Flipping Book - IMRT
|
L01 Opening and Welcome - Tournel |
8 |
|
L02 Treatment a=of Rectal Cancer Using IMRT/IGRT - Engels |
38 |
|
Slide Number 1 |
38 |
|
Slide Number 2 |
39 |
|
Local recurrence rate (update) |
40 |
|
Preoperative chemoRT or RT alone? |
41 |
|
Adverse effects of long-course chemoRT |
42 |
|
Efforts to improve outcome |
43 |
|
3D-Conformal RT: 3-field technique |
44 |
|
3D-conformal RT vs IMRT |
45 |
|
+ Image-guided RT (IG-IMRT) |
46 |
|
UZ Brussel approach |
47 |
|
Phase II study 2005 – 2010 |
48 |
|
Dose-volume constraints for IMRT: small bowel |
49 |
|
Dose-volume constraints for IMRT: bladder |
50 |
|
Dose-volume constraints for IMRT: pelvic bone + plexus |
51 |
|
Dose-volume constraints for IMRT: bone marrow |
52 |
|
Proposed dose-volume constraints IMRT rectal cancer |
53 |
|
IG-IMRT by helical tomotherapy with a simultaneous integrated boost |
54 |
|
Acute toxicity |
55 |
|
Surgical characteristics and downstaging |
56 |
|
Late toxicity |
57 |
|
Follow-up (median 54 months; range: 27-79 months) |
58 |
|
2010: Multicentric randomized trial (NCT 01224392) |
59 |
|
Study design |
60 |
|
Patient population (n = 169) |
61 |
|
Acute toxicity |
62 |
|
Surgical parameters |
63 |
|
Pathology |
64 |
|
Primary endpoint |
65 |
|
Outcome (median follow-up 14 months) |
66 |
|
Preoperative RT with a simultaneous integrated boost compared to chemoRT for T3-4 rectal cancer: a multicentric randomized trial |
67 |
|
Acknowledgements |
68 |
|
L03 Treatment of Lung and Liver Tumours Using Dynamic Tracking - Gavaert |
69 |
|
L04 Treatment of Oligometastases Using a SBRT/IMRT/IGRT - Van Den Begin |
128 |
|
Treatment of oligometastasesusing SBRT/IMRT/IGRT |
128 |
|
1. SBRT and oligometastatic disease |
129 |
|
Stereotactic Body Radiation Therapy |
130 |
|
Oligometastatic disease |
131 |
|
Oligometastases: A distinct disease entity at the clinical level |
132 |
|
Stereotactic radiotherapy for oligometastases: a prognostic model for survival |
133 |
|
Overall Survival |
134 |
|
Patient-inherent risk factors associated with impaired OS |
135 |
|
Risk factor analysis |
136 |
|
Patient non-inherent risk factors associated with impaired OS |
137 |
|
Impact of SBRT on overall survival as compared to standard of care? |
138 |
|
2. Helical Tomotherapy IMRTfor oligometastatic disease: analysis of recurrences |
139 |
|
Slide Number 19 |
140 |
|
Helical tomotherapy for oligometastatic CRC:UZ Brussel experience |
141 |
|
Cause of local failure after SBRT |
142 |
|
Patterns of local failure |
143 |
|
Tomotherapy for moving targets? |
144 |
|
3. Phase II study of SBRT for oligometastatic cancer |
145 |
|
Phase II study of Vero SBRT for oligometastatic cancer |
146 |
|
2. Motion management |
147 |
|
Treatment algorithm |
148 |
|
A. ITV-approach: 4D-CT |
149 |
|
A. ITV-approach: contouring |
150 |
|
Case 1: 54 year old patient with lungmetastasis |
151 |
|
Daily cone beam CT positioning with ITV approach |
152 |
|
B. Dynamic Tumor tracking: Vero |
153 |
|
The Vero positioning system |
154 |
|
Implantation of fiducial |
155 |
|
B. Dynamic Tumor tracking |
156 |
|
Potential benefits of Dynamic Tracking |
157 |
|
Slide Number 38 |
158 |
|
Case 2: multiple-met tracking |
159 |
|
Case 2: 2 livermetastases |
160 |
|
Volumetric imaging + Dynamic Tracking |
161 |
|
Inter-fractional organ-at-risk motion |
162 |
|
Slide Number 45 |
163 |
|
Toxicity |
164 |
|
Local control (median follow-up 12 months) |
165 |
|
Local control ITV vs Tracking |
166 |
|
Local control according to location |
167 |
|
PFS and OS (n=44 patients) |
168 |
|
Conclusions: SBRT for oligometastases |
169 |
|
Acknowledgements |
170 |
|
L05 Radiosurgery - Gavaert |
171 |
|
L06 Radtional of IMRT; Clinicians View - Lohr |
236 |
|
IMRT - a physician‘s view(As if physician‘s, physicists and RTs should have different views of the world…..) |
236 |
|
Slide Number 2 |
237 |
|
Disclosure |
238 |
|
Drivers of IMRT |
239 |
|
Technical Basis |
240 |
|
Radiotherapy Treatment Planning |
241 |
|
Treatment Delivery |
242 |
|
Inverse Planning |
243 |
|
Requirements |
244 |
|
Prescription |
245 |
|
Everything works fine up to here |
246 |
|
Optimization |
247 |
|
Optimization Strategies |
248 |
|
IMRT-Capable Delivery System |
249 |
|
Basic treatment techniques |
250 |
|
2 “Slices” Treated per Rotation |
251 |
|
Ok, everything is almost perfect up to this point |
252 |
|
Clinical Application of IMRT |
253 |
|
Most important indications and treatment philosophy |
254 |
|
Slide Number 20 |
255 |
|
IMRT clinical outcome |
256 |
|
Avoiding unnecessary toxicity |
257 |
|
Slide Number 23 |
258 |
|
Slide Number 24 |
259 |
|
IMRT is evil….is it? The SEER-Database suggests… |
260 |
|
Slide Number 26 |
261 |
|
Caveat: Marginal misses and high doses to large volumes |
262 |
|
Tata Memorial Randomized Trial |
263 |
|
Slide Number 29 |
264 |
|
Slide Number 30 |
265 |
|
Now comes the strange part….. |
266 |
|
Target Delineation |
267 |
|
The good news, however…… |
268 |
|
Hypofractionation/SIB-> Watch the Volume |
269 |
|
Brain tumor cells are interdispersed with normal cellsThe Brain is the central human organ. Severe damage here alters the personality….and thus effectively kills the patient alive |
270 |
|
There is good news on the secondary tumor front: |
271 |
|
Randomized Data: PORTEC etc. |
272 |
|
Convenience and Optimization of existing Paradigms |
273 |
|
Head and Neck |
274 |
|
Slide Number 40 |
275 |
|
Slide Number 41 |
276 |
|
Slide Number 42 |
277 |
|
Clinical Results with Tangential IMRT |
278 |
|
Scatter Reduction with tangential IMRT |
279 |
|
NPC |
280 |
|
IMRT allows SRS with relatively large leaf sizesand facilitates multi-lesion treatments with one isocenter |
281 |
|
Inhomogenous dose sagittal |
282 |
|
Transversal inhomogenous |
283 |
|
Treatment Times |
284 |
|
A very special patient |
285 |
|
Quality assurance with Gafchromic EBT3 films |
286 |
|
IGRT / Online-adaptation |
287 |
|
Target / Organ Motion |
288 |
|
Slide Number 54 |
289 |
|
Slide Number 55 |
290 |
|
