Radiation therapy has become increasingly effective and safe as vendors continue to innovate technologies that benefit the patient. At ASTRO 2018, this patient-centric approach was exemplified and demonstrated not only in ways that match treatments to patients, but in how technologies can adjust to patient movement and anatomical changes, and to increase the precision of treatments. ITN Contributing Editor Greg Freiherr showcases several new technologies that are helping to advance this field.

For additional patient-centered care coverage, see:

Conversations with Greg Freiherr: The Accuray Philosophy

ASTRO Puts Patients First

This is an example of the FDA-cleared OpenSight augmented reality (AR) system for surgical planning from NovaRad at the Radiological Society Of North America (RSNA) 2018 meeting. It uses a Hololens headset to register an overlay of the patient’s MR or Ct scan in the patient. The operator can use hand movements to slice through and manipulate the images.

The vendor gained an FDA indication for AR to be used in surgical planning in 2018. NovaRad is working with the FDA for a second indication for use of the AR in the operating room during procedures.

This video is jerky, slightly misaligned and the hand movements did not always respond because itwas shot with an iPhone inside the visor. The image quality and hand movements are much better when actually wearing it on your head and aligned for the specific user.

Read more about this technology

Related VR and AR Content:

VIDEO: Using Virtual and Augmented Reality to Examine Brain Anatomy and Pathology at MD Anderson

Virtual Reality Boosts Revenues and Patient Understanding

Augmented Reality is Taking Over Radiology Training

VIDEO: Augmented Reality for Surgical Planning Example

Philips and Microsoft Showcase Augmented Reality for Image-Guided Minimally Invasive Therapies

Reimagining Brain Surgery 

VR in the OR 

Radiologist Uses Virtual Reality as Interventional Radiology Teaching Tool 

This is an example of how artificial intelligence (AI) can help improve patient care by pulling together patient data from numerous sources and then select medical records that are specific to a patient’s diagnosis and treatment for a defined disease state. This is Siemens’ AI-Pathway Companion introduced at the Radiological Society Of North America (RSNA) 2018 meeting. In this examples. A prostate cancer patient has all their data on a single time line that can be accessed by single clicks on the points to open reports, images, procedures or labs.

At the end of the time line it integrates AI driven clinical decision support that recommends the next course of action based on clinical guidelines. The guidelines cited can also be opened for review by the clinician.

Here is an example of how artificial intelligence (AI) is helping radiologists with faster workflow to improve care. This example from the Philips Illumeo system shows a spine CT and how the radiologist can use the tool bar to gain one-click, immediate access to three prior CT studies that will open with the exact slate slice view and orientation as the current exam. This was shown at the 2018 Radiological Society of North America (RSNA) meeting.

Read more in the article “How Artificial Intelligence Will Change Medical Imaging.”

Watch the VIDEO AI Technogy Report from RSNA 2017.

At the 2018 Radiological Society of North America (RSNA) meeting, Hitachi showed a new computed tomography (CT) scanner designed for larger sized patients. The Scenaria View offers both 64 and 128 slice versions (it is also field upgradable from 64 to 128 later on). It has an 80 cm bore and the table has a weight capacity of 550 pounds. The X-ray tube also can achieve high energies up to 700 mA.  The system has clearance in Japan and Europe and will be submitted for FDA clearance soon.

Read more about the system.

An interview with A. M. Niser Syed, M.D., medical director, radiation oncology and endocurietherapy, MemorialCare Cancer Institute, Long Beach, Calif. At the American Society for Radiotherapy and Oncology (ASTRO) 2018 annual meeting, he presented a study of 1,200 patients using a single session of intra-operative radiation therapy (IORT) using the Xoft X-ray emitting brachytherapy system. 

Genomics can be used to assess a patient's radiosensitivity, which can be used to increase or decrease the radiation that needs to be delivered to treat the tumor and spare surrounding healthy tissue. Javier Torres-Roca, M.D., associate professor of radiation oncology, Moffit Cancer Center, and co-founder of the genomics company Cvergenx, spoke on this topic at the ASTRO 2018 conference. 

Find more news, videos and late-breating studies from ASTRO 2018.

Interview with Peyman Kabolizadeh, M.D., the medical director of Beaumont Proton Therapy Center, Royal Oak, Mich. He explains how proton therapy fits into Beaumont's overall strategy of cancer treatment. He also explains Beaumont's development of proton arc therapy that is in development. He spoke on these topics at that ASTRO 2018 meeting.

Read the article "Beaumont Hospital Cancer Institute Performs First Irradiation of Spot Scanning Proton Arc Therapy Plan."
 

Kristin Higgins, M.D., medical director of radiation oncology at the Emory Clinic at the Winship Cancer Institute, and associate professor, Department of Radiation Oncology, Emory University School of Medicine, explains how the use of a novel positron-emission tomography, computed tomography (PET-CT) system combined with a linac in a single gantry might offer a new approach to real-time adaptive therapy. She spoke to ITN at the 2018 ASTRO conference.

Read the article about the technology displayed at ASTRO 2018 — Biology Guided Radiotherapy May Improve Physician Confidence in Treatment of Multiple Tumors

Read more about the start-up company that created the system.

Eric Morris, a Ph.D. candidate at Henry Ford Hospital and Wayne State University, explains his project to automate registration and segmentation of cardiac structures in treatment planning scans for breast cancer radiation therapy.

