2.Broadening the therapeutic band width - Cambridge 2016 v1.1 - handout + lecture.pdf |
1 |
Slide Number 1 |
1 |
Broadening the therapeutic band width Neil Burnet |
2 |
Slide Number 3 |
3 |
Introduction |
4 |
RT is potent and cost-effective |
5 |
Introduction |
6 |
Quality of RT affects outcome |
7 |
Quality of RT affects outcome |
8 |
Quality of RT affects outcome |
9 |
Quality of RT affects outcome |
10 |
Slide Number 11 |
11 |
Slide Number 12 |
12 |
Broadening RT band width |
13 |
Broadening RT band width |
14 |
Slide Number 15 |
15 |
Increase the therapeutic ratio |
16 |
Increase the therapeutic ratio |
17 |
Increase the therapeutic ratio |
18 |
Increase the therapeutic ratio |
19 |
Increase the therapeutic ratio |
20 |
Increase the therapeutic ratio |
21 |
Normal tissue toxicities |
22 |
Pelvic Ewing’s sarcoma |
23 |
Normal tissue response |
24 |
Normal tissue response |
25 |
Normal tissue response |
26 |
Normal tissue response |
27 |
Normal tissue response |
28 |
Normal tissue response |
29 |
Slide Number 30 |
30 |
Image guidance |
31 |
Broadening the band width |
32 |
Broadening the band width |
33 |
Broadening the band width |
34 |
Broadening the band width |
35 |
Broadening the band width |
36 |
Broadening the band width |
37 |
Treatment volumes compared |
38 |
Use the best equipment you can! |
39 |
Ca prostate |
40 |
Ca nasopharynx |
41 |
Ca breast |
42 |
Slide Number 43 |
43 |
IMRT for chordoma |
44 |
IMRT for chordoma |
45 |
Bandwidth |
46 |
Conclusions |
47 |
Slide Number 48 |
48 |
3.DoseAlgorithms |
49 |
Slide Number 1 |
49 |
Slide Number 2 |
50 |
Acknowledgements |
51 |
Computer-Aided Treatment Planning |
52 |
Dose Calculation Problem |
53 |
Complexity of dose calculation |
54 |
Expectations |
55 |
Dose Calculation Methods |
56 |
Evolution of Photon Beam Dose Algorithms |
57 |
X-Rays: Energy Deposition in a Nutshell |
58 |
Dose Spread Kernel |
59 |
Method: Convolution/Superposition |
60 |
Convolution - Point Kernel |
61 |
Pencil Kernel Integration |
62 |
Pencil beam kernel |
63 |
Pencil beam kernel |
64 |
Breast Tangent Example |
65 |
Total Energy Released per MAss (TERMA) |
66 |
Physics considerations |
67 |
Influence of Head Scatter |
68 |
CT Data to Tissue Properties |
69 |
Images Support Dose Calculations |
70 |
Density Scaling Approximation |
71 |
Calculated Data |
72 |
Electronic Disequilibrium |
73 |
Summary model based & MC approaches |
74 |
Advanced Kernel Methods |
75 |
RPC/RTOG phantom for SBRT |
76 |
A Simple Algorithm Check |
77 |
A Simple Algorithm Check: MU’s |
78 |
Energy Absorbed by an Inhomogeneity |
79 |
Energy Absorbed by an Inhomogeneity |
80 |
Clinical impact of dose calculation |
81 |
Summary – Evolution, not Revolution |
82 |
4.ICRU planning and prescribing - Cambridge 2016 - v1.1 handout + lecture |
83 |
Slide Number 1 |
83 |
ICRU guidance on planning and prescribing Neil Burnet |
84 |
Summary |
85 |
The history of radiotherapy |
86 |
ICRU guidance |
87 |
ICRU guidance |
88 |
Prescribing |
89 |
Prescribing |
90 |
Prescribing |
91 |
Prescribing |
92 |
Prescribing |
93 |
Prescribing |
94 |
Prescribing |
95 |
Prescribing |
96 |
Prescribing |
97 |
Prescribing |
98 |
Prescribing |
99 |
Prescribing |
100 |
Prescribing |
101 |
Prescribing |
102 |
Prescribing |
103 |
Lung doses |
104 |
Prescribing |
105 |
Prescribing |
106 |
ICRU guidance |
107 |
Slide Number 26 |
108 |
Target volumes |
109 |
Target volumes |
110 |
Summary |
111 |
Target volumes - PTV |
112 |
Target volumes - PTV |
113 |
Slide Number 32 |
114 |
Other volumes - TD |
115 |
Other volumes - RVR |
116 |
Target volumes – OARs |
117 |
Target volumes – OARs |
118 |
Target volumes – OARs |
119 |
Target volumes – OARs |
120 |
Target volumes – OARs |
121 |
Target volumes – OARs + PRVs |
122 |
Target volumes – OARs + PRVs |
123 |
Target volumes – OARs + PRVs |
124 |
Target volumes – PRV |
125 |
Target volumes – PRV or optimising structure? |
126 |
Hypothalamus DVHs |
127 |
Hypothalamus DVHs |
128 |
Hypothalamus DVHs |
129 |
Planning dose limits |
130 |
Planning limits |
131 |
Planning constraints |
132 |
Planning constraints |
133 |
Planning constraints |
134 |
Prioritising |
135 |
Slide Number 54 |
136 |
Objectives and Priorities |
137 |
GBM - IMRT plan DVHs |
138 |
Constraints and Priorities |
139 |
Target volumes – overlaps |
140 |
Target volumes – overlaps |
141 |
Target volumes – overlaps |
142 |
Target volumes – overlaps |
143 |
Target volumes – overlaps |
144 |
Target volumes – overlaps |
145 |
Target volumes – overlaps |
146 |
Take home messages |
147 |
Slide Number 66 |
148 |
Slide Number 67 |
149 |
ICRU guidance |
150 |
Homogeneity Index |
151 |
Conformity Index |
152 |
Equivalent Uniform Dose - EUD |
153 |
Equivalent Uniform Dose - EUD |
154 |
Equivalent Uniform Dose - EUD |
155 |
TCP, NTCP, PUC |
156 |
Slide Number 75 |
157 |