Possible (partial) remedy: IMRT/VMAT in computer-controlled deep-inspiration breath hold |
291 |
|
Volumetric imaging - online during a treatment fraction |
292 |
|
The good thing that comes out of these machines: |
293 |
|
New methods for detection of subclinical metastasesa) in general ->Liquid Biopsy |
294 |
|
Polyclonality is always a problem with any (vaccination) strategy: |
295 |
|
New methods for detection of subclinical metastasesb) providing topical information at high resolution->MRI |
296 |
|
Slide Number 62 |
297 |
|
Slide Number 63 |
298 |
|
Oligometastases/Multitargets |
299 |
|
Oligomets – all lesions on one device |
300 |
|
New treatment possibilities in metastatic patientsMultiple lesions with one setup |
301 |
|
Immuntherapie |
302 |
|
Slide Number 68 |
303 |
|
CP-Inhibitor combinations |
304 |
|
RT Fraction Size |
305 |
|
…..and keeping in mind this…. |
306 |
|
And finally: Is there anything left for……… |
307 |
|
Slide Number 73 |
308 |
|
Rationale for Particles in Radiosurgery |
309 |
|
Drivers of IMRT |
310 |
|
L07 IMRT Delivery Techniques - Schwarz |
311 |
|
Slide Number 1 |
311 |
|
Slide Number 2 |
312 |
|
Why did we end up with IMRT? |
313 |
|
How can we modulated particle fluence? |
314 |
|
Slide Number 5 |
315 |
|
Subfields (or segments) |
316 |
|
Slide Number 7 |
317 |
|
Slide Number 8 |
318 |
|
“Close-in” technique |
319 |
|
“Sweep” technique |
320 |
|
Pro’s and Con’s |
321 |
|
Sequencing & Optimization:The “reducing levels” technique (Xia, Verhey) |
322 |
|
Slide Number 13 |
323 |
|
Slide Number 14 |
324 |
|
The “reducing levels” technique (Xia, Verhey) |
325 |
|
The “reducing levels” technique (Xia, Verhey) |
326 |
|
The “reducing levels” technique (Xia, Verhey) |
327 |
|
The “reducing levels” technique (Xia, Verhey) |
328 |
|
The “reducing levels” technique (Xia, Verhey) |
329 |
|
The “reducing levels” technique (Xia, Verhey) |
330 |
|
The “reducing levels” technique (Xia, Verhey) |
331 |
|
The “reducing levels” technique (Xia, Verhey) |
332 |
|
The “reducing levels” technique (Xia, Verhey) |
333 |
|
Delivered MUs |
334 |
|
IMRT-relevant features of MLCs |
335 |
|
Geometric design: single focused |
336 |
|
Geometric design: double focused |
337 |
|
What is the optimum leaf width ? |
338 |
|
Tongue & groove effect |
339 |
|
Slide Number 30 |
340 |
|
Leaf transmission and interleaf leakage |
341 |
|
Slide Number 32 |
342 |
|
Slide Number 33 |
343 |
|
‘serial tomotherapy’ mimic system |
344 |
|
Elekta MLCi2 |
345 |
|
Elekta Agility |
346 |
|
Elekta Beam Modulator |
347 |
|
Varian MLCs - 1 |
348 |
|
VARIAN MLCs -2 |
349 |
|
Collimation geometry |
350 |
|
Slide Number 41 |
351 |
|
Slide Number 42 |
352 |
|
Dynamic rotation therapy |
353 |
|
VMAT in action |
354 |
|
Differences among techniques |
355 |
|
Single Arc techniques |
356 |
|
Quite some discussions on the subject |
357 |
|
Not all rotational techniques are created equal |
358 |
|
Static field IMRT vs arc techniques |
359 |
|
Dedicated IMRT/IGRT devices |
360 |
|
TomoTherapy HI -ART System |
361 |
|
HT dose delivery system |
362 |
|
Cyberknife |
363 |
|
Slide Number 54 |
364 |
|
Slide Number 55 |
365 |
|
Imaging System |
366 |
|
General purpose vs dedicated devices |
367 |
|
Conclusions |
368 |
|
L08 3_Dosimetry issues 2015_Koen Tournel |
369 |
|
L09 TPS Commissioning - Schwarz |
439 |
|
Slide Number 1 |
439 |
|
Overview |
440 |
|
Four steps to define, baseline and monitor the performances of radiotherapy equipment. |
441 |
|
1/4 |
442 |
|
2/4 |
443 |
|
3/4 |
444 |
|
4/4 |
445 |
|
Where does ‘patient specific QA’ fits into this scheme? |
446 |
|
Commissioning of TPS |
447 |
|
Slide Number 10 |
448 |
|
How to consider all variables in the acceptability criteria ? |
449 |
|
Slide Number 12 |
450 |
|
Slide Number 13 |
451 |
|
First, what you can NOT commission/QA |
452 |
|
Slide Number 15 |
453 |
|
IMRT Highly automated planning procedure |
454 |
|
Slide Number 17 |
455 |
|
Slide Number 18 |
456 |
|
Accurate dose computation during the optimisation |
457 |
|
Combining different algorithms in the optimisation |
458 |
|
1. Modelling/measuring OF for small and/or elongated fields |
459 |
|
2. MLC modelling |
460 |
|
3. Beam ‘tails’ modeling |
461 |
|
4. Sensitivity of beam model w.r.t. detector type |
462 |
|
Measurements vs. calculations1D dose profiles |
463 |
|
Measurements vs. calculations2-D dose distributions |
464 |
|
Gamma function |
465 |
|
In practice |
466 |
|
Slide Number 29 |
467 |
|
Gamma Matrix |
468 |
|
Gamma as an error detection system |
469 |
|
Apply (and verify) ‘test case’ fluences |
470 |
|
Slide Number 33 |
471 |
|
Dedicated phantoms |
472 |
|
Plastic vs realistic patient representations |
473 |
|
External audits in IMRT commissioning/verification |
474 |
|
RPC experience - USAcceptance criteria: 7% and 4mmIbbott IJROBP 2008 |
475 |
|
Slide Number 38 |
476 |
|
Slide Number 39 |
477 |
|
L10 IMRT Optimization ; ALgorithms and Cost Functions - Sohn |
478 |
|
IMRT Optimization:Algorithms and Cost Functions |
478 |
|
Disclosure |
479 |
|
FAQ: |
480 |
|
How close are our objectives to a physically feasible dose? |
481 |
|
With 4 beams… |
482 |
|
With 4 beams… |
483 |
|
What if the gradient has to be tighter? |
484 |
|
What if the gradient has to be tighter? |
485 |
|
Solution for this special case:Use more beam angles! |
486 |
|
So, why optimization? |
487 |
|
FAQ: |
488 |
|
The IMRT optimization problem:What is optimized, and what are the variables? |
489 |
|
FAQ: |
490 |
|
The popular understanding |
491 |
|
The popular fear |
492 |
|
The truth: degeneracy of the optimization problem, non-uniqueness of the solution |
493 |
|
Fluence profile optimization (No MLC) |
494 |
|
Next: SequencingAdd (a lot of!) delivery constraints… |
495 |
|
Principles: The optimization problem for the different IMRT techniques |
496 |
|
Optimization Algorithms |
497 |
|
FAQ: |
498 |
|
What are typical treatment goals? |
499 |
|
Without the laws of physics, all goalscould be fulfilled simultaneously |
500 |
|
There exists a boundary that separatesphysical from unphysical solutions |
501 |
|
