This is an example of the Mirada DLCExpert deep learning software that automatically identifies organs, segments and auto-contours them as the first step in creating radiation oncology treatment plans. This example of a segmented prostate computed tomography (CT) scan being used to plan radiotherapy was created without any human intervention. It was demonstrated at the American Association of Physicists in Medicine (AAPM) 2019 meeting. 

This example shows OAR Space hydrogel (outlined in blue) injected to create space between the prostate and the rectum to prevent damage to that radiation sensitive structure. The gel is hard to identify on the CT scan because it looks like part of the rectum or prostate. But the softwares AI has been trained to identify it when present.

The DLCExpert software was cleared by the FDA in July 2018 and was first shown at ASTRO 2018. It automatically identifies anatomical structures and contours them to save staff time. The files created by the software are vendor neutral and can be imported into any vendor’s treatment planning system. Read more about this software. 

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This is a lung cancer tumor radiotherapy treatment plan for the Accuray CyberKnife system demonstrated at the American Association of Physicists in Medicine (AAPM) 2019 meeting. The blue lines are the radiation beam lines that are shot from different positions to all intersect in the tumor to deliver the prescribed amount of radiation and prevent damage to surrounding healthy tissue. The beams also are planned around the critical structure organs near the target tumor to limit their dose. The organs are color coded to differentiate them on the treatment plan and to help with the estimated radiation dose each receives based on the plan. After the plan is optimized, it is fed into the radiotherapy treatment system computer to deliver the treatment once the patient is positioned on the treatment table exactly as they are in the CT scans used to create the plan. 

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Pierre Qian, MBBS, cardiac electrophysiologist fellow, Brigham and Women's Hospital, explains how his facility is working with radiation oncology to use radio therapy to noninvasively ablate ventricular tachycardia (VT). He spoke on this topics during a joint electrophysiology session by the Heart Rhythm Society (HRS) and the Society of Cardiovascular Computed Tomography (SCCT) at the SCCT 2019 meeting.

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Mahadevappa Mahesh, Ph.D., chief of medical physicist and professor of radiology and medical physics, Johns Hopkins University, Baltimore, and treasurer of the American Association of Physicists in Medicine (AAPM), explains some of the trends in medical physics and new features of the AAPM 2019 meeting. 

Watch the related VIDEO: Bridging Diversity in Medical Physics to Improve Patient Care — Interview with AAPM President Cynthia McCollough, Ph.D., at the 2019 AAPM meeting.
 

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Cynthia McCollough, Ph.D., director of the Mayo Clinic Computed Tomography (CT) Clinical Innovation Center, professor of medical physics and biomedical engineering, and the 2019 president of the American Association of Physicists in Medicine (AAPM), explains the "building bridges" theme of the 2019 AAPM meeting. 

This theme was the focus of her president’s address at the 2019 AAPM meeting. She spoke on the theme of diversity and how to break down the barriers between various minorities, male-female, religion, national origin, etc. She gave many photo examples of how we pigeon hole people into neat categories and that we often say we have equally in society, however her images showed recent images of big political summits where there are no women present, or they were the secretaries in the background. She said in medical practice, department administration and collaboration on projects, people need to be cognoscente of bias they have engrained by culture for which they may not even be aware.

She showed a slide of the AAPM membership makeup by generation and said members need to keep in mind the way each generation thinks and communicates varies by their generation's life experience and upbringing. McCollough said understanding these differences can help bridge perceived gaps in communication. 

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Stephen Sorensen, Ph.D., DABR, chief of medical physics, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, explains the first commercial use of the Zap-X stereotactic radio surgery (SRS) brain radiotherapy system. The system uses a capsule-like shield to surround the gantry and patient, eliminating the need for expensive room build outs requiring vaults. The goal of the system is to expand SRS brain therapy by making it easier and less expensive to acquire the treatment system. Sorensen spoke about this system in sessions at the American Association of Physicists in Medicine (AAPM) 2019 meeting.

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This is a walk through of the ViewRay MRIdian MRI-guided radiotherapy system installed at Henry Ford Medical Center — Cottage. The system has been in service for about two years. The walk through shows the entry way into the vault and the warnings about entering an MRI environment. Anyone who enters the treatment room must undergo a metal detector scan first to make sure all ferrous metal is removed.

Read more about the center's first year experience with the system.