Tissue architecture |
158 |
Target volumes – PRV |
159 |
Target volumes – PRV |
160 |
Target volumes – PRV |
161 |
5.nonIMRT |
162 |
Slide Number 1 |
162 |
Slide Number 2 |
163 |
Slide Number 3 |
164 |
Slide Number 4 |
165 |
Slide Number 5 |
166 |
Slide Number 6 |
167 |
Slide Number 7 |
168 |
Slide Number 8 |
169 |
Slide Number 9 |
170 |
Slide Number 10 |
171 |
Slide Number 11 |
172 |
Slide Number 12 |
173 |
Slide Number 13 |
174 |
Slide Number 14 |
175 |
Slide Number 15 |
176 |
Slide Number 16 |
177 |
Slide Number 17 |
178 |
Slide Number 18 |
179 |
Slide Number 19 |
180 |
Slide Number 20 |
181 |
Slide Number 21 |
182 |
Slide Number 22 |
183 |
Slide Number 23 |
184 |
Slide Number 24 |
185 |
Slide Number 25 |
186 |
Slide Number 26 |
187 |
Slide Number 27 |
188 |
Slide Number 28 |
189 |
Slide Number 29 |
190 |
Slide Number 30 |
191 |
Slide Number 31 |
192 |
Slide Number 32 |
193 |
Slide Number 33 |
194 |
Slide Number 34 |
195 |
Slide Number 35 |
196 |
Slide Number 36 |
197 |
Slide Number 37 |
198 |
Slide Number 38 |
199 |
Slide Number 39 |
200 |
Slide Number 40 |
201 |
Slide Number 41 |
202 |
Slide Number 42 |
203 |
Slide Number 43 |
204 |
Slide Number 44 |
205 |
Slide Number 45 |
206 |
Slide Number 46 |
207 |
Slide Number 47 |
208 |
Slide Number 48 |
209 |
6.Lung relation between 3D dose distributions and clinical toxicities new update on site |
210 |
Slide Number 1 |
210 |
Relationships between 3D dose distributions and clinical toxicities - Chest |
211 |
SBRT: success story |
212 |
SBRT: improving outcomes stage I LC |
213 |
„Standards“ for dose/prescription to PTV? |
214 |
SBRT: wide use, high heterogeneity |
215 |
SBRT: „magic BED10“ of 100 Gy? |
216 |
Slide Number 8 |
217 |
Elekta group: Doses vs. outcome |
218 |
SPACE - A randomized study of SBRT vs conventional fractionated radiotherapy in medically inoperable stage I NSCLCJ. Nyman et al. world lung 2015 |
219 |
Central tumors: outcome from expert treatment |
220 |
Central tumors |
221 |
Toxicity! |
222 |
Pat. S.D. *1943, SCC |
223 |
Another fatal necrosis after central SBRT… |
224 |
Slide Number 16 |
225 |
Slide Number 17 |
226 |
Slide Number 18 |
227 |
Slide Number 19 |
228 |
Slide Number 20 |
229 |
Slide Number 21 |
230 |
Slide Number 22 |
231 |
Slide Number 23 |
232 |
Slide Number 24 |
233 |
Slide Number 25 |
234 |
Slide Number 26 |
235 |
Slide Number 27 |
236 |
Course post SBRT |
237 |
Slide Number 29 |
238 |
Esophageal toxicity |
239 |
Slide Number 31 |
240 |
Slide Number 32 |
241 |
Slide Number 33 |
242 |
Slide Number 34 |
243 |
Slide Number 35 |
244 |
Slide Number 36 |
245 |
Slide Number 37 |
246 |
There is more than dose and fractionation… |
247 |
9.Planning Aspects Breast Cancer_DvdBongard |
248 |
Slide Number 1 |
248 |
Slide Number 2 |
249 |
Planning aspects in breast RT |
250 |
Slide Number 4 |
251 |
Slide Number 5 |
252 |
Slide Number 6 |
253 |
Breast-conserving surgery +/- whole breast RT |
254 |
RT after mastectomy and axillary lymph node dissection |
255 |
Slide Number 9 |
256 |
Regional lymph node irradiation – delineation on planning CT |
257 |
Slide Number 11 |
258 |
Therapeutic window: principle of radiotherapy |
259 |
Radiotherapy-induced toxicityLocal radiotherapy (Breast/Chest wall) |
260 |
Radiotherapy-induced toxicityRegional radiotherapy |
261 |
Acute toxicity skin - Radiation dermatitis |
262 |
Late skin / breast toxicity |
263 |
Lung - Radiation pneumonitis (subacute toxicity) |
264 |
Left-side breast cancer and RTThe heart |
265 |
Radiation-induced heart disease |
266 |
Radiation-induced heart diseaseRegional radiotherapy |
267 |
Cardiac toxicity and mortality due to RT |
268 |
Arm oedema -After axillary surgery and/or regional radiotherapy |
269 |
Regional radiotherapy instead of axillary surgery |
270 |
Brachial plexus Regional radiotherapy boost |
271 |
Radiation-induced secondary cancer after breast radiotherapy |
272 |
Planning aspects in breast RT |
273 |
Hypofractionation – breast Radiotherapy |
274 |
Hypofractionation – whole breast irradiation |
275 |
Canadian study |
276 |
Toxicity – hypofractionated and conventional scheme |
277 |
Hypofractionation – Clinical practice |
278 |
Hypofractionation – FAST (FORWARD) |
279 |
Planning aspects in breast RT |
280 |
Partial breast RT - Rationale |
281 |
Accelerated partial breast RT - Advantages |
282 |
Accelerated Partial breast RT (APBI) - guidelines |
283 |
APBI – low-risk patients |
284 |
APBI - Methods |
285 |
APBI - Methods |
286 |
APBI - External Beam RT |
287 |
Whole vs. Partial breast irradiation – phase III studies |
288 |
Whole vs. Partial breast irradiation – phase III studies |
289 |
Extreme breast hypofractionation – preoperative single-dose PBI |
290 |
Preoperative single dose Radiotherapysupine position – UMC Utrecht |
291 |
MRI – complete response |
292 |
Planning aspects in breast RT |