In other words: Treatment goals contradict each other! How can these be balanced? |
502 |
|
Cost Functions can be Balanced by Weight Factors: the Lagrange Function |
503 |
|
Parametrisation of the Solution Space byWeight Factors |
504 |
|
Navigating the Solution Space:Libraries of Proposals (‘multicriterial/Pareto-optimization’) |
505 |
|
Navigating the Solution Space:Constrained Optimization and Sensitivity |
506 |
|
Navigating the Solution Space:Constrained Optimization and Sensitivity |
507 |
|
„Automated planning“ |
508 |
|
FAQ: |
509 |
|
Because: |
510 |
|
FAQ: |
511 |
|
MLC delivery deviates from the ideal profiles |
512 |
|
Precise dose computation DURING fluence profile optimization is immensely expensive! |
513 |
|
How to tackle these problems… |
514 |
|
Iterative segment shape (aperture) optimization |
515 |
|
How to tackle these problems… |
516 |
|
Direct aperture optimization needs a control ofsegment shapes and good initial segment shapes |
517 |
|
This is why… |
518 |
|
Rotational IMRT techniques:Alternatives for the creation of initial guesses |
519 |
|
FAQ: |
520 |
|
How much optimization is in an optimizer? |
521 |
|
FAQ: |
522 |
|
Again: What are Typical Treatment Goals? |
523 |
|
A cost function rewards the positive aspects of a DVHand penalizes the negative ones in a single number |
524 |
|
A cost function rewards the positive aspects of a DVHand penalizes the negative ones in a single number |
525 |
|
Properties of Cost Functions |
526 |
|
The most Common Physical Cost Function:One-Sided Quadratic Penalties |
527 |
|
The Purpose of a Cost Function is to control the Shape of the DVH: Control Weights |
528 |
|
Local Control of a Quadratic Overdose Penalty |
529 |
|
Control of a Target DVH by a One-SidedQuadratic Underdosage Penalty |
530 |
|
Control of a Target DVH by Two One-Sided Quadratic Penalties |
531 |
|
Can quadratic penalties controlall aspects of dose? |
532 |
|
DVH Control for Organs with a Large Volume Effect: DVH Constraints |
533 |
|
Local Control of a DVH constraint: |
534 |
|
DVH Control for Organs with a Large Volume Effect: Multiple DVH Constraints |
535 |
|
How does a Parallel Complication Modelcontrol the DVH? |
536 |
|
Local Control of a Parallel Cost Function |
537 |
|
How does a Serial Complication Model control the DVH ? |
538 |
|
Local Control of a Serial Cost Function |
539 |
|
FAQ: |
540 |
|
Clinical relevance of the serial cost function |
541 |
|
Summary & Conclusions |
542 |
|
Summary & Conclusions [2] |
543 |
|
L11 Image-Guided & Adaptive; Concept and Approaches - Sohn |
544 |
|
Adaptive Radiotherapy |
544 |
|
Disclosure |
545 |
|
The common planning approach |
546 |
|
This is what actually happens! |
547 |
|
Classification of errors&uncertainties according to their stochastic nature |
548 |
|
‘Adaptive RT’:How it all started |
549 |
|
Adaptive RT:The fundamental, yet abstract picture… |
550 |
|
The simplest, non-adaptive planning approach as process |
551 |
|
Margins: The PTV-concept |
552 |
|
How large does the margin have to be? |
553 |
|
Which assumptions are behind this formula? |
554 |
|
This is where adaptive RT comes in! |
555 |
|
Adapting the isocentre:Setup correction protocols |
556 |
|
Estimation of the patient-individual setup error |
557 |
|
Estimation of the patient-individual setup error |
558 |
|
Adapting the isocentre:Setup correction protocols |
559 |
|
Some proposed setup protocols… |
560 |
|
How to evaluate and find the best strategy?:Treatment course simulation approaches |
561 |
|
How to evaluate and find the best strategy?:Treatment course simulation approaches |
562 |
|
Treatment course simulations for use of different setup protocols |
563 |
|
The ‘Toolbox’ of Adaptive RT |
564 |
|
One step further: Margin adaption |
565 |
|
Margin adaptation ‘visually’ |
566 |
|
The Beaumont offline adaptive RT approach |
567 |
|
The Beaumont offline adaptive RT approach:Eliminate systematic errors of the organ geometry! |
568 |
|
The Beaumont offline adaptive RT approach |
569 |
|
What are the clinical benefits? |
570 |
|
The next step: more than one re-optimization,dose accumulation, probabilistic planning |
571 |
|
The next step: more than one re-optimization,dose accumulation, probabilistic planning |
572 |
|
The next step: more than one re-optimization,dose accumulation, probabilistic planning |
573 |
|
The ‘Toolbox’ of Adaptive RT |
574 |
|
This was all offline ART…Now: Online Adaptive Re-Planning |
575 |
|
This was all offline ART…Now: Online Adaptive Re-Planning |
576 |
|
Zero Margins in daily online ART/IGRT?Intrafraction motion: prostate |
577 |
|
Zero Margins in daily online ART/IGRT?Intrafraction motion: prostate |
578 |
|
Zero Margins in daily online ART/IGRT?Intrafraction motion: prostate |
579 |
|
Further limitations of daily rigid isocentre adaptations:Deformable uncertainties |
580 |
|
Further limitations of daily rigid isocentre adaptations:Deformable uncertainties |
581 |
|
Daily rigid isocentre adaptations/IGRT:Conclusions |
582 |
|
Treatment of targets with large interfractional deformations: Plan-selection strategies |
583 |
|
Treatment of targets with large interfractional deformations: Plan-selection strategies |
584 |
|
Anatomical changes of trending nature |
585 |
|
Anatomical changes of trending nature |
586 |
|
Anatomical changes of trending nature |
587 |
|
Biologically Adapted Radiotherapy |
588 |
|
Further reading… |
589 |
|
Conclusions |
590 |
|
Conclusions [2] |
591 |
|
Finally: Some (more) words of caution |
592 |
|
L12 Image-Guided & Adaptive; Clinical Applications - Lohr |
593 |
|
IGRT for IMRT |
593 |
|
Disclosure |
594 |
|
Basic treatment techniques |
595 |
|
Slide Number 4 |
596 |
|
T2w: (A) IMRT vs. (B) 3D |
597 |
|
Slide Number 6 |
598 |
|
Dose-Escalated Irradiation of Paraspinal Metastases |
599 |
|
MIMiC |
600 |
|
The HI•ART TomoTherapy System |
601 |
|
Dr. T. Rock Mackie with the University of Wisconsin Tomotherapy Research Unit |
602 |
|
UW Tomotherapy Research Unit |
603 |
|
This is where we want to go |
604 |
|
Megavoltage CT Images |
