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Sample records for invasive image-guided transcortical

  1. A Case of Ruptured Peripheral Aneurysm of the Anterior Inferior Cerebellar Artery Associated with an Arteriovenous Malformation : A Less Invasive Image-Guided Transcortical Approach

    Science.gov (United States)

    Lee, Seung Hwan; Bang, Jae Seung; Kim, Gook Ki

    2009-01-01

    A 47-year-old man presented with a subarachnoid hemorrhage (SAH) and right cerebellar hematoma was referred for evaluation. Cerebral angiography revealed a distal anterior inferior cerebellar artery (AICA) aneurysm associated with an arteriovenous malformation (AVM). Successful obliteration and complete removal of the aneurysm and AVM were obtained using transcortical approach under the guidance of neuronavigation system. The association of a peripheral AICA aneurysm and a cerebellar AVM by the same artery is unique. The reported cases of conventional surgery for this disease complex are not common and their results are variable. Less invasive surgery using image-guided neuronavigation system would be helpful and feasible for a peripheral aneurysm combining an AVM of the posterior fossa in selective cases. PMID:20062576

  2. Procedures minimally invasive image-guided

    International Nuclear Information System (INIS)

    Mora Guevara, Alejandro

    2011-01-01

    A literature review focused on minimally invasive procedures, has been performed at the Department of Radiology at the Hospital Calderon Guardia. A multidisciplinary team has been raised for decision making. The materials, possible complications and the available imaging technique such as ultrasound, computed tomography, magnetic resonance imaging, have been determined according to the procedure to be performed. The revision has supported medical interventions didactically enjoying the best materials, resources and conditions for a successful implementation of procedures and results [es

  3. Nonsurgical, image-guided, minimally invasive therapy for thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Hegedüs, Laszlo; Pacella, Claudio Maurizio

    2013-01-01

    Context: Nodular thyroid disease is very common. Most nodules are asymptomatic, are benign by fine-needle aspiration, remain stable, and can be followed by observation alone in the majority of the patients. Occasionally, nodules grow or cause symptoms requiring treatment. So far, surgery has been...... our main option for treatment. Objective: In this review, we discuss nonsurgical, minimally invasive approaches for small thyroid masses, including indications, efficacy, side effects, and costs. Evidence Acquisition: We selected recent publications related to minimally invasive thyroid techniques...... therapy is recommended for recurrent benign thyroid cysts. Either ultrasound-guided laser or radiofrequency ablation can be used for symptomatic solid nodules with normal or abnormal thyroid function. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical...

  4. Gamma Imaging-Guided Minimally Invasive Breast Biopsy: Initial Clinical Experience.

    Science.gov (United States)

    Brem, Rachel F; Mehta, Anita K; Rapelyea, Jocelyn A; Akin, Esma A; Bazoberry, Adriana M; Velasco, Christel D

    2018-03-01

    The purpose of this study was to evaluate our initial experience with gamma imaging-guided vacuum-assisted breast biopsy in women with abnormal findings. A retrospective review of patients undergoing breast-specific gamma imaging (BSGI), also known as molecular breast imaging (MBI), between April 2011 and October 2015 found 117 nonpalpable mammographically and sonographically occult lesions for which gamma imaging-guided biopsies were recommended. Biopsy was performed with a 9-gauge vacuum-assisted device with subsequent placement of a titanium biopsy site marker. Medical records and pathologic findings were evaluated. Of the 117 biopsies recommended, 104 were successful and 13 were canceled. Of the 104 performed biopsies, 32 (30.8%) had abnormal pathologic findings. Of those 32 biopsies, nine (28.1%) found invasive cancers, six (18.8%) found ductal carcinoma in situ (DCIS), and 17 (53.1%) found high-risk lesions. Of the 17 high-risk lesions, there were three (17.6%) lobular carcinomas in situ, five (29.4%) atypical ductal hyperplasias, two (11.8%) atypical lobular hyperplasias, one (5.9%) flat epithelial atypia, and six (35.3%) papillomas. Two cases of atypical ductal hyperplasia were upgraded to DCIS at surgery. The overall cancer detection rate for gamma imaging-guided biopsy was 16.3%. In this study, gamma imaging-guided biopsy had a positive predictive value of total successful biopsies of 16.3% for cancer and 30.8% for cancer and high-risk lesions. Gamma imaging-guided biopsy is a viable approach to sampling BSGI-MBI-detected lesions without sonographic or mammographic correlate. Our results compare favorably to those reported for MRI-guided biopsy.

  5. New real-time MR image-guided surgical robotic system for minimally invasive precision surgery

    International Nuclear Information System (INIS)

    Hashizume, M.; Yasunaga, T.; Konishi, K.; Tanoue, K.; Ieiri, S.; Kishi, K.; Nakamoto, H.; Ikeda, D.; Sakuma, I.; Fujie, M.; Dohi, T.

    2008-01-01

    To investigate the usefulness of a newly developed magnetic resonance (MR) image-guided surgical robotic system for minimally invasive laparoscopic surgery. The system consists of MR image guidance [interactive scan control (ISC) imaging, three-dimensional (3-D) navigation, and preoperative planning], an MR-compatible operating table, and an MR-compatible master-slave surgical manipulator that can enter the MR gantry. Using this system, we performed in vivo experiments with MR image-guided laparoscopic puncture on three pigs. We used a mimic tumor made of agarose gel and with a diameter of approximately 2 cm. All procedures were successfully performed. The operator only advanced the probe along the guidance device of the manipulator, which was adjusted on the basis of the preoperative plan, and punctured the target while maintaining the operative field using robotic forceps. The position of the probe was monitored continuously with 3-D navigation and 2-D ISC images, as well as the MR-compatible laparoscope. The ISC image was updated every 4 s; no artifact was detected. A newly developed MR image-guided surgical robotic system is feasible for an operator to perform safe and precise minimally invasive procedures. (orig.)

  6. Quality assurance of multiport image-guided minimally invasive surgery at the lateral skull base.

    Science.gov (United States)

    Nau-Hermes, Maria; Schmitt, Robert; Becker, Meike; El-Hakimi, Wissam; Hansen, Stefan; Klenzner, Thomas; Schipper, Jörg

    2014-01-01

    For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG), which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes.

  7. Quality Assurance of Multiport Image-Guided Minimally Invasive Surgery at the Lateral Skull Base

    Directory of Open Access Journals (Sweden)

    Maria Nau-Hermes

    2014-01-01

    Full Text Available For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG, which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes.

  8. Image-guided therapy and minimally invasive surgery in children: a merging future

    International Nuclear Information System (INIS)

    Shlomovitz, Eran; Amaral, Joao G.; Chait, Peter G.

    2006-01-01

    Minimally invasive image-guided therapy for children, also known as pediatric interventional radiology (PIR), is a new and exciting field of medicine. Two key elements that helped the rapid evolution and dissemination of this specialty were the creation of devices appropriate for the pediatric population and the development of more cost-effective and minimally invasive techniques. Despite its clear advantages to children, many questions are raised regarding who should be performing these procedures. Unfortunately, this is a gray zone with no clear answer. Surgeons fear that interventional radiologists will take over additional aspects of the surgical/procedural spectrum. Interventional radiologists, on the other hand, struggle to avoid becoming highly specialized technicians rather than physicians who are responsible for complete care of their patients. In this article, we briefly discuss some of the current aspects of minimally invasive image-guided therapy in children and innovations that are expected to be incorporated into clinical practice in the near future. Then, we approach the current interspecialty battles over the control of this field and suggest some solutions to these issues. Finally, we propose the development of a generation of physicians with both surgical and imaging skills. (orig.)

  9. Technology improvements for image-guided and minimally invasive spine procedures.

    Science.gov (United States)

    Cleary, Kevin; Clifford, Mark; Stoianovici, Dan; Freedman, Matthew; Mun, Seong K; Watson, Vance

    2002-12-01

    This paper reports on technology developments aimed at improving the state of the art for image-guided minimally invasive spine procedures. Back pain is a major health problem with serious economic consequences. Minimally invasive procedures to treat back pain are rapidly growing in popularity due to improvements in technique and the substantially reduced trauma to the patient versus open spinal surgery. Image guidance is an enabling technology for minimally invasive procedures, but technical problems remain that may limit the wider applicability of these techniques. The paper begins with a discussion of low back pain and the potential shortcomings of open back surgery. The advantages of minimally invasive procedures are enumerated, followed by a list of technical problems that must be overcome to enable the more widespread dissemination of these techniques. The technical problems include improved intraoperative imaging, fusion of images from multiple modalities, the visualization of oblique paths, percutaneous spine tracking, mechanical instrument guidance, and software architectures for technology integration. Technical developments to address some of these problems are discussed next. The discussion includes intraoperative computerized tomography (CT) imaging, magnetic resonance imaging (MRI)/CT image registration, three-dimensional (3-D) visualization, optical localization, and robotics for percutaneous instrument placement. Finally, the paper concludes by presenting several representative clinical applications: biopsy, vertebroplasty, nerve and facet blocks, and shunt placement. The program presented here is a first step to developing the physician-assist systems of the future, which will incorporate visualization, tracking, and robotics to enable the precision placement and manipulation of instruments with minimal trauma to the patient.

  10. Image-guided ultrasound phased arrays are a disruptive technology for non-invasive therapy

    Science.gov (United States)

    Hynynen, Kullervo; Jones, Ryan M.

    2016-01-01

    Focused ultrasound offers a non-invasive way of depositing acoustic energy deep into the body, which can be harnessed for a broad spectrum of therapeutic purposes, including tissue ablation, the targeting of therapeutic agents, and stem cell delivery. Phased array transducers enable electronic control over the beam geometry and direction, and can be tailored to provide optimal energy deposition patterns for a given therapeutic application. Their use in combination with modern medical imaging for therapy guidance allows precise targeting, online monitoring, and post-treatment evaluation of the ultrasound-mediated bioeffects. In the past there have been some technical obstacles hindering the construction of large aperture, high-power, densely-populated phased arrays and, as a result, they have not been fully exploited for therapy delivery to date. However, recent research has made the construction of such arrays feasible, and it is expected that their continued development will both greatly improve the safety and efficacy of existing ultrasound therapies as well as enable treatments that are not currently possible with existing technology. This review will summarize the basic principles, current statures, and future potential of image-guided ultrasound phased arrays for therapy. PMID:27494561

  11. Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer

    International Nuclear Information System (INIS)

    Whalley, D.; Caine, H.; McCloud, P.; Guo, L.; Kneebone, A.; Eade, T.

    2015-01-01

    To describe the feasibility of image guided intensity modulated radiotherapy (IG-IMRT) using daily soft tissue matching in the treatment of bladder cancer. Twenty-eight patients with muscle-invasive carcinoma of the bladder were recruited to a protocol of definitive radiation using IMRT with accelerated hypofractionation with simultaneous integrated boost (SIB). Isotropic margins of .5 and 1 cm were used to generate the high risk and intermediate risk planning target volumes respectively. Cone beam CT (CBCT) was acquired daily and a soft tissue match was performed. Cystoscopy was scheduled 6 weeks post treatment. The median age was 83 years (range 58-92). Twenty patients had stage II or III disease, and eight were stage IV. Gross disease received 66 Gy in 30 fractions in 11 patients (ten with concurrent chemotherapy) or 55 Gy in 20 fractions for those of poorer performance status or with palliative intent. All patients completed radiation treatment as planned. Three patients ceased chemotherapy early due to toxicity. Six patients (21 %) had acute Grade ≥ 2 genitourinary (GU) toxicity and six (21 %) had acute Grade ≥ 2 gastrointestinal (GI) toxicity. Five patients (18 %) developed Grade ≥2 late GU toxicity and no ≥2 late GI toxicity was observed. Nineteen patients underwent cystoscopy following radiation, with complete response (CR) in 16 cases (86 %), including all patients treated with chemoradiotherapy. Eight patients relapsed, four of which were local relapses. Of the patients with local recurrence, one underwent salvage cystectomy. For patients treated with definitive intent, freedom from locoregional recurrence (FFLR) and overall survival (OS) was 90 %/100 % for chemoradiotherapy versus 86 %/69 % for radiotherapy alone. IG- IMRT using daily soft tissue matching is a feasible in the treatment of bladder cancer, enabling the delivery of accelerated synchronous integrated boost with good early local control outcomes and low toxicity

  12. Validation of minimally invasive, image-guided cochlear implantation using Advanced Bionics, Cochlear, and Medel electrodes in a cadaver model.

    Science.gov (United States)

    McRackan, Theodore R; Balachandran, Ramya; Blachon, Grégoire S; Mitchell, Jason E; Noble, Jack H; Wright, Charles G; Fitzpatrick, J Michael; Dawant, Benoit M; Labadie, Robert F

    2013-11-01

    Validation of a novel minimally invasive, image-guided approach to implant electrodes from three FDA-approved manufacturers-Medel, Cochlear, and Advanced Bionics-in the cochlea via a linear tunnel from the lateral cranium through the facial recess to the cochlea. Custom microstereotactic frames that mount on bone-implanted fiducial markers and constrain the drill along the desired path were utilized on seven cadaver specimens. A linear tunnel was drilled from the lateral skull to the cochlea followed by a marginal, round window cochleostomy and insertion of the electrode array into the cochlea through the drilled tunnel. Post-insertion CT scan and histological analysis were used to analyze the results. All specimens ([Formula: see text]) were successfully implanted without visible injury to the facial nerve. The Medel electrodes ([Formula: see text]) had minimal intracochlear trauma with 8, 8, and 10 (out of 12) electrodes intracochlear. The Cochlear lateral wall electrodes (straight research arrays) ([Formula: see text]) had minimal trauma with 20 and 21 of 22 electrodes intracochlear. The Advanced Bionics electrodes ([Formula: see text]) were inserted using their insertion tool; one had minimal insertion trauma and 14 of 16 electrodes intracochlear, while the other had violation of the basilar membrane just deep to the cochleostomy following which it remained in scala vestibuli with 13 of 16 electrodes intracochlear. Minimally invasive, image-guided cochlear implantation is possible using electrodes from the three FDA-approved manufacturers. Lateral wall electrodes were associated with less intracochlear trauma suggesting that they may be better suited for this surgical technique.

  13. Non-invasive cardiac pacing with image-guided focused ultrasound

    Science.gov (United States)

    Marquet, Fabrice; Bour, Pierre; Vaillant, Fanny; Amraoui, Sana; Dubois, Rémi; Ritter, Philippe; Haïssaguerre, Michel; Hocini, Mélèze; Bernus, Olivier; Quesson, Bruno

    2016-11-01

    Currently, no non-invasive cardiac pacing device acceptable for prolonged use in conscious patients exists. High Intensity Focused Ultrasound (HIFU) can be used to perform remote pacing using reversibility of electromechanical coupling of cardiomyocytes. Here we described an extracorporeal cardiac stimulation device and study its efficacy and safety. We conducted experiments ex vivo and in vivo in a large animal model (pig) to evaluate clinical potential of such a technique. The stimulation threshold was determined in 10 different ex vivo hearts and different clinically relevant electrical effects such as consecutive stimulations of different heart chambers with a single ultrasonic probe, continuous pacing or the inducibility of ventricular tachycardia were shown. Using ultrasonic contrast agent, consistent cardiac stimulation was achievable in vivo for up to 1 hour sessions in 4 different animals. No damage was observed in inversion-recovery MR sequences performed in vivo in the 4 animals. Histological analysis revealed no differences between stimulated and control regions, for all ex vivo and in vivo cases.

  14. A novel method for texture-mapping conoscopic surfaces for minimally invasive image-guided kidney surgery.

    Science.gov (United States)

    Ong, Rowena; Glisson, Courtenay L; Burgner-Kahrs, Jessica; Simpson, Amber; Danilchenko, Andrei; Lathrop, Ray; Herrell, S Duke; Webster, Robert J; Miga, Michael; Galloway, Robert L

    2016-08-01

    Organ-level registration is critical to image-guided therapy in soft tissue. This is especially important in organs such as the kidney which can freely move. We have developed a method for registration that combines three-dimensional locations from a holographic conoscope with an endoscopically obtained textured surface. By combining these data sources clear decisions as to the tissue from which the points arise can be made. By localizing the conoscope's laser dot in the endoscopic space, we register the textured surface to the cloud of conoscopic points. This allows the cloud of points to be filtered for only those arising from the kidney surface. Once a valid cloud is obtained we can use standard surface registration techniques to perform the image-space to physical-space registration. Since our methods use two distinct data sources we test for spatial accuracy and characterize temporal effects in phantoms, ex vivo porcine and human kidneys. In addition we use an industrial robot to provide controlled motion and positioning for characterizing temporal effects. Our initial surface acquisitions are hand-held. This means that we take approximately 55 s to acquire a surface. At that rate we see no temporal effects due to acquisition synchronization or probe speed. Our surface registrations were able to find applied targets with submillimeter target registration errors. The results showed that the textured surfaces could be reconstructed with submillimetric mean registration errors. While this paper focuses on kidney applications, this method could be applied to any anatomical structures where a line of sight can be created via open or minimally invasive surgical techniques.

  15. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis.

    Science.gov (United States)

    Mauri, Giovanni; Sconfienza, Luca Maria; Pescatori, Lorenzo Carlo; Fedeli, Maria Paola; Alì, Marco; Di Leo, Giovanni; Sardanelli, Francesco

    2017-08-01

    To systematically review studies concerning imaging-guided minimally-invasive breast cancer treatments. An online database search was performed for English-language articles evaluating percutaneous breast cancer ablation. Pooled data and 95% confidence intervals (CIs) were calculated. Technical success, technique efficacy, minor and major complications were analysed, including ablation technique subgroup analysis and effect of tumour size on outcome. Forty-five studies were analysed, including 1,156 patients and 1,168 lesions. Radiofrequency (n=577; 50%), microwaves (n=78; 7%), laser (n=227; 19%), cryoablation (n=156; 13%) and high-intensity focused ultrasound (HIFU, n=129; 11%) were used. Pooled technical success was 96% (95%CI 94-97%) [laser=98% (95-99%); HIFU=96% (90-98%); radiofrequency=96% (93-97%); cryoablation=95% (90-98%); microwave=93% (81-98%)]. Pooled technique efficacy was 75% (67-81%) [radiofrequency=82% (74-88); cryoablation=75% (51-90); laser=59% (35-79); HIFU=49% (26-74)]. Major complications pooled rate was 6% (4-8). Minor complications pooled rate was 8% (5-13%). Differences between techniques were not significant for technical success (p=0.449), major complications (p=0.181) or minor complications (p=0.762), but significant for technique efficacy (p=0.009). Tumour size did not impact on variables (p>0.142). Imaging-guided percutaneous ablation techniques of breast cancer have a high rate of technical success, while technique efficacy remains suboptimal. Complication rates are relatively low. • Imaging-guided ablation techniques for breast cancer are 96% technically successful. • Overall technique efficacy rate is 75% but largely inhomogeneous among studies. • Overall major and minor complication rates are low (6-8%).

  16. Validation of Minimally-Invasive, Image-guided Cochlear Implantation Using Advanced Bionics, Cochlear, and Medel Electrodes in a Cadaver Model

    Science.gov (United States)

    McRackan, Theodore R; Balachandran, Ramya; Blachon, Grégoire S; Mitchell, Jason E; Noble, Jack H; Wright, Charles G; Fitzpatrick, J. Michael; Dawant, Benoit M; Labadie, Robert F

    2015-01-01

    Purpose Validation of a novel minimally-invasive, image-guided approach to implant electrodes from three FDA-approved manufacturers—Medel, Cochlear, and Advanced Bionics—in the cochlea via a linear tunnel from the lateral cranium through the facial recess to the cochlea. Methods Custom microstereotactic frames that mount on bone-implanted fiducial markers and constrain the drill along the desired path were utilized on seven cadaver specimens. A linear tunnel was drilled from the lateral skull to the cochlea followed by a marginal, round-window cochleostomy and insertion of the electrode array into the cochlea through the drilled tunnel. Post-insertion CT scan and histological analysis were used to analyze the results. Results All specimens (N=7) were successfully implanted without visible injury to the facial nerve. The Medel electrodes (N=3) had minimal intracochlear trauma with 8, 8, and 10 (out of 12) electrodes intracochlear. The Cochlear lateral wall electrodes (straight research arrays) (N=2) had minimal trauma with 20 and 21 of 22 electrodes intracochlear. The Advanced Bionics electrodes (N=2) were inserted using their insertion tool; one had minimal insertion trauma and 14 of 16 electrodes intracochlear while the other had violation of the basilar membrane just deep to the cochleostomy following which it remained in scala vestibuli with 13 of 16 electrodes intracochlear. Conclusions Minimally invasive, image-guided cochlear implantation is possible using electrodes from the three FDA-approved manufacturers. Lateral wall electrodes were associated with less intracochlear trauma suggesting that they may be better suited for this surgical technique. PMID:23633113

  17. Image guided prostate cancer treatments

    Energy Technology Data Exchange (ETDEWEB)

    Bard, Robert L. [Bard Cancer Center, Biofoundation for Angiogenesis Research and Development, New York, NY (United States); Fuetterer, Jurgen J. [Radboud Univ. Nijmegen, Medical Centre (Netherlands). Dept. of Radiology; Sperling, Dan (ed.) [Sperling Prostate Center, Alpha 3TMRI, New York, NY (United States)

    2014-07-01

    Systematic overview of the application of ultrasound and MRI in the diagnosis and treatment of diseases of the lower urinary tract. Detailed information on image-guided therapies, including focused ultrasound, photodynamic therapy, and microwave and laser ablation. Numerous high-quality illustrations based on high-end equipment. Represents the state of the art in Non Invasive Imaging and Minimally Invasive Ablation Treatment (MIAT). Image-Guided Prostate Cancer Treatments is a comprehensive reference and practical guide on the technology and application of ultrasound and MRI in the male pelvis, with special attention to the prostate. The book is organized into three main sections, the first of which is devoted to general aspects of imaging and image-guided treatments. The second section provides a systematic overview of the application of ultrasound and MRI to the diagnosis and treatment of diseases of the lower urinary tract. Performance of the ultrasound and MRI studies is explained, and the normal and abnormal pathological anatomy is reviewed. Correlation with the ultrasound in the same plane is provided to assist in understanding the MRI sequences. Biopsy and interventional procedures, ultrasound-MRI fusion techniques, and image-guided therapies, including focused ultrasound, photodynamic therapy, microwave and laser ablation, are all fully covered. The third section focuses on securing treatment effectiveness and the use of follow-up imaging to ensure therapeutic success and detect tumor recurrence at an early stage, which is vital given that prompt focal treatment of recurrence is very successful. Here, particular attention is paid to the role of Doppler ultrasound and DCE-MRI technologies. This book, containing a wealth of high-quality illustrations based on high-end equipment, will acquaint beginners with the basics of prostate ultrasound and MRI, while more advanced practitioners will learn new skills, means of avoiding pitfalls, and ways of effectively

  18. Quantitative Discomanometry: Correlation of Intradiscal Pressure Values to Pain Reduction in Patients With Intervertebral Disc Herniation Treated With Percutaneous, Minimally Invasive, Image-Guided Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Filippiadis, Dimitrios K., E-mail: dfilippiadis@yahoo.gr; Mazioti, A., E-mail: argyromazioti@yahoo.gr; Papakonstantinou, O., E-mail: sogofianol@gmail.com; Brountzos, E., E-mail: ebrountz@med.uoa.gr [University General Hospital ' Attikon' , Second Radiology Department (Greece); Gouliamos, A., E-mail: agouliam@med.uoa.gr [University General Hospital ' Areteion' , First Radiology Department (Greece); Kelekis, N., E-mail: kelnik@med.uoa.gr; Kelekis, A., E-mail: akelekis@med.uoa.gr [University General Hospital ' Attikon' , Second Radiology Department (Greece)

    2012-10-15

    Purpose: To illustrate quantitative discomanometry's (QD) diagnostic efficacy and predictive value in discogenic-pain evaluation in a prospective study correlating intradiscal pressure values with pain reduction after percutaneous image-guided technique (i.e., percutaneous decompression, PD). Materials and Methods: During the last 3 years, 36 patients [21 male and 15 female (mean age 36 {+-} 5.8 years)] with intervertebral disc hernia underwent QD before PD. Under absolute sterilization and fluoroscopy, a mixture of contrast medium and normal saline (3:1 ratio) was injected. A discmonitor performed a constant rate injection and recorded pressure and volume values, thus producing the relative pressure-volume curve. PD was then performed. Pain reduction and improved mobility were recorded at 3, 12, and 24 months after PD using clinical evaluation and a numeric visual scale (NVS; 0 to 10 units). Results: Mean pain values of 7.5 {+-} 1.9 (range 4 to 8) NVS units were recorded before PD; these decreased to 2.9 {+-} 2.44 at 3 months, 1.0 {+-} 1.9 at 12 months, and 1.0 {+-} 1.9 NVS units at 24 months after PD. Recorded correlations (pressure, volume, significant pain-reduction values) with bilateral statistical significance included a maximum injected volume of 2.4 ml (p = 0.045), P{sub o} < 14 psi [initial pressure required to inject 0.1 ml of the mixture inside the disc (p = 0.05)], P{sub max} {<=} 65 psi [greatest pressure value on the curve (p = 0.018)], and P{sub max} - P{sub o} {<=} 47 psi (p = 0.038). Patients meeting these pressure or volume cut-off points, either independently or as a total, had significant pain reduction (>4 NVS units) after PD. No complications were noted. Conclusions: QD is an efficient technique that may have predictive value for discogenic pain evaluation. It might serve as a useful tool for patient selection for intervertebral disc therapies.

  19. Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the paediatric virtual autopsy trial

    Science.gov (United States)

    2014-01-01

    Background In light of declining autopsy rates around the world, post-mortem MR imaging is a promising alternative to conventional autopsy in the investigation of infant death. A major drawback of this non-invasive autopsy approach is the fact that histopathological and microbiological examination of the tissue is not possible. The objective of this prospective study is to compare the performance of minimally invasive, virtual autopsy, including CT-guided biopsy, with conventional autopsy procedures in a paediatric population. Methods/Design Foetuses, newborns and infants that are referred for autopsy at three different institutions associated with the University of Zurich will be eligible for recruitment. All bodies will be examined with a commercial CT and a 3 Tesla MRI scanner, masked to the results of conventional autopsy. After cross-sectional imaging, CT-guided tissue sampling will be performed by a multifunctional robotic system (Virtobot) allowing for automated post-mortem biopsies. Virtual autopsy results will be classified with regards to the likely final diagnosis and major pathological findings and compared to the results of conventional autopsy, which remains the diagnostic gold standard. Discussion There is an urgent need for the development of alternative post-mortem examination methods, not only as a counselling tool for families and as a quality control measure for clinical diagnosis and treatment but also as an instrument to advance medical knowledge and clinical practice. This interdisciplinary study will determine whether virtual autopsy will narrow the gap in information between non-invasive and traditional autopsy procedures. Trial Registration ClinicalTrials.gov: NCT01888380 PMID:24438163

  20. Image-guided urological interventions: What the urologists must know

    Directory of Open Access Journals (Sweden)

    Chandan J Das

    2015-01-01

    Full Text Available Advances in imaging technology, especially in the last two decades, have led to a paradigm shift in the field of image-guided interventions in urology. While the traditional biopsy and drainage techniques are firmly established, image-based stone management and endovascular management of hematuria have evolved further. Ablative techniques for renal and prostate cancer and prostate artery embolization for benign prostatic hypertrophy have evolved into viable alternative treatments. Many urologic diseases that were earlier treated surgically are now effectively managed using minimally invasive image-guided techniques, often on a day care basis using only local anesthesia or conscious sedation. This article presents an overview of the technique and status of various image-guided urological procedures, including recent emerging techniques.

  1. Image-Guided Cancer Nanomedicine

    OpenAIRE

    Dong-Hyun Kim

    2018-01-01

    Multifunctional nanoparticles with superior imaging properties and therapeutic effects have been extensively developed for the nanomedicine. However, tumor-intrinsic barriers and tumor heterogeneity have resulted in low in vivo therapeutic efficacy. The poor in vivo targeting efficiency in passive and active targeting of nano-therapeutics along with the toxicity of nanoparticles has been a major problem in nanomedicine. Recently, image-guided nanomedicine, which can deliver nanoparticles loca...

  2. Transcortical Motor Aphasia in Recovery: A Case Report

    Directory of Open Access Journals (Sweden)

    Jacqueline Stark

    2015-04-01

    Full Text Available Introduction The symptomatology of transcortical motor aphasia (TMA or dynamic aphasia (Luria & Tsvetkova, 1970 allows the clinician to investigate “the particularly interesting stage in transition from initial thought to final verbal expression” and “to study in pure form the lack of speech initiative” (Rubens, 1976,p. 302. The symptoms described in the literature include: difficulty initiating speech, limited spontaneous speech, intact repetition, good auditory comprehension. In contrast, agrammatic sentence production is associated with Broca’s aphasia. Language data from a participant presenting with TMA and also agrammatic symptoms who showed a good recovery are analyzed. The aim of this presentation is to tease apart the observed language features to arrive at a better understanding of the nature of specific symptoms and their impact on language processing. Methods Participant GS: a 17-year-old carpenter’s apprentice, suffered a massive stroke. A complete occlusion of the left anterior-cerebral-artery was diagnosed. Procedure From 4 weeks to 10 months post onset GS was administered standardized language tests and tasks covering all linguistic levels. A matched control person (MH was also tested. Results Selected results and examples are given in Table 1. GS’s initiation of spontaneously produced speech is captured by his slow rate of production and verbal output for texts in comparison to control MH. As shown in Table 1, specific syntactic features showed impairment. At six months his aphasia had evolved into a mild impairment. Discussion The utterances produced by a classical TMA patient are usually grammatical. In part, this applies to G.S. However, he also reveals the following difficulties: simplification of syntactic structure, substitutions and omissions of articles, frequent omission of prepositions, verb agreement and selection errors, and reversal of subject and object noun phrases various sentence and discourse

  3. Image-guided transorbital procedures with endoscopic video augmentation.

    Science.gov (United States)

    DeLisi, Michael P; Mawn, Louise A; Galloway, Robert L

    2014-09-01

    Surgical interventions to the orbital space behind the eyeball are limited to highly invasive procedures due to the confined nature of the region along with the presence of several intricate soft tissue structures. A minimally invasive approach to orbital surgery would enable several therapeutic options, particularly new treatment protocols for optic neuropathies such as glaucoma. The authors have developed an image-guided system for the purpose of navigating a thin flexible endoscope to a specified target region behind the eyeball. Navigation within the orbit is particularly challenging despite its small volume, as the presence of fat tissue occludes the endoscopic visual field while the surgeon must constantly be aware of optic nerve position. This research investigates the impact of endoscopic video augmentation to targeted image-guided navigation in a series of anthropomorphic phantom experiments. A group of 16 surgeons performed a target identification task within the orbits of four skull phantoms. The task consisted of identifying the correct target, indicated by the augmented video and the preoperative imaging frames, out of four possibilities. For each skull, one orbital intervention was performed with video augmentation, while the other was done with the standard image guidance technique, in random order. The authors measured a target identification accuracy of 95.3% and 85.9% for the augmented and standard cases, respectively, with statistically significant improvement in procedure time (Z=-2.044, p=0.041) and intraoperator mean procedure time (Z=2.456, p=0.014) when augmentation was used. Improvements in both target identification accuracy and interventional procedure time suggest that endoscopic video augmentation provides valuable additional orientation and trajectory information in an image-guided procedure. Utilization of video augmentation in transorbital interventions could further minimize complication risk and enhance surgeon comfort and

  4. Live-Wire-Based Segmentation of 3D Anatomical Structures for Image-Guided Lung Interventions

    NARCIS (Netherlands)

    Lu, K.; Xu, S.; Xue, Z.; Wong, S.T.

    2011-01-01

    Computed Tomography (CT) has been widely used for assisting lung cancer detection/diagnosis and treatment. In lung cancer diagnosis, suspect lesions or regions of interest (ROIs) are usually analyzed in screening CT scans, and CT-based image-guided minimally invasive procedures are performed for

  5. Frameless image-guided neurosurgery in motion

    NARCIS (Netherlands)

    Woerdeman, P.A.

    2008-01-01

    The general objective of this thesis was the enhancement of image-guidance system use by optimizing “man-machine” interaction in frameless image-guided neurosurgery. Part I. The application of frameless stereotaxy in the neurosurgical practice We aimed to compare three patient-to-image registration

  6. Quality assurance for image-guided radiotherapy

    International Nuclear Information System (INIS)

    Marinello, Ginette

    2008-01-01

    The topics discussed include, among others, the following: Quality assurance program; Image guided radiotherapy; Commissioning and quality assurance; Check of agreement between visual and displayed scales; quality controls: electronic portal imaging device (EPID), MV-kV and kV-kV, cone-beam CT (CBCT), patient doses. (P.A.)

  7. Image-guided plasma therapy of cutaneous wound

    Science.gov (United States)

    Zhang, Zhiwu; Ren, Wenqi; Yu, Zelin; Zhang, Shiwu; Yue, Ting; Xu, Ronald

    2014-02-01

    The wound healing process involves the reparative phases of inflammation, proliferation, and remodeling. Interrupting any of these phases may result in chronically unhealed wounds, amputation, or even patient death. Despite the clinical significance in chronic wound management, no effective methods have been developed for quantitative image-guided treatment. We integrated a multimodal imaging system with a cold atmospheric plasma probe for image-guided treatment of chronic wound. Multimodal imaging system offers a non-invasive, painless, simultaneous and quantitative assessment of cutaneous wound healing. Cold atmospheric plasma accelerates the wound healing process through many mechanisms including decontamination, coagulation and stimulation of the wound healing. The therapeutic effect of cold atmospheric plasma is studied in vivo under the guidance of a multimodal imaging system. Cutaneous wounds are created on the dorsal skin of the nude mice. During the healing process, the sample wound is treated by cold atmospheric plasma at different controlled dosage, while the control wound is healed naturally. The multimodal imaging system integrating a multispectral imaging module and a laser speckle imaging module is used to collect the information of cutaneous tissue oxygenation (i.e. oxygen saturation, StO2) and blood perfusion simultaneously to assess and guide the plasma therapy. Our preliminary tests show that cold atmospheric plasma in combination with multimodal imaging guidance has the potential to facilitate the healing of chronic wounds.

  8. External fixation of the metacarpal fracture with transcortical pins and fiberglass east in Simmental calf

    International Nuclear Information System (INIS)

    Martins, E.A.N.; Camargo, L.M.

    2003-01-01

    A six-month-old 245 kg male Simmental calf was referred to the Veterinary Hospital in Cuiabá, MT, with closed comminuted diaphyseal fracture in metacarpus. It was given preference to external fixation as means of fracture immobilization, and transcortical pins and fiberglass cast were used. This technique showed effective immobilization of the fracture, less expensive and feasible to be done in the field [pt

  9. Image-guided positioning and tracking.

    Science.gov (United States)

    Ruan, Dan; Kupelian, Patrick; Low, Daniel A

    2011-01-01

    Radiation therapy aims at maximizing tumor control while minimizing normal tissue complication. The introduction of stereotactic treatment explores the volume effect and achieves dose escalation to tumor target with small margins. The use of ablative irradiation dose and sharp dose gradients requires accurate tumor definition and alignment between patient and treatment geometry. Patient geometry variation during treatment may significantly compromise the conformality of delivered dose and must be managed properly. Setup error and interfraction/intrafraction motion are incorporated in the target definition process by expanding the clinical target volume to planning target volume, whereas the alignment between patient and treatment geometry is obtained with an adaptive control process, by taking immediate actions in response to closely monitored patient geometry. This article focuses on the monitoring and adaptive response aspect of the problem. The term "image" in "image guidance" will be used in a most general sense, to be inclusive of some important point-based monitoring systems that can be considered as degenerate cases of imaging. Image-guided motion adaptive control, as a comprehensive system, involves a hierarchy of decisions, each of which balances simplicity versus flexibility and accuracy versus robustness. Patient specifics and machine specifics at the treatment facility also need to be incorporated into the decision-making process. Identifying operation bottlenecks from a system perspective and making informed compromises are crucial in the proper selection of image-guidance modality, the motion management mechanism, and the respective operation modes. Not intended as an exhaustive exposition, this article focuses on discussing the major issues and development principles for image-guided motion management systems. We hope these information and methodologies will facilitate conscientious practitioners to adopt image-guided motion management systems

  10. A purely functional Imaging based approach for transcortical resection of lesion involving the dominant atrium: Towards safer, imaging-guided, tailored cortico-leucotomies.

    Science.gov (United States)

    Frati, Alessandro; Pesce, Alessandro; D'Andrea, Giancarlo; Fraschetti, Flavia; Salvati, Maurizio; Cimatti, Marco; Esposito, Vincenzo; Raco, Antonino

    2018-04-01

    The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard "anatomical" approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment. Patient, surgery and lesion-related data were recorded to identify the relationships with outcome. Eloquent areas fMRI and the course of Arcuate Fasciculus (AF), Inferior frontooccipital fasciculus (IFOF), Optic radiation (OR) and corticospinal tract (CST) have been investigated with preoperative MRI sequences and DTI reconstruction. The final cohort consisted of 43 patients, 19 males and 24 females; average age was 56.8 years. We recorded 9 transient and 3 permanent postoperative deficits, only one of those was caused by an edema interference with DTI reconstruction. Preoperative functional status, histology and volume of the lesion proved to be independent factors affecting results. A purely functional surgical approach to the DA provided promising preliminary results. A direct DTI-fMRI visualization of the eloquent structures proximal to DA allows surgeon to conceive an ultra-precise and "tailored" cortico-leucotomy for an optimal exposure of the lesion. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. INNOLAB- image guided surgery and therapy lab

    Directory of Open Access Journals (Sweden)

    Fritzsche Holger

    2017-09-01

    Full Text Available Incremental innovation, something better or cheaper or more effective, is the standard innovation process for medical product development. Disruptive innovation is often not recognized as disruptive, because it very often starts as a simple and easy alternative to existing products with much reduced features and bad performance. Innovation is the invention multiplied with a commercial use, or in other words something that eventually provides a value to a clinical user or patient. To create such innovation not a technology push (technology delivered from a technical need perspective but rather a pull (by learning and working with the clinical users is required. Medical technology students need to understand that only through proper observation, procedure know-how and subsequent analysis and evaluation, clinically relevant and affordable innovation can be generated and possibly subsequently used for entrepreneurial ventures. The dedicated laboratory for innovation, research and entrepreneurship- INNOLAB ego.-INKUBATOR IGT (Image Guided Therapies is financed by the state of Sachsen-Anhalt as part of the European ego.-INKUBATOR program with (EFRE funds at the university clinic operated by the technical chair for catheter technologies and image guided surgeries. It forms a network node between medicine, research and economics. It teaches students to lead innovation processes, technology transfer to the user and is designed to stimulate the start-up intentions.

  12. Image-Guided Spinal Ablation: A Review

    International Nuclear Information System (INIS)

    Tsoumakidou, Georgia; Koch, Guillaume; Caudrelier, Jean; Garnon, Julien; Cazzato, Roberto Luigi; Edalat, Faramarz; Gangi, Afshin

    2016-01-01

    The image-guided thermal ablation procedures can be used to treat a variety of benign and malignant spinal tumours. Small size osteoid osteoma can be treated with laser or radiofrequency. Larger tumours (osteoblastoma, aneurysmal bone cyst and metastasis) can be addressed with radiofrequency or cryoablation. Results on the literature of spinal microwave ablation are scarce, and thus it should be used with caution. A distinct advantage of cryoablation is the ability to monitor the ice-ball by intermittent CT or MRI. The different thermal insulation, temperature and electrophysiological monitoring techniques should be applied. Cautious pre-procedural planning and intermittent intra-procedural monitoring of the ablation zone can help reduce neural complications. Tumour histology, patient clinical-functional status and life-expectancy should define the most efficient and least disabling treatment option.

  13. Image-Guided Spinal Ablation: A Review

    Energy Technology Data Exchange (ETDEWEB)

    Tsoumakidou, Georgia, E-mail: gtsoumakidou@yahoo.com; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr; Garnon, Julien, E-mail: julien.garnon@chru-strasbourg.fr; Cazzato, Roberto Luigi, E-mail: roberto-luigi.cazzato@chru-strasbourg.fr; Edalat, Faramarz, E-mail: faramarz.edalat@gmail.com; Gangi, Afshin, E-mail: gangi@unistra.fr [Strasbourg University Hospital (France)

    2016-09-15

    The image-guided thermal ablation procedures can be used to treat a variety of benign and malignant spinal tumours. Small size osteoid osteoma can be treated with laser or radiofrequency. Larger tumours (osteoblastoma, aneurysmal bone cyst and metastasis) can be addressed with radiofrequency or cryoablation. Results on the literature of spinal microwave ablation are scarce, and thus it should be used with caution. A distinct advantage of cryoablation is the ability to monitor the ice-ball by intermittent CT or MRI. The different thermal insulation, temperature and electrophysiological monitoring techniques should be applied. Cautious pre-procedural planning and intermittent intra-procedural monitoring of the ablation zone can help reduce neural complications. Tumour histology, patient clinical-functional status and life-expectancy should define the most efficient and least disabling treatment option.

  14. Inorganic Nanoparticles for Image-Guided Therapy.

    Science.gov (United States)

    Yoon, Hong Yeol; Jeon, Sangmin; You, Dong Gil; Park, Jae Hyung; Kwon, Ick Chan; Koo, Heebeom; Kim, Kwangmeyung

    2017-01-18

    Recently, nanotechnology has provided significant advances in biomedical applications including diagnosis and therapy. In particular, nanoparticles have emerged as valuable outcomes of nanotechnology due to their unique physicochemical properties based on size, shape, and surface properties. Among them, a large amount of research has reported imaging and therapeutic applications using inorganic nanoparticles with special properties. Inorganic nanoparticles developed for imaging and therapy contain metal (Au), metal oxide (Fe 3 O 4 , WO 3 , WO 2.9 ), semiconductor nanocrystal (quantum dots (QDs)), and lanthanide-doped upconversion nanoparticles (UCNPs). Based on their intrinsic properties, they can generate heat, reactive oxygen species (ROS), or energy transfer, so that they can be used for both imaging and therapy. In this review, we introduce biocompatible inorganic nanoparticles for image-guided thermal and photodynamic therapy, and discuss their promising results from in vitro and in vivo studies for biomedical applications.

  15. Image-guided surgical navigation in otology.

    Science.gov (United States)

    Kohan, Darius; Jethanamest, Daniel

    2012-10-01

    To evaluate the efficacy of image-guided surgical navigation (IGSN) in otologic surgery and establish practice guidelines. Prospective study. Between January 2003 and January 2010, all patients requiring complicated surgery for chronic otitis media, glomus jugulare, atresia, cerebrospinal fluid leak with or without encephalocele, and cholesterol granuloma of the petrous apex were offered IGSN. The accuracy of IGSN relative to pertinent pathology and 11 anatomic landmarks was established. Additionally IGSN-related operative time, complications, and surgical outcome were recorded. In the study period there were 820 otologic procedures, among 94 patients (96 ears) with disease meeting proposed criteria. Thirteen patients (15 procedures) consented to the use of IGSN. All patients had a minimum 6 months of follow-up. The average additional operative time required was 36.7 minutes. The mean accuracy error was 1.1 mm laterally at the tragus but decreased to 0.8 mm medially at the level of the oval window. The mean accuracy of IGSN was within 1 mm in 10 of the 11 targeted surgical anatomic landmarks. Interactive image-guided surgical navigation during complex otologic surgery may improve surgical outcome and decrease morbidity by providing an accurate real-time display of surgical instrumentation relative to patient anatomy and pathology. In select cases, the extra cost of imaging immediately prior to surgery and extra operating room time may be compensated by enhancing the ability to distinguish distorted anatomy relative to disease, potentially improving surgical outcome. IGSN, although useful, does not replace surgical expertise and experience. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  16. Image-guided radiation therapy: physician's perspectives

    International Nuclear Information System (INIS)

    Gupta, T.; Anand Narayan, C.

    2012-01-01

    The evolution of radiotherapy has been ontogenetically linked to medical imaging. Over the years, major technological innovations have resulted in substantial improvements in radiotherapy planning, delivery, and verification. The increasing use of computed tomography imaging for target volume delineation coupled with availability of computer-controlled treatment planning and delivery systems have progressively led to conformation of radiation dose to the target tissues while sparing surrounding normal tissues. Recent advances in imaging technology coupled with improved treatment delivery allow near-simultaneous soft-tissue localization of tumor and repositioning of patient. The integration of various imaging modalities within the treatment room for guiding radiation delivery has vastly improved the management of geometric uncertainties in contemporary radiotherapy practice ushering in the paradigm of image-guided radiation therapy (IGRT). Image-guidance should be considered a necessary and natural corollary to high-precision radiotherapy that was long overdue. Image-guided radiation therapy not only provides accurate information on patient and tumor position on a quantitative scale, it also gives an opportunity to verify consistency of planned and actual treatment geometry including adaptation to daily variations resulting in improved dose delivery. The two main concerns with IGRT are resource-intensive nature of delivery and increasing dose from additional imaging. However, increasing the precision and accuracy of radiation delivery through IGRT is likely to reduce toxicity with potential for dose escalation and improved tumor control resulting in favourable therapeutic index. The radiation oncology community needs to leverage this technology to generate high-quality evidence to support widespread adoption of IGRT in contemporary radiotherapy practice. (author)

  17. Removal of 11 incompletely erupted, impacted cheek teeth in 10 horses using a dental alveolar transcortical osteotomy and buccotomy approach.

    Science.gov (United States)

    Tremaine, W Henry; McCluskie, Laura K

    2010-10-01

    To describe surgical technique and outcome in 10 horses with impacted cheek teeth that were removed by a transcortical osteotomy and buccotomy technique. Case series. Horses (n=10) with impacted cheek teeth. Medical records (2002-2008) of horses with impacted cheek teeth requiring removal were reviewed; surgical technique and outcome were determined. Exodontia of 11 cheek teeth was performed surgically in 10 horses; 3 horses had complications (residual swelling of the mandible) that resolved and all horses returned to their previous use. Transcortical buccotomy technique is effective for removal of incompletely erupted impacted cheek teeth in horses and has a good long-term prognosis for remission of clinical signs. Transcortical buccotomy approach is an effective technique for removal of unerupted impacted equine cheek teeth. © Copyright 2010 by The American College of Veterinary Surgeons.

  18. Nature of spelling errors in transcortical sensory aphasia: a case study.

    Science.gov (United States)

    Clark, L W; Grossfeld, M L

    1983-01-01

    The nature and extent of spelling errors in a patient with transcortical sensory aphasia were investigated. The two experimental conditions required the patient to spell monosyllabic and polysyllabic words both verbally and in written form. Analysis of the spelling errors revealed partially preserved knowledge of the visual image of a word as a whole, as well as preserved knowledge of temporal order. Our patient's error patterns in both conditions were more similar than dissimilar. These findings in conjunction with results reported in the literature indicate that patients exhibiting different aphasia syndromes use separate spelling strategies.

  19. Image-guided drug delivery : Preclinical applications and clinical translation

    NARCIS (Netherlands)

    Ojha, Tarun; Rizzo, Larissa; Storm, G; Kiessling, Fabian; Lammers, Twan

    2015-01-01

    Image-guided drug delivery refers to the combination of drug targeting and imaging. Preclinically, image-guided drug delivery can be used for several different purposes, including for monitoring biodistribution, target site accumulation, off-target localization, drug release and drug efficacy.

  20. Image-guided drug delivery: preclinical applications and clinical translation

    NARCIS (Netherlands)

    Ojha, Tarun; Rizzo, Larissa; Storm, Gerrit; Kiessling, Fabian; Lammers, Twan Gerardus Gertudis Maria

    2015-01-01

    Image-guided drug delivery refers to the combination of drug targeting and imaging. Preclinically, image-guided drug delivery can be used for several different purposes, including for monitoring biodistribution, target site accumulation, off-target localization, drug release and drug efficacy.

  1. Quantifying attention shifts in augmented reality image-guided neurosurgery.

    Science.gov (United States)

    Léger, Étienne; Drouin, Simon; Collins, D Louis; Popa, Tiberiu; Kersten-Oertel, Marta

    2017-10-01

    Image-guided surgery (IGS) has allowed for more minimally invasive procedures, leading to better patient outcomes, reduced risk of infection, less pain, shorter hospital stays and faster recoveries. One drawback that has emerged with IGS is that the surgeon must shift their attention from the patient to the monitor for guidance. Yet both cognitive and motor tasks are negatively affected with attention shifts. Augmented reality (AR), which merges the realworld surgical scene with preoperative virtual patient images and plans, has been proposed as a solution to this drawback. In this work, we studied the impact of two different types of AR IGS set-ups (mobile AR and desktop AR) and traditional navigation on attention shifts for the specific task of craniotomy planning. We found a significant difference in terms of the time taken to perform the task and attention shifts between traditional navigation, but no significant difference between the different AR set-ups. With mobile AR, however, users felt that the system was easier to use and that their performance was better. These results suggest that regardless of where the AR visualisation is shown to the surgeon, AR may reduce attention shifts, leading to more streamlined and focused procedures.

  2. Image-guided facet joint injection.

    Science.gov (United States)

    Peh, Wcg

    2011-01-01

    Chronic spine pain poses a peculiar diagnostic and therapeutic challenge due to multiple pain sources, overlapping clinical features and nonspecific radiological findings. Facet joint injection is an interventional pain management tool for facet-related spinal pain that can be effectively administered by a radiologist. This technique is the gold standard for identifying facet joints as the source of spinal pain. The major indications for facet injections include strong clinical suspicion of the facet syndrome, focal tenderness over the facet joints, low back pain with normal radiological findings, post-laminectomy syndrome with no evidence of arachnoiditis or recurrent disc disease, and persistent low back pain after spinal fusion. The contraindications are more ancillary, with none being absolute. Like any synovial joint degeneration, inflammation and injury can lead to pain on motion, initiating a vicious cycle of physical deconditioning, irritation of facet innervations and muscle spasm. Image-guided injection of local anesthetic and steroid into or around the facet joint aims to break this vicious cycle and thereby provide pain relief. This outpatient procedure has high diagnostic accuracy, safety and reproducibility but the therapeutic outcome is variable.

  3. Image-guided and adaptive radiotherapy

    International Nuclear Information System (INIS)

    Louvel, G.; Chajon, E.; Henry, O.; Cazoulat, G.; Le Maitre, A.; Simon, A.; Bensadoun, R.J.; Crevoisier, R. de

    2012-01-01

    Image-guided radiotherapy (IGRT) aims to take into account anatomical variations occurring during irradiation by visualization of anatomical structures. It may consist of a rigid registration of the tumour by moving the patient, in case of prostatic irradiation for example. IGRT associated with intensity-modulated radiotherapy (IMRT) is strongly recommended when high-dose is delivered in the prostate, where it seems to reduce rectal and bladder toxicity. In case of significant anatomical deformations, as in head and neck tumours (tumour shrinking and decrease in volume of the salivary glands), re-planning appears to be necessary, corresponding to the adaptive radiotherapy. This should ideally be 'monitored' and possibly triggered based on a calculation of cumulative dose, session after session, compared to the initial planning dose, corresponding to the concept of dose-guided adaptive radiotherapy. The creation of 'planning libraries' based on predictable organ positions (as in cervical cancer) is another way of adaptive radiotherapy. All of these strategies still appear very complex and expensive and therefore require stringent validation before being routinely applied. (authors)

  4. Cognitive performance change of pediatric patients after conducting frontal transcortical approach to treat lateral ventricular tumor.

    Science.gov (United States)

    Zhu, Wanchun; He, Jintao; Li, Xiang; Wang, Lei; Lu, Zheng; Li, Chunde; Gong, Jian

    2017-12-01

    Applying frontal transcortical approach to treat lateral ventricular tumor is one of the most common neurosurgical manipulations. The frontal transcortical approach generally passes through the middle frontal gyrus in which there is no major function involved in the traditional sense. However, current researches have suggested that the prefrontal cortex (PFC) plays a central role in the whole network of the brain cognitive frame. In addition, cognitive function is crucial in growing and developmental stages and essential for the educational achievement, especially for children. Based on this, the authors in this study analyzed cognitive performance change of pediatric patients who had accepted frontal transcortical operation in 1-year follow-up and discussed the possibility of higher cognitive functions of the damaged region. In this single-center study, 15 pediatric patients (median age at surgery, 9.21 years old; range, 6.42-14.17 years old) who had been treated with frontal transcortical approach for lateral ventricular tumors were selected as research objects. The cognitive function assessment was conducting by adopting the revised Wechsler Intelligence Scale for Children-fourth edition (WISC-IV). In addition, the resting-state functional magnetic resonance imaging (resting-state fMRI) and diffusion tensor imaging (DTI) were carried out to measure the level of co-activation and to explore the functional connectivity between the brain regions at the preoperative period and 1-year follow-up after surgery. GTR was achieved in all patients, and all patients were in good condition after surgery. Compared to the preoperative indices of WISC-IV, patients generally had a lower level of indices of the WISC-IV after surgery, for example, the total IQ was declined to M = 83.60, SD = 9.500 from M = 95.33, SD = 13.844 within 1 year convalescence. The data of perceptual reasoning (t = - 2.392, p = 0.016), processing speed (t = - 2.121, p = 0.033), and

  5. Evaluation of Image-Guided Positioning for Frameless Intracranial Radiosurgery

    International Nuclear Information System (INIS)

    Lamba, Michael; Breneman, John C.; Warnick, Ronald E.

    2009-01-01

    Purpose: The standard for target alignment and immobilization in intracranial radiosurgery is frame-based alignment and rigid immobilization using a stereotactic head ring. Recent improvements in image-guidance systems have introduced the possibility of image-guided radiosurgery with nonrigid immobilization. We present data on the alignment accuracy and patient stability of a frameless image-guided system. Methods and Materials: Isocenter alignment errors were measured for in vitro studies in an anthropomorphic phantom for both frame-based stereotactic and frameless image-guided alignment. Subsequently, in vivo studies assessed differences between frame-based and image-guided alignment in patients who underwent frame-based intracranial radiosurgery. Finally, intratreatment target stability was determined by image-guided alignment performed before and after image-guided mask immobilized radiosurgery. Results: In vitro hidden target localization errors were comparable for the framed (0.7 ± 0.5 mm) and image-guided (0.6 ± 0.2 mm) techniques. The in vivo differences in alignment were 0.9 ± 0.5 mm (anteroposterior), -0.2 ± 0.4 mm (superoinferior), and 0.3 ± 0.5 mm (lateral). For in vivo stability tests, the mean distance differed between the pre- and post-treatment positions with mask-immobilized radiosurgery by 0.5 ± 0.3 mm. Conclusion: Frame-based and image-guided alignment accuracy in vitro was comparable for the system tested. In vivo tests showed a consistent trend in the difference of alignment in the anteroposterior direction, possibly due to torque to the ring and mounting system with frame-based localization. The mask system as used appeared adequate for patient immobilization.

  6. Creutzfeldt-Jakob Disease with Mixed Transcortical Aphasia: Insights into Echolalia

    Directory of Open Access Journals (Sweden)

    S. E. McPherson

    1994-01-01

    Full Text Available Aphasia is a common manifestation of Creutzfeldt-Jakob disease (CJD, and investigation of the linguistic disorders of CJD patients may provide insights into the neurobiological mechanisms of language and aphasia. We report an autopsy-confirmed case of CJD in which the presenting symptom was change in language abilities. The patient ultimately evidenced mixed transcortical aphasia (MTA with echolalia. Disruption of frontal-subcortical circuits with environmental dependency accounts for the symptoms in MTA, including intact repetition and echolalia. Observation in this patient and a review of the literature suggest that frontal-subcortical circuit dysfunction may contribute to the syndrome of echolalia. This hypothesis offers an alternative explanation to “isolation” of the speech area as the cause of MTA.

  7. Experience in the treatment of thoracic herniated disc using image-guided thorascopy.

    Science.gov (United States)

    Bordon, G; Burguet Girona, S

    Thoracoscopic micro-discectomy is a treatment option for thoracic disc disease that combines the advantages of the anterior approach and the benefits of a minimally invasive technique. Adding a navigation system provides many advantages to the usual technique, as it allows accurate marking of the lesion level, improvement in the surgical approach, and precise control of herniated disc resection and vertebral osteotomy. The navigation system also reduces the learning curve for thoracoscopic technique. We report our experience in the treatment of thoracic disc herniation with image-guided thoracoscopy. Copyright © 2015 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Progressive transcortical sensory aphasia and progressive ideational apraxia owing to temporoparietal cortical atrophy.

    Science.gov (United States)

    Funayama, Michitaka; Nakajima, Asuka

    2015-11-11

    In contrast to frontotemporal lobar degeneration, atrophy of the focal posterior lateral cortex has not been thoroughly studied. Three clinical types of focal cortical atrophy have been described: 1) logopenic variant of primary progressive aphasia, which presents with impaired repetition despite normal articulation; 2) posterior cortical atrophy, which presents with prominent visuospatial deficits; and 3) primary progressive apraxia. All three clinical types are characterized by specific patterns of hypometabolism/hypoperfusion: the left posterior perisylvian area in the logopenic variant of primary progressive aphasia, bilateral parietooccipital areas in posterior cortical atrophy, and the parietal cortex in primary progressive apraxia. However, not every patient clearly fits into one of these categories. Here we describe two patients with atypical focal cortical presentations. They presented with a history of a few years of progressive transcortical sensory aphasia characterized by fluent output with normal grammar and syntax, normal repetition, sentence comprehension deficits, and anomia without loss of word meaning. They also presented with progressive apraxia that began at the initial stages. Some forms of posterior symptoms including acalculia, agraphia, and visuospatial deficits were also observed. Hypoperfusion was noted mainly in the left temporoparietal region, which is slightly posterior to the perisylvian area. Although our cases lack in CSF findings and PIB scan, these two cases and previous reports might suggest the existence of a subgroup of patients presenting with transcortical sensory aphasia, apraxia, and posterior symptoms (acalculia, agraphia, and visuospatial deficits) in the setting of Alzheimer's disease. This subgroup may reflect the spectrum of clinical manifestations between logopenic variant of primary progressive aphasia and posterior cortical atrophy.

  9. MO-DE-202-04: Multimodality Image-Guided Surgery and Intervention: For the Rest of Us

    International Nuclear Information System (INIS)

    Shekhar, R.

    2016-01-01

    At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

  10. Image-guided drainage of multiple intraabdominal abscesses in children with perforated appendicitis: an alternative to laparotomy

    Energy Technology Data Exchange (ETDEWEB)

    McCann, Jeffrey W.; Krishnamurthy, Ganesh; Connolly, Bairbre L. [Hospital for Sick Children, Image Guided Therapy, Department of Diagnostic Imaging, Toronto, Ontario (Canada); Maroo, Sanjay; Amaral, Joao G.; Parra, Dimitri; Temple, Michael; John, Philip [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Wales, Paul [Hospital for Sick Children, Department of Surgery, Toronto (Canada)

    2008-06-15

    Appendicitis is the most common cause of an acute abdomen in children. With perforation, multiple intraperitoneal collections can be seen at presentation. In this situation, surgical treatment alone is rarely effective. To determine the role of image-guided drainage in treating patients with acute appendicitis complicated by multiple intraabdominal collections. A retrospective review of patient charts and interventional radiology records was performed to identify all patients with acute complicated appendicitis treated by multiple image-guided drainage procedures. Data reviewed included the number of drainages and aspirations performed, drain dwell time, the clinical course and temperature profile, and the length of inpatient hospital stay and any complications experienced. The study population comprised 42 children with a mean age of 107.6 months. A total of 100 drainage catheters were inserted and 56 aspirations were performed. Of the 42 children, 24 were successfully treated at a single sitting, while 18 returned for further intervention. The mean drain dwell time was 8.18 days. The mean inpatient stay was 15.02 days. Treatment of the acute presentation with image-guided intervention was successful in 92.3% of children. Successful management of acute perforated appendicitis with multiple intraabdominal abscesses can be achieved with multiple minimally invasive image-guided drainage procedures. (orig.)

  11. Image-guided pleural biopsy: diagnostic yield and complications

    Energy Technology Data Exchange (ETDEWEB)

    Benamore, R.E. [Department of Radiology and Department of Histopathology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester (United Kingdom)]. E-mail: rachelbenamore@doctors.org.uk; Scott, K. [Department of Radiology and Department of Histopathology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester (United Kingdom); Richards, C.J. [Department of Radiology and Department of Histopathology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester (United Kingdom); Entwisle, J.J. [Department of Radiology and Department of Histopathology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester (United Kingdom)

    2006-08-15

    Background: Pleural biopsy and cytology are standard procedures for the investigation of pleural disease. Recent medical literature has suggested that image-guided pleural biopsy shows improved sensitivity for the diagnosis of pleural malignancy, when compared with the more commonly performed reverse bevel needle biopsy such as Abrams' needle. In our centre there has been an increasing trend towards performing image-guided pleural biopsies, and to our knowledge there is no large published series documenting the complication rate and diagnostic yield. Methods: The radiology and pathology databases were searched for all image-guided [computed tomography (CT) and ultrasound (US)] pleural biopsies from January 2001 to December 2004. All imaging and histology were reviewed, and final diagnostic information about patients was obtained from the respiratory multidisciplinary team database and patient notes. A record was made of complications following biopsy, presence of pleura in the biopsy, and adequacy of tissue for histological diagnosis. Results: A total of 82 patients underwent 85 image-guided pleural biopsies over a 4-year period. 80 cases were performed under CT and five under US guidance. The rate of new pneumothorax detected by chest radiography was 4.7%. No patient required a chest drain or blood transfusion to treat complications. In 10 (12%) cases, there was inadequate tissue to reach a confident histological diagnosis and in eight (9%) of these, no pleura was present. Assuming all suspicious and inadequate biopsies are treated as benign, which is the worst case scenario, image-guided pleural biopsy has a sensitivity and specificity of 76% and 100%, respectively, for the diagnosis of malignant disease. Conclusions: Image-guided pleural biopsy is a safe procedure with few associated complications and has a higher sensitivity than previously published series for reverse cutting needle biopsy in the diagnosis of malignant pleural disease.

  12. Multifunctional nanoparticles as a tissue adhesive and an injectable marker for image-guided procedures

    Science.gov (United States)

    Shin, Kwangsoo; Choi, Jin Woo; Ko, Giho; Baik, Seungmin; Kim, Dokyoon; Park, Ok Kyu; Lee, Kyoungbun; Cho, Hye Rim; Han, Sang Ihn; Lee, Soo Hong; Lee, Dong Jun; Lee, Nohyun; Kim, Hyo-Cheol; Hyeon, Taeghwan

    2017-07-01

    Tissue adhesives have emerged as an alternative to sutures and staples for wound closure and reconnection of injured tissues after surgery or trauma. Owing to their convenience and effectiveness, these adhesives have received growing attention particularly in minimally invasive procedures. For safe and accurate applications, tissue adhesives should be detectable via clinical imaging modalities and be highly biocompatible for intracorporeal procedures. However, few adhesives meet all these requirements. Herein, we show that biocompatible tantalum oxide/silica core/shell nanoparticles (TSNs) exhibit not only high contrast effects for real-time imaging but also strong adhesive properties. Furthermore, the biocompatible TSNs cause much less cellular toxicity and less inflammation than a clinically used, imageable tissue adhesive (that is, a mixture of cyanoacrylate and Lipiodol). Because of their multifunctional imaging and adhesive property, the TSNs are successfully applied as a hemostatic adhesive for minimally invasive procedures and as an immobilized marker for image-guided procedures.

  13. Technique development for photoacoustic imaging guided interventions

    Science.gov (United States)

    Cheng, Qian; Zhang, Haonan; Yuan, Jie; Feng, Ting; Xu, Guan; Wang, Xueding

    2015-03-01

    Laser-induced thermotherapy (LITT), i.e. tissue destruction induced by a local increase of temperature by means of laser light energy transmission, has been frequently used for minimally invasive treatments of various diseases such as benign thyroid nodules and liver cancer. The emerging photoacoustic (PA) imaging, when integrated with ultrasound (US), could contribute to LITT procedure. PA can enable a good visualization of percutaneous apparatus deep inside tissue and, therefore, can offer accurate guidance of the optical fibers to the target tissue. Our initial experiment demonstrated that, by picking the strong photoacoustic signals generated at the tips of optical fibers as a needle, the trajectory and position of the fibers could be visualized clearly using a commercial available US unit. When working the conventional US Bscan mode, the fibers disappeared when the angle between the fibers and the probe surface was larger than 60 degree; while working on the new PA mode, the fibers could be visualized without any problem even when the angle between the fibers and the probe surface was larger than 75 degree. Moreover, with PA imaging function integrated, the optical fibers positioned into the target tissue, besides delivering optical energy for thermotherapy, can also be used to generate PA signals for on-line evaluation of LITT. Powered by our recently developed PA physio-chemical analysis, PA measurements from the tissue can provide a direct and accurate feedback of the tissue responses to laser ablation, including the changes in not only chemical compositions but also histological microstructures. The initial experiment on the rat liver model has demonstrated the excellent sensitivity of PA imaging to the changes in tissue temperature rise and tissue status (from native to coagulated) when the tissue is treated in vivo with LITT.

  14. Radiologists' leading position in image-guided therapy

    NARCIS (Netherlands)

    Helmberger, Thomas; Martí-Bonmatí, Luis; Pereira, Philippe; Gillams, Alice; Martínez, Jose; Lammer, Johannes; Malagari, Katarina; Gangi, Afshin; de Baere, Thierry; Adam, E. Jane; Rasch, Coen; Budach, Volker; Reekers, Jim A.

    2013-01-01

    Image-guided diagnostic and therapeutic procedures are related to, or performed under, some kind of imaging. Such imaging may be direct inspection (as in open surgery) or indirect inspection as in endoscopy or laparoscopy. Common to all these techniques is the transformation of optical and visible

  15. MR imaging-guided percutaneous cryotherapy for lung tumors: initial experience.

    Science.gov (United States)

    Liu, Shangang; Ren, Ruimei; Liu, Ming; Lv, Yubo; Li, Bin; Li, Chengli

    2014-09-01

    To evaluate prospectively the initial clinical experience of magnetic resonance (MR) imaging-guided percutaneous cryotherapy of lung tumors. MR imaging-guided percutaneous cryotherapy was performed in 21 patients with biopsy-proven lung tumors (12 men, 9 women; age range, 39-79 y). Follow-up consisted of contrast-enhanced chest computed tomography (CT) scan performed at 3-month intervals to assess tumor control; CT scanning was carried out for 12 months or until death. Cryotherapy procedures were successfully completed in all 21 patients. Pneumothorax occurred in 7 (33.3%) of 21 patients. Chest tube placement was required in one (4.8%) case. Hemoptysis was exhibited by 11 (52.4%) patients, and pleural effusion occurred in 6 (28.6%) patients. Other complications were observed in 14 (66.7%) patients. The mean follow-up period was 10.5 months (range, 9-12 mo) in patients who died. At month 12 of follow-up, 7 (33.3%) patients had a complete response to therapy, and 10 (47.6%) patients showed a partial response. In addition, two patients had stable disease, and two patients developed progressive disease; one patient developed a tumor in the liver, and the other developed a tumor in the brain. The 1-year local control rate was 81%, and 1-year survival rate was 90.5%. MR imaging-guided percutaneous cryotherapy appears feasible, effective, and minimally invasive for lung tumors. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  16. Value of MR contrast media in image-guided body interventions.

    Science.gov (United States)

    Saeed, Maythem; Wilson, Mark

    2012-01-28

    In the past few years, there have been multiple advances in magnetic resonance (MR) instrumentation, in vivo devices, real-time imaging sequences and interventional procedures with new therapies. More recently, interventionists have started to use minimally invasive image-guided procedures and local therapies, which reduce the pain from conventional surgery and increase drug effectiveness, respectively. Local therapy also reduces the systemic dose and eliminates the toxic side effects of some drugs to other organs. The success of MR-guided procedures depends on visualization of the targets in 3D and precise deployment of ablation catheters, local therapies and devices. MR contrast media provide a wealth of tissue contrast and allows 3D and 4D image acquisitions. After the development of fast imaging sequences, the clinical applications of MR contrast media have been substantially expanded to include pre- during- and post-interventions. Prior to intervention, MR contrast media have the potential to localize and delineate pathologic tissues of vital organs, such as the brain, heart, breast, kidney, prostate, liver and uterus. They also offer other options such as labeling therapeutic agents or cells. During intervention, these agents have the capability to map blood vessels and enhance the contrast between the endovascular guidewire/catheters/devices, blood and tissues as well as direct therapies to the target. Furthermore, labeling therapeutic agents or cells aids in visualizing their delivery sites and tracking their tissue distribution. After intervention, MR contrast media have been used for assessing the efficacy of ablation and therapies. It should be noted that most image-guided procedures are under preclinical research and development. It can be concluded that MR contrast media have great value in preclinical and some clinical interventional procedures. Future applications of MR contrast media in image-guided procedures depend on their safety, tolerability

  17. Image guided surgery versus conventional brain tumor and craniotomy localization.

    Science.gov (United States)

    Mahvash, Mehran; Boettcher, Ioannis; Petridis, Athanasios K; Besharati Tabrizi, Leila

    2017-02-01

    Accurate brain lesion and craniotomy localization is an essential step in neurosurgical procedures. Image guided techniques transfer the information of neuroimaging about brain lesion localization to the patient. A critical view is necessary to find out how safe and reliable it is to transfer this information to the patient's head without using image guided systems. The aim of this study was to investigate the value of image guided brain lesion and craniotomy localization compared to conventional methods. A new developed test was performed with 10 neurosurgeons from different clinics. The first task was to perform the conventional tumor localization, planning of craniotomy and skin incision using the MRI dataset of a patient with a left temporal brain tumor. Second, the neurosurgeons were asked to plan the craniotomy and skin incision using MRI based 3D visualization with the exact localization of the segmented brain tumor. Both plans of each neurosurgeon were compared and analyzed according to the calculated brain tumor localization, location, shape and size of craniotomy. All neurosurgeons changed the craniotomy localization and skin incision in the second part of the task using the image guided tumor visualization. The mean error (±standard deviation) of tumor localization of the conventional planning was 11.45±5.09 mm in the anterior-posterior (AP) and 12±7.91 mm in the superior-inferior (SI) direction. The mean error of the craniotomy localization using conventional planning was 10.18±6.09 mm in the AP and 10.75±8.18 mm in the SI direction. The craniotomy size was significantly larger using conventional planning of the craniotomy (P=0.035). Conventional brain tumor and craniotomy localization leads more frequently to errors and oversized craniotomy. Image guided surgery can reduce these errors and increase the safety and orientation for preoperative planning.

  18. Image-guided pain therapy. Sympathicolysis; Bildgestuetzte Schmerztherapie. Sympathikolyse

    Energy Technology Data Exchange (ETDEWEB)

    Burbelko, M.; Wagner, H.J. [Vivantes Klinikum im Friedrichshain, Institut fuer Radiologie und Interventionelle Therapie, Berlin (Germany); Gutberlet, M.; Grothoff, M. [Universitaet Leipzig - Herzzentrum, Abteilung fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany)

    2015-06-15

    In the autonomic nerve system most sympathetic neurons synapse peripherally in the ganglia of the sympathetic trunk. A reduction in sympathicotonia by partial elimination of these ganglia is a therapeutic approach that has been used for more than 100 years. In the early 1920s the first attempts at percutaneous sympathicolysis (SL) were carried out. Nowadays, minimally invasive image-guided SL has become an integral part of interventional radiology. Established indications for SL are hyperhidrosis, critical limb ischemia and the complex regional pain syndrome. The standard imaging guidance modality in SL is computed tomography (CT) which allows the exact placement of the puncture needle in the target area under visualization of the surrounding structures. Ethanol is normally used for chemical lysis, which predominantly eliminates the unmyelinated autonomic axons. In order to visualize the distribution of the ethanol during application, iodine-containing contrast medium is added. The sympathetic nervous system (SNS) controls sweat secretion via the efferent neurons; therefore, effective therapy of idiopathic palmar, axillary and plantar hyperhidrosis can be achieved when SL is performed at the corresponding level of the sympathetic trunk. Furthermore, due to the vasomotor innervation of most blood vessels, by reduction of the sympathicotonus an atony of the smooth muscles and therefore vasodilatation occurs, which is used as a palliative therapeutic option in patients with critical limb ischemia. By elimination of the afferent sensory fibers this also results in pain relief. This principle is also used in the SL therapy of the complex regional pain syndrome. After the introduction of CT guidance, major complications have become rare events. In addition to the usual risks of percutaneous interventions there are, however, a number of specific complications, such as syncope caused by irritation of cardiac sympathetic nerves in thoracic SL and ureteral injury in lumbar

  19. Middle Temporal Gyrus Versus Inferior Temporal Gyrus Transcortical Approaches to High-Grade Astrocytomas in the Mediobasal Temporal Lobe: A Comparison of Outcomes, Functional Restoration, and Surgical Considerations.

    Science.gov (United States)

    Quinones-Hinojosa, Alfredo; Raza, Shaan M; Ahmed, Ishrat; Rincon-Torroella, Jordina; Chaichana, Kaisorn; Olivi, Alessandro

    2017-01-01

    High-grade astrocytomas of the mesial temporal lobe may pose surgical challenges. Several approaches (trans-sylvian, subtemporal, and transcortical) have been designed to circumnavigate the critical neurovascular structures and white fiber tracts that surround this area. Considering the paucity of literature on the transcortical approach for these lesions, we describe our institutional experience with transcortical approaches to Grade III/IV astrocytomas in the mesial temporal lobe. Between 1999 and 2009, 23 patients underwent surgery at the Johns Hopkins Medical Institutions for Grade III/IV astrocytomas involving the mesial temporal lobe (without involvement of the temporal neocortex). Clinical notes, operative records, and imaging were reviewed. Thirteen patients had tumors in the dominant hemisphere. All patients underwent surgery via a transcortical approach (14 via the inferior temporal gyrus and 9 via the middle temporal gyrus). Gross total resection was obtained in 92 % of the cohort. Neurological outcomes were: clinically significant stroke (2 patients), new visual deficits (2 patients), new speech deficit (1 patient); seizure control (53 %). In comparison to reported results in the literature for the transylvian and subtemporal approaches, the transcortical approach may provide the access necessary for a gross total resection with minimal neurological consequences. In our series of patients, there was no statistically significant difference in outcomes between the middle temporal gyrus versus the inferior temporal gyrus trajectories.

  20. [Image-guided bone consolidation in oncology: Cementoplasty and percutaneous screw fixation].

    Science.gov (United States)

    Buy, Xavier; Cazzato, Roberto Luigi; Catena, Vittorio; Roubaud, Guilhem; Kind, Michele; Palussiere, Jean

    2017-05-01

    Bone metastases are a common finding in oncology. They often induce pain but also fractures which impair quality of life, especially when involving weight-bearing bones. Percutaneous image-guided consolidation techniques play a major role for the management of bone metastases. Cementoplasty aims to stabilize bone and control pain by injecting acrylic cement into a weakened bone. This minimally invasive technique has proven its efficacy for bones submitted to compression forces: vertebra, acetabular roof, and condyles. However, long bone diaphysis should be treated with caution due to lower resistance of the cement subject to torsional forces. The recent improvements of navigation systems allow percutaneous image-guided screw fixation without requiring open surgery. This fast-track procedure avoids postponing introduction of systemic therapies. If needed, cementoplasty can be combined with screw insertion to ensure better anchoring in major osteolysis. Interventional radiology bone consolidation techniques increase the therapeutic field in oncology. A multidisciplinary approach remains mandatory to select the best indications. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  1. Intracranial depth electrodes implantation in the era of image-guided surgery

    Directory of Open Access Journals (Sweden)

    Ricardo Silva Centeno

    2011-08-01

    Full Text Available The advent of modern image-guided surgery has revolutionized depth electrode implantation techniques. Stereoelectroencephalography (SEEG, introduced by Talairach in the 1950s, is an invasive method for three-dimensional analysis on the epileptogenic zone based on the technique of intracranial implantation of depth electrodes. The aim of this article is to discuss the principles of SEEG and their evolution from the Talairach era to the image-guided surgery of today, along with future prospects. Although the general principles of SEEG have remained intact over the years, the implantation of depth electrodes, i.e. the surgical technique that enables this method, has undergone tremendous evolution over the last three decades, due the advent of modern imaging techniques, computer systems and new stereotactic techniques. The use of robotic systems, the constant evolution of imaging and computing techniques and the use of depth electrodes together with microdialysis probes will open up enormous prospects for applying depth electrodes and SEEG both for investigative use and for therapeutic use. Brain stimulation of deep targets and the construction of "smart" electrodes may, in the near future, increase the need to use this method.

  2. Intracranial depth electrodes implantation in the era of image-guided surgery.

    Science.gov (United States)

    Centeno, Ricardo Silva; Yacubian, Elza Márcia Targas; Caboclo, Luis Otávio Sales Ferreira; Júnior, Henrique Carrete; Cavalheiro, Sérgio

    2011-08-01

    The advent of modern image-guided surgery has revolutionized depth electrode implantation techniques. Stereoelectroencephalography (SEEG), introduced by Talairach in the 1950s, is an invasive method for three-dimensional analysis on the epileptogenic zone based on the technique of intracranial implantation of depth electrodes. The aim of this article is to discuss the principles of SEEG and their evolution from the Talairach era to the image-guided surgery of today, along with future prospects. Although the general principles of SEEG have remained intact over the years, the implantation of depth electrodes, i.e. the surgical technique that enables this method, has undergone tremendous evolution over the last three decades, due the advent of modern imaging techniques, computer systems and new stereotactic techniques. The use of robotic systems, the constant evolution of imaging and computing techniques and the use of depth electrodes together with microdialysis probes will open up enormous prospects for applying depth electrodes and SEEG both for investigative use and for therapeutic use. Brain stimulation of deep targets and the construction of "smart" electrodes may, in the near future, increase the need to use this method.

  3. Transcortical selective amygdalohippocampectomy technique through the middle temporal gyrus revisited: An anatomical study laboratory investigation.

