Day 2 :
Keynote Forum
Pedro Serrano Ojeda
Caribbean Radiation Oncology Centre, USA
Keynote: The cancer solution: Cancer starvation therapyâ€-The end of cancer treatment failure
Time : 09:00-09:30
Biography:
Dr. Pedro Serrano-Ojeda, M.D., a certified radiation oncologist, founded Caribbean Radiation Oncology Center in 2007 in Puerto Rico. He expanded the company a few years later with the announcement of its first facility outside of the island in Doral, Florida that opened in summer 2015. The facility is one of the first in Florida to feature the TomoTherapy HDA unit – the latest TomoTherapy Hi-Art Treatment System and the most integrated and advanced system for comprehensive cancer treatment that is available today.rnDr. Serrano-Ojeda received his medical degree from the Ponce School of Medicine & Health Sciences. In 2011, the American Association for Physics in Medicine publication named Caribbean Radiation Oncology Center as part of the guidelines for quality assurance for TomoTherapy technology, setting a new standard for care. Most recently the U.S. Patent and Trademark Office (PTO) has formally published his Cancer Starvation Therapy. Dr. Serrano-Ojeda is deeply committed to learning, to his patients and to his family. He lives in Coral Gables, Florida, with his wife and two daughters.rn
Abstract:
Adaptation and evolution are basic components of survival, a trait ubiquitous to all living species and unfortunately an ever present trait in cancer cells. The conference is a glimpse into the non-distant oncologic future about how we will overcome tumor treatment resistance through a medication; I have come to call Cancer Starvation Therapy (CST).rn
Keynote Forum
Marc Griffiths
University of West Of England, UK
Keynote: The impact of new hybrid imaging technology on the nuclear medicine workforce: Opportunities and challenges
Time : 09:30-10:00
Biography:
Dr Marc Griffiths is an Associate Dean within the Faculty of Health and Applied Sciences at the University of the West of England, Bristol and completed his Professional Doctorate in 2014. His Professional Doctorate evaluated the impact of the introduction of new hybrid imaging technology on the nuclear medicine workforce. He has published a number of papers in peer reviewed journals related to the development of the nuclear medicine workforce and associated factors, including mentorship, education and training competencies. Marc works closely with education commissioners and is involved in healthcare workforce planning and scenario modelling.
Abstract:
Health professionals across the world now work within an environment of flux and uncertainty, which inevitably presents new opportunities and challenges for the workforce in terms of developing new skills and knowledge. The introduction of any new hybrid imaging technology may require appropriate staff training, considerations for service redesign and patient workflow dynamics, as part of the change process. Staffing a modern hybrid imaging environment requires a skilled and competent workforce, who should have the opportunity to further develop their working practice and clinical service provision. Balancing the needs of effective service delivery, workforce development and holistic patient-centric care requires careful planning and collaboration with a range of healthcare professionals. Introducing new hardware and software technology requires appropriate social frameworks, which may include ensuring clarity of role and responsibilities in order that the emerging relationship with the patient is maintained. There is a potential danger of ‘patient objectification’ during high technology examinations, such as hybrid imaging techniques, and the subsequent dehumanization process that may occur. Creating an environment where workforce flexibility is present, in terms of understanding the position of new technology within the patients’ journey and a greater understanding of the need to reshape the delivery of such clinical services, is paramount to the ongoing development of hybrid imaging within the modern healthcare domain.rn
Keynote Forum
Timo Joensuu
Docrates Cancer Center, Finland
Keynote: Multimodality approach in the treatment of metastatic prostate cancer
Time : 10:00-10:30
Biography:
Timo Joensuu is one of the leading European experts in prostate cancer with vast experience in both patient care and clinical studies. His special interests in the field of prostate cancer are multi-modality diagnostics, both internal and external radiotherapy and drug treatments. He can well be called as one of the Nordic pioneers in radiotherapy. He is one of the founders of Docrates Cancer Center, the only Nordic private cancer center providing all aspects of cancer diagnostics and treatments under one roof. The patient-centric care model is a driving force in his medical work, resulting among other things active participation on the patient organizations’ work both home and abroad.rn
Abstract:
Androgen deprivation has been the only treatment recommended by guidelines for metastatic prostate cancer. The radiotherapy and radiopharmaceuticals like Samarium are used mainly as pain killers. Hormonal therapies are well established but the problem is that castration resistant disease eventually emerges and then our patients are expected to survive about two years. Our personalized clinical practice has been to combine different treatment modalities in primarily metastatic prostate cancer in order to decrease the number of cancer cells as low as possible. Diagnostic procedures we start with ermp MRI of the prostate which will be done in most cases already before biopsies, followed by NaF-PET-CT and/or choline-/PSMA-PET-CT. First goal is to get PSA down (<1). All men receive mamillar irradiation with 12Gy, 6/9 Me-V. We combine LHRH analogs or Degarelix with bicalutamide plus zoledronic acid or denosumab and if it appears that we do not reach our first target we combine Docetaxel and most recently we have included also abiraterone/enzalutamide to the systemic therapy per need. Immediately, when our goal has been achieved we start radical VMAT radiotherapy of the prostate. We fuse all of our primary scanning with dose planning-CT and try to irradiate also bone metastases including also the lymph nodes to the target volumes. In addition some patients have received samarium intensified by mitoxantrone. The good feasibility of this multimodality approach and follow up-results will be presented.