605 |
|
Verification/QA |
606 |
|
Slide Number 15 |
607 |
|
Slide Number 16 |
608 |
|
Slide Number 17 |
609 |
|
Slide Number 18 |
610 |
|
Slide Number 19 |
611 |
|
Slide Number 20 |
612 |
|
Slide Number 21 |
613 |
|
Slide Number 22 |
614 |
|
And for a more detailed Discussion of Positioning Errors please turn to: |
615 |
|
Slide Number 24 |
616 |
|
Slide Number 25 |
617 |
|
Slide Number 26 |
618 |
|
Stereotactic Ultrasound-System |
619 |
|
Image Guided Radiotherapy (IGRT) |
620 |
|
Motiavation for kV-Imaging… |
621 |
|
… and cone-beam scanning |
622 |
|
Dose for positioning verification I |
623 |
|
Dose for positioning verification 2 |
624 |
|
Target / Organ Motion |
625 |
|
Slide Number 34 |
626 |
|
Neck Flexibility |
627 |
|
Daily vs. less frequent Imaging: Spinal cord dose |
628 |
|
ART (IMRT) – Dosimetric Benefits |
629 |
|
Slide Number 38 |
630 |
|
Slide Number 39 |
631 |
|
Precision Immobilizatin for Pelvic Tumors |
632 |
|
BAT-Procedure |
633 |
|
Slide Number 42 |
634 |
|
Slide Number 43 |
635 |
|
Slide Number 44 |
636 |
|
Slide Number 45 |
637 |
|
Slide Number 46 |
638 |
|
Slide Number 47 |
639 |
|
HexaPOD® |
640 |
|
IGRT: CBCT |
641 |
|
Slide Number 50 |
642 |
|
Slide Number 51 |
643 |
|
Slide Number 52 |
644 |
|
CBCT (XVI) with ABCin partial breath-hold vs. total breath-hold |
645 |
|
4D-CBCT |
646 |
|
Slide Number 55 |
647 |
|
Slide Number 56 |
648 |
|
Slide Number 57 |
649 |
|
Slide Number 58 |
650 |
|
Slide Number 59 |
651 |
|
Slide Number 60 |
652 |
|
Slide Number 61 |
653 |
|
Influence of IGRT on clinical outcome |
654 |
|
Slide Number 63 |
655 |
|
Surface-based Surveillance |
656 |
|
Catalyst Characteristics |
657 |
|
Ansatz kV+MV-Rekonstruktion |
658 |
|
Slide Number 67 |
659 |
|
Beispiel: Tumor shape Star10, after registration of iso-shift 1(automatic registration with in-house developed software - Matlab) |
660 |
|
Slide Number 69 |
661 |
|
2- MRI and LINAC |
662 |
|
3- MR LINAC |
663 |
|
L13 IMRT in Breast and Risk of Secondary Cancer After IMRT - Lohr |
664 |
|
Breast IMRTSecondary Tumor Risk |
664 |
|
Disclosure |
665 |
|
Slide Number 3 |
666 |
|
Clinical Application of IMRT |
667 |
|
Most important indications and treatment philosophy |
668 |
|
Slide Number 6 |
669 |
|
IMRT clinical outcome |
670 |
|
Tumor Localizations |
671 |
|
There are two different paradigms that have to be discussed separately: |
672 |
|
1. Improvement of Dose Homogeneit for Tangent Irradiation |
673 |
|
Slide Number 11 |
674 |
|
Slide Number 12 |
675 |
|
Optimization of Tangent Irradiation |
676 |
|
Optimization of Tangent Irradiation |
677 |
|
Breast IMRT - Dose Calculation |
678 |
|
Breast IMRT - Dose Calculation |
679 |
|
Slide Number 17 |
680 |
|
Clinical Results with Tangential IMRT |
681 |
|
Fox Chase experience, Median F/U 31 mo, 946 women46 + 16 Gy |
682 |
|
Scatter Reduction with tangential IMRT |
683 |
|
Peripheral dose after 2D, 3D and Tangential IMRT |
684 |
|
Tangential (!!!) IMRT vs. DIBH |
685 |
|
Slide Number 23 |
686 |
|
Distribution of Coronary Artery Stenosis After Radiation for Breast Cancer |
687 |
|
Supine Breast Movement – intra- and interfraction |
688 |
|
Slide Number 26 |
689 |
|
Slide Number 27 |
690 |
|
Slide Number 28 |
691 |
|
Slide Number 29 |
692 |
|
Slide Number 30 |
693 |
|
Slide Number 31 |
694 |
|
Slide Number 32 |
695 |
|
Slide Number 33 |
696 |
|
Slide Number 34 |
697 |
|
Current status of breast IMRT |
698 |
|
IMRT vs. VMAT |
699 |
|
First clinical data |
700 |
|
Slide Number 38 |
701 |
|
Prone vs. Supine |
702 |
|
Hypofractionation/SIB-> Watch the Volume |
703 |
|
SIB Breast – Localization? |
704 |
|
Slide Number 42 |
705 |
|
Second Malignancies |
706 |
|
IMRT-Capable Delivery System |
707 |
|
There is nothing new under the sun……2 |
708 |
|
There is nothing new under the sun……1 |
709 |
|
“The most important prerequisite for the development of a second neoplasm is cure of the primary malignancy” |
710 |
|
Slide Number 48 |
711 |
|
Risk estimates for secondary cancer after exposure to ionizing radiation |
712 |
|
Different Aspects of Carcinogenesis - Synopsis |
713 |
|
Problems identifying true incidence numbers of secondary cancer after exposure to ionizing radiation |
714 |
|
Low Dose Models |
715 |
|
Slide Number 53 |
716 |
|
Slide Number 54 |
717 |
|
High(er) Dose Exposure |
718 |
|
Low Doses are evil…….are they??? |
719 |
|
Hodgkin II (GHSG) |
720 |
|
Hodgkin III (Yale) |
721 |
|
Hodgkin III: Pediatric HD |
722 |
|
Hodgkin III: Pediatric HD |
723 |
|
Hodgkin III: Pediatric HD |
724 |
|
Breast I |
725 |
|
Breast II – Italian Data (Allegro Project) |
726 |
|
Breast III Breast Cancer Survivors |
727 |
|
Breast III – DBCG Data (Allegro-Project) |
728 |
|
Breast III – DBCG Data (Allegro-Project) |
729 |
|
And most recently…… |
730 |
|
This just in……. |
731 |
|
This just in……. |
732 |
|
Slide Number 70 |
733 |
|
Slide Number 71 |
734 |
|
KV Radiation |
735 |
|
Randomized Data: PORTEC etc. |
736 |
|
“The most important prerequisite for the development of a second neoplasm is cure of the primary malignancy” |
737 |
|
Secondary Carcinoma |
738 |
|
Slide Number 76 |
739 |
|
Secondary Tumors: H&N |
740 |
|
Specific Problems with IMRT |
741 |
|
Secondary Tumors |
742 |
|
Reasons for a potentially increased incidence of secondary tumors by IMRT |
743 |
|
Slide Number 81 |
744 |
|
Prostate IMRT |
745 |
|
Slide Number 83 |
746 |
|
Pediatric Oncology is a problem…but not a disastrous oneThe St. Jude Data….Conventional RT Techniques |
747 |
|
Slide Number 85 |
748 |
|
Slide Number 86 |
749 |
|
Assessment of radiation-induced second cancer risks in proton therapy and IMRT for organs inside the primary radiation field |
750 |
|
Does this sufficiently reflect reality? |
751 |
|
Slide Number 89 |
752 |
|
Problems with Modelling |
753 |
|
Slide Number 91 |
754 |
|
Conclusions |
755 |
|
Where the real danger lurks…… |
756 |
|
L14 IMRT in Hodgkin's Lymphoma and Secondary Cancer Risks - Filippi |
757 |
|
Highly conformal techniques in Hodgkin’s Lymphoma: indications, techniques, results |
757 |
|
Slide Number 2 |