    Science.gov (United States)

    Bozkurt, Baran; da Silva Centeno, Ricardo; Chaddad-Neto, Feres; da Costa, Marcos Devanir Silva; Goiri, Marcelo Augusto Acosta; Karadag, Ali; Tugcu, Bekir; Ovalioglu, Talat Cem; Tanriover, Necmettin; Kaya, Serdar; Yagmurlu, Kaan; Grande, Andrew

    2016-12-01

    The anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SelAH) have been used for surgical treatment of mesial temporal lobe epilepsy. We examined the comprehensive white matter tract anatomy of the temporal lobe to gain an insight into the trans-middle temporal gyrus, a lateral approach which has been commonly used. The transmiddle temporal gyrus approach was performed in a stepwise manner on cadaveric human heads to examine the traversing white matter pathways through it and the structures located in the temporal horn. We reviewed the literature to compare the trans-middle temporal gyrus approach with other SelAH techniques based on surgical outcomes. There does not appear to be a significant difference in seizure outcome between SelAH and ATL. However, the SelAH provides a better neuropsychological outcomes than the ATL in selected patients. Each SelAH approach has individual advantages and disadvantages. Based on our anatomical study, in the transcortical amygdalohippocampectomy technique through the middle temporal gyrus the white matter pathways to be encountered. In the temporal horn, the collateral eminence, hippocampus, lateral ventricular sulcus, choroidal fissure, inferior choroidal point, choroid plexus, fimbria of the fornix, and amygdala are exposed. The subpial dissection is performed along the lateral ventricular sulcus from the collateral eminence on lateral side and from the choroidal fissure on medial side by microdissector for en bloc resection of the hippocampus proper. The trans-middle temporal gyrus approach is commonly used in treatment of mesial temporal lobe epilepsy patients. A better anatomical and functional understanding of the structures of the temporal lobe is crucial for safer and more accurate surgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. The concept of transcortical cell assemblies: a key to the understanding of cortical lateralization and interhemispheric interaction.

    Science.gov (United States)

    Pulvermüller, F; Mohr, B

    1996-01-01

    According to Hebb, elements of higher cognitive processes, such as concepts, words and mental images, are realized in the brain as cortical cell assemblies, i.e. large and strongly connected neuron populations that form functional units. Neurons belonging to such assemblies may be scattered over wide cortical areas, and some cell assemblies may even comprise neurons of both hemispheres (transcortical assemblies). If full activation (ignition) of an assembly leads to fast circulation of neuronal activity in the assembly, this process should be visible in high-frequency cortical responses. Some evidence will be reviewed that cell assembly ignition indeed leads to changes in high-frequency cortical responses which can be recorded in the EEG and MEG. Within the cell assembly-framework, the question of cortical laterality translates into the question of how neurons of transcortical assemblies are balanced between the hemispheres. This approach allows for different degrees of laterality. Recent evidence is summarized that the degree of laterality indeed differs between language units. For example, the cortical representation of certain words appears to be strongly lateralized to the left hemisphere while those of others are less lateralized. If neurons of both hemispheres are part of one assembly bihemispheric processing should lead to a processing advantage compared to processing in the dominant hemisphere alone. The latter appears to be the case for lexical processing, as revealed by recent behavioral studies. In conclusion, the cell assembly-framework suggests a more fine-grained description of the issue of cortical laterality; it is not appropriate to ask whether "modules" supporting higher cortical functions are located either in the left or right hemisphere. Rather, it appears fruitful to ask how the neurons of transcortical cell assemblies are balanced between the hemispheres.

  5. The efficacy of Elekta Synergy image-guided radiotherapy

    International Nuclear Information System (INIS)

    Takamatsu, Shigeyuki; Takanaka, Tsuyoshi; Kumano, Tomoyasu

    2008-01-01

    We evaluated the efficacy of Elekta Synergy image-guided radiotherapy (IGRT) system equipped with cone beam CT (CBCT) for high accuracy radiation therapy. In cases set up with body marking who had large set up error could be adjusted by this system within 1 mm error. IGRT with CBCT correction provided precise set up. Elekta Synergy IGRT system is useful for high accuracy set up and will facilitate novel precise radiotherapy techniques. (author)

  6. A Survey of auditory display in image-guided interventions.

    Science.gov (United States)

    Black, David; Hansen, Christian; Nabavi, Arya; Kikinis, Ron; Hahn, Horst

    2017-10-01

    This article investigates the current state of the art of the use of auditory display in image-guided medical interventions. Auditory display is a means of conveying information using sound, and we review the use of this approach to support navigated interventions. We discuss the benefits and drawbacks of published systems and outline directions for future investigation. We undertook a review of scientific articles on the topic of auditory rendering in image-guided intervention. This includes methods for avoidance of risk structures and instrument placement and manipulation. The review did not include auditory display for status monitoring, for instance in anesthesia. We identified 15 publications in the course of the search. Most of the literature (60%) investigates the use of auditory display to convey distance of a tracked instrument to an object using proximity or safety margins. The remainder discuss continuous guidance for navigated instrument placement. Four of the articles present clinical evaluations, 11 present laboratory evaluations, and 3 present informal evaluation (2 present both laboratory and clinical evaluations). Auditory display is a growing field that has been largely neglected in research in image-guided intervention. Despite benefits of auditory displays reported in both the reviewed literature and non-medical fields, adoption in medicine has been slow. Future challenges include increasing interdisciplinary cooperation with auditory display investigators to develop more meaningful auditory display designs and comprehensive evaluations which target the benefits and drawbacks of auditory display in image guidance.

  7. Image-guided radiotherapy for locally advanced head and neck cancer

    Directory of Open Access Journals (Sweden)

    Nam Phong Nguyen

    2013-07-01

    Full Text Available Treatment of locally advanced head and neck cancer remains a challenge because of the head and neck complex anatomy and the tumor invasion to the adjacent organs and/or metastases to the cervical nodes. Postoperative irradiation or concurrent chemoradiation may lead to damage of radiosensitive structures such as the salivary glands, mandible, cochlea, larynx, and pharyngeal muscles. Xerostomia, osteoradionecrosis, deafness, hoarseness of the voice, dysphagia, and aspiration remain serious complications of head and neck irradiation and impair patient quality of life. Intensity-modulated and image-guided radiotherapy by virtue of steep dose gradient and daily imaging may allow for decreased radiation of the organs at risk for complication while preserving loco-regional control.

  8. Transcortical mixed aphasia due to cerebral infarction in left inferior frontal lobe and temporo-parietal lobe

    International Nuclear Information System (INIS)

    Maeshima, S.; Matsumoto, T.; Ueyoshi, A.; Toshiro, H.; Sekiguchi, E.; Okita, R.; Yamaga, H.; Ozaki, F.; Moriwaki, H.; Roger, P.

    2002-01-01

    We present a case of transcortical mixed aphasia caused by a cerebral embolism. A 77-year-old right-handed man was admitted to our hospital with speech disturbance and a right hemianopia. His spontaneous speech was remarkably reduced, and object naming, word fluency, comprehension, reading and writing were all severely disturbed. However, repetition of phonemes and sentences and reading aloud were fully preserved. Although magnetic resonance imaging (MRI) showed cerebral infarcts in the left frontal and parieto-occipital lobe which included the inferior frontal gyrus and angular gyrus, single photon emission CT revealed a wider area of low perfusion over the entire left hemisphere except for part of the left perisylvian language areas. The amytal (Wada) test, which was performed via the left internal carotid artery, revealed that the left hemisphere was dominant for language. Hence, it appears that transcortical mixed aphasia may be caused by the isolation of perisylvian speech areas, even if there is a lesion in the inferior frontal gyrus, due to disconnection from surrounding areas. (orig.)

  9. Transcortical mixed aphasia due to cerebral infarction in left inferior frontal lobe and temporo-parietal lobe

    Energy Technology Data Exchange (ETDEWEB)

    Maeshima, S.; Matsumoto, T.; Ueyoshi, A. [Department of Physical Medicine and Rehabilitation, Wakayama Medical University, Wakayama (Japan); Toshiro, H.; Sekiguchi, E.; Okita, R.; Yamaga, H.; Ozaki, F.; Moriwaki, H. [Department of Neurological Surgery, Hidaka General Hospital, Wakayama (Japan); Roger, P. [School of Communication Sciences and Disorders, University of Sydney, Sydney, NSW (Australia)

    2002-02-01

    We present a case of transcortical mixed aphasia caused by a cerebral embolism. A 77-year-old right-handed man was admitted to our hospital with speech disturbance and a right hemianopia. His spontaneous speech was remarkably reduced, and object naming, word fluency, comprehension, reading and writing were all severely disturbed. However, repetition of phonemes and sentences and reading aloud were fully preserved. Although magnetic resonance imaging (MRI) showed cerebral infarcts in the left frontal and parieto-occipital lobe which included the inferior frontal gyrus and angular gyrus, single photon emission CT revealed a wider area of low perfusion over the entire left hemisphere except for part of the left perisylvian language areas. The amytal (Wada) test, which was performed via the left internal carotid artery, revealed that the left hemisphere was dominant for language. Hence, it appears that transcortical mixed aphasia may be caused by the isolation of perisylvian speech areas, even if there is a lesion in the inferior frontal gyrus, due to disconnection from surrounding areas. (orig.)

  10. A (short) history of image-guided radiotherapy

    International Nuclear Information System (INIS)

    Verellen, Dirk; Ridder, Mark de; Storme, Guy

    2008-01-01

    Progress in radiotherapy is guided by the need to realize improved dose distributions, i.e. the ability to reduce the treatment volume toward the target volume and still ensuring coverage of that target volume in all dimensions. Poor ability to control the tumour's location limits the accuracy with which radiation can be delivered to tumour-bearing tissue. Image-guided radiation therapy (IGRT) aims at in-room imaging guiding the radiation delivery based on instant knowledge of the target location and changes in tumour volume during treatment. Advancements are usually not to be attributed to a single event, but rather a combination of many small improvements that together enable a superior result. Image-guidance is an important link in the treatment chain and as such a major factor in this synergetic process. A historic review shows that many of the so-called new developments are not so new at all, but did not make it into mainstream radiotherapy practice at that time. Recent developments in improved IT infrastructures, novel irradiation techniques, and better knowledge of functional and morphologic information may have created the need and optimal environment to revive the interest in IGRT

  11. Usefulness of automated biopsy guns in image-guided biopsy

    International Nuclear Information System (INIS)

    Lee, Jung Hyung; Rhee, Chang Soo; Lee, Sung Moon; Kim, Hong; Woo, Sung Ku; Suh, Soo Jhi

    1994-01-01

    To evaluate the usefulness of automated biopsy guns in image-guided biopsy of lung, liver, pancreas and other organs. Using automated biopsy devices, 160 biopsies of variable anatomic sites were performed: Biopsies were performed under ultrasonographic(US) guidance in 95 and computed tomographic (CT) guidance in 65. We retrospectively analyzed histologic results and complications. Specimens were adequate for histopathologic diagnosis in 143 of the 160 patients(89.4%)-Diagnostic tissue was obtained in 130 (81.3%), suggestive tissue obtained in 13(8.1%), and non-diagnostic tissue was obtained in 14(8.7%). Inadequate tissue was obtained in only 3(1.9%). There was no statistically significant difference between US-guided and CT-guided percutaneous biopsy. There was no occurrence of significant complication. We have experienced mild complications in only 5 patients-2 hematuria and 2 hematochezia in transrectal prostatic biopsy, and 1 minimal pneumothorax in CT-guided percutaneous lung biopsy. All of them were resolved spontaneously. The image-guided biopsy using the automated biopsy gun was a simple, safe and accurate method of obtaining adequate specimen for the histopathologic diagnosis

  12. Image-Guided Transcranial Focused Ultrasound Stimulates Human Primary Somatosensory Cortex

    Science.gov (United States)

    Lee, Wonhye; Kim, Hyungmin; Jung, Yujin; Song, In-Uk; Chung, Yong An; Yoo, Seung-Schik

    2015-03-01

    Focused ultrasound (FUS) has recently been investigated as a new mode of non-invasive brain stimulation, which offers exquisite spatial resolution and depth control. We report on the elicitation of explicit somatosensory sensations as well as accompanying evoked electroencephalographic (EEG) potentials induced by FUS stimulation of the human somatosensory cortex. As guided by individual-specific neuroimage data, FUS was transcranially delivered to the hand somatosensory cortex among healthy volunteers. The sonication elicited transient tactile sensations on the hand area contralateral to the sonicated hemisphere, with anatomical specificity of up to a finger, while EEG recordings revealed the elicitation of sonication-specific evoked potentials. Retrospective numerical simulation of the acoustic propagation through the skull showed that a threshold of acoustic intensity may exist for successful cortical stimulation. The neurological and neuroradiological assessment before and after the sonication, along with strict safety considerations through the individual-specific estimation of effective acoustic intensity in situ and thermal effects, showed promising initial safety profile; however, equal/more rigorous precautionary procedures are advised for future studies. The transient and localized stimulation of the brain using image-guided transcranial FUS may serve as a novel tool for the non-invasive assessment and modification of region-specific brain function.

  13. Image-guided Interstitial Photodynamic Therapy for Squamous Cell Carcinomas: Preclinical investigation

    Science.gov (United States)

    Sajisevi, Mirabelle; Rigual, Nestor R; Bellnier, David A.; Seshadri, Mukund

    2014-01-01

    Objective Photodynamic therapy (PDT) is a clinically approved minimally invasive treatment for cancer. In this preclinical study, using an imaging-guided approach, we examined the potential utility of PDT in the management of bulky squamous cell carcinomas (SCCs). Methods To mimic bulky oropharyngeal cancers seen in the clinical setting, intramuscular SCCs were established in six-to-eight week old female C3H mice. Animals were injected with the photosensitizer, 2-[hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH; 0.4 μmol/kg, i.v.) and tumors were illuminated 24 hours post injection with 665 nm light. PDT as a single treatment modality was administered by surface illumination or by interstitial placement of fibers (iPDT). Magnetic resonance imaging was used to guide treatment and assess tumor response to PDT along with correlative histopathologic assessment. Results Interstitial HPPH-PDT resulted in a marked change on T2 maps 24 hours post treatment compared to untreated controls or transcutaneous illumination. Corresponding apparent diffusion coefficient maps also showed hyperintense areas in tumors following iPDT suggestive of effective photodynamic cell kill. Histologic sections (H&E) confirmed presence of extensive tumor necrosis following iPDT. Conclusions These results highlight the potential utility of PDT in the treatment of bulky oropharyngeal cancers. The findings of our study also demonstrate the utility of MRI as a non-invasive tool for mapping of early tissue response to PDT. PMID:25750858

  14. Image-guided radiotherapy for effective radiotherapy delivery

    CERN Document Server

    Karlsson, Ulf Lennart

    2016-01-01

    Image-guided radiotherapy (IGRT) is a new radiotherapy technology that combines the rapid dose fall off associated with intensity-modulated radiotherapy (IMRT) and daily tumor imaging allowing for high precision tumor dose delivery and effective sparing of surrounding normal organs. The new radiation technology requires close collaboration between radiologists, nuclear medicine specialists, and radiation oncologists to avoid marginal miss. Modern diagnostic imaging such as positron emission tomography (PET) scans, positron emission tomography with Computed Tomograpgy (PET-CT), and magnetic resonance imaging (MRI) allows the radiation oncologist to target the positive tumor with high accuracy. As the tumor is well visualized during radiation treatment, the margins required to avoid geographic miss can be safely reduced , thus sparing the normal organs from excessive radiation. When the tumor is located close to critical radiosensitive structures such as the spinal cord, IGRT can deliver a high dose of radiatio...

  15. [Diagnosis of bone lesions using image guided percutaneous biopsy].

    Science.gov (United States)

    Contreras, Oscar; Burdiles, Alvaro

    2006-10-01

    Percutaneous biopsies have a good sensitivity and specificity for the diagnosis of bone lesions. To report the experience with 270 percutaneous bone lesions biopsies guided with fluoroscopy or computed tomography. Retrospective review of the medical records of 270 patients (mean age 53.4 years, range 4 to 95 years; 134 female) subjected to a percutaneous biopsy of a bone lesion, guided either by computed tomography or fluoroscopy. The final analysis included the tumor type, tumor malignancy, tumor grade and complications of the procedure. One hundred seventy nine lesions were malignant and 91 benign. Of the malignant lesions, 95 were metastatic and 84 were primary. In 3 cases, the initial diagnosis was a false negative (1.1%). Only one patient had a local hematoma after the procedure. Image guided percutaneous biopsy of bone lesions is a safe, effective, fast and economic procedure to obtain a pathological diagnosis of bone lesions.

  16. Fast-MICP for frameless image-guided surgery

    International Nuclear Information System (INIS)

    Lee, Jiann-Der; Huang, Chung-Hsien; Wang, Sheng-Ta; Lin, Chung-Wei; Lee, Shin-Tseng

    2010-01-01

    Purpose: In image-guided surgery (IGS) systems, image-to-physical registration is critical for reliable anatomical information mapping and spatial guidance. Conventional stereotactic frame-based or fiducial-based approaches provide accurate registration but are not patient-friendly. This study proposes a frameless cranial IGS system that uses computer vision techniques to replace the frame or fiducials with the natural features of the patient. Methods: To perform a cranial surgery with the proposed system, the facial surface of the patient is first reconstructed by stereo vision. Accuracy is ensured by capturing parallel-line patterns projected from a calibrated LCD projector. Meanwhile, another facial surface is reconstructed from preoperative computed tomography (CT) images of the patient. The proposed iterative closest point (ICP)-based algorithm [fast marker-added ICP (Fast-MICP)] is then used to register the two facial data sets, which transfers the anatomical information from the CT images to the physical space. Results: Experimental results reveal that the Fast-MICP algorithm reduces the computational cost of marker-added ICP (J.-D. Lee et al., ''A coarse-to-fine surface registration algorithm for frameless brain surgery,'' in Proceedings of International Conference of the IEEE Engineering in Medicine and Biology Society, 2007, pp. 836-839) to 10% and achieves comparable registration accuracy, which is under 3 mm target registration error (TRE). Moreover, two types of optical-based spatial digitizing devices can be integrated for further surgical navigation. Anatomical information or image-guided surgical landmarks can be projected onto the patient to obtain an immersive augmented reality environment. Conclusion: The proposed frameless IGS system with stereo vision obtains TRE of less than 3 mm. The proposed Fast-MICP registration algorithm reduces registration time by 90% without compromising accuracy.

  17. Radiologists' leading position in image-guided therapy.

    Science.gov (United States)

    Helmberger, Thomas; Martí-Bonmatí, Luis; Pereira, Philippe; Gillams, Alice; Martínez, Jose; Lammer, Johannes; Malagari, Katarina; Gangi, Afshin; de Baere, Thierry; Adam, E Jane; Rasch, Coen; Budach, Volker; Reekers, Jim A

    2013-02-01

    Image-guided diagnostic and therapeutic procedures are related to, or performed under, some kind of imaging. Such imaging may be direct inspection (as in open surgery) or indirect inspection as in endoscopy or laparoscopy. Common to all these techniques is the transformation of optical and visible information to a monitor or the eye of the operator. Image-guided therapy (IGT) differs by using processed imaging data acquired before, during and after a wide range of different imaging techniques. This means that the planning, performing and monitoring, as well as the control of the therapeutic procedure, are based and dependent on the "virtual reality" provided by imaging investigations. Since most of such imaging involves radiology in the broadest sense, there is a need to characterise IGT in more detail. In this paper, the technical, medico-legal and medico-political issues will be discussed. The focus will be put on state-of-the-art imaging, technical developments, methodological and legal requisites concerning radiation protection and licensing, speciality-specific limitations and crossing specialty borders, definition of technical and quality standards, and finally to the issue of awareness of IGT within the medical and public community. The specialty-specific knowledge should confer radiologists with a significant role in the overall responsibility for the imaging-related processes in various non-radiological specialties. These processes may encompass purchase, servicing, quality management, radiation protection and documentation, also taking responsibility for the definition and compliance with the legal requirements regarding all radiological imaging performed by non-radiologists.

  18. Tumor Penetrating Theranostic Nanoparticles for Enhancement of Targeted and Image-guided Drug Delivery into Peritoneal Tumors following Intraperitoneal Delivery.

    Science.gov (United States)

    Gao, Ning; Bozeman, Erica N; Qian, Weiping; Wang, Liya; Chen, Hongyu; Lipowska, Malgorzata; Staley, Charles A; Wang, Y Andrew; Mao, Hui; Yang, Lily

    2017-01-01

    The major obstacles in intraperitoneal (i.p.) chemotherapy of peritoneal tumors are fast absorption of drugs into the blood circulation, local and systemic toxicities, inadequate drug penetration into large tumors, and drug resistance. Targeted theranostic nanoparticles offer an opportunity to enhance the efficacy of i.p. therapy by increasing intratumoral drug delivery to overcome resistance, mediating image-guided drug delivery, and reducing systemic toxicity. Herein we report that i.p. delivery of urokinase plasminogen activator receptor (uPAR) targeted magnetic iron oxide nanoparticles (IONPs) led to intratumoral accumulation of 17% of total injected nanoparticles in an orthotopic mouse pancreatic cancer model, which was three-fold higher compared with intravenous delivery. Targeted delivery of near infrared dye labeled IONPs into orthotopic tumors could be detected by non-invasive optical and magnetic resonance imaging. Histological analysis revealed that a high level of uPAR targeted, PEGylated IONPs efficiently penetrated into both the peripheral and central tumor areas in the primary tumor as well as peritoneal metastatic tumor. Improved theranostic IONP delivery into the tumor center was not mediated by nonspecific macrophage uptake and was independent from tumor blood vessel locations. Importantly, i.p. delivery of uPAR targeted theranostic IONPs carrying chemotherapeutics, cisplatin or doxorubicin, significantly inhibited the growth of pancreatic tumors without apparent systemic toxicity. The levels of proliferating tumor cells and tumor vessels in tumors treated with the above theranostic IONPs were also markedly decreased. The detection of strong optical signals in residual tumors following i.p. therapy suggested the feasibility of image-guided surgery to remove drug-resistant tumors. Therefore, our results support the translational development of i.p. delivery of uPAR-targeted theranostic IONPs for image-guided treatment of peritoneal tumors.

  19. Concept for quantifying the dose from image guided radiotherapy

    International Nuclear Information System (INIS)

    Schneider, Uwe; Hälg, Roger; Besserer, Jürgen

    2015-01-01

    Radiographic image guidance is routinely used for patient positioning in radiotherapy. All radiographic guidance techniques can give a significant radiation dose to the patient. The dose from diagnostic imaging is usually managed by using effective dose minimization. In contrast, image-guided radiotherapy adds the imaging dose to an already high level of therapeutic radiation which cannot be easily managed using effective dose. The purpose of this work is the development of a concept of IGRT dose quantification which allows a comparison of imaging dose with commonly accepted variations of therapeutic dose. It is assumed that dose variations of the treatment beam which are accepted in the spirit of the ALARA convention can also be applied to the additional imaging dose. Therefore we propose three dose categories: Category I: The imaging dose is lower than a 2 % variation of the therapy dose. Category II: The imaging dose is larger than in category I, but lower than the therapy dose variations between different treatment techniques. Category III: The imaging dose is larger than in Category II. For various treatment techniques dose measurements are used to define the dose categories. The imaging devices were categorized according to the measured dose. Planar kV-kV imaging is a category I imaging procedure. kV-MV imaging is located at the edge between category I and II and is for increasing fraction size safely a category I imaging technique. MV-MV imaging is for all imaging technologies a category II procedure. MV fan beam CT for localization is a category I technology. Low dose protocols for kV CBCT are located between category I and II and are for increasing fraction size a category I imaging technique. All other investigated Pelvis-CBCT protocols are category II procedures. Fan beam CT scout views are category I technology. Live imaging modalities are category III for conventional fractionation, but category II for stereotactic treatments. Dose from radiotherapy

  20. An image guided algorithm for range map super-resolution

    Science.gov (United States)

    Lei, Jieyu; Han, Shaokun; Xia, Wenze; Wang, Liang; Zhai, Yu

    2018-01-01

    Three-dimensional imaging is increasingly becoming important in a number of applications that observe and analyze real-world environments. Range sensors, such as flash imaging Lidar and Time-of-flight camera, which can deliver high accuracy range measurement images, but are limited by the low resolution. To overcome this limitation, this paper shows the benefit of multimodal sensor system, combining a low-resolution range sensor with a high-resolution optical sensor, in order to provide a high-resolution, low-noise range image of the scene. First, an extrinsic calibration algorithm is used to align the range map with optical image. Then, an image-guided algorithm is proposed to solve the super-resolution optimization problem. This algorithm using the Markov Random Field framework. It defines an energy function that combines a standard quadratic data term and a regularizing term with the weighting factors that relate optical image edges to range map edges. Experiments on synthetic and real data are provided and analyzed to validate this method. The result confirms that the quality of the estimated high-resolution range map is improved. This work can be extended for video super-resolution with the consideration of temporal coherence.

  1. Synthesis of multifunctional gold nanoparticles for image guided therapy

    International Nuclear Information System (INIS)

    Laurent, Gautier

    2014-01-01

    The original properties of nanoparticles make them extremely attractive in the field of oncology. In fast, gold nanoparticles coated by macrocyclic ligands allow imaging and therapy with only one object. Therefore, multifunctional platforms are very promising for image-guided therapy, winch constitutes an important step towards personalization of treatment. This consists of stimulating the therapeutic activity of the nanoparticles when their accumulation is high within the tumor zone and low in healthy tissues. A higher selectivity of the treatment is therefore expected. Biodistribution study by SPECT/CT has shown free circulation, renal elimination and a moderate retention by the liver of the nanoparticles. However, this retention is not due to the opsonisation processes. The MRI study of rats' brain carrying a gliosarcoma has shown an accumulation of nanoparticles Au-at-FADOTAGA-Gd in the tumor. Moreover, the co-labeling of these nanoparticles by Ge and 64Cts2+ was successfully performed. As a result, PET/MRI images, a much researched combination but rarely achieved, were acquired on the same animal alter intravenous injection of the co-labeled nanoparticles. The radiosensitizing character of nanoparticles Au-at-TADOTAGA was confirmed by the follow up of tumor growth alter a treatment by MRT (microbeam irradiation) 15 minutes after intratumoral injection of nanoparticles. The therapeutic gain of this treatment has been validated by MRT 24 hours after intravenous injection of nanoparticles to rats carrying gliosarcoma (radioresistant tumor in radiosensitive organ). (author)

  2. Depth perception of stereo overlays in image-guided surgery

    Science.gov (United States)

    Johnson, Laura; Edwards, Philip; Griffin, Lewis; Hawkes, David

    2004-05-01

    See-through augmented reality (AR) systems for image-guided surgery merge volume rendered MRI/CT data directly with the surgeon"s view of the patient during surgery. Research has so far focused on optimizing the technique of aligning and registering the computer-generated anatomical images with the patient"s anatomy during surgery. We have previously developed a registration and calibration method that allows alignment of the virtual and real anatomy to ~1mm accuracy. Recently we have been investigating the accuracy with which observers can interpret the combined visual information presented with an optical see-through AR system. We found that depth perception of a virtual image presented in stereo below a physical surface was misperceived compared to viewing the target in the absence of a surface. Observers overestimated depth for a target 0-2cm below the surface and underestimated the depth for all other presentation depths. The perceptual error could be reduced, but not eliminated, when a virtual rendering of the physical surface was displayed simultaneously with the virtual image. The findings suggest that misperception is due either to accommodation conflict between the physical surface and the projected AR image, or the lack of correct occlusion between the virtual and real surfaces.

  3. Image-guided fusion and navigation: applications in tumor ablation.

    Science.gov (United States)

    Appelbaum, Liat; Mahgerefteh, Sam Y; Sosna, Jacob; Goldberg, S Nahum

    2013-12-01

    Navigation technology and multimodality image fusion represent an important development in interventional radiology. It is a rapidly developing field with great promise for improving, optimizing, and refining our workflow, especially for performing complex and difficult biopsies and ablations. It can potentially reduce procedure time, radiation dose, and complications while enhancing procedure accuracy and effectiveness. Additionally, such techniques are likely to greatly benefit less experienced operators and shorten the long learning curve to mastery of conventional procedures. Here, we describe different aspects of currently available image-guided fusion devices including the types of clinically available technological platforms (electromagnetic vs optical fusion) used to fuse prior and real-time images; pretest planning software; and advantages and limitations reported in preclinical and emerging clinical studies. Much refinement and development still needs to be performed for both the tracking systems and preablation software predictability, but this is anticipated as substantial research within the framework of multiple academic industrial partnerships is ongoing. © 2013 Published by Elsevier Inc.

  4. An analysis of tracking error in image-guided neurosurgery.

    Science.gov (United States)

    Gerard, Ian J; Collins, D Louis

    2015-10-01

    This study quantifies some of the technical and physical factors that contribute to error in image-guided interventions. Errors associated with tracking, tool calibration and registration between a physical object and its corresponding image were investigated and compared with theoretical descriptions of these errors. A precision milled linear testing apparatus was constructed to perform the measurements. The tracking error was shown to increase in linear fashion with distance normal to the camera, and the tracking error ranged between 0.15 and 0.6 mm. The tool calibration error increased as a function of distance from the camera and the reference tool (0.2-0.8 mm). The fiducial registration error was shown to improve when more points were used up until a plateau value was reached which corresponded to the total fiducial localization error ([Formula: see text]0.8 mm). The target registration error distributions followed a [Formula: see text] distribution with the largest error and variation around fiducial points. To minimize errors, tools should be calibrated as close as possible to the reference tool and camera, and tools should be used as close to the front edge of the camera throughout the intervention, with the camera pointed in the direction where accuracy is least needed during surgery.

  5. Photoacoustic image-guided drug delivery in the prostate

    Science.gov (United States)

    Tang, Shanshan; Chen, Jian; Samant, Pratik; Xiang, Liangzhong

    2016-03-01

    Image guided drug delivery is a novel strategy that combines the effect of therapy and visibility into one system. Here we apply photoacoustic (PA) imaging to visualize the drug delivery process, and perform a simulation study on monitoring the photosensitizer concentration in a prostate tumor during photodynamic therapy (PDT). A 3D optical model of the human prostate is developed, and the light absorption distribution in the prostate is estimated by the Monte Carlo simulation method. The filtered back-projection algorithm is used to reconstruct PA images. PA images of transurethral laser/transrectal ultrasound are compared to those of transrectal laser/ultrasound. Results show that the transurethral laser has a better penetration depth in the prostate compared with transrectal one. Urethral thermal safety is investigated via COMSOL Multiphysics, and the results show that the proposed pulsed transurethral laser will cause no thermal damage on the urethral surface. Regression analysis for PA signal amplitude and drug concentration demonstrates that the PA technique has the potential to monitor drug distributions in PDT, as well as in other laser-based prostate therapy modalities.

  6. A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma.

    Science.gov (United States)

    Welch, B T; Eiken, P W; Atwell, T D; Peikert, T; Yi, E S; Nichols, F; Schmit, G D

    2017-06-01

    Mesothelioma has been considered a difficult pathologic diagnosis to achieve via image-guided core needle biopsy. The purpose of this study was to assess the diagnostic sensitivity of percutaneous image-guided biopsy for diagnosis of pleural mesothelioma. Retrospective review was performed to identify patients with a confirmed diagnosis of pleural mesothelioma and who underwent image-guided needle biopsy between January 1, 2002, and January 1, 2016. Thirty-two patients with pleural mesothelioma were identified and included for analysis in 33 image-guided biopsy procedures. Patient, procedural, and pathologic characteristics were recorded. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE)]. Percutaneous image-guided biopsy was associated with an overall sensitivity of 81%. No CTCAE clinically significant complications were observed. No image-guided procedures were complicated by pneumothorax or necessitated chest tube placement. No patients had tumor seeding of the biopsy tract. Percutaneous image-guided biopsy can achieve high sensitivity for pathologic diagnosis of pleural mesothelioma with a low procedural complication rate, potentially obviating need for surgical biopsy.

  7. A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Welch, B. T., E-mail: Welch.brian@mayo.edu; Eiken, P. W.; Atwell, T. D. [Mayo Clinic, Department of Radiology (United States); Peikert, T. [Mayo Clinic, Department of Pulmonary and Critical Care Medicine (United States); Yi, E. S. [Mayo Clinic, Department of Pathology (United States); Nichols, F. [Mayo Clinic, Department of Thoracic Surgery (United States); Schmit, G. D. [Mayo Clinic, Department of Radiology (United States)

    2017-06-15

    PurposeMesothelioma has been considered a difficult pathologic diagnosis to achieve via image-guided core needle biopsy. The purpose of this study was to assess the diagnostic sensitivity of percutaneous image-guided biopsy for diagnosis of pleural mesothelioma.Materials and MethodsRetrospective review was performed to identify patients with a confirmed diagnosis of pleural mesothelioma and who underwent image-guided needle biopsy between January 1, 2002, and January 1, 2016. Thirty-two patients with pleural mesothelioma were identified and included for analysis in 33 image-guided biopsy procedures. Patient, procedural, and pathologic characteristics were recorded. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE)].ResultsPercutaneous image-guided biopsy was associated with an overall sensitivity of 81%. No CTCAE clinically significant complications were observed. No image-guided procedures were complicated by pneumothorax or necessitated chest tube placement. No patients had tumor seeding of the biopsy tract.ConclusionPercutaneous image-guided biopsy can achieve high sensitivity for pathologic diagnosis of pleural mesothelioma with a low procedural complication rate, potentially obviating need for surgical biopsy.

  8. IMRT for Image-Guided Single Vocal Cord Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Osman, Sarah O.S., E-mail: s.osman@erasmusmc.nl [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Astreinidou, Eleftheria; Boer, Hans C.J. de; Keskin-Cambay, Fatma; Breedveld, Sebastiaan; Voet, Peter; Al-Mamgani, Abrahim; Heijmen, Ben J.M.; Levendag, Peter C. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2012-02-01

    Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose {+-} standard deviation to the planning target volume was 67 {+-} 1 Gy. The contralateral vocal cord dose was reduced from 66 {+-} 1 Gy in the conventional plans to 39 {+-} 8 Gy and 36 {+-} 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

  9. IMRT for Image-Guided Single Vocal Cord Irradiation

    International Nuclear Information System (INIS)

    Osman, Sarah O.S.; Astreinidou, Eleftheria; Boer, Hans C.J. de; Keskin-Cambay, Fatma; Breedveld, Sebastiaan; Voet, Peter; Al-Mamgani, Abrahim; Heijmen, Ben J.M.; Levendag, Peter C.

    2012-01-01

    Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose ± standard deviation to the planning target volume was 67 ± 1 Gy. The contralateral vocal cord dose was reduced from 66 ± 1 Gy in the conventional plans to 39 ± 8 Gy and 36 ± 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

  10. Image guided versus palpation guided core needle biopsy of palpable breast masses: a prospective study

    Directory of Open Access Journals (Sweden)

    Smriti Hari

    2016-01-01

    Interpretation & conclusions: Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates.

  11. Determination of parameters of image quality a system of image guided radiotherapy based on CBCT

    International Nuclear Information System (INIS)

    Gutierrez Ramos, S.; Luis Simon Florencio, J.; Rodriguez Alarcon, C.; Vicent Granado, D.; Herrador Cordoba, M.

    2013-01-01

    In modern radiotherapy image-guided treatments constitute one of the fundamental advances. Therefore the knowledge of the goodness of its operation is essential for the correct application of the treatment. The objective of this study is to determine the quality parameters of a system of image guided recently acquired by our Center, and compare them with those specified by the manufacturer and those published in the literature. (Author)

  12. Health technology assessment of image-guided radiotherapy (IGRT): A systematic review of current evidence

    OpenAIRE

    Arabloo, Jalal; Hamouzadeh, Pejman; Mousavinezhad, Seyedeh Maryam; Mobinizadeh, Mohammadreza; Olyaeemanesh, Alireza; Pooyandjoo, Morvarid

    2016-01-01

    Background: Image-guided radiotherapy used multiple imaging during the radiation therapy course to improve the precision and accuracy of health care provider's treatment. Objectives: This study aims to assess the safety, effectiveness and economic aspects of image-guided radiation therapy for decision-making about this technology in Iran. Methods: In this study, the most important medical databases such as PubMed and Cochrane Library were searched until November 2014. The systematic reviews, ...

  13. Testicular Doses in Image-Guided Radiotherapy of Prostate Cancer

    International Nuclear Information System (INIS)

    Deng Jun; Chen Zhe; Yu, James B.; Roberts, Kenneth B.; Peschel, Richard E.; Nath, Ravinder

    2012-01-01

    Purpose: To investigate testicular doses contributed by kilovoltage cone-beam computed tomography (kVCBCT) during image-guided radiotherapy (IGRT) of prostate cancer. Methods and Materials: An EGS4 Monte Carlo code was used to calculate three-dimensional dose distributions from kVCBCT on 3 prostate cancer patients. Absorbed doses to various organs were compared between intensity-modulated radiotherapy (IMRT) treatments and kVCBCT scans. The impact of CBCT scanning mode, kilovoltage peak energy (kVp), and CBCT field span on dose deposition to testes and other organs was investigated. Results: In comparison with one 10-MV IMRT treatment, a 125-kV half-fan CBCT scan delivered 3.4, 3.8, 4.1, and 5.7 cGy to the prostate, rectum, bladder, and femoral heads, respectively, accounting for 1.7%, 3.2%, 3.2%, and 8.4% of megavoltage photon dose contributions. However, the testes received 2.9 cGy from the same CBCT scan, a threefold increase as compared with 0.7 cGy received during IMRT. With the same kVp, full-fan mode deposited much less dose to organs than half-fan mode, ranging from 9% less for prostate to 69% less for testes, except for rectum, where full-fan mode delivered 34% more dose. As photon beam energy increased from 60 to 125 kV, kVCBCT-contributed doses increased exponentially for all organs, irrespective of scanning mode. Reducing CBCT field span from 30 to 10 cm in the superior–inferior direction cut testicular doses from 5.7 to 0.2 cGy in half-fan mode and from 1.5 to 0.1 cGy in full-fan mode. Conclusions: Compared with IMRT, kVCBCT-contributed doses to the prostate, rectum, bladder, and femoral heads are clinically insignificant, whereas dose to the testes is threefold more. Full-fan CBCT usually deposits much less dose to organs (except for rectum) than half-fan mode in prostate patients. Kilovoltage CBCT–contributed doses increase exponentially with photon beam energy. Reducing CBCT field significantly cuts doses to testes and other organs.

  14. Image guided dose escalated prostate radiotherapy: still room to improve

    Directory of Open Access Journals (Sweden)

    Milosevic Michael

    2009-11-01

    Full Text Available Abstract Background Prostate radiotherapy (RT dose escalation has been reported to result in improved biochemical control at the cost of greater late toxicity. We report on the application of 79.8 Gy in 42 fractions of prostate image guided RT (IGRT. The primary objective was to assess 5-year biochemical control and potential prognostic factors by the Phoenix definition. Secondary endpoints included acute and late toxicity by the Radiotherapy Oncology Group (RTOG scoring scales. Methods From October/2001 and June/2003, 259 men were treated with at least 2-years follow-up. 59 patients had low, 163 intermediate and 37 high risk disease. 43 had adjuvant hormonal therapy (HT, mostly for high- or multiple risk factor intermediate-risk disease (n = 25. They received either 3-dimensional conformal RT (3DCRT, n = 226 or intensity modulated RT (IMRT including daily on-line IGRT with intraprostatic fiducial markers. Results Median follow-up was 67.8 months (range 24.4-84.7. There was no severe (grade 3-4 acute toxicity, and grade 2 acute gastrointestinal (GI toxicity was unusual (10.1%. The 5-year incidence of grade 2-3 late GI and genitourinary (GU toxicity was 13.7% and 12.1%, with corresponding grade 3 figures of 3.5% and 2.0% respectively. HT had an association with an increased risk of grade 2-3 late GI toxicity (11% v 21%, p = 0.018. Using the Phoenix definition for biochemical failure, the 5 year-bNED is 88.4%, 76.5% and 77.9% for low, intermediate and high risk patients respectively. On univariate analysis, T-category and Gleason grade correlated with Phoenix bNED (p = 0.006 and 0.039 respectively. Hormonal therapy was not a significant prognostic factor on uni- or multi-variate analysis. Men with positive prostate biopsies following RT had a lower chance of bNED at 5 years (34.4% v 64.3%; p = 0.147. Conclusion IGRT to 79.8 Gy results in favourable rates of late toxicity compared with published non-IGRT treated cohorts. Future avenues of

  15. Commissioning an image-guided localization system for radiotherapy

    International Nuclear Information System (INIS)

    Phillips, Mark H.; Singer, Karen; Miller, Elizabeth; Stelzer, Keith

    2000-01-01

    Purpose: To describe the design and commissioning of a system for the treatment of classes of tumors that require highly accurate target localization during a course of fractionated external-beam therapy. This system uses image-guided localization techniques in the linac vault to position patients being treated for cranial tumors using stereotactic radiotherapy, conformal radiotherapy, and intensity-modulated radiation therapy techniques. Design constraints included flexibility in the use of treatment-planning software, accuracy and precision of repeat localization, limits on the time and human resources needed to use the system, and ease of use. Methods and Materials: A commercially marketed, stereotactic radiotherapy system, based on a system designed at the University of Florida, Gainesville, was adapted for use at the University of Washington Medical Center. A stereo pair of cameras in the linac vault were used to detect the position and orientation of an array of fiducial markers that are attached to a patient's biteblock. The system was modified to allow the use of either a treatment-planning system designed for stereotactic treatments, or a general, three-dimensional radiation therapy planning program. Measurements of the precision and accuracy of the target localization, dose delivery, and patient positioning were made using a number of different jigs and devices. Procedures were developed for the safe and accurate clinical use of the system. Results: The accuracy of the target localization is comparable to that of other treatment-planning systems. Gantry sag, which cannot be improved, was measured to be 1.7 mm, which had the effect of broadening the dose distribution, as confirmed by a comparison of measurement and calculation. The accuracy of positioning a target point in the radiation field was 1.0 ± 0.2 mm. The calibration procedure using the room-based lasers had an accuracy of 0.76 mm, and using a floor-based radiosurgery system it was 0.73 mm

  16. Transarterial Fiducial Marker Placement for Image-guided Proton Therapy for Malignant Liver Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Ohta, Kengo, E-mail: yesterday.is.yesterday@gmail.com; Shimohira, Masashi, E-mail: mshimohira@gmail.com [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan); Sasaki, Shigeru, E-mail: ssasaki916@yahoo.co.jp; Iwata, Hiromitsu, E-mail: h-iwa-ncu@nifty.com; Nishikawa, Hiroko, E-mail: piroko1018@gmail.com; Ogino, Hiroyuki, E-mail: oginogio@gmail.com; Hara, Masaki, E-mail: mhara@med.nagoya-cu.ac.jp [Nagoya City West Medical Center, Department of Radiation Oncology, Nagoya Proton Therapy Center (Japan); Hashizume, Takuya, E-mail: tky300@gmail.com; Shibamoto, Yuta, E-mail: yshiba@med.nagoya-cu.ac.jp [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan)

    2015-10-15

    PurposeThe aim of this study is to analyze the technical and clinical success rates and safety of transarterial fiducial marker placement for image-guided proton therapy for malignant liver tumors.Methods and MaterialsFifty-five patients underwent this procedure as an interventional treatment. Five patients had 2 tumors, and 4 tumors required 2 markers each, so the total number of procedures was 64. The 60 tumors consisted of 46 hepatocellular carcinomas and 14 liver metastases. Five-mm-long straight microcoils of 0.018 inches in diameter were used as fiducial markers and placed in appropriate positions for each tumor. We assessed the technical and clinical success rates of transarterial fiducial marker placement, as well as the complications associated with it. Technical success was defined as the successful delivery and placement of the fiducial coil, and clinical success was defined as the completion of proton therapy.ResultsAll 64 fiducial coils were successfully installed, so the technical success rate was 100 % (64/64). Fifty-four patients underwent proton therapy without coil migration. In one patient, proton therapy was not performed because of obstructive jaundice due to bile duct invasion by hepatocellular carcinoma. Thus, the clinical success rate was 98 % (54/55). Slight bleeding was observed in one case, but it was stopped immediately and then observed. None of the patients developed hepatic infarctions due to fiducial marker migration.ConclusionTransarterial fiducial marker placement appears to be a useful and safe procedure for proton therapy for malignant liver tumors.

  17. Transarterial Fiducial Marker Placement for Image-guided Proton Therapy for Malignant Liver Tumors

    International Nuclear Information System (INIS)

    Ohta, Kengo; Shimohira, Masashi; Sasaki, Shigeru; Iwata, Hiromitsu; Nishikawa, Hiroko; Ogino, Hiroyuki; Hara, Masaki; Hashizume, Takuya; Shibamoto, Yuta

    2015-01-01

    PurposeThe aim of this study is to analyze the technical and clinical success rates and safety of transarterial fiducial marker placement for image-guided proton therapy for malignant liver tumors.Methods and MaterialsFifty-five patients underwent this procedure as an interventional treatment. Five patients had 2 tumors, and 4 tumors required 2 markers each, so the total number of procedures was 64. The 60 tumors consisted of 46 hepatocellular carcinomas and 14 liver metastases. Five-mm-long straight microcoils of 0.018 inches in diameter were used as fiducial markers and placed in appropriate positions for each tumor. We assessed the technical and clinical success rates of transarterial fiducial marker placement, as well as the complications associated with it. Technical success was defined as the successful delivery and placement of the fiducial coil, and clinical success was defined as the completion of proton therapy.ResultsAll 64 fiducial coils were successfully installed, so the technical success rate was 100 % (64/64). Fifty-four patients underwent proton therapy without coil migration. In one patient, proton therapy was not performed because of obstructive jaundice due to bile duct invasion by hepatocellular carcinoma. Thus, the clinical success rate was 98 % (54/55). Slight bleeding was observed in one case, but it was stopped immediately and then observed. None of the patients developed hepatic infarctions due to fiducial marker migration.ConclusionTransarterial fiducial marker placement appears to be a useful and safe procedure for proton therapy for malignant liver tumors

  18. Percutaneous image-guided cryoablation: current applications and results in the oncologic field.

    Science.gov (United States)

    Cazzato, Roberto Luigi; Garnon, Julien; Ramamurthy, Nitin; Koch, Guillaume; Tsoumakidou, Georgia; Caudrelier, Jean; Arrigoni, Francesco; Zugaro, Luigi; Barile, Antonio; Masciocchi, Carlo; Gangi, Afshin

    2016-12-01

    Percutaneous imaging-guided cryoablation (PICA) is a recently developed technique, which applies extreme hypothermia to destroy tumours under close imaging surveillance. It is minimally invasive, safe, repeatable, and does not interrupt or compromise other oncologic therapies. It presents several advantages over more established heat-based thermal ablation techniques (e.g. radiofrequency ablation; RFA) including intrinsic analgesic properties, superior monitoring capability on multi-modal imaging, ability to treat larger tumours, and preservation of tissue collagenous architecture. There has been a recent large increase in reports evaluating the utility of PICA in a wide range of patients and tumours, but systematic analysis of the literature is challenging due to the rapid pace of change and predominance of extensively heterogeneous level III studies. The precise onco-therapeutic role of PICA has not been established. This narrative review outlines the available evidence for PICA in a range of tumours. Current indications include curative therapy of small T1a renal tumours; curative/palliative therapy of small primary/secondary lung tumours where RFA is unsuitable; palliation of painful bone metastases; and urologic treatment of organ-confined prostate cancer. There is growing evidence to support its use for small hepatic tumours, and encouraging results have been obtained for breast tumours, extra-abdominal desmoid tumours, and management of higher-stage tumours and oligometastatic disease. However, the overall evidence base is weak, effectively restricting PICA to cases where standard therapy and RFA are unsuitable. As the technique and evidence continue to mature, the benefits of this emerging technique will hopefully become more widely available to cancer patients in the future.

  19. Magnetic resonance imaging-guided focused ultrasound to increase localized blood-spinal cord barrier permeability.

    Science.gov (United States)

    Payne, Allison H; Hawryluk, Gregory W; Anzai, Yoshimi; Odéen, Henrik; Ostlie, Megan A; Reichert, Ethan C; Stump, Amanda J; Minoshima, Satoshi; Cross, Donna J

    2017-12-01

    Spinal cord injury (SCI) affects thousands of people every year in the USA, and most patients are left with some permanent paralysis. Therapeutic options are limited and only modestly affect outcome. To address this issue, we used magnetic resonance imaging-guided focused ultrasound (MRgFUS) as a non-invasive approach to increase permeability in the blood-spinal cord barrier (BSCB). We hypothesize that localized, controlled sonoporation of the BSCB by MRgFUS will aid delivery of therapeutics to the injury. Here, we report our preliminary findings for the ability of MRgFUS to increase BSCB permeability in the thoracic spinal cord of a normal rat model. First, an excised portion of normal rat spinal column was used to characterize the acoustic field and to estimate the insertion losses that could be expected in an MRgFUS blood spinal cord barrier opening. Then, in normal rats, MRgFUS was applied in combination with intravenously administered microbubbles to the spinal cord region. Permeability of the BSCB was indicated as signal enhancement by contrast administered prior to T1-weighted magnetic resonance imaging and verified by Evans blue dye. Neurological testing using the Basso, Beattie, and Breshnahan scale and the ladder walk was normal in 8 of 10 rats tested. Two rats showed minor impairment indicating need for further refinement of parameters. No gross tissue damage was evident by histology. In this study, we have opened successfully the blood spinal cord barrier in the thoracic region of the normal rat spine using magnetic resonance-guided focused ultrasound combined with microbubbles.

  20. Image-guided stereotactic surgery using ultrasonography and reconstructive three-dimensional CT-imaging system

    Energy Technology Data Exchange (ETDEWEB)

    Kawamura, Hirotsune; Iseki, Hiroshi; Umezawa, Yoshihiro (Tokyo Women' s Medical Coll. (Japan)) (and others)

    1991-12-01

    A new simulation and navigation system utilizing three-dimensional CT images has been developed for image-guided stereotactic surgery. Preoperative CT images are not always useful in predicting the intraoperative location of lesions, for cerebral lesions are easily displaced or distorted by gravity, brain retraction, and/or CSF aspiration during operative procedure. This new system, however, has the advantage that the intraoperative locations of intracranial lesions or the anatomical structures of the brain can be precisely confirmed during stereotactic surgery. Serial CT images were obtained from a patient whose head had been fixed to the ISEKI CT-guided stereotactic frame. The data of serial CT images were saved on a floppy disc and then transferred to the work station (IRIS) using the off line. In order to find the best approach angle for ultrasound-guided stereotactic surgery, three-dimenstional CT images were reconstructed using the work station. The site of the craniotomy or the angle of the trajectory of the ultrasound probe was measured preoperatively based on the three-dimensional CT images. Then, in the operating room, the patient's head was fixed to the ISEKI frame with the subframe at the same position as before according to the measurement of the CT images. In a case of cystic glioma, the predicable ultrasonograms from three-dimensional reconstructive CT images were ascertained to correspond well to the actual ultrasound images during ultrasound-guided stereotactic surgery. Therefore, the new simulation and navigation system can be judged to be a powerful operative supporting modality for correcting the locations of cerebral lesions; it allows one to perform stereotactic surgery more accurately and less invasively. (author).

  1. Minimally invasive image-guided therapy for inoperable hepatocellular carcinoma: What is the evidence today?

    NARCIS (Netherlands)

    Seinstra, Beatrijs A.; van Delden, Otto M.; van Erpecum, Karel J.; van Hillegersberg, Richard; Mali, Willem P. Th M.; van den Bosch, Maurice A. A. J.

    2010-01-01

    Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver that accounts for an important health problem worldwide. Only 10-15% of HCC patients are suitable candidates for hepatic resection and liver transplantation due to the advanced stage of the disease at time of diagnosis and

  2. Image guided, minimally invasive adenomectomy for solitary gland disease in primary hyperparathyroidism

    NARCIS (Netherlands)

    Smit, Pieter Casper

    2001-01-01

    Introduction: Since the introduction in the 1970s of the unilateral approach in surgery for primary hyperparathyroidism by Wang, authors have increasingly been recommending limited forms of parathyroid surgery. Although unilateral explorations reduce operation time and admission days, decrease

  3. Image guided surgery in the management of craniocerebral gunshot injuries

    OpenAIRE

    Elserry, Tarek; Anwer, Hesham; Esene, Ignatius Ngene

    2013-01-01

    Background: A craniocerebral trauma caused by firearms is a complex injury with high morbidity and mortality. One of the most intriguing and controversial part in their management in salvageable patients is the decision to remove the bullet/pellet. A bullet is foreign to the brain and, in principle, should be removed. Surgical options for bullet extraction span from conventional craniotomy, through C-arm-guided surgery to minimally invasive frame or frameless stereotaxy. But what is the best ...

  4. A study of image-guided radiotherapy of bladder cancer based on lipiodol injection in the bladder wall

    International Nuclear Information System (INIS)

    Soendergaard, Jimmi; Muren, Ludvig Paul; Elstroem, Ulrik Vindelev; Grau, Cai; Hoeyer, Morten; Oerding Olsen, Kasper

    2010-01-01

    Purpose. We have tested a procedure of focal injection of the contrast medium Lipiodol as a fiducial marker for image-guided boost of the tumor in bladder cancer radiotherapy (RT). In this study, we have evaluated the feasibility and the safety of the method as well as the inter- and intra-fraction shift of the bladder tumor. Materials and methods. Five patients with muscle invasive urinary bladder cancer were included in the study. Lipiodol was injected during flexible cystoscopy into the submucosa of the bladder wall at the periphery of the tumor or the post resection tumor-bed. Cone-beam CT (CBCT) scans were acquired daily throughout the course of RT. Results. Lipiodol demarcation of the bladder tumor was feasible and safe with only a minimum of side effects related to the procedure. The Lipiodol spots were visible on CT and CBCT scans for the duration of the RT course. More than half of all the treatment fractions required a geometric shift of 5 mm or more to match on the Lipiodol spots. The mean intra-fraction shift (3D) of the tumor was 3 mm, largest in the anterior-posterior and cranial-caudal directions. Conclusion. This study demonstrates that Lipiodol can be injected into the bladder mucosa and subsequently visualized on CT and CBCT as a fiducial marker. The relatively large inter-fraction shifts in the positions of Lipiodol spots compared to the intra-fraction movement indicates that image-guided RT based on radio-opaque markers is important for RT of the bladder cancer tumor.

  5. Image-guided thermal ablation with MR-based thermometry

    Science.gov (United States)

    Zhu, Mingming; Sun, Ziqi

    2017-01-01

    Thermal ablation techniques such as radiofrequency, microwave, high intensity focused ultrasound (HIFU) and laser have been used as minimally invasive strategies for the treatment of variety of cancers. MR thermometry methods are readily available for monitoring thermal distribution and deposition in real time, leading to decrease of incidents of normal tissue damage around targeted lesion. HIFU and laser-induced thermal therapy (LITT) are the two widely accepted tumor ablation techniques because of their compatibility with MR systems. MRI provides multiple temperature dependent parameters for thermal imaging, such as signal intensity, T1, T2, diffusion coefficient, magnetization transfer, proton resonance frequency shift (PRFS, including phase imaging and spectroscopy) as well as frequency shift of temperature sensitive contrast agents. Absolute temperature mapping techniques, including both spectroscopic imaging using metabolites as a reference and phase imaging using fat as a reference, are immune to susceptibility effects and are not dependent on phase differences. These techniques are intrinsically more reliable than relative temperature measurement by phase mapping methods. If the limitation of low temporal and spatial resolution could be overcome, these methods may be preferred for MR-guided thermal ablation systems. As of today, the most popular MR thermal imaging method applied in tumor thermal ablation surgery is, however, still PRFS based phase mapping technique, which only provides relative temperature change and is prone to motion artifacts. PMID:28812002

  6. Image-guided thermal ablation with MR-based thermometry.

    Science.gov (United States)

    Zhu, Mingming; Sun, Ziqi; Ng, Chin K

    2017-06-01

    Thermal ablation techniques such as radiofrequency, microwave, high intensity focused ultrasound (HIFU) and laser have been used as minimally invasive strategies for the treatment of variety of cancers. MR thermometry methods are readily available for monitoring thermal distribution and deposition in real time, leading to decrease of incidents of normal tissue damage around targeted lesion. HIFU and laser-induced thermal therapy (LITT) are the two widely accepted tumor ablation techniques because of their compatibility with MR systems. MRI provides multiple temperature dependent parameters for thermal imaging, such as signal intensity, T1, T2, diffusion coefficient, magnetization transfer, proton resonance frequency shift (PRFS, including phase imaging and spectroscopy) as well as frequency shift of temperature sensitive contrast agents. Absolute temperature mapping techniques, including both spectroscopic imaging using metabolites as a reference and phase imaging using fat as a reference, are immune to susceptibility effects and are not dependent on phase differences. These techniques are intrinsically more reliable than relative temperature measurement by phase mapping methods. If the limitation of low temporal and spatial resolution could be overcome, these methods may be preferred for MR-guided thermal ablation systems. As of today, the most popular MR thermal imaging method applied in tumor thermal ablation surgery is, however, still PRFS based phase mapping technique, which only provides relative temperature change and is prone to motion artifacts.

  7. Characterization and evaluation of ionizing and non-ionizing imaging systems used in state of the art image-guided radiation therapy techniques

    Science.gov (United States)

    Stanley, Dennis Nichols

    With the growing incidence of cancer worldwide, the need for effective cancer treatment is paramount. Currently, radiation therapy exists as one of the few effective, non-invasive methods of reducing tumor size and has the capability for the elimination of localized tumors. Radiation therapy utilizes non-invasive external radiation to treat localized cancers but to be effective, physicians must be able to visualize and monitor the internal anatomy and target displacements. Image-Guided Radiation Therapy frequently utilizes planar and volumetric imaging during a course of radiation therapy to improve the precision and accuracy of the delivered treatment to the internal anatomy. Clinically, visualization of the internal anatomy allows physicians to refine the treatment to include as little healthy tissue as possible. This not only increases the effectiveness of treatment by damaging only the tumor but also increases the quality of life for the patient by decreasing the amount of healthy tissue damaged. Image-Guided Radiation Therapy is commonly used to treat tumors in areas of the body that are prone to movement, such as the lungs, liver, and prostate, as well as tumors located close to critical organs and tissues such as the tumors in the brain and spinal cord. Image-Guided Radiation Therapy can utilize both ionizing modalities, like x-ray based planar radiography and cone-beam CT, and nonionizing modalities like MRI, ultrasound and video-based optical scanning systems. Currently ionizing modalities are most commonly utilized for their ability to visualize and monitor internal anatomy but cause an increase to the total dose to the patient. Nonionizing imaging modalities allow frequent/continuous imaging without the increase in dose; however, they are just beginning to be clinically implemented in radiation oncology. With the growing prevalence and variety of Image-Guided Radiation Therapy imaging modalities the ability to evaluate the overall image quality, monitor

  8. Image guided surgery in the management of craniocerebral gunshot injuries.

    Science.gov (United States)

    Elserry, Tarek; Anwer, Hesham; Esene, Ignatius Ngene

    2013-01-01

    A craniocerebral trauma caused by firearms is a complex injury with high morbidity and mortality. One of the most intriguing and controversial part in their management in salvageable patients is the decision to remove the bullet/pellet. A bullet is foreign to the brain and, in principle, should be removed. Surgical options for bullet extraction span from conventional craniotomy, through C-arm-guided surgery to minimally invasive frame or frameless stereotaxy. But what is the best surgical option? We prospectively followed up a cohort of 28 patients with cranio-cerebral gunshot injury (CCHSI) managed from January to December 2012 in our department of neurosurgery. The missiles were extracted via stereotaxy (frame or frameless), C-arm-guided, or free-hand-based surgery. Cases managed conservatively were excluded. The Glasgow Outcome Score was used to assess the functional outcome on discharge. Five of the eight "stereotactic cases" had an excellent outcome after missile extraction while the initially planned stereotaxy missed locating the missile in three cases and were thus subjected to free hand craniotomy. Excellent outcome was obtained in five of the nine "neuronavigation cases, five of the eight cases for free hand surgery based on the bony landmarks, and five of the six C-arm-based surgery. Conventional craniotomy isn't indicated in the extraction of isolated, retained, intracranial firearm missiles in civilian injury but could be useful when the missile is incorporated within a surgical lesion. Stereotactic surgery could be useful for bullet extraction, though with limited precision in identifying small pellets because of their small sizes, thus exposing patients to same risk of brain insult when retrieving a missile by conventional surgery. Because of its availability, C-arm-guided surgery continues to be of much benefit, especially in emergency situations. We recommend an extensive long-term study of these treatment modalities for CCGSI.

  9. Current status and future prospects of multi-dimensional image-guided particle therapy

    NARCIS (Netherlands)

    Mori, Shinichiro; Zenklusen, Silvan; Knopf, Antje-Christin

    In this review article we emphasize the importance of "imaging" and "image guidance" in advanced particle therapy from a clinical point of view. Although the image-guided radiotherapy (IGRT) technology used for photon and particle therapy is closely similar, the focus of its application in the two

  10. Injectable Colloidal Gold for Use in Intrafractional 2D Image-Guided Radiation Therapy

    DEFF Research Database (Denmark)

    Jølck, Rasmus Irming; Rydhog, Jonas S.; Christensen, Anders Nymark

    2015-01-01

    In the western world, approximately 50% of all cancer patients receive radiotherapy alone or in combination with surgery or chemotherapy. Image-guided radiotherapy (IGRT) has in recent years been introduced to enhance precision of the delivery of radiation dose to tumor tissue. Fiducial markers a...

  11. Feasibility and effectiveness of image-guided percutaneous biopsy of the urinary bladder.

    Science.gov (United States)

    Butros, Selim Reha; McCarthy, Colin James; Karaosmanoğlu, Ali Devrim; Shenoy-Bhangle, Anuradha S; Arellano, Ronald S

    2015-08-01

    To evaluate the indications, technique, results, and complications of image-guided percutaneous biopsy of the urinary bladder. This retrospective study included 15 patients (10 male, 5 female) who underwent image-guided percutaneous biopsy of the urinary bladder between January 1999 and December 2013. The medical records, imaging studies, procedural details, and long-term follow-up of each patient were reviewed in detail to assess the feasibility of percutaneous bladder biopsy. Ten patients had focal bladder masses and 5 patients had asymmetric or diffuse bladder wall thickening. Eleven patients had either negative or unsatisfactory cystoscopies prior to the biopsy. Percutaneous biopsies were performed under computed tomography guidance in 12 patients and ultrasound in 3 patients. All procedures were technically successful and there were no procedural complications. Malignancy was confirmed in 8 patients, among whom 6 had transitional cell carcinoma, 1 cervical cancer, and 1 prostate cancer metastasis. Seven patients had a benign diagnosis, including 3 that were later confirmed by pathology following surgery and 2 patients with a false-negative result. The overall sensitivity was 80% and accuracy was 87%. Image-guided percutaneous biopsy of the urinary bladder is a safe and technically feasible procedure with a high sensitivity and accuracy rate. Although image-guided bladder biopsy is an uncommon procedure, it should be considered in selected cases when more traditional methods of tissue sampling are either not possible or fail to identify abnormalities detected by cross-sectional imaging.

  12. Automated tru-cut imaging-guided core needle biopsy of canine ...

    African Journals Online (AJOL)

    The purpose of this study was to evaluate the diagnostic value of imaging-guided core needle biopsy for canine orbital mass diagnosis. A second excisional biopsy obtained during surgery or necropsy was used as the reference standard. A prospective feasibility study was conducted in 23 canine orbital masses at a single ...

  13. Image-guided diagnosis of prostate cancer can increase detection of tumors

    Science.gov (United States)

    In the largest prospective study to date of image-guided technology for identifying suspicious regions of the prostate to biopsy, researchers compared the ability of this technology to detect high-risk prostate cancer with that of the current standard of

  14. Image guided surgery : New technology for surgery of soft tissue and bone sarcomas

    NARCIS (Netherlands)

    Reijnders, K.; Coppes, M. H.; van Hulzen, A. L. J.; Gravendeel, J. P.; van Ginkel, R. J.; Hoekstra, H. J.

    Aim: Providing the surgical oncologist with a new means of performing safe and radical sarcoma surgery with the help of image guidance technology. Method: Two patients with pelvic sarcomas were operated upon with the help of an intra-operative navigation system. The technology of image guided

  15. Spatially varying Riemannian elasticity regularization: Application to thoracic CT registration in image-guided radiotherapy

    DEFF Research Database (Denmark)

    Bjerre, Troels; Hansen, Mads Fogtmann; Aznar, M.

    2012-01-01

    For deformable registration of computed tomography (CT) scans in image guided radiation therapy (IGRT) we apply Riemannian elasticity regularization. We explore the use of spatially varying elasticity parameters to encourage bone rigidity and local tissue volume change only in the gross tumor...

  16. Microencapsulation of indocyanine green for potential applications in image-guided drug delivery.

    Science.gov (United States)

    Zhu, Zhiqiang; Si, Ting; Xu, Ronald X

    2015-02-07

    We present a novel process to encapsulate indocyanine green (ICG) in liposomal droplets at high concentration for potential applications in image-guided drug delivery. The microencapsulation process follows two consecutive steps of droplet formation by liquid-driven coaxial flow focusing (LDCFF) and solvent removal by oil phase dewetting. These biocompatible lipid vesicles may have important applications in drug delivery and fluorescence imaging.

  17. Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma

    Directory of Open Access Journals (Sweden)

    Yoshiko Doi, MD

    2017-04-01

    Conclusions: Significant reductions in fV5, fV10, fMLD, V5, and MLD were achieved with the functional image guided VMAT plan without negative effects on other factors. LAA-based functional image guided radiation therapy planning in VMAT is a feasible method to spare the functional lung in patients with MPM.

  18. Neurolinguistic analysis of the language abilities of a patient with a "double disconnection syndrome": a case of subangular alexia in the presence of mixed transcortical aphasia.

    Science.gov (United States)

    Pirozzolo, F J; Kerr, K L; Obrzut, J E; Morley, G K; Haxby, J V; Lundgren, S

    1981-02-01

    In contrast to the classic form of alexia without agraphia, subangular alexia results from a single lesion located deep in the white matter of the left parietal lobe. In the present report, a patient with subangular alexia and features of mixed transcortical aphasia is described. Neurolinguistic findings include: alexia without agraphia, paucity of spontaneous speech, moderate auditory comprehension difficulty, excellent repetition, echopraxia, colour agnosia, and naming disorder. Neurolinguistic tests revealed intact phonological organisation and grammatical filter." Our studies revealed a "double disconnection syndrome," the co-existence of two relatively rare neurobehavioural disorders. Furthermore, the studies reported here clearly show dissociations of language functions in both the visual and auditory modality, which demonstrates that the stages of language processing are separable.

  19. IGF-1 receptor targeted nanoparticles for image-guided therapy of stroma-rich and drug resistant human cancer.

    Science.gov (United States)

    Zhou, Hongyu; Qian, Weiping; Uckun, Fatih M; Zhou, Zhiyang; Wang, Liya; Wang, Andrew; Mao, Hui; Yang, Lily

    2016-04-17

    Low drug delivery efficiency and drug resistance from highly heterogeneous cancer cells and tumor microenvironment represent major challenges in clinical oncology. Growth factor receptor, IGF-1R, is overexpressed in both human tumor cells and tumor associated stromal cells. The level of IGF-1R expression is further up-regulated in drug resistant tumor cells. We have developed IGF-1R targeted magnetic iron oxide nanoparticles (IONPs) carrying multiple anticancer drugs into human tumors. This IGF-1R targeted theranostic nanoparticle delivery system has an iron core for non-invasive MR imaging, amphiphilic polymer coating to ensure the biocompatibility as well as for drug loading and conjugation of recombinant human IGF-1 as targeting molecules. Chemotherapy drugs, Doxorubicin (Dox), was encapsulated into the polymer coating and/or conjugated to the IONP surface by coupling with the carboxyl groups. The ability of IGF1R targeted theranostic nanoparticles to penetrate tumor stromal barrier and enhance tumor cell killing has been demonstrated in human pancreatic cancer patient tissue derived xenograft (PDX) models. Repeated systemic administrations of those IGF-1R targeted theranostic IONP carrying Dox led to breaking the tumor stromal barrier and improved therapeutic effect. Near infrared (NIR) optical and MR imaging enabled noninvasive monitoring of nanoparticle-drug delivery and therapeutic responses. Our results demonstrated that IGF-1R targeted nanoparticles carrying multiple drugs are promising combination therapy approaches for image-guided therapy of stroma-rich and drug resistant human cancer, such as pancreatic cancer.

  20. The Use of Cone Beam Computed Tomography for Image Guided Gamma Knife Stereotactic Radiosurgery: Initial Clinical Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Li, Winnie; Cho, Young-Bin [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Ansell, Steve [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Laperriere, Normand; Ménard, Cynthia; Millar, Barbara-Ann [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Zadeh, Gelareh [Division of Neurosurgery, University of Toronto University Health Network, Toronto Western Hospital, Toronto, Ontario (Canada); Macfeeters-Hamilton Centre for Neuro-oncology, Ontario Cancer Institute, Toronto, Ontario (Canada); Kongkham, Paul; Bernstein, Mark [Division of Neurosurgery, University of Toronto University Health Network, Toronto Western Hospital, Toronto, Ontario (Canada); Jaffray, David A. [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Department of Medical Biophysics, University of Toronto, Toronto, Ontario (Canada); Chung, Caroline, E-mail: caroline.chung.md@gmail.com [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)

    2016-09-01

    Purpose: The present study used cone beam computed tomography (CBCT) to measure the inter- and intrafraction uncertainties for intracranial stereotactic radiosurgery (SRS) using the Leksell Gamma Knife (GK). Methods and Materials: Using a novel CBCT system adapted to the GK radiosurgery treatment unit, CBCT images were acquired immediately before and after treatment for each treatment session within the context of a research ethics board–approved prospective clinical trial. Patients were immobilized in the Leksell coordinate frame (LCF) for both volumetric CBCT imaging and GK-SRS delivery. The relative displacement of the patient's skull to the stereotactic reference (interfraction motion) was measured for each CBCT scan. Differences between the pre- and post-treatment CBCT scans were used to determine the intrafraction motion. Results: We analyzed 20 pre- and 17 post-treatment CBCT scans in 20 LCF patients treated with SRS. The mean translational pretreatment setup error ± standard deviation in the left-right, anteroposterior, and craniocaudal directions was −0.19 ± 0.32, 0.06 ± 0.27, and −0.23 ± 0.2 mm, with a maximum of −0.74, −0.53, and −0.68 mm, respectively. After an average time between the pre- and post-treatment CBCT scans of 82 minutes (range 27-170), the mean intrafraction error ± standard deviation for the LCF was −0.03 ± 0.05, −0.03 ± 0.18, and −0.03 ± 0.12 mm in the left-right, anteroposterior, and craniocaudual direction, respectively. Conclusions: Using CBCT on a prototype image guided GK Perfexion unit, we were able to measure the inter- and intrafraction positional changes for GK-SRS using the invasive frame. In the era of image guided radiation therapy, the use of CBCT image guidance for both frame- and non–frame-based immobilization systems could serve as a useful quality assurance tool. Our preliminary measurements can guide the application of achievable thresholds for inter- and intrafraction

  1. Radiation resistivity of pure silica core image guides for industrial fiberscopes

    International Nuclear Information System (INIS)

    Okamoto, Shinichi; Ohnishi, Tokuhiro; Kanazawa, Tamotsu; Tsuji, Yukio; Hayami, Hiroyuki; Ishitani, Tadayoshi; Akutsu, Takeji; Suzuki, Koichi.

    1991-01-01

    Industrial fiberscopes incorporating pure silica core image guides have been extensively used for remote visual inspection in radiation fields including nuclear power plants, owing to their superior radiation resistivity. The authors have been intensively conducting R and D on improving radiation resistivity of pure silica core image guides. This paper reports the results of experiments to compare the effects of core materials on radiation resistivity and to investigate the dependence of radiation resistivity on total dose, does rate, and support pipe material. The results confirmed the superior radiation resistivity of the core material containing fluorine at any irradiation condition and indicated the existence of a critical dose rate at which radiation-induced deterioration was stabilized. No difference in radiation resistivity attributable to support layer material was observed. (author)

  2. Optimizing MR imaging-guided navigation for focused ultrasound interventions in the brain

    Science.gov (United States)

    Werner, B.; Martin, E.; Bauer, R.; O'Gorman, R.

    2017-03-01

    MR imaging during transcranial MR imaging-guided Focused Ultrasound surgery (tcMRIgFUS) is challenging due to the complex ultrasound transducer setup and the water bolus used for acoustic coupling. Achievable image quality in the tcMRIgFUS setup using the standard body coil is significantly inferior to current neuroradiologic standards. As a consequence, MR image guidance for precise navigation in functional neurosurgical interventions using tcMRIgFUS is basically limited to the acquisition of MR coordinates of salient landmarks such as the anterior and posterior commissure for aligning a stereotactic atlas. Here, we show how improved MR image quality provided by a custom built MR coil and optimized MR imaging sequences can support imaging-guided navigation for functional tcMRIgFUS neurosurgery by visualizing anatomical landmarks that can be integrated into the navigation process to accommodate for patient specific anatomy.

  3. Technical aspects of image-guided respiration-gated radiation therapy

    International Nuclear Information System (INIS)

    Jiang, Steve B.

    2006-01-01

    In this review article, we discuss various technical aspects of image-guided respiration-gated radiation therapy. We first review some basic concepts related to respiratory gating, including gating window, duty cycle, residual motion, internal/external gating, amplitude/phase gating, etc. We then discuss 2 implementations of image-guided respiration-gated treatment, i.e., the Mitsubishi/Hokkaido technique for internal gating and the MGH technique for external gating. Several existing problems related to respiratory gating, namely external gating mode (phase vs. amplitude), imaging dose for internal gating, gated treatment for lung cancer without implanted fiducial makers, as well as gated intensity-modulated radiation therapy issues, are also discussed along with potential solutions

  4. Image-guided Percutaneous Transhepatic Removal of Fish Bone from Liver Abscess.

    Science.gov (United States)

    Lau, Chin Wah; Wong, Kang Min; Gogna, Apoorva

    2017-02-01

    We present a case of a woman who was diagnosed with a hepatic abscess secondary to a migrated fish bone. As the patient did not improve after percutaneous drainage of the abscess, image-guided percutaneous transhepatic removal of the fish bone was performed. Fish bones in hepatic abscesses are typically removed surgically, with the fish bone left in situ in a number of cases. There has been only another reported case of percutaneous transhepatic fish bone removal. We conclude that in the rare case of a hepatic abscess complicating fish bone migration, image-guided percutaneous transhepatic removal of the offending foreign body is a feasible alternative to surgery, especially in high surgical risk patients.

  5. Hard and soft nanoparticles for image-guided surgery in nanomedicine

    Energy Technology Data Exchange (ETDEWEB)

    Locatelli, Erica; Monaco, Ilaria; Comes Franchini, Mauro, E-mail: mauro.comesfranchini@unibo.it [University of Bologn, Department of Industrial Chemistry, “Toso Montanari” (Italy)

    2015-08-15

    The use of hard and/or soft nanoparticles for therapy, collectively called nanomedicine, has great potential in the battle against cancer. Major research efforts are underway in this area leading to development of new drug delivery approaches and imaging techniques. Despite this progress, the vast majority of patients who are affected by cancer today sadly still need surgical intervention, especially in the case of solid tumors. An important perspective for researchers is therefore to provide even more powerful tools to the surgeon for pre- and post-operative approaches. In this context, image-guided surgery, in combination with nanotechnology, opens a new strategy to win this battle. In this perspective, we will analyze and discuss the recent progress with nanoparticles of both metallic and biomaterial composition, and their use to develop powerful systems to be applied in image-guided surgery.

  6. A novel augmented reality system of image projection for image-guided neurosurgery.

    Science.gov (United States)

    Mahvash, Mehran; Besharati Tabrizi, Leila

    2013-05-01

    Augmented reality systems combine virtual images with a real environment. To design and develop an augmented reality system for image-guided surgery of brain tumors using image projection. A virtual image was created in two ways: (1) MRI-based 3D model of the head matched with the segmented lesion of a patient using MRIcro software (version 1.4, freeware, Chris Rorden) and (2) Digital photograph based model in which the tumor region was drawn using image-editing software. The real environment was simulated with a head phantom. For direct projection of the virtual image to the head phantom, a commercially available video projector (PicoPix 1020, Philips) was used. The position and size of the virtual image was adjusted manually for registration, which was performed using anatomical landmarks and fiducial markers position. An augmented reality system for image-guided neurosurgery using direct image projection has been designed successfully and implemented in first evaluation with promising results. The virtual image could be projected to the head phantom and was registered manually. Accurate registration (mean projection error: 0.3 mm) was performed using anatomical landmarks and fiducial markers position. The direct projection of a virtual image to the patients head, skull, or brain surface in real time is an augmented reality system that can be used for image-guided neurosurgery. In this paper, the first evaluation of the system is presented. The encouraging first visualization results indicate that the presented augmented reality system might be an important enhancement of image-guided neurosurgery.

  7. Post-Prostatectomy Image-Guided Radiotherapy: The Invisible Target Concept.

    Science.gov (United States)

    Vilotte, Florent; Antoine, Mickael; Bobin, Maxime; Latorzeff, Igor; Supiot, Stéphane; Richaud, Pierre; Thomas, Laurence; Leduc, Nicolas; Guérif, Stephane; Iriondo-Alberdi, Jone; de Crevoisier, Renaud; Sargos, Paul

    2017-01-01

    In the era of intensity-modulated radiation therapy, image-guided radiotherapy (IGRT) appears crucial to control dose delivery and to promote dose escalation while allowing healthy tissue sparing. The place of IGRT following radical prostatectomy is poorly described in the literature. This review aims to highlight some key points on the different IGRT techniques applicable to prostatic bed radiotherapy. Furthermore, methods used to evaluate target motion and to reduce planning target volume margins will also be explored.

  8. Implementation of a new system of radiotherapy by image-guided based on structures light

    International Nuclear Information System (INIS)

    Brualla Gonzalez, L.; Granero Cabanero, D.; Gonzalez Sanchis, A.; Vicedo Gonzalez, A.; Garcia Hernandez, M. T.; Almendros Blanco, P.; Gordo Partearroyo, J. C.; Pastor Peidro, J. R.; Parreno Romeu, L.; Rosello Ferrando, J.

    2013-01-01

    It has acquired in our facility, a new system of image guided radiotherapy. This equipment is based on Imaging using visible light, a pattern that is known about the surface of the patient. For a particular case have been established as secondary objectives variations of volume control during treatment and its ability to allow the location of the tumor bed within the breast volume. Finally, discusses the possibilities of the system for monitoring the position of the patient during the treatment. (Author)

  9. Craniospinal treatment with IMRT multi-isocentric and image-guided linear accelerator based on Gantry

    International Nuclear Information System (INIS)

    Sanz Beltran, M.; Caballero Perea, B.; Rodriguez Rodriguez, C.; Arminio Diaz, E.; Lopez Fernandez, A.; Gomez Fervienza, J. R.; Crespo Diez, P.; Cantarero Valenzuela, N.; Alvarez Sanchez, M.; Martin Martin, G.; Gomez Fervienza, J. r.; Crespo Diez, P.; Cantarero Valenzuela, N.; Alvarez Sanchez, M.; Martin Martin, G.