- Radiation Therapy
Clinical Nuclear Medicine
Diagnostic Imaging
Chair
Mian M Alauddin
University Of Texas MD Anderson Cancer Centre, USA
Session Introduction
Mian M. Alauddin
University of Texas MD Anderson Cancer Center, USA
Title: Synthesis of a [18F]-labeled ceritinib analogue for positron emission tomography of anaplastic lymphoma kinase, a receptor tyrosine kinase, in lung cancer
Time : 10:45-11:05
Biography:
Dr. Alauddin has completed his PhD at the age of 39 years from the University of Manitoba, Winnipeg, Canada, and postdoctoral training from California Institute of Technology (Caltech), Pasadena, CA, USA. He is an Associate Professor at the Universityof Texas MD Anderson Cancer Center. He has developmed many PET radiopharmaceuticals for early detection of cancer and HSV-tk gene expression. He has published more than 100 preer reviewed papers in reputed journals and has been serving as an editorial board member of some reputed journals
Abstract:
Anaplastic lymphoma kinase (ALK), an oncogenic receptor tyrosine kinase, has emerged as a therapeutic target in solid and hematologic tumors. Although several ALK inhibitors have gained approval for therapy, non-invasive indicators of target engagement or predictive biomarkers in vivo are lacking. We designed and synthesized a radiolabeled analogue of the ALK inhibitor ceritinib, [18F]fluoroethyl-ceritinib, (]18F]-FEC), for use with positron emission tomography (PET). We used two methods to synthesize [18F]-FEC. Method 1: [18F]fluoroethyl-tosylate was prepared by radiofluorination of ethylene glycol di-tosylate, purified by HPLC and coupled with ceritinib at 120oC. The product was purified by flash chromatography to yield [18F]-FEC. Alternatively, a precursor compound, chloroethyl-ceritnib, was synthesized and fluorinated with K18F/kryptofix. The product was purified by HPLC or flash chromatography to yield [18F]-FEC. Method 1 produced [18F]-FEC with an average decay-corrected yield of 24% (n=4), specific activity of 1200 mCi/μmol, and >99% purity; synthesis time was 115 min from the end of bombardment (EOB). Method 2 produced [18F]-FEC with an average yield of 7% (n=4), specific activity of 1500 mCi/μmol, and >99% purity; synthesis time was 65 min from the EOB. Of these two methods, we judged Method 1 to be the better choice for producing a pure compound for biological applications. Synthesis of a novel [18F]ceritinib analogue has been achieved in good yields, with high purity and specific activity. The compound is a potential PET imaging agent for the detection of ALK overexpressing solid tumors, such as lung cancer, and should be tested in vitro and in vivo.
Karl Herholz
University of Manchester, UK
Title: Planning and Monitoring Brain Tumour Therapy by Positron Emission Tomography (PET)
Time : 11:05-11:25
Biography:
Karl Herholz is Professor in Clinical Neuroscience at the University of Manchester. He leads neuroscience research at the Wolfson Molecular Imaging Centre with particular research interest in positron emission tomography (PET). He is also Honorary Consultant at Salford Royal Hospital and the Nuclear Medicine Department, Central Manchester Foundation Trust. Before joining Manchester University he worked as a clinical neurologist and professor of neurology at University Hospital and the Max-Planck Institute for Neurological Research in Cologne, Germany. He has leading roles in several international multicentre PET studies. His research has been published in more than 400 research papers (ISI H-index 67) and several books.
