Kim Garbarino

Henry Ford Health System

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Benjamin Movsas

Henry Ford Health System

Kenneth Levin

Henry Ford Health System

Carri Glide‐Hurst

University of Wisconsin–Madison

Indrin J. Chetty

Oakland University

Samuel Ryu

Stony Brook University

M. Salim Siddiqui

Henry Ford Health System

Sishir Rao

Henry Ford Health System

Eleanor M. Walker

Henry Ford Health System

Daniel T. Myers

Henry Ford Health System

J. Kim

Henry Ford Health System

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Henry Ford Health System

Henry Ford Hospital

Wayne State University

The Barbara Ann Karmanos Cancer Institute

Michigan State University

Henry Ford Health + Michigan State University Health Sciences

Faculty of Public Health

Alexandria University

Michigan United

Radiation Oncology Associates

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How Often are Previously Undetected Radiographic Abnormalities Detected at the Time of CT Simulation for Breast Cancer Patients?

American Journal of Clinical Oncology (2010)

Sishir Rao Anushka Patel Kenneth Levin Mei Lu Kim Garbarino

In most institutions, planning computed tomography (CT) scans are not interpreted by diagnostic radiologists. The purpose of this analysis was to determine the percentage of cases in which a previously undetected radiographic finding was found on review of CT simulation images by diagnostic radiology.At the Henry Ford West Bloomfield Center, CT simulations are prospectively interpreted by diagnostic radiologists and a formal report is generated. CT simulation scan reports of 332 consecutive breast cancer patients from 2000 to 2006 were reviewed. The percentage of these reports in which a previously undetected abnormality was noted on the planning CT was determined. Prior and subsequent diagnostic CT scans were also reviewed to determine the clinical relevance of these diagnostic abnormalities.Of 332 patients with CT simulations for breast cancer treatment planning, 52 patients (16%) had a newly detected abnormality noted. Of these, 31 patients (or 60% of the abnormal findings) were deemed by diagnostic radiology to have potentially significant findings (e.g., "can not exclude metastatic disease"), and a follow-up CT or magnetic resonance imaging scan was recommended. Abnormalities in this category included previously undetected lung nodules, liver lesions, kidney/adrenal lesions, and sclerotic bony lesions. On follow-up, however, to date, these findings have demonstrated no clinical significance, although further follow-up is needed in many patients.In this study, a significant proportion of breast cancer patients undergoing CT planning studies were diagnosed with potential abnormalities for which follow-up was recommended by diagnostic radiology. To date, these findings have not been clinically relevant, though further follow-up is needed in many of the patients. Thus, in cases of clinical uncertainty, a diagnostic radiologist should be consulted and follow-up imaging obtained if necessary.

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10.1097/coc.0b013e3181a76a3d

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Quantifying the Dosimetric Impact of a Novel Synthetic CT Algorithm for MR Simulation of Prostate Cancer Radiation Therapy

International Journal of Radiation Oncology*Biology*Physics (2015)

Kim Garbarino J.P. Kim Ning Wen L. Schultz Kenneth Levin

10.1016/j.ijrobp.2015.07.377

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How Often Are Previously Undetected Radiographic Abnormalities Detected at the Time of CT Simulation?

International Journal of Radiation Oncology*Biology*Physics (2007)

Sishir Rao K. Levin Kim Garbarino Daniel T. Myers Eleanor M. Walker

Abnormality

10.1016/j.ijrobp.2007.07.170

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Dosimetric evaluation of synthetic CT relative to bulk density assignment-based magnetic resonance-only approaches for prostate radiotherapy

Radiation Oncology (2015)

Joshua Kim Kim Garbarino Lonni Schultz Kenneth Levin Benjamin Movsas

Magnetic resonance imaging (MRI) has been incorporated as an adjunct to CT to take advantage of its excellent soft tissue contrast for contouring. MR-only treatment planning approaches have been developed to avoid errors introduced during the MR-CT registration process. The purpose of this study is to evaluate calculated dose distributions after incorporating a novel synthetic CT (synCT) derived from magnetic resonance simulation images into prostate cancer treatment planning and to compare dose distributions calculated using three previously published MR-only treatment planning methodologies. An IRB-approved retrospective study evaluated 15 prostate cancer patients that underwent IMRT (n = 11) or arc therapy (n = 4) to a total dose of 70.2-79.2 Gy. Original treatment plans were derived from CT simulation images (CT-SIM). T1-weighted, T2-weighted, and balanced turbo field echo images were acquired on a 1.0 T high field open MR simulator with patients immobilized in treatment position. Four MR-derived images were studied: bulk density assignment (10 HU) to water (MRW), bulk density assignments to water and bone with pelvic bone values derived either from literature (491 HU, MRW+B491) or from CT-SIM population average bone values (300 HU, MRW+B300), and synCTs. Plans were recalculated using fixed monitor units, plan dosimetry was evaluated, and local dose differences were characterized using gamma analysis (1 %/1 mm dose difference/distance to agreement). While synCT provided closest agreement to CT-SIM for D95, D99, and mean dose (<0.7 Gy (1 %)) compared to MRW, MRW+B491, and MRW+B300, pairwise comparisons showed differences were not significant (p < 0.05). Significant improvements were observed for synCT in the bladder, but not for rectum or penile bulb. SynCT gamma analysis pass rates (97.2 %) evaluated at 1 %/1 mm exceeded those from MRW (94.7 %), MRW+B300 (94.0 %), or MRW+B491 (90.4 %). One subject’s synCT gamma (1 %/1 mm) results (89.9 %) were lower than MRW (98.7 %) and MRW+B300 (96.7 %) due to increased rectal gas during MR-simulation that did not affect bulk density assignment-based calculations but was reflected in higher rectal doses for synCT. SynCT values provided closest dosimetric and gamma analysis agreement to CT-SIM compared to bulk density assignment-based CT surrogates. SynCTs may provide additional clinical value in treatment sites with greater air-to-soft tissue ratio.

10.1186/s13014-015-0549-7

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Citations (56)