on the magnitude of the local pixel gradients. To test our method, we have acquired CBCT scans of phantoms using three 2DASG prototypes with different grid geometries. Projections were acquired with a linac mounted CBCT system, operated in offset detector geometry. These projections were then corrected in the following steps: first, projections were corrected using a gantry angle-specific gain correction map; next, projections were corrected by applying our adTVM method. CBCT images were reconstructed using FDK filtered backprojection algorithm. To evaluate adTVM's performance, pixel value statistics and contrast-to-noise ratio (CNR) were compared in CBCT images corrected with and without our adTVM method. RESULTS Without our adTVM method, all three 2DASG prototypes introduced ring artifacts with varying intensities in CBCT images. With our method, significant reduction in ring artifacts was observed in all test cases. Standard deviation of CT numbers was reduced by 7-74% in uniform density phantom CBCT images, CNR was increased by 8-67%, and CT number accuracy of contrast objects embedded in the phantom was preserved. CONCLUSION We propose a new method to suppress ring artifacts caused by the 2DASG's septa shadows in CBCT images. Our initial investigations indicated that adTVM method could substantially reduce such ring artifacts while preserving CT number accuracy and maintaining good spatial resolution. Therefore, our method may potentially play an important role in enabling the implementation of 2DASGs in flat panel detector based CBCT systems.
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Affiliation(s)
- Timur Alexeev
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706, Aurora, CO, 80045, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706, Aurora, CO, 80045, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706, Aurora, CO, 80045, USA
| | - Cem Altunbas
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706, Aurora, CO, 80045, USA
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19
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Weiss J, Kavanagh B, Deal A, Villaruz L, Stevenson J, Camidge R, Borghaei H, West J, Kirpalani P, Morris D, Lee C, Pecot CV, Zagar T, Stinchcombe T, Pennell N. Phase II study of stereotactic radiosurgery for the treatment of patients with oligoprogression on erlotinib. Cancer Treat Res Commun 2019; 19:100126. [PMID: 30852467 DOI: 10.1016/j.ctarc.2019.100126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/20/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Retrospective studies have evaluated the approach of stereotactic radiotherapy (SRT) to address oligoprogression in patients with EGFR mutant NSCLC on TKI therapy, it has never been prospectively studied. MATERIALS AND METHODS We treated 25 patients with EGFR mutant NSCLC on erlotinib who had 3 or fewer sites of extra-cranial progression with SRT to progressing sites, followed by re-initiation of erlotinib. RESULTS Median PFS from the initiation of SRT was 6 months (95% CI 2.5 to 11.6) and median OS was 29 months (95% CI 21.7 to 36.3). Neither baseline nor changes in the Veristrat proteomic predicted PFS. CONCLUSIONS SRT and TKI continuation may be considered for select patients with EGFR mutant NSCLC and oligo-progression on EGFR TKI therapy.
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Affiliation(s)
- Jared Weiss
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Brian Kavanagh
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Allison Deal
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Liza Villaruz
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - James Stevenson
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Ross Camidge
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Hossein Borghaei
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Jack West
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Padmini Kirpalani
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - David Morris
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States
| | - Carrie Lee
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Chad V Pecot
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Timothy Zagar
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States
| | - Thomas Stinchcombe
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
| | - Nathan Pennell
- Lineberger Cancer Center at the University of North Carolina, 170 Manning Drive, Room 3115, Campus Box 7305, Chapel Hill, NC 27514, United States.
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20
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Pacheco JM, Gao D, Smith D, Purcell T, Hancock M, Bunn P, Robin T, Liu A, Karam S, Gaspar L, Kavanagh B, Rusthoven C, Aisner D, Doebele R, Camidge DR. Natural History and Factors Associated with Overall Survival in Stage IV ALK-Rearranged Non-Small Cell Lung Cancer. J Thorac Oncol 2018; 14:691-700. [PMID: 30599201 DOI: 10.1016/j.jtho.2018.12.014] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Clinical variables describing the natural history and longitudinal therapy outcomes of stage IV anaplastic lymphoma kinase gene rearrangement positive (ALK-positive) NSCLC and their relationship with long-term overall survival (OS) have not previously been described in detail. METHODS Patients with stage IV NSCLC treated with an ALK inhibitor at the University of Colorado Cancer Center from 2009 through November 2017 were identified retrospectively. OS curves were constructed by using Kaplan-Meier methods. Multivariate Cox proportional hazard analysis was used to determine the relationship of variables with OS. RESULTS Of the 110 patients with ALK-positive NSCLC who were identified, 105 received crizotinib as their initial ALK inhibitor. With a median follow-up time of 47 months, the median OS time from diagnosis of stage IV disease was 81 months (6.8 years). Brain metastases at diagnosis of stage IV disease (hazard ratio = 1.01, p = 0.971) and year of stage IV presentation (p = 0.887) did not influence OS. More organs with tumor at diagnosis of stage IV disease was associated with worse OS (HR = 1.49 for each additional organ with disease, including the CNS [p = 0.002]). Each additional month of pemetrexed-based therapy was associated with a 7% relative decrease in risk of death. CONCLUSION Patients with stage IV ALK-positive NSCLC can have prolonged OS. Brain metastases at diagnosis of stage IV disease does not influence OS. Having more organs involved with tumor at stage IV presentation is associated with worse outcomes. Prolonged benefit from pemetrexed is associated with better outcomes.
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Affiliation(s)
- Jose M Pacheco
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado.