Abstract:
Modern brain tumour imaging mainly relies on MR, while PET can provide additional information for grading, therapy planning and assessment of response to therapy. PET is most informative when used jointly with MR by image registration and fusion display. 18F-FDG does not provide good contrast from normal brain, but can predict prognosis and differentiate cerebral lymphoma from nonmalignant lesions. Amino acid tracers including 11C-methionine, 18F-fluoroethyltyrosine (FET), and 18F-fluoroDOPA provide high sensitivity, which is most useful for detecting recurrent or residual gliomas, including most low-grade gliomas. 18F-fluorothymidine (FLT) is a proliferation marker with potential for tumor grading and monitoring of therapy, but it can only be used in tumors with absent or broken blood–brain barrier. Ligands for somatostatin receptors are of particular interest in pituitary adenomas and meningiomas. Tracers to image expression of specific cellular markers, neovascularization, hypoxia, and phospholipid synthesis are under investigation for potential clinical use.
Michael Friebe
Otto-von-Guericke-University,Germany
Title: Intraoperative Radiation Delivery Concepts placed and monitored with handheld SPECT/US Hybrid Imaging Techniques
Biography:
Michael Friebe has been involved in diagnostic imaging and image guided therapeutic products and services, as founder / innovator / CEO investor, and scientist. Dr. Friebe currently is a Board Member of two startup R&D companies, as well as investment partner of a medical technology startup-fund. Dr. Friebe is an affiliated professor with the chair for Computer Aided Medical Procedures (CAMP) at TU München, and full professor of Image Guided Therapies at the Ottovon- Guericke-University in Magdeburg, Germany. He is listed inventor of more than 60 patent applications and the author of numerous papers.
Abstract:
Intraoperative radiation therapy (Low Dose and High Dose nuclear and electronic brachytherapy) is a potential therapy option for local tumours, and oligometastatic cancer treatment. The main benefits are that it can deliver the cell-killing radiation (beta or gamma rays) through small incisions - after surgical treatment or removal - and that it spares healthy tissue of radiation exposure. Radiation protection issues, and accurate dose measurement and quality assurance are the main issues to be resolved. Imaging for placement and therapy verification are essential tools allowing the therapist to accurately determine the tumour location, to place the therapy catheter, and subsequently to quantify and measure the dose delivered and maybe even get a confirmation on the cell killing effects. The talk will give a short overview of some of the current technologies used (Re-188, Y-90, Ir-192, miniature X-ray tubes) and the shortfalls and possible solutions of these therapy approaches particularly when combined with functional (SPECT) and anatomical imaging (US) hybrids and combinations with MRI imaging.
Dimitris Drikakis
University of Strathclyde, UK
Title: Increasing chemotherapy efficiency via shock waves
Biography:
Dimitris Drikakis is the Executive Dean of the Faculty of Engineering and Professor of Engineering Science at the University of Strathclyde, Glasgow, UK. Prior to his current position he has held academic as well as academic management posts at Cranfield University, Queen Mary University of London, University of Manchester, University of Erlangen-Nuremberg, Germany, and University of Marseille, France. His expertise is in fluid mechanics, fluid/material interface, shock physics, and nanotechnology. He has received twice (2008 and 2011) the William Penney Fellowship Award by the UK’s Atomic Establishment Plc. in recognition of his contributions to shock waves and turbulence, and also received the 2014 Innovator of the Year Award by the Innovation Institute for gas filtration using carbon nanotubes. He has co-authored two books in the field of computational fluid dynamics and has published about 380 journal and conference papers in the above technical areas.