    2011-01-01

    The objective is the realization of craniospinal treatment with a linear accelerator equipped with gantry based on MLC, carbon fiber table and Image Guided capability. The great length of treatment (patient l,80m in height) was a great difficulty for want of full length of the longitudinal movement of the table to adequately cover the PTV, plus free metallic screws fastening the head of the table extender preventing further incidents.

  10. The role of contrast-enhanced ultrasonography in image-guided liver ablations

    Energy Technology Data Exchange (ETDEWEB)

    Pescatori, Lorenzo Carlo [Postgraduate School in Radiodiagnostics, University Studi di Milano, Milan (Italy); Sconfienza, Luca Maria; Mauri, Giovanni [Radiology Unit, Policlinico San Donato Research Hospital, Milan (Italy)

    2016-01-15

    We read with great interest the paper by Kim et al. entitled “Local ablation therapy with contrast enhanced ultrasonography for hepatocellular carcinoma: a practical review,” recently published in Ultrasonography. We think that contrast-enhanced ultrasonography (CEUS), together with the development of reliable navigation systems, is likely to represent one of the most important advances in image-guided ablations in recent years. Thus, we offer some considerations on the topic.

  11. Structure-Inherent Targeting of Near-Infrared Fluorophores for Image-Guided Surgery

    OpenAIRE

    Jo, Danbi; Hyun, Hoon

    2017-01-01

    Although various clinical imaging modalities have been developed to visualize internal body structures and detect abnormal tissues prior to surgical procedures, most medical imaging modalities do not provide disease-specific images in real-time. Optical imaging can provide the surgeon with real-time visualization of the surgical field for intraoperative image-guided surgery. Imaging in the near-infrared (NIR) window (650-900 nm), also known as the ?therapeutic window? has high potential by of...

  12. High-Performance 3D Image Processing Architectures for Image-Guided Interventions

    Science.gov (United States)

    2008-01-01

    K. Kyriacou, C. Davatzikos, S. J. Zinreich, and R. N. Bryan, "Nonlinear elastic registration of brain images with tumor pathology using a...Colon Diverticulitis : Imaging with Low-Dose Unenhanced Multi-Detector Row CT," Radiology, vol. 237(1), pp. 189-196, 2005. [178] D. Sennst, M...ABSTRACT Title of Document: HIGH-PERFORMANCE 3D IMAGE PROCESSING ARCHITECTURES FOR IMAGE -GUIDED INTERVENTIONS Omkar

  13. Percutaneous inner-ear access via an image-guided industrial robot system.

    Science.gov (United States)

    Baron, S; Eilers, H; Munske, B; Toennies, J L; Balachandran, R; Labadie, R F; Ortmaier, T; Webster, R J

    2010-01-01

    Image-guided robots have been widely used for bone shaping and percutaneous access to interventional sites. However, due to high-accuracy requirements and proximity to sensitive nerves and brain tissues, the adoption of robots in inner-ear surgery has been slower. In this paper the authors present their recent work towards developing two image-guided industrial robot systems for accessing challenging inner-ear targets. Features of the systems include optical tracking of the robot base and tool relative to the patient and Kalman filter-based data fusion of redundant sensory information (from encoders and optical tracking systems) for enhanced patient safety. The approach enables control of differential robot positions rather than absolute positions, permitting simplified calibration procedures and reducing the reliance of the system on robot calibration in order to ensure overall accuracy. Lastly, the authors present the results of two phantom validation experiments simulating the use of image-guided robots in inner-ear surgeries such as cochlear implantation and petrous apex access.

  14. Structure-Inherent Targeting of Near-Infrared Fluorophores for Image-Guided Surgery.

    Science.gov (United States)

    Jo, Danbi; Hyun, Hoon

    2017-05-01

    Although various clinical imaging modalities have been developed to visualize internal body structures and detect abnormal tissues prior to surgical procedures, most medical imaging modalities do not provide disease-specific images in real-time. Optical imaging can provide the surgeon with real-time visualization of the surgical field for intraoperative image-guided surgery. Imaging in the near-infrared (NIR) window (650-900 nm), also known as the "therapeutic window" has high potential by offering low absorbance and scattering in tissues resulting in minimized background autofluorescence. Clinically, optical fluorescence imaging with the targeted contrast agents provides opportunities for significant advances in intraoperative image-guided surgery. There are only two clinically available NIR fluorophores, indocyanine green (ICG) and methylene blue (MB), that support the image-guided surgery. However, neither of them perform in vivo by providing optimum specificity and stability for targeted image guidance. Therefore, it is of paramount importance to develop targeted NIR fluorophores for unmet clinical needs. Using the right combination of an NIR fluorescence imaging system and a targeted fluorophore, the desired target tissues can be imaged to provide real-time fluorescence guidance without changing the field-of-view during surgery. Thus, in a clinical discipline, the development of NIR fluorophores for 'structure-inherent targeting' is an unmet need for early phase diagnostics with accurate targeting.

  15. MR-compatible laparoscope with a distally mounted CCD for MR image-guided surgery

    Energy Technology Data Exchange (ETDEWEB)

    Yasunaga, Takefumi; Konishi, Kozo; Yamaguchi, Shohei; Okazaki, Ken; Hong, Jae-sung; Nakashima, Hideaki [Kyushu University, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Fukuoka (Japan); Ieiri, Satoshi; Tanoue, Kazuo [Kyushu University Hospital, Department of Advanced Medicine and Innovative Technology, Fukuoka (Japan); Fukuyo, Tsuneo [Shinko Optical Co. Ltd, Bunkyo-ku, Tokyo (Japan); Hashizume, Makoto [Kyushu University, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Fukuoka (Japan); Kyushu University Hospital, Department of Advanced Medicine and Innovative Technology, Fukuoka (Japan)

    2007-06-15

    Objects We have developed a new MR-compatible laparoscope that incorporates a distally mounted charge-coupled device (CCD). The MR-compatibility and feasibility of laparoscopy using the new laparoscope were evaluated during MR image-guided laparoscopic radiofrequency ablation therapy (RFA). Materials and methods MR compatibility of the laparoscope was investigated in terms of MR image artifact caused by electromagnetic interference (EMI) and susceptibility. MR images were obtained using spin echo and gradient echo pulse sequences with a 0.3 T open MRI unit. We performed an in vivo experiment with MR image-guided laparoscopic RFA on three pigs; near real-time MR images and 3-D navigation were possible using intraoperative MR images. Agarose gel was injected into the pigs' livers as puncture targets; the diameter of each target was approximately 20 mm. Results Artifacts resulting from EMI were not found in phantom experiments. MR image-guided laparoscopic RFA was successfully performed in all procedures. Both the laparoscopic vision and near real-time MR images were clear. No artifact was detected on the MR images and the surgeon was able to confirm the true position of the probe and target during treatment using the near real-time MR images. Conclusion Laparoscopic surgery is feasible under intraoperative MR image-guidance using a newly developed MR-compatible laparoscope with a distally mounted CCD. (orig.)

  16. Surgical assessment of the insula. Part 1: surgical anatomy and morphometric analysis of the transsylvian and transcortical approaches to the insula.

    Science.gov (United States)

    Benet, Arnau; Hervey-Jumper, Shawn L; Sánchez, Jose Juan González; Lawton, Michael T; Berger, Mitchel S

    2016-02-01

    Transcortical and transsylvian corridors have been previously described as the main surgical approaches to the insula, but there is insufficient evidence to support one approach versus the other. The authors performed a cadaveric comparative study regarding insular exposure, surgical window and freedom, between the transcortical and transsylvian approaches (with and without cutting superficial sylvian bridging veins). Surgical anatomy and skull surface reference points to the different insular regions are also described. Sixteen cadaveric specimens were embalmed with a customized formula to enhance neurosurgical simulation. Two different blocks were defined in the study: first, transsylvian without (TS) and with the superficial sylvian bridging veins cut (TSVC) and transcortical (TC) approaches to the insula were simulated in all (16) specimens. Insular surface exposure, surgical window and surgical freedom were calculated for each procedure and related to the Berger-Sanai insular glioma classification (Zones I-IV) in 10 specimens. Second, the venous drainage pattern and anatomical landmarks considered critical for surgical planning were studied in all specimens. In the insular Zone I (anterior-superior), the TC approach provided the best insular exposure compared with both TS and TSVC. The surgical window obtained with the TC approach was also larger than that obtained with the TS. The TC approach provided 137% more surgical freedom than the TS approach. Only the TC corridor provided complete insular exposure. In Zone II (posterior-superior), results depended on the degree of opercular resection. Without resection of the precentral gyrus in the operculum, insula exposure, surgical windows and surgical freedom were equivalent. If the opercular cortex was resected, the insula exposure and surgical freedom obtained through the TC approach was greater to that of the other groups. In Zone III (posterior-inferior), the TC approach provided better surgical exposure than

  17. Combined image guided monitoring the pharmacokinetics of rapamycin loaded human serum albumin nanoparticles with a split luciferase reporter

    Science.gov (United States)

    Wang, Fu; Yang, Kai; Wang, Zhe; Ma, Ying; Gutkind, J. Silvio; Hida, Naoki; Niu, Gang; Tian, Jie

    2016-02-01

    Imaging guided techniques have been increasingly employed to investigate the pharmacokinetics (PK) and biodistribution of nanoparticle based drug delivery systems. In most cases, however, the PK profiles of drugs could vary significantly from those of drug delivery carriers upon administration in the blood circulation, which complicates the interpretation of image findings. Herein we applied a genetically encoded luciferase reporter in conjunction with near infrared (NIR) fluorophores to investigate the respective PK profiles of a drug and its carrier in a biodegradable drug delivery system. In this system, a prototype hydrophobic agent, rapamycin (Rapa), was encapsulated into human serum albumin (HSA) to form HSA Rapa nanoparticles, which were then labeled with Cy5 fluorophore to facilitate the fluorescence imaging of HSA carrier. Meanwhile, we employed transgenetic HN12 cells that were modified with a split luciferase reporter, whose bioluminescence function is regulated by Rapa, to reflect the PK profile of the encapsulated agent. It was interesting to discover that there existed an obvious inconsistency of PK behaviors between HSA carrier and rapamycin in vitro and in vivo through near infrared fluorescence imaging (NIFRI) and bioluminescence imaging (BLI) after treatment with Cy5 labeled HSA Rapa. Nevertheless, HSA Rapa nanoparticles manifested favorable in vivo PK and tumor suppression efficacy in a follow-up therapeutic study. The developed strategy of combining a molecular reporter and a fluorophore in this study could be extended to other drug delivery systems to provide profound insights for non-invasive real-time evaluation of PK profiles of drug-loaded nanoparticles in pre-clinical studies.Imaging guided techniques have been increasingly employed to investigate the pharmacokinetics (PK) and biodistribution of nanoparticle based drug delivery systems. In most cases, however, the PK profiles of drugs could vary significantly from those of drug delivery

  18. Magnetic resonance imaging-guided focused laser interstitial thermal therapy for subinsular metastatic adenocarcinoma: technical case report.

    Science.gov (United States)

    Hawasli, Ammar H; Ray, Wilson Z; Murphy, Rory K J; Dacey, Ralph G; Leuthardt, Eric C

    2012-06-01

    To describe the novel use of the AutoLITT System (Monteris Medical, Winnipeg, Manitoba, Canada) for focused laser interstitial thermal therapy (LITT) with intraoperative magnetic resonance imaging (MRI) and stereotactic image guidance for the treatment of metastatic adenocarcinoma in the left insula. The patient was a 61-year-old right-handed man with a history of metastatic adenocarcinoma of the colon. He had previously undergone resection of multiple lesions, Gamma Knife radiosurgery, and whole-brain radiation. Despite treatment of a left insular tumor, serial imaging revealed that the lesion continued to enlarge. Given the refractory nature of this tumor to radiation and the deep-seated location, the patient elected to undergo LITT treatment. The center of the lesion and entry point on the scalp were identified with STEALTH (Medtronic, Memphis, Tennessee) image-guided navigation. The AXiiiS Stereotactic Miniframe (Monteris Medical) for the LITT system was secured onto the skull, and a trajectory was defined to achieve access to the centroid of the tumor. After a burr hole was made, a gadolinium template probe was inserted into the AXiiiS base. The trajectory was confirmed via an intraoperative MRI, and the LITT probe driver was attached to the base and CO2-cooled, side-firing laser LITT probe. The laser was activated and thermometry images were obtained. Two trajectories, posteromedial and anterolateral, produced satisfactory tumor ablation. LITT with intraoperative MRI and stereotactic image guidance is a newly available, minimally invasive, and therapeutically viable technique for the treatment of deep seated brain tumors.

  19. Monitoring of breathing motion in image-guided PBS proton therapy: comparative analysis of optical and electromagnetic technologies.

    Science.gov (United States)

    Fattori, Giovanni; Safai, Sairos; Carmona, Pablo Fernández; Peroni, Marta; Perrin, Rosalind; Weber, Damien Charles; Lomax, Antony John

    2017-03-31

    Motion monitoring is essential when treating non-static tumours with pencil beam scanned protons. 4D medical imaging typically relies on the detected body surface displacement, considered as a surrogate of the patient's anatomical changes, a concept similarly applied by most motion mitigation techniques. In this study, we investigate benefits and pitfalls of optical and electromagnetic tracking, key technologies for non-invasive surface motion monitoring, in the specific environment of image-guided, gantry-based proton therapy. Polaris SPECTRA optical tracking system and the Aurora V3 electromagnetic tracking system from Northern Digital Inc. (NDI, Waterloo, CA) have been compared both technically, by measuring tracking errors and system latencies under laboratory conditions, and clinically, by assessing their practicalities and sensitivities when used with imaging devices and PBS treatment gantries. Additionally, we investigated the impact of using different surrogate signals, from different systems, on the reconstructed 4D CT images. Even though in controlled laboratory conditions both technologies allow for the localization of static fiducials with sub-millimetre jitter and low latency (31.6 ± 1 msec worst case), significant dynamic and environmental distortions limit the potential of the electromagnetic approach in a clinical setting. The measurement error in case of close proximity to a CT scanner is up to 10.5 mm and precludes its use for the monitoring of respiratory motion during 4DCT acquisitions. Similarly, the motion of the treatment gantry distorts up to 22 mm the tracking result. Despite the line of sight requirement, the optical solution offers the best potential, being the most robust against environmental factors and providing the highest spatial accuracy. The significant difference in the temporal location of the reconstructed phase points is used to speculate on the need to apply the same monitoring system for imaging and treatment to

  20. A magnetic resonance image-guided breast needle intervention robot system: overview and design considerations.

    Science.gov (United States)

    Park, Samuel Byeongjun; Kim, Jung-Gun; Lim, Ki-Woong; Yoon, Chae-Hyun; Kim, Dong-Jun; Kang, Han-Sung; Jo, Yung-Ho

    2017-08-01

    We developed an image-guided intervention robot system that can be operated in a magnetic resonance (MR) imaging gantry. The system incorporates a bendable needle intervention robot for breast cancer patients that overcomes the space limitations of the MR gantry. Most breast coil designs for breast MR imaging have side openings to allow manual localization. However, for many intervention procedures, the patient must be removed from the gantry. A robotic manipulation system with integrated image guidance software was developed. Our robotic manipulator was designed to be slim, so as to fit between the patient's side and the MR gantry wall. Only non-magnetic materials were used, and an electromagnetic shield was employed for cables and circuits. The image guidance software was built using open source libraries. In situ feasibility tests were performed in a 3-T MR system. One target point in the breast phantom was chosen by the clinician for each experiment, and our robot moved the needle close to the target point. Without image-guided feedback control, the needle end could not hit the target point (distance = 5 mm) in the first experiment. Using our robotic system, the needle hits the target lesion of the breast phantom at a distance of 2.3 mm from the same target point using image-guided feedback. The second experiment was performed using other target points, and the distance between the final needle end point and the target point was 0.8 mm. We successfully developed an MR-guided needle intervention robot for breast cancer patients. Further research will allow the expansion of these interventions.

  1. Optimization of an Image-Guided Laser-Induced Choroidal Neovascularization Model in Mice.

    Directory of Open Access Journals (Sweden)

    Yan Gong

    Full Text Available The mouse model of laser-induced choroidal neovascularization (CNV has been used in studies of the exudative form of age-related macular degeneration using both the conventional slit lamp and a new image-guided laser system. A standardized protocol is needed for consistent results using this model, which has been lacking. We optimized details of laser-induced CNV using the image-guided laser photocoagulation system. Four lesions with similar size were consistently applied per eye at approximately double the disc diameter away from the optic nerve, using different laser power levels, and mice of various ages and genders. After 7 days, the mice were sacrificed and retinal pigment epithelium/choroid/sclera was flat-mounted, stained with Isolectin B4, and imaged. Quantification of the area of the laser-induced lesions was performed using an established and constant threshold. Exclusion criteria are described that were necessary for reliable data analysis of the laser-induced CNV lesions. The CNV lesion area was proportional to the laser power levels. Mice at 12-16 weeks of age developed more severe CNV than those at 6-8 weeks of age, and the gender difference was only significant in mice at 12-16 weeks of age, but not in those at 6-8 weeks of age. Dietary intake of omega-3 long-chain polyunsaturated fatty acid reduced laser-induced CNV in mice. Taken together, laser-induced CNV lesions can be easily and consistently applied using the image-guided laser platform. Mice at 6-8 weeks of age are ideal for the laser-induced CNV model.

  2. Fabrication of multifaceted, micropatterned surfaces and image-guided patterning using laser scanning lithography.

    Science.gov (United States)

    Slater, John H; West, Jennifer L

    2014-01-01

    This protocol describes the implementation of laser scanning lithography (LSL) for the fabrication of multifaceted, patterned surfaces and for image-guided patterning. This photothermal-based patterning technique allows for selective removal of desired regions of an alkanethiol self-assembled monolayer on a metal film through raster scanning a focused 532 nm laser using a commercially available laser scanning confocal microscope. Unlike traditional photolithography methods, this technique does not require the use of a physical master and instead utilizes digital "virtual masks" that can be modified "on the fly" allowing for quick pattern modifications. The process to create multifaceted, micropatterned surfaces, surfaces that display pattern arrays of multiple biomolecules with each molecule confined to its own array, is described in detail. The generation of pattern configurations from user-chosen images, image-guided LSL is also described. This protocol outlines LSL in four basic sections. The first section details substrate preparation and includes cleaning of glass coverslips, metal deposition, and alkanethiol functionalization. The second section describes two ways to define pattern configurations, the first through manual input of pattern coordinates and dimensions using Zeiss AIM software and the second via image-guided pattern generation using a custom-written MATLAB script. The third section describes the details of the patterning procedure and postpatterning functionalization with an alkanethiol, protein, and both, and the fourth section covers cell seeding and culture. We end with a general discussion concerning the pitfalls of LSL and present potential improvements that can be made to the technique. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. The use of virtual fiducials in image-guided kidney surgery

    Science.gov (United States)

    Glisson, Courtenay; Ong, Rowena; Simpson, Amber; Clark, Peter; Herrell, S. D.; Galloway, Robert

    2011-03-01

    The alignment of image-space to physical-space lies at the heart of all image-guided procedures. In intracranial surgery, point-based registrations can be used with either skin-affixed or bone-implanted extrinsic objects called fiducial markers. The advantages of point-based registration techniques are that they are robust, fast, and have a well developed mathematical foundation for the assessment of registration quality. In abdominal image-guided procedures such techniques have not been successful. It is difficult to accurately locate sufficient homologous intrinsic points in imagespace and physical-space, and the implantation of extrinsic fiducial markers would constitute "surgery before the surgery." Image-space to physical-space registration for abdominal organs has therefore been dominated by surfacebased registration techniques which are iterative, prone to local minima, sensitive to initial pose, and sensitive to percentage coverage of the physical surface. In our work in image-guided kidney surgery we have developed a composite approach using "virtual fiducials." In an open kidney surgery, the perirenal fat is removed and the surface of the kidney is dotted using a surgical marker. A laser range scanner (LRS) is used to obtain a surface representation and matching high definition photograph. A surface to surface registration is performed using a modified iterative closest point (ICP) algorithm. The dots are extracted from the high definition image and assigned the three dimensional values from the LRS pixels over which they lie. As the surgery proceeds, we can then use point-based registrations to re-register the spaces and track deformations due to vascular clamping and surgical tractions.

  4. Five Fraction Image-Guided Radiosurgery for Primary and Recurrent Meningiomas

    Directory of Open Access Journals (Sweden)

    Eric Karl Oermann

    2013-08-01

    Full Text Available Purpose: Benign tumors that arise from the meninges can be difficult to treat due to their potentially large size and proximity to critical structures such as cranial nerves and sinuses. Single fraction radiosurgery may increase the risk of symptomatic peritumoral edema. In this study, we report our results on the efficacy and safety of five fraction image-guided radiosurgery for benign meningiomas. Materials/Methods: Clinical and radiographic data from 38 patients treated with five fraction radiosurgery were reviewed retrospectively. Mean tumor volume was 3.83mm3 (range, 1.08-20.79 mm3. Radiation was delivered using the CyberKnife, a frameless robotic image-guided radiosurgery system with a median total dose of 25 Gy (range, 25 Gy-35 Gy. Results: The median follow-up was 20 months. Acute toxicity was minimal with eight patients (21% requiring a short course of steroids for headache at the end of treatment. Pre-treatment neurological symptoms were present in 24 patients (63.2%. Post treatment, neurological symptoms resolved completely in 14 patients (58.3%, and were persistent in eight patients (33.3%. There were no local failures, 24 tumors remained stable (64% and 14 regressed (36%. Pre-treatment peritumoral edema was observed in five patients (13.2%. Post-treatment asymptomatic peritumoral edema developed in five additional patients (13.2%. On multivariate analysis, pre-treatment peritumoral edema and location adjacent to a large vein were significant risk factors for radiographic post-treatment edema (p = 0.001 and p = 0.026 respectively. Conclusions: These results suggest that five fraction image-guided radiosurgery is well tolerated with a response rate for neurologic symptoms that is similar to other standard treatment options. Rates of peritumoral edema and new cranial nerve deficits following five fraction radiosurgery were low. Longer follow-up is required to validate the safety and long-term effectiveness of this treatment approach.

  5. Chest wall sarcomas are accurately diagnosed by image-guided core needle biopsy.

    Science.gov (United States)

    Kachroo, Puja; Pak, Peter S; Sandha, Harpavan S; Nelson, Scott D; Seeger, Leanne L; Cameron, Robert B; Eilber, Fritz C; Lee, Jay M

    2012-01-01

    Sarcomas are rare mesenchymal malignancies. Accurate preoperative diagnosis is a prerequisite in considering investigational or institutional management algorithms that include neoadjuvant treatment. We reviewed our experience using core needle biopsy for chest wall sarcomas. A retrospective review of our sarcoma databases revealed that 40 core needle biopsies and 35 tumor resections were performed in 34 patients, with chest wall musculoskeletal tumors, referred to the University of California, Los Angeles from 1991 to 2010. Primary, metastatic, or recurrent sarcomas involving the sternum, ribs, and soft tissues of the chest wall were evaluated for (1) adequacy of tissue from image-guided core needle biopsies and (2) accuracy in determining malignancy, histological subtype, and sarcoma grade. Twenty-eight of the 40 needle biopsy samples (70%) were adequate for histopathological analysis. Forty-two percent of nondiagnostic findings occurred due to insufficient tissue, whereas the remainder had sufficient tissue, but the pathologist was unable to determine specific histology. Excluding the nondiagnostic samples, the accuracy in determining malignancy, histological subtype, and grade in sarcomas was 100, 92, and 87%, respectively. The sensitivity and specificity of determining malignancy and high-grade sarcomas were 100, 100, 77, and 100%, respectively. There were no complications from the image-guided biopsies. We demonstrated that image-guided core needle biopsy when performed and reviewed by experienced radiologists and musculoskeletal pathologists is a safe and accurate diagnostic technique for chest wall sarcomas. Core needle biopsy should be considered in the multidisciplinary approach to chest wall musculoskeletal tumors, especially when induction therapy is considered.

  6. Image-guided percutaneous disc sampling: impact of antecedent antibiotics on yield

    International Nuclear Information System (INIS)

    Agarwal, V.; Wo, S.; Lagemann, G.M.; Tsay, J.; Delfyett, W.T.

    2016-01-01

    Aim: To evaluate the effect of antecedent antimicrobial therapy on diagnostic yield from percutaneous image-guided disc-space sampling. Materials and methods: A retrospective review of the electronic health records of all patients who underwent image-guided percutaneous sampling procedures for suspected discitis/osteomyelitis over a 5-year period was performed. One hundred and twenty-four patients were identified. Demographics, medical history, and culture results were recorded as well as duration of presenting symptoms and whether antecedent antibiotic therapy had been administered. Results: Of the 124 patients identified who underwent image-guided percutaneous disc-space sampling, 73 had received antecedent antibiotic treatment compared with 51 who had not. The overall positive culture rate for the present study population was 24% (n=30). The positive culture rate from patients previously on antibiotics was 21% (n=15) compared with 29% (n=15) for patients who had not received prior antibiotic treatment, which is not statistically significant (p=0.26). Eighty-six percent (n=63) of patients who had antecedent antibiotics received treatment for 4 or more days prior to their procedure, whereas 14% (n=10) received treatment for 1–3 days prior to their procedure. The difference in culture positivity rate between these two groups was not statistically significant (p=0.43). Culture results necessitated a change in antibiotic therapy in a third of the patients who had received antecedent antibiotic therapy. Conclusion: Antecedent antibiotic therapy, regardless of duration, did not result in significantly diminished diagnostic yield from percutaneous sampling for suspected discitis/osteomyelitis. The present results suggest that percutaneous biopsy may nonetheless yield positive diagnostic information despite prior antimicrobial therapy. If the diagnostic information may impact choice of therapeutic regimen, percutaneous biopsy should still be considered in cases where

  7. Quality assurance (QA) and quality control (QC) of image guided radiotherapy (IGRT). Osaka Rosai Hospital experience

    International Nuclear Information System (INIS)

    Tsuboi, Kazuki; Yagi, Masayuki; Fujiwara, Kanta

    2013-01-01

    The linear accelerator with image guided radiation therapy (IGRT) was introduced in May 2010. We performed the verification of the IGRT system, id est (i.e.), acceptance test and our original performance test and confirmed the acceptability for clinical use. We also performed daily QA/QC program before the start of treatment. One-year experience of QA/QC program showed excellent stability of IGRT function compared with our old machine. We further hope to establish the more useful management system and QA/QC program. (author)

  8. Bladder cancer diagnosis with fluorescence-image-guided optical coherence tomography

    Science.gov (United States)

    Wang, Z. G.; Durand, D. B.; Adler, H.; Pan, Y. T.

    2006-02-01

    A fluorescence-image-guided OCT (FIG-OCT) system is described, and its ability to enhance the sensitivity and specificity is examined in an animal bladder cancer model. Total 97 specimens were examined by fluorescence imaging, OCT and histological microscopy. The sensitivity and specificity of FIG-OCT is 100% and 93% respectively, compared to 79% and 53% for fluorescence imaging, while the OCT examination time has been dramatically decreased by 3~4 times. In combination of endoscopic OCT, FIG-OCT is a promising technique for effective early bladder cancer diagnosis.

  9. Lanthanide-doped upconverting luminescent nanoparticle platforms for optical imaging-guided drug delivery and therapy.

    Science.gov (United States)

    Shen, Jie; Zhao, Liang; Han, Gang

    2013-05-01

    Lanthanide-doped upconverting luminescent nanoparticles (UCNPs) are promising materials for optical imaging-guided drug delivery and therapy due to their unique optical and chemical properties. UCNPs absorb low energy near-infrared (NIR) light and emit high-energy shorter wavelength photons. Their special features allow them to overcome various problems associated with conventional imaging probes and to provide versatility for creating nanoplatforms with both imaging and therapeutic modalities. Here, we discuss several approaches to fabricate and utilize UCNPs for traceable drug delivery and therapy. Published by Elsevier B.V.

  10. Image-Guided Hydrodynamic Gene Delivery: Current Status and Future Directions

    Directory of Open Access Journals (Sweden)

    Kenya Kamimura

    2015-08-01

    Full Text Available Hydrodynamics-based delivery has been used as an experimental tool to express transgene in small animals. This in vivo gene transfer method is useful for functional analysis of genetic elements, therapeutic effect of oligonucleotides, and cancer cells to establish the metastatic cancer animal model for experimental research. Recent progress in the development of image-guided procedure for hydrodynamics-based gene delivery in large animals directly supports the clinical applicability of this technique. This review summarizes the current status and recent progress in the development of hydrodynamics-based gene delivery and discusses the future directions for its clinical application.

  11. Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

    LENUS (Irish Health Repository)

    Moran, Deirdre E

    2012-09-01

    Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.

  12. Magnetic Nanoparticle Facilitated Drug Delivery for Cancer Therapy with Targeted and Image-Guided Approaches.

    Science.gov (United States)

    Huang, Jing; Li, Yuancheng; Orza, Anamaria; Lu, Qiong; Guo, Peng; Wang, Liya; Yang, Lily; Mao, Hui

    2016-06-14

    With rapid advances in nanomedicine, magnetic nanoparticles (MNPs) have emerged as a promising theranostic tool in biomedical applications, including diagnostic imaging, drug delivery and novel therapeutics. Significant preclinical and clinical research has explored their functionalization, targeted delivery, controllable drug release and image-guided capabilities. To further develop MNPs for theranostic applications and clinical translation in the future, we attempt to provide an overview of the recent advances in the development and application of MNPs for drug delivery, specifically focusing on the topics concerning the importance of biomarker targeting for personalized therapy and the unique magnetic and contrast-enhancing properties of theranostic MNPs that enable image-guided delivery. The common strategies and considerations to produce theranostic MNPs and incorporate payload drugs into MNP carriers are described. The notable examples are presented to demonstrate the advantages of MNPs in specific targeting and delivering under image guidance. Furthermore, current understanding of delivery mechanisms and challenges to achieve efficient therapeutic efficacy or diagnostic capability using MNP-based nanomedicine are discussed.

  13. Four-dimensional targeting error analysis in image-guided radiotherapy

    International Nuclear Information System (INIS)

    Riboldi, M; Baroni, G; Sharp, G C; Chen, G T Y

    2009-01-01

    Image-guided therapy (IGT) involves acquisition and processing of biomedical images to actively guide medical interventions. The proliferation of IGT technologies has been particularly significant in image-guided radiotherapy (IGRT), as a way to increase the tumor targeting accuracy. When IGRT is applied to moving tumors, image guidance becomes challenging, as motion leads to increased uncertainty. Different strategies may be applied to mitigate the effects of motion: each technique is related to a different technological effort and complexity in treatment planning and delivery. The objective comparison of different motion mitigation strategies can be achieved by quantifying the residual uncertainties in tumor targeting, to be detected by means of IGRT technologies. Such quantification requires an extension of targeting error theory to a 4D space, where the 3D tumor trajectory as a function of time measured (4D Targeting Error, 4DTE). Accurate 4DTE analysis can be represented by a motion probability density function, describing the statistical fluctuations of tumor trajectory. We illustrate the application of 4DTE analysis through examples, including weekly variations in tumor trajectory as detected by 4DCT, respiratory gating via external surrogates and real-time tumor tracking.

  14. Reliability of the bony anatomy in image-guided stereotactic radiotherapy of brain metastases.

    Science.gov (United States)

    Guckenberger, Matthias; Baier, Kurt; Guenther, Iris; Richter, Anne; Wilbert, Juergen; Sauer, Otto; Vordermark, Dirk; Flentje, Michael

    2007-09-01

    To evaluate whether the position of brain metastases remains stable between planning and treatment in cranial stereotactic radiotherapy (SRT). Eighteen patients with 20 brain metastases were treated with single-fraction (17 lesions) or hypofractionated (3 lesions) image-guided SRT. Median time interval between planning and treatment was 8 days. Before treatment a cone-beam CT (CBCT) and a conventional CT after application of i.v. contrast were acquired. Setup errors using automatic bone registration (CBCT) and manual soft-tissue registration of the brain metastases (conventional CT) were compared. Tumor size was not significantly different between planning and treatment. The three-dimensional setup error (mean +/- SD) was 4.0 +/- 2.1 mm and 3.5 +/- 2.2 mm according to the bony anatomy and the lesion itself, respectively. A highly significant correlation between automatic bone match and soft-tissue registration was seen in all three directions (r >/= 0.88). The three-dimensional distance between the isocenter according to bone match and soft-tissue registration was 1.7 +/- 0.7 mm, maximum 2.8 mm. Treatment of intracranial pressure with steroids did not influence the position of the lesion relative to the bony anatomy. With a time interval of approximately 1 week between planning and treatment, the bony anatomy of the skull proved to be an excellent surrogate for the target position in image-guided SRT.

  15. An integrated multimodality image-guided robot system for small-animal imaging research

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, Wen-Lin [Department of Radiology, Tzu-Chi University and Radiation Oncology, Buddhist Tzu-Chi General Hospital Hualien, Taiwan (China); Hsin Wu, Tung [Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan (China); Hsu, Shih-Ming [Department of Biomedical Imaging and Radiological Sciences, China Medical University, Taichung, Taiwan (China); Chen, Chia-Lin [Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan (China); Lee, Jason J.S., E-mail: jslee@ym.edu.tw [Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan (China); Huang, Yung-Hui, E-mail: yhhuang@isu.edu.tw [Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan (China)

    2011-10-01

    We design and construct an image-guided robot system for use in small-animal imaging research. This device allows the use of co-registered small-animal PET-MRI images to guide the movements of robotic controllers, which will accurately place a needle probe at any predetermined location inside, for example, a mouse tumor, for biological readouts without sacrificing the animal. This system is composed of three major components: an automated robot device, a CCD monitoring mechanism, and a multimodality registration implementation. Specifically, the CCD monitoring mechanism was used for correction and validation of the robot device. To demonstrate the value of the proposed system, we performed a tumor hypoxia study that involved FMISO small-animal PET imaging and the delivering of a pO{sub 2} probe into the mouse tumor using the image-guided robot system. During our evaluation, the needle positioning error was found to be within 0.153{+-}0.042 mm of desired placement; the phantom simulation errors were within 0.693{+-}0.128 mm. In small-animal studies, the pO{sub 2} probe measurements in the corresponding hypoxia areas showed good correlation with significant, low tissue oxygen tensions (less than 6 mmHg). We have confirmed the feasibility of the system and successfully applied it to small-animal investigations. The system could be easily adapted to extend to other biomedical investigations in the future.

  16. Imaging guided interventional procedures in paediatric uroradiology--a case based overview

    Energy Technology Data Exchange (ETDEWEB)

    Riccabona, M. E-mail: michael.riccabona@kfunigraz.ac.at; Sorantin, E.; Hausegger, K

    2002-08-01

    Objective: To describe the potential and application of interventional image guided procedures in the paediatric urinary tract. Patients and methods: The different techniques are illustrated using case reports. The examples comprise established indications such as percutaneous nephrostomy for compromised kidneys in obstructive uropathy and infection, sonographic guided renal biopsy including monitoring or treatment of complications after biopsy, and evaluation and balloon dilatation of childhood renal artery stenosis. There are new applications such as treatment of stenosis in cutaneous ureterostomy or sonographically guided catheterism for deployment of therapeutic agents. Results: Generally, the procedures are safe and successful. However, complications may occur, and peri-/post-interventional monitoring is mandatory to insure early detection and adequate management. Sometimes additional treatment such as percutaneous embolisation of a symptomatic post biopsy arterio-venous fistula, or a second biopsy for recurrent disease may become necessary. Conclusion: Imaging guided interventional procedures are performed successfully in a variety of diseases of the paediatric urinary tract. They can be considered a valuable additional modality throughout infancy and childhood.

  17. High contrast optical imaging methods for image guided laser ablation of dental caries lesions

    Science.gov (United States)

    LaMantia, Nicole R.; Tom, Henry; Chan, Kenneth H.; Simon, Jacob C.; Darling, Cynthia L.; Fried, Daniel

    2014-02-01

    Laser based methods are well suited for automation and can be used to selectively remove dental caries to minimize the loss of healthy tissues and render the underlying enamel more resistant to acid dissolution. The purpose of this study was to determine which imaging methods are best suited for image-guided ablation of natural non-cavitated carious lesions on occlusal surfaces. Multiple caries imaging methods were compared including near-IR and visible reflectance and quantitative light fluorescence (QLF). In order for image-guided laser ablation to be feasible, chemical and physical modification of tooth surfaces due to laser irradiation cannot greatly reduce the contrast between sound and demineralized dental hard tissues. Sound and demineralized surfaces of 48 extracted human molar teeth with non-cavitated lesions were examined. Images were acquired before and after laser irradiation using visible and near-IR reflectance and QLF at several wavelengths. Polarization sensitive-optical coherence tomography was used to confirm that lesions were present. The highest contrast was attained at 1460-nm and 1500-1700-nm, wavelengths coincident with higher water absorption. The reflectance did not decrease significantly after laser irradiation for those wavelengths.

  18. Image-guided biopsy in patients with suspected ovarian carcinoma: a safe and effective technique?

    Energy Technology Data Exchange (ETDEWEB)

    Griffin, Nyree; Grant, Lee A.; Freeman, Susan J.; Berman, Laurence H.; Sala, Evis [Addenbrooke' s Hospital, Department of Radiology, Cambridge (United Kingdom); Jimenez-Linan, Mercedes [Addenbrooke' s Hospital, Department of Histopathology, Cambridge (United Kingdom); Earl, Helena; Ahmed, Ahmed Ashour; Crawford, Robin; Brenton, James [Addenbrooke' s Hospital, Department of Oncology, Cambridge (United Kingdom)

    2009-01-15

    In patients with suspected advanced ovarian carcinoma, a precise histological diagnosis is required before commencing neo-adjuvant chemotherapy. This study aims to determine the diagnostic accuracy and complication rate of percutaneous biopsies performed under ultrasound or computed tomography guidance. Between 2002 to 2007, 60 consecutive image-guided percutaneous biopsies were performed in patients with suspected ovarian cancer. The following variables were recorded: tissue biopsied, imaging technique, experience of operator, biopsy needle gauge, number of passes, complications, and final histology. Forty-seven patients had omental biopsies, 12 pelvic mass biopsies, and 1 para-aortic lymph node biopsy. Thirty-five biopsies were performed under ultrasound, 25 under computed tomography guidance. Biopsy needle gauges ranged from 14-20 swg with two to five passes for each patient. There were no complications. Histology was obtained in 52 (87%) patients. Percutaneous image-guided biopsy of peritoneal disease or pelvic mass is safe with high diagnostic accuracy. The large-gauge biopsy needle is as safe as the small gauge needle, but has the added value of obtaining tissue samples for immunohistochemistry and genomic studies. (orig.)

  19. Constructing a clinical decision-making framework for image-guided radiotherapy using a Bayesian Network

    International Nuclear Information System (INIS)

    Hargrave, C; Deegan, T; Gibbs, A; Poulsen, M; Moores, M; Harden, F; Mengersen, K

    2014-01-01

    A decision-making framework for image-guided radiotherapy (IGRT) is being developed using a Bayesian Network (BN) to graphically describe, and probabilistically quantify, the many interacting factors that are involved in this complex clinical process. Outputs of the BN will provide decision-support for radiation therapists to assist them to make correct inferences relating to the likelihood of treatment delivery accuracy for a given image-guided set-up correction. The framework is being developed as a dynamic object-oriented BN, allowing for complex modelling with specific subregions, as well as representation of the sequential decision-making and belief updating associated with IGRT. A prototype graphic structure for the BN was developed by analysing IGRT practices at a local radiotherapy department and incorporating results obtained from a literature review. Clinical stakeholders reviewed the BN to validate its structure. The BN consists of a sub-network for evaluating the accuracy of IGRT practices and technology. The directed acyclic graph (DAG) contains nodes and directional arcs representing the causal relationship between the many interacting factors such as tumour site and its associated critical organs, technology and technique, and inter-user variability. The BN was extended to support on-line and off-line decision-making with respect to treatment plan compliance. Following conceptualisation of the framework, the BN will be quantified. It is anticipated that the finalised decision-making framework will provide a foundation to develop better decision-support strategies and automated correction algorithms for IGRT.

  20. Clinical practice of image-guided spine radiosurgery - results from an international research consortium

    Directory of Open Access Journals (Sweden)

    Guckenberger Matthias

    2011-12-01

    Full Text Available Abstract Background Spinal radiosurgery is a quickly evolving technique in the radiotherapy and neurosurgical communities. However, the methods of spine radiosurgery have not been standardized. This article describes the results of a survey about the methods of spine radiosurgery at five international institutions. Methods All institutions are members of the Elekta Spine Radiosurgery Research Consortium and have a dedicated research and clinical focus on image-guided radiosurgery. The questionnaire consisted of 75 items covering all major steps of spine radiosurgery. Results Strong agreement in the methods of spine radiosurgery was observed. In particular, similarities were observed with safety and quality assurance playing an important role in the methods of all institutions, cooperation between neurosurgeons and radiation oncologists in case selection, dedicated imaging for target- and organ-at-risk delineation, application of proper safety margins for the target volume and organs-at-risk, conformal planning and precise image-guided treatment delivery, and close clinical and radiological follow-up. In contrast, three major areas of uncertainty and disagreement were identified: 1 Indications and contra-indications for spine radiosurgery; 2 treatment dose and fractionation and 3 tolerance dose of the spinal cord. Conclusions Results of this study reflect the current practice of spine radiosurgery in large academic centers. Despite close agreement was observed in many steps of spine radiosurgery, further research in form of retrospective and especially prospective studies is required to refine the details of spinal radiosurgery in terms of safety and efficacy.

  1. Biophysical characterization of a relativistic proton beam for image-guided radiosurgery.

    Science.gov (United States)

    Yu, Zhan; Vanstalle, Marie; La Tessa, Chiara; Jiang, Guo-Liang; Durante, Marco

    2012-07-01

    We measured the physical and radiobiological characteristics of 1 GeV protons for possible applications in stereotactic radiosurgery (image-guided plateau-proton radiosurgery). A proton beam was accelerated at 1 GeV at the Brookhaven National Laboratory (Upton, NY) and a target in polymethyl methacrylate (PMMA) was used. Clonogenic survival was measured after exposures to 1-10 Gy in three mammalian cell lines. Measurements and simulations demonstrate that the lateral scattering of the beam is very small. The lateral dose profile was measured with or without the 20-cm plastic target, showing no significant differences up to 2 cm from the axis A large number of secondary swift protons are produced in the target and this leads to an increase of approximately 40% in the measured dose on the beam axis at 20 cm depth. The relative biological effectiveness at 10% survival level ranged between 1.0 and 1.2 on the beam axis, and was slightly higher off-axis. The very low lateral scattering of relativistic protons and the possibility of using online proton radiography during the treatment make them attractive for image-guided plateau (non-Bragg peak) stereotactic radiosurgery.

  2. Integration of intraoperative stereovision imaging for brain shift visualization during image-guided cranial procedures

    Science.gov (United States)

    Schaewe, Timothy J.; Fan, Xiaoyao; Ji, Songbai; Roberts, David W.; Paulsen, Keith D.; Simon, David A.

    2014-03-01

    Dartmouth and Medtronic Navigation have established an academic-industrial partnership to develop, validate, and evaluate a multi-modality neurosurgical image-guidance platform for brain tumor resection surgery that is capable of updating the spatial relationships between preoperative images and the current surgical field. A stereovision system has been developed and optimized for intraoperative use through integration with a surgical microscope and an image-guided surgery system. The microscope optics and stereovision CCD sensors are localized relative to the surgical field using optical tracking and can efficiently acquire stereo image pairs from which a localized 3D profile of the exposed surface is reconstructed. This paper reports the first demonstration of intraoperative acquisition, reconstruction and visualization of 3D stereovision surface data in the context of an industry-standard image-guided surgery system. The integrated system is capable of computing and presenting a stereovision-based update of the exposed cortical surface in less than one minute. Alternative methods for visualization of high-resolution, texture-mapped stereovision surface data are also investigated with the objective of determining the technical feasibility of direct incorporation of intraoperative stereo imaging into future iterations of Medtronic's navigation platform.

  3. Anser EMT: the first open-source electromagnetic tracking platform for image-guided interventions.

    Science.gov (United States)

    Jaeger, Herman Alexander; Franz, Alfred Michael; O'Donoghue, Kilian; Seitel, Alexander; Trauzettel, Fabian; Maier-Hein, Lena; Cantillon-Murphy, Pádraig

    2017-06-01

    Electromagnetic tracking is the gold standard for instrument tracking and navigation in the clinical setting without line of sight. Whilst clinical platforms exist for interventional bronchoscopy and neurosurgical navigation, the limited flexibility and high costs of electromagnetic tracking (EMT) systems for research investigations mitigate against a better understanding of the technology's characterisation and limitations. The Anser project provides an open-source implementation for EMT with particular application to image-guided interventions. This work provides implementation schematics for our previously reported EMT system which relies on low-cost acquisition and demodulation techniques using both National Instruments and Arduino hardware alongside MATLAB support code. The system performance is objectively compared to other commercial tracking platforms using the Hummel assessment protocol. Positional accuracy of 1.14 mm and angular rotation accuracy of [Formula: see text] are reported. Like other EMT platforms, Anser is susceptible to tracking errors due to eddy current and ferromagnetic distortion. The system is compatible with commercially available EMT sensors as well as the Open Network Interface for image-guided therapy (OpenIGTLink) for easy communication with visualisation and medical imaging toolkits such as MITK and 3D Slicer. By providing an open-source platform for research investigations, we believe that novel and collaborative approaches can overcome the limitations of current EMT technology.

  4. Image-guided conformation arc therapy for prostate cancer: Early side effects

    International Nuclear Information System (INIS)

    Soete, Guy; Verellen, Dirk; Michielsen, Dirk; Rappe, Bernard; Keuppen, Frans; Storme, Guy

    2006-01-01

    Purpose: To evaluate early side effects in prostate cancer patients treated with image-guided conformation arc therapy (IGCAT) using a minimultileaf collimator and daily X-ray-assisted patient positioning. Methods and Materials: Between May 2000 and November 2004, 238 cT1-T3N0M0 tumors were treated with doses of 70 or 78 Gy. Seventy patients also received neoadjuvant or concurrent hormonal treatment. Median follow-up is 18 months (range, 4-55 months). Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer toxicity scoring system was used to evaluate early side effects. Results: Grade 1, 2, and >2 acute side effects occurred in 19, 6, and 0% (gastrointestinal) and 37, 16, and 0% (genitourinary) of the patients. No relation between radiation dose and early side effects was observed. Conclusion: Patients treated with image-guided conformation arc therapy experience a low rate of Grade 2 (i.e., requiring medication) early side effects. The definitive evaluation of late side effects and biochemical control requires further follow-up

  5. Multimodal scanning laser ophthalmoscopy for image guided treatment of age-related macular degeneration

    Science.gov (United States)

    Hammer, Daniel X.; Ferguson, R. D.; Patel, Ankit H.; Iftimia, Nicusor V.; Mujat, Mircea; Husain, Deeba

    2009-02-01

    Subretinal neovascular membranes (SRNM) are a deleterious complication of laser eye injury and retinal diseases such as age-related macular degeneration (AMD), choroiditis, and myopic retinopathy. Photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) drugs are approved treatment methods. PDT acts by selective dye accumulation, activation by laser light, and disruption and clotting of the new leaky vessels. However, PDT surgery is currently not image-guided, nor does it proceed in an efficient or automated manner. This may contribute to the high rate of re-treatment. We have developed a multimodal scanning laser ophthalmoscope (SLO) for automated diagnosis and image-guided treatment of SRNMs associated with AMD. The system combines line scanning laser ophthalmoscopy (LSLO), fluorescein angiography (FA), indocyanine green angiography (ICGA), PDT laser delivery, and retinal tracking in a compact, efficient platform. This paper describes the system hardware and software design, performance characterization, and automated patient imaging and treatment session procedures and algorithms. Also, we present initial imaging and tracking measurements on normal subjects and automated lesion demarcation and sizing analysis of previously acquired angiograms. Future pre-clinical testing includes line scanning angiography and PDT treatment of AMD subjects. The automated acquisition procedure, enhanced and expedited data post-processing, and innovative image visualization and interpretation tools provided by the multimodal retinal imager may eventually aid in the diagnosis, treatment, and prognosis of AMD and other retinal diseases.

  6. Development of automatic navigation measuring system using template-matching software in image guided neurosurgery

    International Nuclear Information System (INIS)

    Watanabe, Yohei; Hayashi, Yuichiro; Fujii, Masazumi; Wakabayashi, Toshihiko; Kimura, Miyuki; Tsuzaka, Masatoshi; Sugiura, Akihiro

    2010-01-01

    An image-guided neurosurgery and neuronavigation system based on magnetic resonance imaging has been used as an indispensable tool for resection of brain tumors. Therefore, accuracy of the neuronavigation system, provided by periodic quality assurance (QA), is essential for image-guided neurosurgery. Two types of accuracy index, fiducial registration error (FRE) and target registration error (TRE), have been used to evaluate navigation accuracy. FRE shows navigation accuracy on points that have been registered. On the other hand, TRE shows navigation accuracy on points such as tumor, skin, and fiducial markers. This study shows that TRE is more reliable than FRE. However, calculation of TRE is a time-consuming, subjective task. Software for QA was developed to compute TRE. This software calculates TRE automatically by an image processing technique, such as automatic template matching. TRE was calculated by the software and compared with the results obtained by manual calculation. Using the software made it possible to achieve a reliable QA system. (author)

  7. Accuracy validation of an image guided laparoscopy system for liver resection

    Science.gov (United States)

    Thompson, Stephen; Totz, Johannes; Song, Yi; Johnsen, Stian; Stoyanov, Danail; Ourselin, Sébastien; Gurusamy, Kurinchi; Schneider, Crispin; Davidson, Brian; Hawkes, David; Clarkson, Matthew J.

    2015-03-01

    We present an analysis of the registration component of a proposed image guidance system for image guided liver surgery, using contrast enhanced CT. The analysis is performed on a visually realistic liver phantom and in-vivo porcine data. A robust registration process that can be deployed clinically is a key component of any image guided surgery system. It is also essential that the accuracy of the registration can be quantified and communicated to the surgeon. We summarise the proposed guidance system and discuss its clinical feasibility. The registration combines an intuitive manual alignment stage, surface reconstruction from a tracked stereo laparoscope and a rigid iterative closest point registration to register the intra-operative liver surface to the liver surface derived from CT. Testing of the system on a liver phantom shows that subsurface landmarks can be localised to an accuracy of 2.9 mm RMS. Testing during five porcine liver surgeries demonstrated that registration can be performed during surgery, with an error of less than 10 mm RMS for multiple surface landmarks.

  8. Image guided surgery innovation with graduate students - a new lecture format

    Directory of Open Access Journals (Sweden)

    Friebe Michael

    2015-09-01

    Full Text Available In Image Guided Surgeries (IGS, incremental innovation is normally not a technology push (technology delivered but rather a pull (by learning and working with the clinical users from understanding how these surgeries are performed. Engineers need to understand that only through proper observation, procedure know-how and subsequent analysis and evaluation, clinically relevant innovation can be generated. And, it is also essential to understand the associated health economics that could potentially come with new technological approaches. We created a new lecture format (6 ECTS for graduate students that combined the basics of image guided procedures with innovation tools (Design Thinking, Lean Engineering, Value Proposition Canvas, Innovation Games and actual visits of a surgical procedure. The students had to attend these procedures in small groups and had to identify and work on one or more innovation projects based on their observations and based on a prioritisation of medical need, pains and gains of the stakeholders, and ease of implementation. Almost 200 graduate students completed this training in the past 5 years with excellent results for the participating clinicians, and for the future engineers. This paper presents the lecture content, the setup, some statistics and results with the hope that other institutions will follow to offer similar programs that not only help the engineering students identify what clinically relevant innovation is (invention x clinical implementation, but that also pave the path for future interdisciplinary teams that will lead to incremental and disruptive innovation.

  9. Image-guided Tumor Ablation: Standardization of Terminology and Reporting Criteria—A 10-Year Update

    Science.gov (United States)

    Solbiati, Luigi; Brace, Christopher L.; Breen, David J.; Callstrom, Matthew R.; Charboneau, J. William; Chen, Min-Hua; Choi, Byung Ihn; de Baère, Thierry; Dodd, Gerald D.; Dupuy, Damian E.; Gervais, Debra A.; Gianfelice, David; Gillams, Alice R.; Lee, Fred T.; Leen, Edward; Lencioni, Riccardo; Littrup, Peter J.; Livraghi, Tito; Lu, David S.; McGahan, John P.; Meloni, Maria Franca; Nikolic, Boris; Pereira, Philippe L.; Liang, Ping; Rhim, Hyunchul; Rose, Steven C.; Salem, Riad; Sofocleous, Constantinos T.; Solomon, Stephen B.; Soulen, Michael C.; Tanaka, Masatoshi; Vogl, Thomas J.; Wood, Bradford J.; Goldberg, S. Nahum

    2014-01-01

    Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. © RSNA, 2014 Online supplemental material is available for this article. PMID:24927329

  10. Intrapleural fibrinolytics combined with image-guided chest tube drainage for pleural infection.

    Science.gov (United States)

    Levinson, Gary M; Pennington, Daniel W

    2007-04-01

    To present our method of treating pleural infection by using a combination of image-guided chest tube drainage and intrapleural fibrinolytics. We retrospectively reviewed the medical charts and radiographs of 30 consecutive patients with pleural infection who were seen at our institution from December 15, 1995, to July 1, 2006, 27 of whom received intrapleural urokinase or tissue-type plasminogen activator. End points were death, length of stay in the hospital, and percentage of patients who needed surgery. Placement of chest tubes required image guidance 45.7% of the time. Three patients (10%; 95% confidence interval, 2.1%-26.5%) died of complications from pleural infection. None of the 30 patients (0%; 95% confidence interval, 0%-9.5%) required surgery for treatment of pleural infection. The median hospital length of stay was 11 days. In the treatment of pleural infection, intrapleural urokinase or tissue-type plasminogen activator in combination with careful image-guided placement of chest tubes is highly effective in resolving the effusion and curing the infection.

  11. Image-guided bone resection as a prospective alternative to cutting templates—A preliminary study.

    Science.gov (United States)

    Pietruski, Piotr; Majak, Marcin; Światek-Najwer, Ewelina; Popek, Michal; Jaworowski, Janusz; Zuk, Magdalena; Nowakowski, Filip

    2015-09-01

    To evaluate the accuracy of craniomaxillofacial resections performed with an image-guided surgical sagittal saw. Twenty-four craniomaxillofacial resections were performed using an image-guided sagittal saw. Surgical outcomes were compared with a preoperative virtual plan in terms of the resected bone volume, control point position and osteotomy trajectory angle. Each measurement was performed twice by two independent observers. The best convergence between the planned and actual bone resection was observed for the orbital region (6.33 ± 4.04%). The smallest mean difference between the preoperative and postoperative control point positions (2.00 ± 0.66 mm) and the lowest mean angular deviation between the virtual and actual osteotomy (5.49 ± 3.17 degrees) were documented for the maxillary region. When all the performed procedures were analyzed together, mean difference between the planned and actual bone resection volumes was 9.48 ± 4.91%, mean difference between the preoperative and postoperative control point positions amounted to 2.59 ± 1.41 mm, and mean angular deviation between the planned and actual osteotomy trajectory equaled 8.21 ± 5.69 degrees. The results of this study are encouraging but not fully satisfactory. If further improved, the hereby presented navigation technique may become a valuable supporting method for craniomaxillofacial resections. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  12. An integrated multimodality image-guided robot system for small-animal imaging research

    International Nuclear Information System (INIS)

    Hsu, Wen-Lin; Hsin Wu, Tung; Hsu, Shih-Ming; Chen, Chia-Lin; Lee, Jason J.S.; Huang, Yung-Hui

    2011-01-01

    We design and construct an image-guided robot system for use in small-animal imaging research. This device allows the use of co-registered small-animal PET-MRI images to guide the movements of robotic controllers, which will accurately place a needle probe at any predetermined location inside, for example, a mouse tumor, for biological readouts without sacrificing the animal. This system is composed of three major components: an automated robot device, a CCD monitoring mechanism, and a multimodality registration implementation. Specifically, the CCD monitoring mechanism was used for correction and validation of the robot device. To demonstrate the value of the proposed system, we performed a tumor hypoxia study that involved FMISO small-animal PET imaging and the delivering of a pO 2 probe into the mouse tumor using the image-guided robot system. During our evaluation, the needle positioning error was found to be within 0.153±0.042 mm of desired placement; the phantom simulation errors were within 0.693±0.128 mm. In small-animal studies, the pO 2 probe measurements in the corresponding hypoxia areas showed good correlation with significant, low tissue oxygen tensions (less than 6 mmHg). We have confirmed the feasibility of the system and successfully applied it to small-animal investigations. The system could be easily adapted to extend to other biomedical investigations in the future.

  13. Application of Automated Image-guided Patch Clamp for the Study of Neurons in Brain Slices.

    Science.gov (United States)

    Wu, Qiuyu; Chubykin, Alexander A

    2017-07-31

    Whole-cell patch clamp is the gold-standard method to measure the electrical properties of single cells. However, the in vitro patch clamp remains a challenging and low-throughput technique due to its complexity and high reliance on user operation and control. This manuscript demonstrates an image-guided automatic patch clamp system for in vitro whole-cell patch clamp experiments in acute brain slices. Our system implements a computer vision-based algorithm to detect fluorescently labeled cells and to target them for fully automatic patching using a micromanipulator and internal pipette pressure control. The entire process is highly automated, with minimal requirements for human intervention. Real-time experimental information, including electrical resistance and internal pipette pressure, are documented electronically for future analysis and for optimization to different cell types. Although our system is described in the context of acute brain slice recordings, it can also be applied to the automated image-guided patch clamp of dissociated neurons, organotypic slice cultures, and other non-neuronal cell types.

  14. WE-DE-207A-00: Advances in Image-Guided Neurointerventions-Clinical Pull and Technology Push

    International Nuclear Information System (INIS)

    2016-01-01

    pursued. For the highest spatial and temporal resolution, x-ray guidance with fluoroscopy and angiography although dominant are still being vastly improved. New detectors such as the Micro-Angiographic Fluoroscope (MAF) and x-ray source designs that enable higher outputs while maintaining small focal spots will be highlighted along with new methods for minimizing the radiation dose to patients. Additionally, new platforms for training and device testing that include patient-specific 3D printed vascular phantoms and new metrics such as generalized relative object detectability for objectively inter-comparing systems will be discussed. This will improve the opportunity for better evaluation of these technological advances which should contribute to the safety and efficacy of image guided minimally invasive neuro-endovascular procedures. Learning Objectives: To understand the operation of new x-ray imaging chain components such as detectors and sources To be informed about the latest testing methods, with 3D printed vascular phantoms, and new evaluation metrics for advanced imaging in x-ray image guided neurovascular interventions Advances in cone beam CT anatomical and functional imaging in angio-suite to enable one-stop-shop stroke imaging workflow Guang-Hong Chen - The introduction of flat-panel detector based cone-beam CT in clinical angiographic imaging systems enabled treating physicians to obtain three-dimensional anatomic roadmaps for bony structure, soft brain tissue, and vasculatures for treatment planning and efficacy checking after the procedures. However, much improvement is needed to reduce image artifacts, reduce radiation dose, and add potential functional imaging capability to provide four-dimensional dynamic information of vasculature and brain perfusion. In this presentation, some of the new techniques developed to address radiation dose issues, image artifact reduction and brain perfusion using C-arm cone-beam CT imaging system will be introduced for the

  15. WE-DE-207A-00: Advances in Image-Guided Neurointerventions-Clinical Pull and Technology Push

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    pursued. For the highest spatial and temporal resolution, x-ray guidance with fluoroscopy and angiography although dominant are still being vastly improved. New detectors such as the Micro-Angiographic Fluoroscope (MAF) and x-ray source designs that enable higher outputs while maintaining small focal spots will be highlighted along with new methods for minimizing the radiation dose to patients. Additionally, new platforms for training and device testing that include patient-specific 3D printed vascular phantoms and new metrics such as generalized relative object detectability for objectively inter-comparing systems will be discussed. This will improve the opportunity for better evaluation of these technological advances which should contribute to the safety and efficacy of image guided minimally invasive neuro-endovascular procedures. Learning Objectives: To understand the operation of new x-ray imaging chain components such as detectors and sources To be informed about the latest testing methods, with 3D printed vascular phantoms, and new evaluation metrics for advanced imaging in x-ray image guided neurovascular interventions Advances in cone beam CT anatomical and functional imaging in angio-suite to enable one-stop-shop stroke imaging workflow Guang-Hong Chen - The introduction of flat-panel detector based cone-beam CT in clinical angiographic imaging systems enabled treating physicians to obtain three-dimensional anatomic roadmaps for bony structure, soft brain tissue, and vasculatures for treatment planning and efficacy checking after the procedures. However, much improvement is needed to reduce image artifacts, reduce radiation dose, and add potential functional imaging capability to provide four-dimensional dynamic information of vasculature and brain perfusion. In this presentation, some of the new techniques developed to address radiation dose issues, image artifact reduction and brain perfusion using C-arm cone-beam CT imaging system will be introduced for the

  16. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

    Directory of Open Access Journals (Sweden)

    Murray JR

    2015-11-01

    Full Text Available Julia R Murray,1,2 Helen A McNair,2 David P Dearnaley1,2 1Academic Urology Unit, Institute of Cancer Research, London, 2Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK Abstract: The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion. Keywords: radiotherapy, prostate cancer, post-prostatectomy, image-guided radiation therapy

  17. Multi-institutional MicroCT image comparison of image-guided small animal irradiators

    Science.gov (United States)

    Johnstone, Chris D.; Lindsay, Patricia; E Graves, Edward; Wong, Eugene; Perez, Jessica R.; Poirier, Yannick; Ben-Bouchta, Youssef; Kanesalingam, Thilakshan; Chen, Haijian; E Rubinstein, Ashley; Sheng, Ke; Bazalova-Carter, Magdalena

    2017-07-01

    To recommend imaging protocols and establish tolerance levels for microCT image quality assurance (QA) performed on conformal image-guided small animal irradiators. A fully automated QA software SAPA (small animal phantom analyzer) for image analysis of the commercial Shelley micro-CT MCTP 610 phantom was developed, in which quantitative analyses of CT number linearity, signal-to-noise ratio (SNR), uniformity and noise, geometric accuracy, spatial resolution by means of modulation transfer function (MTF), and CT contrast were performed. Phantom microCT scans from eleven institutions acquired with four image-guided small animal irradiator units (including the commercial PXi X-RAD SmART and Xstrahl SARRP systems) with varying parameters used for routine small animal imaging were analyzed. Multi-institutional data sets were compared using SAPA, based on which tolerance levels for each QA test were established and imaging protocols for QA were recommended. By analyzing microCT data from 11 institutions, we established image QA tolerance levels for all image quality tests. CT number linearity set to R 2  >  0.990 was acceptable in microCT data acquired at all but three institutions. Acceptable SNR  >  36 and noise levels  1.5 lp mm-1 for MTF  =  0.2) was obtained at all but four institutions due to their large image voxel size used (>0.275 mm). Ten of the eleven institutions passed the set QA tolerance for geometric accuracy (2000 HU for 30 mgI ml-1). We recommend performing imaging QA with 70 kVp, 1.5 mA, 120 s imaging time, 0.20 mm voxel size, and a frame rate of 5 fps for the PXi X-RAD SmART. For the Xstrahl SARRP, we recommend using 60 kVp, 1.0 mA, 240 s imaging time, 0.20 mm voxel size, and 6 fps. These imaging protocols should result in high quality images that pass the set tolerance levels on all systems. Average SAPA computation time for complete QA analysis for a 0.20 mm voxel, 400 slice Shelley phantom microCT data set

  18. Pre-surgical integration of FMRI and DTI of the sensorimotor system in transcortical resection of a high-grade insular astrocytoma

    Directory of Open Access Journals (Sweden)

    Chelsea eEkstrand

    2016-03-01

    Full Text Available Herein we report on a patient with a WHO Grade III astrocytoma in the right insular region in close proximity to the internal capsule who underwent a right frontotemporal craniotomy. Total gross resection of insular gliomas remains surgically challenging based on the possibility of damage to the corticospinal tracts. However, maximizing the extent of resection has been shown to decrease future adverse outcomes. Thus, the goal of such surgeries should focus on maximizing extent of resection while minimizing possible adverse outcomes. In this case, pre-surgical planning included integration of functional magnetic resonance imaging (fMRI and diffusion tensor imaging (DTI, to localize motor and sensory pathways. Novel fMRI tasks were individually developed for the patient to maximize both somatosensory and motor activation simultaneously in areas in close proximity to the tumor. Information obtained was used to optimize resection trajectory and extent, facilitating gross total resection of the astrocytoma. Across all three motor-sensory tasks administered, fMRI revealed an area of interest just superior and lateral to the astrocytoma. Further, DTI analyses showed displacement of the corona radiata around the superior dorsal surface of the astrocytoma, extending in the direction of the activation found using fMRI. Taking into account these results, a transcortical superior temporal gyrus surgical approach was chosen in order to avoid the area of interest identified by fMRI and DTI. Total gross resection was achieved and minor post-surgical motor and sensory deficits were temporary. This case highlights the utility of comprehensive pre-surgical planning, including fMRI and DTI, to maximize surgical outcomes on a case-by-case basis.

  19. Hypofractionated Image Guided Radiation Therapy in Treating Patients With Stage IV Breast Cancer

    Science.gov (United States)

    2017-06-26

    Central Nervous System Metastases; Invasive Ductal Breast Carcinoma; Invasive Ductal Breast Carcinoma With Predominant Intraductal Component; Invasive Lobular Breast Carcinoma; Invasive Lobular Breast Carcinoma With Predominant in Situ Component; Liver Metastases; Lobular Breast Carcinoma in Situ; Lung Metastases; Male Breast Cancer; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Recurrent Breast Cancer; Stage IV Breast Cancer; Tubular Ductal Breast Carcinoma; Tumors Metastatic to Brain

  20. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

    Science.gov (United States)

    Murray, Julia R; McNair, Helen A; Dearnaley, David P

    2015-01-01

    The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion.

  1. Image-guided nerve cryoablation for post-thoracotomy pain syndrome.

    Science.gov (United States)

    Koethe, Yilun; Mannes, Andrew J; Wood, Bradford J

    2014-06-01

    Chronic post-thoracotomy pain syndrome (PTPS) can cause significant patient distress and is frequently difficult to manage. Percutaneous intercostal nerve (ICN) cryoablation by palpation of surface landmarks can be risky, as inaccurate probe placement can lead to hemo- or pneumothorax. Experience with image-guided ICN cryoablation with treatment planning and device navigation is limited. A patient with intractable PTPS was treated with ICN cryoablation under cone-beam computed tomography guidance with software-assisted needle trajectory planning and ablation zone simulation. This procedure provided the patient ~8 weeks of relief. This case demonstrated that ICN cryoablation is feasible under image guidance with device navigation and ablation simulation and may result in a few months of pain relief in cases of intractable PTPS.

  2. Image-guided radiotherapy of bladder cancer: bladder volume variation and its relation to margins

    DEFF Research Database (Denmark)

    Muren, Ludvig; Redpath, Anthony Thomas; Lord, Hannah

    2007-01-01

    : The correlation between the relative bladder volume (RBV, defined as repeat scan volume/planning scan volume) and the margins required to account for internal motion was first studied using a series of 20 bladder cancer patients with weekly repeat CT scanning during treatment. Both conformal RT (CRT) and IGRT......BACKGROUND AND PURPOSE: To control and account for bladder motion is a major challenge in radiotherapy (RT) of bladder cancer. This study investigates the relation between bladder volume variation and margins in conformal and image-guided RT (IGRT) for this disease. MATERIALS AND METHODS...... these patients were given fluid intake restrictions on alternating weeks during treatment. RESULTS: IGRT gave the strongest correlation between the RBV and margin size (R(2)=0.75; p10mm were required in only 1% of the situations when the RBV1, whereas isotropic margins >10...

  3. Extensive endoscopic image-guided sinus surgery decreases BPI-ANCA in patients with cystic fibrosis

    DEFF Research Database (Denmark)

    Aanaes, K; Rasmussen, N; Pressler, T

    2012-01-01

    of BPI-ANCA may be due to the costimulation of BPI when mounting an immune response against P. aeruginosa. The effect of surgery aiming to eradicate bacteria and infected tissue on BPI-ANCA levels is sparsely described. A cohort of patients with CF were included: 53 patients having extensive image......-guided sinus surgery (EIGSS) with topical postoperative antibiotic treatment, 131 non-operated controls and 36 who had double lung transplantation (LTX). In all 219 patients, serum samples before and after surgery or at similar intervals were analysed for IgG and IgA BPI-ANCA. The EIGSS group showed a highly...... in patients with CF, indicating that extensive removal of infected tissue influences the pathogenic process of autoantibody production. The results shown herein are in favour of applying EIGSS in selected patients with CF and for using BPI-ANCA as a surrogate marker for guiding further therapeutic...

  4. Stereotactic Image-Guided Intensity Modulated Radiotherapy Using the HI-ART II Helical Tomotherapy System

    International Nuclear Information System (INIS)

    Holmes, Timothy W.; Hudes, Richard; Dziuba, Sylwester; Kazi, Abdul; Hall, Mark; Dawson, Dana

    2008-01-01

    The highly integrated adaptive radiation therapy (HI-ART II) helical tomotherapy unit is a new radiotherapy machine designed to achieve highly precise and accurate treatments at all body sites. The precision and accuracy of the HI-ART II is similar to that provided by stereotactic radiosurgery systems, hence the historical distinction between external beam radiotherapy and stereotactic procedures based on differing precision requirements is removed for this device. The objectives of this work are: (1) to describe stereotactic helical tomotherapy processes (SRS, SBRT); (2) to show that the precision and accuracy of the HI-ART meet the requirements defined for SRS and SBRT; and (3) to describe the clinical implementation of a stereotactic image-guided intensity modulated radiation therapy (IG-IMRT) system that incorporates optical motion management

  5. Novel Use of an Image-Guided Stereotactic Approach in Trauma for Localization of Transcranial Bullet.

    Science.gov (United States)

    Vo, Dat T; Cravens, George F; Germann, Robert E

    2017-07-21

    Penetrating brain injuries from gunshot wounds can carry a poor prognosis and require an aggressive, multifaceted approach to obtain a good prognosis and outcome. An initial evaluation requires appropriate imaging studies followed by management and prophylaxis against increased intracranial pressure, infection, and seizures. Surgical management is then followed to ensure the watertight closure of any wounds, removal of any areas of hematoma, and removal of any potential areas of infection. In this paper, we report the case of a patient who presented with a self-inflicted gunshot wound to the head and then received aggressive medical and surgical management. This case presents that an image-guided stereotactic approach with suitable medical management should be used in patients with penetrating missile injuries to the head.

  6. The use of fiducial markers in image-guided radiotherapy for gastric cancer

    International Nuclear Information System (INIS)

    Sia, Joseph; Hamilton, Chris; Glance, Simon; Chandran, Sujievvan; Vaughan, Rhys

    2013-01-01

    The use of fiducial markers (FM) in image-guided radiotherapy (IGRT) to increase treatment precision is emerging for upper gastrointestinal malignancies. To our knowledge there is no data beyond technical reports for the use of FMs in IGRT for gastric cancers in the current literature. We report a case of an 89-year old gentleman with localised gastric cancer who was deemed unfit for surgery and chemotherapy. He had FMs inserted endoscopically around the tumour via ultrasound guidance and received radiotherapy with a high-dose palliative intent via a two-phase technique to 54Gy in 30 fractions with IGRT. The use of FMs allowed confidence in tumour delineation and together with IGRT enabled precise and safe delivery of a higher dose. The patient tolerated the treatment without significant toxicity and had no evidence of residual or recurrent tumour 12months following radiotherapy. The use of FMs with IGRT in upper gastrointestinal malignancies warrants further collaborative studies.

  7. The value of image-guided intensity-modulated radiotherapy in challenging clinical settings

    Science.gov (United States)

    Treece, S J; Mukesh, M; Rimmer, Y L; Tudor, S J; Dean, J C; Benson, R J; Gregory, D L; Horan, G; Jefferies, S J; Russell, S G; Williams, M V; Wilson, C B; Burnet, N G

    2013-01-01

    Objective To illustrate the wider potential scope of image-guided intensity-modulated radiotherapy (IG-IMRT), outside of the “standard” indications for IMRT. Methods Nine challenging clinical cases were selected. All were treated with radical intent, although it was accepted that in several of the cases the probability of cure was low. IMRT alone was not adequate owing to the close proximity of the target to organs at risk, the risk of geographical miss, or the need to tighten planning margins, making image-guided radiotherapy an essential integral part of the treatment. Discrepancies between the initial planning scan and the daily on-treatment megavoltage CT were recorded for each case. The three-dimensional displacement was compared with the margin used to create the planning target volume (PTV). Results All but one patient achieved local control. Three patients developed metastatic disease but benefited from good local palliation; two have since died. A further patient died of an unrelated condition. Four patients are alive and well. Toxicity was low in all cases. Without daily image guidance, the PTV margin would have been insufficient to ensure complete coverage in 49% of fractions. It was inadequate by >3 mm in 19% of fractions, and by >5 mm in 9%. Conclusion IG-IMRT ensures accurate dose delivery to treat the target and avoid critical structures, acting as daily quality assurance for the delivery of complex IMRT plans. These patients could not have been adequately treated without image guidance. Advances in knowledge IG-IMRT can offer improved outcomes in less common clinical situations, where conventional techniques would provide suboptimal treatment. PMID:23255544

  8. Lipiodol as a Fiducial Marker for Image-Guided Radiation Therapy for Bladder Cancer

    Directory of Open Access Journals (Sweden)

    Jessica M. Freilich

    2014-04-01

    Full Text Available Purpose To evaluate Lipiodol as a liquid, radio-opaque fiducial marker for image-guided radiation therapy (IGRT for bladder cancer.Materials and Methods Between 2011 and 2012, 5 clinical T2a-T3b N0 M0 stage II-III bladder cancer patients were treated with maximal transurethral resection of a bladder tumor (TURBT and image-guided radiation therapy (IGRT to 64.8 Gy in 36 fractions ± concurrent weekly cisplatin-based or gemcitabine chemotherapy. Ten to 15mL Lipiodol, using 0.5mL per injection, was injected into bladder submucosa circumferentially around the entire periphery of the tumor bed immediately following maximal TURBT. The authors looked at inter-observer variability regarding the size and location of the tumor bed (CTVboost on computed tomography scans with versus without Lipiodol.Results Median follow-up was 18 months. Lipiodol was visible on every orthogonal two-dimensional kV portal image throughout the entire, 7-week course of IGRT. There was a trend towards improved inter-observer agreement on the CTVboost with Lipiodol (p = 0.06. In 2 of 5 patients, the tumor bed based upon Lipiodol extended outside a planning target volume that would have been treated with a radiation boost based upon a cystoscopy report and an enhanced computed tomography (CT scan for staging. There was no toxicity attributable to Lipiodol.Conclusions Lipiodol constitutes a safe and effective fiducial marker that an urologist can use to demarcate a tumor bed immediately following maximal TURBT. Lipiodol decreases inter-observer variability in the definition of the extent and location of a tumor bed on a treatment planning CT scan for a radiation boost.

  9. SU-E-J-191: Motion Prediction Using Extreme Learning Machine in Image Guided Radiotherapy

    International Nuclear Information System (INIS)

    Jia, J; Cao, R; Pei, X; Wang, H; Hu, L

    2015-01-01

    Purpose: Real-time motion tracking is a critical issue in image guided radiotherapy due to the time latency caused by image processing and system response. It is of great necessity to fast and accurately predict the future position of the respiratory motion and the tumor location. Methods: The prediction of respiratory position was done based on the positioning and tracking module in ARTS-IGRT system which was developed by FDS Team (www.fds.org.cn). An approach involving with the extreme learning machine (ELM) was adopted to predict the future respiratory position as well as the tumor’s location by training the past trajectories. For the training process, a feed-forward neural network with one single hidden layer was used for the learning. First, the number of hidden nodes was figured out for the single layered feed forward network (SLFN). Then the input weights and hidden layer biases of the SLFN were randomly assigned to calculate the hidden neuron output matrix. Finally, the predicted movement were obtained by applying the output weights and compared with the actual movement. Breathing movement acquired from the external infrared markers was used to test the prediction accuracy. And the implanted marker movement for the prostate cancer was used to test the implementation of the tumor motion prediction. Results: The accuracy of the predicted motion and the actual motion was tested. Five volunteers with different breathing patterns were tested. The average prediction time was 0.281s. And the standard deviation of prediction accuracy was 0.002 for the respiratory motion and 0.001 for the tumor motion. Conclusion: The extreme learning machine method can provide an accurate and fast prediction of the respiratory motion and the tumor location and therefore can meet the requirements of real-time tumor-tracking in image guided radiotherapy

  10. Early Outcomes From Three Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Mendenhall, Nancy P.; Li Zuofeng; Hoppe, Bradford S.; Marcus, Robert B.; Mendenhall, William M.; Nichols, R. Charles; Morris, Christopher G.; Williams, Christopher R.; Costa, Joseph; Henderson, Randal

    2012-01-01

    Purpose: To report early outcomes with image-guided proton therapy for prostate cancer. Methods and Materials: We accrued 211 prostate cancer patients on prospective Institutional Review Board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low–risk disease, dose escalation from 78 to 82 CGE for intermediate-risk disease, and 78 CGE with concomitant docetaxel followed by androgen deprivation for high-risk disease. Minimum follow-up was 2 years. Results: One intermediate-risk patient and 2 high-risk patients had disease progression. Pretreatment genitourinary (GU) symptom management was required in 38% of patients. A cumulative 88 (42%) patients required posttreatment GU symptom management. Four transient Grade 3 GU toxicities occurred, all among patients requiring pretreatment GU symptom management. Multivariate analysis showed correlation between posttreatment GU 2+ symptoms and pretreatment GU symptom management (p < 0.0001) and age (p = 0.0048). Only 1 Grade 3+ gastrointestinal (GI) symptom occurred. The prevalence of Grade 2+ GI symptoms was 0 (0%), 10 (5%), 12 (6%), and 8 (4%) at 6, 12, 18, and 24 months, with a cumulative incidence of 20 (10%) patients at 2 years after proton therapy. Univariate and multivariate analyses showed significant correlation between Grade 2+ rectal bleeding and proctitis and the percentage of rectal wall (rectum) receiving doses ranging from 40 CGE (10 CGE) to 80 CGE. Conclusions: Early outcomes with image-guided proton therapy suggest high efficacy and minimal toxicity with only 1.9% Grade 3 GU symptoms and <0.5% Grade 3 GI toxicities.