| | - Dexiang Gao
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado; School of Medicine and Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Derek Smith
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado; School of Medicine and Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Thomas Purcell
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - Mark Hancock
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - Paul Bunn
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - Tyler Robin
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - Arthur Liu
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - Sana Karam
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - Laurie Gaspar
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - Brian Kavanagh
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - Chad Rusthoven
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - Dara Aisner
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert Doebele
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | - D Ross Camidge
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
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21
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Vinogradskiy Y, Rusthoven CG, Schubert L, Jones B, Faught A, Castillo R, Castillo E, Gaspar LE, Kwak J, Waxweiler T, Dougherty M, Gao D, Stevens C, Miften M, Kavanagh B, Guerrero T, Grills I. Interim Analysis of a Two-Institution, Prospective Clinical Trial of 4DCT-Ventilation-based Functional Avoidance Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:1357-1365. [PMID: 30353873 DOI: 10.1016/j.ijrobp.2018.07.186] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/13/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Functional imaging has been proposed that uses 4DCT images to calculate 4DCT-based lung ventilation (4DCT-ventilation). We have started a 2-institution, phase 2 prospective trial evaluating the feasibility, safety, and preliminary efficacy of 4DCT-ventilation functional avoidance. The trial hypothesis is that the rate of grade ≥2 radiation pneumonitis could be reduced to 12% with functional avoidance, compared with a 25% rate of pneumonitis with a historical control. The trial employed a Simon 2-stage design with a planned futility analysis after 17 evaluable patients. The purpose of this work is to present the trial design and implementation, dosimetric data, and clinical results for the planned futility analysis. METHODS AND MATERIALS Eligible patients were patients with lung cancer who were prescribed doses of 45 to 75 Gy. For each patient, the 4DCT data were used to generate a 4DCT-ventilation image using the Hounsfield unit technique along with a compressible flow-based image registration algorithm. Two intensity modulated radiation therapy treatment plans were generated: (1) a standard lung plan and (2) a functional avoidance treatment plan that aimed to reduce dose to functional lung while meeting target and normal tissue constraints. Patients were treated with the functional avoidance plan and evaluated for thoracic toxicity (presented as rate and 95% confidence intervals [CI]) with a 1-year follow-up. RESULTS The V20 to functional lung was 21.6% ± 9.5% (mean ± standard deviation) with functional avoidance, representing a decrease of 3.2% (P < .01) relative to standard, nonfunctional treatment plans. The rates of grade ≥2 and grade ≥3 radiation pneumonitis were 17.6% (95% CI, 3.8%-43.4%) and 5.9% (95% CI, 0.1%-28.7%), respectively. CONCLUSIONS Dosimetrically, functional avoidance achieved reduction in doses to functional lung while meeting target and organ at risk constraints. On the basis of Simon's 2-stage design and the 17.6% grade ≥2 pneumonitis rate, the trial met its futility criteria and has continued accrual.
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Affiliation(s)
- Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Austin Faught
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Richard Castillo
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Laurie E Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer Kwak
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Timothy Waxweiler
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Dexiang Gao
- Department of Pediatrics and Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, Colorado
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
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22
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Jain A, Mohamed A, Kavanagh B, Shah PS, Kuipers BCW, El-Khuffash A, Mertens L, Jankov RP, McNamara PJ. Cardiopulmonary Adaptation During First Day of Life in Human Neonates. J Pediatr 2018; 200:50-57.e2. [PMID: 29803302 DOI: 10.1016/j.jpeds.2018.04.051] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/21/2018] [Accepted: 04/20/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the natural history of cardiopulmonary physiology in the first 24 hours after birth. STUDY DESIGN A prospective observational study of healthy newborns was conducted at a large tertiary perinatal center. Echocardiography was performed at <0.5, 2-3, 7-10, and 22-24 hours of age. Specifically, assessment of pulmonary vascular resistance (PVR) (pulmonary artery acceleration time [PAAT], right ventricular ejection time, right ventricular ejection time:PAAT [PVR index], and PAAT indexed to heart rate [PAATi]), ventricular outputs (right and left), and ventricular function (tricuspid annular planar excursion, right ventricular [RV] fractional area change [FAC], RV/left ventricular [LV] global peak longitudinal strain, and LV ejection fraction) were performed. One-way repeated-measures ANOVA analysis was performed for time-dependent variables. RESULTS In total, 15 neonates (9 males), born at 40 ± 0.8 weeks and 3.5 ± 0.5 kg, respectively, were studied. We observed increased PAATi (P < .05) by 2-3 hours, followed by a subsequent decline in all indices of PVR (PVR index, PAATi, midsystolic notching, and right-to-left ductal flow [P < .0001]). Although right and left ventricular stroke volume increased over the study interval (P < .001), LV output remained stable. All indices of RV function (tricuspid annular planar excursion, RV fractional area change 4-chamber, and RV global peak longitudinal strain-3 chamber [P < .001]) increased during the study interval. CONCLUSION The immediate transition after birth is characterized by lower PVR, reversal of the transductal shunt, and increased biventricular stroke volume. The differential adaptive response of the RV and LV is novel and may relate to loading conditions and patent ductus arteriosus closure.
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Affiliation(s)
- Amish Jain
- Department of Pediatrics, Mount Sinai Hospital, New York, NY; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Adel Mohamed
- Department of Pediatrics, Mount Sinai Hospital, New York, NY; Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian Kavanagh
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada; The Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, New York, NY; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bart C W Kuipers
- Department of Pediatrics, Mount Sinai Hospital, New York, NY; Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Afif El-Khuffash
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, Toronto, Ontario, Canada
| | - Luc Mertens
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Robert P Jankov
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; School of Medicine (Department of Paediatrics), The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrick J McNamara
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada; School of Medicine (Department of Paediatrics), The Royal College of Surgeons in Ireland, Dublin, Ireland
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23
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Westerly DC, Behbahani RA, Kavanagh B, Liu A, Miften M, Serkova NJ, Diot Q. Design considerations for a pulse line ion accelerator (PLIA)-based PET isotope generator. Med Phys 2018; 45:3812-3819. [PMID: 29905959 DOI: 10.1002/mp.13050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/11/2018] [Accepted: 05/30/2018] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Positron emission tomography (PET) imaging remains limited due to the cost associated with on-site production of short half-life, positron-emitting isotopes. In this work, we examine the use of a pulse line ion accelerator (PLIA) to accelerate protons for single-dose PET isotope production. METHODS Time-domain electromagnetic field and particle-in-cell (PIC) simulations were performed for a 1.5-m PLIA structure modeled in CST Microwave Studio and Particle Studio software. Scaled measurements from a kV ramp-pulse generator were incorporated into the simulations to accelerate a 1 A, 50 ns proton beam injected with initial kinetic energy of 100 keV. A uniform, 3 T, solenoidal magnetic field was used to provide external beam focusing. Electromagnetic fields and particle phase space were recorded with ns resolution for subsequent analysis. RESULTS Applying a scaled 100 kV, 20 ns ramped voltage pulse to the PLIA input resulted in a travelling electric field wave inside the structure with accelerating gradient of 2.4 MV/m. The observed wave speed was 1.2 × 107 m/s and is in good agreement with theoretical predictions. Phase space monitors showed both acceleration and bunching of the proton beam, with a maximum kinetic energy of 2.5 MeV, observed at the exit of the single PLIA stage. Evaluation of beam position monitors at different locations in the accelerator showed bunch compression and minimal beam divergence, illustrating that the 3 T field is adequate to contain the beam over the length of the PLIA structure. CONCLUSION Simulations performed in this work demonstrate the feasibility of using a PLIA structure to accelerate protons with MV/m level gradients. Combining several PLIA stages in series could allow for a low-cost accelerator suitable for dose-on-demand PET isotope production.