758 |
|
Early Stage HL |
759 |
|
Slide Number 4 |
760 |
|
Slide Number 5 |
761 |
|
Slide Number 6 |
762 |
|
Slide Number 7 |
763 |
|
Slide Number 8 |
764 |
|
Slide Number 9 |
765 |
|
Slide Number 10 |
766 |
|
What do we learn from NCIC/ECOG HD6? |
767 |
|
Chemotherapy alone for early stage HL |
768 |
|
Slide Number 13 |
769 |
|
INRT Guidelines |
770 |
|
Slide Number 15 |
771 |
|
Slide Number 16 |
772 |
|
Slide Number 17 |
773 |
|
Slide Number 18 |
774 |
|
Slide Number 19 |
775 |
|
Slide Number 20 |
776 |
|
Slide Number 21 |
777 |
|
Do we have clinical data on safety and efficacy of INRT/ISRT? |
778 |
|
Slide Number 23 |
779 |
|
Slide Number 24 |
780 |
|
Slide Number 25 |
781 |
|
Slide Number 26 |
782 |
|
Early Stage HL |
783 |
|
Slide Number 28 |
784 |
|
Slide Number 29 |
785 |
|
Slide Number 30 |
786 |
|
Slide Number 31 |
787 |
|
Slide Number 32 |
788 |
|
Slide Number 33 |
789 |
|
Slide Number 34 |
790 |
|
Slide Number 35 |
791 |
|
BREACH STUDY |
792 |
|
Slide Number 37 |
793 |
|
Highly-Conformal Techniques for early stage HL? |
794 |
|
Slide Number 39 |
795 |
|
Slide Number 40 |
796 |
|
Slide Number 41 |
797 |
|
Slide Number 42 |
798 |
|
Risk of second malignancies with modern RT in HL |
799 |
|
Slide Number 44 |
800 |
|
Slide Number 45 |
801 |
|
Estimating second cancer risks after contemporary RT |
802 |
|
Slide Number 47 |
803 |
|
Key is the shape of the dose-response relationshipfor radiation-induced carcinogenesis... |
804 |
|
Competition between oncogenic transformation & cell killing |
805 |
|
However, recent epidemiology suggests that the risks are not small at large doses |
806 |
|
However, recent epidemiology suggests that the risks are not small at large doses |
807 |
|
Slide Number 52 |
808 |
|
Slide Number 53 |
809 |
|
|
810 |
|
Slide Number 55 |
811 |
|
Slide Number 56 |
812 |
|
Do results change when using different radiobiological models?What are the consequences for IMRT?May IMRT be optimized taking into account secondary cancers risk? |
813 |
|
Slide Number 58 |
814 |
|
OED for dose inhomogeneity |
815 |
|
The “full” model: low-dose, cell killing and repopulation |
816 |
|
Slide Number 61 |
817 |
|
Slide Number 62 |
818 |
|
Slide Number 63 |
819 |
|
Slide Number 64 |
820 |
|
Slide Number 65 |
821 |
|
Slide Number 66 |
822 |
|
Slide Number 67 |
823 |
|
Slide Number 68 |
824 |
|
Slide Number 69 |
825 |
|
Slide Number 70 |
826 |
|
Slide Number 71 |
827 |
|
Final Remarks |
828 |
|
L15 Patient Specific QA - Schwarz |
829 |
|
Slide Number 1 |
829 |
|
IMRT QA - The optimistic point of view |
830 |
|
IMRT QA - The pessimistic point of view |
831 |
|
Ensuring quality is this |
832 |
|
… AND this too |
833 |
|
A few criteria to evalutate a patient-specific QA procedure |
834 |
|
The big picture |
835 |
|
What about good old checklists? |
836 |
|
Slide Number 9 |
837 |
|
Slide Number 10 |
838 |
|
Slide Number 11 |
839 |
|
Commissioning of ‘class solutions’ + limited QA |
840 |
|
2. 2-D dosimetry + gamma analysis |
841 |
|
Gamma as an error detection system |
842 |
|
Gamma function: pros |
843 |
|
Gamma function: cons |
844 |
|
Slide Number 17 |
845 |
|
Generalized gradient analysis -2 |
846 |
|
Gamma parameters |
847 |
|
Sensitivity of gamma analysis on a 2D dataset |
848 |
|
Lack of correlation with clinical indices |
849 |
|
Slide Number 22 |
850 |
|
Slide Number 23 |
851 |
|
Slide Number 24 |
852 |
|
Slide Number 25 |
853 |
|
3. Monte Carlo dose calculation |
854 |
|
Slide Number 27 |
855 |
|
4. In-vivo dosimetry |
856 |
|
Slide Number 29 |
857 |
|
3D verification of a prostate VMAT treatment |
858 |
|
Dose-based corrections protocols? |
859 |
|
From gamma metric to estimated clinical impact |
860 |
|
‘Perturbation’ methods |
861 |
|
Conclusions |
862 |
|
Slide Number 35 |
863 |
|
L16 Modeling Adverse Effects After 3DCRT and IMRT - Gagliardi |
864 |
|
Modelling adverse effects after radiation therapy |
864 |
|
Slide Number 2 |
865 |
|
Slide Number 3 |
866 |
|
Slide Number 4 |
867 |
|
Slide Number 5 |
868 |
|
Slide Number 6 |
869 |
|
Slide Number 7 |
870 |
|
Tissue architecture (1) |
871 |
|
Tissue architecture (2) |
872 |
|
Slide Number 10 |
873 |
|
”Phenomenological - Quasi mechanistic ” NTCP models (DVH based) |
874 |
|
Lyman model (1985, Rad Res 104, 13-19) |
875 |
|
Slide Number 13 |
876 |
|
Slide Number 14 |
877 |
|
Slide Number 15 |
878 |
|
Slide Number 16 |
879 |
|
Relative seriality model (Källman et al 1992) |
880 |
|
Slide Number 18 |
881 |
|
Mechanistic modelling |
882 |
|
3D organ model |
883 |
|
Input data: Dose-volume data |
884 |
|
Dose-calculation algorithms |
885 |
|
Slide Number 23 |
886 |
|
Slide Number 24 |
887 |
|
Slide Number 25 |
888 |
|
Clinical data (2) |
889 |
|
Slide Number 27 |
890 |
|
OPTIMIZATION PROCEDURE |
891 |
|
Why are parameters uncertain? |
892 |
|
Model accuracy |
893 |
|
Peeters et al, IJROBP, 2006 |
894 |
|
Accounting for confounding factors |
895 |
|
Summarising |
896 |
|
Slide Number 34 |
897 |
|
L17 Review of Dose-Volume Relationships; H&N - Gagliardi |
898 |
|
H&N irradiation:dose-volume predictors and NTCP parameters for some complication |
898 |
|
Slide Number 2 |
899 |
|
Slide Number 3 |
900 |
|
Slide Number 4 |
901 |
|
Xerostomia - PAROTID GLANDS |
902 |
|
Slide Number 6 |
903 |
|
PAROTID GLANDS – dose-volume recommendations for xerostomia < 20% |
904 |
|
PAROTID GLANDS |
905 |
|
Slide Number 9 |
906 |
|
Parotids: other updates… |
907 |
|
PAROTID GLANDS – |
908 |
|
Slide Number 12 |
909 |
|
Slide Number 13 |
910 |
|
Slide Number 14 |
911 |
|
Entity and speed of the recovery vs Dmean: a model |
912 |
|
Slide Number 17 |
914 |
|
What is the best measure of xerostomia? |
915 |
|
Less xerostomy (RTOG scale) with tomotherapy than with sliding window IMRT |
916 |
|
Validation of QUANTEC guidelines for xerostomia |
917 |
|
LARYNX AND PHARYNX irradiation |
918 |
|
Slide Number 22 |
919 |
|
Slide Number 23 |
920 |
|
Slide Number 24 |
921 |
|
DYSPHAGIA |
922 |
|
Validation of QUANTEC guidelines for disphagia |
923 |
|
Xerostomia and disphagia after IMRT |
924 |
|
Slide Number 28 |
925 |