293 |
Optimal cardiac sparing – Breath-hold technique |
294 |
Breath hold techniques |
295 |
UMC Utrecht – voluntary deep inspiration breath hold techniquelocal +/- regional lymph nodes |
296 |
Breath hold analysis |
297 |
Breath hold technique |
298 |
Compliance Breath hold technique |
299 |
Planning aspects in breast RT |
300 |
Forward IMRT / 3DCRT |
301 |
More advanced planning techniquesin breast cancer patients |
302 |
Comparison of 3D-CRT, IMRT, VMAT in locoregional RT (including internal mammary nodes) |
303 |
3D-CRT compared with VMAT |
304 |
Multibeam-IMRT compared with VMAT |
305 |
Comparison of 3D-CRT, IMRT, VMAT locoregional RT including IMN |
306 |
Other indications VMAT - Funnel chest Heartl 2014 |
307 |
What about second cancer risk? |
308 |
Recommendations VMAT and m-IMRT |
309 |
Take home messages – innovations in RT breast cancer |
310 |
Thank you for your attention! |
311 |
Planning aspects in breast RT |
312 |
Boost on tumor bed: decreased local recurrence |
313 |
Boost on tumor bed – breast fibrosis |
314 |
Breast fibrosis – Increased risk of |
315 |
Simultaneously integrated boost (SIB)instead of sequential boost |
316 |
Sequential boost vs. SIB |
317 |
Simultaneously integrated boost (SIB) |
318 |
Preoperative external beam Radiotherapyprone position |
319 |
sp |
320 |
Slide Number 74 |
321 |
Slide Number 75 |
322 |
Treatment and Toxicity - Conclusions |
323 |
9a.Breast case_2016 |
324 |
Slide Number 1 |
324 |
Case 1: Breast |
325 |
Introduction case 1: Breast and regional lymph nodes (i.e. axillary, supraclavicular and internal mammary nodes) |
326 |
Mrs H, 54 years old |
327 |
Titles in Arial |
328 |
Titles in Arial |
329 |
Titles in Arial |
330 |
Titles in Arial |
331 |
BI-RADS: Breast Imaging-reporting and data system |
332 |
BI-RADS classification |
333 |
Mrs H, 54 years old |
334 |
Mrs H, 54 years old |
335 |
MRI - BI-RADS classification |
336 |
Slide Number 14 |
337 |
Mrs H, 54 years old |
338 |
Slide Number 16 |
339 |
Slide Number 17 |
340 |
Mrs H, 54 years old |
341 |
Slide Number 19 |
342 |
Slide Number 20 |
343 |
Mrs H, 54 years old |
344 |
Mrs H - Treatment |
345 |
Mrs H - Treatment |
346 |
Locoregional RT – Organs at risk |
347 |
Breast planning – session objectives |
348 |
11.Practical aspects of IMRT planning |
349 |
Slide Number 1 |
349 |
Optimalisation 3DCRT |
350 |
Optimalisatie IMRT |
351 |
Slide Number 4 |
352 |
Slide Number 5 |
353 |
Optimization |
354 |
20 tips and tricks for happy IMRT planning |
355 |
20 tips and tricks for happy IMRT planning |
356 |
20 tips and tricks for happy IMRT planning |
357 |
20 tips and tricks for happy IMRT planning |
358 |
20 tips and tricks for happy IMRT planning |
359 |
20 tips and tricks for happy IMRT planning |
360 |
20 tips and tricks for happy IMRT planning |
361 |
20 tips and tricks for happy IMRT planning |
362 |
20 tips and tricks for happy IMRT planning |
363 |
20 tips and tricks for happy IMRT planning |
364 |
Slide Number 17 |
365 |
what happens to the dose in the posterior part of PTVwhen the patient is shifted 1 cm dorsally? |
366 |
Slide Number 19 |
367 |
20 tips and tricks for happy IMRT planning |
368 |
20 tips and tricks for happy IMRT planning |
369 |
20 tips and tricks for happy IMRT planning |
370 |
20 tips and tricks for happy IMRT planning |
371 |
20 tips and tricks for happy IMRT planning |
372 |
20 tips and tricks for happy IMRT planning |
373 |
20 tips and tricks for happy IMRT planning |
374 |
20 tips and tricks for happy IMRT planning |
375 |
20 tips and tricks for happy IMRT planning |
376 |
20 tips and tricks for happy IMRT planning |
377 |
20 tips and tricks for happy IMRT planning |
378 |
20 tips and tricks for happy IMRT planning |
379 |
20 tips and tricks for happy IMRT planning |
380 |
20 tips and tricks for happy IMRT planning |
381 |
20 tips and tricks for happy IMRT planning |
382 |
20 tips and tricks for happy IMRT planning |
383 |
20 tips and tricks for happy IMRT planning |
384 |
Slide Number 37 |
385 |
Conclusions |
386 |
12.practical aspects IMRT |
387 |
Slide Number 1 |
387 |
Slide Number 2 |
388 |
Slide Number 3 |
389 |
Slide Number 4 |
390 |
Slide Number 5 |
391 |
Slide Number 6 |
392 |
Slide Number 7 |
393 |
Slide Number 8 |
394 |
Slide Number 9 |
395 |
Slide Number 10 |
396 |
Slide Number 11 |
397 |
Slide Number 12 |
398 |
Slide Number 13 |
399 |
Slide Number 14 |
400 |
Slide Number 15 |
401 |
Slide Number 16 |
402 |
Slide Number 17 |
403 |
Slide Number 18 |
404 |
Slide Number 19 |
405 |
Slide Number 20 |
406 |
Slide Number 21 |
407 |
Slide Number 22 |
408 |
Slide Number 23 |
409 |
Slide Number 24 |
410 |
Slide Number 25 |
411 |
Slide Number 26 |
412 |
Slide Number 27 |
413 |
Slide Number 28 |
414 |
Slide Number 29 |
415 |
Slide Number 30 |
416 |
Slide Number 31 |
417 |
Slide Number 32 |
418 |
Slide Number 33 |