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Affiliation(s)
- David C Westerly
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Reza A Behbahani
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Natalie J Serkova
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
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24
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Affiliation(s)
- Hossam El Beheiry
- Department of Anesthesia and Pain Management, Toronto Western Hospital, 399 Bathurst St., Rm. 2MC405, M5T 2S8, Toronto, Ontario, Canada.
| | - Brian Kavanagh
- Departments of Anesthesia and Critical Care Medicine, Hospital for Sick Children; and the Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
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25
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Knoll MA, Kavanagh B, Katz M. The 2017 American Society of Radiation Oncology (ASTRO) annual meeting: Taking a deeper dive into social media. Adv Radiat Oncol 2018; 3:230-233. [PMID: 30197934 PMCID: PMC6127968 DOI: 10.1016/j.adro.2018.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Miriam A Knoll
- John Theurer Cancer Center, Memorial Sloan Kettering-Hackensack Meridian Health Partnership, Hackensack, New Jersey
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Boulder, Colorado
| | - Matthew Katz
- Department of Radiation Oncology, Lowell General Hospital, Lowell, Massachusetts
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26
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Alexeev T, Kavanagh B, Miften M, Altunbas C. Two-dimensional antiscatter grid: A novel scatter rejection device for Cone-beam computed tomography. Med Phys 2018; 45:529-534. [PMID: 29235120 DOI: 10.1002/mp.12724] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/08/2017] [Accepted: 12/04/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Scattered radiation remains to be a major cause of image quality degradation in Flat Panel Detector (FPD)-based Cone-beam computed tomography (CBCT). We have been investigating a novel two-dimensional antiscatter grid (2D-ASG) concept to reduce scatter intensity, and hence improve CBCT image quality. We present the first CBCT imaging experiments performed with the 2D-ASG prototype, and demonstrate its efficacy in improving CBCT image quality. METHODS A 2D-ASG prototype with septa focused to x-ray source was additively manufactured from tungsten and mounted on a Varian TrueBeam CBCT system. CBCT projections of phantoms were acquired with an offset detector geometry using TrueBeam's "developer" mode. To minimize the effect of gantry flex, projections were gain corrected on angle-specific bases. CBCT images were reconstructed using a filtered backprojection algorithm and image quality improvement was quantified by measuring contrast-to-noise ratio (CNR) and CT number accuracy in images acquired with no antiscatter grid (NO-ASG), conventional one dimensional antiscatter grid (1D-ASG), and the 2D-ASG prototype. RESULTS A significant improvement in contrast resolution was achieved using our 2D-ASG prototype compared to results of 1D-ASG and NO-ASG acquisitions. Compared to NO-ASG and 1D-ASG experiments, the CNR of material inserts improved by as much as 86% and 54% respectively. Using 2D-ASG, CT number underestimation in water equivalent material section of the phantom was reduced by up to 325 HU when compared to NO-ASG and up to 179 HU when compared to 1D-ASG. CONCLUSION We successfully performed the first CBCT imaging experiments with a 2D-ASG prototype. 2D-ASG provided significantly higher CT number accuracy, higher CNR, and diminished scatter-induced image artifacts in qualitative evaluations. We strongly believe that utilization of a 2D-ASG may potentially lead to better soft tissue visualization in CBCT and may enable novel clinical applications that require high CT number accuracy.
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Affiliation(s)
- Timur Alexeev
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 , Aurora, CO, 80045, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 , Aurora, CO, 80045, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 , Aurora, CO, 80045, USA
| | - Cem Altunbas
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop F-706 , Aurora, CO, 80045, USA
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27
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Miften M, Vinogradskiy Y, Moiseenko V, Grimm J, Yorke E, Jackson A, Tomé WA, Ten Haken RK, Ohri N, Méndez Romero A, Goodman KA, Marks LB, Kavanagh B, Dawson LA. Radiation Dose-Volume Effects for Liver SBRT. Int J Radiat Oncol Biol Phys 2018; 110:196-205. [PMID: 29482870 DOI: 10.1016/j.ijrobp.2017.12.290] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/29/2017] [Indexed: 12/20/2022]
Abstract
Stereotactic body radiation therapy (SBRT) has emerged as an effective, noninvasive treatment option for primary liver cancer and metastatic disease occurring in the liver. Although SBRT can be highly effective for establishing local control in hepatic malignancies, a tradeoff exists between tumor control and normal tissue complications. The objective of the present study was to review the normal tissue dose-volume effects for SBRT-induced liver and gastrointestinal toxicities and derive normal tissue complication probability models.
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Affiliation(s)
- Moyed Miften
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado.
| | | | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Jimm Grimm
- Department of Radiation Oncology and Molecular Radiology Sciences, Baltimore, Maryland
| | - Ellen Yorke
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Jackson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Alejandra Méndez Romero
- Department of Radiation Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Karyn A Goodman
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado
| | - Laura A Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Jaffee EM, Dang CV, Agus DB, Alexander BM, Anderson KC, Ashworth A, Barker AD, Bastani R, Bhatia S, Bluestone JA, Brawley O, Butte AJ, Coit DG, Davidson NE, Davis M, DePinho RA, Diasio RB, Draetta G, Frazier AL, Futreal A, Gambhir SS, Ganz PA, Garraway L, Gerson S, Gupta S, Heath J, Hoffman RI, Hudis C, Hughes-Halbert C, Ibrahim R, Jadvar H, Kavanagh B, Kittles R, Le QT, Lippman SM, Mankoff D, Mardis ER, Mayer DK, McMasters K, Meropol NJ, Mitchell B, Naredi P, Ornish D, Pawlik TM, Peppercorn J, Pomper MG, Raghavan D, Ritchie C, Schwarz SW, Sullivan R, Wahl R, Wolchok JD, Wong SL, Yung A. Future cancer research priorities in the USA: a Lancet Oncology Commission. Lancet Oncol 2017; 18:e653-e706. [PMID: 29208398 PMCID: PMC6178838 DOI: 10.1016/s1470-2045(17)30698-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 12/12/2022]
Abstract
We are in the midst of a technological revolution that is providing new insights into human biology and cancer. In this era of big data, we are amassing large amounts of information that is transforming how we approach cancer treatment and prevention. Enactment of the Cancer Moonshot within the 21st Century Cures Act in the USA arrived at a propitious moment in the advancement of knowledge, providing nearly US$2 billion of funding for cancer research and precision medicine. In 2016, the Blue Ribbon Panel (BRP) set out a roadmap of recommendations designed to exploit new advances in cancer diagnosis, prevention, and treatment. Those recommendations provided a high-level view of how to accelerate the conversion of new scientific discoveries into effective treatments and prevention for cancer. The US National Cancer Institute is already implementing some of those recommendations. As experts in the priority areas identified by the BRP, we bolster those recommendations to implement this important scientific roadmap. In this Commission, we examine the BRP recommendations in greater detail and expand the discussion to include additional priority areas, including surgical oncology, radiation oncology, imaging, health systems and health disparities, regulation and financing, population science, and oncopolicy. We prioritise areas of research in the USA that we believe would accelerate efforts to benefit patients with cancer. Finally, we hope the recommendations in this report will facilitate new international collaborations to further enhance global efforts in cancer control.
