Treatment Planning

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S Kalnicki - One of the best experts on this subject based on the ideXlab platform.

  • tumor biology guided radiotherapy Treatment Planning gross tumor volume versus functional tumor volume
    Seminars in Nuclear Medicine, 2008
    Co-Authors: Chandan Guha, Alan A Alfieri, Donald M Blaufox, S Kalnicki

    This issue of Seminars in Nuclear Medicine deals with a watershed event in cancer Treatment—the combined use of functional and anatomical information to guide therapeutic interventions. The use of positron emission tomography/computed tomography (PET/CT) in radiation Treatment Planning and tumor response evaluation brings a paradigm change in the development of image-guided therapies into routine clinical practice. The implications, as seen in the following articles, are not only promising but also groundbreaking. And, as in every new scientific breakthrough, each step forward generates a myriad of additional important clinical and research questions. Functional imaging takes advantage of the subtle differences between normal and malignant tissues at the cellular level to reveal in vivo unique functional characteristics of neoplasms. The ultimate goal of the partnership between nuclear medicine physicians and radiation oncologists is to use this information with absolute clarity in target definition for radiation Treatment Planning and therapy, as well as response evaluation. Functional imaging can provide metabolic information and behavioral correlation along with the anatomical imaging for correlative target delineation. Additionally, as a purely diagnostic instrument, PET/CT provides a tool for oncologists to make critical decisions regarding radiation Treatment Planning modifications secondary to changes in tumor staging (up or down), Treatment field modifications, localized control, sites of residual and/or metastatic disease and post therapy response evaluation. The articles in this issue of the seminars provide insights into the current state-of-the-art of functional imaging techniques, mostly centered on the use of 18 F-fluorodeoxyglucose PET/CT in image guided oncologic therapies. Because it is a novel science, the future of image-guided functional Treatment Planning is bright with technologic and biologic innovations, translational research and new clinical applications.

G P Kearney - One of the best experts on this subject based on the ideXlab platform.

H Paganetti - One of the best experts on this subject based on the ideXlab platform.

  • robust proton Treatment Planning physical and biological optimization
    Seminars in Radiation Oncology, 2018
    Co-Authors: Jan Unkelbach, H Paganetti

    Accurate prediction of tumor control and toxicities in radiation therapy faces many uncertainties. Besides interpatient variability in the response to radiation, there are also dosimetric uncertainties, that is, differences between the dose displayed in a Treatment Planning system and the dose actually delivered to the patient. These uncertainties originate from several sources including imperfect knowledge of the patient geometry, approximation in the physics of radiation interaction with tissues, and uncertainties in the biological effectiveness of radiation. Generally, uncertainties are considered in the Treatment Planning process by applying margins. In intensity-modulated radiotherapy (IMRT), this leads to the Planning target volume (PTV) concept. Intensity-modulated proton therapy (IMPT) is widely considered as the future of proton therapy. The Treatment Planning methods for IMPT and IMRT are similar and based on mathematical optimization techniques for both modalities. However, the PTV concept has fundamental limitations in IMPT. Therefore, researchers have developed robust optimization methods that directly incorporate uncertainties into the IMPT optimization problem. In recent years, vendors of commercial Planning systems have started to implement these methods so that robust IMPT Planning becomes available in clinical practice. This article summarizes uncertainties in proton therapy and the limitations of the PTV concept to deal with them. Subsequently, robust optimization techniques to overcome these limitations are reviewed.

Anne Marie Kuijpersjagtman - One of the best experts on this subject based on the ideXlab platform.

  • records needed for orthodontic diagnosis and Treatment Planning a systematic review
    PLOS ONE, 2013
    Co-Authors: Robine J Rischen, Hero K Breuning, Ewald M Bronkhorst, Anne Marie Kuijpersjagtman

    BACKGROUND: Traditionally, dental models, facial and intra-oral photographs and a set of two-dimensional radiographs are used for orthodontic diagnosis and Treatment Planning. As evidence is lacking, the discussion is ongoing which specific records are needed for the process of making an orthodontic Treatment plan. OBJECTIVE: To estimate the contribution and importance of different diagnostic records for making an orthodontic diagnosis and Treatment plan. DATA SOURCES: An electronic search in PubMed (1948-July 2012), EMBASE Excerpta Medica (1980-July 2012), CINAHL (1982-July 2012), Web of Science (1945-July 2012), Scopus (1996-July 2012), and Cochrane Library (1993-July 2012) was performed. Additionally, a hand search of the reference lists of included studies was performed to identify potentially eligible studies. There was no language restriction. STUDY SELECTION: THE PATIENT, INTERVENTION, COMPARATOR, OUTCOME (PICO) QUESTION FORMULATED FOR THIS STUDY WAS AS FOLLOWS: for patients who need orthodontic Treatment (P), will the use of record set X (I) compared with record set Y (C) change the Treatment plan (O)? Only primary publications were included. DATA EXTRACTION: Independent extraction of data and quality assessment was performed by two observers. RESULTS: Of the 1041 publications retrieved, 17 met the inclusion criteria. Of these, 4 studies were of high quality. Because of the limited number of high quality studies and the differences in study designs, patient characteristics, and reference standard or index test, a meta-analysis was not possible. CONCLUSION: Cephalograms are not routinely needed for orthodontic Treatment Planning in Class II malocclusions, digital models can be used to replace plaster casts, and cone-beam computed tomography radiographs can be indicated for impacted canines. Based on the findings of this review, the minimum record set required for orthodontic diagnosis and Treatment Planning could not be defined. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42012002365.

Edward M Messing - One of the best experts on this subject based on the ideXlab platform.

  • automated Treatment Planning engine for prostate seed implant brachytherapy
    International Journal of Radiation Oncology Biology Physics, 1999
    Co-Authors: J B Y Zhang, R A Brasacchio, Paul Okunieff, Deborah J Rubens, John Strang, Arvind Soni, Edward M Messing

    Abstract Purpose: To develop a computer-intelligent Planning engine for automated Treatment Planning and optimization of ultrasound- and template-guided prostate seed implants. Methods and Materials: The genetic algorithm was modified to reflect the 2D nature of the implantation template. A multi-objective decision scheme was used to rank competing solutions, taking into account dose uniformity and conformity to the Planning target volume (PTV), dose-sparing of the urethra and the rectum, and the sensitivity of the resulting dosimetry to seed misplacement. Optimized Treatment plans were evaluated using selected dosimetric quantifiers, dose–volume histogram (DVH), and sensitivity analysis based on simulated seed placement errors. These dosimetric Planning components were integrated into the Prostate Implant Planning Engine for Radiotherapy (PIPER). Results: PIPER has been used to produce a variety of plans for prostate seed implants. In general, maximization of the minimum peripheral dose (mPD) for given implanted total source strength tended to produce peripherally weighted seed patterns. Minimization of the urethral dose further reduced the loading in the central region of the PTV. Isodose conformity to the PTV was achieved when the set of objectives did not reflect seed positioning uncertainties; the corresponding optimal plan generally required fewer seeds and higher source strength per seed compared to the manual Planning experience. When seed placement uncertainties were introduced into the set of Treatment Planning objectives, the optimal plan tended to reach a compromise between the preplanned outcome and the likelihood of retaining the preferred outcome after implantation. The reduction in the volatility of such seed configurations optimized under uncertainty was verified by sensitivity studies. Conclusion: An automated Treatment Planning engine incorporating real-time sensitivity analysis was found to be a useful tool in dosimetric Planning for prostate brachytherapy.