419 |
Slide Number 34 |
420 |
Slide Number 35 |
421 |
Slide Number 36 |
422 |
Slide Number 37 |
423 |
13.Physical and biological optimisation |
424 |
Physical and biological optimisation |
424 |
Slide Number 2 |
425 |
Slide Number 3 |
426 |
Slide Number 4 |
427 |
Slide Number 5 |
428 |
Slide Number 6 |
429 |
Optimization in the biology domain |
430 |
Slide Number 8 |
431 |
Slide Number 9 |
432 |
Slide Number 10 |
433 |
Equivalent uniform dose |
434 |
Equivalent uniform dose |
435 |
Equivalent uniform dose |
436 |
Equivalent uniform dose |
437 |
Equivalent uniform dose |
438 |
Equivalent uniform dose |
439 |
Slide Number 17 |
440 |
Slide Number 18 |
441 |
Can we go beyond EUD? |
442 |
Can we go beyond EUD? |
443 |
Slide Number 21 |
444 |
Slide Number 22 |
445 |
Conclusions |
446 |
14.Particle therapy planning |
447 |
Slide Number 1 |
447 |
Slide Number 2 |
448 |
Slide Number 3 |
449 |
Differences between proton and photon planning |
450 |
Unfair comparison |
451 |
Slide Number 6 |
452 |
Slide Number 7 |
453 |
Radiation Production |
454 |
Fundamental Difference in Penetration |
455 |
Energy lost = Dose deposition |
456 |
Passive vs. active particle beam delivery |
457 |
Skull base chordoma |
458 |
Sacrum chordoma |
459 |
Prostate |
460 |
Slide Number 15 |
461 |
Slide Number 16 |
462 |
Slide Number 17 |
463 |
Dealing with uncertainties in TP |
464 |
Clinical example for dose distortion |
465 |
Treatment plan robustness |
466 |
Robust beam arrangement |
467 |
Robust beam arrangement |
468 |
Beam specific margins |
469 |
Robust optimisation |
470 |
Robustness considerations e.g. Prostate |
471 |
Penumbra |
472 |
Penumbra |
473 |
Slide Number 29 |
474 |
CT artefacts due to metallic implants |
475 |
RBE protons |
476 |
SBO (SFUD) and MBO (IMPT) |
477 |
SBO vs MBO example prostate case |
478 |
Optimization strategy |
479 |
Field matching |
480 |
Particle planning basics |
481 |
Potential of ART |
482 |
CIBT wrt PT: Some important differences for TP |
483 |
CIBT wrt PT: Some important differences for TP |
484 |
C vs p: Skull base |
485 |
C vs p: Sacrum |
486 |
Some practical aspect in ion beam planning |
487 |
Some practical aspect in ion beam planning |
488 |
Conclusion |
489 |
15Prostate case_Estro course ATP_2016_DvdBongard |
490 |
Slide Number 1 |
490 |
Introduction Case 2: Prostate |
491 |
Mr R, 80 years old |
492 |
Prostate biopsy |
493 |
Mr R, 80 years old |
494 |
Gleason score |
495 |
Mr R, 80 years old |
496 |
Mr R, 80 years old |
497 |
FLAME trialFocal Lesion Ablative Microboost in prostatE cancer |
498 |
FLAME trialFocal Lesion Ablative Microboost in prostatE cancer |
499 |
Prostate - RT planning and position verification |
500 |
RT planning |
501 |
Planning-CT – fiducial gold marker |
502 |
Planning-CT and -MRI |
503 |
Planning-CT and –MRIChanges in rectal and bladder filling |
504 |
Functional MRI – prostate tumor (GTV2: 95 Gy) |
505 |
MRI – special case |
506 |
Prostate RT – Organs at risk + FLAME constraints |
507 |
Prostate planning – session objectives |
508 |
16.Case2planning aspects Prostate ESTRO |
509 |
Slide Number 1 |
509 |
Slide Number 2 |
510 |
Slide Number 3 |
511 |
Slide Number 4 |
512 |
some suggestions |
513 |
16a.Prostate case discussion v1.0_2016_TP_PDF |
514 |
Slide Number 1 |
514 |
Prostate case discussion |
515 |
Clinical details |
516 |
Switch to Oncentra revue |
517 |
Individual planning session |
518 |
Which is the ‘best’ plan? |
519 |
17.Basic principles of rotational IMRT planning |
520 |
Basic principles of rotational IMRT planning |
520 |
In my institute |
521 |
Rotational IMRT not really new |
522 |
Slide Number 4 |
523 |
Slide Number 5 |
524 |
Slide Number 6 |
525 |
Slide Number 7 |
526 |
Slide Number 8 |
527 |
So…. |
528 |
So how does is work in practise? |
529 |
Slide Number 11 |
530 |
Slide Number 12 |
531 |
Slide Number 13 |
532 |
Static IMRT vs VMAT - Conceptual issues |
533 |
IMRT vs. VMAT - Conceptual differences |
534 |
Static IMRT |
535 |
VMAT |
536 |
IMRT vs. VMAT - Conceptual differences |
537 |
Slide Number 19 |
538 |
Slide Number 20 |
539 |
Slide Number 21 |
540 |
Slide Number 22 |
541 |
Slide Number 23 |
542 |
Slide Number 24 |
543 |
Slide Number 25 |
544 |
Slide Number 26 |
545 |
Alternatively: |
546 |
Slide Number 28 |
547 |
So ….. |
548 |
RapidArc single arc versus double arc |
549 |
Slide Number 31 |
550 |
Slide Number 32 |
551 |
rotational cone beam IMRT vs static IMRT |
552 |
Slide Number 34 |
553 |
Slide Number 35 |
554 |
Conclusions |
555 |
18.ESTROATP_VanHerk_margins_final |
556 |
Slide Number 1 |
556 |
Geometric uncertainties and how to deal with them |
557 |
Problems in radiotherapy: |
558 |
How can we solve this problem ? |
559 |
Image Guided Radiotherapy |
560 |
IGRT Technologies |
561 |
IGRT is brilliant ! |
562 |
Nomenclature |
563 |