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Affiliation(s)
| | - Chi Van Dang
- Ludwig Institute for Cancer Research New York, NY; Wistar Institute, Philadelphia, PA, USA.
| | - David B Agus
- University of Southern California, Beverly Hills, CA, USA
| | - Brian M Alexander
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Alan Ashworth
- University of California San Francisco, San Francisco, CA, USA
| | | | - Roshan Bastani
- Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Sangeeta Bhatia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeffrey A Bluestone
- University of California San Francisco, San Francisco, CA, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | | | - Atul J Butte
- University of California San Francisco, San Francisco, CA, USA
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nancy E Davidson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Mark Davis
- California Institute for Technology, Pasadena, CA, USA
| | | | | | - Giulio Draetta
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Lindsay Frazier
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrew Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Patricia A Ganz
- Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Levi Garraway
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; The Broad Institute, Cambridge, MA, USA; Eli Lilly and Company, Boston, MA, USA
| | | | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Faculty of Medicine and IHPME, University of Toronto, Toronto, Canada
| | - James Heath
- California Institute for Technology, Pasadena, CA, USA
| | - Ruth I Hoffman
- American Childhood Cancer Organization, Beltsville, MD, USA
| | - Cliff Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Chanita Hughes-Halbert
- Medical University of South Carolina and the Hollings Cancer Center, Charleston, SC, USA
| | - Ramy Ibrahim
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Hossein Jadvar
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
| | - Rick Kittles
- College of Medicine, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Scott M Lippman
- University of California San Diego Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - David Mankoff
- Department of Radiology and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elaine R Mardis
- The Institute for Genomic Medicine at Nationwide Children's Hospital Columbus, OH, USA; College of Medicine, Ohio State University, Columbus, OH, USA
| | - Deborah K Mayer
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Kelly McMasters
- The Hiram C Polk Jr MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | | | | | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dean Ornish
- University of California San Francisco, San Francisco, CA, USA
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | | | - Martin G Pomper
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Derek Raghavan
- Levine Cancer Institute, Carolinas HealthCare, Charlotte, NC, USA
| | | | - Sally W Schwarz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Richard Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Jedd D Wolchok
- Ludwig Center for Cancer Immunotherapy, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Sandra L Wong
- Department of Surgery, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alfred Yung
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sheehan J, Suh JH, Kavanagh B, Xu Z, Ren L, Sheehan K, Lunsford LD. Training Neurosurgery and Radiation Oncology Residents in Stereotactic Radiosurgery: Assessment Gathered from Participants in AANS and ASTRO Training Course. World Neurosurg 2017; 109:e669-e675. [PMID: 29061451 DOI: 10.1016/j.wneu.2017.10.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) represents an expanding approach for neurosurgeons and radiation oncologists. We evaluate educational gaps of senior residents drawn from each specialty as part of a focused SRS course. We also evaluate the strengths and limitations of SRS training in current residency programs of the course residents and faculty. METHODS The American Association of Neurological Surgeons and American Society of Radiation Oncology jointly held a senior resident course in SRS. Residents were nominated by program directors from across the United States. Thirty residents were chosen to participate in the course. The residents were surveyed before and after the course. Faculty (n = 14) were also surveyed to ascertain their perspectives on current training in SRS. RESULTS Most (96.7%) of the residents planned to perform SRS when finished, and 94% anticipated SRS indications to expand. Regarding SRS technique, 47% reported average/above average understanding of intracranial SRS; only 17% expressed similar understanding of spinal SRS. Before the course, 76.6% noted below average/average ability to recognize and manage SRS complications. Twenty-three percent of the faculty indicated that graduating residents from their programs were unprepared to perform radiosurgery. Residents' self-assessed understanding of brain SRS indication (P = 0.000693), SRS techniques (P = 0.000021), spinal SRS indications (P = 0.000050), spinal SRS techniques (P = 0.000019), and complication recognition and management (P = 0.00033) significantly improved following the course. CONCLUSIONS Knowledge and training gaps in SRS appear evident to the senior residents and faculty of both specialties. We believe that other educational opportunities for SRS experience are necessary to optimize clinical competency, as well as meet future clinical staffing needs for this expanding, multidisciplinary approach. Further evaluation of gaps in SRS is necessary through a larger, nationwide survey of U.S. neurosurgeons, program directors, and residents.
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Affiliation(s)
- Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
| | - John H Suh
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Denver, Colorado, USA
| | - Zhiyuan Xu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Lydia Ren
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kimball Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - L Dade Lunsford
- Department of Radiation Oncology, University of Colorado, Denver, Colorado, USA; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Yang X, Su LJ, La Rosa FG, Smith EE, Schlaepfer IR, Cho SK, Kavanagh B, Park W, Flaig TW. The Antineoplastic Activity of Photothermal Ablative Therapy with Targeted Gold Nanorods in an Orthotopic Urinary Bladder Cancer Model. Bladder Cancer 2017; 3:201-210. [PMID: 28824948 PMCID: PMC5545915 DOI: 10.3233/blc-170096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gold nanoparticles treated with near infrared (NIR) light can be heated preferentially, allowing for thermal ablation of targeted cells. The use of novel intravesical nanoparticle-directed therapy in conjunction with laser irradiation via a fiber optic cystoscope, represents a potential ablative treatment approach in patients with superficial bladder cancer. OBJECTIVE To examine the thermal ablative effect of epidermal growth factor receptor (EGFR)-directed gold nanorods irradiated with NIR light in an orthotopic urinary bladder cancer model. METHODS Gold nanorods linked to an anti-EGFR antibody (Conjugated gold NanoRods - CNR) were instilled into the bladder cavity of an orthotopic murine xenograft model with T24 bladder cancer cells expressing luciferase. NIR light was externally administered via an 808 nm diode laser. This treatment was repeated weekly for 4 weeks. The anti-cancer effect was monitored by an in vivo imaging system in a non-invasive manner, which was the primary outcome of our study. RESULTS The optimal approach for an individual treatment was 2.1 W/cm2 laser power for 30 seconds. Using this in vivo model, NIR light combined with CNR demonstrated a statistically significant reduction in tumor-associated bioluminescent activity (n = 16) compared to mice treated with laser alone (n = 14) at the end of the study (p = 0.035). Furthermore, the CNR+NIR light treatment significantly abrogated bioluminescence signals over a 6-week observation period, compared to pre-treatment levels (p = 0.045). CONCLUSIONS Photothermal tumor ablation with EGFR-directed gold nanorods and NIR light proved effective and well tolerated in a murine in vivo model of urinary bladder cancer.