|
SWALLOWING: PC and SL |
926 |
|
SWALLOWING: dose to superior and middle constrictor muscles |
927 |
|
SWALLOWING: predictors |
928 |
|
SWALLOWING: oral mucosa irradiation/ risk of PEG (Sanguineti et al, 2011) |
929 |
|
Confirming Oral Mucosa DVH related to late swallowing problems |
930 |
|
Slide Number 34 |
931 |
|
Slide Number 35 |
932 |
|
Volume changes during RT imaged by IGRT to assess normal tissue effects |
933 |
|
Slide Number 37 |
934 |
|
cranial, caudal and medial regions of the OAR showed larger interobserver variabilities |
935 |
|
Changes in anatomy over the course of treatment |
936 |
|
Changes in anatomy over the course of treatment |
937 |
|
Changes in anatomy over the course of treatment |
938 |
|
Automated VMAT planning |
939 |
|
Slide Number 43 |
940 |
|
Slide Number 44 |
941 |
|
L18 IMRT in Head and Neck - Lohr |
942 |
|
Head and Neck IMRTTolerance Doses (Parotid Gland, Spinal Cord, Optic Pathways) |
942 |
|
Disclosure |
943 |
|
Clinical Application of IMRT |
944 |
|
Most important indications and treatment philosophy |
945 |
|
Slide Number 5 |
946 |
|
IMRT clinical outcome |
947 |
|
Canadian H&N IMRT-Review and Consensus |
948 |
|
Cost Effectiveness of IMRT |
949 |
|
Tumor Localizations |
950 |
|
Recent Review |
951 |
|
10J post full neck IMRT |
952 |
|
Head and Neck |
953 |
|
Slide Number 13 |
954 |
|
Slide Number 14 |
955 |
|
Slide Number 15 |
956 |
|
Slide Number 16 |
957 |
|
Slide Number 17 |
958 |
|
Slide Number 18 |
959 |
|
Slide Number 19 |
960 |
|
Slide Number 20 |
961 |
|
Slide Number 21 |
962 |
|
Slide Number 22 |
963 |
|
Slide Number 23 |
964 |
|
Slide Number 24 |
965 |
|
Slide Number 25 |
966 |
|
Slide Number 26 |
967 |
|
Slide Number 27 |
968 |
|
Slide Number 28 |
969 |
|
Slide Number 29 |
970 |
|
Slide Number 30 |
971 |
|
Parotid Tolerance -> The (almost) definitive data…. |
972 |
|
Slide Number 32 |
973 |
|
Slide Number 33 |
974 |
|
It usually is, but you gotta watch out! |
975 |
|
It usually is, but you gotta watch out! |
976 |
|
UMM example – cancer of the lower lip |
977 |
|
Relapse Pattern OCC - PMH |
978 |
|
Slide Number 38 |
979 |
|
Slide Number 39 |
980 |
|
Slide Number 40 |
981 |
|
Slide Number 41 |
982 |
|
Slide Number 42 |
983 |
|
Slide Number 43 |
984 |
|
Parsport – Parotid Dose Response Relationship |
985 |
|
GORTEC 2004-3 |
986 |
|
Tata Memorial Randomized Trial |
987 |
|
Tata Memorial Randomized Trial |
988 |
|
And if you want everything in one publication… ….go for the Metaanalysis |
989 |
|
So IMRT is evil….is it? The SEER-Database suggests… |
990 |
|
Slide Number 50 |
991 |
|
Slide Number 51 |
992 |
|
Slide Number 52 |
993 |
|
Slide Number 53 |
994 |
|
Slide Number 54 |
995 |
|
Slide Number 55 |
996 |
|
Slide Number 56 |
997 |
|
Slide Number 57 |
998 |
|
Slide Number 58 |
999 |
|
Slide Number 59 |
1000 |
|
Slide Number 60 |
1001 |
|
Optic Nerve Toxicity: Quantec |
1002 |
|
No Optic Neuropathy at <45/1,8 Gy in Nonfunctioning Pituitary Adenoma - High SD are problematic |
1003 |
|
No ON at Proton Doses of <55GyE |
1004 |
|
Single Dose vs. Fractionated Tolerance for Meningeoma |
1005 |
|
Optic Neuropathy Risk after RS |
1006 |
|
Optic Neuropathy Risk - Synopsis |
1007 |
|
Plexopathy |
1008 |
|
Slide Number 68 |
1009 |
|
Start with the close call….Lhermitte‘s (RT+Cht w/ Carbo/Tax) |
1010 |
|
Spinal Cord Damage – Review 1 |
1011 |
|
Spinal Cord Damage – Review 2 |
1012 |
|
How much RT can I give after conventional RT? |
1013 |
|
Maximum Doses to Spinal cord of 20 Gy in 1-3 SDLower than expected Tox – high parallelity of Spinal Cord |
1014 |
|
Partial Volume Spinal Cord Reirradiation |
1015 |
|
How much SBRT can I give after conventional RT? |
1016 |
|
Daily vs. less frequent Imaging: Spinal cord dose |
1017 |
|
ART (IMRT) – Dosimetric Benefits |
1018 |
|
IMRT vs. Protons? |
1019 |
|
Slide Number 79 |
1020 |
|
Slide Number 80 |
1021 |
|
Current ASTRO Practice Guideline |
1022 |
|
L19 Pratical IMRT Planning and Biological Optimization - Schwarz |
1023 |
|
Slide Number 1 |
1023 |
|
Slide Number 2 |
1024 |
|
Slide Number 3 |
1025 |
|
Slide Number 4 |
1026 |
|
… more complex problems |
1027 |
|
Slide Number 6 |
1028 |
|
Defining the treatment goals - Cost function |
1029 |
|
One should define a cost function … |
1030 |
|
Slide Number 9 |
1031 |
|
Slide Number 10 |
1032 |
|
Defining the treatment goals - VOI definition |
1033 |
|
PTV:advantages |
1034 |
|
PTV: disadvantages |
1035 |
|
To compensate for the unbalance between target coverage and OAR sparing, we often cheat |
1036 |
|
VOI definitions & c.f. – build up region |
1037 |
|
SIB & dose gradients in the PTV |
1038 |
|
Slide Number 17 |
1039 |
|
“IMRT = dose heterogeneity in the PTV.Live with that.” |
1040 |
|
IMRT to increase PTV dose homogeneity |
1041 |
|
IMRT to increase PTV dose homogeneity |
1042 |
|
Dose heterogeneity is a feature, not a bug |
1043 |
|
IMRT & dose heterogeneity in the PTV |
1044 |
|
“We are not yet ready for EUD/’biological’ optimisation in the clinical practice” |
1046 |
|
For some OARs the estimates for the volume effect parameter is consistent |
1047 |
|
Mean lung dose model |
1048 |
|
Slide Number 27 |
1049 |
|
Slide Number 28 |
1050 |
|
Slide Number 29 |
1051 |
|
Slide Number 30 |
1052 |
|
Commercial implementations - 1 (Philips/Raysearch/(Varian?)) |
1053 |
|
Commercial implementations - 2 (Elekta-Monaco) |
1054 |
|
Slide Number 33 |
1055 |
|
Start from your existing clinical practice. |
1056 |
|
Calculate EUD values for your plans |
1057 |
|
Do the n values suggested in the literature make sense ? |
1058 |
|
Run a sensitivity analysis |
1059 |
|
Slide Number 38 |
1060 |
|
Slide Number 39 |
1061 |
|
Slide Number 40 |
1062 |
|
Slide Number 41 |
1063 |
|
Slide Number 42 |
1064 |
|
Slide Number 43 |
1065 |
|
Slide Number 44 |
1066 |
|
General references |
1067 |
|
Plan reporting |
1068 |
|
Current and future developments |
1069 |
|
IMRT planning & geometrical uncertainties |
1070 |
|
Slide Number 49 |
1071 |
|
Conclusions |
1072 |
|
L20 Impact of Geometrical Uncertainties on IMRT Dose Distributions - Tournel |