Find more content on Henry Ford Hospital

A discussion with Kevin Moore, Ph.D., DABR, deputy director of medical physics and associate professor, University of California San Diego, about his daily clinical use of an artificial intelligence treatment planning software. He spoke on this at the American Association of Physicists in Medicine (AAPM) 2018 meeting.

Also watch the VIDEO: The Impact of Artificial Intelligence on Radiation Therapy — an interview with Steve Jiang, Ph.D.

Find other videos and coverage from AAPM 2018

ITN Editor Dave Fornell takes a tour of some of the innovative new technologies on the expo floor at the 2018 American Association of Physicists in Medicine (AAPM) meeting.

Click here for more coverage of the 2018 AAPM annual meeting.

A discussion with Matthew Freeman, Ph.D., scientist at Los Alamos National Laboratory, New Mexico. He spoke about his research using direct proton imaging on the treatment table without the need for other external or on-board imaging systems. He spoke at the 2018 American Association of Physicists in Medicine (AAPM) meeting.

Lawrence Tanenbaum, M.D., FACR, vice president and director of advanced imaging at RadNet, discusses the latest research on the effects of gadolinium contrast retention following magnetic resonance imaging (MRI) exams, and how facilities can best manage its use.

Sheila Sferrella, president of Regents Health Resources and Bill Finerfrock, president of Capitol Associates, discuss the national progress in transitioning from computed radiography (CR) to digital radiography (DR) systems. Sferrella is the chair and Finerfrock is a member of the AHRA Regulatory Affairs Committee. 

Watch the related Technology Report on Digital Radiography Systems

Watch part 1 of the conversation with Sferrella and Finerfrock on clinical decision support updates

Watch part 3 on site-neutral payments

Ehsan Samei, Ph.D., DABR, FAAPM, FSPIE, director of the Duke University Clinical Imaging Physics Group and head of the Duke medical physics graduate program, explained this new program at the American Association of Physicists in Medicine (AAPM) 2018 meeting.

Additional AAPM news and videos

Robert Junk and Tobias Gilk, MRSO, MRSE, of architectural firm RAD-Planning, discuss the different types of safety hazards associated with magnetic resonance imaging (MRI) and how to assess your own protocols to find and eliminate inefficiencies that could lead to safety hazards. 

Watch the related VIDEO New App Improves MRI Safety For Implantable Devices

Read the related article "Closing the Loopholes in MRI Safety"

This is an example of how Cherenkov radiation glow can be collected with image intensifier cameras during radiotherapy to show the exact location of the beam and the amount of dose delivered. This can be used to quickly verify everything matches the treatment plan and dosimetry. This video was shot in the booth of DoseOptics at the 2018 American Association of Physicists in Medicine (AAPM). The company is developing this technology and hopes to submit it to U.S. Food and Drug Administration(FDA) for review in the next year. 

Other coverage from the AAPM 2018 meeting.

#AAPM2018

At SIIM 2018, Alexander J. Towbin, M.D., Radiologist, Department of Radiology and Medical Imaging, Neil D. Johnson Chair of Radiology Informatics, Associate Chief of Radiology Informatics, at Cincinnati Children’s Hospital, discusses the meaning of patient engagement and describes some of the patient engagement initiatives that he has seen successfully implemented in various practices.

Watch another VIDEO interview with Towbin "Translational and Reproducible Research in Medical Imaging."

Read the article "Essentials of Pediatric Imaging" with input from Towbin.

ITN Contributing Editor Greg Freiherr interviews Eliot Siegel, M.D., radiology professor at the University of Maryland School of Medicine and chief of Imaging Services at the VA Maryland Health Care System.

It’s ridiculous to think that in the coming two decades, artificial intelligence will replace radiologists, says AI expert Eliot Siegel, M.D. Even if AI got good at reading medical images, “radiologists do much more than that,” he says.

In the accompanying video interview, Siegel, a radiology professor at the University of Maryland School of Medicine and chief of Imaging Services at the VA Maryland Health Care System, will highlight these and other reasons why it’s ridiculous to think computers will replace radiologists. He’ll discuss them during a SIIM debate on the subject June 2 that will include Bradley J. Erickson, M.D., associate research chair in the radiology department at Mayo Clinic in Rochester. 

AI might not replace radiologists, but it could radically change the practice of radiology in just a few years, he says. During a SIIM session June 1, Siegel will moderate discussions among executives from several companies, including GE Healthcare and newcomer Aidoc, who will look at radiology AI applications and roadmap how these and future applications will incorporate AI. 

One thing is for sure, says Siegel: AI is going to dramatically increase radiologists’ use of lab data, genomics and digital pathology. Several of these data types may become integral parts of reading oncologic images, according to Siegel, who will provide details at SIIM May 31 in “Point-of-Care Precision Medicine: Real-time Radiomics-Genomics in the Reading Room.”

Editor’s note: This pre-SIIM video interview is the first in a series of three by Greg Freiherr. The series features industry luminaries discussing key issues associated with the upcoming SIIM conference. The first interview, Building An Effective Enterprise Imaging Strategy featuring Kim Garriott, can be viewed here.

Related Video: ITN Editorial Director Melinda Taschetta-Millane discusses "Machine Learning and the Future of Radiology" with Eliot Siegel at SIIM 2017.