EPID dosimetry QA to catch gross errors: used for all curative patients at NKI |
564 |
Gross errors detected in NKI |
565 |
What happens in the other 99.6% ? |
566 |
Motion counts? Prostate trial data (1996) |
567 |
The major uncertainties not solved by IGRT |
568 |
Delineation variation: CT versus CT + PET |
569 |
Are prostate markers perfect ? |
570 |
Intra-fraction motion: CBCT during VMAT |
571 |
Intra-fraction motion: CBCT during VMAT |
572 |
Slide Number 18 |
573 |
Analysis of uncertaintiesKeep the measurement sign! |
574 |
Demonstration – errors in RT |
575 |
Slide Number 21 |
576 |
Slide Number 22 |
577 |
Slide Number 23 |
578 |
Slide Number 24 |
579 |
Slide Number 25 |
580 |
2.5S + 0.7s is a simplification |
581 |
Practical examples |
582 |
Prostate: 2.5 S + 0.7 s |
583 |
Prostate: 2.5 S + 0.7 sNow add IGRT |
584 |
Lung planning target volume concepts |
585 |
Image selection approaches to derive representative 3D data |
586 |
Very clear lung tumor: classic RT |
587 |
Very clear lung tumor: IGRT hypo |
588 |
Planned dose distribution: hypofractionated lung treatment 3x18 Gy |
589 |
Realized dose distribution with daily IGRT on tumor (no gating) |
590 |
Clinical results with mid-V |
591 |
But what about the CTV ? |
592 |
Slide Number 38 |
593 |
Conclusions |
594 |
Slide Number 40 |
595 |
19.Molecular imaging RT UN |
596 |
Slide Number 1 |
596 |
Molecular imaging in radiotherapy |
597 |
Medical imaging in radiation oncology |
598 |
Types of medical imaging |
599 |
Q1: In your center, do you use functional imaging for radiotherapy planning? |
600 |
Q2: How do you / would you use functional imaging for radiotherapy planning? |
601 |
Imaging literature, example PET |
602 |
Imaging literature, example PET |
603 |
FDG-PET/CT in diagnosis of solid tumors |
604 |
SPN: probability of malignancy |
605 |
Medical imaging in radiation oncology |
606 |
Slide Number 12 |
607 |
Imaging for GTV delineation |
608 |
Molecular imaging for GTV delineation |
609 |
Reduction of IOV by new imaging methods |
610 |
Slide Number 16 |
611 |
Slide Number 17 |
612 |
Slide Number 18 |
613 |
Slide Number 19 |
614 |
Slide Number 20 |
615 |
Slide Number 21 |
616 |
Slide Number 22 |
617 |
CTV: nodal spread |
618 |
Diagnostic accuracy of FDG-PET/CT in N-staging of NSCLC |
619 |
Slide Number 25 |
620 |
Slide Number 26 |
621 |
Slide Number 27 |
622 |
PET-Plan Study: diagnostic expert-panel |
623 |
PET-Plan Panel:overall observer agreement by phase |
624 |
Slide Number 30 |
625 |
Are you sure about your finding? |
626 |
Imaging for RT-planning: soon before treatment! |
627 |
Medical imaging in radiation oncology |
628 |
Cone-Beam CT |
629 |
Imaging for adaptive radiotherapy |
630 |
Slide Number 36 |
631 |
... dose painting |
632 |
PET in RT planning: beyond GTV |
633 |
Slide Number 39 |
634 |
Slide Number 40 |
635 |
Prediction of local recurrence |
636 |
Prediction of NT-reactions? |
637 |
Response prediction during RT? |
638 |
„cooking recipe“ for the translation of new imaging modalities in radiation oncology |
639 |
Medical imaging in radiation oncology |
640 |
Morphological assessment of response |
641 |
“Functional” response assessment |
642 |
|
643 |
20.MRI in treatment planning_PDF |
644 |
Slide Number 1 |
644 |
MRI in treatment planning |
645 |
Introduction:MRI – why, where, when? |
646 |
Introduction:MRI – why, where, when? |
647 |
Introduction:MRI – why, where, when? |
648 |
Introduction:MRI – why, where, when? |
649 |
Functional imaging modalities in MRI |
650 |
DWI images |
651 |
DWI images – ADC maps |
652 |
DWI images – ADC maps |
653 |
DWI images – ADC maps |
654 |
DWI images – ADC maps |
655 |
DWI images – ADC maps |
656 |
DWI images – ADC maps |
657 |
Diffusion tensor imaging - DTI |
658 |
Diffusion tensor imaging - DTI |
659 |
Diffusion tensor imaging - DTI |
660 |
Spectroscopic Magnetic Resonance |
661 |
Perfusion weighted images - PWI |
662 |
Perfusion weighted images - PWI |
663 |
Perfusion weighted images - PWI |
664 |
Perfusion weighted images - PWI |
665 |
Perfusion weighted images - PWI |
666 |
New MRI imaging modalities and radiotherapy planning |
667 |
New MRI imaging modalities and radiotherapy planning |
668 |
1. MRI for targeting: prostate |
669 |
1. MRI for targeting: prostate |
670 |
1. MRI for targeting: prostate |
671 |
1. MRI for targeting: prostate |
672 |
1. MRI for targeting: cervix |
673 |
1. MRI for targeting: cervix |
674 |
1. MRI for targeting: cervix |
675 |
1. MRI for targeting: brain |
676 |
1. MRI for targeting: brain |
677 |
1. MRI for targeting: brain |
678 |
1. MRI for targeting: brain |
679 |
1. MRI for targeting: brain |
680 |
1. MRI for targeting: brain |
681 |
New MRI imaging modalities and radiotherapy planning |
682 |
2. Direct planning on MRI images |
683 |
2. Direct planning on MRI images |
684 |
2. Direct planning on MRI images |
685 |