1073 |
|
L21 Review of Dose-Volume Relationships; Pelvis - Gagliardi |
1166 |
|
Pelvis irradiation:overview of dose-volume predictors and NTCP parameters |
1166 |
|
Slide Number 2 |
1167 |
|
Slide Number 3 |
1168 |
|
Rectal bleeding |
1169 |
|
Michalski et al, IJROBP vol 76, n3, S123-S129, 2010 |
1170 |
|
Slide Number 6 |
1171 |
|
Slide Number 7 |
1172 |
|
Slide Number 8 |
1173 |
|
Peeters et al, IJROBP, 2006 |
1174 |
|
Slide Number 10 |
1175 |
|
Slide Number 11 |
1176 |
|
TO BLEED OR NOT TO BLEED – Valdagni et al, Int.J Rad Onc Biol Phys, feb 2009 |
1177 |
|
Rectum, summary |
1178 |
|
Rectal bleeding: dose-volume, dose-surface or dose wall? |
1179 |
|
FOECAL INCONTINENCE |
1180 |
|
Slide Number 16 |
1181 |
|
Foecal incontinence |
1182 |
|
Foecal incontinence |
1183 |
|
Summary RECTUM: dose-volume response relationships |
1184 |
|
BLADDER |
1185 |
|
Slide Number 21 |
1186 |
|
Slide Number 22 |
1187 |
|
GU toxicity- what do we know? |
1188 |
|
Moore et al, IJROBP, 2015 |
1189 |
|
Slide Number 25 |
1190 |
|
…more results from large studies! |
1191 |
|
Slide Number 27 |
1192 |
|
Slide Number 28 |
1193 |
|
Slide Number 29 |
1194 |
|
Slide Number 30 |
1195 |
|
Slide Number 31 |
1196 |
|
Slide Number 32 |
1197 |
|
PENILE BULB: erectile dysfunction |
1198 |
|
Slide Number 34 |
1199 |
|
Erectile dysfunction – dose response relationship? |
1200 |
|
Slide Number 36 |
1201 |
|
Slide Number 37 |
1202 |
|
Slide Number 38 |
1203 |
|
L22 IMRT of Prostate Cancer - Lohr |
1204 |
|
Tumor Localizations |
1204 |
|
|
1205 |
|
|
1206 |
|
|
1207 |
|
Do we have to treat CAP? |
1208 |
|
Slide Number 6 |
1209 |
|
Slide Number 7 |
1210 |
|
Do we need high doses? |
1211 |
|
Slide Number 9 |
1212 |
|
Slide Number 10 |
1213 |
|
Long Term Results Dutch Dose Escalation Trial |
1214 |
|
1st comprehensive Metaanalysis on Dose Escalation |
1215 |
|
Slide Number 13 |
1216 |
|
Slide Number 14 |
1217 |
|
MRC RT01 Long Term Results |
1218 |
|
Slide Number 16 |
1219 |
|
Slide Number 17 |
1220 |
|
Actuarial disease-free survival |
1221 |
|
Actuarial incidence of late toxicity |
1222 |
|
The Benchmark Publication |
1223 |
|
LATE TOXICITY AFTER INTENSITY-MODULATED RADIATION THERAPY FOR LOCALIZED PROSTATE CANCER: AN EXPLORATION OF DOSE–VOLUME HISTOGRAM PARAMETERS |
1224 |
|
How? |
1225 |
|
3D-Confomal vs. IMRT |
1226 |
|
Slide Number 24 |
1227 |
|
Intensity Modulated Radiotherapy (IMRT) |
1228 |
|
Slide Number 26 |
1229 |
|
3D-Confomal vs. IMRT + Boost |
1230 |
|
Prostate Motion |
1231 |
|
Slide Number 29 |
1232 |
|
Slide Number 30 |
1233 |
|
Slide Number 31 |
1234 |
|
Prostate Motion and time |
1235 |
|
Spacer/Balloon |
1236 |
|
Rectal Balloon |
1237 |
|
Hydrogel - System |
1238 |
|
Prostata- / Gel-Volume |
1239 |
|
Slide Number 37 |
1240 |
|
The DIL concept |
1241 |
|
Slide Number 39 |
1242 |
|
Slide Number 40 |
1243 |
|
Slide Number 41 |
1244 |
|
Tumor Distribution |
1245 |
|
Lymph node RT (adjuvant? Manifest?) |
1246 |
|
Slide Number 44 |
1247 |
|
Slide Number 45 |
1248 |
|
PET |
1249 |
|
Slide Number 47 |
1250 |
|
Slide Number 48 |
1251 |
|
LN Boost with Protons |
1252 |
|
Initial Plan to Pelvic LN and Prostated Bed, 0-44 Gy |
1253 |
|
Boost to Prostate Bed and LN, 44-60 Gy (to be followed by further Boost to Prostate Bed (and LN in the Prostate Bed to 71/75 Gy) |
1254 |
|
Slide Number 52 |
1255 |
|
Hypofractionation |
1256 |
|
(Partial) Paradigm Shift (back) to High Single Doses |
1257 |
|
Slide Number 55 |
1258 |
|
Slide Number 56 |
1259 |
|
The experience with moderate Hypofractionation |
1260 |
|
The most recent data |
1261 |
|
(Moderate) Hypofractionation – The CHHIP Trial |
1262 |
|
Protons |
1263 |
|
Slide Number 61 |
1264 |
|
Salvage |
1265 |
|
Slide Number 63 |
1266 |
|
The Timing of Salvage Radiotherapy After RadicalProstatectomy: A Systematic Review |
1267 |
|
Dose Escalation for PSA-Relapse |
1268 |
|
Dose escalation for salvage RT - Mannheim |
1269 |
|
Synopsis |
1270 |
|
L23 Dose Claculations in Static and Rotational IMRT - Sohn |
1271 |
|
Dose Calculation in Static and Rotational IMRT |
1271 |
|
Disclosures |
1272 |
|
Differences in Dose calculation algorithms– A clinically relevant issue? |
1273 |
|
Differences in Dose calculation algorithms– A clinically relevant issue? |
1274 |
|
Precise dose calculation is still a challenge:Be aware of potential software BUGS! |
1275 |
|
Slide Number 6 |
1276 |
|
Slide Number 7 |
1277 |
|
Technical background:Typical components of an accelerator head |
1278 |
|
Is it really important to focus mainly on radiation transport in the patient? |
1279 |
|
Monte Carlo simulations of the accelerator head |
1280 |
|
Crossprofiles and depth dose curvesby components |
1281 |
|
Variation of the output factor for primary and secondary photons |
1282 |
|
Output factors by Components |
1283 |
|
Electron contamination |
1284 |
|
Energy spectra of primary photons:Angular dependence |
1285 |
|
Important Conclusion so far |
1286 |
|
Usual model of the radiation source |
1287 |
|
Field-size depenence ofOutput-factor ‘explained’ … |
1288 |
|
Technical background:Typical components of an accelerator head |
1289 |
|
Example:Leaf and jaw transmission, inter-leaf leakage |
1290 |
|
Effects of the beam modulating elements that need to be modeled for high-precision dose calculation |
1291 |
|
Where are we now? |
1292 |
|
What happens in the patient… |
1293 |
|
Modelling particle transport in the patient:Dose calculation methods |
1294 |
|
Kernel-based methods: Separation of Photon-fluence and energy deposition |
1295 |
|
Kernel-based methods:The TERMA concept |
1296 |
|
Kernel-based methods:Energy deposition point kernel |
1297 |
|
Kernel-based methods:Convolution/Superposition |
1298 |
|
Kernel-based methods:Convolution/Superposition |
1299 |
|
Kernel-based methods: Dose calculation in inhomogeneous media |
1300 |
|
Kernel-based methods: Rectilinear density rescaling of the kernel |
1301 |
|
Kernel-based methods: Rectilinear density rescaling of the kernel |
1302 |
|
Kernel-based methods: ‘Collapsed Cone’ approximation for efficient density rescaling |