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Magid Awadalla, MBBS, is an advanced cardiac imaging research fellow at Massachusetts General Hospital. He has been involved in an imaging study of cardiac changes from photon radiotherapy in breast cancer patients using serial cardiac magnetic resonance imaging (MRI). The radiotherapy beams used to treat breast cancer pass close to the neighboring heart, which can cause cardiac cell damage leading to issues like heart failure later on. He spoke on the topic of cardio-oncology at the American College of Cardiology (ACC) 2019 meeting.

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

ITN Editor Dave Fornell took a tour of some of the most innovative technologies on display on the expo floor at the American Society for Radiation Oncology (ASTRO) 2018 conference. The overview includes new technologies for proton therapy, MRI-guded radiation therapy, PET-guided radiotherapy, brachytherapy, SRS quality assurance, 3-D printing and mobile connectivity to the oncology information system.

Find links to all the ASTRO 2018 latebreakers, key news and VIDEOS in the article "Late-breaking Radiation Therapy Clinical Trials at ASTRO 2018."
 

Aadel Chaudhuri, M.D., assistant professor of radiation oncology, Washington University, St. Louis, Mo., explains his research on using blood tests to collect circulating lung tumor cells to assess their response to radiotherapy. This use of liquid biopsies can eliminate the need for invasive needle biopsies. He spoke on this topic at the American Society for Radiotherapy and Oncology (ASTRO) 2018 annual meeting. 

James Welsh, M.D., associate professor, radiation oncology, MD Anderson Cancer Center, Houston, explains how targeted nanoparticles can be used to precondition tumors to improve response to radiation therapy. He spoke on this topic at the ASTRO 2018 meeting.

Anne Hubbard, MBA, director of health policy for the American Society for Radiation Oncology (ASTRO), gives an update on where things are at for radiotherapy reimbursement, CMS conversion factors and MACRA. She spoke on this topic at the 2018 ASTRO conference.

Read the related article "ASTRO: CMS Report on Radiation Therapy Payment Model Charts Path to Value-Based Cancer Care."

Elizabeth Chabner-Thompson, M.D., MPH, radiation oncologist, Northern Westchester Hospital, Northwell Health, Mt. Kisco, N.Y., and CEO of Masthead, explains an FDA-cleared bra she designed for improved patient positioning of women undergoing radiation therapy. She spoke to ITN at the 2018 ASTRO conference. 

Benjamin Movsas, M.D., chair of radiation oncology at Henry Ford Cancer Institute, describes the benefits the department has realized from using the first FDA-approved magnetic resonance imaging (MRI)-guided radiation therapy system to allow real-time treatment tracking.

Watch the related VIDEO: MRI-Guided Radiation Therapy Trial for Pancreatic Cancer.

Register to view a webinar on the ViewRay MRI-guided radiation therapy system.

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Carri Glide-Hurst, Ph.D., and Benjamin Movsas, M.D., discuss Henry Ford Hospital's involvement in a national clinical trial assessing the effectiveness of magnetic resonance imaging (MRI)-guided radiation therapy in pancreatic cancer.

Watch the related VIDEO: Clinical Use of the ViewRay MRIdian Linac System at Henry Ford — Interview with Benjamin Movsas, M.D.

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Register to view a webinar on the ViewRay MRI-guided radiation therapy system.

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.

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A discussion with Martin Vallieres, Ph.D., post-doctoral fellow at McGill University, Montreal, Canada. He spoke on this topic in sessions at the American Association of Physicists in Medicine (AAPM) 2018 meeting. He explains radiomics and how it can be used in both medical imaging and radiation therapy. 

Read the related article "Hidden Information Behind Imaging Tests for Cancer May Unlock New Approaches to Radiation Therapy."

Read the related article "Computer Program Beats Physicians at Brain Cancer Diagnoses."

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A discussion with Steve Jiang, Ph.D., director of the medical artificial intelligence and automation lab and vice-chair of the Department of Radiation Oncology, University of Texas Southwestern. He spoke in sessions at AAPM 2018 about how AI will change treatment planning, radiation oncology and medical imaging.

Watch the VIDEO: Real-world Implementation of Deep Learning for Treatment Planning — 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. 

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American Association of Physicists in Medicine (AAPM) President Bruce Thomadsen, M.D., professor of medical physics at the University of Wisconsin, Madison, discusses the future direction of medical physics in a changing healthcare environment at the 2018 AAPM meeting.

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