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Affiliation(s)
- Xiaoping Yang
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado Cancer Center, Aurora, CO, USA
| | - Lih-Jen Su
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Francisco G La Rosa
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado Cancer Center, Aurora, CO, USA
| | - Elizabeth Erin Smith
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado Cancer Center, Aurora, CO, USA
| | - Isabel R Schlaepfer
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Suehyun K Cho
- Department of Electrical, Computer and Energy Engineering, University of Colorado, Boulder, CO, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Wounjhang Park
- Department of Electrical, Computer and Energy Engineering, University of Colorado, Boulder, CO, USA
| | - Thomas W Flaig
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado Cancer Center, Aurora, CO, USA
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Vinogradskiy Y, Schubert L, Diot Q, Waxweiller T, Koo P, Castillo R, Castillo E, Guerrero T, Rusthoven C, Gaspar L, Kavanagh B, Miften M. Regional Lung Function Profiles of Stage I and III Lung Cancer Patients: An Evaluation for Functional Avoidance Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 95:1273-80. [PMID: 27354134 DOI: 10.1016/j.ijrobp.2016.02.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/17/2016] [Accepted: 02/25/2016] [Indexed: 02/01/2023]
Abstract
PURPOSE The development of clinical trials is underway to use 4-dimensional computed tomography (4DCT) ventilation imaging to preferentially spare functional lung in patients undergoing radiation therapy. The purpose of this work was to generate data to aide with clinical trial design by retrospectively characterizing dosimetric and functional profiles for patients with different stages of lung cancer. METHODS AND MATERIALS A total of 118 lung cancer patients (36% stage I and 64% stage III) from 2 institutions were used for the study. A 4DCT-ventilation map was calculated using the patient's 4DCT imaging, deformable image registration, and a density-change-based algorithm. To assess each patient's spatial ventilation profile both quantitative and qualitative metrics were developed, including an observer-based defect observation and metrics based on the ventilation in each lung third. For each patient we used the clinical doses to calculate functionally weighted mean lung doses and metrics that assessed the interplay between the spatial location of the dose and high-functioning lung. RESULTS Both qualitative and quantitative metrics revealed a significant difference in functional profiles between the 2 stage groups (P<.01). We determined that 65% of stage III and 28% of stage I patients had ventilation defects. Average functionally weighted mean lung dose was 19.6 Gy and 5.4 Gy for stage III and I patients, respectively, with both groups containing patients with large spatial overlap between dose and high-function regions. CONCLUSION Our 118-patient retrospective study found that 65% of stage III patients have regionally variant ventilation profiles that are suitable for functional avoidance. Our results suggest that regardless of disease stage, it is possible to have unique spatial interplay between dose and high-functional lung, highlighting the importance of evaluating the function of each patient and developing a personalized functional avoidance treatment approach.
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Affiliation(s)
- Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Timothy Waxweiller
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Phillip Koo
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard Castillo
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, Texas
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Laurie Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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Altunbas C, Kavanagh B, Alexeev T, Miften M. Transmission characteristics of a two dimensional antiscatter grid prototype for CBCT. Med Phys 2017; 44:3952-3964. [PMID: 28513847 DOI: 10.1002/mp.12346] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/13/2017] [Accepted: 05/03/2017] [Indexed: 12/13/2022] Open
Abstract
AIM High fraction of scattered radiation in cone-beam CT (CBCT) imaging degrades CT number accuracy and visualization of low contrast objects. To suppress scatter in CBCT projections, we developed a focused, two-dimensional antiscatter grid (2DASG) prototype. In this work, we report on the primary and scatter transmission characteristics of the 2DASG prototype aimed for linac mounted, offset detector geometry CBCT systems in radiation therapy, and compared its performance to a conventional one-dimensional ASG (1DASG). METHODS The 2DASG is an array of through-holes separated by 0.1 mm septa that was fabricated from tungsten using additive manufacturing techniques. Through-holes' focusing geometry was designed for offset detector CBCT in Varian TrueBeam system. Two types of ASGs were evaluated: (a) a conventional 1DASG with a grid ratio of 10, (b) the 2DASG prototype with a grid ratio of 8.2. To assess the scatter suppression performance of both ASGs, Scatter-to-primary ratio (SPR) and scatter transmission fraction (Ts) were measured using the beam stop method. Scatter and primary intensities were modulated by varying the phantom thickness between 10 and 40 cm. Additionally, the effect of air gap and bow tie (BT) filter on SPR and Ts were evaluated. Average primary transmission fraction (TP ) and pixel specific primary transmission were also measured for both ASGs. To assess the effect of transmission characteristics on projection image signal-to-noise ratio (SNR), SNR improvement factor was calculated. Improvement in contrast to noise ratio (CNR) was demonstrated using a low contrast object. RESULTS In comparison to 1DASG, 2DASG reduced SPRs by a factor of 3 to 6 across the range of phantom setups investigated. Ts values for 1D and 2DASGs were in the range of 21 to 29%, and 5 to 14% respectively. 2DASG continued to provide lower SPR and Ts at increased air gap and with BT filter. Tp of 1D and 2DASGs were 70.6% and 84.7% respectively. Due to the septal shadow of the 2DASG, its pixel specific primary transmission values varied between 32.5% and 99.1%. With respect to 1DASG, 2DASG provided up to factor of 1.7 more improvement in SNR across the SPR range investigated. Moreover, 2DASG provided improved visualization of low contrast objects with respect to 1DASG and NOASG setups. CONCLUSIONS When compared to a conventional 1DASG, 2DASG prototype provided noticeably lower SPR and Ts values, indicating its superior scatter suppression performance. 2DASG also provided 19% higher average primary transmission that was attributed to the absence of interseptal spacers and optimized grid geometry. Our results indicate that the combined effect of lower scatter and higher primary transmission provided by 2DASG may potentially translate into more accurate CT numbers and improved contrast resolution in CBCT images.