  11. Lipiodol as a Fiducial Marker for Image-Guided Radiation Therapy for Bladder Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Freilich, Jessica M.; Spiess, Philippe E.; Biagioli, Matthew C.; Fernandez, Daniel C.; Shi, Ellen J.; Hunt, Dylan C.; Gupta, Shilpa; Wilder, Richard B., E-mail: richard.wilder@moffitt.org [Moffitt Cancer Center, Tampa, FL (United States)

    2014-03-15

    Purpose: To evaluate Lipiodol as a liquid, radio-opaque fiducial marker for image-guided radiation therapy (IGRT) for bladder cancer; Materials and Methods: Between 2011 and 2012, 5 clinical T2a-T3b N0 M0 stage II-III bladder cancer patients were treated with maximal transurethral resection of a bladder tumor (TURBT) and image-guided radiation therapy (IGRT) to 64.8 Gy in 36 fractions ± concurrent weekly cisplatin-based or gemcitabine chemotherapy. Ten to 15mL Lipiodol, using 0.5mL per injection, was injected into bladder submucosa circumferentially around the entire periphery of the tumor bed immediately following maximal TURBT. The authors looked at inter-observer variability regarding the size and location of the tumor bed (CTVboost) on computed tomography scans with versus without Lipiodol. Results: Median follow-up was 18 months. Lipiodol was visible on every orthogonal two-dimensional kV portal image throughout the entire, 7-week course of IGRT. There was a trend towards improved inter-observer agreement on the CTVboost with Lipiodol (p = 0.06). In 2 of 5 patients, the tumor bed based upon Lipiodol extended outside a planning target volume that would have been treated with a radiation boost based upon a cystoscopy report and an enhanced computed tomography (CT) scan for staging. There was no toxicity attributable to Lipiodol: Conclusions: Lipiodol constitutes a safe and effective fiducial marker that an urologist can use to demarcate a tumor bed immediately following maximal TURBT. Lipiodol decreases inter-observer variability in the definition of the extent and location of a tumor bed on a treatment planning CT scan for a radiation boost. (author)

  12. A new fiducial marker for Image-guided radiotherapy of prostate cancer: Clinical experience

    International Nuclear Information System (INIS)

    Carl, Jesper; Nielsen, Jane; Holmberg, Mats; Hoejkjaer Larsen, Erik; Fabrin, Knud; Fisker, Rune V.

    2008-01-01

    Background. A new fiducial marker for image guided radiotherapy (IGRT) based on a removable prostate stent made of Ni Ti has been developed during two previous clinical feasibility studies. The marker is currently being evaluated for IGRT treatment in a third clinical study. Method. The new marker is used to co-register MR and planning CT scans with high accuracy in the region around the prostate. The co-registered MR-CT volumes are used for delineation of GTV before planning. In each treatment session the IGRT system is used to position the patient before treatment. The IGRT system use a stereo pair of kV images matched to corresponding Digital Reconstructed Radiograms (DRR) from the planning CT scan. The match is done using mutual gray scale information. The pair of DRR's for positioning is created in the IGRT system with a threshold in the Look Up Table (LUT). The resulting match provides the necessary shift in couch coordinates to position the stent with an accuracy of 1-2 mm within the planned position. Results. At the present time 39 patients have received the new marker. Of the 39 one has migrated to the bladder. Deviations of more than 5 mm between CTV outlined on CT and MR are seen in several cases and in anterior-posterior (AP), left-right (LR) and cranial-caudal (CC) directions. Intra-fraction translation movements up to +/- 3 mm are seen as well. As the stent is also clearly visible on images taken with high voltage x-rays using electronic portal images devices (EPID), the positioning has been verified independently of the IGRT system. Discussion. The preliminary result of an on going clinical study of a Ni Ti prostate stent, potentially a new fiducial marker for image guided radiotherapy, looks promising. The risk of migration appears to be much lower compared to previous designs

  13. Biologic targets identified from dynamic 18FDG-PET and implications for image-guided therapy

    International Nuclear Information System (INIS)

    Rusten, Espen; Malinen, Eirik; Roedal, Jan; Bruland, Oeyvind S.

    2013-01-01

    Purpose: The outcome of biologic image-guided radiotherapy depends on the definition of the biologic target. The purpose of the current work was to extract hyper perfused and hypermetabolic regions from dynamic positron emission tomography (D-PET) images, to dose escalate either region and to discuss implications of such image guided strategies. Methods: Eleven patients with soft tissue sarcomas were investigated with D-PET. The images were analyzed using a two-compartment model producing parametric maps of perfusion and metabolic rate. The two image series were segmented and exported to a treatment planning system, and biological target volumes BTV per and BTV met (perfusion and metabolism, respectively) were generated. Dice's similarity coefficient was used to compare the two biologic targets. Intensity-modulated radiation therapy (IMRT) plans were generated for a dose painting by contours regime, where planning target volume (PTV) was planned to 60 Gy and BTV to 70 Gy. Thus, two separate plans were created for each patient with dose escalation of either BTV per or BTV met . Results: BTV per was somewhat smaller than BTV met (209 ±170 cm 3 against 243 ±143 cm 3 , respectively; population-based mean and s.d.). Dice's coefficient depended on the applied margin, and was 0.72 ±0.10 for a margin of 10 mm. Boosting BTV per resulted in mean dose of 69 ±1.0 Gy to this region, while BTV met received 67 ±3.2 Gy. Boosting BTV met gave smaller dose differences between the respective non-boost DVHs (such as D 98 ). Conclusions: Dose escalation of one of the BTVs results in a partial dose escalation of the other BTV as well. If tumor aggressiveness is equally pronounced in hyper perfused and hypermetabolic regions, this should be taken into account in the treatment planning

  14. Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

    International Nuclear Information System (INIS)

    Yaacob, Yazmin; Nguyen, Dang V; Mohamed, Zahiah; Ralib, A Razali A; Zakaria, Rozman; Muda, Sobri

    2013-01-01

    To report our early experience in image-guided chemoport insertions by interventional radiologists. This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV) as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy. The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%), followed by catheter-related infection (9/161; 5.6%). Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8%) chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit. Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication

  15. Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications.

    Science.gov (United States)

    Yaacob, Yazmin; Nguyen, Dang V; Mohamed, Zahiah; Ralib, A Razali A; Zakaria, Rozman; Muda, Sobri

    2013-04-01

    To report our early experience in image-guided chemoport insertions by interventional radiologists. This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV) as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy. The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%), followed by catheter-related infection (9/161; 5.6%). Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8%) chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit. Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication.

  16. Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

    Directory of Open Access Journals (Sweden)

    Yazmin Yaacob

    2013-01-01

    Full Text Available Purpose: To report our early experience in image-guided chemoport insertions by interventional radiologists. Materials and Methods: This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy. Results: The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%, followed by catheter-related infection (9/161; 5.6%. Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8% chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit. Conclusion: Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication.

  17. Nerve-Highlighting Fluorescent Contrast Agents for Image-Guided Surgery

    Directory of Open Access Journals (Sweden)

    Summer L. Gibbs-Strauss

    2011-03-01

    Full Text Available Nerve damage is the major morbidity of many surgeries, resulting in chronic pain, loss of function, or both. The sparing of nerves during surgical procedures is a vexing problem because surrounding tissue often obscures them. To date, systemically administered nerve-highlighting contrast agents that can be used for nerve-sparing image-guided surgery have not been reported. In the current study, physicochemical and optical properties of 4,4‘-[(2-methoxy-1,4-phenylenedi-(1E-2,1-ethenediyl]bis-benzenamine (BMB and a newly synthesized, red-shifted derivative 4-[(1E-2-[4-[(1E-2-[4-aminophenyl]ethenyl]-3-methoxyphenyl]ethenyl]-benzonitrile (GE3082 were characterized in vitro and in vivo. Both agents crossed the blood-nerve barrier and blood-brain barrier and rendered myelinated nerves fluorescent after a single systemic injection. Although both BMB and GE3082 also exhibited significant uptake in white adipose tissue, GE3082 underwent a hypsochromic shift in adipose tissue that provided a means to eliminate the unwanted signal using hyperspectral deconvolution. Dose and kinetic studies were performed in mice to determine the optimal dose and drug-imaging interval. The results were confirmed in rat and pig, with the latter used to demonstrate, for the first time, simultaneous fluorescence imaging of blood vessels and nerves during surgery using the FLARE™ (Fluorescence-Assisted Resection and Exploration imaging system. These results lay the foundation for the development of ideal nerve-highlighting fluorophores for image-guided surgery.

  18. A Low-Cost, Passive Navigation Training System for Image-Guided Spinal Intervention.

    Science.gov (United States)

    Lorias-Espinoza, Daniel; Carranza, Vicente González; de León, Fernando Chico-Ponce; Escamirosa, Fernando Pérez; Martinez, Arturo Minor

    2016-11-01

    Navigation technology is used for training in various medical specialties, not least image-guided spinal interventions. Navigation practice is an important educational component that allows residents to understand how surgical instruments interact with complex anatomy and to learn basic surgical skills such as the tridimensional mental interpretation of bidimensional data. Inexpensive surgical simulators for spinal surgery, however, are lacking. We therefore designed a low-cost spinal surgery simulator (Spine MovDigSys 01) to allow 3-dimensional navigation via 2-dimensional images without altering or limiting the surgeon's natural movement. A training system was developed with an anatomical lumbar model and 2 webcams to passively digitize surgical instruments under MATLAB software control. A proof-of-concept recognition task (vertebral body cannulation) and a pilot test of the system with 12 neuro- and orthopedic surgeons were performed to obtain feedback on the system. Position, orientation, and kinematic variables were determined and the lateral, posteroanterior, and anteroposterior views obtained. The system was tested with a proof-of-concept experimental task. Operator metrics including time of execution (t), intracorporeal length (d), insertion angle (α), average speed (v¯), and acceleration (a) were obtained accurately. These metrics were converted into assessment metrics such as smoothness of operation and linearity of insertion. Results from initial testing are shown and the system advantages and disadvantages described. This low-cost spinal surgery training system digitized the position and orientation of the instruments and allowed image-guided navigation, the generation of metrics, and graphic recording of the instrumental route. Spine MovDigSys 01 is useful for development of basic, noninnate skills and allows the novice apprentice to quickly and economically move beyond the basics. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Site-specific induction of lymphatic malformations in a rat model for image-guided therapy

    International Nuclear Information System (INIS)

    Short, Robert F.; Shiels, William E.; Sferra, Thomas J.; Nicol, Kathleen K.; Schofield, Minka; Wiet, Gregory J.

    2007-01-01

    Lymphatic malformation is a common benign mass in children and adults and is representative of a derangement in lymphangiogenesis. These lesions have high recurrence rates and significant morbidity associated with surgery. Several sclerotherapy regimens have been developed clinically to treat lymphatic malformations; however, an animal model has not been developed that is adequate to test the efficacy of image-guided therapeutic interventions. To develop an animal model suitable for evaluation of percutaneous treatments of lymphatic malformations. Male Harlan Sprague-Dawley rats (n = 9) received two US-guided injections of Incomplete Freund's Adjuvant (IFA) over a 2-week period. All nine rats were injected twice into the peritoneum (IP); a subgroup (n = 3) received additional injections into the neck. Three animals that received IP injections of saline were used as controls. The injection sites were monitored for the development of lesions by high-resolution ultrasonography at 2-week intervals for 100 days. High-resolution (4.7 Tesla) magnetic resonance imaging was then performed on two animals noted to have developed masses. The rats were sacrificed and histologic examination of the identified lesions was performed, including immunohistochemical staining for vascular (CD31) and lymphatic (Flt-4 and Prox-1) endothelium. All animals injected with IFA developed cystic lesions. The three animals injected at dual sites were noted to have both microcystic and macrocystic malformations in the neck and microcystic plaque-like lesions in the peritoneum. The macrocystic malformations (≥5 mm) in the neck were detected by ultrasonography and grossly later during necropsy. Histopathologic analysis revealed the cystic spaces to be lined by lymphatic endothelium supported by a connective tissue stroma. Control animals did not exhibit detectable lesions with either ultrasonography or necropsy. This model represents a promising tool for translational development of image-guided

  20. Comparison of 3D C-arm fluoroscopy and 3D image-guided navigation for minimally invasive pelvic surgery.

    Science.gov (United States)

    Li, Bin; He, Jiliang; Zhu, Zexing; Zhou, Dongsheng; Hao, Zhenhai; Wang, Yonghui; Li, Qinghu

    2015-10-01

    This study aims to compare the efficacy and accuracy of percutaneous screw fixation using three-dimensional [Formula: see text] navigation and conventional C-arm fluoroscopy in pelvic fracture surgery. This was a retrospective study of 81 patients with pelvic fractures treated using percutaneous screw fixation between June 2005 and January 2011. All pelvic fractures were treated with closed reduction, small open reduction, or medium open reduction. Intraoperative radiation exposure, fixation, surgical outcome, and functional recovery were compared based on the fluoroscopy navigation method used during screw fixation. Radiographic follow-up was assessed at 1, 3, 6, and 9 months postoperatively, and a CT scan was completed at 9 months postoperatively. A total of 130 cannulated screws were placed. Average screw fixation time and fluoroscopy exposure time in [Formula: see text] group were lower than the C-arm fluoroscopy group ([Formula: see text] vs [Formula: see text]) [Formula: see text]. Seventy-four of the 81 patients made a full recovery. Successful outcome was confirmed with radiological imaging and postoperative follow-up at 6-24 months. No delayed union or nonunion was detected. No significant difference in functional recovery at 6 months postoperative was found due to the fluoroscopy imaging technique. Percutaneous screw fixation using the [Formula: see text] navigational system minimizes the fluoroscope exposure and screw insertion time, while improving screw insertion accuracy. Moreover, the [Formula: see text] navigational system provided a reliable method for fluoroscopy imaging in pelvic fractures.

  1. Implementation of image-guided intensity-modulated accelerated partial breast irradiation. Three-year results of a phase II clinical study

    International Nuclear Information System (INIS)

    Meszaros, Norbert; Major, Tibor; Stelczer, Gabor; Zaka, Zoltan; Takacsi-Nagy, Zoltan; Fodor, Janos; Polgar, Csaba; Mozsa, Emoke; Pukancsik, David

    2017-01-01

    To report 3-year results of accelerated partial breast irradiation (APBI) using image-guided intensity-modulated radiotherapy (IG-IMRT) following breast conserving surgery (BCS) for low-risk early invasive breast cancer. Between July 2011 and March 2014, 60 patients with low-risk early invasive breast cancer underwent BCS and were enrolled in this phase II prospective study. The total dose was 36.9 Gy (9 fractions of 4.1 Gy, two fractions/day). Patient setup errors were detected in LAT, LONG and VERT directions. Local tumour control, survival results, early and late side effects and cosmetic outcome were assessed. At a median follow-up of 39 months, all patients were alive and neither locoregional nor distant failure occurred. One contralateral breast cancer and two new primary malignancies outside the breast were observed. No grade (G) 3-4 acute toxicity was detected. G1 and G2 erythema occurred in 21 (35%) and 2 (3.3%) patients, respectively; while G1 oedema was observed in 23 (38.8%) cases. G1 and G2 pain was reported by 6 (10%) and 2 (3.3%) patients, respectively. Among the late radiation side effects, G1 pigmentation or telangiectasia, G1 fibrosis and G1 asymptomatic fat necrosis occurred in 10 (16.7%), 7 (11.7%) and 3 (5%) patients, respectively. No ≥ G2 late toxicity was detected. Cosmetic outcome was excellent in 43 (71.7%) and good in 17 (28.3%) patients. IG-IMRT is a reproducible and feasible technique for delivery of external beam APBI following BCS for treatment of low-risk, early-stage invasive breast carcinoma. In order to avoid toxicity, image guidance performed before each radiation fraction is necessary to minimize the PTV. Three-year results are promising, early and late radiation side-effects are minimal, and cosmetic results are excellent to good. (orig.) [de

  2. Image Guided Radiation Therapy Strategies for Pelvic Lymph Node Irradiation in High-Risk Prostate Cancer: Motion and Margins

    NARCIS (Netherlands)

    Kershaw, Lucy; van Zadelhoff, Laila; Heemsbergen, Wilma; Pos, Floris; van Herk, Marcel

    2018-01-01

    To quantify the relative motion of the pelvic lymph nodes (LNs), seminal vesicles (SV) and prostate and define indicative margins for image-guided radiotherapy based on bony anatomy or prostate correction strategies for a 3 or 6 degrees-of-freedom couch. Nineteen patients had a planning computed

  3. Image-guided left ventricular lead placement in cardiac resynchronization therapy for patients with heart failure: a meta-analysis.

    Science.gov (United States)

    Jin, Yan; Zhang, Qi; Mao, Jia-Liang; He, Ben

    2015-05-10

    Heart failure (HF) is a debilitating condition that affects millions of people worldwide. One means of treating HF is cardiac resynchronization therapy (CRT). Recently, several studies have examined the use of echocardiography (ECHO) in the optimization of left ventricular (LV) lead placement to increase the response to CRT. The objective of this study was to synthesize the available data on the comparative efficacy of image-guided and standard CRT. We searched the PubMed, Cochrane, Embase, and ISI Web of Knowledge databases through April 2014 with the following combinations of search terms: left ventricular lead placement, cardiac resynchronization therapy, image-guided, and echocardiography-guided. Studies meeting all of the inclusion criteria and none of the exclusion criteria were eligible for inclusion. The primary outcome measures were CRT response rate, change in LV ejection fraction (LVEF), and change in LV end systolic volume (LVESV). Secondary outcomes included the rates of all-cause mortality and HF-related hospitalization. Our search identified 103 articles, 3 of which were included in the analysis. In total, 270 patients were randomized to the image-guided CRT and 241, to the standard CRT. The pooled estimates showed a significant benefit for image-guided CRT (CRT response: OR, 2.098, 95 % CI, 1.432-3.072; LVEF: difference in means, 3.457, 95 % CI, 1.910-5.005; LVESV: difference in means, -20.36, 95 % CI, -27.819 - -12.902). Image-guided CRT produced significantly better clinical outcomes than the standard CRT. Additional trials are warranted to validate the use of imaging in the prospective optimization of CRT.

  4. Body-mounted robotic instrument guide for image-guided cryotherapy of renal cancer.

    Science.gov (United States)

    Hata, Nobuhiko; Song, Sang-Eun; Olubiyi, Olutayo; Arimitsu, Yasumichi; Fujimoto, Kosuke; Kato, Takahisa; Tuncali, Kemal; Tani, Soichiro; Tokuda, Junichi

    2016-02-01

    Image-guided cryotherapy of renal cancer is an emerging alternative to surgical nephrectomy, particularly for those who cannot sustain the physical burden of surgery. It is well known that the outcome of this therapy depends on the accurate placement of the cryotherapy probe. Therefore, a robotic instrument guide may help physicians aim the cryotherapy probe precisely to maximize the efficacy of the treatment and avoid damage to critical surrounding structures. The objective of this paper was to propose a robotic instrument guide for orienting cryotherapy probes in image-guided cryotherapy of renal cancers. The authors propose a body-mounted robotic guide that is expected to be less susceptible to guidance errors caused by the patient's whole body motion. Keeping the device's minimal footprint in mind, the authors developed and validated a body-mounted, robotic instrument guide that can maintain the geometrical relationship between the device and the patient's body, even in the presence of the patient's frequent body motions. The guide can orient the cryotherapy probe with the skin incision point as the remote-center-of-motion. The authors' validation studies included an evaluation of the mechanical accuracy and position repeatability of the robotic instrument guide. The authors also performed a mock MRI-guided cryotherapy procedure with a phantom to compare the advantage of robotically assisted probe replacements over a free-hand approach, by introducing organ motions to investigate their effects on the accurate placement of the cryotherapy probe. Measurements collected for performance analysis included accuracy and time taken for probe placements. Multivariate analysis was performed to assess if either or both organ motion and the robotic guide impacted these measurements. The mechanical accuracy and position repeatability of the probe placement using the robotic instrument guide were 0.3 and 0.1 mm, respectively, at a depth of 80 mm. The phantom test indicated

  5. Minimally Invasive Cochlear Implantation Assisted by Bi-planar Device: An Exploratory Feasibility Study in vitro

    Directory of Open Access Journals (Sweden)

    Jia Ke

    2016-01-01

    Conclusions: This exploratory study demonstrated the safety of the newly developed image-guided minimally invasive cochlear implantation assisted by the bi-planar device and established the operational procedures. Further, more in vitro experiments are needed to improve the system operation and its safety.

  6. The Mobius AIRO mobile CT for image-guided proton therapy: Characterization & commissioning.

    Science.gov (United States)

    Oliver, Jasmine A; Zeidan, Omar A; Meeks, Sanford L; Shah, Amish P; Pukala, Jason; Kelly, Patrick; Ramakrishna, Naren R; Willoughby, Twyla R

    2017-05-01

    The purpose of this study was to characterize the Mobius AIRO Mobile CT System for localization and image-guided proton therapy. This is the first known application of the AIRO for proton therapy. Five CT images of a Catphan ® 504 phantom were acquired on the AIRO Mobile CT System, Varian EDGE radiosurgery system cone beam CT (CBCT), Philips Brilliance Big Bore 16 slice CT simulator, and Siemens SOMATOM Definition AS 20 slice CT simulator. DoseLAB software v.6.6 was utilized for image quality analysis. Modulation transfer function, scaling discrepancy, geometric distortion, spatial resolution, overall uniformity, minimum uniformity, contrast, high CNR, and maximum HU deviation were acquired. Low CNR was acquired manually using the CTP515 module. Localization accuracy and CT Dose Index were measured and compared to reported values on each imaging device. For treatment delivery systems (Edge and Mevion), the localization accuracy of the 3D imaging systems were compared to 2D imaging systems on each system. The AIRO spatial resolution was 0.21 lp mm -1 compared with 0.40 lp mm -1 for the Philips CT Simulator, 0.37 lp mm -1 for the Edge CBCT, and 0.35 lp mm -1 for the Siemens CT Simulator. AIRO/Siemens and AIRO/Philips differences exceeded 100% for scaling discrepancy (191.2% and 145.8%). The AIRO exhibited higher dose (>27 mGy) than the Philips CT Simulator. Localization accuracy (based on the MIMI phantom) was 0.6° and 0.5 mm. Localization accuracy (based on Stereophan) demonstrated maximum AIRO-kV/kV shift differences of 0.1 mm in the x-direction, 0.1 mm in the y-direction, and 0.2 mm in the z-direction. The localization accuracy of AIRO was determined to be within 0.6° and 0.5 mm despite its slightly lower image quality overall compared to other CT imaging systems at our institution. Based on our study, the Mobile AIRO CT system can be utilized accurately and reliably for image-guided proton therapy. © 2017 The Authors. Journal of Applied Clinical Medical

  7. A technique for adaptive image-guided helical tomotherapy for lung cancer

    International Nuclear Information System (INIS)

    Ramsey, Chester R.; Langen, Katja M.; Kupelian, Patrick A.; Scaperoth, Daniel D.; Meeks, Sanford L.; Mahan, Stephen L.; Seibert, Rebecca M.

    2006-01-01

    Purpose: The gross tumor volume (GTV) for many lung cancer patients can decrease during the course of radiation therapy. As the tumor reduces in size during treatment, the margin added around the GTV effectively becomes larger, which can result in the excessive irradiation of normal lung tissue. The specific goal of this study is to evaluate the feasibility of using image-guided adaptive radiation therapy to adjust the planning target volume weekly based on the previous week's CT image sets that were used for image-guided patient setup. Methods and Materials: Megavoltage computed tomography (MVCT) images of the GTV were acquired daily on a helical tomotherapy system. These images were used to position the patient and to measure reduction in GTV volume. A planning study was conducted to determine the amount of lung-sparing that could have been achieved if adaptive therapy had been used. Treatment plans were created in which the target volumes were reduced after tumor reduction was measured. Results: A total of 158 MVCT imaging sessions were performed on 7 lung patients. The GTV was reduced by 60-80% during the course of treatment. The tumor reduction in the first 60 days of treatment can be modeled using the second-order polynomial R 0.0002t 2 - 0.0219t + 1.0, where R is the percent reduction in GTV, and t is the number of elapsed days. Based on these treatment planning studies, the absolute volume of ipsilateral lung receiving 20 Gy can be reduced between 17% and 23% (21% mean) by adapting the treatment delivery. The benefits of adaptive therapy are the greatest for tumor volumes ≥25 cm 3 and are directly dependent on GTV reduction during treatment. Conclusions: Megavoltage CT-based image guidance can be used to position lung cancer patients daily. This has the potential to decrease margins associated with daily setup error. Furthermore, the adaptive therapy technique described in this article can decrease the volume of healthy lung tissue receiving above 20 Gy

  8. Integral test phantom for dosimetric quality assurance of image guided and intensity modulated stereotactic radiotherapy.

    Science.gov (United States)

    Létourneau, Daniel; Keller, Harald; Sharpe, Michael B; Jaffray, David A

    2007-05-01

    The objective of this work is to develop a dosimetric phantom quality assurance (QA) of linear accelerators capable of cone-beam CT (CBCT) image guided and intensity-modulated radiotherapy (IG-IMRT). This phantom is to be used in an integral test to quantify in real-time both the performance of the image guidance and the dose delivery systems in terms of dose localization. The prototype IG-IMRT QA phantom consisted of a cylindrical imaging phantom (CatPhan) combined with an array of 11 radiation diodes mounted on a 10 cm diameter disk, oriented perpendicular to the phantom axis. Basic diode response characterization was performed for 6 and 18 MV photons. The diode response was compared to planning system calculations in the open and penumbrae regions of simple and complex beam arrangements. The clinical use of the QA phantom was illustrated in an integral test of an IG-IMRT treatment designed for a clinical spinal radiosurgery case. The sensitivity of the phantom to multileaf collimator (MLC) calibration and setup errors in the clinical setting was assessed by introducing errors in the IMRT plan or by displacing the phantom. The diodes offered good response linearity and long-term reproducibility for both 6 and 18 MV. Axial dosimetry of coplanar beams (in a plane containing the beam axes) was made possible with the nearly isoplanatic response of the diodes over 360 degrees of gantry (usually within +/-1%). For single beam geometry, errors in phantom placement as small as 0.5 mm could be accurately detected (in gradient > or = 1% /mm). In clinical setting, MLC systematic errors of 1 mm on a single MLC bank introduced in the IMRT plan were easily detectable with the QA phantom. The QA phantom demonstrated also sufficient sensitivity for the detection of setup errors as small as 1 mm for the IMRT delivery. These results demonstrated that the prototype can accurately and efficiently verify the entire IG-IMRT process. This tool, in conjunction with image guidance

  9. Integral test phantom for dosimetric quality assurance of image guided and intensity modulated stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Letourneau, Daniel; Keller, Harald; Sharpe, Michael B.; Jaffray, David A.

    2007-01-01

    The objective of this work is to develop a dosimetric phantom quality assurance (QA) of linear accelerators capable of cone-beam CT (CBCT) image guided and intensity-modulated radiotherapy (IG-IMRT). This phantom is to be used in an integral test to quantify in real-time both the performance of the image guidance and the dose delivery systems in terms of dose localization. The prototype IG-IMRT QA phantom consisted of a cylindrical imaging phantom (CatPhan) combined with an array of 11 radiation diodes mounted on a 10 cm diameter disk, oriented perpendicular to the phantom axis. Basic diode response characterization was performed for 6 and 18 MV photons. The diode response was compared to planning system calculations in the open and penumbrae regions of simple and complex beam arrangements. The clinical use of the QA phantom was illustrated in an integral test of an IG-IMRT treatment designed for a clinical spinal radiosurgery case. The sensitivity of the phantom to multileaf collimator (MLC) calibration and setup errors in the clinical setting was assessed by introducing errors in the IMRT plan or by displacing the phantom. The diodes offered good response linearity and long-term reproducibility for both 6 and 18 MV. Axial dosimetry of coplanar beams (in a plane containing the beam axes) was made possible with the nearly isoplanatic response of the diodes over 360 deg. of gantry (usually within ±1%). For single beam geometry, errors in phantom placement as small as 0.5 mm could be accurately detected (in gradient ≥1%/mm). In clinical setting, MLC systematic errors of 1 mm on a single MLC bank introduced in the IMRT plan were easily detectable with the QA phantom. The QA phantom demonstrated also sufficient sensitivity for the detection of setup errors as small as 1 mm for the IMRT delivery. These results demonstrated that the prototype can accurately and efficiently verify the entire IG-IMRT process. This tool, in conjunction with image guidance capabilities

  10. Body-mounted robotic instrument guide for image-guided cryotherapy of renal cancer

    Science.gov (United States)

    Hata, Nobuhiko; Song, Sang-Eun; Olubiyi, Olutayo; Arimitsu, Yasumichi; Fujimoto, Kosuke; Kato, Takahisa; Tuncali, Kemal; Tani, Soichiro; Tokuda, Junichi

    2016-01-01

    Purpose: Image-guided cryotherapy of renal cancer is an emerging alternative to surgical nephrectomy, particularly for those who cannot sustain the physical burden of surgery. It is well known that the outcome of this therapy depends on the accurate placement of the cryotherapy probe. Therefore, a robotic instrument guide may help physicians aim the cryotherapy probe precisely to maximize the efficacy of the treatment and avoid damage to critical surrounding structures. The objective of this paper was to propose a robotic instrument guide for orienting cryotherapy probes in image-guided cryotherapy of renal cancers. The authors propose a body-mounted robotic guide that is expected to be less susceptible to guidance errors caused by the patient’s whole body motion. Methods: Keeping the device’s minimal footprint in mind, the authors developed and validated a body-mounted, robotic instrument guide that can maintain the geometrical relationship between the device and the patient’s body, even in the presence of the patient’s frequent body motions. The guide can orient the cryotherapy probe with the skin incision point as the remote-center-of-motion. The authors’ validation studies included an evaluation of the mechanical accuracy and position repeatability of the robotic instrument guide. The authors also performed a mock MRI-guided cryotherapy procedure with a phantom to compare the advantage of robotically assisted probe replacements over a free-hand approach, by introducing organ motions to investigate their effects on the accurate placement of the cryotherapy probe. Measurements collected for performance analysis included accuracy and time taken for probe placements. Multivariate analysis was performed to assess if either or both organ motion and the robotic guide impacted these measurements. Results: The mechanical accuracy and position repeatability of the probe placement using the robotic instrument guide were 0.3 and 0.1 mm, respectively, at a depth

  11. The effective quality assurance for image guided device using the AMC G-Box

    International Nuclear Information System (INIS)

    Kim, Chong Mi

    2014-01-01

    According to the rapid increase recently in image-guided radiation therapy, It is necessary to control of the image guidance system completely. In particular for the main subject to the accuracy of image guided radiation therapy device to be done essentially the quality assurance. We made efficient phantom in AMC for the management of the accurate and efficient. By setting up of five very important as a quality assurance inventory of the Image guidance system, we made (AMC G-Box) phantom for quality assurance efficient and accurate. Quality assurance list were the Iso-center align, the real measurement, the center align of four direction, the accuracy of table movement and the reproducibility of Hounsfield Unit. The rectangular phantom; acrylic with a thickness of 1 cm to 10 cm × 10 cm × 10 cm was inserted the three materials with different densities respectively for measure the CBCT HU. The phantom was to perform a check of consistency centered by creating a marker that indicates the position of the center fixed. By performing the quality assurance using the phantom of existing, comparing the resulting value to the different resulting value using the AMC G-Box, experiment was analyzed time and problems. Therapy equipment was used Varian device. It was measured twice at 1-week intervals. When implemented quality assurance of an image guidance system using AMC G-Box and a phantom existing has been completed, the quality assurance result is similar in 0.2 mm ± 0.1. In the case of the conventional method, it was 45 minutes at 30 minutes. When using AMC G-Box, it takes 20 minutes 15 minutes, and declined to 50% of the time. The consistency and accurate of image guidance system tend to decline using device. Therefore, We need to perform thoroughly on the quality assurance related. It needs to be checked daily to consistency check especially. When using the AMC G-Box, It is possible to enhance the accuracy of the patient care and equipment efficiently performing

  12. Predictors of Toxicity After Image-guided High-dose-rate Interstitial Brachytherapy for Gynecologic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Larissa J. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States); Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States)

    2012-12-01

    Purpose: To identify predictors of grade 3-4 complications and grade 2-4 rectal toxicity after three-dimensional image-guided high-dose-rate (HDR) interstitial brachytherapy for gynecologic cancer. Methods and Materials: Records were reviewed for 51 women (22 with primary disease and 29 with recurrence) treated with HDR interstitial brachytherapy. A single interstitial insertion was performed with image guidance by computed tomography (n = 43) or magnetic resonance imaging (n = 8). The median delivered dose in equivalent 2-Gy fractions was 72.0 Gy (45 Gy for external-beam radiation therapy and 24 Gy for brachytherapy). Toxicity was reported according to the Common Toxicity Criteria for Adverse Events. Actuarial toxicity estimates were calculated by the Kaplan-Meier method. Results: At diagnosis, the median patient age was 62 years and the median tumor size was 3.8 cm. The median D90 and V100 were 71.4 Gy and 89.5%; the median D2cc for the bladder, rectum, and sigmoid were 64.6 Gy, 61.0 Gy, and 52.7 Gy, respectively. The actuarial rates of all grade 3-4 complications at 2 years were 20% gastrointestinal, 9% vaginal, 6% skin, 3% musculoskeletal, and 2% lymphatic. There were no grade 3-4 genitourinary complications and no grade 5 toxicities. Grade 2-4 rectal toxicity was observed in 10 patients, and grade 3-4 complications in 4; all cases were proctitis with the exception of 1 rectal fistula. D2cc for rectum was higher for patients with grade 2-4 (68 Gy vs 57 Gy for grade 0-1, P=.03) and grade 3-4 (73 Gy vs 58 Gy for grade 0-2, P=.02) rectal toxicity. The estimated dose that resulted in a 10% risk of grade 2-4 rectal toxicity was 61.8 Gy (95% confidence interval, 51.5-72.2 Gy). Discussion: Image-guided HDR interstitial brachytherapy results in acceptable toxicity for women with primary or recurrent gynecologic cancer. D2cc for the rectum is a reliable predictor of late rectal complications. Three-dimensional-based treatment planning should be performed to ensure

  13. Predictors of Toxicity After Image-guided High-dose-rate Interstitial Brachytherapy for Gynecologic Cancer

    International Nuclear Information System (INIS)

    Lee, Larissa J.; Viswanathan, Akila N.

    2012-01-01

    Purpose: To identify predictors of grade 3-4 complications and grade 2-4 rectal toxicity after three-dimensional image-guided high-dose-rate (HDR) interstitial brachytherapy for gynecologic cancer. Methods and Materials: Records were reviewed for 51 women (22 with primary disease and 29 with recurrence) treated with HDR interstitial brachytherapy. A single interstitial insertion was performed with image guidance by computed tomography (n = 43) or magnetic resonance imaging (n = 8). The median delivered dose in equivalent 2-Gy fractions was 72.0 Gy (45 Gy for external-beam radiation therapy and 24 Gy for brachytherapy). Toxicity was reported according to the Common Toxicity Criteria for Adverse Events. Actuarial toxicity estimates were calculated by the Kaplan-Meier method. Results: At diagnosis, the median patient age was 62 years and the median tumor size was 3.8 cm. The median D90 and V100 were 71.4 Gy and 89.5%; the median D2cc for the bladder, rectum, and sigmoid were 64.6 Gy, 61.0 Gy, and 52.7 Gy, respectively. The actuarial rates of all grade 3-4 complications at 2 years were 20% gastrointestinal, 9% vaginal, 6% skin, 3% musculoskeletal, and 2% lymphatic. There were no grade 3-4 genitourinary complications and no grade 5 toxicities. Grade 2-4 rectal toxicity was observed in 10 patients, and grade 3-4 complications in 4; all cases were proctitis with the exception of 1 rectal fistula. D2cc for rectum was higher for patients with grade 2-4 (68 Gy vs 57 Gy for grade 0-1, P=.03) and grade 3-4 (73 Gy vs 58 Gy for grade 0-2, P=.02) rectal toxicity. The estimated dose that resulted in a 10% risk of grade 2-4 rectal toxicity was 61.8 Gy (95% confidence interval, 51.5-72.2 Gy). Discussion: Image-guided HDR interstitial brachytherapy results in acceptable toxicity for women with primary or recurrent gynecologic cancer. D2cc for the rectum is a reliable predictor of late rectal complications. Three-dimensional-based treatment planning should be performed to ensure

  14. Systematic measurements of whole-body imaging dose distributions in image-guided radiation therapy

    International Nuclear Information System (INIS)

    Hälg, Roger A.; Besserer, Jürgen; Schneider, Uwe

    2012-01-01

    Purpose: The full benefit of the increased precision of contemporary treatment techniques can only be exploited if the accuracy of the patient positioning is guaranteed. Therefore, more and more imaging modalities are used in the process of the patient setup in clinical routine of radiation therapy. The improved accuracy in patient positioning, however, results in additional dose contributions to the integral patient dose. To quantify this, absorbed dose measurements from typical imaging procedures involved in an image-guided radiation therapy treatment were measured in an anthropomorphic phantom for a complete course of treatment. The experimental setup, including the measurement positions in the phantom, was exactly the same as in a preceding study of radiotherapy stray dose measurements. This allows a direct combination of imaging dose distributions with the therapy dose distribution. Methods: Individually calibrated thermoluminescent dosimeters were used to measure absorbed dose in an anthropomorphic phantom at 184 locations. The dose distributions from imaging devices used with treatment machines from the manufacturers Accuray, Elekta, Siemens, and Varian and from computed tomography scanners from GE Healthcare were determined and the resulting effective dose was calculated. The list of investigated imaging techniques consisted of cone beam computed tomography (kilo- and megavoltage), megavoltage fan beam computed tomography, kilo- and megavoltage planar imaging, planning computed tomography with and without gating methods and planar scout views. Results: A conventional 3D planning CT resulted in an effective dose additional to the treatment stray dose of less than 1 mSv outside of the treated volume, whereas a 4D planning CT resulted in a 10 times larger dose. For a daily setup of the patient with two planar kilovoltage images or with a fan beam CT at the TomoTherapy unit, an additional effective dose outside of the treated volume of less than 0.4 mSv and 1

  15. The frontal bone skull post for image guided surgery of the nasopharynx.

    Science.gov (United States)

    Vlantis, Alexander C; Chan, H S; Hung, Terry; Tong, Michael C F; Van Hasselt, C Andrew

    2008-05-01

    To describe the use of the mastoid skull post of a surgical image guidance system for image guided surgery and intraoperative navigation of the nasopharynx. This adaptation overcomes the limitations of a headset frame or head clamp and can be applied to open and closed surgery of the nasal cavities, sinuses, orbits, midface and anterior skull base. A sterile mastoid skull post of a surgical image guidance system was securely screwed into the outer table of the frontal bone and a passive reference frame fixed to it. The position of the reference frame relative to the patient's head remained constant during surgery. Between August 2002 and November 2006, 22 patients underwent a surgical nasopharyngectomy using an image guidance system and frontal bone skull post. No surgical complications or complications of the frontal bone skull post occurred. Using the skull post of a surgical image guidance system anchored to the frontal bone to carry a passive reference frame provides real-time visual information about the relationship of relevant anatomy to the surgical field on a fully mobile head in open or closed procedures of the midface and anterior skull base while accuracy and sterility are maintained. (c) 2008 Wiley-Liss, Inc.

  16. Towards image-guided atrial septal defect repair: an ex vivo analysis

    Science.gov (United States)

    Kwartowitz, David M.; Mefleh, Fuad N.; Baker, George H.

    2012-02-01

    The use of medical images in the operating room for navigation and planning is well established in many clinical disciplines. In cardiology, the use of fluoroscopy for the placement of catheters within the heart has become the standard of care. While fluoroscopy provides a live video sequence with the current location, it poses risks the patient and clinician through exposure to radiation. Radiation dose is cumulative and thus children are at even greater risk from exposure. To reduce the use of radiation, and improve surgical technique we have begun development of an image-guided navigation system, which can deliver therapeutic devices via catheter. In this work we have demonstrated the intrinsic properties of our imaging system, which have led to the development of a phantom emulating a childs heart with an ASD. Further investigation into the use of this information, in a series of mock clinical experiments, will be performed to design procedures for inserting devices into the heart while minimizing fluoroscopy use.

  17. The clinical utility of multimodal MR image-guided needle biopsy in cerebral gliomas.

    Science.gov (United States)

    Yao, Chengjun; Lv, Shunzeng; Chen, Hong; Tang, Weijun; Guo, Jun; Zhuang, Dongxiao; Chrisochoides, Nikos; Wu, Jinsong; Mao, Ying; Zhou, Liangfu

    2016-01-01

    Our aim was to evaluate the diagnostic value of multimodal Magnetic Resonance (MR) Image in the stereotactic biopsy of cerebral gliomas, and investigate its implications. Twenty-four patients with cerebral gliomas underwent (1)H Magnetic Resonance Spectroscopy ((1)H-MRS)- and intraoperative Magnetic Resonance Imaging (iMRI)-supported stereotactic biopsy, and 23 patients underwent only the preoperative MRI-guided biopsy. The diagnostic yield, morbidity and mortality rates were analyzed. In addition, 20 patients underwent subsequent tumor resection, thus the diagnostic accuracy of the biopsy was further evaluated. The diagnostic accuracies of biopsies evaluated by tumor resection in the trial groups were better than control groups (92.3% and 42.9%, respectively, p = 0.031). The diagnostic yield in the trial groups was better than the control groups, but the difference was not statistically significant (100% and 82.6%, respectively, p = 0.05). The morbidity and mortality rates were similar in both groups. Multimodal MR image-guided glioma biopsy is practical and valuable. This technique can increase the diagnostic accuracy in the stereotactic biopsy of cerebral gliomas. Besides, it is likely to increase the diagnostic yield but requires further validation.

  18. Near-infrared image-guided laser ablation of dental decay

    Science.gov (United States)

    Tao, You-Chen; Fried, Daniel

    2009-09-01

    Image-guided laser ablation systems are now feasible for dentistry with the recent development of nondestructive high-contrast imaging modalities such as near-IR (NIR) imaging and optical coherence tomography (OCT) that are capable of discriminating between sound and demineralized dental enamel at the early stages of development. Our objective is to demonstrate that images of demineralized tooth surfaces have sufficient contrast to be used to guide a CO2 laser for the selective removal of natural and artificial caries lesions. NIR imaging and polarization-sensitive optical coherence tomography (PS-OCT) operating at 1310-nm are used to acquire images of natural lesions on extracted human teeth and highly patterned artificial lesions produced on bovine enamel. NIR and PS-OCT images are analyzed and converted to binary maps designating the areas on the samples to be removed by a CO2 laser to selectively remove the lesions. Postablation NIR and PS-OCT images confirmed preferential removal of demineralized areas with minimal damage to sound enamel areas. These promising results suggest that NIR and PS-OCT imaging systems can be integrated with a CO2 laser ablation system for the selective removal of dental caries.

  19. Image-guided recording system for spatial and temporal mapping of neuronal activities in brain slice.

    Science.gov (United States)

    Choi, Geonho; Lee, Jeonghyeon; Kim, Hyeongeun; Jang, Jaemyung; Im, Changkyun; Jeon, Nooli; Jung, Woonggyu

    2018-03-01

    In this study, we introduce the novel image-guided recording system (IGRS) for efficient interpretation of neuronal activities in the brain slice. IGRS is designed to combine microelectrode array (MEA) and optical coherence tomography at the customized upright microscope. It allows to record multi-site neuronal signals and image of the volumetric brain anatomy in a single body configuration. For convenient interconnection between a brain image and neuronal signals, we developed the automatic mapping protocol that enables us to project acquired neuronal signals on a brain image. To evaluate the performance of IGRS, hippocampal signals of the brain slice were monitored, and corresponding with two-dimensional neuronal maps were successfully reconstructed. Our results indicated that IGRS and mapping protocol can provide the intuitive information regarding long-term and multi-sites neuronal signals. In particular, the temporal and spatial mapping capability of neuronal signals would be a very promising tool to observe and analyze the massive neuronal activity and connectivity in MEA-based electrophysiological studies. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  20. Trajectory planning method for reduced patient risk in image-guided neurosurgery: concept and preliminary results

    Science.gov (United States)

    Shamir, Reuben R.; Joskowicz, Leo; Antiga, Luca; Foroni, Roberto I.; Shoshan, Yigal

    2010-02-01

    We present a new preoperative planning method to quantify and help reduce the risk associated with needle and tool insertion trajectories in image-guided keyhole neurosurgery. The goal is to quantify the risk of a proposed straight trajectory, and/or to find the trajectory with the lowest risk to nearby brain structures based on pre-operative CT/MRI images. The method automatically computes the risk associated with a given trajectory, or finds the trajectory with the lowest risk to nearby brain structures based on preoperative image segmentation and on a risk volume map. The surgeon can revise the suggested trajectory, add a new one using interactive 3D visualization, and obtain a quantitative risk measure. The trajectory risk is evaluated based on the tool placement uncertainty, on the proximity of critical brain structures, and on a predefined table of quantitative geometric risk measures. Our preliminary results on a clinical dataset with eight targets show a significant reduction in trajectory risk and a shortening of the preoperative planning time as compared to the conventional method.

  1. 5-ALA Fluorescence Image Guided Resection of Glioblastoma Multiforme: A Meta-Analysis of the Literature

    Directory of Open Access Journals (Sweden)

    Samy Eljamel

    2015-05-01

    Full Text Available Background: Glioblastoma multiforme (GBM is one of the most deadly cancers in humans. Despite recent advances in anti-cancer therapies, most patients with GBM die from local disease progression. Fluorescence image guided surgical resection (FIGR was recently advocated to enhance local control of GBM. This is meta-analyses of 5-aminolevulinic (5-ALA induced FIGR. Materials: Review of the literature produced 503 potential publications; only 20 of these fulfilled the inclusion criteria of this analysis, including a total of 565 patients treated with 5-ALA-FIGR reporting on its outcomes and 800 histological samples reporting 5-ALA-FIGR sensitivity and specificity. Results: The mean gross total resection (GTR rate was 75.4% (95% CI: 67.4–83.5, p < 0.001. The mean time to tumor progression (TTP was 8.1 months (95% CI: 4.7–12, p < 0.001. The mean overall survival gain reported was 6.2 months (95% CI: −1–13, p < 0.001. The specificity was 88.9% (95% CI: 83.9–93.9, p < 0.001 and the sensitivity was 82.6% (95% CI: 73.9–91.9, p < 0.001. Conclusion: 5-ALA-FIGR in GBM is highly sensitive and specific, and imparts significant benefits to patients in terms of improved GTR and TTP.

  2. Development and application of stent-based image guided navigation system for oral and maxillofacial surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Woo Jin; Kim, Dae Seung [Interdisciplinary Program in Radiation Applied Life Science, Dental Research Institute and BK21, College of Medicine, Seoul National University, Seoul (Korea, Republic of); Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul; Heo, Min Suk; Huh, Kyung Hoe; Kim, Myung Jin; Lee, Jee Ho [Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2009-09-15

    The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. We devised a patient-specific stent for patient-to-image registration and navigation. Three dimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. The accuracy over 8 anatomical landmarks showed an overall mean of 0.56 {+-} 0.16 mm. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.

  3. Development and application of stent-based image guided navigation system for oral and maxillofacial surgery

    International Nuclear Information System (INIS)

    Lee, Woo Jin; Kim, Dae Seung; Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul; Heo, Min Suk; Huh, Kyung Hoe; Kim, Myung Jin; Lee, Jee Ho

    2009-01-01

    The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. We devised a patient-specific stent for patient-to-image registration and navigation. Three dimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. The accuracy over 8 anatomical landmarks showed an overall mean of 0.56 ± 0.16 mm. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.

  4. Virtual Reality Aided Positioning of Mobile C-Arms for Image-Guided Surgery

    Directory of Open Access Journals (Sweden)

    Zhenzhou Shao

    2014-06-01

    Full Text Available For the image-guided surgery, the positioning of mobile C-arms is a key technique to take X-ray images in a desired pose for the confirmation of current surgical outcome. Unfortunately, surgeons and patient often suffer the radiation exposure due to the repeated imaging when the X-ray image is of poor quality or not captured at a good projection view. In this paper, a virtual reality (VR aided positioning method for the mobile C-arm is proposed by the alignment of 3D surface model of region of interest and preoperative anatomy, so that a reference pose of the mobile C-arm with respect to the inside anatomy can be figured out from outside view. It allows a one-time imaging from the outside view to greatly reduce the additional radiation exposure. To control the mobile C-arm to the desired pose, the mobile C-arm is modeled as a robotic arm with a movable base. Experiments were conducted to evaluate the accuracy of appearance model and precision of mobile C-arm positioning. The appearance model was reconstructed with the average error of 2.16 mm. One-time imaging of mobile C-arm was achieved, and new modeling of mobile C-arm with 8 DoFs enlarges the working space in the operating room.

  5. Image-Guided Surgery Using Invisible Near-Infrared Light: Fundamentals of Clinical Translation

    Directory of Open Access Journals (Sweden)

    Sylvain Gioux

    2010-09-01

    Full Text Available The field of biomedical optics has matured rapidly over the last decade and is poised to make a significant impact on patient care. In particular, wide-field (typically > 5 cm, planar, near-infrared (NIR fluorescence imaging has the potential to revolutionize human surgery by providing real-time image guidance to surgeons for tissue that needs to be resected, such as tumors, and tissue that needs to be avoided, such as blood vessels and nerves. However, to become a clinical reality, optimized imaging systems and NIR fluorescent contrast agents will be needed. In this review, we introduce the principles of NIR fluorescence imaging, analyze existing NIR fluorescence imaging systems, and discuss the key parameters that guide contrast agent development. We also introduce the complexities surrounding clinical translation using our experience with the Fluorescence-Assisted Resection and Exploration (FLARE™ imaging system as an example. Finally, we introduce state-of-the-art optical imaging techniques that might someday improve image-guided surgery even further.

  6. Possibility of transrectal photoacoustic imaging-guided biopsy for detection of prostate cancer

    Science.gov (United States)

    Ishihara, Miya; Shinchi, Masayuki; Horiguchi, Akio; Shinmoto, Hiroshi; Tsuda, Hitoshi; Irisawa, Kaku; Wada, Takatsugu; Asano, Tomohiko

    2017-03-01

    A transrectral ultrasonography (TRUS) guided prostate biopsy is mandatory for histological diagnosis in patients with an elevated serum prostate-specific antigen (PSA), but its diagnostic accuracy is not satisfactory; therefore, a considerable number of patients are forced to have an unnecessary repeated biopsy. Photoacoustic (PA) imaging has the ability to visualize the distribution of hemoglobin clearly. Thus, there is the potential to acquire different maps of small vessel networks between cancerous and normal tissue. We developed an original TRUS-type PA probe consisting of a microconvex array transducer with an optical illumination system providing coregistered PA and ultrasound images. The purpose of this study is to demonstrate the clinical possibility of a transrectral PA image. The prostate biopsy cores obtained by transrectal systemic biopsies under TRUS guidance were stained with HE staining and anti-CD34 antibodies as a marker of the endothelium of the blood vessel in order to find a pattern in the map of a small vessel network, which allows for imaging-based identification of prostate cancer. We analyzed the association of PA signal patterns, the cancer location by a magnetic resonance imaging (MRI) study, and the pathological diagnosis with CD34 stains as a prospective intervention study. In order to demonstrate the TRUS-merged-with-PA imaging guided targeted biopsy combined with a standard biopsy for capturing the clinically significant tumors, we developed a puncture needle guide attachment for the original TRUS-type PA probe.

  7. Selecting electrode configurations for image-guided cochlear implant programming using template matching.

    Science.gov (United States)

    Zhang, Dongqing; Zhao, Yiyuan; Noble, Jack H; Dawant, Benoit M

    2018-04-01

    Cochlear implants (CIs) are neural prostheses that restore hearing using an electrode array implanted in the cochlea. After implantation, the CI processor is programmed by an audiologist. One factor that negatively impacts outcomes and can be addressed by programming is cross-electrode neural stimulation overlap (NSO). We have proposed a system to assist the audiologist in programming the CI that we call image-guided CI programming (IGCIP). IGCIP permits using CT images to detect NSO and recommend deactivation of a subset of electrodes to avoid NSO. We have shown that IGCIP significantly improves hearing outcomes. Most of the IGCIP steps are robustly automated but electrode configuration selection still sometimes requires manual intervention. With expertise, distance-versus-frequency curves, which are a way to visualize the spatial relationship learned from CT between the electrodes and the nerves they stimulate, can be used to select the electrode configuration. We propose an automated technique for electrode configuration selection. A comparison between this approach and one we have previously proposed shows that our method produces results that are as good as those obtained with our previous method while being generic and requiring fewer parameters.

  8. A finite state model for respiratory motion analysis in image guided radiation therapy

    International Nuclear Information System (INIS)

    Wu Huanmei; Sharp, Gregory C; Salzberg, Betty; Kaeli, David; Shirato, Hiroki; Jiang, Steve B

    2004-01-01

    Effective image guided radiation treatment of a moving tumour requires adequate information on respiratory motion characteristics. For margin expansion, beam tracking and respiratory gating, the tumour motion must be quantified for pretreatment planning and monitored on-line. We propose a finite state model for respiratory motion analysis that captures our natural understanding of breathing stages. In this model, a regular breathing cycle is represented by three line segments, exhale, end-of-exhale and inhale, while abnormal breathing is represented by an irregular breathing state. In addition, we describe an on-line implementation of this model in one dimension. We found this model can accurately characterize a wide variety of patient breathing patterns. This model was used to describe the respiratory motion for 23 patients with peak-to-peak motion greater than 7 mm. The average root mean square error over all patients was less than 1 mm and no patient has an error worse than 1.5 mm. Our model provides a convenient tool to quantify respiratory motion characteristics, such as patterns of frequency changes and amplitude changes, and can be applied to internal or external motion, including internal tumour position, abdominal surface, diaphragm, spirometry and other surrogates

  9. A finite state model for respiratory motion analysis in image guided radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Wu Huanmei [College of Computer and Information Science, Northeastern University, Boston, MA 02115 (United States); Sharp, Gregory C [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States); Salzberg, Betty [College of Computer and Information Science, Northeastern University, Boston, MA 02115 (United States); Kaeli, David [Department of Electrical and Computer Engineering, Northeastern University, Boston, MA 02115 (United States); Shirato, Hiroki [Department of Radiation Medicine, Hokkaido University School of Medicine, Sapporo (Japan); Jiang, Steve B [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)

    2004-12-07

    Effective image guided radiation treatment of a moving tumour requires adequate information on respiratory motion characteristics. For margin expansion, beam tracking and respiratory gating, the tumour motion must be quantified for pretreatment planning and monitored on-line. We propose a finite state model for respiratory motion analysis that captures our natural understanding of breathing stages. In this model, a regular breathing cycle is represented by three line segments, exhale, end-of-exhale and inhale, while abnormal breathing is represented by an irregular breathing state. In addition, we describe an on-line implementation of this model in one dimension. We found this model can accurately characterize a wide variety of patient breathing patterns. This model was used to describe the respiratory motion for 23 patients with peak-to-peak motion greater than 7 mm. The average root mean square error over all patients was less than 1 mm and no patient has an error worse than 1.5 mm. Our model provides a convenient tool to quantify respiratory motion characteristics, such as patterns of frequency changes and amplitude changes, and can be applied to internal or external motion, including internal tumour position, abdominal surface, diaphragm, spirometry and other surrogates.

  10. Gold Nanocage-Photosensitizer Conjugates for Dual-Modal Image-Guided Enhanced Photodynamic Therapy

    Science.gov (United States)

    Srivatsan, Avinash; Jenkins, Samir V.; Jeon, Mansik; Wu, Zhijin; Kim, Chulhong; Chen, Jingyi; Pandey, Ravindra K.

    2014-01-01

    We have demonstrated that gold nanocage-photosensitizer conjugates can enable dual image-guided delivery of photosensitizer and significantly improve the efficacy of photodynamic therapy in a murine model. The photosensitizer, 3-devinyl-3-(1'-hexyloxyethyl)pyropheophorbide (HPPH), was noncovalently entrapped in the poly(ethylene glycol) monolayer coated on the surface of gold nanocages. The conjugate is stable in saline solutions, while incubation in protein rich solutions leads to gradual unloading of the HPPH, which can be monitored optically by fluorescence and photoacoustic imaging. The slow nature of the release in turn results in an increase in accumulation of the drug within implanted tumors due to the passive delivery of gold nanocages. Furthermore, the conjugate is found to generate more therapeutic singlet oxygen and have a lower IC50 value than the free drug alone. Thus the conjugate shows significant suppression of tumor growth as compared to the free drug in vivo. Short-term study showed neither toxicity nor phenotypical changes in mice at therapeutic dose of the conjugates or even at 100-fold higher than therapeutic dose of gold nanocages. PMID:24465274

  11. A small animal image guided irradiation system study using 3D dosimeters

    International Nuclear Information System (INIS)

    Qian, Xin; Wuu, Cheng-Shie; Admovics, John

    2015-01-01

    In a high resolution image-guided small animal irradiation platform, a cone beam computed tomography (CBCT) is integrated with an irradiation unit for precise targeting. Precise quality assurance is essential for both imaging and irradiation components. The conventional commissioning techniques with films face major challenges due to alignment uncertainty and labour intensive film preparation and scanning. In addition, due to the novel design of this platform the mouse stage rotation for CBCT imaging is perpendicular to the gantry rotation for irradiation. Because these two rotations are associated with different mechanical systems, discrepancy between rotation isocenters exists. In order to deliver x-ray precisely, it is essential to verify coincidence of the imaging and the irradiation isocenters. A 3D PRESAGE dosimeter can provide an excellent tool for checking dosimetry and verifying coincidence of irradiation and imaging coordinates in one system. Dosimetric measurements were performed to obtain beam profiles and percent depth dose (PDD). Isocentricity and coincidence of the mouse stage and gantry rotations were evaluated with starshots acquired using PRESAGE dosimeters. A single PRESAGE dosimeter can provide 3 -D information in both geometric and dosimetric uncertainty, which is crucial for translational studies

  12. A small animal image guided irradiation system study using 3D dosimeters

    Science.gov (United States)

    Qian, Xin; Admovics, John; Wuu, Cheng-Shie

    2015-01-01

    In a high resolution image-guided small animal irradiation platform, a cone beam computed tomography (CBCT) is integrated with an irradiation unit for precise targeting. Precise quality assurance is essential for both imaging and irradiation components. The conventional commissioning techniques with films face major challenges due to alignment uncertainty and labour intensive film preparation and scanning. In addition, due to the novel design of this platform the mouse stage rotation for CBCT imaging is perpendicular to the gantry rotation for irradiation. Because these two rotations are associated with different mechanical systems, discrepancy between rotation isocenters exists. In order to deliver x-ray precisely, it is essential to verify coincidence of the imaging and the irradiation isocenters. A 3D PRESAGE dosimeter can provide an excellent tool for checking dosimetry and verifying coincidence of irradiation and imaging coordinates in one system. Dosimetric measurements were performed to obtain beam profiles and percent depth dose (PDD). Isocentricity and coincidence of the mouse stage and gantry rotations were evaluated with starshots acquired using PRESAGE dosimeters. A single PRESAGE dosimeter can provide 3 -D information in both geometric and dosimetric uncertainty, which is crucial for translational studies.

  13. High volume image guided injections and structured rehabilitation in shoulder impingement syndrome: a retrospective study

    Science.gov (United States)

    Morton, Sarah; Chan, Otto; Ghozlan, Asser; Price, Jessica; Perry, John; Morrissey, Dylan

    2015-01-01

    Summary Background the aim was to establish the effect of a high volume-image guided injection and structured rehabilitation (HVIGI&SR) on both pain and function in shoulder impingement syndrome (SIS). Methods 44 participants treated between January 2008 and January 2012 with a >3 month history of recalcitrant ultrasound-confirmed SIS were sent a retrospective questionnaire. All participants had received a HVIGI under ultrasound-guidance consisting of 20 mls of Marcaine with 50 mg of hydrocortisone, followed by a period of physiotherapist-led rehabilitation. The validated Shoulder Pain and Disability Index (SPADI) score was used to establish the change in the score between 1 week pre-injection and 3 weeks post-injection, along with an 11-point pain scale. Results 59% of participants responded. There was a clinically and statistically significant decrease in the SPADI score of 58.7 ± 29.9 (p<0.01). 76% of participants had an improvement in their score of over 50% from their initial score. There was a clinically and statistically significant improvement in pain of 5.19 ± 2.62 (p<0.01) on the numerical rating scale of pain. Conclusion HVIGI&SR should be considered for short-term treatment of SIS as it showed a significant improvement in both pain and function. A prolonged period of physiotherapist-led rehabilitation can then be undertaken for long term benefits. PMID:26605194

  14. Designing a wearable navigation system for image-guided cancer resection surgery.

    Science.gov (United States)

    Shao, Pengfei; Ding, Houzhu; Wang, Jinkun; Liu, Peng; Ling, Qiang; Chen, Jiayu; Xu, Junbin; Zhang, Shiwu; Xu, Ronald

    2014-11-01

    A wearable surgical navigation system is developed for intraoperative imaging of surgical margin in cancer resection surgery. The system consists of an excitation light source, a monochromatic CCD camera, a host computer, and a wearable headset unit in either of the following two modes: head-mounted display (HMD) and Google glass. In the HMD mode, a CMOS camera is installed on a personal cinema system to capture the surgical scene in real-time and transmit the image to the host computer through a USB port. In the Google glass mode, a wireless connection is established between the glass and the host computer for image acquisition and data transport tasks. A software program is written in Python to call OpenCV functions for image calibration, co-registration, fusion, and display with augmented reality. The imaging performance of the surgical navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex vivo tissue model. Surgical margins identified by the wearable navigation system are co-incident with those acquired by a standard small animal imaging system, indicating the technical feasibility for intraoperative surgical margin detection. The proposed surgical navigation system combines the sensitivity and specificity of a fluorescence imaging system and the mobility of a wearable goggle. It can be potentially used by a surgeon to identify the residual tumor foci and reduce the risk of recurrent diseases without interfering with the regular resection procedure.

  15. Image-Guided Hypofractionated Radiotherapy in Low-Risk Prostate Cancer Patients

    Directory of Open Access Journals (Sweden)

    Maurizio Valeriani

    2014-01-01

    Full Text Available Aim. To evaluate efficacy and toxicity of image-guided hypofractionated radiotherapy (HFRT in the treatment of low-risk prostate cancer. Outcomes and toxicities of this series of patients were compared to another group of 32 low-risk patients treated with conventional fractionation (CFRT. Methods. Fifty-nine patients with low-risk prostate cancer were analysed. Total dose for the prostate and proximal seminal vesicles was 60 Gy delivered in 20 fractions. Results. The median follow-up was 30 months. The actuarial 4-year overall survival, biochemical free survival, and disease specific survival were 100%, 97.4%, and 97.4%, respectively. Acute grade 1-2 gastrointestinal (GI and genitourinary (GU toxicity rates were 11.9% and 40.7%, respectively. Grade 1 GI and GU late toxicity rates were 8.5% and 13.6%, respectively. No grade ≥2 late toxicities were recorded. Acute grade 2-3 GU toxicity resulted significantly lower (P=0.04 in HFRT group compared to the CFRT group. The cumulative 4-year incidence of grade 1-2 GU toxicity was significantly higher (P<0.001 for HFRT patients. Conclusions. Our study demonstrated that hypofractionated regimen provided excellent biochemical control in favorable risk prostate cancer patients. The incidence of GI and GU toxicity was low. However, HFRT presented higher cumulative incidence of low-grade late GU toxicity than CFRT.

  16. Image-guided macular laser therapy: design considerations and progress toward implementation

    Science.gov (United States)

    Berger, Jeffrey W.; Shin, David S.

    1999-06-01

    Laser therapy is currently the only treatment of proven benefit for exudative age related macular degeneration and diabetic retinopathy. To guide treatment for macular diseases, investigations were initiated to permit overlay of previously-stored angiographic images and image sequences superimposed onto the real-time biomicroscopic fundus image. Prior to treatment, a set of partially overlapping fundus images is acquired and montaged in order to provide a map for subsequent tracking operations. A binocular slit-lamp biomicroscope interfaced to a CCD camera, framegrabber board, and PC permits acquisition and rendering of retinal images. Computer-vision algorithms facilitate robust tracking, registration, and near-video-rate image overlay of previously-stored retinal photographic and angiographic images onto the real-time fundus image. Laser treatment is guided in this augmented reality environment where the borders of the treatment target--for example, the boundaries of a choroidal neovascularization complex--are easily identified through overlay of angiographic information superimposed on, and registered with, the real-time fundus image. During periods of misregistration as judged by the amplitude of the tracking similarity metric, laser function is disabled, affording additional safety. Image-guided macular laser therapy should facilitate accurate targeting of treatable lesions and less unintentional retinal injury when compared with standard techniques.

  17. Image-guided core-needle biopsy of peripheral lymph nodes allows the diagnosis of lymphomas

    International Nuclear Information System (INIS)

    Kerviler, Eric de; Bazelaire, Cedric de; Mathieu, Olivier; Frija, Jacques; Mounier, Nicolas; Gisselbrecht, Christian; Brethon, Benoit; Briere, Josette; Marolleau, Jean-Pierre; Brice, Pauline

    2007-01-01

    It is commonly admitted that the diagnosis of lymphomas can be assessed by the image-guided needle biopsy (IGNB) of deep lymph nodes. However, when peripheral lymph nodes are present, surgical dissection remains the standard strategy. The aim of this study was to evaluate the diagnostic yield of IGNB of peripheral lymph nodes in patients with suspected lymphomas. The records of 180 multisampling IGNBs of peripheral lymph nodes in 180 patients were reviewed. One hundred and twenty-three IGNBs were observed at first diagnosis and 57 at progression using large-cutting core-biopsy needles ranging between 18 G and 14 G in size. Immunohistochemistry studies were performed in all cases and at least one biopsy was systematically frozen. A diagnosis of lymphoma with sufficient information such that a therapeutic decision could be made was obtained in 146 of the 152 patients with lymphoproliferative disorders (96%). IGNB was equally effective in making the correct diagnosis of lymphoma at the time of original diagnosis than at relapse. The results did not depend on the biopsy site, lymph nodes size, or needle type. We recommend that IGNB may be performed as an initial procedure for the diagnosis of lymphomas either in the presence of peripheral or deep lymph nodes, as it avoids surgery. (orig.)

  18. Feasibility of Tomotherapy-based image-guided radiotherapy for small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Nam Phong Nguyen

    2013-11-01

    Full Text Available Background: To assess the tolerance of patients with small cell lung cancer undergoing chemoradiation with tomotherapy-based image-guided radiotherapy (IGRT.Materials and methods: A retrospective review of the toxicity profile for nine patients with small cell lung cancer of the limited stage who underwent chemoradiation delivered with helical tomotherapy (HT has been conducted.Results: Acute grade 3-4 hematologic and esophagitis toxicities developed in two and three patients respectively. One patient developed a pulmonary embolism during radiotherapy. Seven patients had weight loss ranging from 0 to 30 pounds (median: 4 pounds. Three patients had treatment breaks ranging from 2 to 12 days. At a median follow-up of 11 months (range: 2-24 months, no patients developed any radiation related toxicities such as grade 3-4 pneumonitis or other long-term complications. The median survival was estimated to be 15 months. There were 2 local recurrences, 3 mediastinal recurrences, and six distant metastases.Conclusion: Grade 3-4 toxicities remained significant during chemoradiation when radiation was delivered with tomotherapy-based IGRT. However, the absence of grade 3-4 pneumonitis is promising and the use of HT needs to be investigated in future prospective studies.

  19. Rapid block matching based nonlinear registration on GPU for image guided radiation therapy

    Science.gov (United States)

    Wang, An; Disher, Brandon; Carnes, Greg; Peters, Terry M.

    2010-02-01

    To compensate for non-uniform deformation due to patient motion within and between fractions in image guided radiation therapy, a block matching technique was adapted and implemented on a standard graphics processing unit (GPU) to determine the displacement vector field that maps the nonlinear transformation between successive CT images. Normalized cross correlation (NCC) was chosen as the similarity metric for the matching step, with regularization of the displacement vector field being performed by Gaussian smoothing. A multi-resolution framework was adopted to further improve the performance of the algorithm. The nonlinear registration algorithm was first applied to estimate the intrafractional motion from 4D lung CT images. It was also used to calculate the inter-fractional organ deformation between planning CT (PCT) and Daily Cone Beam CT (CBCT) images of thorax. For both experiments, manual landmark-based evaluation was performed to quantify the registration performance. In 4D CT registration, the mean TRE of 5 cases was 1.75 mm. In PCT-CBCT registration, the TRE of one case was 2.26mm. Compared to the CPU-based AtamaiWarp program, our GPU-based implementation achieves comparable registration accuracy and is ~25 times faster. The results highlight the potential utility of our algorithm for online adaptive radiation treatment.

  20. Stereotactic image-guided navigation in the preoperative imaging of perforators for DIEP flap breast reconstruction.

    Science.gov (United States)

    Rozen, W M; Ashton, M W; Stella, D L; Phillips, T J; Taylor, G I

    2008-01-01

    Preoperative imaging is sought prior to DIEA (Deep Inferior Epigastric Artery) perforator flaps due to the potential for maximizing operative success and minimizing operative complications. Recent advances include the use of computed tomography (CT) angiography (CTA) and magnetic resonance angiography. Image-guided stereotactic surgery is a recent technique that has been used with success in several fields of surgery. The variability of perforator anatomy makes DIEA perforator flap surgery a suitable candidate for such technology, but as yet this has not been described. A study was undertaken to determine the feasibility of CT-guided stereotaxy technique in DIEA perforator flap surgery and to compare findings with both conventional CTA and operative findings. Five consecutive patients planned for an elective DIEA perforator flap were recruited. Each patient underwent preoperative imaging of the anterior abdominal wall vasculature with both conventional CTA and CT-guided stereotactic imaging. Imaging findings were compared to operative findings. In all cases, all the major perforators were accurately localized with stereotactic imaging and with conventional CTA. Stereotactic navigation demonstrated a slightly better (nonsignificant) correlation with perforator location than conventional CTA. As such, CT-guided stereotactic imaging is an accurate method for the preoperative planning of DIEA perforator flaps, providing additional and potentially more accurate data to conventional CTA. With no additional scanning required, the method described in this paper allows the combined use of both methods for preoperative planning. (c) 2008 Wiley-Liss, Inc.

  1. Molecular image guided radiation therapy-MIGRT in radiobioluminescence and nanoradioguidance

    International Nuclear Information System (INIS)

    Rao, V.L. Papineni

    2014-01-01

    Accurate dose delivery to malignant tissue in radiotherapy is essential for enhancing the treatment efficacy while minimizing morbidity of surrounding normal tissues. Advances in therapeutic strategies and diagnosis technologies along with our understanding of the biology of tumor response to radiation therapy have paved way to allow nearly 60% of current cancer patients to be treated with Radiation Therapy. The confluence of molecular imaging and nanotechnology fields are bridging physics and medicine and are quickly making strides in opening new avenues and therapeutic strategies that complement radiation therapy - with a distinct footprint in immunotherapy, adoptive cell therapy, and targeted chemotherapy. Incorporating optical imaging in radiation therapy in my laboratory, endogenous bioluminescence resulting from whole body irradiation in different organs, and in different animals, which is distinct from the Cherenkov radiation. The endogenous bioluminescence in response to irradiation is coined recently as radiobioluminescence. Thus with the necessity, the design, construction, and validation of Molecular Image Guided Radiation Therapy (MIGRT) instrumentation for preclinical theragnostics is carried out

  2. A novel thermal accelerant for augmentation of microwave energy during image-guided tumor ablation

    Science.gov (United States)

    Park, William K. C.; Maxwell, Aaron W. P.; Frank, Victoria E.; Primmer, Michael P.; Paul, Jarod B.; Susai, Cynthia; Collins, Scott A.; Borjeson, Tiffany M.; Baird, Greyson L.; Lombardo, Kara A.; Dupuy, Damian E.

    2017-02-01

    The greatest challenge in image-guided thermal ablation (IGTA) of liver tumors is a relatively high recurrence rate (ca. 30%) due to incomplete ablation. To meet this challenge, we have developed a novel Thermal Accelerator (TA) to demonstrate its capability to, 1) augment microwave (MW) energy from a distance unattainable by antenna alone; 2) turn into a gel at body temperature; 3) act as a CT or US contrast. We have examined the TA efficiency using in vitro and ex vivo models: microwave power, TA dose, frequencies and TA-to-tip distance were varied, and temperature readings compared with and without TA. Using the in vitro model, it was established that both the rate and magnitude of increase in ablation zone temperature were significantly greater with TA under all tested conditions (pCT, TA density was proportional to dose, with average values ranging from 329 HU to 3071 HU at 10 mg/mL and 1,000mg/mL, respectively. TA can be accurately deposited to a target area using CT or US as image-guidance and augment MW energy effectively so that ablation time is significantly reduced, which will contribute to complete ablation. The preliminary results obtained from in vivo experiments using swine as an animal model are consistent with the observations made in in vitro and en vivo studies.

  3. Image-guided multipolar radiofrequency ablation of liver tumours: initial clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Terraz, Sylvain; Constantin, Christophe; Becker, Christoph D. [Geneva University Hospital, Department of Radiology, Geneva 14 (Switzerland); Majno, Pietro Edoardo; Mentha, Gilles [Geneva University Hospital, Department of Surgery, Geneva 14 (Switzerland); Spahr, Laurent [Geneva University Hospital, Department of Gastroenterology, Geneva 14 (Switzerland)

    2007-09-15

    The local effectiveness and clinical usefulness of multipolar radiofrequency (RF) ablation of liver tumours was evaluated. Sixty-eight image-guided RF sessions were performed using a multipolar device with bipolar electrodes in 53 patients. There were 45 hepatocellular carcinomas (HCC) and 42 metastases with a diameter {<=}3 cm (n = 55), 3.1-5 cm (n = 29) and >5 cm (n = 3); 26 nodules were within 5 mm from large vessels. Local effectiveness and complications were evaluated after RF procedures. Mean follow-up was 17 {+-} 10 months. Recurrence and survival rates were analysed by the Kaplan-Meier method. The primary and secondary technical effectiveness rate was 82% and 95%, respectively. The major and minor complication rate was 2.9%, respectively. The local tumour progression at 1- and 2-years was 5% and 9% for HCC nodules and 17% and 31% for metastases, respectively; four of 26 nodules (15%) close to vessels showed local progression. The survival at 1 year and 2 years was 97% and 90% for HCC and 84% and 68% for metastases, respectively. Multipolar RF technique creates ablation zones of adequate size and tailored shape and is effective to treat most liver tumours, including those close to major hepatic vessels. (orig.)

  4. An Ultrasound Imaging-Guided Robotic HIFU Ablation Experimental System and Accuracy Evaluations.

    Science.gov (United States)

    An, Chih Yu; Syu, Jia Hao; Tseng, Ching Shiow; Chang, Chih-Ju

    2017-01-01

    In recent years, noninvasive thermal treatment by using high-intensity focused ultrasound (HIFU) has high potential in tumor treatment. The goal of this research is to develop an ultrasound imaging-guided robotic HIFU ablation system for tumor treatment. The system integrates the technologies of ultrasound image-assisted guidance, robotic positioning control, and HIFU treatment planning. With the assistance of ultrasound image guidance technology, the tumor size and location can be determined from ultrasound images as well as the robotic arm can be controlled to position the HIFU transducer to focus on the target tumor. After the development of the system, several experiments were conducted to measure the positioning accuracy of this system. The results show that the average positioning error is 1.01 mm with a standard deviation 0.34, and HIFU ablation accuracy is 1.32 mm with a standard deviation 0.58, which means this system is confirmed with its possibility and accuracy.

  5. Hyaluronic acid-functionalized bismuth oxide nanoparticles for computed tomography imaging-guided radiotherapy of tumor.

    Science.gov (United States)

    Du, Fengyi; Lou, Jiaming; Jiang, Rong; Fang, Zhengzou; Zhao, Xuefen; Niu, Yuanyuan; Zou, Shenqiang; Zhang, Miaomiao; Gong, Aihua; Wu, Chaoyang

    2017-01-01

    The inherent radioresistance and inaccuracy of localization of tumors weaken the clinical implementation effectiveness of radiotherapy. To overcome these limitations, hyaluronic acid-functionalized bismuth oxide nanoparticles (HA-Bi 2 O 3 NPs) were synthesized by one-pot hydrothermal method for target-specific computed tomography (CT) imaging and radiosensitization of tumor. After functionalization with hyaluronic acid, the Bi 2 O 3 NPs possessed favorable solubility in water and excellent biocompatibility and were uptaken specifically by cancer cells overexpressing CD44 receptors. The as-prepared HA-Bi 2 O 3 NPs exhibited high X-ray attenuation efficiency and ideal radiosensitivity via synergizing X-rays to induce cell apoptosis and arrest the cell cycle in a dose-dependent manner in vitro. Remarkably, these properties offered excellent performance in active-targeting CT imaging and enhancement of radiosensitivity for inhibition of tumor growth. These findings demonstrated that HA-Bi 2 O 3 NPs as theranostic agents exhibit great promise for CT imaging-guided radiotherapy in diagnosis and treatment of tumors.

  6. Risks and Benefits of Ceasing or Continuing Anticoagulant Medication for Image-Guided Procedures for Spine Pain: A Systematic Review.

