New horizons in particle therapy systems
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Particle therapy is rapidly expanding and claiming its position as the treatment modality of choice in teletherapy. However, the rate of expansion continues to be restricted by the size and cost of the associated particle therapy systems and their operation. Additional technical limitations such as dose delivery rate, treatment process efficiency, and achievement of superior dose conformity potentially hinder the complete fulfillment of the promise of particle therapy. These topics are explored in this review considering the current state of particle therapy systems and what improvements are required to overcome the current challenges. Beam production systems (accelerators), beam transport systems including gantries and beam delivery systems are addressed explicitly in these regards.Keywords:
Particle Therapy
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Abstract Background Breast intraoperative radiotherapy (IORT) is a partial irradiation technique that delivers a single fraction of radiation dose to the tumour bed during surgery. The use of this technique is increasing (especially in the Middle East), and therefore, it is essential to have a comprehensive approach to this treatment modality. The aim of this study is to conduct a literature review on available IORT modalities during breast irradiation as well as dedicated IORT machines and associated treatment procedures. The main IORT trials and corresponding clinical outcomes are also studied. Materials and Methods A computerised search was performed through MEDLINE, PubMed, PubMed Central, ISI web of knowledge and reference list of related articles. Results IORT is now feasible through using two main modalities, including low-kilovolt IORT and intraoperative electron radiotherapy (IOERT). The dedicated machines employed and treatment procedure for mentioned modalities are quite different. The outcomes of implemented clinical trials showed that IORT is not inferior to external beam radiotherapy (EBRT) in specifically selected and well-informed patients and can be considered as an alternative to EBRT. Conclusion Although the clinical outcomes of introduced IORT methods are comparable, but based on the review results, it could be said that IOERT is the most effective technical method, in view of the treatment time and dose uniformity concepts. The popularity of IORT is mainly due to the distinguished obtained results during breast cancer treatment. Despite the presence of some technical challenges, it is expected that the IORT technique will become more widespread in the immediate future.
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Effective management of both acute and chronic musculoskeletal pain revolves around a good history and physical examination, as well as a more detailed knowledge of anatomy than is required in other related medical disciplines. Imaging - if indicated - should not be looked upon as the panacea for problem solving but needs to be considered in the light of what a particular modality is best designed to do.In the practice of cost effective medicine, a specific imaging modality must be chosen on the basis that it is the best economically to provide the information sought which in turn allows the formulation of an appropriate management plan.Ultrasound imaging has many advantages over other modalities for assessing musculoskeletal dysfunction. The major advantages are no radiation, 'real time' allows visualisation of functioning tissue, and it is the gold standard for assessing tendons. The most expensive or latest imaging modality is not always the most appropriate.
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Optimizing the extent of resection remains a primary goal of surgery for diffuse gliomas and most brain tumors. Limitations of capabilities of human visualization necessitate the use of adjuncts to augment and improve outcomes. This review serves to encapsulate the commonly used adjuncts in neurosurgical oncology. There exists a plethora of such techniques which can broadly be divided into image-guided techniques (including navigation and real-time intraoperative imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging) as well as optical imaging techniques (of which fluorescence is the most widely used one). This review describes these techniques briefly and reviews pertinent literature focusing on the utility and benefits of these modalities. Both diagnostic accuracy and the therapeutic outcomes are discussed. Although each modality is supported by published literature, the quality of the evidence is variable. It is difficult to make comparisons across studies due to variability in study design, populations included, and the techniques used for the assessment of outcomes. It is likely that a combination of modalities will be synergistic and judicious use of the range of adjuncts is advisable.
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Purpose: Radiation treatment modalities will continue to emerge that promise better clinical outcomes albeit technologically challenging to implement. An important question facing the radiotherapy community then is the need to justify the added technological effort for the clinical return. Mobile tumor radiotherapy is a typical example, where 4D tumor tracking radiotherapy (4DTRT) has been proposed over the simpler conventional modality for better results. The modality choice per patient can depend on a wide variety of factors. In this work, we studied the complication‐free tumor control probability ( P + ) index, which combines the physical complexity of the treatment plan with the radiobiological characteristics of the clinical case at hand and therefore found to be useful in evaluating different treatment techniques and estimating the expected clinical effectiveness of different radiation modalities. Methods: 4DCT volumes of 18 previously treated lung cancer patients with tumor motion and size ranging from 2 mm to 15 mm and from 4 cc to 462 cc, respectively, were used. For each patient, 4D treatment plans were generated to extract the 4D dose distributions, which were subsequently used with clinically derived radiobiological parameters to compute the P + index per modality. Results: The authors observed, on average, a statistically significant increase in P + of 3.4% ± 3.8% ( p < 0.003) in favor of 4DTRT. There was high variability among the patients with a <0.5% up to 13.4% improvement in P + . Conclusions: The observed variability in the improvement of the clinical effectiveness suggests that the relative benefit of tracking should be evaluated on a per patient basis. Most importantly, this variability could be effectively captured in the computed P + . The index can thus be useful to discriminate and hence point out the need for a complex modality like 4DTRT over another. Besides tumor mobility, a wide range of other factors, e.g., size, location, fractionation, etc., can affect the relative benefits. Application of the P + objective is a simple and effective way to combine these factors in the evaluation of a treatment plan.
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Implant imaging is critical because it provides most of the information regarding the proposed implant site preoperatively. The inherent accuracy and precision of conventional radiographic modalities such as intraoral and panoramic radiography are limited; the modalities like CT and MRI are time taking, tedious and expensive. So one should always consider on how much information is really required to best serve the interests of his patients. Even with increased diagnostic procedures, it is not always necessary that, it will automatically result in better treatment or will improve patient???s outcome. A decision as to what imaging modalities need to be used should be based on sound knowledge of the advantages and the limitations of each modality.
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Medical imaging technologies that combine the capabilities of two or more imaging modalities are becoming increasingly important in the diagnosis, staging, treatment, and monitoring of disease. In particular, the combination of morphological imaging modalities (e.g., x‐ray, CT, ultrasound, and MR) with functional or molecular imaging modalities (e.g., optical, PET, SPECT, and functional MR) offers synergistic advances. This session provides an overview of technical and physical aspects of such developments, reviews the most prevalent technologies under consideration, addresses the challenges and limitations of such technologies, and discusses the opportunities for future research in multi‐modality imaging. Example multi‐modality approaches include x‐ray / ultrasound, CT / PET, MR / PET, and Optical / CT. Applications include pre‐clinical imaging, diagnosis and staging, image guidance, and treatment response monitoring. Educational Objectives: 1. An understanding of the technical and physical factors of multi‐modality image quality, registration, and accuracy. 2. An understanding of the challenges and potential opportunities associated with various multi‐modality imaging technologies. 3. An understanding of the various clinical applications enabled by such technologies.
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Many different types of radiation have been exploited to provide images of the structure and function of tissues inside a living subject. Each imaging modality is characterized by differing resolutions on the spatial and temporal scales, and by a different sensitivity for measuring properties related to morphology or function. Combinations of imaging modalities that integrate the strengths of two modalities, and at the same time eliminate one or more weaknesses of an individual modality, thus offer the prospect of improved diagnostics, therapeutic monitoring, and preclinical research using imaging approaches. This review discusses the advantages and challenges in developing multimodality imaging systems for in vivo use, highlights some successful combinations that are now routinely used in the clinic and in research, and discusses recent advances in multimodality instrumentation that may offer new opportunities for imaging.
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