2. Direct planning on MRI images |
686 |
2. Direct planning on MRI images |
687 |
2. Direct planning on MRI images |
688 |
2. Direct planning on MRI images |
689 |
2. Direct planning on MRI images |
690 |
2. Direct planning on MRI images |
691 |
2. Direct planning on MRI images |
692 |
2. Direct planning on MRI images |
693 |
2. Direct planning on MRI images |
694 |
2. Direct planning on MRI images |
695 |
New MRI imaging modalities and radiotherapy planning |
696 |
MR-Linac |
697 |
MR-60Co |
698 |
MRI – 60Co: imaging features |
699 |
MRI – 60Co: imaging features |
700 |
MRI – 60Co: imaging features |
701 |
Slide Number 59 |
702 |
Slide Number 60 |
703 |
Slide Number 61 |
704 |
New MRI imaging modalities and radiotherapy planning: conclusions |
705 |
New MRI imaging modalities and radiotherapy planning: conclusions |
706 |
Slide Number 64 |
707 |
22.Advanced planning strategies for lung tumours (physical aspects)_pdf |
708 |
Advanced planning strategies for lung tumours physical aspects |
708 |
Why use IMRT in lung |
709 |
Why use IMRT in lung |
710 |
Why not use IMRT in lung |
711 |
Why not use IMRT in lung |
712 |
Why not use IMRT in lung |
713 |
Why not use IMRT in lung |
714 |
Slide Number 8 |
715 |
Slide Number 9 |
716 |
So forget about IMRT for lung if you don’t have these fancy tools? |
717 |
Key findings: |
718 |
Slide Number 12 |
719 |
Slide Number 13 |
720 |
Slide Number 14 |
721 |
Why? 1 |
722 |
Why? 2 |
723 |
So ……. |
724 |
IGRT (not addressed in this course) is key here |
725 |
Slide Number 19 |
726 |
Baseline shifts |
727 |
4D CBCT + GTV Contour |
728 |
Apply Correction |
729 |
Conclusions |
730 |
22.advanced planning strategies lung_pdf |
731 |
Slide Number 1 |
731 |
Relationships between 3D dose distributions and clinical toxicities - Chest |
732 |
Normal tissues in the chest |
733 |
IOV in NT contouring: impact on dose calculation and plan optimisation |
734 |
Dose limits for normal tissues in the chest |
735 |
Esophagus: acute reactions |
736 |
Acute esophagitis: dose/volume effects |
737 |
Esophagus: late reactions |
738 |
Esophagus: planning constraints |
739 |
Esophagus: anatomy |
740 |
Esophagus: contouring |
741 |
Esophagus: geographic miss |
742 |
Find the esophagus |
743 |
Find the esophagus |
744 |
Find the esophagus |
745 |
Find the esophagus |
746 |
Lung (RILD) |
747 |
RILD: influence factors |
748 |
RILD: corelation between MLD and probability of symptomatic pneumonitis |
749 |
Slide Number 20 |
750 |
Slide Number 21 |
751 |
Lung: planning constraints I |
752 |
Lung: what about low doses? |
753 |
Lung: what about low doses? |
754 |
Lung: planning constraints II |
755 |
Lung: contouring |
756 |
Spinal cord |
757 |
Spinal cord: planning constraints |
758 |
Spinal cord: contouring |
759 |
Heart |
760 |
Heart |
761 |
Heart: planning constraints |
762 |
Heart: Delineation |
763 |
Heart: contouring |
764 |
Slide Number 35 |
765 |
Bone |
766 |
Slide Number 37 |
767 |
Brachial plexus |
768 |
Brachial plexus: toxicity |
769 |
Brachial plexus: planning constraints |
770 |
Contouring the brachial plexus |
771 |
Contouring the brachial plexus |
772 |
Thanks to: |
773 |
23.Lisbon APS lung case UN |
774 |
Slide Number 1 |
774 |
Case 3 (lung) |
775 |
Slide Number 3 |
776 |
Slide Number 4 |
777 |
Slide Number 5 |
778 |
Slide Number 6 |
779 |
Slide Number 7 |
780 |
24.Case2planning aspects T3 LungESTRO |
781 |
Slide Number 1 |
781 |
Slide Number 2 |
782 |
Slide Number 3 |
783 |
Slide Number 4 |
784 |
Slide Number 5 |
785 |
Slide Number 6 |
786 |
Slide Number 7 |
787 |
Slide Number 8 |
788 |
Slide Number 9 |
789 |
24a.Lung case discussion Cambrige_pdf |
790 |
Slide Number 1 |
790 |
Lung case discussion |
791 |
Slide Number 3 |
792 |
Slide Number 4 |
793 |
Slide Number 5 |
794 |
Which is the ‘best’ plan? |
795 |
Slide Number 7 |
796 |
Which is the ‘best’ plan? |
797 |
Switch to Oncentra revue |
798 |
Individual planning session |
799 |
25.ESTROATP_VanHerk_Sharpe_ConceptsAdaptive_final |
800 |
Slide Number 1 |
800 |
Adaptive radiotherapy |
801 |
What is ART? |
802 |
ART Concepts |
803 |
Adaptive Concept |
804 |
Slide Number 6 |
805 |
Slide Number 7 |
806 |
Slide Number 8 |
807 |
Slide Number 9 |
808 |
When to correct ? |
809 |
Adaptive Radiation Therapy |
810 |
The Evolving Role of IGRT |
811 |
Initial PTV |
812 |
Confidence-Limited PTV (cl-PTV) |
813 |
Volume Difference: PTV vs cl-PTV |
814 |
Initial PTV & cl-PTV Do NOT Overlap |
815 |
Reality check: setup error pattern |
816 |
Adaptive radiotherapy |
817 |
Adaptive radiotherapy (naïve summary after 5 fractions) |
818 |
Naïve running estimates |
819 |
Slide Number 21 |
820 |
Methods: average prostate |
821 |
Slide Number 23 |
822 |
Results |
823 |
Slide Number 25 |
824 |
Differential Variability |
825 |
Benefits of Daily IG-IMRT |
826 |
Tumour Regression |
827 |
Summary |