    Science.gov (United States)

    Smith, Clark C; Schneider, Byron; McCormick, Zachary L; Gill, Jatinder; Loomba, Vivek; Engel, Andrew J; Duszynski, Belinda; King, Wade

    2018-03-01

    To determine the risks of continuing or ceasing anticoagulant or antiplatelet medications prior to image-guided procedures for spine pain. Systematic review of the literature with comprehensive analysis of the published data. Following a search of the literature for studies pertaining to spine pain interventions in patients on anticoagulant medication, seven reviewers appraised the studies identified and assessed the quality of evidence presented. Evidence was sought regarding risks associated with either continuing or ceasing anticoagulant and antiplatelet medication in patients having image-guided interventional spine procedures. The evidence was evaluated in accordance with the Grades of Recommendation, Assessment, Development, and Evaluation system. From a source of 120 potentially relevant articles, 14 provided applicable evidence. Procedures involving interlaminar access carry a nonzero risk of hemorrhagic complications, regardless of whether anticoagulants are ceased or continued. For other procedures, hemorrhagic complications have not been reported, and case series indicate that they are safe when performed in patients who continue anticoagulants. Three articles reported the adverse effects of ceasing anticoagulants, with serious consequences, including death. Other than for interlaminar procedures, the evidence does not support the view that anticoagulant and antiplatelet medication must be ceased before image-guided spine pain procedures. Meanwhile, the evidence shows that ceasing anticoagulants carries a risk of serious consequences, including death. Guidelines on the use of anticoagulants should reflect these opposing bodies of evidence.

  7. Integrated Digital Tomosynthesis for patient positioning of image-guided radiation therapy.

    Science.gov (United States)

    Yan, Hui; Dai, Jian-Rong

    2017-04-01

    Digital Tomosynthesis (DTS), originally developed for diagnostic applications, has been recently introduced to image guided radiotherapy (IGRT). Due to limited scan range, DTS was featured by anisotropic spatial resolution. A new approach, integrated DTS (IDTS), was developed to improve image resolution of DTS for patient positioning in IGRT. For registration purpose, both on-board IDTS (O-IDTS) and reference IDTS (R-IDTS) were required. O-IDTS was generated from cone-beam (CB) projections acquired in two narrow scan ranges separated by 90°. R-IDTS was generated from digitally reconstructed radiographs (DRR) computed from planning CT in the same two narrow scan ranges. Target offsets were determined by registration of O-IDTS and R-IDTS. The reconstruction algorithms of DRR and IDTS were implemented on general purpose graphics processing unit (GPGPU) for acceleration purpose. IDTS approach was evaluated by phantom and patient cases. Comparing with DTS, IDTS provided high-resolution images in both coronal view and sagittal views. The image resolution of IDTS in axial view was significantly improved compared to that of DTS, but still inferior compared to that of cone-beam computed tomography (CBCT). Reconstruction accuracy and registration accuracy for all cases were high which was within 1mm. Reconstruction performance of IDTS using general purpose graphics processing unit (GPGPU) can be substantially improved, thus competent for daily clinical use. IDTS can provide high-resolution images in coronal and sagittal views with fewer CB projections. Image registration based on IDTS was simple and reliable compared to DTS. IDTS is potentially a useful imaging tool for fast patient positioning in IGRT. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  8. Plan of the day selection for online image-guided adaptive post-prostatectomy radiotherapy.

    Science.gov (United States)

    Gill, Suki; Pham, Daniel; Dang, Kim; Bressel, Mathias; Kron, Tomas; Siva, Shankar; Tran, Phillip K; Tai, Keen Hun; Foroudi, Farshad

    2013-05-01

    To compare the cone-beam CT (CBCT) soft tissue localization disparity between radiation oncologists (RO) and radiation therapy technologists (RTT) in a novel online protocol of image-guided adaptive radiotherapy to the postoperative prostate bed. Using the planning CT and pre-treatment CBCTs from the first week of radiotherapy, four adaptive plans of different sizes were derived for each of eight post-prostatectomy patients. Four ROs collectively defined the reference answer, i.e. the plan of the day and isocentre correction for 40 CBCTs taken in weeks 2-6 of treatment for each patient. RTTs were randomly assigned five of these CBCTs; and asked to record their plan of the day selection and isocentre correction. RTT selection and reference answers were compared. The distance between the RTT selection and the reference answer was calculated. A total of 33 RTTs took part in this study. The average difference in CTV volume (reference answer-RTT selection) was 1.32 cm(3) (SD 29 cm(3)) overall. The average difference between reference answer and RTT isocentre coordinates was SI 1mm (SD 4.8mm), LR 1.1mm (SD 4.0mm) and AP -0.2mm (SD 3.9 mm). Distance of superior 8mm, inferior 6mm, left 4mm, right 2mm, anterior 6mm and posterior 6mm covered 100% of the CTV in 90% of fractions. The difference between RTT and RO selection of adaptive volumes is small and can be accounted for in a clinically acceptable CTV to PTV margin. Adaptive post-prostatectomy radiotherapy is feasible, in the setting of an academic center although at the moment, we have insufficient evidence to suggest that margins can yet be reduced with IGART with the current protocol. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

  9. Toxicity after post-prostatectomy image-guided intensity-modulated radiotherapy using Australian guidelines.

    Science.gov (United States)

    Chin, Stephen; Aherne, Noel J; Last, Andrew; Assareh, Hassan; Shakespeare, Thomas P

    2017-12-01

    We evaluated single institution toxicity outcomes after post-prostatectomy radiotherapy (PPRT) via image-guided intensity-modulated radiation therapy (IG-IMRT) with implanted fiducial markers following national eviQ guidelines, for which late toxicity outcomes have not been published. Prospectively collected toxicity data were retrospectively reviewed for 293 men who underwent 64-66 Gy IG-IMRT to the prostate bed between 2007 and 2015. Median follow-up after PPRT was 39 months. Baseline grade ≥2 genitourinary (GU), gastrointestinal (GI) and sexual toxicities were 20.5%, 2.7% and 43.7%, respectively, reflecting ongoing toxicity after radical prostatectomy. Incidence of new (compared to baseline) acute grade ≥2 GU and GI toxicity was 5.8% and 10.6%, respectively. New late grade ≥2 GU, GI and sexual toxicity occurred in 19.1%, 4.7% and 20.2%, respectively. However, many patients also experienced improvements in toxicities. For this reason, prevalence of grade ≥2 GU, GI and sexual toxicities 4 years after PPRT was similar to or lower than baseline (21.7%, 2.6% and 17.4%, respectively). There were no grade ≥4 toxicities. Post-prostatectomy IG-IMRT using Australian contouring guidelines appears to have tolerable acute and late toxicity. The 4-year prevalence of grade ≥2 GU and GI toxicity was virtually unchanged compared to baseline, and sexual toxicity improved over baseline. This should reassure radiation oncologists following these guidelines. Late toxicity rates of surgery and PPRT are higher than following definitive IG-IMRT, and this should be taken into account if patients are considering surgery and likely to require PPRT. © 2017 The Royal Australian and New Zealand College of Radiologists.

  10. Empyema and Effusion: Outcome of Image-Guided Small-Bore Catheter Drainage

    International Nuclear Information System (INIS)

    Keeling, A. N.; Leong, S.; Logan, P. M.; Lee, M. J.

    2008-01-01

    Empyema and complicated pleural effusion represent common medical problems. Current treatment options are multiple. The purpose of this study was to access the outcome of image-guided, small-bore catheter drainage of empyema and effusion. We evaluated 93 small-bore catheters in 82 patients with pleural effusion (n = 30) or empyema (n = 52), over a 2-year period. Image guidance was with ultrasound (US; n = 56) and CT (n = 37). All patients were followed clinically, with catheter dwell times, catheter outcome, pleural fluid outcome, reinsertion rates, and need for urokinase or surgery recorded. Ninety-three small-bore chest drains (mean=10.2 Fr; range, 8.2-12.2 Fr) were inserted, with an average dwell time of 7.81 days for empyemas and 7.14 days for effusions (p > 0.05). Elective removal rates (73% empyema vs 86% effusions) and dislodgement rates (12% empyema vs 13% effusions) were similar for both groups. Eight percent of catheters became blocked and 17% necessitated reinsertion in empyemas, with no catheters blocked or requiring reinsertion in effusions (p < 0.05). Thirty-two patients (51%) required urokinase in the empyema group, versus 2 patients (6%) in the effusion group (p < 0.05). All treatment failures, requiring surgery, occurred in the empyema group (19%; n = 12; p < 0.05). In conclusion, noninfected pleural collections are adequately treated with small-bore catheters, however, empyemas have a failure rate of 19%. The threshold for using urokinase and larger-bore catheters should be low in empyema

  11. Evaluation of Setup Error Correction for Patients Using On Board Imager in Image Guided Radiation Therapy

    International Nuclear Information System (INIS)

    Kang, Soo Man

    2008-01-01

    To reduce side effects in image guided radiation therapy (IGRT) and to improve the quality of life of patients, also to meet accurate SETUP condition for patients, the various SETUP correction conditions were compared and evaluated by using on board imager (OBI) during the SETUP. Each 30 cases of the head, the neck, the chest, the belly, and the pelvis in 150 cases of IGRT patients was corrected after confirmation by using OBI at every 2-3 day. Also, the difference of the SETUP through the skin-marker and the anatomic SETUP through the OBI was evaluated. General SETUP errors (Transverse, Coronal, Sagittal) through the OBI at original SETUP position were Head and Neck: 1.3 mm, Brain: 2 mm, Chest: 3 mm, Abdoman: 3.7 mm, Pelvis: 4 mm. The patients with more that 3 mm in the error range were observed in the correction devices and the patient motions by confirming in treatment room. Moreover, in the case of female patients, the result came from the position of hairs during the Head and Neck, Brain tumor. Therefore, after another SETUP in each cases of over 3 mm in the error range, the treatment was carried out. Mean error values of each parts estimated after the correction were 1 mm for the head, 1.2 mm for the neck, 2.5 mm for the chest, 2.5 mm for the belly, and 2.6 mm for the pelvis. The result showed the correction of SETUP for each treatment through OBI is extremely difficult because of the importance of SETUP in radiation treatment. However, by establishing the average standard of the patients from this research result, the better patient satisfaction and treatment results could be obtained.

  12. Diagnostic performance of imaging-guided core needle biopsy of the mesentery and peritoneum.

    Science.gov (United States)

    Pérez Montilla, M E; Lombardo Galera, S; Espejo Herrero, J J; Sastoque, J M; Zurera Tendero, L

    2018-01-21

    To evaluate the diagnostic performance of imaging-guided core needle biopsy of nodules and diffuse infiltration of the omentum or of the peritoneum. We retrospectively evaluated 57 patients who underwent core needle biopsy of the peritoneum or of the omentum between March 2014 and January 2017. We used computed tomography (CT) to plan the biopsy. Biopsies were guided by CT or ultrasonography (US). We classified the results as diagnostic (benign / malignant) or inconclusive (inadequate sample). We calculated the sensitivity, specificity, positive-predictive value, and negative predictive value. We analyzed whether the specimen was diagnostic depending on the imaging technique used (CT or US) and on the type of omental or peritoneal involvement from which the specimen was obtained (mass, nodule, or diffuse involvement). All (100%) the percutaneous biopsies were diagnostic. The sensitivity of the technique was 98.18% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value was 50%. Both the specimens obtained under CT guidance (n=10) and those obtained under US guidance (n=47) were diagnostic. Likewise, biopsies of masses (n=24), of nodules (n=17), and even of diffuse infiltration (n=16) of the peritoneum or omentum enabled the histologic diagnosis. The rate of complications was 1.75% (one death). Percutaneous core needle biopsy has high sensitivity regardless of the imaging technique used to guide the technique (CT or US) and of the type of lesion biopsied (mass, nodule, diffuse infiltration). It is a useful technique with a very low rate of complications, although severe complications can occur. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Technical Note: Rapid prototyping of 3D grid arrays for image guided therapy quality assurance

    Energy Technology Data Exchange (ETDEWEB)

    Kittle, David; Holshouser, Barbara; Slater, James M.; Guenther, Bob D.; Pitsianis, Nikos P.; Pearlstein, Robert D. [Department of Radiation Medicine, Epilepsy Radiosurgery Research Program, Loma Linda University, Loma Linda, California 92354 (United States); Department of Radiology, Loma Linda University Medical Center, Loma Linda, California 92354 (United States); Department of Radiation Medicine, Loma Linda University, Loma Linda, California 92354 (United States); Department of Physics, Duke University, Durham, North Carolina 27708 (United States); Department of Electrical and Computer Engineering and Department of Computer Science, Duke University, Durham, North Carolina 27708 (United States); Department of Radiation Medicine, Epilepsy Radiosurgery Research Program, Loma Linda University, Loma Linda, California 92354 and Department of Surgery-Neurosurgery, Duke University and Medical Center, Durham, North Carolina 27710 (United States)

    2008-12-15

    Three dimensional grid phantoms offer a number of advantages for measuring imaging related spatial inaccuracies for image guided surgery and radiotherapy. The authors examined the use of rapid prototyping technology for directly fabricating 3D grid phantoms from CAD drawings. We tested three different fabrication process materials, photopolymer jet with acrylic resin (PJ/AR), selective laser sintering with polyamide (SLS/P), and fused deposition modeling with acrylonitrile butadiene styrene (FDM/ABS). The test objects consisted of rectangular arrays of control points formed by the intersections of posts and struts (2 mm rectangular cross section) and spaced 8 mm apart in the x, y, and z directions. The PJ/AR phantom expanded after immersion in water which resulted in permanent warping of the structure. The surface of the FDM/ABS grid exhibited a regular pattern of depressions and ridges from the extrusion process. SLS/P showed the best combination of build accuracy, surface finish, and stability. Based on these findings, a grid phantom for assessing machine-dependent and frame-induced MR spatial distortions was fabricated to be used for quality assurance in stereotactic neurosurgical and radiotherapy procedures. The spatial uniformity of the SLS/P grid control point array was determined by CT imaging (0.6x0.6x0.625 mm{sup 3} resolution) and found suitable for the application, with over 97.5% of the control points located within 0.3 mm of the position specified in CAD drawing and none of the points off by more than 0.4 mm. Rapid prototyping is a flexible and cost effective alternative for development of customized grid phantoms for medical physics quality assurance.

  14. Technical Note: Rapid prototyping of 3D grid arrays for image guided therapy quality assurance

    International Nuclear Information System (INIS)

    Kittle, David; Holshouser, Barbara; Slater, James M.; Guenther, Bob D.; Pitsianis, Nikos P.; Pearlstein, Robert D.

    2008-01-01

    Three dimensional grid phantoms offer a number of advantages for measuring imaging related spatial inaccuracies for image guided surgery and radiotherapy. The authors examined the use of rapid prototyping technology for directly fabricating 3D grid phantoms from CAD drawings. We tested three different fabrication process materials, photopolymer jet with acrylic resin (PJ/AR), selective laser sintering with polyamide (SLS/P), and fused deposition modeling with acrylonitrile butadiene styrene (FDM/ABS). The test objects consisted of rectangular arrays of control points formed by the intersections of posts and struts (2 mm rectangular cross section) and spaced 8 mm apart in the x, y, and z directions. The PJ/AR phantom expanded after immersion in water which resulted in permanent warping of the structure. The surface of the FDM/ABS grid exhibited a regular pattern of depressions and ridges from the extrusion process. SLS/P showed the best combination of build accuracy, surface finish, and stability. Based on these findings, a grid phantom for assessing machine-dependent and frame-induced MR spatial distortions was fabricated to be used for quality assurance in stereotactic neurosurgical and radiotherapy procedures. The spatial uniformity of the SLS/P grid control point array was determined by CT imaging (0.6x0.6x0.625 mm 3 resolution) and found suitable for the application, with over 97.5% of the control points located within 0.3 mm of the position specified in CAD drawing and none of the points off by more than 0.4 mm. Rapid prototyping is a flexible and cost effective alternative for development of customized grid phantoms for medical physics quality assurance.

  15. Evaluation of a cone beam computed tomography geometry for image guided small animal irradiation

    International Nuclear Information System (INIS)

    Yang, Yidong; Armour, Michael; Wang, Ken Kang-Hsin; Gandhi, Nishant; Wong, John; Iordachita, Iulian; Siewerdsen, Jeffrey

    2015-01-01

    The conventional imaging geometry for small animal cone beam computed tomography (CBCT) is that a detector panel rotates around the head-to-tail axis of an imaged animal (‘tubular’ geometry). Another unusual but possible imaging geometry is that the detector panel rotates around the anterior-to-posterior axis of the animal (‘pancake’ geometry). The small animal radiation research platform developed at Johns Hopkins University employs the pancake geometry where a prone-positioned animal is rotated horizontally between an x-ray source and detector panel. This study is to assess the CBCT image quality in the pancake geometry and investigate potential methods for improvement. We compared CBCT images acquired in the pancake geometry with those acquired in the tubular geometry when the phantom/animal was placed upright simulating the conventional CBCT geometry. Results showed signal-to-noise and contrast-to-noise ratios in the pancake geometry were reduced in comparison to the tubular geometry at the same dose level. But the overall spatial resolution within the transverse plane of the imaged cylinder/animal was better in the pancake geometry. A modest exposure increase to two folds in the pancake geometry can improve image quality to a level close to the tubular geometry. Image quality can also be improved by inclining the animal, which reduces streak artifacts caused by bony structures. The major factor resulting in the inferior image quality in the pancake geometry is the elevated beam attenuation along the long axis of the phantom/animal and consequently increased scatter-to-primary ratio in that orientation. Not withstanding, the image quality in the pancake-geometry CBCT is adequate to support image guided animal positioning, while providing unique advantages of non-coplanar and multiple mice irradiation. This study also provides useful knowledge about the image quality in the two very different imaging geometries, i.e. pancake and tubular geometry

  16. Anisotropic Margin Expansions in 6 Anatomic Directions for Oropharyngeal Image Guided Radiation Therapy

    International Nuclear Information System (INIS)

    Yock, Adam D.; Garden, Adam S.; Court, Laurence E.; Beadle, Beth M.; Zhang, Lifei; Dong, Lei

    2013-01-01

    Purpose: The purpose of this work was to determine the expansions in 6 anatomic directions that produced optimal margins considering nonrigid setup errors and tissue deformation for patients receiving image-guided radiation therapy (IGRT) of the oropharynx. Methods and Materials: For 20 patients who had received IGRT to the head and neck, we deformably registered each patient's daily images acquired with a computed tomography (CT)-on-rails system to his or her planning CT. By use of the resulting vector fields, the positions of volume elements within the clinical target volume (CTV) (target voxels) or within a 1-cm shell surrounding the CTV (normal tissue voxels) on the planning CT were identified on each daily CT. We generated a total of 15,625 margins by dilating the CTV by 1, 2, 3, 4, or 5 mm in the posterior, anterior, lateral, medial, inferior, and superior directions. The optimal margins were those that minimized the relative volume of normal tissue voxels positioned within the margin while satisfying 1 of 4 geometric target coverage criteria and 1 of 3 population criteria. Results: Each pair of geometric target coverage and population criteria resulted in a unique, anisotropic, optimal margin. The optimal margin expansions ranged in magnitude from 1 to 5 mm depending on the anatomic direction of the expansion and on the geometric target coverage and population criteria. Typically, the expansions were largest in the medial direction, were smallest in the lateral direction, and increased with the demand of the criteria. The anisotropic margin resulting from the optimal set of expansions always included less normal tissue than did any isotropic margin that satisfied the same pair of criteria. Conclusions: We demonstrated the potential of anisotropic margins to reduce normal tissue exposure without compromising target coverage in IGRT to the head and neck

  17. Markerless laser registration in image-guided oral and maxillofacial surgery.

    Science.gov (United States)

    Marmulla, Rüdiger; Lüth, Tim; Mühling, Joachim; Hassfeld, Stefan

    2004-07-01

    The use of registration markers in computer-assisted surgery is combined with high logistic costs and efforts. Markerless patient registration using laser scan surface registration techniques is a new challenging method. The present study was performed to evaluate the clinical accuracy in finding defined target points within the surgical site after markerless patient registration in image-guided oral and maxillofacial surgery. Twenty consecutive patients with different cranial diseases were scheduled for computer-assisted surgery. Data set alignment between the surgical site and the computed tomography (CT) data set was performed by markerless laser scan surface registration of the patient's face. Intraoral rigidly attached registration markers were used as target points, which had to be detected by an infrared pointer. The Surgical Segment Navigator SSN++ has been used for all procedures. SSN++ is an investigative product based on the SSN system that had previously been developed by the presenting authors with the support of Carl Zeiss (Oberkochen, Germany). SSN++ is connected to a Polaris infrared camera (Northern Digital, Waterloo, Ontario, Canada) and to a Minolta VI 900 3D digitizer (Tokyo, Japan) for high-resolution laser scanning. Minimal differences in shape between the laser scan surface and the surface generated from the CT data set could be detected. Nevertheless, high-resolution laser scan of the skin surface allows for a precise patient registration (mean deviation 1.1 mm, maximum deviation 1.8 mm). Radiation load, logistic costs, and efforts arising from the planning of computer-assisted surgery of the head can be reduced because native (markerless) CT data sets can be used for laser scan-based surface registration.

  18. Automatic block-matching registration to improve lung tumor localization during image-guided radiotherapy

    Science.gov (United States)

    Robertson, Scott Patrick

    To improve relatively poor outcomes for locally-advanced lung cancer patients, many current efforts are dedicated to minimizing uncertainties in radiotherapy. This enables the isotoxic delivery of escalated tumor doses, leading to better local tumor control. The current dissertation specifically addresses inter-fractional uncertainties resulting from patient setup variability. An automatic block-matching registration (BMR) algorithm is implemented and evaluated for the purpose of directly localizing advanced-stage lung tumors during image-guided radiation therapy. In this algorithm, small image sub-volumes, termed "blocks", are automatically identified on the tumor surface in an initial planning computed tomography (CT) image. Each block is independently and automatically registered to daily images acquired immediately prior to each treatment fraction. To improve the accuracy and robustness of BMR, this algorithm incorporates multi-resolution pyramid registration, regularization with a median filter, and a new multiple-candidate-registrations technique. The result of block-matching is a sparse displacement vector field that models local tissue deformations near the tumor surface. The distribution of displacement vectors is aggregated to obtain the final tumor registration, corresponding to the treatment couch shift for patient setup correction. Compared to existing rigid and deformable registration algorithms, the final BMR algorithm significantly improves the overlap between target volumes from the planning CT and registered daily images. Furthermore, BMR results in the smallest treatment margins for the given study population. However, despite these improvements, large residual target localization errors were noted, indicating that purely rigid couch shifts cannot correct for all sources of inter-fractional variability. Further reductions in treatment uncertainties may require the combination of high-quality target localization and adaptive radiotherapy.

  19. Laser range scanning for image-guided neurosurgery: investigation of image-to-physical space registrations.

    Science.gov (United States)

    Cao, Aize; Thompson, R C; Dumpuri, P; Dawant, B M; Galloway, R L; Ding, S; Miga, M I

    2008-04-01

    In this article a comprehensive set of registration methods is utilized to provide image-to-physical space registration for image-guided neurosurgery in a clinical study. Central to all methods is the use of textured point clouds as provided by laser range scanning technology. The objective is to perform a systematic comparison of registration methods that include both extracranial (skin marker point-based registration (PBR), and face-based surface registration) and intracranial methods (feature PBR, cortical vessel-contour registration, a combined geometry/intensity surface registration method, and a constrained form of that method to improve robustness). The platform facilitates the selection of discrete soft-tissue landmarks that appear on the patient's intraoperative cortical surface and the preoperative gadolinium-enhanced magnetic resonance (MR) image volume, i.e., true corresponding novel targets. In an 11 patient study, data were taken to allow statistical comparison among registration methods within the context of registration error. The results indicate that intraoperative face-based surface registration is statistically equivalent to traditional skin marker registration. The four intracranial registration methods were investigated and the results demonstrated a target registration error of 1.6 +/- 0.5 mm, 1.7 +/- 0.5 mm, 3.9 +/- 3.4 mm, and 2.0 +/- 0.9 mm, for feature PBR, cortical vessel-contour registration, unconstrained geometric/intensity registration, and constrained geometric/intensity registration, respectively. When analyzing the results on a per case basis, the constrained geometric/intensity registration performed best, followed by feature PBR, and finally cortical vessel-contour registration. Interestingly, the best target registration errors are similar to targeting errors reported using bone-implanted markers within the context of rigid targets. The experience in this study as with others is that brain shift can compromise extracranial

  20. Image-guided smart laser system for precision implantation of cells in cartilage

    Science.gov (United States)

    Katta, Nitesh; Rector, John A.; Gardner, Michael R.; McElroy, Austin B.; Choy, Kevin C.; Crosby, Cody; Zoldan, Janet; Milner, Thomas E.

    2017-03-01

    State-of-the-art treatment for joint diseases like osteoarthritis focus on articular cartilage repair/regeneration by stem cell implantation therapy. However, the technique is limited by a lack of precision in the physician's imaging and cell deposition toolkit. We describe a novel combination of high-resolution, rapid scan-rate optical coherence tomography (OCT) alongside a short-pulsed nanosecond thulium (Tm) laser for precise cell seeding in cartilage. The superior beam quality of thulium lasers and wavelength of operation 1940 nm offers high volumetric tissue removal rates and minimizes the residual thermal footprint. OCT imaging enables targeted micro-well placement, precise cell deposition, and feature contrast. A bench-top system is constructed using a 15 W, 1940 nm, nanosecond-pulsed Tm fiber laser (500 μJ pulse energy, 100 ns pulse duration, 30kHz repetition rate) for removing tissue, and a swept source laser (1310 ± 70 nm, 100 kHz sweep rate) for OCT imaging, forming a combined Tm/OCT system - a "smart laser knife". OCT assists the smart laser knife user in characterizing cartilage to inform micro-well placement. The Tm laser creates micro-wells (2.35 mm diameter length, 1.5 mm width, 300 μm deep) and micro-incisions (1 mm wide, 200 μm deep) while OCT image-guidance assists and demonstrates this precision cutting and cell deposition with real-time feedback. To test micro-well creation and cell deposition protocol, gelatin phantoms are constructed mimicking cartilage optical properties and physiological structure. Cell viability is then assessed to illustrate the efficacy of the hydrogel deposition. Automated OCT feedback is demonstrated for cutting procedures to avoid important surface/subsurface structures. This bench-top smart laser knife system described here offers a new image-guided approach to precise stem cell seeding that can enhance the efficacy of articular cartilage repair.

  1. Clinical application of image-guided radiotherapy, IGRT (on the Varian OBI platform)

    International Nuclear Information System (INIS)

    Sorcini, B.; Tilikidis, A.

    2006-01-01

    Image-guided radiation therapy (IGRT) can be used to measure and correct positional errors for target and critical structures immediately prior to or during treatment delivery. Some of the most recent available methods applied for target localization are: trans-abdominal ultrasound, implanted markers with in room MV or kV X-rays, optical surface tracking systems, implantable electromagnetic markers, in room CT such as kVCT on rail, kilo-voltage or mega-voltage cone-beam CT (CBCT) and helical megavoltage CT. The verification of the accurate treatment position in conjunction with detailed anatomical information before every fraction can be essential for the outcome of the treatment. In this paper we present the on-board imager (OBI, Varian Medical Systems, Palo Alto, CA) that has been in routine clinical use at the Karolinska University Hospital since June 2004. The OBI has been used for on-line set-up correction of prostate patients using internal gold markers. Displacements of these markers can be monitored radiographically during the treatment course and the registered marker shifts act as a surrogate for prostate motion. For this purpose, on-board kV-kV seems to be an ideal system in terms of image quality. The CBCT function of OBI was installed in March 2005 at our department. It focuses on localizing tumors based on internal anatomy, not just on the conventional external marks or tattoos. The CBCT system provides the capacity for soft tissue imaging in the treatment position and real-time radiographic monitoring during treatment delivery. (authors)

  2. Phthalocyanine-loaded graphene nanoplatform for imaging-guided combinatorial phototherapy

    Directory of Open Access Journals (Sweden)

    Taratula O

    2015-03-01

    Full Text Available Olena Taratula,1 Mehulkumar Patel,2 Canan Schumann,1 Michael A Naleway,1 Addison J Pang,1 Huixin He,2 Oleh Taratula1 1Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA; 2Department of Chemistry, Rutgers University-Newark, Newark, NJ, USA Abstract: We report a novel cancer-targeted nanomedicine platform for imaging and prospect for future treatment of unresected ovarian cancer tumors by intraoperative multimodal phototherapy. To develop the required theranostic system, novel low-oxygen graphene nanosheets were chemically modified with polypropylenimine dendrimers loaded with phthalocyanine (Pc as a photosensitizer. Such a molecular design prevents fluorescence quenching of the Pc by graphene nanosheets, providing the possibility of fluorescence imaging. Furthermore, the developed nanoplatform was conjugated with poly(ethylene glycol, to improve biocompatibility, and with luteinizing hormone-releasing hormone (LHRH peptide, for tumor-targeted delivery. Notably, a low-power near-infrared (NIR irradiation of single wavelength was used for both heat generation by the graphene nanosheets (photothermal therapy [PTT] and for reactive oxygen species (ROS-production by Pc (photodynamic therapy [PDT]. The combinatorial phototherapy resulted in an enhanced destruction of ovarian cancer cells, with a killing efficacy of 90%–95% at low Pc and low-oxygen graphene dosages, presumably conferring cytotoxicity to the synergistic effects of generated ROS and mild hyperthermia. An animal study confirmed that Pc loaded into the nanoplatform can be employed as a NIR fluorescence agent for imaging-guided drug delivery. Hence, the newly developed Pc-graphene nanoplatform has the significant potential as an effective NIR theranostic probe for imaging and combinatorial phototherapy. Keywords: graphene nanosheets, phthalocyanine, photothermal therapy, photodynamic therapy, theranostic 

  3. Inter- and Intrafraction Uncertainty in Prostate Bed Image-Guided Radiotherapy

    International Nuclear Information System (INIS)

    Huang, Kitty; Palma, David A.; Scott, Danielle; McGregor, Danielle; Gaede, Stewart; Yartsev, Slav; Bauman, Glenn; Louie, Alexander V.; Rodrigues, George

    2012-01-01

    Purpose: The goals of this study were to measure inter- and intrafraction setup error and prostate bed motion (PBM) in patients undergoing post-prostatectomy image-guided radiotherapy (IGRT) and to propose appropriate population-based three-dimensional clinical target volume to planning target volume (CTV–PTV) margins in both non-IGRT and IGRT scenarios. Methods and Materials: In this prospective study, 14 patients underwent adjuvant or salvage radiotherapy to the prostate bed under image guidance using linac-based kilovoltage cone-beam CT (kV-CBCT). Inter- and intrafraction uncertainty/motion was assessed by offline analysis of three consecutive daily kV-CBCT images of each patient: (1) after initial setup to skin marks, (2) after correction for positional error/immediately before radiation treatment, and (3) immediately after treatment. Results: The magnitude of interfraction PBM was 2.1 mm, and intrafraction PBM was 0.4 mm. The maximum inter- and intrafraction prostate bed motion was primarily in the anterior–posterior direction. Margins of at least 3–5 mm with IGRT and 4–7 mm without IGRT (aligning to skin marks) will ensure 95% of the prescribed dose to the clinical target volume in 90% of patients. Conclusions: PBM is a predominant source of intrafraction error compared with setup error and has implications for appropriate PTV margins. Based on inter- and estimated intrafraction motion of the prostate bed using pre- and post-kV-CBCT images, CBCT IGRT to correct for day-to-day variances can potentially reduce CTV–PTV margins by 1–2 mm. CTV–PTV margins for prostate bed treatment in the IGRT and non-IGRT scenarios are proposed; however, in cases with more uncertainty of target delineation and image guidance accuracy, larger margins are recommended.

  4. Diabetic mastopathy: Imaging features and the role of image-guided biopsy in its diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Hyeon; Kim, Eun Kyung; Kim, Min Jung; Moon, Hee Jung; Yoon, Jung Hyun [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-03-15

    The goal of this study was to evaluate the imaging features of diabetic mastopathy (DMP) and the role of image-guided biopsy in its diagnosis. Two experienced radiologists retrospectively reviewed the mammographic and sonographic images of 19 pathologically confirmed DMP patients. The techniques and results of the biopsies performed in each patient were also reviewed. Mammograms showed negative findings in 78% of the patients. On ultrasonography (US), 13 lesions were seen as masses and six as non-mass lesions. The US features of the mass lesions were as follows: irregular shape (69%), oval shape (31%), indistinct margin (69%), angular margin (15%), microlobulated margin (8%), well-defined margin (8%), heterogeneous echogenicity (62%), hypoechoic echogenicity (38%), posterior shadowing (92%), parallel orientation (100%), the absence of calcifications (100%), and the absence of vascularity (100%). Based on the US findings, 17 lesions (89%) were classified as Breast Imaging Reporting and Data System category 4 and two (11%) as category 3. US-guided core biopsy was performed in 18 patients, and 10 (56%) were diagnosed with DMP on that basis. An additional vacuum-assisted biopsy was performed in seven patients and all were diagnosed with DMP. The US features of DMP were generally suspicious for malignancy, whereas the mammographic findings were often negative or showed only focal asymmetry. Core biopsy is an adequate method for initial pathological diagnosis. However, since it yields non-diagnostic results in a considerable number of cases, the evaluation of correlations between imaging and pathology plays an important role in the diagnostic process.

  5. Retractor-induced brain shift compensation in image-guided neurosurgery

    Science.gov (United States)

    Fan, Xiaoyao; Ji, Songbai; Hartov, Alex; Roberts, David; Paulsen, Keith

    2013-03-01

    In image-guided neurosurgery, intraoperative brain shift significantly degrades the accuracy of neuronavigation that is solely based on preoperative magnetic resonance images (pMR). To compensate for brain deformation and to maintain the accuracy in image guidance achieved at the start of surgery, biomechanical models have been developed to simulate brain deformation and to produce model-updated MR images (uMR) to compensate for brain shift. To-date, most studies have focused on shift compensation at early stages of surgery (i.e., updated images are only produced after craniotomy and durotomy). Simulating surgical events at later stages such as retraction and tissue resection are, perhaps, clinically more relevant because of the typically much larger magnitudes of brain deformation. However, these surgical events are substantially more complex in nature, thereby posing significant challenges in model-based brain shift compensation strategies. In this study, we present results from an initial investigation to simulate retractor-induced brain deformation through a biomechanical finite element (FE) model where whole-brain deformation assimilated from intraoperative data was used produce uMR for improved accuracy in image guidance. Specifically, intensity-encoded 3D surface profiles at the exposed cortical area were reconstructed from intraoperative stereovision (iSV) images before and after tissue retraction. Retractor-induced surface displacements were then derived by coregistering the surfaces and served as sparse displacement data to drive the FE model. With one patient case, we show that our technique is able to produce uMR that agrees well with the reconstructed iSV surface after retraction. The computational cost to simulate retractor-induced brain deformation was approximately 10 min. In addition, our approach introduces minimal interruption to the surgical workflow, suggesting the potential for its clinical application.

  6. Nanotubes-Embedded Indocyanine Green-Hyaluronic Acid Nanoparticles for Photoacoustic-Imaging-Guided Phototherapy.

    Science.gov (United States)

    Wang, Guohao; Zhang, Fan; Tian, Rui; Zhang, Liwen; Fu, Guifeng; Yang, Lily; Zhu, Lei

    2016-03-02

    targeted and PA image-guided dual PTT and PDT cancer therapy.

  7. Development of a software based automatic exposure control system for use in image guided radiation therapy

    Science.gov (United States)

    Morton, Daniel R.

    Modern image guided radiation therapy involves the use of an isocentrically mounted imaging system to take radiographs of a patient's position before the start of each treatment. Image guidance helps to minimize errors associated with a patients setup, but the radiation dose received by patients from imaging must be managed to ensure no additional risks. The Varian On-Board Imager (OBI) (Varian Medical Systems, Inc., Palo Alto, CA) does not have an automatic exposure control system and therefore requires exposure factors to be manually selected. Without patient specific exposure factors, images may become saturated and require multiple unnecessary exposures. A software based automatic exposure control system has been developed to predict optimal, patient specific exposure factors. The OBI system was modelled in terms of the x-ray tube output and detector response in order to calculate the level of detector saturation for any exposure situation. Digitally reconstructed radiographs are produced via ray-tracing through the patients' volumetric datasets that are acquired for treatment planning. The ray-trace determines the attenuation of the patient and subsequent x-ray spectra incident on the imaging detector. The resulting spectra are used in the detector response model to determine the exposure levels required to minimize detector saturation. Images calculated for various phantoms showed good agreement with the images that were acquired on the OBI. Overall, regions of detector saturation were accurately predicted and the detector response for non-saturated regions in images of an anthropomorphic phantom were calculated to generally be within 5 to 10 % of the measured values. Calculations were performed on patient data and found similar results as the phantom images, with the calculated images being able to determine detector saturation with close agreement to images that were acquired during treatment. Overall, it was shown that the system model and calculation

  8. High-volume image-guided injection for recalcitrant medial collateral ligament injuries of the knee

    International Nuclear Information System (INIS)

    Drumm, O.; Chan, O.; Malliaras, P.; Morrissey, D.; Maffulli, N.

    2014-01-01

    Aim: To evaluate the effectiveness of a novel injection technique in the management of recalcitrant medial collateral ligament (MCL) injuries of the knee. Materials and methods: The injection, comprising 10 ml local anaesthetic with 25–50 mg hydrocortisone, is directed beneath the periosteal attachment of the MCL. Twenty-eight patients who received the intervention were asked to complete a questionnaire, a visual analogue scale (VAS) and the International Knee Documentation Committee (IKDC) subjective knee form to quantify symptoms pre-injection and at follow-up. Data were assessed using descriptive statistics. Further analysis was conducted using the Wilcoxon signed-rank test and Fisher's exact test. Results: Sixty-eight percent (n = 19) of patients responded. Three patients were excluded according to the exclusion criteria. Of those studied, 37.5% (n = 6) were professional athletes. At follow-up, patients reported a mean improvement on the VAS of 75.5% (SD = 23.6). There was a significant improvement in IKDC scores (mean difference 42%, SD = 14.2) pre- and post-injection (Wilcoxon signed-rank test, p < 0.001). No residual symptoms were reported by 50% (n = 8) of patients, and a further 37.5% (n = 6) of patients had improved. Of those patients who played sport, two-thirds (n = 10) had returned to their previous level of sport at follow-up, including all of the professional athletes. Conclusion: Periosteal high-volume image-guided injection is a useful treatment for recalcitrant MCL injury. Results are encouraging, particularly amongst the professional athletes studied

  9. Effect of rectal enema on intrafraction prostate movement during image-guided radiotherapy.

    Science.gov (United States)

    Choi, Youngmin; Kwak, Dong-Won; Lee, Hyung-Sik; Hur, Won-Joo; Cho, Won-Yeol; Sung, Gyung Tak; Kim, Tae-Hyo; Kim, Soo-Dong; Yun, Seong-Guk

    2015-04-01

    Rectal volume and movement are major factors that influence prostate location. The aim of this study was to assess the effect of a rectal enema on intrafraction prostate motion. The data from 12 patients with localised prostate cancer were analysed. Each patient underwent image-guided radiotherapy (RT), receiving a total dose of 70 Gy in 28 fractions. Rectal enemas were administered to all of the patients before each RT fraction. The location of the prostate was determined by implanting three fiducial markers under the guidance of transrectal ultrasound. Each patient underwent preparation for IGRT twice before an RT fraction and in the middle of the fraction. The intrafraction displacement of the prostate was calculated by comparing fiducial marker locations before and in the middle of an RT fraction. The rectal enemas were well tolerated by patients. The mean intrafraction prostate movement in 336 RT fractions was 1.11 ± 0.77 mm (range 0.08-7.20 mm). Intrafraction motions of 1, 2 and 3 mm were observed in 56.0%, 89.0% and 97.6% of all RT fractions, respectively. The intrafraction movements on supero-inferior and anteroposterior axes were larger than on the right-to-left axes (P movement, calculated using the van Herk formula (2.5Σ + 0.7σ), was 1.50 mm. A daily rectal enema before each RT fraction was tolerable and yielded little intrafraction prostate displacement. We think the use of rectal enemas is a feasible method to reduce prostate movement during RT. © 2014 The Royal Australian and New Zealand College of Radiologists.

  10. Image-guided radiotherapy for fifty-eight patients with lung cancer

    International Nuclear Information System (INIS)

    Liang Jun; Zhang Tao; Wang Wenqin

    2009-01-01

    Objective: To study the value of image-guided radiotherapy (IGRT) in lung cancer. Methods: From Mar. 2007 to Dec. 2007,58 patients with lung cancer were treated with IGRT. Set-up errors in each axial direction was calculated based on IGRT images of each patient. The change of GTV was evaluated on both cone-beam CT and CT simulator images. Results: Twenty-two patients with left lung cancer,30 with right lung cancer, 5 with mediastinal lymphanode metastasis and one with vertebra metastasis were included. The set-up error in x, y and z axes was (0.02±0.26) cm, (0.14±0.49) cm and ( -0.13± 0.27) cm, respectively,while the rotary set-up error in each axis was -0.15 degree ± 1.59 degree, -0.01 degree ± 1.50 degree and 0.12 degree ±1.08 degree, respectively. The set-up errors were significantly decreased by using of IGRT. GTV movement was observed in 15 patients (25.9%) ,including 5 with left upper lung cancer. GTV moving to the anterior direction was observed in 9 patients,including 4 with]eft upper lung cancer. GTV reduced in 23 (44.2%) patients during treatment. Asymmetric GTV reduction of 22 lesions was observed,with a mean reductive volume of 4.9 cm 3 . When GTV began to shrink,the irradiation dose was 4 -46 Gy, with 20 -30 Gy in 9 patients. Conclusions: The use of IGRT can significantly reduce set-up errors. GTV movement and reduction are observed in some cases. The time to modify the target volume needs to be further studied. (authors)

  11. Effect of rectal enema on intrafraction prostate movement during image-guided radiotherapy

    International Nuclear Information System (INIS)

    Choi, Youngmin; Kwak, Dong-Won; Lee, Hyung-Sik; Hur, Won-Jooh; Cho, Won-Yeol; Sung, Gyung Tak; Kim, Tae-Hyo; Kim, Soo-Dong; Yun, Seong-Guk

    2015-01-01

    Rectal volume and movement are major factors that influence prostate location. The aim of this study was to assess the effect of a rectal enema on intrafraction prostate motion. The data from 12 patients with localised prostate cancer were analysed. Each patient underwent image-guided radiotherapy (RT), receiving a total dose of 70 Gy in 28 fractions. Rectal enemas were administered to all of the patients before each RT fraction. The location of the prostate was determined by implanting three fiducial markers under the guidance of transrectal ultrasound. Each patient underwent preparation for IGRT twice before an RT fraction and in the middle of the fraction. The intrafraction displacement of the prostate was calculated by comparing fiducial marker locations before and in the middle of an RT fraction. The rectal enemas were well tolerated by patients. The mean intrafraction prostate movement in 336 RT fractions was 1.11 ± 0.77 mm (range 0.08–7.20 mm). Intrafraction motions of 1, 2 and 3 mm were observed in 56.0%, 89.0% and 97.6% of all RT fractions, respectively. The intrafraction movements on supero-inferior and anteroposterior axes were larger than on the right-to-left axes (P < 0.05). The CTV-to-PTV margin necessary to allow for movement, calculated using the van Herk formula (2.5Σ + 0.7σ), was 1.50 mm. A daily rectal enema before each RT fraction was tolerable and yielded little intrafraction prostate displacement. We think the use of rectal enemas is a feasible method to reduce prostate movement during RT.

  12. Image-guided adaptive brachytherapy in primary vaginal cancers: A monocentric experience.

    Science.gov (United States)

    Huertas, Andres; Dumas, Isabelle; Escande, Alexandre; Rivin Del Campo, Eleonor; Felefly, Tony; Canova, Charles-Henri; Tailleur, Anne; Gouy, Sebastien; Bentivegna, Enrica; Morice, Philippe; Haie-Meder, Christine; Chargari, Cyrus; Mazeron, Renaud

    2018-02-06

    Primary vaginal cancer is a rare disease for which treatment has been modeled based on cervical cancer. We report our experience in the use of image-guided adaptive brachytherapy (IGABT) in this indication. Patients treated for vaginal cancer with a combination of external beam radiation therapy and IGABT were identified through electronic search. The Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology recommendations for cervical cancer have been extrapolated with the definition of two clinical target volumes (CTVs) corresponding to the residual disease after external beam radiation therapy (CTV BT ), assessed from clinical and imaging findings, and the so-called CTV i , comprising the CTV BT with directional margins and at least the initial disease at diagnosis. Twenty-seven patients were identified. MRI was used for brachytherapy guidance in 82% of the cases. An interstitial component was used in 59% of the cases. The D 90 CTV BT and D 90 CTV i were 73.1 ± 12.8 Gy and 66.6 ± 6.7 Gy, respectively. After a median followup of 40.1 months, nine recurrences in 8 patients were observed of which four were local. Local relapses occurred within the CTV BT . Three-year local control and disease-free rates were 82% and 65%, respectively. At 2 years, the Grade 2-4 gastrointestinal or urinary morbidity accrual rate was 9%. Twelve patients experienced late sexual morbidity, including three patients with Grade 3 stenosis. IGABT is feasible in vaginal cancer with promising outcomes. Harmonizing the definition of CTVs is required to allow comparisons between experiences and to perform multicenter studies. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  13. Interactive contour delineation and refinement in treatment planning of image-guided radiation therapy.

    Science.gov (United States)

    Zhou, Wu; Xie, Yaoqin

    2014-01-06

    The accurate contour delineation of the target and/or organs at risk (OAR) is essential in treatment planning for image-guided radiation therapy (IGRT). Although many automatic contour delineation approaches have been proposed, few of them can fulfill the necessities of applications in terms of accuracy and efficiency. Moreover, clinicians would like to analyze the characteristics of regions of interests (ROI) and adjust contours manually during IGRT. Interactive tool for contour delineation is necessary in such cases. In this work, a novel approach of curve fitting for interactive contour delineation is proposed. It allows users to quickly improve contours by a simple mouse click. Initially, a region which contains interesting object is selected in the image, then the program can automatically select important control points from the region boundary, and the method of Hermite cubic curves is used to fit the control points. Hence, the optimized curve can be revised by moving its control points interactively. Meanwhile, several curve fitting methods are presented for the comparison. Finally, in order to improve the accuracy of contour delineation, the process of the curve refinement based on the maximum gradient magnitude is proposed. All the points on the curve are revised automatically towards the positions with maximum gradient magnitude. Experimental results show that Hermite cubic curves and the curve refinement based on the maximum gradient magnitude possess superior performance on the proposed platform in terms of accuracy, robustness, and time calculation. Experimental results of real medical images demonstrate the efficiency, accuracy, and robustness of the proposed process in clinical applications.

  14. Evaluation of Setup Error Correction for Patients Using On Board Imager in Image Guided Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Soo Man [Dept. of Radiation Oncology, Kosin University Gospel Hospital, Busan (Korea, Republic of)

    2008-09-15

    To reduce side effects in image guided radiation therapy (IGRT) and to improve the quality of life of patients, also to meet accurate SETUP condition for patients, the various SETUP correction conditions were compared and evaluated by using on board imager (OBI) during the SETUP. Each 30 cases of the head, the neck, the chest, the belly, and the pelvis in 150 cases of IGRT patients was corrected after confirmation by using OBI at every 2-3 day. Also, the difference of the SETUP through the skin-marker and the anatomic SETUP through the OBI was evaluated. General SETUP errors (Transverse, Coronal, Sagittal) through the OBI at original SETUP position were Head and Neck: 1.3 mm, Brain: 2 mm, Chest: 3 mm, Abdoman: 3.7 mm, Pelvis: 4 mm. The patients with more that 3 mm in the error range were observed in the correction devices and the patient motions by confirming in treatment room. Moreover, in the case of female patients, the result came from the position of hairs during the Head and Neck, Brain tumor. Therefore, after another SETUP in each cases of over 3 mm in the error range, the treatment was carried out. Mean error values of each parts estimated after the correction were 1 mm for the head, 1.2 mm for the neck, 2.5 mm for the chest, 2.5 mm for the belly, and 2.6 mm for the pelvis. The result showed the correction of SETUP for each treatment through OBI is extremely difficult because of the importance of SETUP in radiation treatment. However, by establishing the average standard of the patients from this research result, the better patient satisfaction and treatment results could be obtained.

  15. Augmented environments for the targeting of hepatic lesions during image-guided robotic liver surgery.

    Science.gov (United States)

    Buchs, Nicolas C; Volonte, Francesco; Pugin, François; Toso, Christian; Fusaglia, Matteo; Gavaghan, Kate; Majno, Pietro E; Peterhans, Matthias; Weber, Stefan; Morel, Philippe

    2013-10-01

    Stereotactic navigation technology can enhance guidance during surgery and enable the precise reproduction of planned surgical strategies. Currently, specific systems (such as the CAS-One system) are available for instrument guidance in open liver surgery. This study aims to evaluate the implementation of such a system for the targeting of hepatic tumors during robotic liver surgery. Optical tracking references were attached to one of the robotic instruments and to the robotic endoscopic camera. After instrument and video calibration and patient-to-image registration, a virtual model of the tracked instrument and the available three-dimensional images of the liver were displayed directly within the robotic console, superimposed onto the endoscopic video image. An additional superimposed targeting viewer allowed for the visualization of the target tumor, relative to the tip of the instrument, for an assessment of the distance between the tumor and the tool for the realization of safe resection margins. Two cirrhotic patients underwent robotic navigated atypical hepatic resections for hepatocellular carcinoma. The augmented endoscopic view allowed for the definition of an accurate resection margin around the tumor. The overlay of reconstructed three-dimensional models was also used during parenchymal transection for the identification of vascular and biliary structures. Operative times were 240 min in the first case and 300 min in the second. There were no intraoperative complications. The da Vinci Surgical System provided an excellent platform for image-guided liver surgery with a stable optic and instrumentation. Robotic image guidance might improve the surgeon's orientation during the operation and increase accuracy in tumor resection. Further developments of this technological combination are needed to deal with organ deformation during surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Toxicity after intensity-modulated, image-guided radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Flentje, Michael; Guckenberger, Matthias; Ok, Sami; Polat, Buelent; Sweeney, Reinhart A.

    2010-01-01

    Purpose: To evaluate toxicity after dose-escalated radiotherapy for prostate cancer using intensity-modulated treatment planning (IMRT) and image-guided treatment (IGRT) delivery. Patients and Methods: 100 patients were treated with simultaneous integrated boost (SIB) IMRT for prostate cancer: doses of 76.23 Gy and 60 Gy in 33 fractions were prescribed to the prostate and the seminal vesicles, respectively, for intermediate- and high-risk patients (n = 74). The total dose was 73.91 Gy in 32 fractions for low-risk patients and after transurethral resection of the prostate (n = 26). The pelvic lymphatics were treated with 46 Gy in 25 fractions in patients with high risk of lymph node metastases using an SIB to the prostate (n = 25). IGRT was practiced with cone-beam computed tomography. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was evaluated prospectively (CTCAE v3.0). Results: Treatment was completed as planned by all patients. Acute GI and GU toxicity grade ≥ 2 was observed in 12% and 42% of the patients, respectively, with 4% suffering from GU toxicity grade 3. 6 weeks after treatment, the incidence of acute toxicity grade ≥ 2 had decreased to 12%. With a median follow-up of 26 months, late GI and GU toxicity grade ≥ 2 was seen in 1.5% and 7.7% of the patients at 24 months. Four patients developed late toxicity grade 3 (GI n = 1; GU n = 3). Presence of acute GI and GU toxicity was significantly associated with late GI (p = 0.0007) and GU toxicity (p = 0.006). Conclusion: High-dose radiotherapy for prostate cancer using IMRT and IGRT resulted in low rates of acute toxicity and preliminary results of late toxicity are promising. (orig.)

  17. Deep architecture neural network-based real-time image processing for image-guided radiotherapy.

    Science.gov (United States)

    Mori, Shinichiro

    2017-08-01

    To develop real-time image processing for image-guided radiotherapy, we evaluated several neural network models for use with different imaging modalities, including X-ray fluoroscopic image denoising. Setup images of prostate cancer patients were acquired with two oblique X-ray fluoroscopic units. Two types of residual network were designed: a convolutional autoencoder (rCAE) and a convolutional neural network (rCNN). We changed the convolutional kernel size and number of convolutional layers for both networks, and the number of pooling and upsampling layers for rCAE. The ground-truth image was applied to the contrast-limited adaptive histogram equalization (CLAHE) method of image processing. Network models were trained to keep the quality of the output image close to that of the ground-truth image from the input image without image processing. For image denoising evaluation, noisy input images were used for the training. More than 6 convolutional layers with convolutional kernels >5×5 improved image quality. However, this did not allow real-time imaging. After applying a pair of pooling and upsampling layers to both networks, rCAEs with >3 convolutions each and rCNNs with >12 convolutions with a pair of pooling and upsampling layers achieved real-time processing at 30 frames per second (fps) with acceptable image quality. Use of our suggested network achieved real-time image processing for contrast enhancement and image denoising by the use of a conventional modern personal computer. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  18. A cadaver study of mastoidectomy using an image-guided human-robot collaborative control system.

    Science.gov (United States)

    Yoo, Myung Hoon; Lee, Hwan Seo; Yang, Chan Joo; Lee, Seung Hwan; Lim, Hoon; Lee, Seongpung; Yi, Byung-Ju; Chung, Jong Woo

    2017-10-01

    Surgical precision would be better achieved with the development of an anatomical monitoring and controlling robot system than by traditional surgery techniques alone. We evaluated the feasibility of robot-assisted mastoidectomy in terms of duration, precision, and safety. Human cadaveric study. We developed a multi-degree-of-freedom robot system for a surgical drill with a balancing arm. The drill system is manipulated by the surgeon, the motion of the drill burr is monitored by the image-guided system, and the brake is controlled by the robotic system. The system also includes an alarm as well as the brake to help avoid unexpected damage to vital structures. Experimental mastoidectomy was performed in 11 temporal bones of six cadavers. Parameters including duration and safety were assessed, as well as intraoperative damage, which was judged via pre- and post-operative computed tomography. The duration of mastoidectomy in our study was comparable with that required for chronic otitis media patients. Although minor damage, such as dura exposure without tearing, was noted, no critical damage to the facial nerve or other important structures was observed. When the brake system was set to 1 mm from the facial nerve, the postoperative average bone thicknesses of the facial nerve was 1.39, 1.41, 1.22, 1.41, and 1.55 mm in the lateral, posterior pyramidal and anterior, lateral, and posterior mastoid portions, respectively. Mastoidectomy can be successfully performed using our robot-assisted system while maintaining a pre-set limit of 1 mm in most cases. This system may thus be useful for more inexperienced surgeons. NA.

  19. Exposure Risks Among Children Undergoing Radiation Therapy: Considerations in the Era of Image Guided Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hess, Clayton B. [Department of Radiation Oncology, University California Davis Comprehensive Cancer Center, Sacramento, California (United States); Thompson, Holly M. [Department of Diagnostic Radiology, University of California Davis Medical Center, Sacramento, California (United States); Benedict, Stanley H. [Department of Radiation Oncology, University California Davis Comprehensive Cancer Center, Sacramento, California (United States); Seibert, J. Anthony [Department of Diagnostic Radiology, University of California Davis Medical Center, Sacramento, California (United States); Wong, Kenneth [Department of Radiation Oncology, University of California Los Angeles Jonsson Comprehensive Cancer Center, University of California David Geffen School of Medicine, Los Angeles, California (United States); Vaughan, Andrew T. [Department of Radiation Oncology, University California Davis Comprehensive Cancer Center, Sacramento, California (United States); Chen, Allen M., E-mail: allenmchen@yahoo.com [Department of Radiation Oncology, University of California Los Angeles Jonsson Comprehensive Cancer Center, University of California David Geffen School of Medicine, Los Angeles, California (United States)

    2016-04-01

    Recent improvements in toxicity profiles of pediatric oncology patients are attributable, in part, to advances in the field of radiation oncology such as intensity modulated radiation (IMRT) and proton therapy (IMPT). While IMRT and IMPT deliver highly conformal dose to targeted volumes, they commonly demand the addition of 2- or 3-dimensional imaging for precise positioning—a technique known as image guided radiation therapy (IGRT). In this manuscript we address strategies to further minimize exposure risk in children by reducing effective IGRT dose. Portal X rays and cone beam computed tomography (CBCT) are commonly used to verify patient position during IGRT and, because their relative radiation exposure is far less than the radiation absorbed from therapeutic treatment beams, their sometimes significant contribution to cumulative risk can be easily overlooked. Optimizing the conformality of IMRT/IMPT while simultaneously ignoring IGRT dose may result in organs at risk being exposed to a greater proportion of radiation from IGRT than from therapeutic beams. Over a treatment course, cumulative central-axis CBCT effective dose can approach or supersede the amount of radiation absorbed from a single treatment fraction, a theoretical increase of 3% to 5% in mutagenic risk. In select scenarios, this may result in the underprediction of acute and late toxicity risk (such as azoospermia, ovarian dysfunction, or increased lifetime mutagenic risk) in radiation-sensitive organs and patients. Although dependent on variables such as patient age, gender, weight, body habitus, anatomic location, and dose-toxicity thresholds, modifying IGRT use and acquisition parameters such as frequency, imaging modality, beam energy, current, voltage, rotational degree, collimation, field size, reconstruction algorithm, and documentation can reduce exposure, avoid unnecessary toxicity, and achieve doses as low as reasonably achievable, promoting a culture and practice of “gentle IGRT.”.

  20. On-line image guided radiation therapy using cone-beam CT (CBCT)

    International Nuclear Information System (INIS)

    Bak, Jin O; Park, Suk Won; Jeong, Kyung Keun; Keum, Ki Chang

    2006-01-01

    Using cone beam CT, we can compare the position of the patients at the simulation and the treatment. In on-line image guided radiation therapy, one can utilize this compared data and correct the patient position before treatments. Using cone beam CT, we investigated the errors induced by setting up the patients when use only the markings on the patients' skin. We obtained the data of three patients that received radiation therapy at the Department of Radiation Oncology in Chung-Ang University during August 2006 and October 2006. Just as normal radiation therapy, patients were aligned on the treatment couch after the simulation and treatment planning. Patients were aligned with lasers according to the marking on the skin that were marked at the simulation time and then cone beam CTs were obtained. Cone beam CTs were fused and compared with simulation CTs and the displacement vectors were calculated. Treatment couches were adjusted according to the displacement vector before treatments. After the treatment, positions were verified with kV X-ray (OBI system). In the case of head and neck patients, the average sizes of the setup error vectors, given by the cone beam CT, were 0.19 cm for the patient A and 0.18 cm for the patient B. The standard deviations were 0.15 cm and 0.21 cm, each. On the other hand, in the case of the pelvis patient, the average and the standard deviation were 0.37 cm and 01 cm. Through the on-line IGRT using cone beam CT, were could correct the setup errors that could occur in the conventional radiotherapy. The importance of the on-line IGRT should be emphasized in the case of 3D conformal therapy and intensity-modulated radiotherapy, which have complex target shapes and steep dose gradients

  1. Cost-effectiveness of MR Imaging-guided Strategies for Detection of Prostate Cancer in Biopsy-Naive Men.

    Science.gov (United States)

    Pahwa, Shivani; Schiltz, Nicholas K; Ponsky, Lee E; Lu, Ziang; Griswold, Mark A; Gulani, Vikas

    2017-10-01

    Purpose To evaluate the cost-effectiveness of multiparametric diagnostic magnetic resonance (MR) imaging examination followed by MR imaging-guided biopsy strategies in the detection of prostate cancer in biopsy-naive men presenting with clinical suspicion of cancer for the first time. Materials and Methods A decision-analysis model was created for biopsy-naive men who had been recommended for prostate biopsy on the basis of abnormal digital rectal examination results or elevated prostate-specific antigen levels (age groups: 41-50 years, 51-60 years, and 61-70 years). The following three major strategies were evaluated: (a) standard transrectal ultrasonography (US)-guided biopsy; (b) diagnostic MR imaging followed by MR imaging-targeted biopsy, with no biopsy performed if MR imaging findings were negative; and (c) diagnostic MR imaging followed by MR imaging-targeted biopsy, with a standard biopsy performed when MR imaging findings were negative. The following three MR imaging-guided biopsy strategies were further evaluated in each MR imaging category: (a) biopsy with cognitive guidance, (b) biopsy with MR imaging/US fusion guidance, and (c) in-gantry MR imaging-guided biopsy. Model parameters were derived from the literature. The primary outcome measure was net health benefit (NHB), which was measured as quality-adjusted life-years (QALYs) gained or lost by investing resources in a new strategy compared with a standard strategy at a willingness-to-pay (WTP) threshold of $50 000 per QALY gained. Probabilistic sensitivity analysis was performed by using Monte Carlo simulations. Results Noncontrast MR imaging followed by cognitively guided MR biopsy (no standard biopsy if MR imaging findings were negative) was the most cost-effective approach, yielding an additional NHB of 0.198 QALY compared with the standard biopsy approach. Noncontrast MR imaging followed by in-gantry MR imaging-guided biopsy (no standard biopsy if MR imaging findings were negative) led to the

  2. Protocol of image guided off-line using cone beam CT megavoltage; Protocolo de imagen guiada off-line mediante Cone Beam CT de megavoltaje

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Ruiz-Zorrilla, J.; Fernandez Leton, J. P.; Perez Moreno, J. M.; Zucca Aparicio, D.; Minambres Moro, A.

    2013-07-01

    The goal of image guided protocols offline is to reduce systematic errors in positioning of the patient in the treatment unit, being more important than the random errors, since the systematic have one contribution in the margin of the CTV to the PTV. This paper proposes a protocol for image guided offline with the different actions to take with their threshold values evaluated previously by anatomic location in a sample of 474 patients and 4821Cone beam Megavoltaje CT (CBCT). (Author)

  3. [Accelerated partial breast irradiation with image-guided intensity-modulated radiotherapy following breast-conserving surgery - preliminary results of a phase II clinical study].

    Science.gov (United States)

    Mészáros, Norbert; Major, Tibor; Stelczer, Gábor; Zaka, Zoltán; Mózsa, Emõke; Fodor, János; Polgár, Csaba

    2015-06-01

    The purpose of the study was to implement accelerated partial breast irradiation (APBI) by means of image-guided intensity-modulated radiotherapy (IG-IMRT) following breast-conserving surgery (BCS) for low-risk early invasive breast cancer. Between July 2011 and March 2014, 60 patients with low-risk early invasive (St I-II) breast cancer who underwent BCS were enrolled in our phase II prospective study. Postoperative APBI was given by means of step and shoot IG-IMRT using 4 to 5 fields to a total dose of 36.9 Gy (9×4.1 Gy) using a twice-a-day fractionation. Before each fraction, series of CT images were taken from the region of the target volume using a kV CT on-rail mounted in the treatment room. An image fusion software was used for automatic image registration of the planning and verification CT images. Patient set-up errors were detected in three directions (LAT, LONG, VERT), and inaccuracies were adjusted by automatic movements of the treatment table. Breast cancer related events, acute and late toxicities, and cosmetic results were registered and analysed. At a median follow-up of 24 months (range 12-44) neither locoregional nor distant failure was observed. Grade 1 (G1), G2 erythema, G1 oedema, and G1 and G2 pain occurred in 21 (35%), 2 (3.3%), 23 (38.3%), 6 (10%) and 2 (3.3%) patients, respectively. No G3-4 acute side effects were detected. Among late radiation side effects G1 pigmentation, G1 fibrosis, and G1 fat necrosis occurred in 5 (8.3%), 7 (11.7%), and 2 (3.3%) patients, respectively. No ≥G2 late toxicity was detected. Excellent and good cosmetic outcome was detected in 45 (75%) and 15 (25%) patients. IG-IMRT is a reproducible and feasible technique for the delivery of APBI following conservative surgery for the treatment of low-risk, early-stage invasive breast carcinoma. Preliminary results are promising, early radiation side effects are minimal, and cosmetic results are excellent.

  4. Long-term decision regret after post-prostatectomy image-guided intensity-modulated radiotherapy.

    Science.gov (United States)

    Shakespeare, Thomas P; Chin, Stephen; Manuel, Lucy; Wen, Shelly; Hoffman, Matthew; Wilcox, Shea W; Aherne, Noel J

    2017-02-01

    Decision regret (DR) may occur when a patient believes their outcome would have been better if they had decided differently about their management. Although some studies investigate DR after treatment for localised prostate cancer, none report DR in patients undergoing surgery and post-prostatectomy radiotherapy. We evaluated DR in this group of patients overall, and for specific components of therapy. We surveyed 83 patients, with minimum 5 years follow-up, treated with radical prostatectomy (RP) and post-prostatectomy image-guided intensity-modulated radiotherapy (IG-IMRT) to 64-66 Gy following www.EviQ.org.au protocols. A validated questionnaire identified DR if men either indicated that they would have been better off had they chosen another treatment, or they wished they could change their mind about treatment. There was an 85.5% response rate, with median follow-up post-IMRT 78 months. Adjuvant IG-IMRT was used in 28% of patients, salvage in 72% and ADT in 48%. A total of 70% of patients remained disease-free. Overall, 16.9% of patients expressed DR for treatment, with fourfold more regret for the RP component of treatment compared to radiotherapy (16.9% vs 4.2%, P = 0.01). DR for androgen deprivation was 14.3%. Patients were regretful of surgery due to toxicity, not being adequately informed about radiotherapy as an alternative, positive margins and surgery costs (83%, 33%, 25% and 8% of regretful patients respectively). Toxicity caused DR in the three radiotherapy-regretful and four ADT-regretful patients. Patients were twice as regretful overall, and of surgery, for salvage vs adjuvant approaches (both 19.6% vs 10.0%). Decision regret after RP and post-prostatectomy IG-IMRT is uncommon, although patients regret RP more than post-operative IG-IMRT. This should reassure urologists referring patients for post-prostatectomy IG-IMRT, particularly in the immediate adjuvant setting. Other implications include appropriate patient selection for RP (and

  5. Spatially weighted mutual information image registration for image guided radiation therapy

    International Nuclear Information System (INIS)

    Park, Samuel B.; Rhee, Frank C.; Monroe, James I.; Sohn, Jason W.

    2010-01-01

    Purpose: To develop a new metric for image registration that incorporates the (sub)pixelwise differential importance along spatial location and to demonstrate its application for image guided radiation therapy (IGRT). Methods: It is well known that rigid-body image registration with mutual information is dependent on the size and location of the image subset on which the alignment analysis is based [the designated region of interest (ROI)]. Therefore, careful review and manual adjustments of the resulting registration are frequently necessary. Although there were some investigations of weighted mutual information (WMI), these efforts could not apply the differential importance to a particular spatial location since WMI only applies the weight to the joint histogram space. The authors developed the spatially weighted mutual information (SWMI) metric by incorporating an adaptable weight function with spatial localization into mutual information. SWMI enables the user to apply the selected transform to medically ''important'' areas such as tumors and critical structures, so SWMI is neither dominated by, nor neglects the neighboring structures. Since SWMI can be utilized with any weight function form, the authors presented two examples of weight functions for IGRT application: A Gaussian-shaped weight function (GW) applied to a user-defined location and a structures-of-interest (SOI) based weight function. An image registration example using a synthesized 2D image is presented to illustrate the efficacy of SWMI. The convergence and feasibility of the registration method as applied to clinical imaging is illustrated by fusing a prostate treatment planning CT with a clinical cone beam CT (CBCT) image set acquired for patient alignment. Forty-one trials are run to test the speed of convergence. The authors also applied SWMI registration using two types of weight functions to two head and neck cases and a prostate case with clinically acquired CBCT/MVCT image sets. The

  6. Markerless EPID image guided dynamic multi-leaf collimator tracking for lung tumors

    Science.gov (United States)

    Rottmann, J.; Keall, P.; Berbeco, R.

    2013-06-01

    Compensation of target motion during the delivery of radiotherapy has the potential to improve treatment accuracy, dose conformity and sparing of healthy tissue. We implement an online image guided therapy system based on soft tissue localization (STiL) of the target from electronic portal images and treatment aperture adaptation with a dynamic multi-leaf collimator (DMLC). The treatment aperture is moved synchronously and in real time with the tumor during the entire breathing cycle. The system is implemented and tested on a Varian TX clinical linear accelerator featuring an AS-1000 electronic portal imaging device (EPID) acquiring images at a frame rate of 12.86 Hz throughout the treatment. A position update cycle for the treatment aperture consists of four steps: in the first step at time t = t0 a frame is grabbed, in the second step the frame is processed with the STiL algorithm to get the tumor position at t = t0, in a third step the tumor position at t = ti + δt is predicted to overcome system latencies and in the fourth step, the DMLC control software calculates the required leaf motions and applies them at time t = ti + δt. The prediction model is trained before the start of the treatment with data representing the tumor motion. We analyze the system latency with a dynamic chest phantom (4D motion phantom, Washington University). We estimate the average planar position deviation between target and treatment aperture in a clinical setting by driving the phantom with several lung tumor trajectories (recorded from fiducial tracking during radiotherapy delivery to the lung). DMLC tracking for lung stereotactic body radiation therapy without fiducial markers was successfully demonstrated. The inherent system latency is found to be δt = (230 ± 11) ms for a MV portal image acquisition frame rate of 12.86 Hz. The root mean square deviation between tumor and aperture position is smaller than 1 mm. We demonstrate the feasibility of real-time markerless DMLC

  7. Acute toxicity in prostate cancer patients treated with and without image-guided radiotherapy

    Directory of Open Access Journals (Sweden)

    Williams Scott

    2011-10-01

    Full Text Available Abstract Background Image-guided radiotherapy (IGRT increases the accuracy of treatment delivery through daily target localisation. We report on toxicity symptoms experienced during radiotherapy treatment, with and without IGRT in prostate cancer patients treated radically. Methods Between 2006 and 2009, acute toxicity data for ten symptoms were collected prospectively onto standardized assessment forms. Toxicity was scored during radiotherapy, according to the Common Terminology Criteria Adverse Events V3.0, for 275 prostate cancer patients before and after the implementation of a fiducial marker IGRT program and dose escalation from 74Gy in 37 fractions, to 78Gy in 39 fractions. Margins and planning constraints were maintained the same during the study period. The symptoms scored were urinary frequency, cystitis, bladder spasm, urinary incontinence, urinary retention, diarrhoea, haemorrhoids, proctitis, anal skin discomfort and fatigue. Analysis was conducted for the maximum grade of toxicity and the median number of days from the onset of that toxicity to the end of treatment. Results In the IGRT group, 14228 toxicity scores were analysed from 249 patients. In the non-IGRT group, 1893 toxicity scores were analysed from 26 patients. Urinary frequency ≥G3 affected 23% and 7% in the non-IGRT and IGRT group respectively (p = 0.0188. Diarrhoea ≥G2 affected 15% and 3% of patients in the non-IGRT and IGRT groups (p = 0.0174. Fatigue ≥G2 affected 23% and 8% of patients in the non-IGRT and IGRT groups (p = 0.0271. The median number of days with a toxicity was higher for ≥G2 (p = 0.0179 and ≥G3 frequency (p = 0.0027, ≥G2 diarrhoea (p = 0.0033 and ≥G2 fatigue (p = 0.0088 in the non-IGRT group compared to the IGRT group. Other toxicities were not of significant statistical difference. Conclusions In this study, prostate cancer patients treated radically with IGRT had less severe urinary frequency, diarrhoea and fatigue during treatment

  8. Reliability of EUCLIDIAN: An autonomous robotic system for image-guided prostate brachytherapy

    International Nuclear Information System (INIS)

    Podder, Tarun K.; Buzurovic, Ivan; Huang Ke; Showalter, Timothy; Dicker, Adam P.; Yu, Yan

    2011-01-01

    Purpose: Recently, several robotic systems have been developed to perform accurate and consistent image-guided brachytherapy. Before introducing a new device into clinical operations, it is important to assess the reliability and mean time before failure (MTBF) of the system. In this article, the authors present the preclinical evaluation and analysis of the reliability and MTBF of an autonomous robotic system, which is developed for prostate seed implantation. Methods: The authors have considered three steps that are important in reliability growth analysis. These steps are: Identification and isolation of failures, classification of failures, and trend analysis. For any one-of-a-kind product, the reliability enhancement is accomplished through test-fix-test. The authors have used failure mode and effect analysis for collection and analysis of reliability data by identifying and categorizing the failure modes. Failures were classified according to severity. Failures that occurred during the operation of this robotic system were considered as nonhomogenous Poisson process. The failure occurrence trend was analyzed using Laplace test. For analyzing and predicting reliability growth, commonly used and widely accepted models, Duane's model and the Army Material Systems Analysis Activity, i.e., Crow's model, were applied. The MTBF was used as an important measure for assessing the system's reliability. Results: During preclinical testing, 3196 seeds (in 53 test cases) were deposited autonomously by the robot and 14 critical failures were encountered. The majority of the failures occurred during the first few cases. The distribution of failures followed Duane's postulation as well as Crow's postulation of reliability growth. The Laplace test index was -3.82 (<0), indicating a significant trend in failure data, and the failure intervals lengthened gradually. The continuous increase in the failure occurrence interval suggested a trend toward improved reliability. The MTBF

  9. Image-guided adaptive radiotherapy for prostate and head-and-neck cancers

    Science.gov (United States)

    O'Daniel, Jennifer C.

    In the current practice of radiation therapy, daily patient alignments have been based on external skin marks or on bone. However, internal organ variation (both motion and volumetric changes) between treatment fractions can displace the treatment target, causing target underdosage and normal tissue overdosage. In order to deliver the radiation treatment as planned, more accurate knowledge of the daily internal anatomy was needed. Additionally, treatments needed to adapt to these variations by either shifting the patient to account for the daily target position or by altering the treatment plan. In this dissertation, the question of whether inter-fractional variations in internal patient anatomy combined with external set-up uncertainties produced measurable differences between planned and delivered doses for prostate and head-and-neck cancer patients was investigated. Image-guided adaptive treatment strategies to improve tumor coverage and/or reduce normal tissue dose were examined. Treatment deliveries utilizing various alignment procedures for ten prostate cancer patients and eleven head-and-neck cancer patients, each of whom received multiple CT scans over the course of treatment, were simulated. The largest prostate dose losses between planning and delivery were correlated with anterior/posterior and superior/inferior prostate displacement. Daily bone alignment sufficiently maintained target coverage for 70% of patients, ultrasound for 90%, and CT for 100%. A no-action-level correction protocol, which corrected the daily bone alignment for the systematic internal displacement of the prostate based on a pre-determined number of CT image sets, successfully improved the prostate and seminal vesicle dosimetric coverage. Three CT image sets were sufficient to accurately correct the bone alignment scheme for the prostate internal systematic shifts. For head-and-neck cancer patient treatment, setup uncertainties and internal organ variations did not greatly affect

  10. Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

    International Nuclear Information System (INIS)

    Poetter, Richard; Kirisits, Christian; Fidarova, Elena F.; Dimopoulos, Johan nes C. A.; Berger, Daniel; Tanderup, Kari; Lindegaard, Jacob C.

