Functional and Molecular Imaging for Radiation Therapy Guidance Department of Radiation Oncology Stanford University School of Medicine L Xing, T Li, Y Yang, E. Schreibmann, B Thorndyke, D. Spielman 4D modeling Gated tx planning 4D planning Adaptive therapy (imaging, planning, delivery) Day 0 Day 14 Day 24 3D/4D CBCT 4D imaging Biological imaging Imaging 3D modeling Treatment planning Pt setup and treatment delivery Targeting in current radiation oncology Inter-fraction organ movement Intra-fraction organ movement, in particularly, respiratory motion Target volume definition & localization PET/CT PET/CT Where is the tumor? 21 September 2000 19 July 2000 18 July 2000 21 August 2000 Is tumor responding to therapy? Is tumor responding to therapy? • Tissue Characterization and Classification • Staging • Restaging • Prognosis • Monitoring Treatment • Tissue Characterization and Classification • Staging • Restaging • Prognosis • Monitoring Treatment Anatomic Molecular Imaging Imaging A. Quon Treatment plan for prostate patient with nodal risk>15% Anterior Field Lateral Field 100% 90% 50% Axial Field Treatment plan for prostate patient with nodal risk <15% Pre-treatment staging & planning
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Functional and Molecular Imaging for Radiation Therapy ... · 2 Shortcomings of Current Radiation Therapy • Staging and treatment decision-making are based largely on anatomical
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Functional and Molecular Imaging for Radiation Therapy Guidance
Department of Radiation OncologyStanford University School of Medicine
L Xing, T Li, Y Yang, E. Schreibmann, B Thorndyke, D. Spielman
4D modeling
Gated tx planning
4D planning
Adaptive therapy (imaging, planning, delivery)
Day 0 Day 14 Day 24
3D/4D CBCT
4D imagingBiological imaging
Imaging 3D modeling Treatment planningPt setup and treatment delivery
Targeting in current radiation oncology
Inter-fraction organ movement
Intra-fraction organ movement, in particularly, respiratory motion
Target volume definition & localization
PET/CTPET/CT
Where is the tumor?
21 September 2000
19 July 2000 18 July 2000
21 August 2000
Is tumor responding to therapy?Is tumor responding to therapy?
• Tissue Characterization and Classification
• Staging
• Restaging
• Prognosis
• Monitoring Treatment
• Tissue Characterization and Classification
• Staging
• Restaging
• Prognosis
• Monitoring Treatment
Anatomic MolecularImaging Imaging
A. Quon
Treatment plan for prostate patient with nodal risk>15%
Anterior Field Lateral Field
100%90%
50%
Axial Field
Treatment plan for prostate patient with nodal risk <15%
Pre-treatment staging & planning
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Shortcomings of Current Radiation Therapy
• Staging and treatment decision-making are based largely on anatomical imaging.
• Tumor volume defined on CT/MRI may often be too small or too large.
• Spatial biology distribution is not considered.
• The whole Rx course takes 5-6 weeks and there is no effective tools to distinguish responders from un-responders.
• Detection of recurrence is problematic.
Where is the tumor?
What is the biology distribution?
Where is the boundary of the tumor?
Imaging 3D modeling Treatment planningPt setup and treatment delivery
4D modeling
4D BCRT planning
Adaptive therapy (imaging, planning, delivery)
Day 0 Day 14 Day 24
3D/4D CBCT4D imagingBiological imaging
IMRT provides an unprecedented means to produce customized 3D-dose distributions with sub-cm resolution.
Integration of radiological imaging techniques allows better patient positioning and dose delivery.
Functional/metabolic imaging modalities are available fornoninvasively providing critical needed metabolic and physiological data.
Molecular imaging techniques are emerging.
Integration of biological and functional Image.-- Biologically Conformal Radiation Therapy (BCRT)
Prescription for molecular/functional image guided IMRT
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Yang Y and Xing L, Med. Phys. 2005.
Functional Image-Guided IMRT
• What needs to be done?
Image fusion.
Inverse treatment planning.
Reliable imaging tools.
Quality assurance .
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S. Hunjan, D. Kim, A. Adalsteinsson, D. Spielman, L. Xing, IJROBP 57, 1159-1173, 2003
Quality Assurance Relationship between the Cho/NAA ratios of the calibration solutionsobtained at 9.4 T versus the calibration-solution-filled vials inside the phantom obtained at 1.5 T using a 2D PRESS sequence.
S. Hunjan, D. Kim, A. Adalsteinsson, D. Spielman, L. Xing, IJROBP 57, 1159-1173, 2003
3D PET
4D PET (after post-acquisition data processing using our new algorithm)
Motion direction
-10 0 10 20 30 40 50 60 70 80-5
0
5
10
15
20
25
30
superioinferior location (mm)
CNR
UngatedGated with 0.4 secGated with 1.0 secRetro. Stacked
CN
R
Motion direction
Intensity profiles along the motion direction
4D PET Image Enhancement - Phantom Validation
(B. Thorndyke, E. Schreibmann, A. Koogn, and L. Xing, IJROBP).
B. Thorndyke, E. Schreibmann, A. Koong, L Xing, Med. Phys. 2006
Functional Image-Guided IMRT
• What needs to be done?
Image fusion.
Inverse treatment planning.
Reliable imaging tools.
Quality assurance .
A lot of research!
P Maxim, S Gambhir, C Contag, and L Xing, Molecular Imaging., 2004
Day11 after inoculation
day1day4 day8
Summary
Next Generation Radiation TherapyIntegration of functional & molecular imagingBiologically Conformal IMRT