828 |
26.Library planning |
829 |
Library planning |
829 |
Slide Number 2 |
830 |
plan of the day |
831 |
issues with library planning delivery |
832 |
potential tumour sites for online adaptive strategies |
833 |
potential tumour sites for online adaptive strategies |
834 |
potential tumour sites for online adaptive strategies |
835 |
Slide Number 8 |
836 |
Slide Number 9 |
837 |
Slide Number 10 |
838 |
Slide Number 11 |
839 |
Slide Number 12 |
840 |
potential tumour sites for online adaptive strategies |
841 |
Slide Number 14 |
842 |
Slide Number 15 |
843 |
Slide Number 16 |
844 |
Slide Number 17 |
845 |
Bladder IGA |
846 |
Slide Number 19 |
847 |
2 CT scans |
848 |
automated planning |
849 |
automated planning |
850 |
Slide Number 23 |
851 |
dose wall maps of voided and full bladder plans |
852 |
Slide Number 25 |
853 |
Slide Number 26 |
854 |
Slide Number 27 |
855 |
Conclusions |
856 |
27.ESTROATP_VanHerk_probplan_final |
857 |
Probabilistic planning |
857 |
Slide Number 2 |
858 |
Variability in Repeated 4D CBCT |
859 |
Slide Number 4 |
860 |
Uncertainty management: Probabilistic IMRT planning without margin |
861 |
Random errors & breathing |
862 |
Statistical Model of Breathing Motion |
863 |
Variability in Motion Day-to-Day Revisted |
864 |
Variability in Motion Day-to-Day Revisited |
865 |
Variability in Motion Day-to-Day Revisited |
866 |
Clinical Lung Case |
867 |
Slide Number 12 |
868 |
Slide Number 13 |
869 |
How DVH cost functions are calculated |
870 |
Slide Number 15 |
871 |
Inclusion of uncertainties in plan optimization |
872 |
Robust vs probabilistic optimization |
873 |
Confidence level of objective functions |
874 |
Materials and Methods |
875 |
Objectives for treatment plans |
876 |
Effect of probabilistic planning |
877 |
Results |
878 |
Slide Number 23 |
879 |
Probabilistic dose painting `by numbers' |
880 |
Conclusions |
881 |
28.Dose painted planning |
882 |
Dose painted planning |
882 |
The vision is clear |
883 |
Slide Number 3 |
884 |
Slide Number 4 |
885 |
Slide Number 5 |
886 |
Slide Number 6 |
887 |
Hypoxia Dose Painting Trail in Tübingen, Germany |
888 |
the FLAME trial: Focal Lesion Ablative Microboost |
889 |
Commercial planning systems do not support dose painting |
890 |
How? |
891 |
How? |
892 |
Slide Number 12 |
893 |
How? |
894 |
Slide Number 14 |
895 |
How? |
896 |
How? |
897 |
How? |
898 |
thresholding might be tricky |
899 |
How? |
900 |
Treatment plan evaluation |
901 |
Slide Number 21 |
902 |
Slide Number 22 |
903 |
Slide Number 23 |
904 |
29.ESTROATP_VanHerk_defimagereg_fina |
905 |
Rigid and deformable registration |
905 |
Image registration |
906 |
Degrees of Freedom |
907 |
Demo rigid registration |
908 |
Deformation vector fields |
909 |
Deformable registration example |
910 |
Slide Number 7 |
911 |
Prostate MRI w/wo Endo Rectal Coil |
912 |
Slide Number 9 |
913 |
QA methods |
914 |
4D Phantoms |
915 |
Registration of anatomically realistic phantom in pelvis |
916 |
Natural Fiducials |
917 |
Results: Lung 4D CT (22)% Bifurcation Points |
918 |
Lung deformable registration easy ? |
919 |
Slide Number 16 |
920 |
Slide Number 17 |
921 |
Analysis of variance Observer places O1, Observer places O2Computer places O3 |
922 |
Results: head and neck CT-CBCT |
923 |
Can you see all anatomical changes ? |
924 |
Easy deformable registration of the bladder? |
925 |
The bladder is a balloon in a box with stuff – it expands isotropic constrained by the organs around it |
926 |
Landmark validation of contour-based bladder registration |
927 |
Registration of shrinking tumor ? |
928 |
Overconfidence in commercial systems |
929 |
Conclusions |
930 |
Thank you for your attention! |
931 |
30.Introduction Case 4 Bilateral oropharaynx_pdf |
932 |
Slide Number 1 |
932 |
Introduction to Case 5: Bilateral Oropharynx |
933 |
Staging |
934 |
HPV status (needed for prognosis) |
935 |
PTV prescription: SIB treatment |
936 |
Slide Number 6 |
937 |
Slide Number 7 |
938 |
Slide Number 8 |
939 |
Slide Number 9 |
940 |
Recommendations for IMRT use |
941 |
OARs constraints |
942 |
OARs constraints |
943 |
OARs constraints |
944 |
Parameters for clinical outcome: Salivary glands |
945 |
Mean dose to both parotids 25 Gy |
946 |
Mean dose to both parotids 35 Gy |
947 |
OARs constraints |
948 |
OARs constraints |
949 |
Parameters for clinical outcome: Salivary gland |
950 |
OARs constraints/objectives |
951 |
Replanning H&N IMRT patients |
952 |
Replanning H&N IMRT patients |
953 |
Replanning H&N IMRT patients |
954 |
Replanning H&N IMRT patients |
955 |
Slide Number 25 |
956 |
Slide Number 26 |
957 |
Patient monitoring: challenges for replanning |
958 |
Patient monitoring: challenges for replanning |
959 |
Slide Number 29 |
960 |
30a.Planning aspects Head and Neck ESTRO |
961 |
Slide Number 1 |
961 |
Slide Number 2 |
962 |