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Affiliation(s)
- Cem Altunbas
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop, F-706, Aurora, CO, 80045, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop, F-706, Aurora, CO, 80045, USA
| | - Timur Alexeev
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop, F-706, Aurora, CO, 80045, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Suite 1032, Mail stop, F-706, Aurora, CO, 80045, USA
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Waxweiler T, Schubert L, Diot Q, Faught A, Stuhr K, Castillo R, Castillo E, Guerrero T, Rusthoven C, Gaspar L, Kavanagh B, Miften M, Vinogradskiy Y. A complete 4DCT-ventilation functional avoidance virtual trial: Developing strategies for prospective clinical trials. J Appl Clin Med Phys 2017; 18:144-152. [PMID: 28436107 PMCID: PMC5689844 DOI: 10.1002/acm2.12086] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/30/2017] [Accepted: 03/08/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction 4DCT‐ventilation is an exciting new imaging modality that uses 4DCT data to calculate lung‐function maps. Because 4DCTs are acquired as standard of care for lung cancer patients undergoing radiotherapy, 4DCT‐ventiltation provides functional information at no extra dosimetric or monetary cost to the patient. The development of clinical trials is underway to use 4DCT‐ventilation imaging to spare functional lung in patients undergoing radiotherapy. The purpose of this work was to perform a virtual trial using retrospective data to develop the practical aspects of a 4DCT‐ventilation functional avoidance clinical trial. Methods The study included 96 stage III lung cancer patients. A 4DCT‐ventilation map was calculated using the patient's 4DCT‐imaging, deformable registration, and a density‐change‐based algorithm. Clinical trial inclusion assessment used quantitative and qualitative metrics based on the patient's spatial ventilation profile. Clinical and functional plans were generated for 25 patients. The functional plan aimed to reduce dose to functional lung while meeting standard target and critical structure constraints. Standard and dose‐function metrics were compared between the clinical and functional plans. Results Our data showed that 69% and 59% of stage III patients have regional variability in function based on qualitative and quantitative metrics, respectively. Functional planning demonstrated an average reduction of 2.8 Gy (maximum 8.2 Gy) in the mean dose to functional lung. Conclusions Our work demonstrated that 60–70% of stage III patients would be eligible for functional planning and that a typical functional lung mean dose reduction of 2.8 Gy can be expected relative to standard clinical plans. These findings provide salient data for the development of functional clinical trials.
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Affiliation(s)
- Timothy Waxweiler
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Austin Faught
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kelly Stuhr
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard Castillo
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laurie Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
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Vinogradskiy Y, Jackson M, Schubert L, Jones B, Castillo R, Castillo E, Guerrero T, Mitchell J, Rusthoven C, Miften M, Kavanagh B. Assessing the use of 4DCT-ventilation in pre-operative surgical lung cancer evaluation. Med Phys 2017; 44:200-208. [PMID: 28102961 DOI: 10.1002/mp.12026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/03/2016] [Accepted: 11/13/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE A primary treatment option for lung cancer patients is surgical resection. Patients who have poor lung function prior to surgery are at increased risk of developing serious and life-threatening complications after surgical resection. Surgeons use nuclear medicine ventilation-perfusion (VQ) scans along with pulmonary function test (PFT) information to assess a patient's pre-surgical lung function. The nuclear medicine images and pre-surgery PFTs are used to calculate percent predicted postoperative (%PPO) PFT values by estimating the amount of functioning lung tissue that would be lost with surgical resection. Nuclear medicine imaging is currently considered the standard of care when evaluating the amount of ventilation that would be lost due to surgery. A novel lung function imaging modality has been developed in radiation oncology that uses 4-Dimensional computed tomography data to calculate ventilation maps (4DCT-ventilation). Compared to nuclear medicine, 4DCT-ventilation is cheaper, does not require a radioactive contrast agent, provides a faster imaging procedure, and has improved spatial resolution. In this work we perform a retrospective study to assess the use of 4DCT-ventilation as a pre-operative surgical lung function evaluation tool. Specifically, the purpose of our study was to compare %PPO PFT values calculated with 4DCT-ventilation and %PPO PFT values calculated with nuclear medicine ventilation-perfusion imaging. METHODS The study included 16 lung cancer patients that had undergone 4DCT imaging, nuclear medicine imaging, and had Forced Expiratory Volume in 1 second (FEV1 ) acquired as part of a standard PFT. The 4DCT datasets, spatial registration, and a density-change-based model were used to compute 4DCT-ventilation maps. Both 4DCT-ventilation and nuclear medicine images were used to calculate %PPO FEV1 . The %PPO FEV1 was calculated by scaling the pre-surgical FEV1 by (1-fraction of total resected ventilation); where the resected ventilation was determined using either the 4DCT-ventilation or nuclear medicine imaging. Calculations were done assuming both lobectomy and pneumonectomy resections. The %PPO FEV1 values were compared between the 4DCT-ventilation-based calculations and the nuclear medicine-based calculations using correlation coefficients, average differences, and Receiver Operating Characteristic (ROC) analysis. RESULTS Overall the 4DCT-ventilation derived %PPO FEV1 values agreed well with nuclear medicine-derived %PPO FEV1 data with correlations of 0.99 and 0.81 for lobectomy and pneumonectomy, respectively. The average differences between the 4DCT-ventilation and nuclear medicine-based calculation for %PPO FEV1 were less than 5%. ROC analysis revealed predictive accuracy that ranged from 87.5% to 100% when assessing the ability of 4DCT-ventilation to predict for nuclear medicine-based %PPO FEV1 values. CONCLUSIONS 4DCT-ventilation is an innovative technology developed in radiation oncology that has great potential to translate to the surgical domain. The high correlation results when comparing 4DCT-ventilation to the current standard of care provide a strong rationale for a prospective clinical trial assessing 4DCT-ventilation in the clinical setting. 4DCT-ventilation can reduce the cost and imaging time for patients while providing improved spatial accuracy and quantitative results for surgeons.