    2008-01-01

    Introduction. Image guided adaptive brachytherapy (IGABT) for cervical cancer, using mainly MRI, is an evolving method, increasingly replacing the 2D approach based on conventional radiography. During the complex 4D chain of this procedure image-assistance is provided for disease assessment, provisional treatment planning ('pre-planning'), applicator placement and reconstruction, as well as for contouring, definitive treatment planning and quality control of dose delivery. With IGABT changes of topography adjacent to the applicator, caused by tumour regression, oedema, organ changes and dilation are identified. Thus, the CTV for IGABT is primarily based on the tumour volume at the time of BT and takes into account both time and spatial domains. IGABT requires systematic concepts for target, OAR, biological modelling, DVH analysis, and dose-volume-adaptation. Methods and Results. This report focuses on the advantages and uncertainties, dose-effect relations and clinical results of the IGABT procedure addressing the current status and future perspectives. Uncertainties during the 4D chain of IGABT are mainly related to target contouring, applicator reconstruction, as well as to inter-fraction, intra-fraction and inter-application variability, as caused by tumour response and organ changes. Different from EBRT where set-up uncertainties are compensated by adding a margin to the CTV, no margins to the lateral and anterior-posterior directions can be used for IGABT. Discussion. By 3D treatment planning for IGABT significant improvement of the DVH parameters is achieved compared to 2D library plans. In small tumours the benefit is primarily obtained by a decrease of dose to nearby OAR while in large tumours the use of supplementary interstitial techniques and optimization may double the target volume that can be treated at a therapeutic dose level. The clinical impact of IGABT could recently be demonstrated by the establishment of some correlations between target- and

  11. Temporal regularization of ultrasound-based liver motion estimation for image-guided radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    O’Shea, Tuathan P., E-mail: tuathan.oshea@icr.ac.uk; Bamber, Jeffrey C.; Harris, Emma J. [Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS foundation Trust, Sutton, London SM2 5PT (United Kingdom)

    2016-01-15

    Purpose: Ultrasound-based motion estimation is an expanding subfield of image-guided radiation therapy. Although ultrasound can detect tissue motion that is a fraction of a millimeter, its accuracy is variable. For controlling linear accelerator tracking and gating, ultrasound motion estimates must remain highly accurate throughout the imaging sequence. This study presents a temporal regularization method for correlation-based template matching which aims to improve the accuracy of motion estimates. Methods: Liver ultrasound sequences (15–23 Hz imaging rate, 2.5–5.5 min length) from ten healthy volunteers under free breathing were used. Anatomical features (blood vessels) in each sequence were manually annotated for comparison with normalized cross-correlation based template matching. Five sequences from a Siemens Acuson™ scanner were used for algorithm development (training set). Results from incremental tracking (IT) were compared with a temporal regularization method, which included a highly specific similarity metric and state observer, known as the α–β filter/similarity threshold (ABST). A further five sequences from an Elekta Clarity™ system were used for validation, without alteration of the tracking algorithm (validation set). Results: Overall, the ABST method produced marked improvements in vessel tracking accuracy. For the training set, the mean and 95th percentile (95%) errors (defined as the difference from manual annotations) were 1.6 and 1.4 mm, respectively (compared to 6.2 and 9.1 mm, respectively, for IT). For each sequence, the use of the state observer leads to improvement in the 95% error. For the validation set, the mean and 95% errors for the ABST method were 0.8 and 1.5 mm, respectively. Conclusions: Ultrasound-based motion estimation has potential to monitor liver translation over long time periods with high accuracy. Nonrigid motion (strain) and the quality of the ultrasound data are likely to have an impact on tracking

  12. Comparing the Zeiss Callisto Eye and the Alcon Verion Image Guided System Toric Lens Alignment Technologies.

    Science.gov (United States)

    Hura, Arjan S; Osher, Robert H

    2017-07-01

    To compare the alignment meridian generated by the Zeiss Callisto Eye (Carl Zeiss AG, Dublin, CA) and the Alcon Verion Image Guided System (Alcon Laboratories, Inc., Fort Worth, TX). In this retrospective comparative evaluation of technology, intraoperative images were captured at different steps in the same surgery, allowing the comparison of the guidance lines generated by the Verion system to the parallel guidance lines generated by the Callisto Eye system. Measurements of each hemi-meridian were quantified using Adobe Photoshop 2015 CC software (Adobe Systems, San Jose, CA). The numbers of degrees separating these alignment meridians were calculated, entered into a database, and analyzed. The authors found that of 98 captured images of 16 eyes, the two technologies were identical in 0 eyes (θ 1 = θ 2 = 0), similar by 3° in 52 (53%) captured images (θ 1 ≠ θ 2 ≠ 0), and different by at least 3° in 46 (47%) captured images (θ 1 ≠ θ 2 ≠ 0). The target meridians were superimposed, the target lines were minimally separated, and the target lines were dissimilar. It was noted that some intraoperative variation occurred from measurement to measurement. Within the small group of 16 cases of routine toric lens implantation in this study, the absolute average number of degrees of misalignment between the Verion and Callisto Eye systems was 3.355 for θ 1 and 3.838 for θ 2 . On average, the intraoperative variation termed "drift" was noted to be 3.963° for θ 1 , and 4.557° for θ 2 . The authors found that small deviations were frequent when comparing two sophisticated technologies. Although deviations greater than 3° occurred in less than 47% of captured images from 16 eyes, smaller but significant variations of less than 3° occurred in 53% of captured images from 16 eyes. It was rare to identify a large deviation. However, the authors identified "drift" in the same eye when measurements were taken at different times. The results indicate that the two

  13. Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Stephen L.; Patel, Pretesh; Song, Haijun [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Freedland, Stephen J. [Surgery Section, Durham Veterans Administration, and Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California (United States); Bynum, Sigrun; Oh, Daniel; Palta, Manisha; Yoo, David; Oleson, James [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Salama, Joseph K., E-mail: joseph.salama@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2016-03-01

    Purpose: Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefore, we report the toxicity and clinical outcomes after postprostatectomy hypofractionated RT. Methods and Materials: From a prospectively maintained database, men receiving image guided hypofractionated intensity modulated RT (HIMRT) with 2.5-Gy fractions constituted our study population. Androgen deprivation therapy was used at the discretion of the radiation oncologist. Acute toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Biochemical recurrence was defined as an increase of 0.1 in prostate-specific antigen (PSA) from posttreatment nadir or an increase in PSA despite treatment. The Kaplan-Meier method was used for the time-to-event outcomes. Results: Between April 2008 and April 2012, 56 men received postoperative HIMRT. The median follow-up time was 48 months (range, 21-67 months). Thirty percent had pre-RT PSA <0.1; the median pre-RT detectable PSA was 0.32 ng/mL. The median RT dose was 65 Gy (range, 57.5-65 Gy). Ten patients received neoadjuvant and concurrent hormone therapy. Posttreatment acute urinary toxicity was limited. There was no acute grade 3 toxicity. Late genitourinary (GU) toxicity of any grade was noted in 52% of patients, 40% of whom had pre-RT urinary incontinence. The 4-year actuarial rate of late grade 3 GU toxicity (exclusively gross hematuria) was 28% (95% confidence interval [CI], 16%-41%). Most grade 3 GU toxicity resolved; only 7% had persistent grade ≥3 toxicity at the last follow-up visit. Fourteen patients experienced biochemical recurrence at a

  14. Temporary organ displacement coupled with image-guided, intensity-modulated radiotherapy for paraspinal tumors

    International Nuclear Information System (INIS)

    Katsoulakis, Evangelia; Thornton, Raymond H; Yamada, Yoshiya; Solomon, Stephen B; Maybody, Majid; Housman, Douglas; Niyazov, Greg; Riaz, Nadeem; Lovelock, Michael; Spratt, Daniel E; Erinjeri, Joseph P

    2013-01-01

    To investigate the feasibility and dosimetric improvements of a novel technique to temporarily displace critical structures in the pelvis and abdomen from tumor during high-dose radiotherapy. Between 2010 and 2012, 11 patients received high-dose image-guided intensity-modulated radiotherapy with temporary organ displacement (TOD) at our institution. In all cases, imaging revealed tumor abutting critical structures. An all-purpose drainage catheter was introduced between the gross tumor volume (GTV) and critical organs at risk (OAR) and infused with normal saline (NS) containing 5-10% iohexol. Radiation planning was performed with the displaced OARs and positional reproducibility was confirmed with cone-beam CT (CBCT). Patients were treated within 36 hours of catheter placement. Radiation plans were re-optimized using pre-TOD OARs to the same prescription and dosimetrically compared with post-TOD plans. A two-tailed permutation test was performed on each dosimetric measure. The bowel/rectum was displaced in six patients and kidney in four patients. One patient was excluded due to poor visualization of the OAR; thus 10 patients were analyzed. A mean of 229 ml (range, 80–1000) of NS 5-10% iohexol infusion resulted in OAR mean displacement of 17.5 mm (range, 7–32). The median dose prescribed was 2400 cGy in one fraction (range, 2100–3000 in 3 fractions). The mean GTV D min and PTV D min pre- and post-bowel TOD IG-IMRT dosimetry significantly increased from 1473 cGy to 2086 cGy (p=0.015) and 714 cGy to 1214 cGy (p=0.021), respectively. TOD increased mean PTV D95 by 27.14% of prescription (p=0.014) while the PTV D05 decreased by 9.2% (p=0.011). TOD of the bowel resulted in a 39% decrease in mean bowel D max (p=0.008) confirmed by CBCT. TOD of the kidney significantly decreased mean kidney dose and D max by 25% (0.022). TOD was well tolerated, reproducible, and facilitated dose escalation to previously radioresistant tumors abutting critical structures while

  15. Acute Toxicity in Definitive Versus Postprostatectomy Image-Guided Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Cheng, Jonathan C.; Schultheiss, Timothy E.; Nguyen, Khanh H.; Wong, Jeffrey Y.C.

    2008-01-01

    Purpose: To assess the incidence of acute gastrointestinal (GI) and genitourinary (GU) injury and the dose-volume response in patients with clinically localized prostate cancer treated with image-guided radiotherapy using helical tomotherapy. Methods and Materials: Between November 2004 and March 2007, 146 consecutive patients with localized prostate cancer were treated with helical tomotherapy at the City of Hope Medical Center. Of the 146 patients, 70 had undergone prostatectomy. Acute GI and GU toxicities were evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Cancer of Medical scoring system. Events were scored for patients developing Grade 2 or greater morbidity within 90 days after the end of radiotherapy (RT). The dosimetric parameters included the minimal dose received by the highest 10%, 20%, 50%, 80%, and 90% of the target volume, the mean rectal dose, minimal rectal dose, maximal rectal dose, and the volume receiving ≥45, ≥65, and ≥70 Gy. These variables, plus the status of radical prostatectomy, hormonal therapy, RT techniques, and medical conditions, were included in a multivariate logistic regression analysis. A goodness-of-fit evaluation was done using the Hosmer-Lemeshow statistic. Results: A dose-response function for acute GI toxicity was elicited. The acute GI Grade 2 or greater toxicity was lower in the definitive RT group than in the postoperative RT group (25% vs. 41%, p <0.05). Acute GU Grade 2 or greater toxicity was comparable between the two groups. No grade 3 or greater complications were observed. No dosimetric variable was significant for GU toxicity. For acute GI toxicity, the significant dosimetric parameters were the minimal dose received by 10%, 20%, and 50% of the target volume and the mean rectal dose; the most predictive parameter was the minimal dose received by 10% of the target volume. The dose-modifying factor was 1.2 for radical prostatectomy. Conclusion: The results of our

  16. Concomitant Imaging Dose and Cancer Risk in Image Guided Thoracic Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yibao; Wu, Hao [Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing (China); Chen, Zhe [Department of Therapeutic Radiology, Yale University, New Haven, Connecticut (United States); Knisely, Jonathan P.S. [Department of Radiation Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York (United States); Nath, Ravinder [Department of Therapeutic Radiology, Yale University, New Haven, Connecticut (United States); Feng, Zhongsu [Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing (China); Bao, Shanglian [Beijing Key Laboratory of Medical Physics and Engineering, Peking University, Beijing (China); Deng, Jun, E-mail: jun.deng@yale.edu [Department of Therapeutic Radiology, Yale University, New Haven, Connecticut (United States)

    2015-11-01

    Purpose: Kilovoltage cone beam computed tomography (CT) (kVCBCT) imaging guidance improves the accuracy of radiation therapy but imposes an extra radiation dose to cancer patients. This study aimed to investigate concomitant imaging dose and associated cancer risk in image guided thoracic radiation therapy. Methods and Materials: The planning CT images and structure sets of 72 patients were converted to CT phantoms whose chest circumferences (C{sub chest}) were calculated retrospectively. A low-dose thorax protocol on a Varian kVCBCT scanner was simulated by a validated Monte Carlo code. Computed doses to organs and cardiac substructures (for 5 selected patients of various dimensions) were regressed as empirical functions of C{sub chest}, and associated cancer risk was calculated using the published models. The exposures to nonthoracic organs in children were also investigated. Results: The structural mean doses decreased monotonically with increasing C{sub chest}. For all 72 patients, the median doses to the heart, spinal cord, breasts, lungs, and involved chest were 1.68, 1.33, 1.64, 1.62, and 1.58 cGy/scan, respectively. Nonthoracic organs in children received 0.6 to 2.8 cGy/scan if they were directly irradiated. The mean doses to the descending aorta (1.43 ± 0.68 cGy), left atrium (1.55 ± 0.75 cGy), left ventricle (1.68 ± 0.81 cGy), and right ventricle (1.85 ± 0.84 cGy) were significantly different (P<.05) from the heart mean dose (1.73 ± 0.82 cGy). The blade shielding alleviated the exposure to nonthoracic organs in children by an order of magnitude. Conclusions: As functions of patient size, a series of models for personalized estimation of kVCBCT doses to thoracic organs and cardiac substructures have been proposed. Pediatric patients received much higher doses than did the adults, and some nonthoracic organs could be irradiated unexpectedly by the default scanning protocol. Increased cancer risks and disease adverse events in the

  17. Dosimetric consequences of translational and rotational errors in frame-less image-guided radiosurgery

    Directory of Open Access Journals (Sweden)

    Guckenberger Matthias

    2012-04-01

    Full Text Available Abstract Background To investigate geometric and dosimetric accuracy of frame-less image-guided radiosurgery (IG-RS for brain metastases. Methods and materials Single fraction IG-RS was practiced in 72 patients with 98 brain metastases. Patient positioning and immobilization used either double- (n = 71 or single-layer (n = 27 thermoplastic masks. Pre-treatment set-up errors (n = 98 were evaluated with cone-beam CT (CBCT based image-guidance (IG and were corrected in six degrees of freedom without an action level. CBCT imaging after treatment measured intra-fractional errors (n = 64. Pre- and post-treatment errors were simulated in the treatment planning system and target coverage and dose conformity were evaluated. Three scenarios of 0 mm, 1 mm and 2 mm GTV-to-PTV (gross tumor volume, planning target volume safety margins (SM were simulated. Results Errors prior to IG were 3.9 mm ± 1.7 mm (3D vector and the maximum rotational error was 1.7° ± 0.8° on average. The post-treatment 3D error was 0.9 mm ± 0.6 mm. No differences between double- and single-layer masks were observed. Intra-fractional errors were significantly correlated with the total treatment time with 0.7mm±0.5mm and 1.2mm±0.7mm for treatment times ≤23 minutes and >23 minutes (p5% in 14% of the patients. A 1 mm safety margin fully compensated intra-fractional patient motion. Conclusions IG-RS with online correction of translational errors achieves high geometric and dosimetric accuracy. Intra-fractional errors decrease target coverage and conformity unless compensated with appropriate safety margins.

  18. CT image-guided intensity-modulated therapy for paraspinal tumors using stereotactic immobilization

    International Nuclear Information System (INIS)

    Yenice, Kamil M.; Lovelock, D. Michael; Hunt, Margie A.; Lutz, Wendell R.; Fournier-Bidoz, Nathalie; Hua, C.-H.; Yamada, Josh; Bilsky, Mark; Lee, Henry; Pfaff, Karl; Spirou, Spiridon V.; Amols, Howard I.

    2003-01-01

    Purpose: To design and implement a noninvasive stereotactic immobilization technique with daily CT image-guided positioning to treat patients with paraspinal lesions accurately and to quantify the systematic and random patient setup errors occurring with this method. Methods and Materials: A stereotactic body frame (SBF) was developed for 'rigid' immobilization of paraspinal patients. The inherent accuracy of this system for stereotactic CT-guided treatment was evaluated with phantom studies. Seven patients with thoracic and lumbar spine lesions were immobilized with the SBF and positioned for 33 treatment fractions using daily CT scans. For all 7 patients, the daily setup errors, as assessed from the daily CT scans, were corrected at each treatment fraction. A retrospective analysis was also performed to assess what the impact on patient treatment would have been without the CT-based corrections (i.e., if patient setup had been performed only with the SBF). Results: The average magnitude of systematic and random errors from uncorrected patient setups using the SBF was approximately 2 mm and 1.5 mm (1 SD), respectively. For fixed phantom targets, the system accuracy for the SBF localization and treatment was shown to be within 1 mm (1 SD) in any direction. Dose-volume histograms incorporating these uncertainties for an intensity-modulated radiotherapy plan for lumbar spine lesions were generated, and the effects on the dose-volume histograms were studied. Conclusion: We demonstrated a very accurate and precise method of patient immobilization and treatment delivery based on a noninvasive SBF and daily image guidance for paraspinal lesions. The SBF provides excellent immobilization for paraspinal targets, with setup accuracy better than 2 mm (1 SD). However, for highly conformal paraspinal treatments, uncorrected systematic and random errors of 2 mm in magnitude can result in a significantly greater (>100%) dose to the spinal cord than planned, even though the

  19. Impact of Sodium Bicarbonate-Buffered Lidocaine on Patient Pain During Image-Guided Breast Biopsy.

    Science.gov (United States)

    Vasan, Alison; Baker, Jay A; Shelby, Rebecca A; Soo, Mary Scott C

    2017-09-01

    This randomized, double-blind controlled study evaluated the effectiveness of sodium bicarbonate-buffered lidocaine on reducing pain during imaging-guided breast biopsies. This prospective, HIPAA-compliant study randomly assigned 85 women undergoing ultrasound- or stereotactic-guided core-needle breast biopsies to receive intradermally and intraparenchymally either 1% lidocaine buffered with sodium bicarbonate (9:1 ratio) (bicarbonate study group) or 1% lidocaine alone (control group). Pain was evaluated using a 0-to-10 Likert pain scale during both intradermal and intraparenchymal anesthesia injections and during tissue sampling. Prebiopsy breast pain, anxiety, medical history, demographics, biopsy type, radiologist level of training, breast density, and lesion histology were recorded. Data were analyzed using analysis of variance and analysis of covariance. Unadjusted mean pain scores were 1.47 and 2.07 (study and control groups, respectively; P = .15) during intradermal injections, and 1.84 and 2.98 (study and control groups, respectively; P = .03) during intraparenchymal injections. Tissue sampling mean pain scores were .81 and 1.71 (study and control groups, respectively; P = .07). Moderator analyses found (1) among patients with preprocedural pain, those in the bicarbonate group experienced less intradermal injection pain (0.85 ± 1.23) than patients in the control group (2.50 ± 2.09); (2) among patients with fatty or scattered fibroglandular tissue, those in the bicarbonate group (1.35 ± 1.95) experienced less intraparenchymal injection pain than the control group (3.52 ± 3.13); and (3) during ultrasound-guided biopsies, patients in the bicarbonate group experienced less tissue-sampling pain (0.23 ± 0.63) than the control group (1.79 ± 3.05). Overall, buffering lidocaine with sodium bicarbonate significantly reduced pain during intraparenchymal injections, and additional pain reduction was found in certain patient subgroups during intradermal

  20. Online Magnetic Resonance Image Guided Adaptive Radiation Therapy: First Clinical Applications

    International Nuclear Information System (INIS)

    Acharya, Sahaja; Fischer-Valuck, Benjamin W.; Kashani, Rojano; Parikh, Parag; Yang, Deshan; Zhao, Tianyu; Green, Olga; Wooten, Omar; Li, H. Harold; Hu, Yanle; Rodriguez, Vivian; Olsen, Lindsey; Robinson, Clifford; Michalski, Jeff; Mutic, Sasa; Olsen, Jeffrey

    2016-01-01

    Purpose: To demonstrate the feasibility of online adaptive magnetic resonance (MR) image guided radiation therapy (MR-IGRT) through reporting of our initial clinical experience and workflow considerations. Methods and Materials: The first clinically deployed online adaptive MR-IGRT system consisted of a split 0.35T MR scanner straddling a ring gantry with 3 multileaf collimator-equipped 60 Co heads. The unit is supported by a Monte Carlo–based treatment planning system that allows real-time adaptive planning with the patient on the table. All patients undergo computed tomography and MR imaging (MRI) simulation for initial treatment planning. A volumetric MRI scan is acquired for each patient at the daily treatment setup. Deformable registration is performed using the planning computed tomography data set, which allows for the transfer of the initial contours and the electron density map to the daily MRI scan. The deformed electron density map is then used to recalculate the original plan on the daily MRI scan for physician evaluation. Recontouring and plan reoptimization are performed when required, and patient-specific quality assurance (QA) is performed using an independent in-house software system. Results: The first online adaptive MR-IGRT treatments consisted of 5 patients with abdominopelvic malignancies. The clinical setting included neoadjuvant colorectal (n=3), unresectable gastric (n=1), and unresectable pheochromocytoma (n=1). Recontouring and reoptimization were deemed necessary for 3 of 5 patients, and the initial plan was deemed sufficient for 2 of the 5 patients. The reasons for plan adaptation included tumor progression or regression and a change in small bowel anatomy. In a subsequently expanded cohort of 170 fractions (20 patients), 52 fractions (30.6%) were reoptimized online, and 92 fractions (54.1%) were treated with an online-adapted or previously adapted plan. The median time for recontouring, reoptimization, and QA was 26

  1. Spatially weighted mutual information image registration for image guided radiation therapy.

    Science.gov (United States)

    Park, Samuel B; Rhee, Frank C; Monroe, James I; Sohn, Jason W

    2010-09-01

    To develop a new metric for image registration that incorporates the (sub)pixelwise differential importance along spatial location and to demonstrate its application for image guided radiation therapy (IGRT). It is well known that rigid-body image registration with mutual information is dependent on the size and location of the image subset on which the alignment analysis is based [the designated region of interest (ROI)]. Therefore, careful review and manual adjustments of the resulting registration are frequently necessary. Although there were some investigations of weighted mutual information (WMI), these efforts could not apply the differential importance to a particular spatial location since WMI only applies the weight to the joint histogram space. The authors developed the spatially weighted mutual information (SWMI) metric by incorporating an adaptable weight function with spatial localization into mutual information. SWMI enables the user to apply the selected transform to medically "important" areas such as tumors and critical structures, so SWMI is neither dominated by, nor neglects the neighboring structures. Since SWMI can be utilized with any weight function form, the authors presented two examples of weight functions for IGRT application: A Gaussian-shaped weight function (GW) applied to a user-defined location and a structures-of-interest (SOI) based weight function. An image registration example using a synthesized 2D image is presented to illustrate the efficacy of SWMI. The convergence and feasibility of the registration method as applied to clinical imaging is illustrated by fusing a prostate treatment planning CT with a clinical cone beam CT (CBCT) image set acquired for patient alignment. Forty-one trials are run to test the speed of convergence. The authors also applied SWMI registration using two types of weight functions to two head and neck cases and a prostate case with clinically acquired CBCT/ MVCT image sets. The SWMI registration with

  2. MO-DE-210-03: Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities

    Energy Technology Data Exchange (ETDEWEB)

    Ding, K. [Johns Hopkins University: Development of Intra-Fraction Soft Tissue Monitoring with Ultrasound Imaging (United States)

    2015-06-15

    Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities. It is inexpensive, portable and provides good soft tissue contrast. For challenging soft tissue targets such as pancreatic cancer, ultrasound imaging can be used in combination with pre-treatment MRI and/or CT to transfer important anatomical features for target localization at time of treatment. The non-invasive and non-ionizing nature of ultrasound imaging is particularly powerful for intra-fraction localization and monitoring. Recognizing these advantages, efforts are being made to incorporate novel robotic approaches to position and manipulate the ultrasound probe during irradiation. These recent enabling developments hold potential to bring ultrasound imaging to a new level of IGRT applications. However, many challenges, not limited to image registration, robotic deployment, probe interference and image acquisition rate, need to be addressed to realize the full potential of IGRT with ultrasound imaging. Learning Objectives: Understand the benefits and limitations in using ultrasound to augment MRI and/or CT for motion monitoring during radiation therapy delivery. Understanding passive and active robotic approaches to implement ultrasound imaging for intra-fraction monitoring. Understand issues of probe interference with radiotherapy treatment. Understand the critical clinical workflow for effective and reproducible IGRT using ultrasound guidance. The work of X.L. is supported in part by Elekta; J.W. and K.D. is supported in part by a NIH grant R01 CA161613 and by Elekta; D.H. is support in part by a NIH grant R41 CA174089.

  3. WE-FG-BRA-09: Using Graphene Oxide Nano Flakes During Image Guided Radiotherapy to Minimize the Potential of Cancer Recurrence Or Metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Toomeh, D; Sajo, E; Hao, Y; Gadoue, S [University Massachusetts Lowell, Lowell, MA (United States); Ngwa, W [University Massachusetts Lowell, Lowell, MA (United States); Harvard Medical School, Boston, MA (United States)

    2016-06-15

    Purpose: An increasing number of studies show that cancer stem cells (CSCs) become more invasive (metastatic) and may escape into the blood stream and lymph nodes during radiotherapy (RT), before they have received a lethal dose during RT. Other Studies have shown that Graphene oxide (GO) can selectively inhibit the proliferative expansion of CSCs across multiplicative tumor types. In this study we investigate the feasibility of using GO during radiotherapy (RT) to minimize the escape of CSCs towards preventing cancer metastasis or recurrence. Methods: We hypothesize that sufficient amount of GO nano-flakes (GONFs) released from new design radiotherapy biomaterials (fiducials or spacers) loaded with the GONFs can reach all tumor cells within typical times of 14 or 21days before the beginning of image-guided radiotherapy (IGRT) following implantation. To test this hypothesis, the space-time diffusion of the GONFs was investigated. Knudsen’s and Cunningham’s numbers were calculated to get the Stokes’ velocities and mobility values, according to these values, diffusion coefficients were calculated. In a previous study it was shown that GONFs concentration of 50 µg/ml were effective. In the diffusion study, 100 µg/ml was chosen as an initial concentration because it has been shown to be relatively non-toxic. Results: The 50 µg/ml concentration in a 2 cm diameter volume of lung tumor could be only achieved using 2 nm and 6 nm GONFs with respective diffusion times of 14 and 21 days. As expected, increased nanoflake size requires longer times to achieve the target 50 µg/ml concentration. Conclusion: The preliminary results indicate the potential of using GONFs delivered via new design radiotherapy biomaterials (e.g. fiducials) to inhibit the proliferative expansion of CSCs. The study avails ongoing in-vivo studies on using GONFs to enhance treatment outcomes for cancer patients.

  4. Accuracy of Image-guided Surgical Systems at the Lateral Skull Base as Clinically Assessed Using Bone-Anchored Hearing Aid Posts as Surgical Targets

    Science.gov (United States)

    Balachandran, Ramya; Fitzpatrick, J. Michael

    2009-01-01

    Objective Image-guided surgical (IGS) technology has been clinically available for over a decade. To date, no acceptable standard exists for reporting the accuracy of IGS systems, especially for lateral skull base applications. We present a validation method that uses the post from bone anchored hearing aid (BAHA) patients as a target. We then compare the accuracy of two IGS systems—one using laser skin-surface scanning (LSSS) and another using a non-invasive fiducial frame (FF) attached to patient via dental bite-block (DBB) for registration. Study design Prospective. Setting Tertiary referral center. Patients Six BAHA patients who had adequate dentition for creation of a DBB. Intervention(s) For each patient, a dental impression was obtained, and a customized DBB was made to hold a FF. Temporal bone CT scans were obtained with the patient wearing the DBB, FF, and a customized marker on the BAHA post. In a mock OR, CT scans were registered to operative anatomy using two methods: (a) LSSS, (b) FF. Main outcome measure(s) For each patient and each system, the position of the BAHA marker in the CT scan and in the mock OR (using optical measurement technology) were compared and the distances between them are reported to demonstrate accuracy. Results Accuracy (mean ± standard deviation) was 1.54 ± 0.63 mm for DBB registration and 3.21 ± 1.02 mm for LSSS registration. Conclusions An IGS system using FF registration is more accurate than one using LSSS (p = 0.03, two-sided Student's t-test). BAHA patients provide a unique patient population upon which IGS systems may be validated. PMID:18836389

  5. Image-guided Percutaneous Drainage for Treatment of Post-Surgical Anastomotic Leak in Patients with Crohn's Disease.

    Science.gov (United States)

    Byrne, James; Stephens, Ryan; Isaacson, Ari; Yu, Hyeon; Burke, Charles

    2016-01-01

    Anastomotic leaks with abscess formation are a common complication after bowel surgery in Crohn's disease patients. Image-guided percutaneous drainage is an attractive alternative to reoperation because of decreased morbidity and length of hospital stay. Because data for this specific population are scarce, the purpose of this study is to determine the safety and efficacy of image-guided percutaneous drainage in the management of post-surgical anastomotic leak in patients with Crohn's disease. A total of 41 patients who underwent percutaneous drain placement for the treatment of fluid collections due to anastomotic leak from September 2004 to November 2013 were retrospectively identified from the electronic medical record and picture archiving and communication system. Data recorded included number, size, and location of anastomotic leaks, number of drains placed, number of follow-up visits, post-drainage complications, abscess resolution, and subsequent surgeries. In all, 41 patients with 76 fluid collections were identified as having received percutaneous drains. The mean number of targeted fluid collections per patient was 1.5, and the mean duration between surgery and percutaneous drain placement was 18.5 days. The mean number of drains placed was 1.6, and the median drain size was 10 French [range 8-16 French]. One of 41 [2.4%] patients experienced a minor complication from drain placement [injury to a superficial abdominal artery] and no major complications occurred. Two of 41 [4.9%] patients required repeat surgeries. Image-guided percutaneous drainage for the treatment of post-surgical anastomotic leaks in Crohn's patients is effective and safe, with low rates of complications and reoperations. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  6. A cognitive engineering framework for the specification of information requirements in medical imaging: application in image-guided neurosurgery.

    Science.gov (United States)

    Morineau, T; Morandi, X; Le Moëllic, N; Jannin, P

    2013-03-01

    This study proposes a framework coming from cognitive engineering, which makes it possible to define what information content has to be displayed or emphasised from medical imaging, for assisting clinicians according to their level of expertise in the domain. We designed a rating scale to assess visualisation systems in image-guided neurosurgery with respect to the depiction of the neurosurgical work domain. This rating scale was based on a neurosurgical work domain analysis. This scale has been used to evaluate visualisation modes among neurosurgeons, residents and engineers. We asked five neurosurgeons, ten medical residents and ten engineers to rate two visualisation modes from the same data (2D MR image vs. 3D computerised image). With this method, the amount of abstract and concrete work domain information displayed by each visualisation mode can be measured. A global difference in quantities of perceived information between both images was observed. Surgeons and medical residents perceived significantly more information than engineers for both images. Unlike surgeons, however, the amount of information perceived by residents and engineers significantly decreased as information abstraction increased. We demonstrated the possibility of measuring the amount of work domain information displayed by different visualisation modes of medical imaging according to different user profiles. Engineers in charge of the design of medical image-guided surgical systems did not perceive the same set of information as surgeons or even medical residents. This framework can constitute a user-oriented approach to evaluate the amount of perceived information from image-guided surgical systems and support their design from a cognitive engineering point of view.

  7. Implementation of Remote 3-Dimensional Image Guided Radiation Therapy Quality Assurance for Radiation Therapy Oncology Group Clinical Trials

    Energy Technology Data Exchange (ETDEWEB)

    Cui Yunfeng [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Galvin, James M. [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Radiation Therapy Oncology Group, American College of Radiology, Philadelphia, Pennsylvania (United States); Parker, William [Department of Medical Physics, McGill University Health Center, Montreal, QC (Canada); Breen, Stephen [Department of Radiation Physics, Princess Margaret Hospital, Toronto, ON (Canada); Yin Fangfang; Cai Jing [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Papiez, Lech S. [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Bednarz, Greg [Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Chen Wenzhou [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Xiao Ying, E-mail: ying.xiao@jefferson.edu [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Radiation Therapy Oncology Group, American College of Radiology, Philadelphia, Pennsylvania (United States)

    2013-01-01

    Purpose: To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Methods and Materials: Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. Results: The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. Conclusion: This first experience indicated that remote review for 3D IGRT as part of QA

  8. Comparison of biometric measurements obtained by the Verion Image-Guided System versus the auto-refracto-keratometer.

    Science.gov (United States)

    Velasco-Barona, Cecilio; Cervantes-Coste, Guadalupe; Mendoza-Schuster, Erick; Corredor-Ortega, Claudia; Casillas-Chavarín, Nadia L; Silva-Moreno, Alejandro; Garza-León, Manuel; Gonzalez-Salinas, Roberto

    2017-04-25

    To compare the biometric measurements obtained from the Verion Image-Guided System to those obtained by auto-refracto-keratometer in normal eyes. This is a prospective, observational, comparative study conducted at the Asociación para Evitar la Ceguera en México I.A.P., Mexico. Three sets of keratometry measurements were obtained using the image-guided system to assess the coefficient of variation, the within-subject standard deviation and intraclass correlation coefficient (ICC). A paired Student t test was used to assess statistical significance between the Verion and the auto-refracto-keratometer. A Pearson's correlation coefficient (r) was obtained for all measurements, and the level of agreement was verified using Bland-Altman plots. The right eyes of 73 patients were evaluated by each platform. The Verion coefficient of variation was 0.3% for the flat and steep keratometry, with the ICC being greater than 0.9 for all parameters measured. Paired t test showed statistically significant differences between groups (P = 0.0001). A good correlation was evidenced for keratometry values between platforms (r = 0.903, P = 0.0001 for K1, and r = 0.890, P = 0.0001). Bland-Altman plots showed a wide data spread for all variables. The image-guided system provided highly repeatable corneal power and keratometry measurements. However, significant differences were evidenced between the two platforms, and although values were highly correlated, they showed a wide data spread for all analysed variables; therefore, their interchangeable use for biometry assessment is not advisable.

  9. An image-guided system for optimized volumetric treatment planning and execution for radiofrequency ablation of liver tumors

    International Nuclear Information System (INIS)

    Banovac, F.; Popa, T.; Cheng, P.; Cleary, K.; Abeledo, H.; Campos-Nanez, E.; Wood, B.J.

    2007-01-01

    Radiofrequency ablation of liver tumors is becoming an increasingly popular option for the treatment of cancer. However, the procedure has several technical challenges, mostly associated with precision targeting of the tumor and ensuring complete ablation coverage. In this paper we describe an image-guided system that we are developing for improved visualization and probe placement during these procedures. The system will include a pre-procedure optimization module and an intra-procedure guidance component. The system concept is explained and some preliminary results are given. While this system is designed for radiofrequency ablation of liver tumors, the methods are applicable to other organs and treatment methods. (orig.)

  10. Residual set-up errors and margins in on-line image-guided prostate localization in radiotherapy

    DEFF Research Database (Denmark)

    Poulsen, Per Rugaard; Muren, Ludvig; Høyer, Morten

    2007-01-01

    BACKGROUND AND PURPOSE: Image-guided on-line correction of the target position allows radiotherapy of prostate cancer with narrow set-up margins. The present study investigated the residual set-up error after on-line prostate localization and its impact on margins. MATERIALS AND METHODS: Prostate...... localization based on two orthogonal X-ray images of gold markers implanted in the prostate was performed with an on-board imager at four treatment sessions for 90 patients. The set-up error in the sagittal plane residual after couch adjustment was evaluated on lateral verification portal images. RESULTS...

  11. Evaluation of volume change in rectum and bladder during application of image-guided radiotherapy for prostate carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Luna, J. A., E-mail: yosimoon13@hotmail.com [Departamento de Física, Universidad Nacional de Costa Rica, Heredia (Costa Rica); Rojas, J. I., E-mail: isaac.rojas@siglo21.cr [Centro Médico Radioterapia Siglo XX1, La Uruca (Costa Rica); PROXTRONICS CR, Ltda, Heredia (Costa Rica)

    2016-07-07

    All prostate cancer patients from Centro Médico Radioterapia Siglo XXI receive Volumetric Modulated Arc Therapy (VMAT). This therapy uses image-guided radiotherapy (IGRT) with the Cone Beam Computed Tomography (CBCT). This study compares the planned dose in the reference CT image against the delivered dose recalculate in the CBCT image. The purpose of this study is to evaluate the anatomic changes and related dosimetric effect based on weekly CBCT directly for patients with prostate cancer undergoing volumetric modulated arc therapy (VMAT) treatment. The collected data were analyzed using one-way ANOVA.

  12. Hounsfield unit recovery in clinical cone beam CT images of the thorax acquired for image guided radiation therapy

    DEFF Research Database (Denmark)

    Thing, Rune Slot; Bernchou, Uffe; Mainegra-Hing, Ernesto

    2016-01-01

    A comprehensive artefact correction method for clinical cone beam CT (CBCT) images acquired for image guided radiation therapy (IGRT) on a commercial system is presented. The method is demonstrated to reduce artefacts and recover CT-like Hounsfield units (HU) in reconstructed CBCT images of five...... lung cancer patients. Projection image based artefact corrections of image lag, detector scatter, body scatter and beam hardening are described and applied to CBCT images of five lung cancer patients. Image quality is evaluated through visual appearance of the reconstructed images, HU...

  13. Daily ultrasound-based image-guided targeting for radiotherapy of upper abdominal malignancies.

    Science.gov (United States)

    Fuss, Martin; Salter, Bill J; Cavanaugh, Sean X; Fuss, Cristina; Sadeghi, Amir; Fuller, Clifton D; Ameduri, Ardow; Hevezi, James M; Herman, Terence S; Thomas, Charles R

    2004-07-15

    Development and implementation of a strategy to use a stereotactic ultrasound (US)-based image-guided targeting device (BAT) to align intensity-modulated radiotherapy (IMRT) target volumes accurately in the upper abdomen. Because the outlines of such targets may be poorly visualized by US, we present a method that uses adjacent vascular guidance structures as surrogates for the target position. We assessed the potential for improvement of daily repositioning and the feasibility of daily application. A total of 62 patients were treated by sequential tomotherapeutic IMRT between October 2000 and June 2003 for cholangiocarcinoma and gallbladder carcinoma (n = 10), hepatocellular carcinoma (n = 10), liver metastases (n = 11), pancreatic carcinoma (n = 20), neuroblastoma (n = 3), and other abdominal and retroperitoneal tumors (n = 8). The target volumes (TVs) and organs at risk were delineated in contrast-enhanced CT data sets. Additionally, vascular guidance structures in close anatomic relation to the TV, or within the TV, were delineated. Throughout the course of IMRT, US BAT images were acquired during daily treatment positioning. In addition to the anatomic structures typically used for US targeting (e.g., the TV and dose-limiting organs at risk), CT contours of guidance structures were superimposed onto the real-time acquired axial and sagittal US images, and target position adjustments, as indicated by the system, were performed accordingly. We report the BAT-derived distribution of shifts in the three principal room axes compared with a skin-mark-based setup, as well as the time required to perform BAT alignment. The capability of the presented method to improve target alignment was assessed in 15 patients by comparing the organ and fiducial position between the respective treatment simulation CT with a control CT study after US targeting in the CT suite. A total of 1,337 BAT alignments were attempted. US images were not useful in 56 setups (4.2%), mainly

  14. Image Guided Radiation Therapy Using Synthetic Computed Tomography Images in Brain Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Price, Ryan G. [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan (United States); Kim, Joshua P.; Zheng, Weili [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Chetty, Indrin J. [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan (United States); Glide-Hurst, Carri, E-mail: churst2@hfhs.org [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan (United States)

    2016-07-15

    Purpose: The development of synthetic computed tomography (CT) (synCT) derived from magnetic resonance (MR) images supports MR-only treatment planning. We evaluated the accuracy of synCT and synCT-generated digitally reconstructed radiographs (DRRs) relative to CT and determined their performance for image guided radiation therapy (IGRT). Methods and Materials: Magnetic resonance simulation (MR-SIM) and CT simulation (CT-SIM) images were acquired of an anthropomorphic skull phantom and 12 patient brain cancer cases. SynCTs were generated using fluid attenuation inversion recovery, ultrashort echo time, and Dixon data sets through a voxel-based weighted summation of 5 tissue classifications. The DRRs were generated from the phantom synCT, and geometric fidelity was assessed relative to CT-generated DRRs through bounding box and landmark analysis. An offline retrospective analysis was conducted to register cone beam CTs (n=34) to synCTs and CTs using automated rigid registration in the treatment planning system. Planar MV and KV images (n=37) were rigidly registered to synCT and CT DRRs using an in-house script. Planar and volumetric registration reproducibility was assessed and margin differences were characterized by the van Herk formalism. Results: Bounding box and landmark analysis of phantom synCT DRRs were within 1 mm of CT DRRs. Absolute planar registration shift differences ranged from 0.0 to 0.7 mm for phantom DRRs on all treatment platforms and from 0.0 to 0.4 mm for volumetric registrations. For patient planar registrations, the mean shift differences were 0.4 ± 0.5 mm (range, −0.6 to 1.6 mm), 0.0 ± 0.5 mm (range, −0.9 to 1.2 mm), and 0.1 ± 0.3 mm (range, −0.7 to 0.6 mm) for the superior-inferior (S-I), left-right (L-R), and anterior-posterior (A-P) axes, respectively. The mean shift differences in volumetric registrations were 0.6 ± 0.4 mm (range, −0.2 to 1.6 mm), 0.2 ± 0.4 mm (range, −0.3 to 1.2 mm), and 0.2 ± 0

  15. Remote Cherenkov Imaging Based Quality Assurance of a Magnetic Resonance Image Guided Radiotherapy System.

    Science.gov (United States)

    Andreozzi, Jacqueline M; Mooney, Karen E; Brůža, Petr; Curcuru, Austen; Gladstone, David J; Pogue, Brian W; Green, Olga

    2018-04-16

    Tools to perform regular quality assurance of magnetic resonance image-guided radiotherapy (MR-IGRT) systems should ideally be independent of interference from the magnetic fields. Remotely acquired optical Cherenkov imaging-based dosimetry measurements in water were investigated for this purpose, comparing measures of dose accuracy, temporal dynamics, and overall integrated IMRT delivery. A 40x30.5x37.5cm 3 water tank doped with 1g/L of quinine sulfate was imaged using an intensified charge coupled device (ICCD) to capture the Cherenkov emission while being irradiated by a commercial MR-IGRT system (ViewRay ™ ). The ICCD was placed down-bore at the end of the couch, 4m from treatment isocenter and behind the 5-Gauss line of the 0.35-T MRI. After establishing optimal camera acquisition settings, square beams of increasing size (4.2x4.2cm 2 , 10.5x10.5 cm 2 , and 14.7x14.7cm 2 ) were imaged at 0.93 frames per second, from an individual cobalt-60 treatment head, to develop projection measures related to percent depth dose (PDD) curves and cross-beam profiles (CPB). These Cherenkov-derived measurements were compared to ionization chamber (IC) and radiographic film dosimetry data, as well as simulation data from the treatment planning system (TPS). An intensity modulated radiotherapy (IMRT) commissioning plan from AAPM TG-119 (C4:C-Shape) was also imaged at 2.1 frames per second, and the single linear sum image from 509 seconds of plan delivery was compared to the dose volume prediction generated by the TPS using gamma index analysis. Analysis of standardized test target images (1024x1024pixels) yielded a pixel resolution of 0.37mm/pixel. The beam width measured from the Cherenkov image-generated projection CBPs was within 1mm accuracy when compared to film measurements for all beams. The 502 point measurements (i.e. pixels) of the Cherenkov image-based projection percent depth dose curves (pPDDs) were compared to pPDDs simulated by the treatment planning system (TPS

  16. Image Guided Radiation Therapy Using Synthetic Computed Tomography Images in Brain Cancer.

    Science.gov (United States)

    Price, Ryan G; Kim, Joshua P; Zheng, Weili; Chetty, Indrin J; Glide-Hurst, Carri

    2016-07-15

    The development of synthetic computed tomography (CT) (synCT) derived from magnetic resonance (MR) images supports MR-only treatment planning. We evaluated the accuracy of synCT and synCT-generated digitally reconstructed radiographs (DRRs) relative to CT and determined their performance for image guided radiation therapy (IGRT). Magnetic resonance simulation (MR-SIM) and CT simulation (CT-SIM) images were acquired of an anthropomorphic skull phantom and 12 patient brain cancer cases. SynCTs were generated using fluid attenuation inversion recovery, ultrashort echo time, and Dixon data sets through a voxel-based weighted summation of 5 tissue classifications. The DRRs were generated from the phantom synCT, and geometric fidelity was assessed relative to CT-generated DRRs through bounding box and landmark analysis. An offline retrospective analysis was conducted to register cone beam CTs (n=34) to synCTs and CTs using automated rigid registration in the treatment planning system. Planar MV and KV images (n=37) were rigidly registered to synCT and CT DRRs using an in-house script. Planar and volumetric registration reproducibility was assessed and margin differences were characterized by the van Herk formalism. Bounding box and landmark analysis of phantom synCT DRRs were within 1 mm of CT DRRs. Absolute planar registration shift differences ranged from 0.0 to 0.7 mm for phantom DRRs on all treatment platforms and from 0.0 to 0.4 mm for volumetric registrations. For patient planar registrations, the mean shift differences were 0.4 ± 0.5 mm (range, -0.6 to 1.6 mm), 0.0 ± 0.5 mm (range, -0.9 to 1.2 mm), and 0.1 ± 0.3 mm (range, -0.7 to 0.6 mm) for the superior-inferior (S-I), left-right (L-R), and anterior-posterior (A-P) axes, respectively. The mean shift differences in volumetric registrations were 0.6 ± 0.4 mm (range, -0.2 to 1.6 mm), 0.2 ± 0.4 mm (range, -0.3 to 1.2 mm), and 0.2 ± 0.3 mm (range, -0.2 to 1.2 mm) for the S-I, L-R, and

  17. Evaluation of different fiducial markers for image-guided radiotherapy and particle therapy.

    Science.gov (United States)

    Habermehl, Daniel; Henkner, Katrin; Ecker, Swantje; Jäkel, Oliver; Debus, Jürgen; Combs, Stephanie E

    2013-07-01

    Modern radiotherapy (RT) techniques are widely used in the irradiation of moving organs. A crucial step in ensuring the correct position of a target structure directly before or during treatment is daily image guidance by computed tomography (CT) or X-ray radiography (image-guided radiotherapy, IGRT). Therefore, combinations of modern irradiation devices and imaging, such as on-board imaging (OBI) with X-rays, or in-room CT such as the tomotherapy system, have been developed. Moreover, combinations of linear accelerators and in-room CT-scanners have been designed. IGRT is of special interest in hypofractionated and radiosurgical treatments where high single doses are applied in the proximity of critical organs at risk. Radiographically visible markers in or in close proximity to the target structure may help to reproduce the position during RT and could therefore be used as external surrogates for motion monitoring. Criteria sought for fiducial markers are (i) visibility in the radiologic modalities involved in radiotherapeutic treatment planning and image guidance, such as CT and kilovoltage (kV) OBI), (ii) low production of imaging artifacts, and (iii) low perturbation of the therapeutic dose to the target volume. Photon interaction with interstitial markers has been shown to be not as important as in particle therapy, where interaction of the particle beam, especially with metal markers, can have a significant impact on treatment. This applies especially with a scanned ion beam. Recently we commenced patient recruitment at our institution within the PROMETHEUS trial, which evaluates a hypofractionation regime, starting with 4 x 10 Gy (RBE), for patients with hepatocellular carcinoma. The aim of this work is, therefore, to evaluate potential implantable fiducial markers for enabling precise patient and thus organ positioning in scanned ion beams. To transfer existing knowledge of marker application from photon to particle therapy, we used a range of commercially

  18. Vaginal Dose Is Associated With Toxicity in Image Guided Tandem Ring or Ovoid-Based Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Susko, Matthew; Craciunescu, Oana; Meltsner, Sheridan; Yang, Yun; Steffey, Beverly; Cai, Jing; Chino, Junzo, E-mail: junzo.chino@duke.edu

    2016-04-01

    Purpose: To calculate vaginal doses during image guided brachytherapy with volume-based metrics and correlate with long-term vaginal toxicity. Methods and Materials: In this institutional review board–approved study, institutional databases were searched to identify women undergoing computed tomography and/or magnetic resonance–guided brachytherapy at the Duke Cancer Center from 2009 to 2015. All insertions were contoured to include the vagina as a 3-dimensional structure. All contouring was performed on computed tomography or magnetic resonance imaging and used a 0.4-cm fixed brush to outline the applicator and/or packing, expanded to include any grossly visible vagina. The surface of the cervix was specifically excluded from the contour. High-dose-rate (HDR) and low-dose-rate (LDR) doses were converted to the equivalent dose in 2-Gy fractions using an α/β of 3 for late effects. The parameters D0.1cc, D1cc, and D2cc were calculated for all insertions and summed with prior external beam therapy. Late and subacute toxicity to the vagina were determined by the Common Terminology Criteria for Adverse Events version 4.0 and compared by the median and 4th quartile doses, via the log-rank test. Univariate and multivariate hazard ratios were calculated via Cox regression. Results: A total of 258 insertions in 62 women who underwent definitive radiation therapy including brachytherapy for cervical (n=48) and uterine cancer (n=14) were identified. Twenty HDR tandem and ovoid, 32 HDR tandem and ring, and 10 LDR tandem and ovoid insertions were contoured. The median values (interquartile ranges) for vaginal D0.1cc, D1cc, and D2cc were 157.9 (134.4-196.53) Gy, 112.6 (96.7-124.6) Gy, and 100.5 (86.8-108.4) Gy, respectively. At the 4th quartile cutoff of 108 Gy for D2cc, the rate of late grade 1 toxicity at 2 years was 61.2% (95% confidence interval [CI] 43.0%-79.4%) below 108 Gy and 83.9% (63.9%-100%) above (P=.018); grade 2 or greater toxicity was 36.2% (95% CI 15

  19. Minimally invasive tension band wiring technique for olecranon fractures.

    Science.gov (United States)

    Takada, Naoya; Kato, Kenji; Fukuta, Makoto; Wada, Ikuo; Otsuka, Takanobu

    2013-12-01

    Some types of implants, such as plates, screws, wires, and nails, have been used for open reduction and internal fixation of olecranon fractures. A ≥ 10 cm longitudinal incision is used for open reduction and internal fixation of olecranon fractures. According to previous studies, tension band wiring is a popular method that gives good results. However, back out of the wires after the surgery is one of the main postoperative complications. Moreover, if the Kirschner wires are inserted through the anterior ulnar cortex, they may impinge on the radial neck, supinator muscle, or biceps tendon. Herein, we describe the minimally invasive tension band wiring technique using Ring-Pin. This technique can be performed through a 2 cm incision. Small skin incisions are advantageous from an esthetic viewpoint. Ring-Pin was fixed by using a dedicated cable wire that does not back out unless the cable wire breaks or slips out of the dedicated metallic clamp. As the pins are placed in intramedullary canal, this technique does not lead to postoperative complications that may occur after transcortical fixation by conventional tension band wiring. Minimally invasive tension band wiring is one of the useful options for the treatment of olecranon fractures with some advantages.

  20. Evaluation of radiation dose and positioning accuracy on X-ray volume imaging system for image-guided radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Jason Chia-Hsien [Division of Radiation Oncology, Department of Oncology, and Cancer Research Center, National Taiwan University Hospital, Taipei, Taiwan (China); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Liang, C.-H. [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (China); Wu, J.-K. [Division of Radiation Oncology, Department of Oncology, and Cancer Research Center, National Taiwan University Hospital, Taipei, Taiwan (China); Huang, K.-M. [Division of Radiation Oncology, Department of Oncology, and Cancer Research Center, National Taiwan University Hospital, Taipei, Taiwan (China); Department of Radiological Technology, Yuanpei University, Hsinchu, Taiwan (China); Wu, T.-H. [Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan (China); Tsai, C.-J.; Chen, C.-L. [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (China); Lee, Jason J.S. [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (China)], E-mail: jslee@ym.edu.tw

    2008-05-15

    Linear accelerators equipped with X-ray volumetric cone-beam Imaging (XVI) system enable verification of location of patients and displacement of tumors for image-guided radiotherapy (IGRT). The objective of this study is to evaluate the positioning accuracy using the XVI system for image-guided patient setup and to establish a lower-dose imaging protocol without sacrificing positioning accuracy for routine treatment courses. Several low-dose imaging protocols are proposed by modifying tube voltage from 120 to 100 kV and lowering tube current from 40 to 10 mA. The positioning accuracy of both bone and gray value registration methods provided by XVI system were also evaluated. Phantom study revealed that the gray value algorithm was more accurate than the bone algorithm in position and registration. However, both translational and rotational accuracies were less than 0.15 mm and 0.8' deg. at all dimensions, which were considered negligible in clinical applications. In addition, the lower-dose protocol (100 kV, 10 mA) produced relative much less radiation dose compared to the default CBCT protocol in the XVI system. In conclusion, our proposed lower-dose protocol results in significant radiation dose reduction without compromising positioning accuracy and may have the potential to be adopted for clinical usage in the future.

  1. Novel bright-emission small-molecule NIR-II fluorophores forin vivotumor imaging and image-guided surgery.

    Science.gov (United States)

    Sun, Yao; Ding, Mingmin; Zeng, Xiaodong; Xiao, Yuling; Wu, Huaping; Zhou, Hui; Ding, Bingbing; Qu, Chunrong; Hou, Wei; Er-Bu, Aga; Zhang, Yejun; Cheng, Zhen; Hong, Xuechuan

    2017-05-01

    Though high brightness and biocompatible small NIR-II dyes are highly desirable in clinical or translational cancer research, their fluorescent cores are relatively limited and their synthetic processes are somewhat complicated. Herein, we have explored the design and synthesis of novel NIR-II fluorescent materials ( H1 ) without tedious chromatographic isolation with improved fluorescence performance (QY ≈ 2%) by introducing 2-amino 9,9-dialkyl-substituted fluorene as a donor into the backbone. Several types of water-soluble and biocompatible NIR-II probes: SXH , SDH , and H1 NPs were constructed via different chemical strategies based on H1 , and then their potential to be used in in vivo tumor imaging and image-guided surgery in the NIR-II region was explored. High levels of uptake were obtained for both passive and active tumor targeting probes SXH and SDH . Furthermore, high resolution imaging of blood vessels on tumors and the whole body of living mice using H1 NPs for the first time has demonstrated precise NIR-II image-guided sentinel lymph node (SLN) surgery.

  2. SU-F-J-188: Clinical Implementation of in Room Mobile CT for Image Guided Proton Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Li, H; Wu, R; Poenisch, F; Zhang, L; Palmer, M; Gautam, A; Sahoo, N; Zhang, X; Balter, P; Gillin, M; Gunn, B; Frank, S; Zhu, X [UT MD Anderson Cancer Center, Houston, TX (United States)

    2016-06-15

    Purpose: To implement soft-tissue image-guided proton therapy using inroom mobile CT. Methods: Anthropomorphic phantom was first used to determine the setup accuracy using in- room mobile CT. Laser and bbs were used for the initial setup (marked isocenter). CT data was then acquired with in-room mobile CT (daily CT). The shift between the marked isocenter and the planned isocenter (final isocenter) was determined from the daily CT using in-house Computer Assisted Targeting (CAT) software. Orthogonal DRRs of the day was also generated from the daily CT. The phantom was then transferred on the treatment couch top to the treatment machine using a transportation system, and again aligned to the marked isocenter. Couch shifts were made to align the phantom to the final isocenter using the shifts as determined using the CAT software, and verified using orthogonal X-ray images with the daily DRRs. Results: Phantom data suggests that following the setup procedure as described above, targeting accuracy could be within 1 mm. Patient data are being acquired and analyzed. Conclusion: In-room mobile CT is capable of providing soft-tissue image-guided proton therapy.

  3. Visual spatial ability for surgical trainees: implications for learning endoscopic, laparoscopic surgery and other image-guided procedures.

    Science.gov (United States)

    Henn, Patrick; Gallagher, Anthony G; Nugent, Emmeline; Seymour, Neal E; Haluck, Randy S; Hseino, Hazem; Traynor, Oscar; Neary, Paul C

    2018-02-12

    In image-guided procedures, a high level of visual spatial ability may be an advantage for surgical trainees. We assessed the visual spatial ability of surgical trainees. Two hundred and thirty-nine surgical trainees and 61 controls were tested on visual spatial ability using 3 standardised tests, the Card Rotation, Cube Comparison and Map-Planning Tests. Two hundred and twenty-one, 236 and 236 surgical trainees and 61 controls completed the Card Rotation test, Cube Comparison test and Map-Planning test, respectively. Two percent of surgical trainees performed statistically significantly worse than their peers on card rotation and map-planning test, > 1% on Cube Comparison test. Surgical trainees performed statistically significantly better than controls on all tests. Two percent of surgical trainees performed statistically significantly worse than their peers on visual spatial ability. The implication of this finding is unclear, further research is required that can look at the learning and educational portfolios of these trainees who perform poorly on visual spatial ability, and ascertain if they are struggling to learn skills for image-guided procedures.

  4. Patients' perception of care during image-guided breast biopsy in a rural community breast center: communication matters.

    Science.gov (United States)

    Brandon, Catherine J; Mullan, Patricia B

    2011-03-01

    This retrospective study surveyed women about their experience with image-guided breast biopsies in a rural cancer center. Our study objectives were to determine: women's perception of their emotional and physical comfort during the biopsy; the clarity and acceptability of the communication about the biopsy, as well as the methods used to provide the results of her biopsy and treatment options; and the overall impressions of the technical and personal care she received. A single mailed survey of 500 biopsy patients. The response rate was 43% (n = 215). Prior to their biopsy, 22% had been concerned that the biopsy would be painful and 43% were concerned that the biopsy might show cancer. Almost all women rated the communication about the biopsy procedure as understandable (99%) and accurately reflecting their experience (99%.). Most (77%) patients characterized the biopsy as producing minimal discomfort, although 5% disagreed. Most patients (98%) characterized their physician and technologists as caring about their emotional and physical comfort. Most patients felt that the typical 1-day wait to receive the results of their biopsy was reasonable (90%) and that the use of the phone to convey the results was acceptable (90%). On comparing patients with a diagnosis of cancer to those without, there was no difference in the level of satisfaction with the use of the phone to communicate biopsy results. This study offers encouragement that communication practices can alleviate the anxiety of women undergoing image-guided breast cancer biopsies.

  5. Present and future of the Image Guided Radiotherapy (I.G.R.T.) and its applications in lung cancer treatment

    International Nuclear Information System (INIS)

    Lefkopoulos, D.; Ferreira, I.; Isambert, A.; Le Pechoux, C.; Mornex, F.

    2007-01-01

    These last years, the new irradiation techniques as the conformal 3D radiotherapy and the IMRT are strongly correlated with the technological developments in radiotherapy. The rigorous definition of the target volume and the organs at risk required by these irradiation techniques, imposed the development of various image guided patient positioning and target tracking techniques. The availability of these imaging systems inside the treatment room has lead to the exploration of performing real-time adaptive radiation therapy. In this paper we present the different image guided radiotherapy (IGRT) techniques and the adaptive radiotherapy (ART) approaches. IGRT developments are focused in the following areas: 1) biological imaging for better definition of tumor volume; 2) 4D imaging for modeling the intra-fraction organ motion; 3) on-board imaging system or imaging devices registered to the treatment machines for inter-fraction patient localization; and 4) treatment planning and delivery schemes incorporating the information derived from the new imaging techniques. As this paper is included in the 'Cancer Radiotherapie' special volume dedicated to the lung cancers, in the description of the different IGRT techniques we try to present the lung tumors applications when this is possible. (author)

  6. Use of cranial surface anatomic fiducials for interactive image-guided navigation in the temporal bone: a cadaveric study.

    Science.gov (United States)

    Vrionis, F D; Foley, K T; Robertson, J H; Shea, J J

    1997-04-01

    Because of the intricate anatomy of the temporal bone, we examined the feasibility and reliability of cranial surface anatomic fiducials to register computed tomographic images of the temporal bone by using a frameless image-guided system. One-millimeter thick computed tomographic slices and the smallest possible field of view were used to register 10 dry and 10 fresh temporal bones from cadavers. The fiducials used for registration included the umbo of the tympanic membrane, emissary foramina, the asterion, various sutures, the tip of the mastoid process, and Henle's spine. Mean initial fiducial registration error ranged from 0.6 to 0.7 mm, and was reduced to 0.5 and 0.4 mm for the dry cranial and cadaveric studies, respectively, by eliminating or reregistering inexact fiducials. Mean target localization error ranged from 0.91 to 2.44 mm for superficial structures of the temporal bone in the dry cranial specimens and from 0.71 to 1.52 mm for deep structures such as the facial nerve, semicircular canals and ossicles in the cadaveric study. Interactive image-guided navigation in the temporal bone is possible with registration of cranial surface anatomic fiducials. It may be useful to the neurosurgeon and otologist in identifying critical anatomic structures of the temporal bone encountered during the translabyrinthine, retrolabyrinthine presigmoid, and suboccipital approaches.

  7. Activatable clinical fluorophore-quencher antibody pairs as dual molecular probes for the enhanced specificity of image-guided surgery

    Science.gov (United States)

    Obaid, Girgis; Spring, Bryan Q.; Bano, Shazia; Hasan, Tayyaba

    2017-12-01

    The emergence of fluorescently labeled therapeutic antibodies has given rise to molecular probes for image-guided surgery. However, the extraneous interstitial presence of an unbound and nonspecifically accumulated probe gives rise to false-positive detection of tumor tissue and margins. Thus, the concept of tumor-cell activation of smart probes provides a potentially superior mechanism of delineating tumor margins as well as small tumor deposits. The combination of molecular targeting with intracellular activation circumvents the presence of extracellular, nonspecific signals of targeted probe accumulation. Here, we present a demonstration of the clinical antibodies cetuximab (cet, anti-EGFR mAb) and trastuzumab (trast, anti-HER-2 mAb) conjugated to Alexa Fluor molecules and IRDye QC-1 quencher optimized at the ratio of 1∶2∶6 to provide the greatest degree of proteolytic fluorescence activation, synonymous with intracellular lysosomal degradation. The cet-AF-Q-C1 conjugate (1∶2∶6) provides up to 9.8-fold proteolytic fluorescence activation. By preparing a spectrally distinct, irrelevant sham IgG-AF-QC-1 conjugate, a dual-activatable probe approach is shown to enhance the specificity of imaging within an orthotopic AsPC-1 pancreatic cancer xenograft model. The dual-activatable approach warrants expedited clinical translation to improve the specificity of image-guided surgery by spectrally decomposing specific from nonspecific probe accumulation, binding, and internalization.

  8. The Development of Augmented Reality to Enhance Minimally Invasive Surgery.

    Science.gov (United States)

    Dodd, Keith; Brooks, Nathaniel P

    2017-12-22

    Minimally invasive surgery (MIS) reduces unnecessary tissue damage to the patient but obscures the natural surgical interface that is provided by open surgical procedures. Multiple feedback mechanisms, mainly visual and tactile, are greatly reduced in MIS. Microscopes, endoscopes, and image-guided navigation traditionally provide enough visual information for successful minimally invasive procedures, although the limited feedback makes these procedures more difficult to learn. Research has been performed to develop alternative solutions that regain additional feedback. Augmented reality (AR), a more recent guidance innovation that overlays digital visual data physically, has begun to be implemented in various applications to improve the safety and efficacy of minimally invasive procedures. This review focuses on the recent implementation of augmented display and direct visual overlay and discusses how these innovations address common feedback concerns associated with minimally invasive surgeries.

  9. Invasive Species

    Science.gov (United States)

    Invasive species have significantly changed the Great Lakes ecosystem. An invasive species is a plant or animal that is not native to an ecosystem, and whose introduction is likely to cause economic, human health, or environmental damage.

  10. Image-guided urologic surgery: intraoperative optical imaging and tissue interrogation (Conference Presentation)

    Science.gov (United States)

    Liao, Joseph C.

    2017-02-01

    Emerging optical imaging technologies can be integrated in the operating room environment during minimally invasive and open urologic surgery, including oncologic surgery of the bladder, prostate, and kidney. These technologies include macroscopic fluorescence imaging that provides contrast enhancement between normal and diseased tissue and microscopic imaging that provides tissue characterization. Optical imaging technologies that have reached the clinical arena in urologic surgery are reviewed, including photodynamic diagnosis, near infrared fluorescence imaging, optical coherence tomography, and confocal laser endomicroscopy. Molecular imaging represents an exciting future arena in conjugating cancer-specific contrast agents to fluorophores to improve the specificity of disease detection. Ongoing efforts are underway to translate optimal targeting agents and imaging modalities, with the goal to improve cancer-specific and functional outcomes.

  11. Image-guided neurosurgery for secondary operative removal of projectiles after missile injury of the brain.

    Science.gov (United States)

    Schulz, Chris; Woerner, Ulrich; Luelsdorf, Peter

    2008-04-01

    The primary treatment of penetrating missile injuries of the brain includes debridement of the scalp, fractured skull, and necrotic brain parenchyma. It is acceptable to remove all bony and metallic fragments that are accessible without additional trauma to nondamaged brain regions. Therefore, bone chips and bullets are often initially retained in the brain and are supposedly responsible for delayed cerebral infections and posttraumatic seizures. We successfully operated on 3 patients electively to remove bony and metallic fragments secondarily after penetrating brain trauma. We used an electromagnetic neuronavigation system for preoperative planning and chose a less invasive approach for the exact intraoperative localization of the fragments. All fragments were extracted without any problems. No patients had any additional neurologic deficits, and no signs of cerebral infections or seizures occurred between 4 and 8 weeks after the operative revision. We recommend the implementation of neuronavigation techniques into the surgical strategy for secondary removal of retained missile fragments.

  12. Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, Scott M., E-mail: Thompson.scott@mayo.edu [Mayo Clinic, Mayo Graduate School, Mayo Medical School and the Mayo Clinic Medical Scientist Training Program, College of Medicine (United States); Callstrom, Matthew R., E-mail: callstrom.matthew@mayo.edu; McKusick, Michael A., E-mail: mckusick.michael@mayo.edu; Woodrum, David A., E-mail: woodrum.david@mayo.edu [Mayo Clinic, Department of Radiology, College of Medicine (United States)

    2015-10-15

    PurposeThe purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).Materials and MethodsAn IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.ResultsEight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.ConclusionImage-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA.

  13. Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

    International Nuclear Information System (INIS)

    Thompson, Scott M.; Callstrom, Matthew R.; McKusick, Michael A.; Woodrum, David A.

    2015-01-01

    PurposeThe purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).Materials and MethodsAn IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.ResultsEight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.ConclusionImage-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA

  14. Prostate displacement during transabdominal ultrasound image-guided radiotherapy assessed by real-time four-dimensional transperineal monitoring

    DEFF Research Database (Denmark)

    Baker, Mariwan; Behrens, Claus F.

    2015-01-01

    Background. Transabdominal ultrasound (TAUS) imaging is currently available for localizing the prostate in daily image-guided radiotherapy (IGRT). The aim of this study was to determine the induced prostate displacement during such TAUS imaging. The prostate displacement was monitored using a novel...... transperineal four-dimensional (4D) US (TPUS) system. Material and methods. Ten prostate cancer patients, with a mean age of 68 years (58/76), were US scanned in the computed tomography (CT) room utilizing the Clarity 4D TPUS monitoring system. The patients were asked to comply with a moderate bladder fi lling...... protocol. After US-CT fusion, the prostate volume was delineated and used as a reference for weekly US imaging in the treatment room. Immediately after treatment delivery the TPUS monitoring system was set up. During real-time monitoring of the prostate, a conventional 2D probe was applied to simulate...

  15. NOTE: Just-in-time tomography (JiTT): a new concept for image-guided radiation therapy

    Science.gov (United States)

    Pang, G.; Rowlands, J. A.

    2005-11-01

    Soft-tissue target motion is one of the main concerns in high-precision radiation therapy. Cone beam computed tomography (CBCT) has been developed recently to image soft-tissue targets in the treatment room and guide the radiation therapy treatment. However, due to its relatively long image acquisition time the CBCT approach cannot provide images of the target at the instant of the treatment and thus it is not adequate for imaging targets with intrafraction motion. In this note, a new approach for image-guided radiation therapy—just-in-time tomography (JiTT)—is proposed. Differing from CBCT, JiTT takes much less time to generate the needed tomographical, beam's-eye-view images of the treatment target at the right moment to guide the radiation therapy treatment.

  16. Just-in-time tomography (JiTT): a new concept for image-guided radiation therapy.

    Science.gov (United States)

    Pang, G; Rowlands, J A

    2005-11-07

    Soft-tissue target motion is one of the main concerns in high-precision radiation therapy. Cone beam computed tomography (CBCT) has been developed recently to image soft-tissue targets in the treatment room and guide the radiation therapy treatment. However, due to its relatively long image acquisition time the CBCT approach cannot provide images of the target at the instant of the treatment and thus it is not adequate for imaging targets with intrafraction motion. In this note, a new approach for image-guided radiation therapy-just-in-time tomography (JiTT)-is proposed. Differing from CBCT, JiTT takes much less time to generate the needed tomographical, beam's-eye-view images of the treatment target at the right moment to guide the radiation therapy treatment.

  17. ESIPT-induced fluorescent o-hydroxycinnamate: a self-monitoring phototrigger for prompt image-guided uncaging of alcohols.

    Science.gov (United States)

    Paul, Amrita; Mengji, Rakesh; Chandy, Olive Abraham; Nandi, Surajit; Bera, Manoranjan; Jana, Avijit; Anoop, Anakuthil; Singh, N D Pradeep

    2017-10-18

    o-Hydroxycinnamate derivatives are well-known phototriggers for fast and direct release of alcohols and amines without proceeding through the cleavage of carbonate or carbamate linkages. Despite these unique features, o-hydroxycinnamates lack extensive applications in biological systems mainly because of their non-fluorescent nature. To overcome this limitation, we have attached a 2-(2'-hydroxyphenyl) benzothiazole (HBT) moiety, capable of rapid excited-state intramolecular proton transfer (ESIPT) to the o-hydroxycinnamate group. The ESIPT effect induced two major advantages to the o-hydroxycinnamate group: (i) large Stokes' shifted fluorescence (orange colour) properties and (ii) distinct fluorescence colour change upon photorelease. In vitro studies exhibited an image guided, photoregulated release of bioactive molecules by the o-hydroxycinnamate-benzothiazole-methyl salicylate conjugate and real-time monitoring of the release action.

  18. Serial removal of caries lesions from tooth occlusal surfaces using near-IR image-guided IR laser ablation

    Science.gov (United States)

    Chan, Kenneth H.; Tom, Henry; Darling, Cynthia L.; Fried, Daniel

    2015-02-01

    Previous studies have established that caries lesions can be imaged with high contrast without the interference of stains at near-IR wavelengths greater than 1300-nm. It has been demonstrated that computer controlled laser scanning systems utilizing IR lasers operating at high pulse repetition rates can be used for serial imaging and selective removal of caries lesions. In this study, we report our progress towards the development of algorithms for generating rasterized ablation maps from near-IR reflectance images for the removal of natural lesions from tooth occlusal surfaces. An InGaAs camera and a filtered tungsten-halogen lamp producing near-IR light in the range of 1500-1700-nm were used to collect crosspolarization reflectance images of tooth occlusal surfaces. A CO2 laser operating at a wavelength of 9.3- μm with a pulse duration of 10-15-μs was used for image-guided ablation.

  19. Just-in-time tomography (JiTT): a new concept for image-guided radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pang, G; Rowlands, J A [Toronto-Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto M4N 3M5 (Canada); Imaging Research, Sunnybrook and Women' s College Health Sciences Centre, Departments of Radiation Oncology and Medical Biophysics, University of Toronto, Toronto (Canada)

    2005-11-07

    Soft-tissue target motion is one of the main concerns in high-precision radiation therapy. Cone beam computed tomography (CBCT) has been developed recently to image soft-tissue targets in the treatment room and guide the radiation therapy treatment. However, due to its relatively long image acquisition time the CBCT approach cannot provide images of the target at the instant of the treatment and thus it is not adequate for imaging targets with intrafraction motion. In this note, a new approach for image-guided radiation therapy-just-in-time tomography (JiTT)-is proposed. Differing from CBCT, JiTT takes much less time to generate the needed tomographical, beam's-eye-view images of the treatment target at the right moment to guide the radiation therapy treatment. (note)

  20. Just-in-time tomography (JiTT): a new concept for image-guided radiation therapy

    International Nuclear Information System (INIS)

    Pang, G; Rowlands, J A

    2005-01-01

    Soft-tissue target motion is one of the main concerns in high-precision radiation therapy. Cone beam computed tomography (CBCT) has been developed recently to image soft-tissue targets in the treatment room and guide the radiation therapy treatment. However, due to its relatively long image acquisition time the CBCT approach cannot provide images of the target at the instant of the treatment and thus it is not adequate for imaging targets with intrafraction motion. In this note, a new approach for image-guided radiation therapy-just-in-time tomography (JiTT)-is proposed. Differing from CBCT, JiTT takes much less time to generate the needed tomographical, beam's-eye-view images of the treatment target at the right moment to guide the radiation therapy treatment. (note)

  1. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem

    Energy Technology Data Exchange (ETDEWEB)

    Callstrom, Matthew R.; Charboneau, J. William; Atwell, Thomas D.; Farrell, Michael A.; Welch, Timothy J.; Maus, Timothy P. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Goetz, Matthew P.; Rubin, Joseph [Mayo Clinic, Department of Oncology, Rochester, MN (United States)

    2006-01-01

    Painful skeletal metastases are a common problem in cancer patients. Although external beam radiation therapy is the current standard of care for cancer patients who present with localized bone pain, 20-30% of patients treated with this modality do not experience pain relief, and few further options exist for these patients. For many patients with painful metastatic skeletal disease, analgesics remain the only alternative treatment option. Recently, image-guided percutaneous methods of tumor destruction have proven effective for treatment of this difficult problem. This review describes the application, limitations, and effectiveness of percutaneous ablative methods including ethanol, methyl methacrylate, laser-induced interstitial thermotherapy (LITT), cryoablation, and percutaneous radiofrequency ablation (RFA) for palliation of painful skeletal metastases. (orig.)

  2. Biocompatible Chitosan-Carbon Dot Hybrid Nanogels for NIR-Imaging-Guided Synergistic Photothermal-Chemo Therapy.

    Science.gov (United States)

    Wang, Hui; Mukherjee, Sumit; Yi, Jinhui; Banerjee, Probal; Chen, Qianwang; Zhou, Shuiqin

    2017-06-07

    Multifunctional nanocarriers with good biocompatibility, good imaging function, and smart drug delivery ability are crucial for realizing highly efficient imaging-guided chemotherapy in vivo. This paper reports a type of chitosan-carbon dot (CD) hybrid nanogels (CCHNs, ∼65 nm) by integrating pH-sensitive chitosan and fluorescent CDs into a single nanostructure for simultaneous near-infrared (NIR) imaging and NIR/pH dual-responsive drug release to improve therapeutic efficacy. Such CCHNs were synthesized via a nonsolvent-induced colloidal nanoparticle formation of chitosan-CD complexes assisted by ethylenediaminetetraacetic acid (EDTA) molecules in the aqueous phase. The selective cross-linking of chitosan chains in the nanoparticles can immobilize small CDs complexed in the chitosan networks. The resultant CCHNs display high colloidal stability, high loading capacity for doxorubicin (DOX), bright and stable fluorescence from UV to NIR wavelength range, efficient NIR photothermal conversion, and intelligent drug release in response to both NIR light and change in pH. The results from in vitro tests on cell model and in vivo tests on different tissues of animal model indicate that the CCHNs are nontoxic. The DOX-loaded CCHNs can permeate into the implanted tumor on mice and release drug molecules efficiently on site to inhibit tumor growth. The additional photothermal treatments from NIR irradiation can further inhibit the tumor growth, benefited from the effective NIR photothermal conversion of CCHNs. The demonstrated CCHNs manifest a great promise toward multifunctional intelligent nanoplatform for highly efficient imaging-guided cancer therapy with low side effects.

  3. The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator.

    Science.gov (United States)

    Keall, Paul J; Nguyen, Doan Trang; O'Brien, Ricky; Caillet, Vincent; Hewson, Emily; Poulsen, Per Rugaard; Bromley, Regina; Bell, Linda; Eade, Thomas; Kneebone, Andrew; Martin, Jarad; Booth, Jeremy T

    2018-02-07

    Until now, real-time image guided adaptive radiation therapy (IGART) has been the domain of dedicated cancer radiotherapy systems. The purpose of this study was to clinically implement and investigate real-time IGART using a standard linear accelerator. We developed and implemented two real-time technologies for standard linear accelerators: (1) Kilovoltage Intrafraction Monitoring (KIM) that finds the target and (2) multileaf collimator (MLC) tracking that aligns the radiation beam to the target. Eight prostate SABR patients were treated with this real-time IGART technology. The feasibility, geometric accuracy and the dosimetric fidelity were measured. Thirty-nine out of forty fractions with real-time IGART were successful (95% confidence interval 87-100%). The geometric accuracy of the KIM system was -0.1 ± 0.4, 0.2 ± 0.2 and -0.1 ± 0.6 mm in the LR, SI and AP directions, respectively. The dose reconstruction showed that real-time IGART more closely reproduced the planned dose than that without IGART. For the largest motion fraction, with real-time IGART 100% of the CTV received the prescribed dose; without real-time IGART only 95% of the CTV would have received the prescribed dose. The clinical implementation of real-time image-guided adaptive radiotherapy on a standard linear accelerator using KIM and MLC tracking is feasible. This achievement paves the way for real-time IGART to be a mainstream treatment option. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Are Modic changes related to outcomes in lumbar disc herniation patients treated with imaging-guided lumbar nerve root blocks?

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Cynthia K., E-mail: cynthia.peterson@balgrist.ch [Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich (Switzerland); Pfirrmann, Christian W.A. [Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich (Switzerland); Hodler, Jürg [Department of Radiology, University Hospital, University of Zürich (Switzerland)

    2014-10-15

    Objective: To compare outcomes after imaging-guided transforaminal lumbar nerve root blocks in MRI confirmed symptomatic disc herniation patients with and without Modic changes (MC). Methods: Consecutive adult patients with MRI confirmed symptomatic lumbar disc herniations and an imaging-guided lumbar nerve root block injection who returned an outcomes questionnaire are included. Numerical rating scale (NRS) pain data was collected prior to injection and 20–30 min after injection. NRS and overall improvement were assessed using the patient's global impression of change (PGIC) scale at 1 day, 1 week and 1 month post injection. The proportion of patients with and without MC on MRI as well as Modic I and Modic II was calculated. These groups were compared for clinically relevant ‘improvement’ using the Chi-squared test. Baseline and follow-up NRS scores were compared for the groups using the unpaired t-test. Results: 346 patients are included with MC present in 57%. A higher percentage of patients without MC reported ‘improvement’ and a higher percentage of patients with MC reported ‘worsening’ but this did not reach statistical significance. The numerical scores on the PGIC and NRS scales showed that patients with MC had significantly higher pain and worse overall improvement scores at 1 month (p = 0.048 and p = 0.03) and a significantly lower 1 month NRS change score (p = 0.04). Conclusions: Patients with MRI confirmed symptomatic lumbar disc herniations and MC report significantly lower levels of pain reduction after a lumbar nerve root block compared to patients without MC.

  5. Five-Year Outcomes from 3 Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Mendenhall, Nancy P.; Hoppe, Bradford S.; Nichols, Romaine C.; Mendenhall, William M.; Morris, Christopher G.; Li, Zuofeng; Su, Zhong; Williams, Christopher R.; Costa, Joseph; Henderson, Randal H.

    2014-01-01

    Purpose: To report 5-year clinical outcomes of 3 prospective trials of image-guided proton therapy for prostate cancer. Methods and Materials: A total of 211 prostate cancer patients (89 low-risk, 82 intermediate-risk, and 40 high-risk) were treated in institutional review board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low-risk disease, 78 to 82 CGE for intermediate-risk disease, and 78 CGE with concomitant docetaxel therapy followed by androgen deprivation therapy for high-risk disease. Toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Median follow-up was 5.2 years. Results: Five-year rates of biochemical and clinical freedom from disease progression were 99%, 99%, and 76% in low-, intermediate-, and high-risk patients, respectively. Actuarial 5-year rates of late CTCAE, version 3.0 (or version 4.0) grade 3 gastrointestinal and urologic toxicity were 1.0% (0.5%) and 5.4% (1.0%), respectively. Median pretreatment scores and International Prostate Symptom Scores at >4 years posttreatment were 8 and 7, 6 and 6, and 9 and 8, respectively, among the low-, intermediate-, and high-risk patients. There were no significant changes between median pretreatment summary scores and Expanded Prostate Cancer Index Composite scores at >4 years for bowel, urinary irritative and/or obstructive, and urinary continence. Conclusions: Five-year clinical outcomes with image-guided proton therapy included extremely high efficacy, minimal physician-assessed toxicity, and excellent patient-reported outcomes. Further follow-up and a larger patient experience are necessary to confirm these favorable outcomes

  6. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Prologo, J.D. [Emory University Hospital, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Atlanta, GA (United States); Passalacqua, Matthew; Patel, Indravadan; Bohnert, Nathan [University Hospitals Case Medical Center, Department of Radiology, Cleveland, OH (United States); Corn, David J. [University Hospitals Case Medical Center, Departments of Radiology and Biomedical Engineering, Cleveland, OH (United States)

    2014-11-15

    The role of image-guided thermal ablation techniques for the nonoperative local management of painful osseous metastatic disease has expanded during recent years, and several advantages of cryoablation in this setting have emerged. The purpose of this study is to retrospectively evaluate and report a single-center experience of CT-guided percutaneous cryoablation in the setting of painful musculoskeletal metastatic disease. This study was approved by the institutional review board and is compliant with the Health Insurance Portability and Accountability Act. Electronic medical records of all patients who underwent percutaneous image-guided palliative cryoablation at our institution were reviewed (n = 61). An intent-to-treat analysis was performed. Records were reviewed for demographic data and anatomical data, primary tumor type, procedure details, and outcome - including change in analgesic requirements (expressed as morphine equivalent dosages), pain scores (utilizing the clinically implemented visual analog scale), subsequent therapies (including radiation and/or surgery), and complications during the 24 h following the procedure and at 3 months. Patients were excluded (n = 7) if data were not retrospectively identifiable at the defined time points. Fifty-four tumors were ablated in 50 patients. There were statistically significant decreases in the median VAS score and narcotic usage at both 24 h and 3 months (p < 0.000). Six patients (11 %) incurred complications related to their therapy. Two patients had no relief at 24 h, of which both reported worsened pain at 3 months. One patient had initial relief but symptom recurrence at 3 months. Four patients went on to have radiation therapy of the ablation site at some point following the procedure. CT-guided cryoablation is a safe, effective, reproducible procedural option for the nonoperative local treatment of painful musculoskeletal metastatic disease. (orig.)

