Volume 35, Issue 12, December 2008
Index of content:
- VISION 20/20
35(2008); http://dx.doi.org/10.1118/1.3002305View Description Hide Description
Intensity modulated radiation therapy(IMRT) is an advanced form of external beam radiation therapy.IMRT offers an additional dimension of freedom as compared with field shaping in three-dimensional conformal radiation therapy because the radiation intensities within a radiation field can be varied according to the preferences of locations within a given beam direction from which the radiation is directed to the tumor. This added freedom allows the treatment planning system to better shape the radiationdoses to conform to the target volume while sparing surrounding normal structures. The resulting dosimetric advantage has shown to translate into clinical advantages of improving local and regional tumor control. It also offers a valuable mechanism for dose escalation to tumors while simultaneously reducing radiation toxicities to the surrounding normal tissue and sensitive structures. In less than a decade, IMRT has become common practice in radiationoncology. Looking forward, the authors wonder if IMRT has matured to such a point that the room for further improvement has diminished and so it is pertinent to ask what the future will hold for IMRT. This article attempts to look from the perspective of the current state of the technology to predict the immediate trends and the future directions. This article will (1) review the clinical experience of IMRT; (2) review what we learned in IMRT planning; (3) review different treatment delivery techniques; and finally, (4) predict the areas of advancements in the years to come.
35(2008); http://dx.doi.org/10.1118/1.3002307View Description Hide Description
Currently, there is an increasing interest in heavy ion radiotherapy (RT) and a number of new facilities are being installed in Europe and Japan. This development is accompanied by intensive technical, physical, and clinical research. The authors identify six research fields where progress is likely and propose a thesis on the expected achievements for each of the fields: (1) Synchrotrons with active energy variation and three-dimensional beam scanning will be the standard in ion beam RT. (2) Common standards for precise measurement, prescription, and reporting of dose will be available. (3) Intensity-modulated particle therapy will be state-of-the-art. (4) Time-adaptive treatments of moving targets will be feasible. (5) Therapeutic effectiveness of heavy ions will be known for the most important indications while cost effectiveness will remain to be shown. (6) The potential of high-linear energy transfer radiation will be known. The rationale for each of these theses is described.
35(2008); http://dx.doi.org/10.1118/1.3020593View Description Hide Description
The current climate of rapid technological evolution is reflected in newer and better methods to modulate and direct radiation beams for cancer therapy. This Vision paper focuses on part of this evolution, locating and targeting moving tumors. The two processes are somewhat independent and in principle different implementations of the locating and targeting processes can be interchanged. Advanced localization and targeting methods have an impact on treatment planning and also present new challenges for quality assurance (QA), that of verifying real-time delivery. Some methods to locate and target moving tumors with radiation beams are currently FDA approved for clinical use—and this availability and implementation will increase with time. Extensions of current capabilities will be the integration of higher order dimensionality, such as rotation and deformation in addition to translation, into the estimate of the patient pose and real-time reoptimization and adaption of delivery to the dynamically changing anatomy of cancer patients.
35(2008); http://dx.doi.org/10.1118/1.3013698View Description Hide Description
Commercially available high-resolution three-dimensional optical imaging modalities—including confocal microscopy, two-photon microscopy, and optical coherence tomography—have fundamentally impacted biomedicine. Unfortunately, such tools cannot penetrate biological tissue deeper than the optical transport mean free path ( in the skin). Photoacoustictomography, which combines strong optical contrast and high ultrasonic resolution in a single modality, has broken through this fundamental depth limitation and achieved superdepth high-resolution optical imaging. In parallel, radio frequency-or microwave-induced thermoacoustic tomography is being actively developed to combine radio frequency or microwave contrast with ultrasonic resolution. In this Vision article, the prospects of photoacoustictomography are envisaged in the following aspects: (1) photoacoustic microscopy of optical absorption emerging as a mainstream technology, (2) melanoma detection using photoacoustic microscopy, (3) photoacoustic endoscopy, (4) simultaneous functional and molecular photoacoustictomography, (5) photoacoustictomography of gene expression, (6) Doppler photoacoustictomography for flow measurement, (7) photoacoustictomography of metabolic rate of oxygen, (8) photoacoustic mapping of sentinel lymph nodes, (9) multiscale photoacoustic imagingin vivo with common signal origins, (10) simultaneous photoacoustic and thermoacoustic tomography of the breast, (11) photoacoustic and thermoacoustic tomography of the brain, and (12) low-background thermoacoustic molecular imaging.