Abstract:
Application of ultrasound to biological tissues has been identified as a promising cancer treatment technique relying on temporal enhancement of biological membrane permeability via shock wave impact. The effects of ultrasonic waves on a 1,2-dipalmitoyl-sn-phospha- tidylcholine biological membrane have been examined through molecular dynamics simulations. Molecular dynamics methods traditionally employ periodic boundary conditions which, however, restrict the total simulation time to the time required for the shock wave crossing the domain, thus limiting the evaluation of the effects of shock waves on the diffusion properties of the membrane. A novel method that allows capturing both the initial shock wave transit as well as the subsequent longer-timescale diffusion phenomena has been successfully developed, validated and verified via convergence studies. Numerical simulations have been carried out with ultrasonic impulses varying from 0.0 to 0.6 mPa s leading to the conclusion that for impulses C0.45 mPa s, no self- recovery of the bilayer is observed and, hence, ultrasound could be applied to the destruction of localized tumor cells. However, for impulses B0.3 mPas, an increase in the transversal diffusivity of the lipids, indicating a consequent enhancement of drug absorption across the membrane, is initially observed followed by a progressive recovery of the initial values, thereby suggesting the advantageous effects of ultrasound on enhancing the chemotherapy efficiency.
Vladka Salapura
University Clinical Centre Ljubljana, Slovenia
Title: Percutaneous Biopsies of Musculoskeletal Lesions With Xperguide Cone Beam CT-Our Experience
Biography:
Vladka Salapura has completed her PhD at the age of 31 years from Medical Faculty Ljubljana, University of Ljubljana, Slovenia. She is the Head of Musculoskeletal Department at University Medical Centre Ljubljana, a vice-president of The Slovenian Association of Radiology and the president of National Medical Committee for Radiology. See has published more than 31 papers in reputable domestic and international journals. She is the editor of a book chapter in Radiology for Medical Students, Medical Faculty Ljubljana, Slovenia and author of a book chapter for Oncology: Research, Diagnostics and Therapy for Medical Students, Oncology Institute Ljubljana, Slovenia.
Abstract:
Purpose: The purpose of our study was to determine feasibility; accuracy and safety of cone-beam CT guided percutaneous biopsies of musculoskeletal system with computer planned needle guidance system. Materials and Methods: Our study included 28 patients who were referred to CT guided percutaneous biopsy of musculoskeletal lesion using cone-beam CT and XperGuide planning system (Allura, Philips) between August 2012 and July 2015 (18 patients from July 2014 were included prospectively). We determined technical and histological success rates. Technical success was defined as needle placement within 5 mm of the target center. Histological success rate was defined as collecting of tissue sample adequate to establish the diagnosis. Complication rate was observed, and sensitivity and specificity for differentiation between malignant and benign lesions were calculated. We measured preparation and procedural time as well as patients’ irradiation dose. Results: Technical success rate was 90%, and histological success rate was 89,3%. The highest histological success rate was observed for lesions in the pelvis and in the lower extremities (p=0,015, Fisher's exact test). We observed no periprocedural complications. Specificity and sensitivity were 100% and 83,3%, respectively. Mean patient preparation time was 49min and mean procedural time was 1h 40min. Mean patient preparation and procedural time was significantly lower for soft-tissue biopsies compared to bone biopsies (p<0,001, Mann Whitney U). Mean effective dose was 13,4mSv. Conclusion: Our findings indicate that computer guided percutaneous biopsy of musculoskeletal lesions using cone-beam CT and XperGuide planning system is a safe and successful diagnostic tool. It can represent a good alternative for standard CT-guided percutaneous biopsies.
Dante Amelio
Proton Therapy Center – Azienda Provinciale per I Servizi Sanitari (APSS), Italy
Title: 18F-DOPA PET for proton therapy treatment planning in high-grade gliomas
Biography:
Dante Amelio has completed his studies in Medicine in 2004 and his specialization in Radiation Oncology in 2008 at University of Perugia (ITA). He trained in Radiation Oncology and Proton Therapy at Paul Sherrer Institute (PSI) - Proton therapy center (Villigen, CH), Heidelberg University - Heidelberg Ion Therapy center (HIT) and Radiation Oncology Department (Heidelberg, GER), Proton Therapy Center and Radiation Oncology Department - Massachusetts General Hospital (Boston, USA). He is a Senior Consultant of the Trento Proton Therapy Center (ITA). His main area of interest is neuro-oncology. He has published more than 10 papers in reputed journals and several book chapters.