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Affiliation(s)
- Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Matthew Jackson
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Bernard Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Richard Castillo
- Department of Radiation Oncology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - John Mitchell
- Department of Surgery, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
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Diot Q, Kavanagh B, Vinogradskiy Y, Garg K, Gaspar L, Miften M. Lung deformations and radiation-induced regional lung collapse in patients treated with stereotactic body radiation therapy. Med Phys 2016; 42:6477-87. [PMID: 26520737 DOI: 10.1118/1.4932624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To differentiate radiation-induced fibrosis from regional lung collapse outside of the high dose region in patients treated with stereotactic body radiation therapy (SBRT) for lung tumors. METHODS Lung deformation maps were computed from pre-treatment and post-treatment computed tomography (CT) scans using a point-to-point translation method. Fifty anatomical landmarks inside the lung (vessel or airway branches) were matched on planning and follow-up scans for the computation process. Two methods using the deformation maps were developed to differentiate regional lung collapse from fibrosis: vector field and Jacobian methods. A total of 40 planning and follow-ups CT scans were analyzed for 20 lung SBRT patients. RESULTS Regional lung collapse was detected in 15 patients (75%) using the vector field method, in ten patients (50%) using the Jacobian method, and in 12 patients (60%) by radiologists. In terms of sensitivity and specificity the Jacobian method performed better. Only weak correlations were observed between the dose to the proximal airways and the occurrence of regional lung collapse. CONCLUSIONS The authors presented and evaluated two novel methods using anatomical lung deformations to investigate lung collapse and fibrosis caused by SBRT treatment. Differentiation of these distinct physiological mechanisms beyond what is usually labeled "fibrosis" is necessary for accurate modeling of lung SBRT-induced injuries. With the help of better models, it becomes possible to expand the therapeutic benefits of SBRT to a larger population of lung patients with large or centrally located tumors that were previously considered ineligible.
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Affiliation(s)
- Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Kavita Garg
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Laurie Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045
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Kim DN, Straka C, Cho LC, Lotan Y, Yan J, Kavanagh B, Raben D, Cooley S, Brindle J, Xie XJ, Pistenmaa D, Timmerman R. Early and multiple PSA bounces can occur following high-dose prostate stereotactic body radiation therapy: Subset analysis of a phase 1/2 trial. Pract Radiat Oncol 2016; 7:e43-e49. [PMID: 27637137 DOI: 10.1016/j.prro.2016.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE We hypothesized that high-dose stereotactic body radiation therapy (SBRT) would lead to faster time to nadir and lower nadir values compared with conventional radiation therapy experiences. We now report prostate-specific antigen (PSA) kinetics following high-dose SBRT in patients treated with radiation alone. METHODS AND MATERIALS Ninety-one patients were enrolled on the phase 1/2 dose escalation study of SBRT for localized prostate cancer. All patients with at least 36 months of follow-up and without hormone therapy were included in this analysis (n = 47). Treatment response parameters evaluated include time to nadir, nadir value, occurrence of PSA bounces (rise of ≥0.2 ng/mL followed by a subsequent fall), magnitude of bounces, duration of bounces, and correlation of bounces with clinical outcomes. RESULTS Median follow-up was 42 months (range, 36-78 months). Treatment dose levels were 45 Gy (n = 10), 47.5 Gy (n = 8), and 50 Gy (n = 29) in 5 fractions. Biochemical control rate was 98%. Median PSA at follow-up was 0.10 ± 0.20 ng/mL. Median time to nadir was 36 ± 11 months. A total of 24/47 (51.1%) patients had ≥1 PSA bounce. Median magnitude of PSA rise during bounce was 0.50 ± 1.2 ng/mL. Median time to first bounce was 9 ± 7.0 months. Median bounce duration was 3 ± 2.3 months for the first bounce and 6 ± 5.2 months for subsequent bounces. Prostate volumes <30 mL were associated with a decreased likelihood of bounce (P = .0202), and increasing prostate volume correlated with increasingly likelihood of having ≥2 bounces (P = .027). Patients reaching PSA nadir of ≤0.1 ng/mL were less likely to experience any bounce (P = .0044). CONCLUSIONS Compared with other SBRT experiences, our study demonstrated a higher PSA bounce rate, a similar or shorter median time to bounce, and a very low nadir. Prostate volume appears correlated with bounce.
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Affiliation(s)
| | | | | | - Yair Lotan
- University of Texas Southwestern, Dallas, Texas
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Vinogradskiy Y, Jackson M, Schubert L, Jones B, Castillo R, Castillo E, Guerrero T, Mitchell J, Kavanagh B, Miften M. WE-AB-BRA-06: 4DCT-Ventilation: A Novel Imaging Modality for Thoracic Surgical Evaluation. Med Phys 2016. [DOI: 10.1118/1.4957735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Altunbas C, Kavanagh B, Miften M. WE-AB-207A-10: Transmission Characteristics of a Two Dimensional Antiscatter Grid Prototype for CBCT. Med Phys 2016. [DOI: 10.1118/1.4957763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Jones B, Campbell W, Stumpf P, Amini A, Schefter T, Kavanagh B, Goodman K, Miften M. Patient-specific motion management and adaptive respiratory gating in Pancreatic SBRT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31576-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Miften M, Vinogradskiy Y, Moiseenko V, Grimm J, Yorke E, Jackson A, Tomé W, Ten Haken R, Ohri N, Romero A, Goodman K, Marks L, Kavanagh B, Dawson L. OC-0097: Radiation dose-volume effects for liver SBRT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Mohler A, Ney D, Gaspar L, Damek D, Kavanagh B, Reddy K, Chen C. QOL-16HEALTH-RELATED QUALITY OF LIFE (HRQoL) IN A PHASE II TRIAL OF HYPOFRACTIONATED INTENSITY-MODULATED RADIATION THERAPY (HYPO-IMRT) WITH TEMOZOLOMIDE (TMZ) AND BEVACIZUMAB (BEV) FOR PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA MULTIFORME (GBM). Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov230.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carlson JA, Nooruddin Z, Rusthoven C, Elias A, Borges VF, Diamond JR, Kavanagh B, Kabos P. Trastuzumab emtansine and stereotactic radiosurgery: an unexpected increase in clinically significant brain edema. Neuro Oncol 2015; 16:1006-9. [PMID: 24497407 DOI: 10.1093/neuonc/not329] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In the last 10 years, multiple new targeted agents have been developed for patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Up to 55% of patients with HER2+ breast cancer will develop brain metastases requiring some form of radiation therapy. The interaction between radiation and these targeted agents is unknown and previously unreported. METHODS In this series, we describe 4 patients who developed clinically significant brain edema at sites of treated brain metastases. These patients were treated with stereotactic radiosurgery and trastuzumab emtansine, the newest FDA-approved agent for metastatic HER2+ breast cancer. Additionally, we present rates of clinically significant radiation necrosis among all breast cancer patients treated during this same time period. RESULTS Using previously published clinical and preclinical data, we then hypothesize possible mechanisms for this striking interaction. CONCLUSION Increased awareness of potential interactions between targeted agents and radiation to the brain is crucial.