  7. Five-Year Outcomes from 3 Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mendenhall, Nancy P., E-mail: menden@shands.ufl.edu [University of Florida Proton Therapy Institute, Jacksonville, Florida (United States); Hoppe, Bradford S.; Nichols, Romaine C.; Mendenhall, William M.; Morris, Christopher G.; Li, Zuofeng; Su, Zhong [University of Florida Proton Therapy Institute, Jacksonville, Florida (United States); Williams, Christopher R.; Costa, Joseph [Division of Urology, College of Medicine, University of Florida, Jacksonville, Florida (United States); Henderson, Randal H. [University of Florida Proton Therapy Institute, Jacksonville, Florida (United States)

    2014-03-01

    Purpose: To report 5-year clinical outcomes of 3 prospective trials of image-guided proton therapy for prostate cancer. Methods and Materials: A total of 211 prostate cancer patients (89 low-risk, 82 intermediate-risk, and 40 high-risk) were treated in institutional review board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low-risk disease, 78 to 82 CGE for intermediate-risk disease, and 78 CGE with concomitant docetaxel therapy followed by androgen deprivation therapy for high-risk disease. Toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Median follow-up was 5.2 years. Results: Five-year rates of biochemical and clinical freedom from disease progression were 99%, 99%, and 76% in low-, intermediate-, and high-risk patients, respectively. Actuarial 5-year rates of late CTCAE, version 3.0 (or version 4.0) grade 3 gastrointestinal and urologic toxicity were 1.0% (0.5%) and 5.4% (1.0%), respectively. Median pretreatment scores and International Prostate Symptom Scores at >4 years posttreatment were 8 and 7, 6 and 6, and 9 and 8, respectively, among the low-, intermediate-, and high-risk patients. There were no significant changes between median pretreatment summary scores and Expanded Prostate Cancer Index Composite scores at >4 years for bowel, urinary irritative and/or obstructive, and urinary continence. Conclusions: Five-year clinical outcomes with image-guided proton therapy included extremely high efficacy, minimal physician-assessed toxicity, and excellent patient-reported outcomes. Further follow-up and a larger patient experience are necessary to confirm these favorable outcomes.

  8. SU-E-J-248: Comparative Study of Two Image Registration for Image-Guided Radiation Therapy in Esophageal Cancer

    International Nuclear Information System (INIS)

    Shang, K; Wang, J; Liu, D; Li, R; Cao, Y; Chi, Z

    2014-01-01

    Purpose: Image-guided radiation therapy (IGRT) is one of the major treatment of esophageal cancer. Gray value registration and bone registration are two kinds of image registration, the purpose of this work is to compare which one is more suitable for esophageal cancer patients. Methods: Twenty three esophageal patients were treated by Elekta Synergy, CBCT images were acquired and automatically registered to planning kilovoltage CT scans according to gray value or bone registration. The setup errors were measured in the X, Y and Z axis, respectively. Two kinds of setup errors were analysed by matching T test statistical method. Results: Four hundred and five groups of CBCT images were available and the systematic and random setup errors (cm) in X, Y, Z directions were 0.35, 0.63, 0.29 and 0.31, 0.53, 0.21 with gray value registration, while 0.37, 0.64, 0.26 and 0.32, 0.55, 0.20 with bone registration, respectively. Compared with bone registration and gray value registration, the setup errors in X and Z axis have significant differences. In Y axis, both measurement comparison results of T value is 0.256 (P value > 0.05); In X axis, the T value is 5.287(P value < 0.05); In Z axis, the T value is −5.138 (P value < 0.05). Conclusion: Gray value registration is recommended in image-guided radiotherapy for esophageal cancer and the other thoracic tumors. Manual registration could be applied when it is necessary. Bone registration is more suitable for the head tumor and pelvic tumor department where composed of redundant interconnected and immobile bone tissue

  9. The Role of Seminal Vesicle Motion in Target Margin Assessment for Online Image-Guided Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Liang Jian; Wu Qiuwen; Yan Di

    2009-01-01

    Purpose: For patients with intermediate- and high-risk prostate cancer, the seminal vesicles (SVs) are included in the clinical target volume (CTV). The purposes of this study are to investigate interfraction motion characteristics of the SVs and determine proper margins for online computed tomography image guidance. Methods and Materials: Twenty-four patients, each with 16 daily helical computed tomography scans, were included in this study. A binary image mask was used for image registration to determine daily organ motion. Two online image-guided radiotherapy strategies (prostate only and prostate + SVs) were simulated in a hypofractionated scheme. Three margin designs were studied for both three-dimensional conformal radiotherapy and intensity-modulated radiotherapy (IMRT). In prostate-only guidance, Margin A was uniformly applied to the whole CTV, and Margin B was applied to the SVs with a fixed 3-mm prostate margin. In prostate plus SV guidance, Margin C was uniformly applied to the CTV. The minimum margins were sought to satisfy the criterion that minimum cumulative CTV dose be more than those of the planning target volume in the plan for greater than 95% of patients. Results: The prostate and SVs move significantly more in the anterior-posterior and superior-inferior than right-left directions. The anterior-posterior motion of the prostate and SVs correlated (R 2 = 0.7). The SVs move significantly more than the prostate. The minimum margins found were 2.5 mm for three-dimensional conformal radiotherapy and 4.5, 4.5, and 3.0 mm for Margins A, B, and C for IMRT, respectively. Margins for IMRT were larger, but the irradiated volume and doses to critical structures were smaller. Minimum margins of 4.5 mm to the SVs and 3 mm to the prostate are recommended for IMRT with prostate-only guidance. Conclusions: The SVs move independently from the prostate gland, and additional margins are necessary for image-guided radiotherapy

  10. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience

    International Nuclear Information System (INIS)

    Prologo, J.D.; Passalacqua, Matthew; Patel, Indravadan; Bohnert, Nathan; Corn, David J.

    2014-01-01

    The role of image-guided thermal ablation techniques for the nonoperative local management of painful osseous metastatic disease has expanded during recent years, and several advantages of cryoablation in this setting have emerged. The purpose of this study is to retrospectively evaluate and report a single-center experience of CT-guided percutaneous cryoablation in the setting of painful musculoskeletal metastatic disease. This study was approved by the institutional review board and is compliant with the Health Insurance Portability and Accountability Act. Electronic medical records of all patients who underwent percutaneous image-guided palliative cryoablation at our institution were reviewed (n = 61). An intent-to-treat analysis was performed. Records were reviewed for demographic data and anatomical data, primary tumor type, procedure details, and outcome - including change in analgesic requirements (expressed as morphine equivalent dosages), pain scores (utilizing the clinically implemented visual analog scale), subsequent therapies (including radiation and/or surgery), and complications during the 24 h following the procedure and at 3 months. Patients were excluded (n = 7) if data were not retrospectively identifiable at the defined time points. Fifty-four tumors were ablated in 50 patients. There were statistically significant decreases in the median VAS score and narcotic usage at both 24 h and 3 months (p < 0.000). Six patients (11 %) incurred complications related to their therapy. Two patients had no relief at 24 h, of which both reported worsened pain at 3 months. One patient had initial relief but symptom recurrence at 3 months. Four patients went on to have radiation therapy of the ablation site at some point following the procedure. CT-guided cryoablation is a safe, effective, reproducible procedural option for the nonoperative local treatment of painful musculoskeletal metastatic disease. (orig.)

  11. Vaginal dose assessment in image-guided brachytherapy for cervical cancer: Can we really rely on dose-point evaluation?

    Science.gov (United States)

    Limkin, Elaine Johanna; Dumas, Isabelle; Rivin Del Campo, Eleonor; Chargari, Cyrus; Maroun, Pierre; Annède, Pierre; Petit, Claire; Seisen, Thomas; Doyeux, Kaya; Tailleur, Anne; Martinetti, Florent; Lefkopoulos, Dimitri; Haie-Meder, Christine; Mazeron, Renaud

    2016-01-01

    Although dose-volume parameters in image-guided brachytherapy have become a standard, the use of posterior-inferior border of the pubic symphysis (PIBS) points has been recently proposed in the reporting of vaginal doses. The aim was to evaluate their pertinence. Nineteen patients who received image-guided brachytherapy after concurrent radiochemotherapy were included. Per treatment, CT scans were performed at Days 2 and 3, with reporting of the initial dwell positions and times. Doses delivered to the PIBS points were evaluated on each plan, considering that they were representative of one-third of the treatment. The movements of the applicator according to the PIBS point were analysed. Mean prescribed doses at PIBS -2, PIBS, PIBS +2 were, respectively, 2.23 ± 1.4, 6.39 ± 6.6, and 31.85 ± 36.06 Gy. Significant differences were observed between the 5 patients with vaginal involvement and the remaining 14 at the level of PIBS +2 and PIBS: +47.60 Gy and +7.46 Gy, respectively (p = 0.023 and 0.03). The variations between delivered and prescribed doses at PIBS points were not significant. However, at International commission on radiation units and measurements rectovaginal point, the delivered dose was decreased by 1.43 ± 2.49 Gy from the planned dose (p = 0.019). The delivered doses at the four points were strongly correlated with the prescribed doses with R(2) ranging from 0.93 to 0.95. The movements of the applicator in regard of the PIBS point assessed with the Digital Imaging and Communications in Medicine coordinates were insignificant. The doses evaluated at PIBS points are not impacted by intrafractional movements. PIBS and PIBS +2 dose points allow distinguishing the plans of patients with vaginal infiltration. Further studies are needed to correlate these parameters with vaginal morbidity. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  12. An Integrated Nanotechnology-Enabled Transbronchial Image-Guided Intervention Strategy for Peripheral Lung Cancer.

    Science.gov (United States)

    Jin, Cheng S; Wada, Hironobu; Anayama, Takashi; McVeigh, Patrick Z; Hu, Hsin Pei; Hirohashi, Kentaro; Nakajima, Takahiro; Kato, Tatsuya; Keshavjee, Shaf; Hwang, David; Wilson, Brian C; Zheng, Gang; Yasufuku, Kazuhiro

    2016-10-01

    Early detection and efficient treatment modality of early-stage peripheral lung cancer is essential. Current nonsurgical treatments for peripheral lung cancer show critical limitations associated with various complications, requiring alternative minimally invasive therapeutics. Porphysome nanoparticle-enabled fluorescence-guided transbronchial photothermal therapy (PTT) of peripheral lung cancer was developed and demonstrated in preclinical animal models. Systemically administered porphysomes accumulated in lung tumors with significantly enhanced disease-to-normal tissue contrast, as confirmed in three subtypes of orthotopic human lung cancer xenografts (A549, H460, and H520) in mice and in an orthotopic VX2 tumor in rabbits. An in-house prototype fluorescence bronchoscope demonstrated the capability of porphysomes for in vivo imaging of lung tumors in the mucosal/submucosal layers, providing real-time fluorescence guidance for transbronchial PTT. Porphysomes also enhanced the efficacy of transbronchial PTT significantly and resulted in selective and efficient tumor tissue ablation in the rabbit model. A clinically used cylindrical diffuser fiber successfully achieved tumor-specific thermal ablation, showing promising evidence for the clinical translation of this novel platform to impact upon nonsurgical treatment of early-stage peripheral lung cancer. Cancer Res; 76(19); 5870-80. ©2016 AACR. ©2016 American Association for Cancer Research.

  13. An improved tracking framework for ultrasound probe localization in image-guided radiosurgery

    Directory of Open Access Journals (Sweden)

    Ipsen Svenja

    2016-09-01

    Full Text Available Real-time target localization with ultrasound holds high potential for image guidance and motion compensation in radiosurgery due to its non-invasive image acquisition free from ionizing radiation. However, a two-step localization has to be performed when integrating ultrasound into the existing radiosurgery workflow. In addition to target localization inside the ultrasound volume, the probe itself has to be localized in order to transform the target position into treatment room coordinates. By adapting existing camera calibration tools, we have developed a method to extend the stereoscopic X-ray tracking system of a radiosurgery platform in order to locate objects such as marker geometries with six degrees of freedom. The calibration was performed with 0.1 mm reprojection error. By using the full area of the flat-panel detectors without pre-processing the extended software increased the tracking volume and resolution by up to 80%, substantially improving patient localization and marker detectability. Furthermore, marker-tracking showed sub-millimeter accuracy and rotational errors below 0.1°. This demonstrates that the developed extension framework can accurately localize marker geometries using an integrated X-ray system, establishing the link for the integration of real-time ultrasound image guidance into the existing system.

  14. Image-guided lumbar facet joint infiltration in nonradicular low back pain

    International Nuclear Information System (INIS)

    Chaturvedi, Arti; Chaturvedi, Sunil; Sivasankar, Rajiv

    2009-01-01

    To assess the efficacy of facet joint infiltrations for pain relief in 44 selected patients with chronic nonradicular low back pain (LBP). Forty-four patients with chronic LBP of more than 3 months' duration were selected for facet joint infiltration. The majority (n = 24) had facetal pain with no evidence of significant facetal arthropathy on imaging. Fifteen patients had radiological evidence of facetal arthropathy, one had a facet joint synovial cyst, three were post–lumbar surgery patients, and two patients had spondylolysis. Facet joint injections were carried out under fluoroscopic guidance in 39 patients and under CT guidance in 5 cases. Pain relief was assessed using the visual analog scale at 1 h post-procedure and, thereafter, at 1, 4, 12, and 24 weeks. A total of 141 facet joints were infiltrated in 44 patients over a 2-year period. There was significant pain relief in 81.8% patients 1 h after the procedure, in 86.3% after 1 week, in 93.3% after 4 weeks, in 85.7% after 12 weeks, and in 62.5% after 24 weeks. No major complications were encountered. Facet nerve block was found to be a simple, minimally invasive, and safe procedure. With meticulous patient selection, we achieved long-term success rates of over 60%. We conclude that this method represents an important alternative treatment for nonradicular back pain

  15. Optical and photoacoustic dual-modality imaging guided synergistic photodynamic/photothermal therapies

    Science.gov (United States)

    Yan, Xuefeng; Hu, Hao; Lin, Jing; Jin, Albert J.; Niu, Gang; Zhang, Shaoliang; Huang, Peng; Shen, Baozhong; Chen, Xiaoyuan

    2015-01-01

    Phototherapies such as photodynamic therapy (PDT) and photothermal therapy (PTT), due to their specific spatiotemporal selectivity and minimal invasiveness, have been widely investigated as alternative treatments of malignant diseases. Graphene and its derivatives not only have been used as carriers to deliver photosensitizers for PDT, but also as photothermal conversion agents (PTCAs) for PTT. Herein, we strategically designed and produced a novel photo-theranostic platform based on sinoporphyrin sodium (DVDMS) photosensitizer-loaded PEGylated graphene oxide (GO-PEG-DVDMS) for enhanced fluorescence/photoacoustic (PA) dual-modal imaging and combined PDT and PTT. The GO-PEG carrier drastically improves the fluorescence of loaded DVDMS via intramolecular charge transfer. Concurrently, DVDMS significantly enhances the near-infrared (NIR) absorption of GO for improved PA imaging and PTT. The cancer theranostic capability of the as-prepared GO-PEG-DVDMS was carefully investigated both in vitro and in vivo. This novel theranostics is well suited for fluorescence/PA dual-modal imaging and synergistic PDT/PTT.

  16. Increased genitourinary fistula rate after bevacizumab in recurrent cervical cancer patients initially treated with definitive radiochemotherapy and image-guided adaptive brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Sturdza, Alina; Kirisits, Christian; Poetter, Richard [Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer CenterVienna, Vienna (Austria); Hofmann, Sandra; Kranawetter, Marlene; Grimm, Christoph; Schwameis, Richard [Medical University Vienna, Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Vienna (Austria); Polterauer, Stephan; Reinthaller, Alexander [Medical University Vienna, Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Vienna (Austria); Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna (Austria); Krainer, Michael [Medical University Vienna, Clinical Division of Oncology, Department of Medicine 1, Comprehensive Cancer Center, Vienna (Austria)

    2017-12-15

    Patients with recurrent cervical cancer (RecCC) who received definitive radiochemotherapy including image-guided adaptive brachytherapy (IGABT) as primary treatment are currently treated in our institution with palliative intent by chemotherapy (CHT) combined with bevacizumab (BEV). We aim to evaluate the risk of gastrointestinal (GI)/genitourinary (GU) fistula formation in these patients. Data of 35 consecutive patients with RecCC treated initially with radiochemotherapy and IGABT were collected. Known and presumed risk factors associated with fistula formation were evaluated. Fistula rate was compared between patients receiving CHT or CHT+BEV. Of the 35 patients, 25 received CHT and 10 patients received CHT+BEV. Clinical characteristics were comparable. Fistulae were reported in 6 patients: two fistulae (8%) in the CHT group, four (40%) in the CHT+BEV group. GU fistula occurred in the CHT+BEV group only (3/4). Of these 6 patients with fistulae, 5 (83%) had undergone previous invasive procedures after the diagnosis of RecCC and 1 patient had undergone pelvic re-irradiation; 3/6 patients had developed a local recurrence. No other risk factors for fistula formation were identified. In patients with RecCC after definitive radiochemotherapy including IGABT, the addition of BEV to CHT may increase the risk for GU fistula formation, particularly after invasive pelvic procedures. Future clinical studies are required to identify predictors for fistula formation to subsequently improve patient selection for the addition of BEV in the RecCC setting. (orig.) [German] Patientinnen mit Rezidiv eines Zervixkarzinoms (RecCC), die primaer eine bildgesteuerte adaptive Brachytherapie (IGABT) und kombinierte Radiochemotherapie (RCHT) erhalten hatten, werden derzeit in unserem Institut mit einer Kombination aus Chemotherapie (CHT) und Bevacizumab (BEV) behandelt. Ziel dieser Studie war es, das Risiko fuer das Auftreten gastrointestinaler (GI) sowie urogenitaler (GU) Fisteln unter CHT

  17. In vivo optoacoustic temperature imaging for image-guided cryotherapy of prostate cancer

    Science.gov (United States)

    Petrova, E. V.; Brecht, H. P.; Motamedi, M.; Oraevsky, A. A.; Ermilov, S. A.

    2018-03-01

    The objective of this study is to demonstrate in vivo the feasibility of optoacoustic temperature imaging during cryotherapy of prostate cancer. We developed a preclinical prototype optoacoustic temperature imager that included pulsed optical excitation at a wavelength of 805 nm, a modified clinical transrectal ultrasound probe, a parallel data acquisition system, image processing and visualization software. Cryotherapy of a canine prostate was performed in vivo using a commercial clinical system, Cryocare® CS, with an integrated ultrasound imaging. The universal temperature-dependent optoacoustic response of blood was employed to convert reconstructed optoacoustic images to temperature maps. Optoacoustic imaging of temperature during prostate cryotherapy was performed in the longitudinal view over a region of 30 mm (long)  ×  10 mm (deep) that covered the rectum, the Denonvilliers fascia, and the posterior portion of the treated gland. The transrectal optoacoustic images showed high-contrast vascularized regions, which were used for quantitative estimation of local temperature profiles. The constructed temperature maps and their temporal dynamics were consistent with the arrangement of the cryoprobe and readouts of the thermal needle sensors. The temporal profiles of the readouts from the thermal needle sensors and the temporal profile estimated from the normalized optoacoustic intensity of the selected vascularized region showed significant resemblance, except for the initial overshoot, that may be explained as a result of the physiological thermoregulatory compensation. The temperature was mapped with errors not exceeding  ±2 °C (standard deviation) consistent with the clinical requirements for monitoring cryotherapy of the prostate. In vivo results showed that the optoacoustic temperature imaging is a promising non-invasive technique for real-time imaging of tissue temperature during cryotherapy of prostate cancer, which can be combined

  18. Magnetic resonance imaging - guided vacuum-assisted breast biopsy: an initial experience in a community hospital

    International Nuclear Information System (INIS)

    Friedman, P.; Enis, S.; Pinyard, J.

    2009-01-01

    To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program. The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings. Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142). This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions. (author)

  19. Magnetic resonance imaging - guided vacuum-assisted breast biopsy: an initial experience in a community hospital

    Energy Technology Data Exchange (ETDEWEB)

    Friedman, P.; Enis, S.; Pinyard, J., E-mail: jpinyard@gmail.com [Morristown Memorial Hospital, The Carol W. and Julius A. Rippel Breast Center, The Carol G. Simon Cancer Centre, Morristown, New Jersey (United States)

    2009-10-15

    To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program. The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings. Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142). This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions. (author)

  20. Image guided interstitial laser thermotherapy: a canine model evaluated by magnetic resonance imaging and quantitative autoradiography.

    Science.gov (United States)

    Muacevic, A; Peller, M; Ruprecht, L; Berg, D; Fend, L; Sroka, R; Reulen, H J; Reiser, M; Tonn, J Ch; Kreth, F W

    2005-02-01

    To determine the applicability and safety of a new canine model suitable for correlative magnetic resonance imaging (MRI) studies and morphological/pathophysiological examination over time after interstitial laser thermotherapy (ILTT) in brain tissue. A laser fibre (Diode Laser 830 nm) with an integrated temperature feedback system was inserted into the right frontal white matter in 18 dogs using frameless navigation technique. MRI thermometry (phase mapping i.e. chemical shift of the proton resonance frequency) during interstitial heating was compared to simultaneously recorded interstitial fiberoptic temperature readings on the border of the lesion. To study brain capillary function in response to ILTT over time quantitative autoradiography was performed investigating the unidirectional blood-to-tissue transport of carbon-14-labelled alpha amino-isobutyric acid (transfer constant K of AIB) 12, 36 hours, 7, 14 days, 4 weeks and 3 months after ILTT. All laser procedures were well tolerated, laser and temperature fibres could be adequately placed in the right frontal lobe in all animals. In 5 animals MRI-based temperature quantification correlated strongly to invasive temperature measurements. In the remaining animals the temperature fibre was located in the area of susceptibility artifacts, therefore, no temperature correlation was possible. The laser lesions consisted of a central area of calcified necrosis which was surrounded by an area of reactive brain tissue with increased permeability. Quantitative autoradiography indicated a thin and spherical blood brain barrier lesion. The magnitude of K of AIB increased from 12 hours to 14 days after ILTT and decreased thereafter. The mean value of K of AIB was 19 times (2 times) that of normal white matter (cortex), respectively. ILTT causes transient, highly localised areas of increased capillary permeability surrounding the laser lesion. Phase contrast imaging for MRI thermomonitoring can currently not be used for

  1. Percutaneous MR Imaging-Guided Cryoablation of Small Renal Masses in a 3-T Closed-Bore MR Imaging Environment: Initial Experience

    NARCIS (Netherlands)

    Oostenbrugge, T.J. van; Langenhuijsen, J.F.; Overduin, C.G.; Jenniskens, S.F.M.; Mulders, P.F.A.; Futterer, J.J.

    2017-01-01

    PURPOSE: To assess the feasibility of percutaneous magnetic resonance (MR) imaging-guided cryoablation of small renal masses (SRMs) in a 3-T environment and to evaluate intraprocedural imaging, procedural safety, and initial outcomes. MATERIALS AND METHODS: The analysis included 9 patients (4 men;

  2. Acute Toxicity After Image-Guided Intensity Modulated Radiation Therapy Compared to 3D Conformal Radiation Therapy in Prostate Cancer Patients

    NARCIS (Netherlands)

    Wortel, Ruud C.; Incrocci, Luca; Pos, Floris J.; Lebesque, Joos V.; Witte, Marnix G.; van der Heide, Uulke A.; van Herk, Marcel; Heemsbergen, Wilma D.

    2015-01-01

    Purpose: Image-guided intensity modulated radiation therapy (IG-IMRT) allows significant dose reductions to organs at risk in prostate cancer patients. However, clinical data identifying the benefits of IG-IMRT in daily practice are scarce. The purpose of this study was to compare dose distributions

  3. In vivo quantification of fluorescent molecular markers in real-time by ratio Imaging for diagnostic screening and image-guided surgery

    NARCIS (Netherlands)

    Bogaards, A.; Sterenborg, H. J. C. M.; Trachtenberg, J.; Wilson, B. C.; Lilge, L.

    2007-01-01

    Future applications of "molecular diagnostic screening" and "molecular image-guided surgery" will demand images of molecular markers with high resolution and high throughput (similar to >= 30 frames/second). MRI, SPECT, PET, optical fluorescence tomography, hyper-spectral fluorescence imaging, and

  4. Rapamycin/DiR loaded lipid-polyaniline nanoparticles for dual-modal imaging guided enhanced photothermal and antiangiogenic combination therapy.

    Science.gov (United States)

    Wang, Jinping; Guo, Fang; Yu, Meng; Liu, Li; Tan, Fengping; Yan, Ran; Li, Nan

    2016-09-10

    Imaging-guided photothermal therapy (PTT) has promising application for treating tumors. Nevertheless, so far imaging-guided photothermal drug-delivery systems have been developed with limited success for tumor chemo-photothermal therapy. In this study, as the proof-of-concept, a stimuli-responsive tumor-targeting rapamycin/DiR loaded lipid-polyaniline nanoparticle (RDLPNP) for dual-modal imaging-guided enhanced PTT efficacy is reported for the first time. In this system, polyaniline (PANI) with π-π electronic conjugated system and effective photothermal efficiency is chosen as the appropriate model receptor of fluorescence resonance energy transfer (FRET), and loaded cyanine probe (e.g., 1,1-dioctadecyl-3,3,3,3-tetramethylindotricarbocyanine iodide, DiR) acts as the donor of near-infrared fluorescence (NIRF). In addition, rapamycin (RAPA), which is used as the antiangiogenesis chemotherapeutic drug, can cutdown the tumor vessels and delay tumor growth obviously. After intravenous treatment of RDLPNPs into Hela tumor bearing mice, fluorescent (from DiR) and enhanced photoacoustic (from DLPNPs) signals were found in tumor site over time, which reached to peak at the 6h time point. After irradiating with an NIR laser, a good anti-tumor effect was observed owing to the enhanced photothermal and antiangiogenic effect of RDLPNPs. These results show that the multifunctional nanoparticle can be used as a promising imaging-guided photothermal drug delivery nanoplatform for cancer therapy. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Photon-counting hexagonal pixel array CdTe detector: Spatial resolution characteristics for image-guided interventional applications

    Science.gov (United States)

    Shrestha, Suman; Karellas, Andrew; Shi, Linxi; Gounis, Matthew J.; Bellazzini, Ronaldo; Spandre, Gloria; Brez, Alessandro; Minuti, Massimo

    2016-01-01

    Purpose: High-resolution, photon-counting, energy-resolved detector with fast-framing capability can facilitate simultaneous acquisition of precontrast and postcontrast images for subtraction angiography without pixel registration artifacts and can facilitate high-resolution real-time imaging during image-guided interventions. Hence, this study was conducted to determine the spatial resolution characteristics of a hexagonal pixel array photon-counting cadmium telluride (CdTe) detector. Methods: A 650 μm thick CdTe Schottky photon-counting detector capable of concurrently acquiring up to two energy-windowed images was operated in a single energy-window mode to include photons of 10 keV or higher. The detector had hexagonal pixels with apothem of 30 μm resulting in pixel pitch of 60 and 51.96 μm along the two orthogonal directions. The detector was characterized at IEC-RQA5 spectral conditions. Linear response of the detector was determined over the air kerma rate relevant to image-guided interventional procedures ranging from 1.3 nGy/frame to 91.4 μGy/frame. Presampled modulation transfer was determined using a tungsten edge test device. The edge-spread function and the finely sampled line spread function accounted for hexagonal sampling, from which the presampled modulation transfer function (MTF) was determined. Since detectors with hexagonal pixels require resampling to square pixels for distortion-free display, the optimal square pixel size was determined by minimizing the root-mean-squared-error of the aperture functions for the square and hexagonal pixels up to the Nyquist limit. Results: At Nyquist frequencies of 8.33 and 9.62 cycles/mm along the apothem and orthogonal to the apothem directions, the modulation factors were 0.397 and 0.228, respectively. For the corresponding axis, the limiting resolution defined as 10% MTF occurred at 13.3 and 12 cycles/mm, respectively. Evaluation of the aperture functions yielded an optimal square pixel size of 54

  6. SU-F-T-529: Dosimetric Investigation of a Rotating Gamma Ray System for ImagedGuided Modulated Arc Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ma, C; Chibani, O; Eldib, A; Chen, L [Fox Chase Cancer Center, Philadelphia, PA (United States); Li, J [Cyber Medical Inc, Xian (China)

    2016-06-15

    Purpose: Because of their effectiveness and efficiency, rotational arc radiotherapy (MAT) techniques have been developed on both specialty machines such as Tomotherapy and conventional linear accelerators. This work investigates a new rotating Gamma therapy system for image guided MAT and SBRT of intra/extracranial tumors. Methods: The CyberMAT system (Cyber Medical Corp., China) consists of a ring gantry with a gamma source (effective source size 1cm and 1.7cm respectively), a 120-leaf MLC, a kV CBCT and an EPID. The treatment couch provides 6-degrees-of-freedom motion compensation and the kV CBCT system has a spatial resolution of 0.4mm for target localization. The maximum dose rate is >4.0 Gy/min and the maximum field size is 40cm × 40cm. Monte Carlo simulations were used to compute dose distributions and compare with measurements. A retrospective study of 125 previously treated SBRT patients was performed to evaluate the dosimetric characteristics of CyberMAT in comparison with existing VMAT systems. Results: Monte Carlo results confirmed the CyberMAT design parameters including output factors and 3D dose distributions. Its beam penumbra is 5mm to 10mm for field sizes 1cm to 10cm, respectively and its isocenter accuracy is <0.5mm. Compared to the 6 MV photons of Tomotherapy and conventional linacs, Cobalt beams produce lower-energy secondary electrons that exhibit better dose properties in low-density lung tissues. Cobalt beams are ideal for peripheral lung tumors with half-arc arrangements to spare the opposite lung and other critical structures. Superior dose distributions have been obtained for brain, head and neck, breast, spine and lung tumors with half/full arc arrangements. Conclusion: Because of the unique dosimetric properties of Cobalt sources and its accurate stereotaxy/dose delivery CyberMAT is ideally suited for image guided MAT and SBRT. Full-arc arrangements are superior for brain and H&N treatments while half-arc arrangements produce best dose

  7. Deformable registration for image-guided spine surgery: preserving rigid body vertebral morphology in free-form transformations

    Science.gov (United States)

    Reaungamornrat, S.; Wang, A. S.; Uneri, A.; Otake, Y.; Zhao, Z.; Khanna, A. J.; Siewerdsen, J. H.

    2014-03-01

    Purpose: Deformable registration of preoperative and intraoperative images facilitates accurate localization of target and critical anatomy in image-guided spine surgery. However, conventional deformable registration fails to preserve the morphology of rigid bone anatomy and can impart distortions that confound high-precision intervention. We propose a constrained registration method that preserves rigid morphology while allowing deformation of surrounding soft tissues. Method: The registration method aligns preoperative 3D CT to intraoperative cone-beam CT (CBCT) using free-form deformation (FFD) with penalties on rigid body motion imposed according to a simple intensity threshold. The penalties enforced 3 properties of a rigid transformation - namely, constraints on affinity (AC), orthogonality (OC), and properness (PC). The method also incorporated an injectivity constraint (IC) to preserve topology. Physical experiments (involving phantoms, an ovine spine, and a human cadaver) as well as digital simulations were performed to evaluate the sensitivity to registration parameters, preservation of rigid body morphology, and overall registration accuracy of constrained FFD in comparison to conventional unconstrained FFD (denoted uFFD) and Demons registration. Result: FFD with orthogonality and injectivity constraints (denoted FFD+OC+IC) demonstrated improved performance compared to uFFD and Demons. Affinity and properness constraints offered little or no additional improvement. The FFD+OC+IC method preserved rigid body morphology at near-ideal values of zero dilatation (D = 0.05, compared to 0.39 and 0.56 for uFFD and Demons, respectively) and shear (S = 0.08, compared to 0.36 and 0.44 for uFFD and Demons, respectively). Target registration error (TRE) was similarly improved for FFD+OC+IC (0.7 mm), compared to 1.4 and 1.8 mm for uFFD and Demons. Results were validated in human cadaver studies using CT and CBCT images, with FFD+OC+IC providing excellent preservation

  8. Implementation of an image guided intensity-modulated protocol for post-prostatectomy radiotherapy: planning data and acute toxicity outcomes.

    Science.gov (United States)

    Chua, Benjamin; Min, Myo; Wood, Maree; Edwards, Sarah; Hoffmann, Matthew; Greenham, Stuart; Kovendy, Andrew; McKay, Michael J; Shakespeare, Thomas P

    2013-08-01

    There is substantial interest in implementation of image-guided intensity-modulated radiotherapy (IG-IMRT) in the post-prostatectomy setting. We describe our implementation of IG-IMRT, and examine how often published organ-at-risk (OAR) constraints were met. Furthermore, we evaluate the incidence of acute genitourinary and gastrointestinal toxicities when patients were treated according to our protocol. Patients were eligible if they received post-prostatectomy radiotherapy (PPRT). Planning data were collected prospectively, and toxicity assessments were collected before, during and after treatment. Seventy-five eligible patients received either 64 Gy (19%) or 66 Gy (81%) in a single phase to the prostate bed. Suggested rectal dose-constraints of V40Gy image guidance. Non-IMRT OAR constraints were met in most cases. IMRT-specific constraints were less often achieved despite margin reductions, suggesting the need for review of guidelines. Severe toxicity was rare, and most patients did not experience deterioration in urinary or bowel function attributable to radiotherapy. © 2013 The Authors. Journal of Medical Imaging and Radiation Oncology © 2013 The Royal Australian and New Zealand College of Radiologists.

  9. Long-term Results of Post-operative Pelvic Image guided Intensity Modulated Radiotherapy in Gynecological Malignancies.

    Science.gov (United States)

    Agrawal, Rashi; Prithiviraj, Sowmiya; Singh, Dinesh; Zamre, Vaishali; Agrawal, Sandeep; Goel, Arun Kumar; Gupta, Kanika; Subramanian, Bala

    2017-05-01

    To assess late clinical outcomes with image guided intensity modulated radiotherapy (IG- IMRT) in gynecological malignancies. We have been practicing IG IMRT for gynecological malignancies since January 2009. Here we are presenting our experience with this modern technique at median follow up of 38 months. During whole treatment bladder filling protocol was followed. Both target volumes and critical structures were contoured according to RTOG guidelines. Dose prescribed to clinical target volume (postop bed and nodal volume) was 50.4 Gy in 28 fractions. Cone beam CT (CBCT) scans were taken to quantify the status of target volume and normal structures. 80 patients were evaluated and analyzed who were treated from January 2009 to December 2014. Median age of our patients was 56.5 years. Out of eighty, forty four patients (55%) were of carcinoma endometrium and the rest 36 (45%) were of carcinoma cervix. None of our patients experienced late grade 3 or 4 bladder toxicity. Although late grade 3 and 4 bowel and rectal toxicity was experienced by single patient. 2.5% patients developed local recurrence, 5% patient developed nodal with distant metastases and 6.25% only distant metastases. Three of our patients developed lung cancer as second primary during follow up. 76.2% atients are alive with regular follow up. Our study concluded that IG IMRT increases patient compliance and reduces long-term side effects in post-operative gynecological malignancies without compromising local-regional control, disease free survival and overall survival.

  10. Image-guided percutaneous management of duodenal perforation following endoscopic retrograde cholangiopancreatography (ERCP): assessment of efficacy and safety.

    Science.gov (United States)

    McCarthy, C J; Butros, S R; Dawson, S L; Arellano, R S

    2018-03-01

    To evaluate the efficacy and safety of image-guided percutaneous drain placement for duodenal perforation following endoscopic retrograde cholangiopancreatography (ERCP). A retrospective review of 7,249 ERCP examinations over a 10-year period was performed to identify cases of duodenal perforation. Indications for ERCP were documented, along with the clinical, laboratory, and imaging findings following perforation. Technical and clinical success of percutaneous drain placement was reviewed. Duodenal perforation occurred in 35 of 7,249 patients during the study period. Management included primary surgical debridement (n=2), conservative management consisting of bowel rest, nasogastric/nasojejunal tube placement (n=20), and percutaneous catheter drainage (n=13). Twenty-seven percutaneous drainage catheters were placed in 13 patients, with a mean duration of catheter drainage of 30.9 days (range 4-108 days). Ten patients were successfully treated with percutaneous management alone, and three required subsequent surgical intervention. Percutaneous management of duodenal perforation related to ERCP is associated with high technical and clinical success, and may obviate the need for surgical intervention. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  11. Magnitude of speed of sound aberration corrections for ultrasound image guided radiotherapy for prostate and other anatomical sites

    International Nuclear Information System (INIS)

    Fontanarosa, Davide; Meer, Skadi van der; Bloemen-van Gurp, Esther; Stroian, Gabriela; Verhaegen, Frank

    2012-01-01

    Purpose: The purpose of this work is to assess the magnitude of speed of sound (SOS) aberrations in three-dimensional ultrasound (US) imaging systems in image guided radiotherapy. The discrepancy between the fixed SOS value of 1540 m/s assumed by US systems in human soft tissues and its actual nonhomogeneous distribution in patients produces small but systematic errors of up to a few millimeters in the positions of scanned structures. Methods: A correction, provided by a previously published density-based algorithm, was applied to a set of five prostate, five liver, and five breast cancer patients. The shifts of the centroids of target structures and the change in shape were evaluated. Results: After the correction the prostate cases showed shifts up to 3.6 mm toward the US probe, which may explain largely the reported positioning discrepancies in the literature on US systems versus other imaging modalities. Liver cases showed the largest changes in volume of the organ, up to almost 9%, and shifts of the centroids up to more than 6 mm either away or toward the US probe. Breast images showed systematic small shifts of the centroids toward the US probe with a maximum magnitude of 1.3 mm. Conclusions: The applied correction in prostate and liver cancer patients shows positioning errors of several mm due to SOS aberration; the errors are smaller in breast cancer cases, but possibly becoming more important when breast tissue thickness increases.

  12. Preliminary results of a new workflow for MRI/CT-based image-guided brachytherapy in cervical carcinoma.

    Science.gov (United States)

    Nemoto, Miho Watanabe; Iwai, Yuma; Togasaki, Gentaro; Kurokawa, Marie; Harada, Rintarou; Kobayashi, Hiroki; Uno, Takashi

    2017-12-01

    We propose a method of image-guided brachytherapy (IGBT) that combines MRI-based target volume delineation for the first fraction with CT datasets of subsequent fractions, using an automatic, applicator-based co-registration, and report our preliminary experience. The MRI of the first fraction was used for the first brachytherapy planning. For each subsequent brachytherapy fraction, after the same applicator insertion, a new CT scan with the applicator in place was obtained. The MR image set was registered to the subsequent brachytherapy treatment planning CT using the applicator for rigid body registration. To demonstrate the registration quality, we used here the Dice index as a measurement of tandem delineation overlap between CT and MRI. The median Dice index was 0.879 (range 0.610-0.932), which indicated that the contours on CT and MRI fitted well. With this combination method, the median D90 of HR CTV and the calculated D2 cm 3 of the bladder, rectum, and sigmoid in each fraction were 7.2 (4.0-10.4), 5.9 (2.3-7.7), 4.0 (1.9-6.7), and 3.8 (0.6-7.2) Gy, respectively. Our described method of MRI-guided IGBT offers a practical option for the benefits of target delineation.

  13. Clinical efficacy and safety of surface imaging guided radiosurgery (SIG-RS) in the treatment of benign skull base tumors.

    Science.gov (United States)

    Lau, Steven K M; Patel, Kunal; Kim, Teddy; Knipprath, Erik; Kim, Gwe-Ya; Cerviño, Laura I; Lawson, Joshua D; Murphy, Kevin T; Sanghvi, Parag; Carter, Bob S; Chen, Clark C

    2017-04-01

    Frameless, surface imaging guided radiosurgery (SIG-RS) is a novel platform for stereotactic radiosurgery (SRS) wherein patient positioning is monitored in real-time through infra-red camera tracking of facial topography. Here we describe our initial clinical experience with SIG-RS for the treatment of benign neoplasms of the skull base. We identified 48 patients with benign skull base tumors consecutively treated with SIG-RS at a single institution between 2009 and 2011. Patients were diagnosed with meningioma (n = 22), vestibular schwannoma (n = 20), or nonfunctional pituitary adenoma (n = 6). Local control and treatment-related toxicity were retrospectively assessed. Median follow-up was 65 months (range 61-72 months). Prescription doses were 12-13 Gy in a single fraction (n = 18), 8 Gy × 3 fractions (n = 6), and 5 Gy × 5 fractions (n = 24). Actuarial tumor control rate at 5 years was 98%. No grade ≥3 treatment-related toxicity was observed. Grade ≤2 toxicity was associated with symptomatic lesions (p = 0.049) and single fraction treatment (p = 0.005). SIG-RS for benign skull base tumors produces clinical outcomes comparable to conventional frame-based SRS techniques while enhancing patient comfort.

  14. Estimate of the shielding effect on secondary cancer risk due to cone-beam CT in image-guided radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Jiwon; Baek, Taeseong; Yoon, Myonggeun [Korea University, Seoul (Korea, Republic of); Kim, Dongwook; Kim, Donghyun [Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

    2014-09-15

    This study evaluated the effect of a simple shielding method using a thin lead sheet on the imaging dose caused by cone-beam computed tomography (CBCT) in image-guided radiation therapy (IGRT). Reduction of secondary doses from CBCT was measured using a radio-photoluminescence glass dosimeter (RPLGD) placed inside an anthropomorphic phantom. The entire body, except for the region scanned by using CBCT, was shielded by wrapping it with a 2-mm lead sheet. Changes in secondary cancer risk due to shielding were calculated using BEIR VII models. Doses to out-of-field organs for head-and-neck, chest, and pelvis scans were decreased 15 ∼ 100%, 23 ∼ 90%, and 23 ∼ 98%, respectively, and the average reductions in lifetime secondary cancer risk due to the 2-mm lead shielding were 1.6, 11.5, and 12.7 persons per 100,000, respectively. These findings suggest that a simple, thin-lead-sheet-based shielding method can effectively decrease secondary doses to out-of-field regions for CBCT, which reduces the lifetime cancer risk on average by 9 per 100,000 patients.

  15. Feasibility of image-guided radiotherapy based on helical tomotherapy to reduce contralateral parotid dose in head and neck cancer

    Science.gov (United States)

    2012-01-01

    Background To evaluate the feasibility of image-guided radiotherapy based on helical Tomotherapy to spare the contralateral parotid gland in head and neck cancer patients with unilateral or no neck node metastases. Methods A retrospective review of 52 patients undergoing radiotherapy for head and neck cancers with image guidance based on daily megavoltage CT imaging with helical tomotherapy was performed. Results Mean contralateral parotid dose and the volume of the contralateral parotid receiving 40 Gy or more were compared between radiotherapy plans with significant constraint (SC) of less than 20 Gy on parotid dose (23 patients) and the conventional constraint (CC) of 26 Gy (29 patients). All patients had PTV coverage of at least 95% to the contralateral elective neck nodes. Mean contralateral parotid dose was, respectively, 14.1 Gy and 24.7 Gy for the SC and CC plans (p parotid receiving 40 Gy or more was respectively 5.3% and 18.2% (p cancer minimized radiotherapy dose to the contralateral parotid gland in patients undergoing elective node irradiation without sacrificing target coverage. PMID:22578076

  16. Feasibility of image-guided radiotherapy based on helical tomotherapy to reduce contralateral parotid dose in head and neck cancer

    International Nuclear Information System (INIS)

    Nguyen, Nam P; Krafft, Shane P; Jang, Siyoung; Hamilton, Russ; Karlsson, Ulf; Abraham, Dave; Vos, Paul; Vinh-Hung, Vincent; Ceizyk, Misty; Smith-Raymond, Lexie; Stevie, Michelle; Slane, Benjamin; Chi, Alexander; Desai, Anand

    2012-01-01

    To evaluate the feasibility of image-guided radiotherapy based on helical Tomotherapy to spare the contralateral parotid gland in head and neck cancer patients with unilateral or no neck node metastases. A retrospective review of 52 patients undergoing radiotherapy for head and neck cancers with image guidance based on daily megavoltage CT imaging with helical tomotherapy was performed. Mean contralateral parotid dose and the volume of the contralateral parotid receiving 40 Gy or more were compared between radiotherapy plans with significant constraint (SC) of less than 20 Gy on parotid dose (23 patients) and the conventional constraint (CC) of 26 Gy (29 patients). All patients had PTV coverage of at least 95% to the contralateral elective neck nodes. Mean contralateral parotid dose was, respectively, 14.1 Gy and 24.7 Gy for the SC and CC plans (p < 0.0001). The volume of contralateral parotid receiving 40 Gy or more was respectively 5.3% and 18.2% (p < 0.0001) Tomotherapy for head and neck cancer minimized radiotherapy dose to the contralateral parotid gland in patients undergoing elective node irradiation without sacrificing target coverage

  17. Potential applications of image-guided radiotherapy for brain metastases and glioblastoma to improve patient quality of life

    Directory of Open Access Journals (Sweden)

    Nam Phong Nguyen

    2013-11-01

    Full Text Available Treatment of glioblastoma multiforme (GBM and brain metastasis remains a challenge because of the poor survival and the potential for brain damage following radiation. Despite concurrent chemotherapy and radiation dose escalation, local recurrence remains the predominant pattern of failure in GBM most likely secondary to repopulation of cancer stem cells. Even though radiotherapy is highly effective for local control of radio-resistant tumors such as melanoma and renal cell cancer, systemic disease progression is the cause of death in most patients with brain metastasis. Preservation of quality of life of cancer survivors is the main issue for patients with brain metastasis. Image-guided radiotherapy (IGRT by virtue of precise radiation dose delivery may reduce treatment time of patients with GBM without excessive toxicity and potentially improve neurocognitive function with preservation of local control in patients with brain metastasis. Future prospective trials for primary brain tumors or brain metastasis should include IGRT to assess its efficacy to improve patient quality of life.

  18. Prostatic fiducial markers implantation by transrectal ultrasound for adaptive image guided radiotherapy in localized cancer: 7-years experience

    Directory of Open Access Journals (Sweden)

    Vito Lacetera

    2014-12-01

    Full Text Available Objective: we present our 7-years’ experience with fiducial gold markers inserted before Image-Guided Radiotherapy (IGRT focusing on our echo-guided technique reporting early and late complications. Material and methods: 78 prostate cancer (PCA patients who underwent fiducial markers placement for adaptive IGRT (period 2007-2014 were selected. Mean patient age was 75 years (range 60-81, mean PSA 7.8 ng/ml (range 3.1-10, clinical stage < T3, mean Gleason Score 6.4 (range 6-7. We recorded early and late complications. Maximum distance between the Clinical Target Volume (CTV and Planning Target Volume (PTV was assessed for each direction and the mean PTV reduction was estimated. Results: we describe in details our echo-guided technique of intraprostatic gold fiducial markers insertion prior to adaptative IGRT. We report rare early toxicity (5-7% grade 1-2, a mean PTV reduction of 37% and a very low late toxicity (only 3.4% bladder G3 and 8% rectal G2 side effects. Conclusion: Our technique of fiducial gold markers implantation for adaptative IGRT is safe and well-tolerated and it resulted helpful to reduce CTV-PTV margin in all cases; the effects on clinical practice seem significant in terms of late toxicity but further investigations are needed with longer follow-up.

  19. Radiosensitizer-eluting nanocoatings on gold fiducials for biological in-situ image-guided radio therapy (BIS-IGRT)

    Energy Technology Data Exchange (ETDEWEB)

    Nagesha, D K; Tada, D B; Stambaugh, C K K; Gultepe, E; Jost, E; Levy, C O; Sridhar, S [Electronic Materials Research Institute and Department of Physics, Northeastern University, Boston, MA 02115 (United States); Cormack, R; Makrigiorgos, G M, E-mail: s.sridhar@neu.ed [Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States)

    2010-10-21

    Image-guided radiation treatments (IGRT) routinely utilize radio-opaque implantable devices, such as fiducials or brachytherapy spacers, for improved spatial accuracy. The therapeutic efficiency of IGRT can be further enhanced by biological in situ dose painting (BIS-IGRT) of radiosensitizers through localized delivery within the tumor using gold fiducial markers that have been coated with nanoporous polymer matrices loaded with nanoparticles (NPs). In this work, two approaches were studied: (i) a free drug release system consisting of Doxorubicin (Dox), a hydrophilic drug, loaded into a non-degradable polymer poly(methyl methacrylate) (PMMA) coating and (ii) poly(d,l-lactic-co-glycolic acid) (PLGA) NPs loaded with fluorescent Coumarin-6, serving as a model for a hydrophobic drug, in a biodegradable chitosan matrix. Temporal release kinetics measurements in buffer were carried out using fluorescence spectroscopy. In the first case of free Dox release, an initial release within the first few hours was followed by a sustained release over the course of the next 3 months. In the second platform, release of NPs and the free drug was controlled by the degradation rate of the chitosan matrix and PLGA. The results show that dosage and rate of release of these radiosensitizers coated on gold fiducials for IGRT can be precisely tailored to achieve the desired release profile for radiation therapy of cancer.

  20. Magnetic resonance imaging properties of multimodality anthropomorphic silicone rubber phantoms for validating surgical robots and image guided therapy systems

    Science.gov (United States)

    Cheung, Carling L.; Looi, Thomas; Drake, James; Kim, Peter C. W.

    2012-02-01

    The development of image guided robotic and mechatronic platforms for medical applications requires a phantom model for initial testing. Finding an appropriate phantom becomes challenging when the targeted patient population is pediatrics, particularly infants, neonates or fetuses. Our group is currently developing a pediatricsized surgical robot that operates under fused MRI and laparoscopic video guidance. To support this work, we describe a method for designing and manufacturing silicone rubber organ phantoms for the purpose of testing the robotics and the image fusion system. A surface model of the organ is obtained and converted into a mold that is then rapid-prototyped using a 3D printer. The mold is filled with a solution containing a particular ratio of silicone rubber to slacker additive to achieve a specific set of tactile and imaging characteristics in the phantom. The expected MRI relaxation times of different ratios of silicone rubber to slacker additive are experimentally quantified so that the imaging properties of the phantom can be matched to those of the organ that it represents. Samples of silicone rubber and slacker additive mixed in ratios ranging from 1:0 to 1:1.5 were prepared and scanned using inversion recovery and spin echo sequences with varying TI and TE, respectively, in order to fit curves to calculate the expected T1 and T2 relaxation times of each ratio. A set of infantsized abdominal organs was prepared, which were successfully sutured by the robot and imaged using different modalities.

  1. Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a first choice?

    International Nuclear Information System (INIS)

    Kabaalioglu, Adnan; Ceken, Kagan; Alimoglu, Emel; Apaydin, Ali

    2006-01-01

    Aim: To evaluate the long-term results of percutaneous imaging-guided treatment of hydatid liver cysts. Materials and methods: Sixty patients with 77 hydatid liver cysts underwent percutaneous treatment with ultrasonography (US) or computed tomography (CT) guidance. Absolute alcohol and hypertonic saline were used for sclerosing the cysts after aspiration. Prophylactic albendazole treatment was given before and after the procedures. Follow-up US and CT were obtained periodically, and changes in cyst morphology were recorded. Minimum follow-up period for the patients included in this study was 12 months. Serological correlation was also available for a group of patients. The outcome of the procedures were categorized into five groups based on morphological changes observed by imaging. Results: Procedures were regarded as successful in 80% and unsuccessful in 20% of patients. Failures most often occurred with type III cysts; less than half (39%) of the total type III cysts had a successful outcome. On the other hand, all type I cysts ended up with cure. Anaphylaxis, pneumotorax and severe pain interrupting the procedures were also among the reasons of failure. Conclusion: Percutaneous aspiration, injection and reaspiration (PAIR) of types I and II hydatid liver cysts is effective and safe in the long-term. Surgery should no longer be regarded as the first choice treatment in all hydatid liver cysts but should be reserved for type III and certain active type IV cysts

  2. Assessment of chitosan-affected metabolic response by peroxisome proliferator-activated receptor bioluminescent imaging-guided transcriptomic analysis.

    Directory of Open Access Journals (Sweden)

    Chia-Hung Kao

    Full Text Available Chitosan has been widely used in food industry as a weight-loss aid and a cholesterol-lowering agent. Previous studies have shown that chitosan affects metabolic responses and contributes to anti-diabetic, hypocholesteremic, and blood glucose-lowering effects; however, the in vivo targeting sites and mechanisms of chitosan remain to be clarified. In this study, we constructed transgenic mice, which carried the luciferase genes driven by peroxisome proliferator-activated receptor (PPAR, a key regulator of fatty acid and glucose metabolism. Bioluminescent imaging of PPAR transgenic mice was applied to report the organs that chitosan acted on, and gene expression profiles of chitosan-targeted organs were further analyzed to elucidate the mechanisms of chitosan. Bioluminescent imaging showed that constitutive PPAR activities were detected in brain and gastrointestinal tract. Administration of chitosan significantly activated the PPAR activities in brain and stomach. Microarray analysis of brain and stomach showed that several pathways involved in lipid and glucose metabolism were regulated by chitosan. Moreover, the expression levels of metabolism-associated genes like apolipoprotein B (apoB and ghrelin genes were down-regulated by chitosan. In conclusion, these findings suggested the feasibility of PPAR bioluminescent imaging-guided transcriptomic analysis on the evaluation of chitosan-affected metabolic responses in vivo. Moreover, we newly identified that downregulated expression of apoB and ghrelin genes were novel mechanisms for chitosan-affected metabolic responses in vivo.

  3. Transfer of systematic computer game training in surgical novices on performance in virtual reality image guided surgical simulators.

    Science.gov (United States)

    Kolga Schlickum, Marcus; Hedman, Leif; Enochsson, Lars; Kjellin, Ann; Felländer-Tsai, Li

    2008-01-01

    We report on a pilot study that investigates the transfer effect of systematic computer game training on performance in image guided surgery. In a group of 22 surgical novices, subjects were matched and randomized into one group training with a 3-D first person shooter (FPS) game and one group training with a 2-D non-FPS game. We also included a control group. Subjects were tested pre- and post training in the MIST-VR and GI-Mentor surgical simulators. We found that subjects with past experience specific to FPS games were significantly better in performing the simulated endoscopy task, both regarding time and efficiency of screening, compared to subjects lacking FPS game experience. Furthermore subjects who underwent systematic FPS game training performed better in the MIST-VR than those training with a 2-D game. Our findings indicate a transfer effect and that experience of video games are important for training outcome in simulated surgical procedures. Video game training can become useful when designing future skills training curricula for surgeons.

  4. Image guided radiotherapy with the Cone Beam CT kV (ElektaTM): Experience of the Leon Berard Centre

    International Nuclear Information System (INIS)

    Pommier, P.; Gassa, F.; Lafay, F.; Claude, L.

    2009-01-01

    Image guide radiotherapy with the Cone Beam CT kV (C.B.C.T.-kV) developed by Elekta has been implemented at the centre Leon Berard in November 2006. The treatment procedure is presented and detailed for prostate cancer I.G.R.T. and non small cell lung cancer (N.S.C.L.C.) stereotactic radiotherapy (S.R.T.). C.B.C.T.-kV is routinely used for S.R.T., selected paediatric cancers, all prostate carcinomas, primitive brain tumours and head and neck cancers that do not require nodes irradiation. Thirty-five to 40 patients are treated within a daily 11-hours period. The general procedure for 3-dimensional images acquisition and their analysis is described. The C.B.C.T.-kV permitted to identify about 10% of prostate cancer patients for whom a positioning with bone-based 2-dimensional images only would have led to an unacceptable dose distribution for at least one session. S.R.T. is now used routinely for inoperable N.S.C.L.C.. The easiness of implementing C.B.C.T.-kV imaging and its expected medical benefit should lead to a rapid diffusion of this technology that is also submitted to prospective and multi centric medico-economical evaluations. (authors)

  5. Evaluation of EphA2 and EphB4 as Targets for Image-Guided Colorectal Cancer Surgery.

    Science.gov (United States)

    Stammes, Marieke A; Prevoo, Hendrica A J M; Ter Horst, Meyke C; Groot, Stéphanie A; Van de Velde, Cornelis J H; Chan, Alan B; de Geus-Oei, Lioe-Fee; Kuppen, Peter J K; Vahrmeijer, Alexander L; Pasquale, Elena B; Sier, Cornelis F M

    2017-02-03

    Targeted image-guided oncologic surgery (IGOS) relies on the recognition of cell surface-associated proteins, which should be abundantly present on tumor cells but preferably absent on cells in surrounding healthy tissue. The transmembrane receptor tyrosine kinase EphA2, a member of the A class of the Eph receptor family, has been reported to be highly overexpressed in several tumor types including breast, lung, brain, prostate, and colon cancer and is considered amongst the most promising cell membrane-associated tumor antigens by the NIH. Another member of the Eph receptor family belonging to the B class, EphB4, has also been found to be upregulated in multiple cancer types. In this study, EphA2 and EphB4 are evaluated as targets for IGOS of colorectal cancer by immunohistochemistry (IHC) using a tissue microarray (TMA) consisting of 168 pairs of tumor and normal tissue. The IHC sections were scored for staining intensity and percentage of cells stained. The results show a significantly enhanced staining intensity and more widespread distribution in tumor tissue compared with adjacent normal tissue for EphA2 as well as EphB4. Based on its more consistently higher score in colorectal tumor tissue compared to normal tissue, EphB4 appears to be a promising candidate for IGOS of colorectal cancer. In vitro experiments using antibodies on human colon cancer cells confirmed the possibility of EphB4 as target for imaging.

  6. Clinical outcomes of image guided radiation therapy (IGRT) with gold fiducial vaginal cuff markers for high-risk endometrial cancer

    International Nuclear Information System (INIS)

    Monroe, Alan T.; Peddada, Anuj V.; Pikaart, Dirk

    2013-01-01

    Objective. To report two year clinical outcomes of image guided radiation therapy (IGRT) to the vaginal cuff and pelvic lymph nodes in a series of high-risk endometrial cancer patients. Methods . Twenty-six consecutive high-risk endometrial cancer patients requiring adjuvant radiation to the vaginal cuff and regional lymph nodes were treated with vaginal cuff fiducial-based IGRT. Seventeen (65%) received sequential chemotherapy, most commonly with a sandwich technique. Brachytherapy followed external radiation in 11 patients to a median dose of 18 Gy in 3 fractions. The median external beam dose delivered was 47.5 Gy in 25 fractions. Results. All 656 fractions were successfully imaged and treated. The median overall translational shift required for correction was 9.1 mm (standard deviation, 5.2 mm) relative to clinical set-up with skin tattoos. Shifts of 1 cm, 1.5 cm, and 2 cm or greater were performed in 43%, 14%, and 4% of patients, respectively. Acute grade 2 gastrointestinal (GI) toxicity occurred in eight patients (30%) and grade 3 toxicity occurred in one. At two years, there have been no local or regional failures and actuarial overall survival is 95%. Conclusion. Daily image guidance for high-risk endometrial cancer results in a low incidence of acute GI/genitourinary (GU) toxicity with uncompromised tumor control at two years. Vaginal cuff translations can be substantial and may possibly result in underdosing if not properly considered

  7. Clinical outcomes of image guided radiation therapy (IGRT) with gold fiducial vaginal cuff markers for high-risk endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Monroe, Alan T.; Peddada, Anuj V. [Dept. of Radiation Oncology, Penrose Cancer Center, Colorado Springs (United States); Pikaart, Dirk [Dept. of Gynecologic Oncology, Penrose Cancer Center, Colorado Springs (United States)

    2013-06-15

    Objective. To report two year clinical outcomes of image guided radiation therapy (IGRT) to the vaginal cuff and pelvic lymph nodes in a series of high-risk endometrial cancer patients. Methods . Twenty-six consecutive high-risk endometrial cancer patients requiring adjuvant radiation to the vaginal cuff and regional lymph nodes were treated with vaginal cuff fiducial-based IGRT. Seventeen (65%) received sequential chemotherapy, most commonly with a sandwich technique. Brachytherapy followed external radiation in 11 patients to a median dose of 18 Gy in 3 fractions. The median external beam dose delivered was 47.5 Gy in 25 fractions. Results. All 656 fractions were successfully imaged and treated. The median overall translational shift required for correction was 9.1 mm (standard deviation, 5.2 mm) relative to clinical set-up with skin tattoos. Shifts of 1 cm, 1.5 cm, and 2 cm or greater were performed in 43%, 14%, and 4% of patients, respectively. Acute grade 2 gastrointestinal (GI) toxicity occurred in eight patients (30%) and grade 3 toxicity occurred in one. At two years, there have been no local or regional failures and actuarial overall survival is 95%. Conclusion. Daily image guidance for high-risk endometrial cancer results in a low incidence of acute GI/genitourinary (GU) toxicity with uncompromised tumor control at two years. Vaginal cuff translations can be substantial and may possibly result in underdosing if not properly considered.

  8. Evaluation of motion measurement using cine MRI for image guided stereotactic body radiotherapy on a new phantom platform

    Science.gov (United States)

    Cai, Jing; Wang, Ziheng; Yin, Fang-Fang

    2011-01-01

    The objective of this study is to investigate accuracy of motion tracking of cine magnetic resonance imaging (MRI) for image-guided stereotactic body radiotherapy. A phantom platform was developed in this work to fulfill the goal. The motion phantom consisted of a platform, a solid thread, a motor and a control system that can simulate motion in various modes. To validate its reproducibility, the phantom platform was setup three times and imaged with fluoroscopy using an electronic portal imaging device (EPID) for the same motion profile. After the validation test, the phantom platform was evaluated using cine MRI at 2.5 frames/second on a 1.5T GE scanner using five different artificial profiles and five patient profiles. The above profiles were again measured with EPID fluoroscopy and used as references. Discrepancies between measured profiles from cine MRI and EPID were quantified using root-mean-square (RMS) and standard deviation (SD). Pearson’s product moment correlational analysis was used to test correlation. The standard deviation for the reproducibility test was 0.28 mm. The discrepancies (RMS) between all profiles measured by cine MRI and EPID fluoroscopy ranged from 0.30 to 0.49 mm for artificial profiles and ranged from 0.75 to 0.91 mm for five patient profiles. The cine MRI sequence could precisely track phantom motion and the proposed motion phantom was feasible to evaluate cine MRI accuracy. PMID:29296304

  9. A new robust markerless method for automatic image-to-patient registration in image-guided neurosurgery system.

    Science.gov (United States)

    Liu, Yinlong; Song, Zhijian; Wang, Manning

    2017-12-01

    Compared with the traditional point-based registration in the image-guided neurosurgery system, surface-based registration is preferable because it does not use fiducial markers before image scanning and does not require image acquisition dedicated for navigation purposes. However, most existing surface-based registration methods must include a manual step for coarse registration, which increases the registration time and elicits some inconvenience and uncertainty. A new automatic surface-based registration method is proposed, which applies 3D surface feature description and matching algorithm to obtain point correspondences for coarse registration and uses the iterative closest point (ICP) algorithm in the last step to obtain an image-to-patient registration. Both phantom and clinical data were used to execute automatic registrations and target registration error (TRE) calculated to verify the practicality and robustness of the proposed method. In phantom experiments, the registration accuracy was stable across different downsampling resolutions (18-26 mm) and different support radii (2-6 mm). In clinical experiments, the mean TREs of two patients by registering full head surfaces were 1.30 mm and 1.85 mm. This study introduced a new robust automatic surface-based registration method based on 3D feature matching. The method achieved sufficient registration accuracy with different real-world surface regions in phantom and clinical experiments.

  10. Radiosensitizer-eluting nanocoatings on gold fiducials for biological in-situ image-guided radio therapy (BIS-IGRT)

    Science.gov (United States)

    Nagesha, D. K.; Tada, D. B.; Stambaugh, C. K. K.; Gultepe, E.; Jost, E.; Levy, C. O.; Cormack, R.; Makrigiorgos, G. M.; Sridhar, S.

    2010-10-01

    Image-guided radiation treatments (IGRT) routinely utilize radio-opaque implantable devices, such as fiducials or brachytherapy spacers, for improved spatial accuracy. The therapeutic efficiency of IGRT can be further enhanced by biological in situ dose painting (BIS-IGRT) of radiosensitizers through localized delivery within the tumor using gold fiducial markers that have been coated with nanoporous polymer matrices loaded with nanoparticles (NPs). In this work, two approaches were studied: (i) a free drug release system consisting of Doxorubicin (Dox), a hydrophilic drug, loaded into a non-degradable polymer poly(methyl methacrylate) (PMMA) coating and (ii) poly(d,l-lactic-co-glycolic acid) (PLGA) NPs loaded with fluorescent Coumarin-6, serving as a model for a hydrophobic drug, in a biodegradable chitosan matrix. Temporal release kinetics measurements in buffer were carried out using fluorescence spectroscopy. In the first case of free Dox release, an initial release within the first few hours was followed by a sustained release over the course of the next 3 months. In the second platform, release of NPs and the free drug was controlled by the degradation rate of the chitosan matrix and PLGA. The results show that dosage and rate of release of these radiosensitizers coated on gold fiducials for IGRT can be precisely tailored to achieve the desired release profile for radiation therapy of cancer.

  11. A study of porcine liver motion during respiration for improving targeting in image-guided needle placements.

    Science.gov (United States)

    Srimathveeravalli, G; Leger, J; Ezell, P; Maybody, M; Gutta, N; Solomon, S B

    2013-01-01

    Liver motion due to respiration restricts targeting and needle placement accuracy during image-guided interventional procedures. Breath holds, imaging techniques, and navigation systems are used to improve targeting accuracy. Data of in-vivo liver behavior under respiration can enhance these approaches. An experimental study was performed using the swine model to capture the dynamics of liver motion during respiration using needles tipped with electromagnetic sensors. The swine liver was segmented into four lobes (right lateral, right medial, left medial and left lateral), and two sensor-tipped needles were placed in each location to acquire representative displacement data. Maximum displacement was found to occur in the left medial and left lateral lobes, in the anterior-posterior direction. Significant lobe-dependent variation in motion behavior was recorded, but a variation within a lobe was minimal and independent of needle approach. Magnitude of displacement in all lobes was found to be monotonically correlated to breathing volume. Displacement of liver was found to be out of phase with breathing by approximately 2 Hz. The positioning of the animal was also found to influence direction and magnitude of liver displacement in different lobes. We have presented previously unavailable data and insight into the role of easily controllable parameters such as breathing volume, patient positioning, and lobe-specific heterogeneity in the displacement of liver due to respiration.

  12. Image Guided Virtual Autopsy: An Adjunct with Radiographic and Computed Tomography Modalities - An Important Tool in Forensic Identification

    Directory of Open Access Journals (Sweden)

    Shalu Rai

    2017-01-01

    Full Text Available The forensic examination of dead bodies is very helpful in order to identify the person, cause of death, gender, and solving the mysterious cases. It includes a number of techniques, out of which autopsy is the primary investigation that is performed in every medicolegal case. Because of mutilation technologies, traditional autopsy technique is most disturbing in terms of emotions and rituals of relatives. The use of radiology in forensic science comprises performance, interpretation, and reporting of radiographs that is helpful in detecting those changes that are not clinically visible. Forensic radiology plays an important role for identification of humans in mass disasters, criminal investigations, and evaluation of cause of death. The introduction of radiological modalities in autopsy techniques is a complementary tool for forensic identification and is known as virtual autopsy. The advance imaging techniques such as computed tomography (CT and magnetic resonance imaging (MRI is used in virtual autopsy in order to visualize and reconstruct the internal organs to know the site, type, and depth of injury. This review elaborates the role of maxillofacial imaging in image-guided virtual autopsy.

  13. Effects of late administration of pentoxifylline and tocotrienols in an image-guided rat model of localized heart irradiation.

    Directory of Open Access Journals (Sweden)

    Vijayalakshmi Sridharan

    Full Text Available Radiation-induced heart disease (RIHD is a long-term side effect of radiotherapy of intrathoracic, chest wall and breast tumors when radiation fields encompass all or part of the heart. Previous studies have shown that pentoxifylline (PTX in combination with α-tocopherol reduced manifestations of RIHD in rat models of local heart irradiation. The relative contribution of PTX and α-tocopherol to these beneficial effects are not known. This study examined the effects of PTX alone or in combination with tocotrienols, forms of vitamin E with potential potent radiation mitigation properties. Rats received localized X-irradiation of the heart with an image-guided irradiation technique. At 3 months after irradiation rats received oral treatment with vehicle, PTX, or PTX in combination with a tocotrienol-enriched formulation. At 6 months after irradiation, PTX-treated rats showed arrhythmia in 5 out of 14 animals. PTX alone or in combination with tocotrienols did not alter cardiac radiation fibrosis, left ventricular protein expression of the endothelial markers von Willebrand factor and neuregulin-1, or phosphorylation of the signal mediators Akt, Erk1/2, or PKCα. On the other hand, tocotrienols reduced cardiac numbers of mast cells and macrophages, but enhanced the expression of tissue factor. While this new rat model of localized heart irradiation does not support the use of PTX alone, the effects of tocotrienols on chronic manifestations of RIHD deserve further investigation.

  14. Medical applications of fast 3D cameras in real-time image-guided radiotherapy (IGRT) of cancer

    Science.gov (United States)

    Li, Shidong; Li, Tuotuo; Geng, Jason

    2013-03-01

    Dynamic volumetric medical imaging (4DMI) has reduced motion artifacts, increased early diagnosis of small mobile tumors, and improved target definition for treatment planning. High speed cameras for video, X-ray, or other forms of sequential imaging allow a live tracking of external or internal movement useful for real-time image-guided radiation therapy (IGRT). However, none of 4DMI can track real-time organ motion and no camera has correlated with 4DMI to show volumetric changes. With a brief review of various IGRT techniques, we propose a fast 3D camera for live-video stereovision, an automatic surface-motion identifier to classify body or respiratory motion, a mechanical model for synchronizing the external surface movement with the internal target displacement by combination use of the real-time stereovision and pre-treatment 4DMI, and dynamic multi-leaf collimation for adaptive aiming the moving target. Our preliminary results demonstrate that the technique is feasible and efficient in IGRT of mobile targets. A clinical trial has been initiated for validation of its spatial and temporal accuracies and dosimetric impact for intensity-modulated RT (IMRT), volumetric-modulated arc therapy (VMAT), and stereotactic body radiotherapy (SBRT) of any mobile tumors. The technique can be extended for surface-guided stereotactic needle insertion in biopsy of small lung nodules.

  15. A review of treatment planning for precision image-guided photon beam pre-clinical animal radiation studies.

    Science.gov (United States)

    Verhaegen, Frank; van Hoof, Stefan; Granton, Patrick V; Trani, Daniela

    2014-12-01

    Recently, precision irradiators integrated with a high-resolution CT imaging device became available for pre-clinical studies. These research platforms offer significant advantages over older generations of animal irradiators in terms of precision and accuracy of image-guided radiation targeting. These platforms are expected to play a significant role in defining experiments that will allow translation of research findings to the human clinical setting. In the field of radiotherapy, but also others such as neurology, the platforms create unique opportunities to explore e.g. the synergy between radiation and drugs or other agents. To fully exploit the advantages of this new technology, accurate methods are needed to plan the irradiation and to calculate the three-dimensional radiation dose distribution in the specimen. To this end, dedicated treatment planning systems are needed. In this review we will discuss specific issues for precision irradiation of small animals, we will describe the workflow of animal treatment planning, and we will examine several dose calculation algorithms (factorization, superposition-convolution, Monte Carlo simulation) used for animal irradiation with kilovolt photon beams. Issues such as dose reporting methods, photon scatter, tissue segmentation and motion will also be discussed briefly. Copyright © 2014. Published by Elsevier GmbH.

  16. Research into the usage of integrated jamming of IR weakening and smoke-screen resisting the IR imaging guided missiles

    Science.gov (United States)

    Wang, Long-tao; Jiang, Ning; Lv, Ming-shan

    2015-10-01

    With the emergence of the anti-ship missle with the capability of infrared imaging guidance, the traditional single jamming measures, because of the jamming mechanism and technical flaws or unsuitable use, greatly reduced the survival probability of the war-ship in the future naval battle. Intergrated jamming of IR weakening + smoke-screen Can not only make jamming to the search and tracking of IR imaging guidance system , but also has feasibility in conjunction, besides , which also make the best jamming effect. The research conclusion has important realistic meaning for raising the antimissile ability of surface ships. With the development of guidance technology, infrared guidance system has expanded by ir point-source homing guidance to infrared imaging guidance, Infrared imaging guidance has made breakthrough progress, Infrared imaging guidance system can use two-dimensional infrared image information of the target, achieve the precise tracking. Which has Higher guidance precision, better concealment, stronger anti-interference ability and could Target the key parts. The traditional single infrared smoke screen jamming or infrared decoy flare interference cannot be imposed effective interference. So, Research how to effectively fight against infrared imaging guided weapons threat measures and means, improving the surface ship antimissile ability is an urgent need to solve.

  17. FPGA-based High-Performance Collision Detection: An Enabling Technique for Image-Guided Robotic Surgery

    Directory of Open Access Journals (Sweden)

    Zhaorui Zhang

    2016-08-01

    Full Text Available Collision detection, which refers to the computational problem of finding the relative placement or con-figuration of two or more objects, is an essential component of many applications in computer graphics and robotics. In image-guided robotic surgery, real-time collision detection is critical for preserving healthy anatomical structures during the surgical procedure. However, the computational complexity of the problem usually results in algorithms that operate at low speed. In this paper, we present a fast and accurate algorithm for collision detection between Oriented-Bounding-Boxes (OBBs that is suitable for real-time implementation. Our proposed Sweep and Prune algorithm can perform a preliminary filtering to reduce the number of objects that need to be tested by the classical Separating Axis Test algorithm, while the OBB pairs of interest are preserved. These OBB pairs are re-checked by the Separating Axis Test algorithm to obtain accurate overlapping status between them. To accelerate the execution, our Sweep and Prune algorithm is tailor-made for the proposed method. Meanwhile, a high performance scalable hardware architecture is proposed by analyzing the intrinsic parallelism of our algorithm, and is implemented on FPGA platform. Results show that our hardware design on the FPGA platform can achieve around 8X higher running speed than the software design on a CPU platform. As a result, the proposed algorithm can achieve a collision frame rate of 1 KHz, and fulfill the requirement for the medical surgery scenario of Robot Assisted Laparoscopy.

  18. Influence of Acquisition Mode of Cone-beam Computed Tomography on Accuracy of Image Registration for Image-guided Radiotherapy.

    Science.gov (United States)

    Taniguchi, Takuya; Hara, Takanori; Shimozato, Tomohiro; Shiraki, Katsuhiko; Ohono, Kousei; Maejima, Ryousyuu

    2017-01-01

    Half scan can acquire images at the 200° rotation in image-guided radiation treatment using cone-beam CT and is useful to evaluate the influence of the half-scan-imaging start angle and imaging direction on image registration accuracy. The half-scan-imaging start angle is changed from 180° to 340° in the clockwise direction and from 180° to 20° in the counter clockwise direction to calculate the registration error. As a result, registration errors between -0.37 mm and 0.27 mm in the left and right directions occur because of the difference in the imaging start angle and approximately 0.3° in the gantry rotation direction because of the difference in the imaging direction. Because half scan does not have data for 360° rotation, depending on the subject structure, inconsistency of opposing data can lower reconstruction accuracy and cause a verification error. In addition, in image acquisition during rotation, the slower the shutter speed is, the more the actual gantry angle and angle information of the image are apart, which is considered the cause of rotation errors. Although these errors are very minute, it is thought that there is no influence on the treatment effect, but these errors are considered an evaluation item indispensable for ensuring the accuracy of high-precision radiation treatment. In addition, these errors need to be considered for ensuring the quality of high-precision radiation treatment.

  19. Commissioning and quality assurance of the X-ray volume Imaging system of an image-guided radiotherapy capable linear accelerator

    Directory of Open Access Journals (Sweden)

    Muralidhar K

    2008-01-01

    Full Text Available An Image-Guided Radiotherapy-capable linear accelerator (Elekta Synergy was installed at our hospital, which is equipped with a kV x-ray volume imaging (XVI system and electronic portal imaging device (iViewGT. The objective of this presentation is to describe the results of commissioning measurements carried out on the XVI facility to verify the manufacturer′s specifications and also to evolve a QA schedule which can be used to test its performance routinely. The QA program consists of a series of tests (safety features, geometric accuracy, and image quality. These tests were found to be useful to assess the performance of the XVI system and also proved that XVI system is very suitable for image-guided high-precision radiation therapy.

  20. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study

    DEFF Research Database (Denmark)

    LU, Fokdal; Sturdza, Alina; Mazeron, Renaud

    2016-01-01

    Background and purpose Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC/IS) applicat......Background and purpose Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC....../IS) applicators. The aim of this analysis was to evaluate the impact on local control and late morbidity of application of combined IS/IC brachytherapy in a large multicentre population. Material/methods 610 patients with LACC from the retroEMBRACE study were included. Patients were divided into an IC group (N...

  1. Near infrared imaging-guided photodynamic therapy under an extremely low energy of light by galactose targeted amphiphilic polypeptide micelle encapsulating BODIPY-Br2.

    Science.gov (United States)

    Liu, Le; Ruan, Zheng; Li, Tuanwei; Yuan, Pan; Yan, Lifeng

    2016-10-18

    Near infrared (NIR) imaging-guided photodynamic therapy (PDT) is attractive, especially the utilization of one dye as both a photosensitizer and fluorescent probe, and the as-synthesized BODIPY-Br 2 molecule is a candidate. Here, a galactose targeted amphiphilic copolymer of a polypeptide was synthesized and its micelles work as nanocarriers for BODIPY for targeting the NIR imaging-guided PDT of hepatoma cancer cells. At the same time, BODIPY could light up the cytoplasm for real-time imaging and kill cancer cells when the light was switched on. In vitro tests performed on both HepG2 and HeLa cells confirmed that the as-prepared PMAGP-POEGMA-PLys-B micelles showed efficient cell suppression of the cells with galactose receptors in the presence of light under an extremely low energy density (6.5 J cm -2 ). This protocol highlights the potential of polypeptides as biodegradable carriers for NIR image-guided and confined targeting photodynamic therapy.