Abstract:
In high-grade gliomas (HGG), treatment planning and evaluation of local response to therapy are usually based on magnetic resonance imaging (MRI) and computed tomography. Although these investigations show the anatomy of the brain with high accuracy they seem insufficient for proper tumor visualization. At the same time, recent technical advances in radiation therapy such as intensity-modulated radiation therapy and proton therapy (PT) provide the ability to deliver higher radiation doses to the most resistant tumor regions as well as reduce the dose delivered to the surrounding normal structures. Therefore, there is an urgent need for new imaging approaches to increase accuracy in tumor delineation for high precision radiotherapy. Imaging the biological and molecular characteristics of tumor tissue by positron emission tomography (PET) is an interesting approach to improve treatment planning for high precision radiotherapy as well as to evaluate tumor response after treatment. In fact, amino acid transport is generally increased in malignant transformation due to high income of the amino acid to the tissue, the intrinsic activity of the amino acid transporter and the rate of the intracellular amino acid metabolism. From this standpoint the amino acid tracer 18F-DOPA (3, 4-dihydroxy-6-[18F] fluoro-L-phenylalanine) has a high tumor-to-background signal and high sensitivity for glioma imaging. For these reasons we routinely integrate our planning with 18F-DOPA PET in patients with HGG treated with PT post-operatively or at progression/relapse (re-irradiation). 18F-DOPA PET imaging may more accurately identify regions of tumor extension and change the expected planning, as determined just by MRI, in many cases. Even though data are not definitive effective chemotherapy combined with highly conformal radiotherapy targeted to areas at highest risk for tumor recurrence may allow us to improve the therapeutic index.
Heming Lu
People’s Hospital of Guangxi Zhuang Autonomous Region, China
Title: Challenges and prospects of adaptive radiation therapy in head and neck cancer
Biography:
Heming Lu is Vice Chairman of Department of Radiation Oncology at the People’s Hospital of Guangxi Zhuang Autonomous Region. His current interests include radiation therapy, especially high precision radiotherapy (IMRT, IGRT, ART) and integrated treatment for head and neck cancer. He has published more than 20 papers in reputed international journals and been serving as an Editorial Board Member for several academic journals.
Abstract:
Intensity-modulated radiation therapy (IMRT) has now replaced conventional radiation therapy and three-dimensional radiation therapy and become a standard treatment technique for head and neck cancer. This technique provides adequate target coverage while maintaining steep dose gradients at the border between the targets and adjacent normal tissues. However, significant anatomic changes may occur throughout the entire treatment course. These changes include the shrinkage of the primary disease and metastatic lymph nodes, external contour because of significant weight loss and displacement/size of the normal structures. As a consequence, the initial planning based on pretreatment condition may not truly reflect the dosimetric variations during the course of IMRT. Thus adaptive radiation therapy (ART), a plan modification and implementation according to tumor response and anatomic changes of normal structures, becomes particularly important. In recent years, many researchers have focused on ART for head and neck cancer patients. Results from dosimetric studies suggest that the initiation of ART during fractionated IMRT provides various benefits, particularly in preventing overdose to the critical structures. The feasibility of ART in clinical practice, both in online and in offline settings, has been broadly reported in the literature. However, many questions remain unanswered: Who would benefit most for ART? What is the optimal timing and frequency to perform ART? Whether ART re-planning can transfer into clinical benefits? Mature outcomes from basic and clinical researches will be necessary to appropriately mold ART into a future treatment standard.