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Hahn C, Kavanagh B, Bhatnagar A, Jacobson G, Lutz S, Patton C, Potters L, Steinberg M. Choosing wisely: the American Society for Radiation Oncology's top 5 list. Pract Radiat Oncol 2015; 4:349-55. [PMID: 25407853 DOI: 10.1016/j.prro.2014.06.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 06/10/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE To highlight 5 interventions that patients should question, as part of the Choosing Wisely campaign. This initiative, led by the American Board of Internal Medicine Foundation, fosters conversations between physicians and patients about treatments and tests that may be overused, unnecessary, or potentially harmful. METHODS AND MATERIALS Potential items were initially compiled using an online survey. They were then evaluated and refined by a work group representing the American Society for Radiation Oncology (ASTRO) Clinical Affairs and Quality, Health Policy, and Government Relations Councils. Literature reviews were carried out to support the recommendation and narrative, as well as to provide references for each item. A final list of 5 items was then selected by the ASTRO Board of Directors. RESULTS ASTRO's 5 recommendations for the Choosing Wisely campaign are the following: (1) Don't initiate whole-breast radiation therapy as a part of breast conservation therapy in women age ≥50 with early-stage invasive breast cancer without considering shorter treatment schedules; (2) don't initiate management of low-risk prostate cancer without discussing active surveillance; (3) don't routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases; (4) don't routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry; and (5) don't routinely use intensity modulated radiation therapy to deliver whole-breast radiation therapy as part of breast conservation therapy. CONCLUSIONS The ASTRO list for the Choosing Wisely campaign highlights radiation oncology interventions that should be discussed between physicians and patients before treatment is initiated. These 5 items provide opportunities to offer higher quality and less costly care.
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Affiliation(s)
- Carol Hahn
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - Ajay Bhatnagar
- Cancer Treatment Services Arizona, Affiliate of 21st Century Oncology, Casa Grande, Arizona
| | - Geraldine Jacobson
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Stephen Lutz
- Blanchard Valley Regional Cancer Center, Findlay, Ohio
| | | | - Louis Potters
- Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, New York
| | - Michael Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Health System, Los Angeles, California
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Chetty IJ, Martel MK, Jaffray DA, Benedict SH, Hahn SM, Berbeco R, Deye J, Jeraj R, Kavanagh B, Krishnan S, Lee N, Low DA, Mankoff D, Marks LB, Ollendorf D, Paganetti H, Ross B, Siochi RAC, Timmerman RD, Wong JW. Technology for Innovation in Radiation Oncology. Int J Radiat Oncol Biol Phys 2015; 93:485-92. [PMID: 26460989 DOI: 10.1016/j.ijrobp.2015.07.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 01/18/2023]
Abstract
Radiation therapy is an effective, personalized cancer treatment that has benefited from technological advances associated with the growing ability to identify and target tumors with accuracy and precision. Given that these advances have played a central role in the success of radiation therapy as a major component of comprehensive cancer care, the American Society for Radiation Oncology (ASTRO), the American Association of Physicists in Medicine (AAPM), and the National Cancer Institute (NCI) sponsored a workshop entitled "Technology for Innovation in Radiation Oncology," which took place at the National Institutes of Health (NIH) in Bethesda, Maryland, on June 13 and 14, 2013. The purpose of this workshop was to discuss emerging technology for the field and to recognize areas for greater research investment. Expert clinicians and scientists discussed innovative technology in radiation oncology, in particular as to how these technologies are being developed and translated to clinical practice in the face of current and future challenges and opportunities. Technologies encompassed topics in functional imaging, treatment devices, nanotechnology, and information technology. The technical, quality, and safety performance of these technologies were also considered. A major theme of the workshop was the growing importance of innovation in the domain of process automation and oncology informatics. The technologically advanced nature of radiation therapy treatments predisposes radiation oncology research teams to take on informatics research initiatives. In addition, the discussion on technology development was balanced with a parallel conversation regarding the need for evidence of efficacy and effectiveness. The linkage between the need for evidence and the efforts in informatics research was clearly identified as synergistic.
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Affiliation(s)
- Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan
| | - Mary K Martel
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - David A Jaffray
- Departments of Radiation Oncology and Medical Biophysics, Princess Margaret Hospital, Toronto, Ontario
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California - Davis Cancer Center, Sacramento, California
| | - Stephen M Hahn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ross Berbeco
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - James Deye
- Radiation Research Programs, National Cancer Institute, Bethesda, Maryland
| | - Robert Jeraj
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Sunil Krishnan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel A Low
- Department of Radiation Oncology, University of California - Los Angeles, Los Angeles, California
| | - David Mankoff
- Department of Radiology, University of Washington Medical School, Seattle, Washington
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Daniel Ollendorf
- Institute for Clinical and Economic Review, Boston, Massachusetts
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Proton Therapy Center, Boston, Massachusetts
| | - Brian Ross
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | | | - Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical School, Dallas, Texas
| | - John W Wong
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
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Vinogradskiy Y, Waxweiler T, Diot Q, Castillo R, Guerrero T, Castillo E, Kavanagh B, Schubert L, Miften M. SU-C-BRA-06: Developing Clinical and Quantitative Guidelines for a 4DCT-Ventilation Functional Avoidance Clinical Trial. Med Phys 2015. [DOI: 10.1118/1.4923816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Altunbas C, Kavanagh B, Miften M. TH-EF-BRB-06: A Method to Synthesize Hybrid KV/MV Projections for Metal Artifact Corrections in CBCT. Med Phys 2015. [DOI: 10.1118/1.4926304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Jones BL, Schefter T, Kavanagh B, Miften M. TH-AB-303-08: Dealing with Erratic Motion: Respiratory Gating Using Internal Surrogates in Pancreatic SBRT. Med Phys 2015. [DOI: 10.1118/1.4926163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Miften M, Vinogradskiy Y, Kavanagh B, Diot Q. OC-0316: Normal lung tissue reaction to stereotactic body radiation therapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bourlon M, Amini A, Kavanagh B, Flaig T. Pancreatic Metastases From Renal Cell Carcinoma Treated With Stereotactic Body Radiation Therapy. Oncology 2014. [DOI: 10.46883/onc.2014.2811.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ney D, Kleinschmidt-DeMasters BK, Carlson J, Damek D, Gaspar L, Kavanagh B, Waziri A, Lillehei K, Reddy K, Chen C. RT-24 * EXTENT OF CEREBRAL RADIONECROSIS IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (GBM) TREATED ON A CLINICAL TRIAL WITH HYPOFRACTIONATED INTENSITY-MODULATED RADIATION THERAPY (HYPO-IMRT) COMBINED WITH TEMOZOLOMIDE (TMZ) AND BEVACIZUMAB (BEV). Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou270.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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