1303 |
|
Kernel-based methods: ‘Collapsed Cone’ approximation for efficient density rescaling |
1304 |
|
Kernel-based methods: ‘Collapsed Cone’ approximation for efficient density rescaling |
1305 |
|
Kernel-based methods: 2D-superposition methods: Pencil Kernel algorithms |
1306 |
|
Kernel-based methods: 2D-superposition methods: Pencil Kernel algorithms |
1307 |
|
Modelling particle transport in the patient:Dose calculation methods |
1308 |
|
Monte Carlo Dose Calculation |
1309 |
|
Monte Carlo Dose Calculation |
1310 |
|
Monte Carlo Dose Calculation |
1311 |
|
Monte Carlo Dose Calculation |
1312 |
|
Special issues for Rotational IMRT |
1313 |
|
Special issues for Rotational IMRT:Discretized Arc vs. Continuous Arc Dose Calculation |
1314 |
|
Linear Boltzmann Transport Equation (LBTE) Solvers |
1315 |
|
further reading… |
1316 |
|
Summary and Conclusions |
1317 |
|
Slide Number 48 |
1318 |
|
Dose calculation issues ‚in practice‘ |
1319 |
|
Base-data for dose-calculations algorithms |
1320 |
|
Base-data for dose-calculations algorithms |
1321 |
|
Dose calculation issues ‚in practice‘:Prostate RT: Rectal gas filling in planning CT |
1322 |
|
Dose calculation issues ‚in practice‘: Dose calculation for lung lesions |
1323 |
|
Dose calculation issues ‚in practice‘: Dose calculation for lung lesions |
1324 |
|
Dose calculation issues ‚in practice‘: Dose calculation for lung lesions |
1325 |
|
Dose calculation issues ‚in practice‘: Dose calculation for lung lesions |
1326 |
|
Dose calculation issues ‚in practice‘:Dosimetric effects of the treatment table/setup devices |
1327 |
|
Dose calculation issues ‚in practice‘:Dose calculation in presence of CT artifacts |
1328 |
|
Dose calculation issues ‚in practice‘:Hounsfield (CT-) value calibration |
1329 |
|
L24 Potential and Limitations of Rotational IMRT - Tournel |
1330 |
|
L25 Highly Conformal Techniques in Early Stage Lung Cancer - Filippi |
1418 |
|
Highly conformal techniques in early stage lung cancer: indications, techniques, normal tissue constraints, results |
1418 |
|
Slide Number 2 |
1419 |
|
Features of Lung SABR |
1420 |
|
Slide Number 4 |
1421 |
|
Slide Number 5 |
1422 |
|
SABR for Stage I NSCLC: phase II studies |
1423 |
|
Slide Number 7 |
1424 |
|
Slide Number 8 |
1425 |
|
Slide Number 9 |
1426 |
|
Slide Number 10 |
1427 |
|
Slide Number 11 |
1428 |
|
SABR is well tolerated: toxicity is uncommon |
1429 |
|
SBRT and severe COPD? |
1430 |
|
Slide Number 14 |
1431 |
|
Slide Number 15 |
1432 |
|
Acute radiological changes after SBRT |
1433 |
|
Slide Number 17 |
1434 |
|
Slide Number 18 |
1435 |
|
Slide Number 19 |
1436 |
|
Slide Number 20 |
1437 |
|
Slide Number 21 |
1438 |
|
Slide Number 22 |
1439 |
|
Slide Number 23 |
1440 |
|
Slide Number 24 |
1441 |
|
Slide Number 25 |
1442 |
|
Slide Number 26 |
1443 |
|
Slide Number 27 |
1444 |
|
Trials of surgery versus SABR |
1445 |
|
Slide Number 29 |
1446 |
|
Slide Number 30 |
1447 |
|
Slide Number 31 |
1448 |
|
Slide Number 32 |
1449 |
|
Slide Number 33 |
1450 |
|
Slide Number 34 |
1451 |
|
Slide Number 35 |
1452 |
|
Slide Number 36 |
1453 |
|
Technical Advances may have an impact on efficacy and toxicity |
1454 |
|
Slide Number 38 |
1455 |
|
Slide Number 39 |
1456 |
|
Slide Number 40 |
1457 |
|
Slide Number 41 |
1458 |
|
Slide Number 42 |
1459 |
|
Prognostic factors? |
1460 |
|
Slide Number 44 |
1461 |
|
Slide Number 45 |
1462 |
|
Slide Number 46 |
1463 |
|
Slide Number 47 |
1464 |
|
Slide Number 48 |
1465 |
|
Slide Number 49 |
1466 |
|
Slide Number 50 |
1467 |
|
Toxicity and Quality of Life |
1468 |
|
Slide Number 52 |
1469 |
|
Slide Number 53 |
1470 |
|
Pulmonary Function and Quality of Life after VMAT-based SABR |
1471 |
|
Slide Number 55 |
1472 |
|
Survivorship following SABR |
1473 |
|
Slide Number 57 |
1474 |
|
Slide Number 58 |
1475 |
|
Slide Number 59 |
1476 |
|
Slide Number 60 |
1477 |
|
Slide Number 61 |
1478 |
|
Final Remarks |
1479 |
|
L26 Highly Conformal Techniques in Advanced Stage Lung Cancer - Filippi |
1480 |
|
Highly conformal techniques in locally advanced lung cancer: indications, techniques, normal tissue constraints, results |
1480 |
|
The “too much” heterogeneous Stage III |
1481 |
|
Slide Number 3 |
1482 |
|
Slide Number 4 |
1483 |
|
Slide Number 5 |
1484 |
|
Slide Number 6 |
1485 |
|
Slide Number 7 |
1486 |
|
Slide Number 8 |
1487 |
|
Slide Number 9 |
1488 |
|
Slide Number 10 |
1489 |
|
Slide Number 11 |
1490 |
|
RTOG 0617 Primary Objective |
1491 |
|
Slide Number 13 |
1492 |
|
RTOG 0617: Local Tumor Failure |
1493 |
|
RTOG 0617: Distant Failure |
1494 |
|
RTOG 0617: Dosimetric Data Distribution |
1495 |
|
Slide Number 17 |
1496 |
|
Slide Number 18 |
1497 |
|
Slide Number 19 |
1498 |
|
Slide Number 20 |
1499 |
|
Slide Number 21 |
1500 |
|
Slide Number 22 |
1501 |
|
Slide Number 23 |
1502 |
|
Slide Number 24 |
1503 |
|
Slide Number 25 |
1504 |
|
Slide Number 26 |
1505 |
|
Slide Number 27 |
1506 |
|
Slide Number 28 |
1507 |
|
What is the preferred dose-fractionation schedule? |
1508 |
|
Slide Number 30 |
1509 |
|
Slide Number 31 |
1510 |
|
Slide Number 32 |
1511 |
|
Changes in radiotherapy fields |
1512 |
|
Slide Number 34 |
1513 |
|
Slide Number 35 |
1514 |
|
Slide Number 36 |
1515 |
|
Slide Number 37 |
1516 |
|
Slide Number 38 |
1517 |
|
Slide Number 39 |
1518 |
|
Slide Number 40 |
1519 |
|
Slide Number 41 |
1520 |
|
Slide Number 42 |
1521 |
|
Slide Number 43 |
1522 |
|
Slide Number 44 |
1523 |
|
Slide Number 45 |
1524 |
|
Comparative studies on clinical outcomes following either 3D-CRT or IMRT |
1525 |
|
Slide Number 47 |
1526 |
|
Slide Number 48 |
1527 |
|
Slide Number 49 |
1528 |
|
Slide Number 50 |
1529 |
|
Slide Number 51 |
1530 |
|
Slide Number 52 |
1531 |
|
Slide Number 53 |
1532 |
|
Slide Number 54 |
1533 |
|
Slide Number 55 |
1534 |
|
Slide Number 56 |
1535 |
|
Slide Number 57 |
1536 |
|
Slide Number 58 |
1537 |
|
Slide Number 59 |
1538 |
|
Slide Number 60 |
1539 |
|
Slide Number 61 |
1540 |
|
Slide Number 62 |
1541 |
|
Slide Number 63 |
1542 |
|
Slide Number 64 |
1543 |
|
Conclusions |
1544 |