Biography:
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Abstract:
In radiation therapy (RT) staging, treatment planning, monitoring and evaluation of response are traditionally based on computed tomography (CT) and magnetic resonance imaging (MRI). These radiological investigations have the significant advantage to show the anatomy with a high resolution, being also called anatomical imaging. In recent years, so called biological imaging methods which visualize metabolic pathways have been developed. These methods offer complementary imaging of various aspects of tumor biology. To date, the most prominent biological imaging system in use is positron emission tomography (PET), whose diagnostic properties have clinically been evaluated for years. The first rationale for using PET in target volume delineation for radiation treatment planning is the higher sensitivity and specificity of PET for tumor tissue in comparison to CT and MRI in some tumor entities. This has been demonstrated in many studies evaluating the results of PET with the results of radiological investigations and histology. The hypothesis tested in these studies was that using PET in addition to CT and/or MRI allows tumor tissue detection with a higher accuracy. The second rationale for integrating PET in the process of radiation treatment planning is the ability of PET to visualize biological pathways, which can be targeted by radiation therapy. The visualization of hypoxia, angiogenesis, proliferation, apoptosis, receptor expression, gene expression etc., leads to the identification of different characteristics of the tumors of different sub areas of the gross tumor mass which can be individually targeted. The aim of this presentation is to discuss the valences and implications of PET in RT. We will focus our evaluation on the following topics: The role of biological imaging for tumor tissue detection/delineation of the gross tumor volume (GTV) and for the visualization of heterogeneous tumor biology. We will discuss the role of FDG-PET and hypoxia-PET (FMISO-PET) in lung and head and neck cancer, the impact of amino acids (AA)-PET in target volume delineation of brain tumors and the role of Choline, Bombesine and PSMA-PET in prostate cancer. Furthermore, we will discuss the impact of animal-PET in the visualization of glioblastoma tumor stem cells. We conclude that, regarding treatment planning in radiotherapy, PET offers advantages in terms of tumor delineation and the description of biological processes.
Antonis Kalemis
Philips, UK
Title: New Technologies in PET imaging and their applications into the Clinic
Biography:
Antonis Kalemis studied biomedical engineering, medical physics and business management, in Greece and the United Kingdom. After his PhD from the Institute of Cancer Research (University of London), he held R&D positions in GE Healthcare and Philips. Since 2007 he works in Philips’ Advanced Molecular Imaging business, looking after research collaborations with academic partners worldwide. He also represents Philips in AIPES (the EU molecular imaging industry association) and is the Chairman of its New Technologies Working Group. He is reviewer in several national/international research grant organisations and scientific journals.
Abstract:
Positron Emission imaging was introduced in the early ‘50s and after the advent of Positron emission tomography in early ‘70s few distinct technological leaps improved the performance of the tomographs and rendered them clinically relevant. A major component that has remained unchanged since its introduction is the photon detection chain based on photomultiplier tubes, rendering nuclear medicine the imaging modality still based, technologically, on vacuum tubes. The recent introduction of solid-state detectors, in this field, allows significant opportunities in the areas of novel imaging modality combinations (e.g. PET/MR) as well as dramatic improvement of image quality and quantification performance. This new generation of hybrid tomographs, in combination with novel highly-specific radiotracers have allowed clinicians to consider PET imaging for new applications or to reconsider its performance in more traditional applications. The proposed talk aims to review the major new (or improved) technologies in PET imaging, such as time-of-flight, solid-state detectors, Anger-logic, iterative reconstruction and corrections and consider the performance benefits that each of them brings. The ultimate aim is to link these technological advancements with expected improvements in clinical performance and provide examples for various different clinical applications
Tejinder Kataria
Medanta Cancer Center, India
Title: Can PETCT parameters predict survival for recurrent head and neck cancer with cyberknife stereotactic body radio therapy (SBRT)?
Biography:
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Abstract:
There are established guidelines for baseline diagnosis and post treatment surveillance among head and neck cancer (HNC) patients with PET-CT parameters like standardized uptake value (SUV), metabolic tumor volume (MTV) and Total lesion glycolysis (TLG). The same remains controversial and experimental among post irradiation (RT) recurrence especially with Stereotactic Body Radiotherapy (SBRT). We analyzed the PET-CT parameters with the intent to co-relate the response and survival among post RT recurrent HNC (rHNC) undergoing Cyberknife SBRT. Materials & Methods: Thirteen (10 male and 3 female) HNC patients with post RT recurrence undergoing Cyberknife- SBRT were analyzed. Six patients had loco-regional recurrences, five had nodal while one each had distant nodal and 2nd primary HNC. All patients had post treatment follow up PET scan and in case of residual disease being a suspicion, had biopsy/FNAC to prove a recurrence. All patients received Cyberknife- SBRT alone with median dose per fraction 6 Gy (5-12 Gy) in 5 fractions (3-7 fractions). Pre Cyberknife median SUVmax, MTV and TLG were calculated using custom-designed software. Post Cyberknife at 10-12 weeks the values were recorded again. At the time of analysis the last follow up status, objective response and median values of PET parameters were used as cutoffs while assessing their prognostic potential through Chi-sqaure test, Cox regression analyses, ROC analysis and Pearson's correlation respectively.