  2. Safety and utility of image-guided research biopsies in relapsed high-grade serous ovarian carcinoma-experience of the BriTROC consortium.

    Science.gov (United States)

    Goranova, T; Ennis, D; Piskorz, A M; Macintyre, G; Lewsley, L A; Stobo, J; Wilson, C; Kay, D; Glasspool, R M; Lockley, M; Brockbank, E; Montes, A; Walther, A; Sundar, S; Edmondson, R; Hall, G D; Clamp, A; Gourley, C; Hall, M; Fotopoulou, C; Gabra, H; Freeman, S; Moore, L; Jimenez-Linan, M; Paul, J; Brenton, J D; McNeish, I A

    2017-05-09

    Investigating tumour evolution and acquired chemotherapy resistance requires analysis of sequential tumour material. We describe the feasibility of obtaining research biopsies in women with relapsed ovarian high-grade serous carcinoma (HGSC). Women with relapsed ovarian HGSC underwent either image-guided biopsy or intra-operative biopsy during secondary debulking, and samples were fixed in methanol-based fixative. Tagged-amplicon sequencing was performed on biopsy DNA. We screened 519 patients in order to enrol 220. Two hundred and two patients underwent successful biopsy, 118 of which were image-guided. There were 22 study-related adverse events (AE) in the image-guided biopsies, all grades 1 and 2; pain was the commonest AE. There were pre-specified significant AE in 3/118 biopsies (2.5%). 87% biopsies were fit-for-purpose for genomic analyses. Median DNA yield was 2.87 μg, and was higher in biopsies utilising 14 G or 16 G needles compared to 18 G. TP53 mutations were identified in 94.4% patients. Obtaining tumour biopsies for research in relapsed HGSC is safe and feasible. Adverse events are rare. The large majority of biopsies yield sufficient DNA for genomic analyses-we recommend use of larger gauge needles and methanol fixation for such biopsies, as DNA yields are higher but with no increase in AEs.

  3. Factors influencing the diagnostic yield and accuracy of image-guided percutaneous needle biopsy of pediatric tumors: single-center audit of a 26-year experience.

    Science.gov (United States)

    Blondiaux, Eléonore; Laurent, Méryle; Audureau, Etienne; Boudjemaa, Sabah; Sileo, Chiara; Lenoir, Marion; Dainese, Linda; Garel, Catherine; Coulomb, Aurore; Ducou le Pointe, Hubert

    2016-03-01

    Image-guided percutaneous core needle biopsy is a common procedure for diagnosis of both solid tumors and hematological malignancies in children. Despite recent improvements, a certain rate of non-diagnostic biopsies persists. To assess the factors influencing the diagnostic yield and accuracy of percutaneous core needle biopsies of pediatric tumors. We conducted a single-center retrospective study of a 26-year experience with image-guided biopsies in children and young adults. Using uni- and multivariate analysis, we evaluated the association of diagnostic yield and accuracy with technical factors (image-guided procedure, pathological technique) and clinical factors (complication rate, histological type and anatomical location). We retrieved data relating to 396 biopsies were performed in 363 children and young adults (mean age: 7.4 years). Overall, percutaneous core needle biopsy showed a diagnostic yield of 89.4% (95% confidence interval [CI] 85.9-92.2) and an accuracy of 90.9% (CI 87.6-93.6) with a complication rate of 2.5% (CI 1.2-4.6).The diagnostic yield increased with the use of advanced tissue assessment techniques (95.7% with immunohistochemistry versus 82.3% without immunohistochemistry; P advanced pathological techniques and an increased number of passes are the two main factors influencing the diagnostic success of biopsies in pediatric tumors.

  4. Late toxicity after intensity modulated and image guided radiation therapy for localized prostate cancer and post-prostatectomy patients.

    Science.gov (United States)

    Hunter, Grant K; Brockway, Kristin; Reddy, Chandana A; Rehman, Sana; Sheplan, Lawrence J; Stephans, Kevin L; Ciezki, Jay P; Xia, Ping; Tendulkar, Rahul D

    2013-01-01

    To examine late gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated for prostate cancer either definitively or post-prostatectomy with both intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT). A total of 333 patients treated definitively and 104 patients treated postoperatively with IMRT and varying IGRT techniques were retrospectively examined to evaluate GI and GU toxicity profiles >1 year from treatment. Available dosimetric data were used for correlative analysis. The median follow-up time for the definitive patients was 41 months and the median follow-up time for the post-prostatectomy patients was 33 months. No late grade 4 or 5 GI or GU toxicities were observed. For definitive patients, the rates of grade ≥2 GI and GU toxicity at 3 years were 4.9% and 4.5%, respectively. In the postoperative cohort the rate of grade >2 GU toxicity was 11.6%, with no grade ≥2 GI toxicity. In the definitive cohort's Cox proportional hazards regression univariate analysis, use of anticoagulation was significantly associated with GI toxicity and age, bladder V50 and IGRT modality were associated with GU toxicity, and only age remained significant in the multivariate model. In univariate analysis for the postoperative cohort, no dosimetric value correlated with GU toxicity, nor did age or time from radical prostatectomy to radiation. IMRT with IGRT achieved low rates of GI and GU toxicity in the definitive and postoperative setting. Copyright © 2013 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  5. Incidence of Post-ablation Syndrome Following Image-Guided Percutaneous Cryoablation of Renal Cell Carcinoma: A Prospective Study.

    Science.gov (United States)

    Zhong, Jim; Bambrook, Janette; Bhambra, Balbir; Smith, Jonathan; Cartledge, Jon; Ralph, Christy; Vasudev, Naveen; Whiteley, Simon; Wah, Tze

    2018-02-01

    To prospectively evaluate the incidence of post-ablation syndrome (fever and flu-like symptoms) and impact on the quality of life in the first 10 days following percutaneous image-guided cryoablation for renal cell carcinoma (RCC). A prospective study of all cryoablation procedures with biopsy proven RCC was conducted with institutional review board approval between 08/2012 and 04/2016. Sixty-four patients (43 males and 21 females) underwent cryoablation. Mean age was 68 (range 24-86). A telephone questionnaire survey was conducted on days 1, 3, 5, 7 and 10 following cryoablation, and complications were recorded. Data collected included temperature, degree of flu-like symptoms, severity of pain, percentage of pain relief with analgesics, interference with general activity and with work (graded on a 0-10 Numeric Intensity Scale). Following cryoablation, six patients (9%) out of 64 developed post-ablation syndrome. Thirty-three patients (52%) developed flu-like symptoms only, which completely resolved by day 10 in 25 patients (39%). One patient had pyrexia only, which was self- limiting by day 10. Twenty-four patients (38%) were asymptomatic. Pain (mean score = 2.1) and interference on general activities (mean score = 1.8) and work (mean score = 2) following cryoablation peaked on day 3 and improved subsequently. Forty-six patients (72%) had 90-100% pain relief by day 10. No major complications were observed. The full spectrum of post-ablation syndrome following cryoablation occurs in approximately 9% of patients; however, 61% of patients experience flu-like symptoms in the first 10 days, which are self-limiting.

  6. Internal target volume for post-hysterectomy vaginal recurrences of cervical cancers during image-guided radiotherapy.

    Science.gov (United States)

    Upasani, Maheshkumar N; Chopra, Supriya; Engineer, Reena; Mahantshetty, Umesh; Medhi, Seema; Mehta, Zubin; Shrivastava, Shyam K

    2015-10-01

    The outcome of post-surgical recurrences of cervical cancer may be improved through radiation dose escalation, which hinges on accurate identification and treatment of the target. The present study quantifies target motion during course of image-guided radiotherapy (IGRT) for vault cancers. All patients underwent planning CT simulation after bladder-filling protocol. A daily pre-treatment megavoltage CT was performed. All translations and rotations were recorded. Post-registration displacement of gross tumour volume (GTV) and centre of mass (COM) of GTV was independently recorded by two observers for fractions one to seven. Day 1 image sets served as reference images against which the displacements of COM were measured. We calculated the displacements of common volume (CV) and encompassing volume (EV) of GTV for both the observers. A total of 90 image data sets of 15 patients were available for evaluation. Individual patient GTV and average GTV by both the observers were comparable. The average shifts for EV were 2.4 mm [standard deviation (SD) ±1.2] in the mediolateral, 4.2 mm (SD ±2.8) in the anteroposterior and 4.0 mm (SD ±2.1) in superoinferior directions. Similarly, the average shifts for CV were 1.9 mm (SD ±0.6) in the mediolateral, 3.7 mm (SD ±2.7) in the anteroposterior and 4.4 mm (SD ±2.7) in superoinferior directions. Using Stroom's/van Herk's formula, the minimum recommended margins would be 4.5/5.2, 8.2/9.4 and 7.3/8.3 mm, respectively, for lateral, anteroposterior and superoinferior directions. Differential directional internal margin is recommended in patients undergoing IGRT for post-surgical recurrence of cervical cancers. Internal organ motion of vault cancers can be accounted for by a directional margin to the gross tumour.

  7. Molecular imaging-guided photothermal/photodynamic therapy against tumor by iRGD-modified indocyanine green nanoparticles.

    Science.gov (United States)

    Yan, Fei; Wu, Hao; Liu, Hongmei; Deng, Zhiting; Liu, Hong; Duan, Wanlu; Liu, Xin; Zheng, Hairong

    2016-02-28

    Multifunctional near-infrared (NIR) nanoparticles demonstrate great potential in tumor theranostic applications. To achieve the sensitive detection and effective phototherapy in the early stage of tumor genesis, it is highly desirable to improve the targeting of NIR theranostic agents to biomarkers and to enhance their accumulation in tumor. Here we report a novel targeted multifunctional theranostic nanoparticle, internalized RGD (iRGD)-modified indocyanine green (ICG) liposomes (iRGD-ICG-LPs), for molecular imaging-guided photothermal therapy (PTT) and photodynamic therapy (PDT) therapy against breast tumor. The iRGD peptides with high affinity to αvβ3 integrin and effective tumor-internalized property were firstly used to synthesize iRGD-PEG2000-DSPE lipopeptides, which were further utilized to fabricate the targeted ICG liposomes. The results indicated that iRGD-ICG-LPs exhibited excellent stability and could provide an accurate and sensitive detection of breast tumor through NIR fluorescence molecular imaging. We further employed this nanoparticle for tumor theranostic application, demonstrating significantly higher tumor accumulation and tumor inhibition efficacy through PTT/PDT effects. Histological analysis further revealed much more apoptotic cells, confirming the advantageous anti-tumor effect of iRGD-ICG-LPs over non-targeted ICG-LPs. Notably, the targeting therapy mediated by iRGD provides almost equivalent anti-tumor efficacy at a 12.5-fold lower drug dose than that by monoclonal antibody, and no tumor recurrence and obvious treatment-induced toxicity were observed in our study. Our study provides a promising strategy to realize the sensitive detection and effective treatment of tumors by integrating molecular imaging into PTT/PDT therapy. Copyright © 2015. Published by Elsevier B.V.

  8. Polymeric micelles as a diagnostic tool for image-guided drug delivery and radiotherapy of HER2 overexpressing breast cancer

    Science.gov (United States)

    Hoang, Nu Bryan

    Block copolymer micelles have emerged as a viable formulation strategy with several drugs relying on this technology in clinical evaluation. To date, information on the tumor penetration and intratumoral distribution of block copolymer micelles (BCM) has been quite limited. Thus, there is impetus to develop a radiolabeled formulation that can be used to gain invaluable insight into the intratumoral distribution of the BCMs. This information could then be used to direct formulation strategies as a means to optimize treatment outcomes. This thesis describes the synthesis and characterization of a targeted block copolymer micelle system based on poly(ethylene glycol)-block -poly(epsilon-caprolactone) labeled with the radionuclide Indium-111 (111In). The incorporation of the imageable component, 111In permits pursuit of image-guided drug delivery for real-time monitoring of tumor localization and intratumoral distribution. Intracellular trafficking of drugs and therapies such as Auger electron emitting radionuclides to perinuclear and nuclear regions of cells is critical to realizing their full therapeutic potential. HER2 specific antibodies (trastuzumab fab fragments) and nuclear localization signal peptides were conjugated to the surface of the BCMs to direct uptake in HER2 expressing cells and subsequent localization in the cell nucleus. Cell uptake was HER2 density dependent, confirming receptor-mediated internalization of the BCMs. Importantly, conjugation of NLS resulted in a significant increase in nuclear uptake of the radionuclide 111In. Successful nuclear targeting was shown to improve the antiproliferative effect of the Auger electrons. In addition, a significant radiation enhancement effect was observed by concurrent delivery of low-dose MTX and 111In in all breast cancer cell lines evaluated. Imaging enabled the accurate quantification of the specific tumor uptake of the micelles and visualization of their degree of tumor penetration in relation to

  9. Image-guided radiotherapy in near real time with intensity-modulated radiotherapy megavoltage treatment beam imaging.

    Science.gov (United States)

    Mao, Weihua; Hsu, Annie; Riaz, Nadeem; Lee, Louis; Wiersma, Rodney; Luxton, Gary; King, Christopher; Xing, Lei; Solberg, Timothy

    2009-10-01

    To utilize image-guided radiotherapy (IGRT) in near real time by obtaining and evaluating the online positions of implanted fiducials from continuous electronic portal imaging device (EPID) imaging of prostate intensity-modulated radiotherapy (IMRT) delivery. Upon initial setup using two orthogonal images, the three-dimensional (3D) positions of all implanted fiducial markers are obtained, and their expected two-dimensional (2D) locations in the beam's-eye-view (BEV) projection are calculated for each treatment field. During IMRT beam delivery, EPID images of the megavoltage treatment beam are acquired in cine mode and subsequently analyzed to locate 2D locations of fiducials in the BEV. Simultaneously, 3D positions are estimated according to the current EPID image, information from the setup portal images, and images acquired at other gantry angles (the completed treatment fields). The measured 2D and 3D positions of each fiducial are compared with their expected 2D and 3D setup positions, respectively. Any displacements larger than a predefined tolerance may cause the treatment system to suspend the beam delivery and direct the therapists to reposition the patient. Phantom studies indicate that the accuracy of 2D BEV and 3D tracking are better than 1 mm and 1.4 mm, respectively. A total of 7330 images from prostate treatments were acquired and analyzed, showing a maximum 2D displacement of 6.7 mm and a maximum 3D displacement of 6.9 mm over 34 fractions. This EPID-based, real-time IGRT method can be implemented on any external beam machine with portal imaging capabilities without purchasing any additional equipment, and there is no extra dose delivered to the patient.

  10. Projector-Based Augmented Reality for Intuitive Intraoperative Guidance in Image-Guided 3D Interstitial Brachytherapy

    International Nuclear Information System (INIS)

    Krempien, Robert; Hoppe, Harald; Kahrs, Lueder; Daeuber, Sascha; Schorr, Oliver; Eggers, Georg; Bischof, Marc; Munter, Marc W.; Debus, Juergen; Harms, Wolfgang

    2008-01-01

    Purpose: The aim of this study is to implement augmented reality in real-time image-guided interstitial brachytherapy to allow an intuitive real-time intraoperative orientation. Methods and Materials: The developed system consists of a common video projector, two high-resolution charge coupled device cameras, and an off-the-shelf notebook. The projector was used as a scanning device by projecting coded-light patterns to register the patient and superimpose the operating field with planning data and additional information in arbitrary colors. Subsequent movements of the nonfixed patient were detected by means of stereoscopically tracking passive markers attached to the patient. Results: In a first clinical study, we evaluated the whole process chain from image acquisition to data projection and determined overall accuracy with 10 patients undergoing implantation. The described method enabled the surgeon to visualize planning data on top of any preoperatively segmented and triangulated surface (skin) with direct line of sight during the operation. Furthermore, the tracking system allowed dynamic adjustment of the data to the patient's current position and therefore eliminated the need for rigid fixation. Because of soft-part displacement, we obtained an average deviation of 1.1 mm by moving the patient, whereas changing the projector's position resulted in an average deviation of 0.9 mm. Mean deviation of all needles of an implant was 1.4 mm (range, 0.3-2.7 mm). Conclusions: The developed low-cost augmented-reality system proved to be accurate and feasible in interstitial brachytherapy. The system meets clinical demands and enables intuitive real-time intraoperative orientation and monitoring of needle implantation

  11. Image-guided radiotherapy for liver cancer using respiratory-correlated computed tomography and cone-beam computed tomography.

    Science.gov (United States)

    Guckenberger, Matthias; Sweeney, Reinhart A; Wilbert, Juergen; Krieger, Thomas; Richter, Anne; Baier, Kurt; Mueller, Gerd; Sauer, Otto; Flentje, Michael

    2008-05-01

    To evaluate a novel four-dimensional (4D) image-guided radiotherapy (IGRT) technique in stereotactic body RT for liver tumors. For 11 patients with 13 intrahepatic tumors, a respiratory-correlated 4D computed tomography (CT) scan was acquired at treatment planning. The target was defined using CT series reconstructed at end-inhalation and end-exhalation. The liver was delineated on these two CT series and served as a reference for image guidance. A cone-beam CT scan was acquired after patient positioning; the blurred diaphragm dome was interpreted as a probability density function showing the motion range of the liver. Manual contour matching of the liver structures from the planning 4D CT scan with the cone-beam CT scan was performed. Inter- and intrafractional uncertainties of target position and motion range were evaluated, and interobserver variability of the 4D-IGRT technique was tested. The workflow of 4D-IGRT was successfully practiced in all patients. The absolute error in the liver position and error in relation to the bony anatomy was 8 +/- 4 mm and 5 +/- 2 mm (three-dimensional vector), respectively. Margins of 4-6 mm were calculated for compensation of the intrafractional drifts of the liver. The motion range of the diaphragm dome was reproducible within 5 mm for 11 of 13 lesions, and the interobserver variability of the 4D-IGRT technique was small (standard deviation, 1.5 mm). In 4 patients, the position of the intrahepatic lesion was directly verified using a mobile in-room CT scanner after application of intravenous contrast. The results of our study have shown that 4D image guidance using liver contour matching between respiratory-correlated CT and cone-beam CT scans increased the accuracy compared with stereotactic positioning and compared with IGRT without consideration of breathing motion.

  12. Effect of imaging frequency on PTV margins and geographical miss during image guided radiation therapy for prostate cancer.

    Science.gov (United States)

    Gupta, Meetakshi; Gamre, Poonam; Kannan, Sadhana; Rokde, Ganesh; Krishnatry, Rahul; Murthy, Vedang

    The relationship between frequency of imaging during image guided radiation therapy (IGRT) and planning target volume (PTV) margin remains unclear. This issue is of practical significance given resource and time intensive nature of IGRT. The purpose of this study was to evaluate PTV margins with predefined and commonly used less-than-daily IGRT schedules using data obtained from patients treated with daily IGRT for prostate cancer. Daily setup error and 3-dimensional daily alignment data for a total of 108 consecutive patients with prostate cancer treated with 2700 fractions of daily image guidance on tomotherapy were retrospectively analyzed. Five IGRT scenarios were simulated: alternate day, twice weekly, once weekly, first 3 days only, and no image guidance. The daily alignment data were modeled to simulate the 5 predefined scenarios by applying appropriate corrections to determine the PTV margin for each image guidance scenario. The data were also analyzed to predict possible geographical miss in any direction using 2 frequently used PTV margins of 7 and 5 mm for all the scenarios. Decreasing the frequency of image guidance increased the mean systematic error and the standard deviation of the systematic error. With decreased image guidance frequency, an increase in PTV margins was required to achieve adequate coverage of the clinical target volume. With reduction in image guidance from 50% to 12%, a gradual increase in percentage of fractions with predicted geographical miss using an isotropic PTV margin of 7 or 5 mm was seen. With every 15% decrease in imaging, a 5% increased risk of geographical miss was estimated. The use of less-than-daily IGRT requires larger PTV margins for patients treated with intensity modulated radiation therapy for prostate cancer. With every 15% reduction, a 5% increased risk of geographical miss was estimated. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  13. Multi-centre experience of implementing image-guided intensity-modulated radiotherapy using the TomoTherapy platform

    International Nuclear Information System (INIS)

    Dean, J.C.; Tudor, G.S.J.; Mott, J.H.; Dunlop, P.R.; Morris, S.L.; Harron, E.C.; Christian, J.A.; Sanghera, P.; Elsworthy, M.; Burnet, N.G.

    2013-01-01

    Use of image guided (IG) intensity modulated radiotherapy (IMRT) is increasing, and helical tomotherapy provides an effective, integrated solution. Practical experience of implementation, shared at a recent UK TomoTherapy Users' meeting, may help centres introducing these techniques using TomoTherapy or other platforms. Seven centres participated, with data shared from 6, varying from 2500 - 4800 new patients per year. Case selection of patients “most likely” to benefit from IG-IMRT was managed in all centres by multi-professional groups comprising clinical oncologists, physicists, treatment planners and radiographers. Radical treatments ranged from 94% to 100%. The proportions of tumour types varied substantially: head and neck: range 0%–100% (mean of centres 50%), prostate: 3%–96% (mean of centres 28%). Head and neck cases were considered most likely to benefit from IMRT, prostate cases from IGRT, or IG-IMRT if pelvic nodes were being treated. IMRT was also selected for complex target volumes, to avoid field junctions, for technical treatment difficulties, and retreatments. Across the centres, every patient was imaged every day, with positional correction before treatment. In one centre, for prostate patients including pelvic treatment, the pelvis was also imaged weekly. All centres had designed a ‘ramp up’ of patient numbers, which was similar in 5. One centre, treating 96% prostate patients, started with 3 and increased to 36 patients per day within 3 months. The variation in case mix implies wide applicability of IG-IMRT. Daily on-line IGRT with IMRT can be routinely implemented into busy departments

  14. Percutaneous Image-Guided Cryoablation of Challenging Mediastinal Lesions Using Large-Volume Hydrodissection: Technical Considerations and Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Garnon, Julien, E-mail: juliengarnon@gmail.com; Koch, Guillaume, E-mail: Guillaume.koch@gmail.com; Caudrelier, Jean, E-mail: caudjean@yahoo.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France); Ramamurthy, Nitin, E-mail: Nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Rao, Pramod, E-mail: pramodrao@me.com [University of Strasbourg, ICube (France); Tsoumakidou, Georgia, E-mail: Georgia.tsoumakidou@chru-strasbourg.fr; Cazzato, Roberto Luigi, E-mail: cazzatorobertoluigi@gmail.com; Gangi, Afshin, E-mail: Afshin.gangi@chru-strasbourg.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France)

    2016-11-15

    ObjectiveThis study was designed to describe the technique of percutaneous image-guided cryoablation with large-volume hydrodissection for the treatment of challenging mediastinal lesions.MethodsBetween March 2014 and June 2015, three patients (mean age 62.7 years) with four neoplastic anterior mediastinal lesions underwent five cryoablation procedures using large-volume hydrodissection. Procedures were performed under general anaesthesia using CT guidance. Lesion characteristics, hydrodissection and cryoablation data, technical success, complications, and clinical outcomes were assessed using retrospective chart review.ResultsLesions (mean size 2.7 cm; range 2–4.3 cm) were in contact with great vessels (n = 13), trachea (n = 3), and mediastinal nerves (n = 6). Hydrodissection was performed intercostally (n = 4), suprasternally (n = 2), transsternally (n = 1), or via the sternoclavicular joint (n = 1) using 1–3 spinal needles over 13.4 (range 7–26) minutes; 450 ml of dilute contrast was injected (range 300–600 ml) and increased mean lesion-collateral structure distance from 1.9 to 7.7 mm. Vulnerable mediastinal nerves were identified in four of five procedures. Technical success was 100 %, with one immediate complication (recurrent laryngeal nerve injury). Mean follow-up period was 15 months. One lesion demonstrated residual disease on restaging PET-CT and was retreated to achieve complete ablation. At last follow-up, two patients remained disease-free, and one patient developed distant disease after 1 year without local recurrence.ConclusionsCryoablation using large-volume hydrodissection is a feasible technique, enabling safe and effective treatment of challenging mediastinal lesions.

  15. Biological in situ Dose Painting for Image-Guided Radiation Therapy Using Drug-Loaded Implantable Devices

    International Nuclear Information System (INIS)

    Cormack, Robert A.; Sridhar, Srinivas; Suh, W. Warren; D'Amico, Anthony V.; Makrigiorgos, G. Mike

    2010-01-01

    Purpose: Implantable devices routinely used for increasing spatial accuracy in modern image-guided radiation treatments (IGRT), such as fiducials or brachytherapy spacers, encompass the potential for in situ release of biologically active drugs, providing an opportunity to enhance the therapeutic ratio. We model this new approach for two types of treatment. Methods and Materials: Radiopaque fiducials used in IGRT, or prostate brachytherapy spacers ('eluters'), were assumed to be loaded with radiosensitizer for in situ drug slow release. An analytic function describing the concentration of radiosensitizer versus distance from eluters, depending on diffusion-elimination properties of the drug in tissue, was developed. Tumor coverage by the drug was modeled for tumors typical of lung stereotactic body radiation therapy treatments for various eluter dimensions and drug properties. Six prostate 125 I brachytherapy cases were analyzed by assuming implantation of drug-loaded spacers. Radiosensitizer-induced subvolume boost was simulated from which biologically effective doses for typical radiosensitizers were calculated in one example. Results: Drug distributions from three-dimensional arrangements of drug eluters versus eluter size and drug properties were tabulated. Four radiosensitizer-loaded fiducials provide adequate radiosensitization for ∼4-cm-diameter lung tumors, thus potentially boosting biologically equivalent doses in centrally located stereotactic body treated lesions. Similarly, multiple drug-loaded spacers provide prostate brachytherapy with flexible shaping of 'biologically equivalent doses' to fit requirements difficult to meet by using radiation alone, e.g., boosting a high-risk region juxtaposed to the urethra while respecting normal tissue tolerance of both the urethra and the rectum. Conclusions: Drug loading of implantable devices routinely used in IGRT provides new opportunities for therapy modulation via biological in situ dose painting.

  16. Emulation of the laparoscopic environment for image-guided liver surgery via an abdominal phantom system with anatomical ligamenture

    Science.gov (United States)

    Heiselman, Jon S.; Collins, Jarrod A.; Clements, Logan W.; Weis, Jared A.; Simpson, Amber L.; Geevarghese, Sunil K.; Jarnagin, William R.; Miga, Michael I.

    2017-03-01

    In order to rigorously validate techniques for image-guided liver surgery (IGLS), an accurate mock representation of the intraoperative surgical scene with quantifiable localization of subsurface targets would be highly desirable. However, many attempts to reproduce the laparoscopic environment have encountered limited success due to neglect of several crucial design aspects. The laparoscopic setting is complicated by factors such as gas insufflation of the abdomen, changes in patient orientation, incomplete organ mobilization from ligaments, and limited access to organ surface data. The ability to accurately represent the influences of anatomical changes and procedural limitations is critical for appropriate evaluation of IGLS methodologies such as registration and deformation correction. However, these influences have not yet been comprehensively integrated into a platform usable for assessment of methods in laparoscopic IGLS. In this work, a mock laparoscopic liver simulator was created with realistic ligamenture to emulate the complexities of this constrained surgical environment for the realization of laparoscopic IGLS. The mock surgical system reproduces an insufflated abdominal cavity with dissectible ligaments, variable levels of incline matching intraoperative patient positioning, and port locations in accordance with surgical protocol. True positions of targets embedded in a tissue-mimicking phantom are measured from CT images. Using this setup, image-to-physical registration accuracy was evaluated for simulations of laparoscopic right and left lobe mobilization to assess rigid registration performance under more realistic laparoscopic conditions. Preliminary results suggest that non-rigid organ deformations and the region of organ surface data collected affect the ability to attain highly accurate registrations in laparoscopic applications.

  17. Cone-beam CT with a flat-panel detector: From image science to image-guided surgery

    Science.gov (United States)

    Siewerdsen, Jeffrey H.

    2011-08-01

    The development of large-area flat-panel X-ray detectors (FPDs) has spurred investigation in a spectrum of advanced medical imaging applications, including tomosynthesis and cone-beam CT (CBCT). Recent research has extended image quality metrics and theoretical models to such applications, providing a quantitative foundation for the assessment of imaging performance as well as a general framework for the design, optimization, and translation of such technologies to new applications. For example, cascaded systems models of the Fourier domain metrics, such as noise-equivalent quanta (NEQ), have been extended to these modalities to describe the propagation of signal and noise through the image acquisition and reconstruction chain and to quantify the factors that govern spatial resolution, image noise, and detectability. Moreover, such models have demonstrated basic agreement with human observer performance for a broad range of imaging conditions and imaging tasks. These developments in image science have formed a foundation for the knowledgeable development and translation of CBCT to new applications in image-guided interventions—for example, CBCT implemented on a mobile surgical C-arm for intraoperative 3D imaging. The ability to acquire high-quality 3D images on demand during surgical intervention overcomes conventional limitations of surgical guidance in the context of preoperative images alone. A prototype mobile C-arm developed in academic-industry partnership demonstrates CBCT with low radiation dose, sub-mm spatial resolution, and soft-tissue visibility potentially approaching that of diagnostic CT. Integration of the 3D imaging system with real-time tracking, deformable registration, endoscopic video, and 3D visualization offers a promising addition to the surgical arsenal in interventions ranging from head-and-neck/skull base surgery to spine, orthopaedic, thoracic, and abdominal surgeries. Cadaver studies show the potential for significant boosts in

  18. Comparison of keratometric measurements obtained by the Verion Image Guided System with optical biometry and auto-keratorefractometer.

    Science.gov (United States)

    Asena, Leyla; Güngör, Sirel Gür; Akman, Ahmet

    2017-04-01

    The aim of this study was to compare the keratometric measurements of Verion Image Guided System with an optical biometer (Zeiss IOLMaster 500, Carl Zeiss Meditec, Jena, Germany) and an automated keratorefractometer (AKR) (Topcon KR-8900, Topcon, Japan). In this prospective clinical trial, the right eyes of 52 patients with cataract were examined (mean age 62.25 ± 12.16 years). The measurements were taken by the three systems in a random order. Keratometric data, magnitude of astigmatism, and astigmatic axis measurements from all three instruments were compared. The results were evaluated using, intraclass correlation coefficients (ICC), Bland-Altman plots, and paired samples t tests. The mean flat/steep K of Verion, IOLMaster, and AKR were 43.22 ± 1.38D/44.23 ± 1.46D, 43.07 ± 1.26D/44.05 ± 1.34D, and 43.07 ± 1.31D/43.89 ± 1.42D, respectively. Flat K readings of Verion were higher than IOLMaster and AKR (p 20° in 9 eyes; the same difference was 30, 11, and 11 eyes, respectively, between Verion and IOLMaster. Although, keratometric and astigmatic results obtained from Verion were not completely interchangeable with IOLMaster and AKR, especially the agreement between Verion and IOLMaster was excellent with ICCs close to one. However, there were pronounced astigmatic axis measurement differences between three instruments.

  19. Bioinspired Multifunctional Melanin-Based Nanoliposome for Photoacoustic/Magnetic Resonance Imaging-Guided Efficient Photothermal Ablation of Cancer.

    Science.gov (United States)

    Zhang, Liang; Sheng, Danli; Wang, Dong; Yao, Yuanzhi; Yang, Ke; Wang, Zhigang; Deng, Liming; Chen, Yu

    2018-01-01

    Background: The construction of theranostic nanosystems with concurrently high biosafety and therapeutic performance is a challenge but has great significance for the clinical translation of nanomedicine for combating cancer. Methods: Bio-inspired melanin-based nanoliposomes (Lip-Mel) as theranostic agents were constructed for simultaneous photoacoustic (PA) imaging- and T 1 -weighted magnetic resonance (MR) imaging-guided photothermal ablation of tumors, which was demonstrated both in vitro and in vivo . The high biosafety of Lip-Mel was also systematically evaluated. Results: The achieved Lip-Mel nanoliposomes demonstrated their imaging capability for both PA and T 1 -weighted MR imaging (r 1 = 0.25 mM -1 ·s -1 ) both in vitro and in vivo , providing the potential for therapeutic guidance and monitoring. Importantly, the desirable photothermal-conversion efficiency of the as-prepared Lip-Mel achieved complete eradication of tumors in breast cancer-bearing mice, exhibiting remarkable photothermal-based therapeutic performance. In particular, the efficient encapsulation of melanin into the PEGylated liposome mitigated the potential toxicity of melanin and improved the photothermal performance of the loaded melanin. Systematic in vivo biosafety evaluations demonstrated the high biocompatibility of Lip-Mel at a high dose of 100 mg/kg. Conclusion: In this work, we reported a bioinspired strategy where melanin, a natural product in the human body, is encapsulated into PEGylated nanoliposomes for efficient theranostics with high biocompatibility. This work provides a new strategy for creating desirable theranostic agents with concurrent high biocompatibility and satisfactory theranostic performance through the use of materials that totally originate from biosystems.

  20. Intraoperative landmarking of vascular anatomy by integration of duplex and Doppler ultrasonography in image-guided surgery. Technical note.

    Science.gov (United States)

    Sure, Ulrich; Benes, Ludwig; Bozinov, Oliver; Woydt, Michael; Tirakotai, Wuttipong; Bertalanffy, Helmut

    2005-02-01

    The integration of ultrasound technology into neuronavigation systems has recently been the subject of reports by several groups. This article describes our preliminary findings with regard to the integration of data derived from intraoperative duplex (color mode) and Doppler ultrasonography into a neuronavigational data set. It was the aim of the study to investigate (1) whether the intraoperative landmarking of vessels that are outlined with ultrasound technology is possible and (2) whether such a technique might be of clinical interest for neurosurgical interventions. The video image of an ultrasound plane (Toshiba, Powervision 6000 SSA-370A, Tokyo, Japan) was integrated into our neuronavigation system (VectorVision2, BrainLab, Heimstetten, Germany). For calibration of the ultrasound plane, an instrument adapter was fixed to the ultrasound probe and then calibrated using a special, predefined calibration phantom. Accordingly, the system supported a combination of the ultrasound plane functionality with the preoperatively acquired neuronavigational data. The duplex and Doppler mode of the ultrasound system displayed the intraoperative vascular anatomy. Once a vessel was outlined during surgery, it could be landmarked by touching the navigation screen. These landmarks were integrated automatically into the neuronavigational data set and could be used to provide intraoperative image updates of the vascular anatomy. This technique was successful in 45 of 47 (95.7%) surgical interventions. Both image-guided ultrasound and duplex-guided integration of vascular anatomy into the neuronavigational data set are technically possible. In the future, this technology may provide useful intraoperative information during surgery of complex cerebral pathologies.

  1. Evaluation of conoscopic holography for estimating tumor resection cavities in model-based image-guided neurosurgery.

    Science.gov (United States)

    Simpson, Amber L; Sun, Kay; Pheiffer, Thomas S; Rucker, D Caleb; Sills, Allen K; Thompson, Reid C; Miga, Michael I

    2014-06-01

    Surgical navigation relies on accurately mapping the intraoperative state of the patient to models derived from preoperative images. In image-guided neurosurgery, soft tissue deformations are common and have been shown to compromise the accuracy of guidance systems. In lieu of whole-brain intraoperative imaging, some advocate the use of intraoperatively acquired sparse data from laser-range scans, ultrasound imaging, or stereo reconstruction coupled with a computational model to drive subsurface deformations. Some authors have reported on compensating for brain sag, swelling, retraction, and the application of pharmaceuticals such as mannitol with these models. To date, strategies for modeling tissue resection have been limited. In this paper, we report our experiences with a novel digitization approach, called a conoprobe, to document tissue resection cavities and assess the impact of resection on model-based guidance systems. Specifically, the conoprobe was used to digitize the interior of the resection cavity during eight brain tumor resection surgeries and then compared against model prediction results of tumor locations. We should note that no effort was made to incorporate resection into the model but rather the objective was to determine if measurement was possible to study the impact on modeling tissue resection. In addition, the digitized resection cavity was compared with early postoperative MRI scans to determine whether these scans can further inform tissue resection. The results demonstrate benefit in model correction despite not having resection explicitly modeled. However, results also indicate the challenge that resection provides for model-correction approaches. With respect to the digitization technology, it is clear that the conoprobe provides important real-time data regarding resection and adds another dimension to our noncontact instrumentation framework for soft-tissue deformation compensation in guidance systems.

  2. Comparison Between Infrared Optical and Stereoscopic X-Ray Technologies for Patient Setup in Image Guided Stereotactic Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Tagaste, Barbara, E-mail: tagaste@cnao.it [Division of Radiation Oncology, European Institute of Oncology, Milano (Italy); Centro Nazionale di Adroterapia Oncologica, Pavia (Italy); Riboldi, Marco [Centro Nazionale di Adroterapia Oncologica, Pavia (Italy); TBM Lab, Department of Bioengineering, Politecnico di Milano University, Milano (Italy); Spadea, Maria F. [TBM Lab, Department of Bioengineering, Politecnico di Milano University, Milano (Italy); Department of Experimental and Clinical Medicine, Universita degli Studi Magna Graecia, Catanzaro (Italy); Bellante, Simone [TBM Lab, Department of Bioengineering, Politecnico di Milano University, Milano (Italy); Baroni, Guido [Centro Nazionale di Adroterapia Oncologica, Pavia (Italy); TBM Lab, Department of Bioengineering, Politecnico di Milano University, Milano (Italy); Cambria, Raffaella; Garibaldi, Cristina [Medical Physics, European Institute of Oncology, Milano (Italy); Ciocca, Mario [Centro Nazionale di Adroterapia Oncologica, Pavia (Italy); Medical Physics, European Institute of Oncology, Milano (Italy); Catalano, Gianpiero [Division of Radiation Oncology, European Institute of Oncology, Milano (Italy); Unit of Radiotherapy, Multimedica Holding Clinical Institute, Castellanza (Italy); Alterio, Daniela [Division of Radiation Oncology, European Institute of Oncology, Milano (Italy); Orecchia, Roberto [Division of Radiation Oncology, European Institute of Oncology, Milano (Italy); Centro Nazionale di Adroterapia Oncologica, Pavia (Italy); Department of Science and Biomedical Technologies, Universita di Milano, Milano (Italy)

    2012-04-01

    Purpose: To compare infrared (IR) optical vs. stereoscopic X-ray technologies for patient setup in image-guided stereotactic radiotherapy. Methods and Materials: Retrospective data analysis of 233 fractions in 127 patients treated with hypofractionated stereotactic radiotherapy was performed. Patient setup at the linear accelerator was carried out by means of combined IR optical localization and stereoscopic X-ray image fusion in 6 degrees of freedom (6D). Data were analyzed to evaluate the geometric and dosimetric discrepancy between the two patient setup strategies. Results: Differences between IR optical localization and 6D X-ray image fusion parameters were on average within the expected localization accuracy, as limited by CT image resolution (3 mm). A disagreement between the two systems below 1 mm in all directions was measured in patients treated for cranial tumors. In extracranial sites, larger discrepancies and higher variability were observed as a function of the initial patient alignment. The compensation of IR-detected rotational errors resulted in a significantly improved agreement with 6D X-ray image fusion. On the basis of the bony anatomy registrations, the measured differences were found not to be sensitive to patient breathing. The related dosimetric analysis showed that IR-based patient setup caused limited variations in three cases, with 7% maximum dose reduction in the clinical target volume and no dose increase in organs at risk. Conclusions: In conclusion, patient setup driven by IR external surrogates localization in 6D featured comparable accuracy with respect to procedures based on stereoscopic X-ray imaging.

  3. Uterine perforation – 5-year experience in 3-D image guided gynaecological brachytherapy at Institute of Oncology Ljubljana

    International Nuclear Information System (INIS)

    Segedin, Barbara; Gugic, Jasenka; Petric, Primoz

    2013-01-01

    Accurate applicator placement is a precondition for the success of gynaecological brachytherapy (BT). Unrecognized uterine perforation can lead to bleeding, infection, high doses to pelvic organs and underdosage of the target volume, resulting in acute morbidity, long-term complications and reduced chance of cure. We aimed to assess the incidence and clinical characteristics of our cases with uterine perforation, review their management and impact on the treatment course. In all patients, treated with utero-vaginal image guided BT for gynaecological cancer between January 2006 and December 2011, the CT/MR images with the applicator in place were reviewed. The incidence of uterine perforations was recorded. Clinical factors that may have predisposed to increased risk of perforation were recorded. Management of perforations and their impact on treatment course was assessed. 219 patients (428 applications) were suitable for analysis. Uterine perforation was found in 13 (3.0%) applications in 10 (4.6%) patients. The most frequent perforation site was posterior uterine wall (n = 9), followed by anterior wall (n = 2) and fundus (n = 2). All cases were managed conservatively, without complications. Prophylactic antibiotics were administered in 8 cases. In 4 patients, abdominal and/or transrectal ultrasound (US) guidance was used on subsequent applications for applicator insertion; adequate applicator placement was achieved and treatment completed as planned in all cases. 3D imaging for BT planning enables accurate identification of uterine perforations. The incidence of perforations at our department is one of the lowest reported in the literature. US guidance of applicator insertion is useful and feasible, allowing to complete the planned treatment even in challenging cases

  4. Impact of Computed Tomography Image Quality on Image-Guided Radiation Therapy Based on Soft Tissue Registration

    International Nuclear Information System (INIS)

    Morrow, Natalya V.; Lawton, Colleen A.; Qi, X. Sharon; Li, X. Allen

    2012-01-01

    Purpose: In image-guided radiation therapy (IGRT), different computed tomography (CT) modalities with varying image quality are being used to correct for interfractional variations in patient set-up and anatomy changes, thereby reducing clinical target volume to the planning target volume (CTV-to-PTV) margins. We explore how CT image quality affects patient repositioning and CTV-to-PTV margins in soft tissue registration-based IGRT for prostate cancer patients. Methods and Materials: Four CT-based IGRT modalities used for prostate RT were considered in this study: MV fan beam CT (MVFBCT) (Tomotherapy), MV cone beam CT (MVCBCT) (MVision; Siemens), kV fan beam CT (kVFBCT) (CTVision, Siemens), and kV cone beam CT (kVCBCT) (Synergy; Elekta). Daily shifts were determined by manual registration to achieve the best soft tissue agreement. Effect of image quality on patient repositioning was determined by statistical analysis of daily shifts for 136 patients (34 per modality). Inter- and intraobserver variability of soft tissue registration was evaluated based on the registration of a representative scan for each CT modality with its corresponding planning scan. Results: Superior image quality with the kVFBCT resulted in reduced uncertainty in soft tissue registration during IGRT compared with other image modalities for IGRT. The largest interobserver variations of soft tissue registration were 1.1 mm, 2.5 mm, 2.6 mm, and 3.2 mm for kVFBCT, kVCBCT, MVFBCT, and MVCBCT, respectively. Conclusions: Image quality adversely affects the reproducibility of soft tissue-based registration for IGRT and necessitates a careful consideration of residual uncertainties in determining different CTV-to-PTV margins for IGRT using different image modalities.

  5. Total error shift patterns for daily CT on rails image-guided radiotherapy to the prostate bed

    Directory of Open Access Journals (Sweden)

    Mota Helvecio C

    2011-10-01

    Full Text Available Abstract Background To evaluate the daily total error shift patterns on post-prostatectomy patients undergoing image guided radiotherapy (IGRT with a diagnostic quality computer tomography (CT on rails system. Methods A total of 17 consecutive post-prostatectomy patients receiving adjuvant or salvage IMRT using CT-on-rails IGRT were analyzed. The prostate bed's daily total error shifts were evaluated for a total of 661 CT scans. Results In the right-left, cranial-caudal, and posterior-anterior directions, 11.5%, 9.2%, and 6.5% of the 661 scans required no position adjustments; 75.3%, 66.1%, and 56.8% required a shift of 1 - 5 mm; 11.5%, 20.9%, and 31.2% required a shift of 6 - 10 mm; and 1.7%, 3.8%, and 5.5% required a shift of more than 10 mm, respectively. There was evidence of correlation between the x and y, x and z, and y and z axes in 3, 3, and 3 of 17 patients, respectively. Univariate (ANOVA analysis showed that the total error pattern was random in the x, y, and z axis for 10, 5, and 2 of 17 patients, respectively, and systematic for the rest. Multivariate (MANOVA analysis showed that the (x,y, (x,z, (y,z, and (x, y, z total error pattern was random in 5, 1, 1, and 1 of 17 patients, respectively, and systematic for the rest. Conclusions The overall daily total error shift pattern for these 17 patients simulated with an empty bladder, and treated with CT on rails IGRT was predominantly systematic. Despite this, the temporal vector trends showed complex behaviors and unpredictable changes in magnitude and direction. These findings highlight the importance of using daily IGRT in post-prostatectomy patients.

  6. Improved accuracy of markerless motion tracking on bone suppression images: preliminary study for image-guided radiation therapy (IGRT)

    Science.gov (United States)

    Tanaka, Rie; Sanada, Shigeru; Sakuta, Keita; Kawashima, Hiroki

    2015-05-01

    The bone suppression technique based on advanced image processing can suppress the conspicuity of bones on chest radiographs, creating soft tissue images obtained by the dual-energy subtraction technique. This study was performed to evaluate the usefulness of bone suppression image processing in image-guided radiation therapy. We demonstrated the improved accuracy of markerless motion tracking on bone suppression images. Chest fluoroscopic images of nine patients with lung nodules during respiration were obtained using a flat-panel detector system (120 kV, 0.1 mAs/pulse, 5 fps). Commercial bone suppression image processing software was applied to the fluoroscopic images to create corresponding bone suppression images. Regions of interest were manually located on lung nodules and automatic target tracking was conducted based on the template matching technique. To evaluate the accuracy of target tracking, the maximum tracking error in the resulting images was compared with that of conventional fluoroscopic images. The tracking errors were decreased by half in eight of nine cases. The average maximum tracking errors in bone suppression and conventional fluoroscopic images were 1.3   ±   1.0 and 3.3   ±   3.3 mm, respectively. The bone suppression technique was especially effective in the lower lung area where pulmonary vessels, bronchi, and ribs showed complex movements. The bone suppression technique improved tracking accuracy without special equipment and implantation of fiducial markers, and with only additional small dose to the patient. Bone suppression fluoroscopy is a potential measure for respiratory displacement of the target. This paper was presented at RSNA 2013 and was carried out at Kanazawa University, JAPAN.

  7. Feasibility study of image guided radiotherapy for lung tumor using online and offline cone-beam CT setup verification

    International Nuclear Information System (INIS)

    Li Hongsheng; Li Baosheng; Lu Jie; Yin Yong; Yu Ningsha; Chen Yiru

    2009-01-01

    Objective: To investigate the feasibility of online and offline cone-beam CT(CBCT) guided radiotherapy for lung cancer. Methods: Fourteen patients with lung tumor treated by three-dimensional conformal radiotherapy were investigated. Online kV CBCT scan, image registration and setup correction were performed before and immediately after radiotherapy. CBCT online-guided correction data were used to calculate the population-based CTV-PTV margins under the condition of non-correction and correction in every fraction respectively. The numbers of initial images and the population-based CTV-PTV margins after the offline compensation of the system setup error were evaluated with the permission of 0.5 mm and 1.5 mm maximal residue error, respectively. Results: Under the condition of non-correction, the required margins for total error were 5.7 mm, 8.0 mm and 7.8 mm in the left-right (x axis), cranio-caudal (y axis) and anterior-posterior(z axis) directions, respectively. When the tumor was corrected in every fraction, the required margins for intra-fraction error were 2.4 mm, 2.4 mm and 2.3 mm in x,y and z axes, respectively. To correct the systematic setup error, 9 sets of CBCT images for 3.3 mm, 3.7 mm and 3.6 mm PTV margins, and 7 sets of CBCT images for 3.9 mm, 4.3 mm and 4.3 mm PTV margins in x,y and z axes were necessary when 0.5 mm and 1.5 mm maximal residue error were permitted respectively. Conclusions: Both of the online CBCT correction and the offline adaptive correction can markedly reduce the impact of setup error and reduce the required PTV margins accordingly. It is feasible to deliver the online and offline image guided radiation for patients with lung tumor. (authors)

  8. Comparative evaluation of two dose optimization methods for image-guided, highly-conformal, tandem and ovoids cervix brachytherapy planning

    Science.gov (United States)

    Ren, Jiyun; Menon, Geetha; Sloboda, Ron

    2013-04-01

    Although the Manchester system is still extensively used to prescribe dose in brachytherapy (BT) for locally advanced cervix cancer, many radiation oncology centers are transitioning to 3D image-guided BT, owing to the excellent anatomy definition offered by modern imaging modalities. As automatic dose optimization is highly desirable for 3D image-based BT, this study comparatively evaluates the performance of two optimization methods used in BT treatment planning—Nelder-Mead simplex (NMS) and simulated annealing (SA)—for a cervix BT computer simulation model incorporating a Manchester-style applicator. Eight model cases were constructed based on anatomical structure data (for high risk-clinical target volume (HR-CTV), bladder, rectum and sigmoid) obtained from measurements on fused MR-CT images for BT patients. D90 and V100 for HR-CTV, D2cc for organs at risk (OARs), dose to point A, conformation index and the sum of dwell times within the tandem and ovoids were calculated for optimized treatment plans designed to treat the HR-CTV in a highly conformal manner. Compared to the NMS algorithm, SA was found to be superior as it could perform optimization starting from a range of initial dwell times, while the performance of NMS was strongly dependent on their initial choice. SA-optimized plans also exhibited lower D2cc to OARs, especially the bladder and sigmoid, and reduced tandem dwell times. For cases with smaller HR-CTV having good separation from adjoining OARs, multiple SA-optimized solutions were found which differed markedly from each other and were associated with different choices for initial dwell times. Finally and importantly, the SA method yielded plans with lower dwell time variability compared with the NMS method.

  9. SU-F-J-57: Effectiveness of Daily CT-Based Three-Dimensional Image Guided and Adaptive Proton Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Moriya, S [University of Tsukuba, Tsukuba, Ibaraki (Japan); National Cancer Center, Kashiwa, Chiba (Japan); Tachibana, H; Hotta, K; Baba, H; Kohno, R; Akimoto, T [National Cancer Center, Kashiwa, Chiba (Japan); Nakamura, N [National Cancer Center Hospital East, Kashiwa, Chiba (Japan); Miyakawa, S; Kurosawa, T [Komazawa University, Setagaya, Tokyo (Japan)

    2016-06-15

    Purpose: Daily CT-based three-dimensional image-guided and adaptive (CTIGRT-ART) proton therapy system was designed and developed. We also evaluated the effectiveness of the CTIGRT-ART. Methods: Retrospective analysis was performed in three lung cancer patients: Proton treatment planning was performed using CT image datasets acquired by Toshiba Aquilion ONE. Planning target volume and surrounding organs were contoured by a well-trained radiation oncologist. Dose distribution was optimized using 180-deg. and 270-deg. two fields in passive scattering proton therapy. Well commissioned Simplified Monte Carlo algorithm was used as dose calculation engine. Daily consecutive CT image datasets was acquired by an in-room CT (Toshiba Aquilion LB). In our in-house program, two image registrations for bone and tumor were performed to shift the isocenter using treatment CT image dataset. Subsequently, dose recalculation was performed after the shift of the isocenter. When the dose distribution after the tumor registration exhibits change of dosimetric parameter of CTV D90% compared to the initial plan, an additional process of was performed that the range shifter thickness was optimized. Dose distribution with CTV D90% for the bone registration, the tumor registration only and adaptive plan with the tumor registration was compared to the initial plan. Results: In the bone registration, tumor dose coverage was decreased by 16% on average (Maximum: 56%). The tumor registration shows better coverage than the bone registration, however the coverage was also decreased by 9% (Maximum: 22%) The adaptive plan shows similar dose coverage of the tumor (Average: 2%, Maximum: 7%). Conclusion: There is a high possibility that only image registration for bone and tumor may reduce tumor coverage. Thus, our proposed methodology of image guidance and adaptive planning using the range adaptation after tumor registration would be effective for proton therapy. This research is partially supported

  10. Image-Guided High-Dose Rate Brachytherapy in Cervix Carcinoma Using Balloon Catheter and Belt Immobilization System.

    Science.gov (United States)

    Fan, Qiyong; Yeung, Anamaria R; Amdur, Robert; Helmig, Richard; Park, Justin; Li, Jonathan; Kahler, Darren; Liu, Chihray; Lu, Bo

    2017-06-01

    The efficacy of image-guided high-dose rate brachytherapy for cervical cancer is limited by the ineffective rectal sparing devices available commercially and the potential applicator movement. We developed a novel device using a balloon catheter and a belt immobilization system, serving for rectal dose reduction and applicator immobilization purposes, respectively. The balloon catheter is constructed by gluing a short inflatable tube to a long regular open-end catheter. Contrast agent (10) cm 3 is injected into the inflatable end, which is affixed to the tandem and ring applicator, to displace the posterior vaginal wall. The belt immobilization system consists of a specially designed bracket that can hold and fix itself to the applicator, a diaper-like Velcro fastener package used for connecting the patient's pelvis to the bracket, and a buckle that holds the fasteners to stabilize the whole system. The treatment data for 21 patients with cervical cancer using both balloon catheter and belt immobilization system were retrospectively analyzed. Computed tomography and magnetic resonance images, acquired about 30 minutes apart, were registered to evaluate the effectiveness of the immobilization system. In comparison with a virtual rectal blade, the balloon decreased the rectal point dose by 34% ± 4.2% (from 276 ± 57 to 182 ± 38 cGy), corresponding to an extra sparing distance of 7.9 ± 1.1 mm. The maximum sparing distance variation per patient is 1.4 ± 0.6 mm, indicating the high interfractional reproducibility for rectum sparing. With the immobilization system, the mean translational and rotational displacements of the applicator set are <3 mm and <1.5°, respectively, in all directions. The rectal balloon provides significant dose reduction to the rectum and it may potentially minimize patient discomfort. The immobilization system permits almost no movement of the applicator during treatment. This work has the potential to be promoted as a standardized solution

  11. Preoperative imaging as the basis for image-guided neurosurgery. EN; Praeoperative Bildgebung. Grundlage der navigationsgestuetzten Neurochirurgie

    Energy Technology Data Exchange (ETDEWEB)

    Winkler, D. (Klinik und Poliklinik fuer Neurochirurgie, Universitaet Leipzig; Klinik fuer Neurochirurgie, Universitaet Leipzig, Liebigstrasse 20, 04103, Leipzig); Strauss, G. (Klinik fuer HNO-Krankheiten, Universitaet Leipzig); Hesse, S.; Sabri, O. (Klinik fuer Nuklearmedizin, Universitaet Leipzig); Goldammer, A.; Meixensberger, J. (Klinik und Poliklinik fuer Neurochirurgie, Universitaet Leipzig); Hund-Georgiadis, M. (Max-Planck-Institut fuer Neuropsychologische Forschung, Leipzig); Richter, A.; Kahn, T. (Klinik fuer Diagnostische Radiologie, Universitaet Leipzig)

    2004-07-01

    With the progressive development of soft- and hardware, the acceptance of image-guided neurosurgery has increased dramatically. Additional image data are required to analyze the nature and the dimensions of pathological processes and the surrounding tissue. In this context, fMRI, SPECT, PET, as well as special modalities of CT and MR imaging, are routinely used. Secondary post-processing options are used to detect intracerebral lesions as well as adjacent functional eloquent regions in the parenchymatous organ pre- and intraoperatively. The integration of different image information guarantees the precise planning and realization of surgical maneuvers. The segmentation of interesting structures and risk structures, as well as their implementation in the neuronavigation systems, help to avoid additional intraoperative traumatization and offer a higher level of safety and precision. In this article the value and limitations of presurgical imaging will be discussed. (orig.) [German] Die bildgestuetzte Neurochirurgie erfaehrt mit der Entwicklung von Soft- und Hardware eine sprunghafte Akzeptanz. Zusaetzliche Bilddaten dienen der Beurteilung von Charakter und Ausdehnung von pathologischen Prozessen und dem Umgebungsgewebe. In diesem Kontext sind fMRT, SPECT, PET und spezielle Modalitaeten der CT- und MRT-Diagnostik zu nennen. Mittels sekundaerer Bildbearbeitung koennen intrazerebrale Laesionen und benachbarte, funktionell eloquente Regionen im parenchymatoesen Organ Gehirn prae- und intraoperativ detektiert werden. Die Integration verschiedener Bildinformationen garantiert eine praezise Planung und Realisierung von chirurgischen Manoevern. Die Segmentation interessierender Strukturen, von Risikostrukturen und deren Implementation in Systeme der Neuronavigation helfen, eine zusaetzliche intraoperative Traumatisierung zu vermeiden, und bieten eine groessere Sicherheit und Praezision. Mit diesem Artikel werden der Wert und die Grenzen praeoperativer Bilddiagnostik

  12. Clinical outcome of hypofractionated breath-hold image-guided SABR of primary lung tumors and lung metastases

    International Nuclear Information System (INIS)

    Boda-Heggemann, Judit; Wenz, Frederik; Lohr, Frank; Frauenfeld, Anian; Weiss, Christel; Simeonova, Anna; Neumaier, Christian; Siebenlist, Kerstin; Attenberger, Ulrike; Heußel, Claus Peter; Schneider, Frank

    2014-01-01

    Stereotactic Ablative RadioTherapy (SABR) of lung tumors/metastases has been shown to be an effective treatment modality with low toxicity. Outcome and toxicity were retrospectively evaluated in a unique single-institution cohort treated with intensity-modulated image-guided breath-hold SABR (igSABR) without external immobilization. The dose–response relationship is analyzed based on Biologically Equivalent Dose (BED). 50 lesions in 43 patients with primary NSCLC (n = 27) or lung-metastases of various primaries (n = 16) were consecutively treated with igSABR with Active-Breathing-Coordinator (ABC®) and repeat-breath-hold cone-beam-CT. After an initial dose-finding/-escalation period, 5x12 Gy for peripheral lesions and single doses of 5 Gy to varying dose levels for central lesions were applied. Overall-survival (OS), progression-free-survival (PFS), progression pattern, local control (LC) and toxicity were analyzed. The median BED2 was 83 Gy. 12 lesions were treated with a BED2 of <80 Gy, and 38 lesions with a BED2 of >80 Gy. Median follow-up was 15 months. Actuarial 1- and 2-year OS were 67% and 43%; respectively. Cause of death was non-disease-related in 27%. Actuarial 1- and 2-year PFS was 42% and 28%. Progression site was predominantly distant. Actuarial 1- and 2 year LC was 90% and 85%. LC showed a trend for a correlation to BED2 (p = 0.1167). Pneumonitis requiring conservative treatment occurred in 23%. Intensity-modulated breath-hold igSABR results in high LC-rates and low toxicity in this unfavorable patient cohort with inoperable lung tumors or metastases. A BED2 of <80 Gy was associated with reduced local control

  13. Objected constrained registration and manifold learning: A new patient setup approach in image guided radiation therapy of thoracic cancer

    International Nuclear Information System (INIS)

    Chen Ting; Jabbour, Salma K.; Haffty, Bruce G.; Yue, Ning; Qin Songbing

    2013-01-01

    Purpose: The management of thoracic malignancies with radiation therapy is complicated by continuous target motion. In this study, a real time motion analysis approach is proposed to improve the accuracy of patient setup. Methods: For 11 lung cancer patients a long training fluoroscopy was acquired before the first treatment, and multiple short testing fluoroscopies were acquired weekly at the pretreatment patient setup of image guided radiotherapy (IGRT). The data analysis consisted of three steps: first a 4D target motion model was constructed from 4DCT and projected to the training fluoroscopy through deformable registration. Then the manifold learning method was used to construct a 2D subspace based on the target motion (kinetic) and location (static) information in the training fluoroscopy. Thereafter the respiratory phase in the testing fluoroscopy was determined by finding its location in the subspace. Finally, the phase determined testing fluoroscopy was registered to the corresponding 4DCT to derive the pretreatment patient position adjustment for the IGRT. The method was tested on clinical image sets and numerical phantoms. Results: The registration successfully reconstructed the 4D motion model with over 98% volume similarity in 4DCT, and over 95% area similarity in the training fluoroscopy. The machine learning method derived the phase values in over 98% and 93% test images of the phantom and patient images, respectively, with less than 3% phase error. The setup approach achieved an average accumulated setup error less than 1.7 mm in the cranial-caudal direction and less than 1 mm in the transverse plane. All results were validated against the ground truth of manual delineations by an experienced radiation oncologist. The expected total time for the pretreatment setup analysis was less than 10 s. Conclusions: By combining the registration and machine learning, the proposed approach has the potential to improve the accuracy of pretreatment setup for

  14. Prospective Randomized Trial for Image-Guided Biopsy Using Cone-Beam CT Navigation Compared with Conventional CT.

    Science.gov (United States)

    Abi-Jaoudeh, Nadine; Fisher, Teresa; Jacobus, John; Skopec, Marlene; Radaelli, Alessandro; Van Der Bom, Imramsjah Martijn; Wesley, Robert; Wood, Bradford J

    2016-09-01

    To compare cone-beam computed tomography (CT) navigation vs conventional CT image guidance during biopsies. Patients scheduled for image-guided biopsies were prospectively and randomly assigned to conventional CT guidance vs cone-beam CT navigation. Radiation dose, accuracy of final needle position, rate of histopathologic diagnosis, and number of needle repositions to reach the target (defined as pullback to adjust position) were compared. A total of 58 patients (mean age, 57 y; 62.1% men) were randomized: 29 patients underwent 33 biopsies with CT guidance and 29 patients with 33 lesions underwent biopsy with cone-beam CT navigation. The average body mass index (BMI) was similar between groups, at 28.8 kg/m(2) ± 6.55 (P = .18). There was no difference between groups in terms of patient and lesion characteristics (eg, size, depth). The average lesion size was 29.1 ± 12.7mm for CT group vs 32.1mm ±16.8mm for cone-beam CT group (P cone-beam CT group was 0.3 ± 0.5, compared with 1.9 ± 2.3 with conventional CT (P cone-beam CT than with conventional CT (P cone-beam CT vs conventional CT (P = .018). Accuracy, defined as the difference between planned and final needle positions, was 4.9 mm ± 4.1 for the cone-beam CT group, compared with 12.2 mm ± 8.1 for conventional CT (P cone-beam CT (P = .67). Cone-beam CT navigation for biopsies improved targeting accuracy with fewer needle repositions, lower skin entry dose, and lower effective dose for planning scan, and a comparable histopathologic diagnosis rate. Copyright © 2016 SIR. All rights reserved.

  15. Image guided multibeam radiotherapy

    International Nuclear Information System (INIS)

    Freijo, J.L.

    2008-01-01

    This paper provides an outlook of the status of the first development stages for an updated design of radiotherapy conformal system based on tumor 3D images obtained as an output the last generation imaging machines as PET, CT and MR which offer a very valuable output in cancer diagnosis. Prospective evaluation of current software codes and acquisition of useful experience in surgical planning involves a multidisciplinary process as an initial and unavoidable stage to develop an expert software and user skills which assures the delivery of the radiation dose is done correctly in geometry and value in each voxel as a radiation protection basic condition. The validation of the images obtained has been done by the production of anatomical models of interest regions by rapid proto typing of the 3D segmented images and its evaluation by contrasting with the real regions during surgical procedures. (author)

  16. Haematuria: an imaging guide.

    LENUS (Irish Health Repository)

    Moloney, Fiachra

    2014-01-01

    This paper discusses the current status of imaging in the investigation of patients with haematuria. The physician must rationalize imaging so that serious causes such as malignancy are promptly diagnosed while at the same time not exposing patients to unnecessary investigations. There is currently no universal agreement about the optimal imaging work up of haematuria. The choice of modality to image the urinary tract will depend on individual patient factors such as age, the presence of risk factors for malignancy, renal function, a history of calculus disease and pregnancy, and other factors, such as local policy and practice, cost effectiveness and availability of resources. The role of all modalities, including conventional radiography, intravenous urography\\/excretory urography, ultrasonography, retrograde pyelography, multidetector computed tomography urography (MDCTU), and magnetic resonance urography, is discussed. This paper highlights the pivotal role of MDCTU in the imaging of the patient with haematuria and discusses issues specific to this modality including protocol design, imaging of the urothelium, and radiation dose. Examination protocols should be tailored to the patient while all the while optimizing radiation dose.

  17. Uncharismatic Invasives

    Directory of Open Access Journals (Sweden)

    Clark, Jonathan L.

    2015-05-01

    Full Text Available Although philosophers have examined the ethics of invasive species management, there has been little research approaching this topic from a descriptive, ethnographic perspective. In this article I examine how invasive species managers think about the moral status of the animals they seek to manage. I do so through a case study of Oregon’s efforts to manage the invasive species that are rafting across the Pacific attached to tsunami debris in the wake of the Japanese tsunami of 2011. Focusing on the state’s response to a dock that washed ashore on Agate Beach with various marine invertebrates attached to it, I argue that these animals’ position on two intersecting scales of moral worth—the sociozoologic scale and the phylogenetic scale—rendered them unworthy of moral consideration.

  18. Implementation of image-guided intensity-modulated accelerated partial breast irradiation. Three-year results of a phase II clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Meszaros, Norbert; Major, Tibor; Stelczer, Gabor; Zaka, Zoltan; Takacsi-Nagy, Zoltan; Fodor, Janos; Polgar, Csaba [National Institute of Oncology, Center of Radiotherapy, Budapest (Hungary); Mozsa, Emoke [National Institute of Oncology, Center of Radiotherapy, Budapest (Hungary); Landesklinikum, Department of Radiooncology and Radiotherapy, Wiener Neustadt (Austria); Pukancsik, David [National Institute of Oncology, Department of Breast and Sarcoma Surgery, Budapest (Hungary)

    2017-01-15

    To report 3-year results of accelerated partial breast irradiation (APBI) using image-guided intensity-modulated radiotherapy (IG-IMRT) following breast conserving surgery (BCS) for low-risk early invasive breast cancer. Between July 2011 and March 2014, 60 patients with low-risk early invasive breast cancer underwent BCS and were enrolled in this phase II prospective study. The total dose was 36.9 Gy (9 fractions of 4.1 Gy, two fractions/day). Patient setup errors were detected in LAT, LONG and VERT directions. Local tumour control, survival results, early and late side effects and cosmetic outcome were assessed. At a median follow-up of 39 months, all patients were alive and neither locoregional nor distant failure occurred. One contralateral breast cancer and two new primary malignancies outside the breast were observed. No grade (G) 3-4 acute toxicity was detected. G1 and G2 erythema occurred in 21 (35%) and 2 (3.3%) patients, respectively; while G1 oedema was observed in 23 (38.8%) cases. G1 and G2 pain was reported by 6 (10%) and 2 (3.3%) patients, respectively. Among the late radiation side effects, G1 pigmentation or telangiectasia, G1 fibrosis and G1 asymptomatic fat necrosis occurred in 10 (16.7%), 7 (11.7%) and 3 (5%) patients, respectively. No ≥ G2 late toxicity was detected. Cosmetic outcome was excellent in 43 (71.7%) and good in 17 (28.3%) patients. IG-IMRT is a reproducible and feasible technique for delivery of external beam APBI following BCS for treatment of low-risk, early-stage invasive breast carcinoma. In order to avoid toxicity, image guidance performed before each radiation fraction is necessary to minimize the PTV. Three-year results are promising, early and late radiation side-effects are minimal, and cosmetic results are excellent to good. (orig.) [German] Evaluierung der 3-Jahres-Ergebnisse der Teilbrustbestrahlung (APBI) mittels bildgefuehrter intensitaetsmodulierter Strahlentherapie (IG-IMRT) nach brusterhaltender Operation (BCS

  19. [Comparison of vacuum bag fixation and Orfit rack with thermoplastic membrane fixation for image-guided cervical cancer radiotherapy].

    Science.gov (United States)

    Li, Y B; Wang, Y L; Zhuo, Y H

    2017-06-23

    are suitable for the cone-beam CT image-guided radiotherapy of cervical cancer patients. However, the displacement in the left and right directions of the vacuum bag fixation is smaller than the Orfit rack with thermoplastic membrane fixation. During the period of treatment, the mean value of the difference of displacement in the anterior and posterior directions of the Orfit rack with thermoplastic membrane fixation is mild, which can be used individually by the patients with a flexible body and good tolerance.

  20. MO-FG-BRA-01: Development of An Image-Guided Dosimetric Planning System for Injectable Brachytherapy Using ELP Nanoparticles

    Energy Technology Data Exchange (ETDEWEB)

    Lafata, K [Duke University, Durham, North Carolina (United States); Duke University Medical Center, Durham, NC (United States); Schaal, J; Liu, W [Duke University, Durham, North Carolina (United States); Cai, J [Duke University Medical Center, Durham, NC (United States)

    2015-06-15

    Purpose: To develop, validate, and evaluate a methodology for determining dosimetry for intratumoral injections of elastin-like-polypeptide (ELP) brachytherapy nanoparticles. These organic-polymer-based nanoparticles are injectable, biodegradable, and genetically tunable. We present a genetically encoded polymer-solution, composed of novel radiolabeled-ELP nanoparticles that are custom-designed to self-assemble into a local source upon intratumoral injection. Our preliminary results of a small animal study demonstrate 100% tumor response, effective radionuclide retention-rates, strong in vivo stability, and no polymer-induced toxicities. While our approach is therefore highly promising for improved brachytherapy, the current workflow lacks a dosimetry framework. Methods: We are developing a robust software framework that provides image-guided dosimetric-planning capabilities for ELP brachytherapy. The user graphically places ELP injection sites within a µCT-planning-image, and independently defines each injection volume, concentration, and radioisotope to be used. The resulting internal dosimetry is then pre-determined by first modeling post-injection ELP advection-diffusion, and then calculating the resulting dose distribution based on a point- dose-kernel-convolution algorithm. We have experimentally measured ELP steady-state concentrations via µSPECT acquisition, and validated our dose calculation algorithm against Monte Carlo simulations of several radioactivity distributions. Finally, we have investigated potential advantages and limitations of various ELP injection parameters. Results: The µSPECT results demonstrated inhomogeneous steady-state distributions of ELP in tissue, and Monte Carlo radioactivity distributions were designed accordingly. Our algorithm yielded a root-mean-square-error of less than 2% for each distribution tested (average root-mean-square-error was 0.73%). Dose-Volume-Histogram analysis of five different plans showed how strategic

  1. SU-E-J-205: Monte Carlo Modeling of Ultrasound Probes for Real-Time Ultrasound Image-Guided Radiotherapy

    International Nuclear Information System (INIS)

    Hristov, D; Schlosser, J; Bazalova, M; Chen, J

    2014-01-01

    Purpose: To quantify the effect of ultrasound (US) probe beam attenuation for radiation therapy delivered under real-time US image guidance by means of Monte Carlo (MC) simulations. Methods: MC models of two Philips US probes, an X6-1 matrix-array transducer and a C5-2 curved-array transducer, were built based on their CT images in the EGSnrc BEAMnrc and DOSXYZnrc codes. Due to the metal parts, the probes were scanned in a Tomotherapy machine with a 3.5 MV beam. Mass densities in the probes were assigned based on an electron density calibration phantom consisting of cylinders with mass densities between 0.2–8.0 g/cm 3 . Beam attenuation due to the probes was measured in a solid water phantom for a 6 MV and 15 MV 15x15 cm 2 beam delivered on a Varian Trilogy linear accelerator. The dose was measured with the PTW-729 ionization chamber array at two depths and compared to MC simulations. The extreme case beam attenuation expected in robotic US image guided radiotherapy for probes in upright position was quantified by means of MC simulations. Results: The 3.5 MV CT number to mass density calibration curve was found to be linear with R 2 > 0.99. The maximum mass densities were 4.6 and 4.2 g/cm 3 in the C5-2 and X6-1 probe, respectively. Gamma analysis of the simulated and measured doses revealed that over 98% of measurement points passed the 3%/3mm criteria for both probes and measurement depths. The extreme attenuation for probes in upright position was found to be 25% and 31% for the C5-2 and X6-1 probe, respectively, for both 6 and 15 MV beams at 10 cm depth. Conclusion: MC models of two US probes used for real-time image guidance during radiotherapy have been built. As a Result, radiotherapy treatment planning with the imaging probes in place can now be performed. J Schlosser is an employee of SoniTrack Systems, Inc. D Hristov has financial interest in SoniTrack Systems, Inc

  2. SU-F-J-209: Quantification of Image-Guidance Benefit in Image-Guided Radiotherapy of Cancers

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, L [Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu (China); Department of Therapeutic Radiology, Yale University, New Haven, CT (United States); Deng, J [Department of Therapeutic Radiology, Yale University, New Haven, CT (United States)

    2016-06-15

    Purpose: Image-guidance has been widely used in radiation oncology for accurate radiotherapy. The goal of this study is to quantify the benefit of image-guidance in image-guided radiotherapy (IGRT) of cancers. Methods: In this study, a new index termed image-guidance benefit (IGB), was proposed to quantify the benefit of image-guidance in cancer radiotherapy. It is calculated as a ratio of the square sum of dose differences between planning dose matrix and actual delivery dose matrix post image-guidance to the square sum of dose summation between the two matrixes, summing over all dose scoring voxels. Ranging from 0 to 1, larger IGB values indicate larger benefit out of image-guidance. With IRB approval, the DICOM RT files and 3D couch shifts applied during IGRT of 2219 patients were collected, based on which patient-specific IGB values were calculated with an in-house MATLAB code. Results: In this study, the mean IGB value was found to be 0.0398 (0.000583–0.999) with a positive correlation between IGB value and 3D couch shift vector at 0.0435 per cm (P<0.0001). With 2 mm shift as a threshold above which an image-guidance is deemed clinically necessary, the corresponding mean IGB value was 0.00457, much less than 0.0398 (P<0.001). However, the IGB values of 56 cases based on couch shifts were less than those based on 2 mm shift. Conclusion: The IGB values were patient-specific and site-dependent. Using 2 mm shifts as criterion for applying image-guidance, the applied image-guidance procedures were found clinically necessary and highly beneficial in 97.5% of cancer patients. However, image-guidance procedures were found over-used in about 2.5% of cancer patients in our current practices of IGRT, which should be avoided as they added no benefit in improving delivery accuracy while increasing cancer risk.

  3. Optimization and quality assurance of an image-guided radiation therapy system for intensity-modulated radiation therapy radiotherapy

    International Nuclear Information System (INIS)

    Tsai, Jen-San; Micaily, Bizhan; Miyamoto, Curtis

    2012-01-01

    To develop a quality assurance (QA) of XVI cone beam system (XVIcbs) for its optimal imaging-guided radiotherapy (IGRT) implementation, and to construe prostate tumor margin required for intensity-modulated radiation therapy (IMRT) if IGRT is unavailable. XVIcbs spatial accuracy was explored with a humanoid phantom; isodose conformity to lesion target with a rice phantom housing a soap as target; image resolution with a diagnostic phantom; and exposure validation with a Radcal ion chamber. To optimize XVIcbs, rotation flexmap on coincidency between gantry rotational axis and that of XVI cone beam scan was investigated. Theoretic correlation to image quality of XVIcbs rotational axis stability was elaborately studied. Comprehensive QA of IGRT using XVIcbs has initially been explored and then implemented on our general IMRT treatments, and on special IMRT radiotherapies such as head and neck (H and N), stereotactic radiation therapy (SRT), stereotactic radiosurgery (SRS), and stereotactic body radiotherapy (SBRT). Fifteen examples of prostate setup accounted for 350 IGRT cone beam system were analyzed. IGRT accuracy results were in agreement ± 1 mm. Flexmap 0.25 mm met the manufacturer's specification. Films confirmed isodose coincidence with target (soap) via XVIcbs, otherwise not. Superficial doses were measured from 7.2–2.5 cGy for anatomic diameters 15–33 cm, respectively. Image quality was susceptible to rotational stability or patient movement. IGRT using XVIcbs on general IMRT treatments such as prostate, SRT, SRS, and SBRT for setup accuracy were verified; and subsequently coordinate shifts corrections were recorded. The 350 prostate IGRT coordinate shifts modeled to Gaussian distributions show central peaks deviated off the isocenter by 0.6 ± 3.0 mm, 0.5 ± 4.5 mm in the X(RL)- and Z(SI)-coordinates, respectively; and 2.0 ± 3.0 mm in the Y(AP)-coordinate as a result of belly and bladder capacity variations. Sixty-eight percent of confidence was within

  4. TU-AB-BRA-12: Quality Assurance of An Integrated Magnetic Resonance Image Guided Adaptive Radiotherapy Machine Using Cherenkov Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Andreozzi, J; Bruza, P; Saunders, S; Pogue, B [Dartmouth College, Hanover, NH (United States); Mooney, K; Curcuru, A; Green, O [Washington University School of Medicine, Saint Louis, MO (United States); Gladstone, D [Dartmouth-Hitchcock Med. Ctr., Lebanon, NH (Lebanon)

    2016-06-15

    Purpose: To investigate the viability of using Cherenkov imaging as a fast and robust method for quality assurance tests in the presence of a magnetic field, where other instruments can be limited. Methods: Water tank measurements were acquired from a clinically utilized adaptive magnetic resonance image guided radiation therapy (MR-IGRT) machine with three multileaf-collimator equipped 60Co sources. Cherenkov imaging used an intensified charge coupled device (ICCD) camera placed 3.5m from the treatment isocenter, looking down the bore of the 0.35T MRI into a water tank. Images were post-processed to make quantitative comparison between Cherenkov light intensity with both film and treatment planning system predictions, in terms of percent depth dose curves as well as lateral beam profile measurements. A TG-119 commissioning test plan (C4: C-Shape) was imaged in real-time at 6.33 frames per second to investigate the temporal and spatial resolution of the Cherenkov imaging technique. Results: A .33mm/pixel Cherenkov image resolution was achieved across 1024×1024 pixels in this setup. Analysis of the Cherenkov image of a 10.5×10.5cm treatment beam in the water tank successfully measured the beam width at the depth of maximum dose within 1.2% of the film measurement at the same point. The percent depth dose curve for the same beam was on average within 2% of ionization chamber measurements for corresponding depths between 3–100mm. Cherenkov video of the TG-119 test plan provided qualitative agreement with the treatment planning system dose predictions, and a novel temporal verification of the treatment. Conclusions: Cherenkov imaging was successfully used to make QA measurements of percent depth dose curves and cross beam profiles of MRI-IGRT radiotherapy machines after only several seconds of beam-on time and data capture; both curves were