Clinical example |
963 |
Conventional IGRT Workflow |
964 |
IGART Workflow/Closed loop principle |
965 |
How to finally evaluate? |
966 |
ART for head and neck cancer |
967 |
Results - adaptation vs non-adaptation |
968 |
Slide Number 9 |
969 |
Control Scan after 10 fractions |
970 |
CT1 + originial ROIs |
971 |
CT2 + new ROIs |
972 |
Deformations |
973 |
Initial plan on CT1&2 |
974 |
Deformed dose on CT2 |
975 |
Original plan CT1&2 |
976 |
Old and new ROIs on CT2 |
977 |
Slide Number 18 |
978 |
Slide Number 19 |
979 |
31.Conclusion_Planning aspects Head and Neck ESTRO |
980 |
Slide Number 1 |
980 |
PTV prescription: SIB treatment |
981 |
OARs constraints/objectives |
982 |
Slide Number 4 |
983 |
Bias dose |
984 |
Different scenarios |
985 |
32.Pareto front |
986 |
Slide Number 1 |
986 |
Slide Number 2 |
987 |
Slide Number 3 |
988 |
What is the pareto principle |
989 |
Slide Number 5 |
990 |
Slide Number 6 |
991 |
Slide Number 7 |
992 |
Sweeping the dose : dose shaping |
993 |
Slide Number 9 |
994 |
Slide Number 10 |
995 |
Slide Number 11 |
996 |
Slide Number 12 |
997 |
Slide Number 13 |
998 |
Slide Number 14 |
999 |
Mnemonic for Pareto front |
1000 |
The „manual“ way to get there |
1001 |
Slide Number 17 |
1002 |
Slide Number 18 |
1003 |
Slide Number 19 |
1004 |
Slide Number 20 |
1005 |
Slide Number 21 |
1006 |
Slide Number 22 |
1007 |
Slide Number 23 |
1008 |
Slide Number 24 |
1009 |
Slide Number 25 |
1010 |
Slide Number 26 |
1011 |
Slide Number 27 |
1012 |
Slide Number 28 |
1013 |
Slide Number 29 |
1014 |
Slide Number 30 |
1015 |
Slide Number 31 |
1016 |
Slide Number 32 |
1017 |
Slide Number 33 |
1018 |
Slide Number 34 |
1019 |
Slide Number 35 |
1020 |
Slide Number 36 |
1021 |
Slide Number 37 |
1022 |
Slide Number 38 |
1023 |
Slide Number 39 |
1024 |
Slide Number 40 |
1025 |
33.Physicist's perspective |
1026 |
Physicist’s perspective |
1026 |
Emerging topics |
1027 |
Automatic normal tissue segmentation |
1028 |
Slide Number 4 |
1029 |
Slide Number 5 |
1030 |
Slide Number 6 |
1031 |
Slide Number 7 |
1032 |
Slide Number 8 |
1033 |
Summary |
1034 |
the planning time to complete a (complex) H&N case is typically |
1035 |
Slide Number 11 |
1036 |
Slide Number 12 |
1037 |
Slide Number 13 |
1038 |
Slide Number 14 |
1039 |
Slide Number 15 |
1040 |
Slide Number 16 |
1041 |
Slide Number 17 |
1042 |
Slide Number 18 |
1043 |
Slide Number 19 |
1044 |
Complications |
1045 |
Clinical Favourability |
1046 |
Wish-list: Formalised DM |
1047 |
Slide Number 23 |
1048 |
Slide Number 24 |
1049 |
Slide Number 25 |
1050 |
Slide Number 26 |
1051 |
Slide Number 27 |
1052 |
Slide Number 28 |
1053 |
Slide Number 29 |
1054 |
Slide Number 30 |
1055 |
Slide Number 31 |
1056 |
Slide Number 32 |
1057 |
Slide Number 33 |
1058 |
Slide Number 34 |
1059 |
Slide Number 35 |
1060 |
Slide Number 36 |
1061 |
Slide Number 37 |
1062 |
Slide Number 38 |
1063 |
the times they are a changin’ |
1064 |
34.Doctor's perspective - Cambridge 2016 - v1.1 handout |
1065 |
Slide Number 1 |
1065 |
The doctor’s perspective |
1066 |
Summary |
1067 |
Use the best tools for the job ! |
1068 |
Treatment volumes compared |
1069 |
Slide Number 6 |
1070 |
Slide Number 7 |
1071 |
Small dose differences matter |
1072 |
Marginal gains |
1073 |
Dialogue – a key component of happy planning |
1074 |
Dialogue – a key component of happy planning |
1075 |
Dialogue – a key component of happy planning |
1076 |
Multi-criteria optimisation (MCO) |
1077 |
Multi-criteria optimisation (MCO) |
1078 |
IMRT – Optimisation |
1079 |
Slide Number 16 |
1080 |
Multi-criteria optimisation (MCO) |
1081 |
Multi-criteria optimisation (MCO) |
1082 |
Normal tissue response data |
1083 |
Normal tissue response data |
1084 |
Normal tissue response data |
1085 |
Normal tissue response data |
1086 |
Dose accumulation |
1087 |
Dose accumulation |
1088 |
Dose accumulation |
1089 |
DSM for highest accumulated dose compared with planned |
1090 |
DSM for lowest accumulated dose compared with planned |
1091 |
Dose accumulation |
1092 |
Dose accumulation |
1093 |
VoxTox - results |
1094 |
Dose accumulation |
1095 |
Individual variation in normal tissue sensitivity |
1096 |
Individual variation in normal tissue sensitivity |
1097 |
Individual variation in normal tissue sensitivity |
1098 |
Individual variation in normal tissue sensitivity |
1099 |
Individual variation in normal tissue sensitivity |
1100 |
Individual variation in normal tissue sensitivity |
1101 |
Individual variation in normal tissue sensitivity |
1102 |
Synergy from physics and biology |
1103 |
Convolving individual radiosensitivity & individual dose accumulation |
1104 |
Convolving individual radiosensitivity & individual dose accumulation |
1105 |
Doctor’s perspective |
1106 |
Doctor’s perspective |
1107 |
Doctor’s perspective |
1108 |
Slide Number 50 |
1109 |