Jun Deng
Yale University School of Medicine, USA
Title: Conscientious Medical Imaging: To Image or Not To Image
Biography:
Jun Deng received his PhD from University of Virginia in 1998 and completed his postdoctoral study at Stanford University School of Medicine in 2001. Currently, he is an Associate Professor of Therapeutic Radiology at Yale University School of Medicine, an American Board of Radiology certified medical physicist, a Fellow of Institute of Physics and a Fellow of American Association of Physicists in Medicine. At Yale, his research has been focused on medical imaging and its impact on cancer radiotherapy and public health. He has published 65 papers in peer-reviewed journals and been serving on editorial board of 14 international journals.
Abstract:
Medical imaging has revolutionized medical practices in the past hundred years, particularly in the radiotherapeutic management of cancers where anatomical and functional imaging procedures are applied routinely in the clinic worldwide for more precise tumor targeting and better soft tissue visualization. Yet, driven largely by technological advances as well as a fee-for-service healthcare model, the use of medical imaging modalities in cancer diagnosis and radiotherapy has increased dramatically in the past thirty years. Moreover, while modern cancer therapy is shifting toward individualized treatments based on patient-specific biology, the application of imaging procedures in cancer radiotherapy remains non-personalized: a ‘one-protocol-fits-all’ practice is often applied in the clinic worldwide. Essentially, the imaging protocols provided by manufacturers are uniformly applied without considering individual differences of patients being scanned. As such, radiation exposure to individuals from medical imaging nowadays has increased over 8 times since 1980, which may become a serious public health concern due to increased secondary cancer risk. Whether to image and how to image an individual patient is not only an ongoing technical issue but also becoming an ethical concern in the clinic. In meeting these challenges, personalized imaging protocol could assist clinicians in making the best use of medical imaging with their patients worldwide. This lecture will address the trend and issues of medical imaging in the US and around the world, and highlight approaches to apply medical imaging more conscientiously in the clinic to minimize radiation exposure and cancer risk, reduce medical costs and improve patient care.
- Therapeutic Nuclear Medicine
Patient Safety And Practice Management
Case Reports
Chair
Ken W D Ledingham
University Of Strathclyde, UK
Co-Chair
Nina Tuncel
Akdeniz University, Turkey
Session Introduction
Nina Tuncel
Title: The environmental dose measurements of high dose Iodine-131 treated thyroid cancer patients during hospitalization period.
Time : 11:45-12:05
Biography:
Nina Tunçel has completed her PhD at the age of 35 years from Istanbul University Oncology Institutes in medical radiation physics. She is the chief medical physic from 1999 to 2013 at Akdeniz University medical school radiation oncology department. She has her career as teaching staff for training Medical Physics at physics department of science faculty of Akdeniz University. She has published more than 30 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
Radioiodine mostly 131I is one of the oldest clinical radionuclide types which used widely spread in diagnosis and currently used in the treatment of both thyreotoxicosis and thyroid cancer. For most thyroid cancer treatments, large doses of 131I are administered to ablate residual thyroid tissue and functional metastases from thyroid cancer. Because of radiation safety considerations, application of large doses of 131I (greater than 800 MBq) requires patient hospitalization. For most patients, 35%-75% of the administered dose is excreted within the first 24 h after dose administration. This study presents the risks associated with high dose 131I treatment which is used in nuclear medicine. Patients were confined to two isolation rooms which were completely covered with lead. Each room is designed for two beds which are separated by lead separators. In the fixed activity protocol, a high activity 3.7-7.4 GBq (100-200 mCi) 131I was administered to12 patients. In general, the patients were isolated for a period of 2-3 days. The dose rates were measured at 1 m from the patient's thyroid and abdominal levels at different interval times. The clean and unclean room dose rate measurements were performed at each isolated room. These were 0.43+0.56 mRh-1 and 1.49+1.99 mRh-1 respectively. The maximum dose rate was measured at the toilet bowl. Moreover the pillow had 5.02+4.35 mRh-1 at the unclean room. Surrounding rooms and service door-corridor measurements were done with patients 7.06+10.33 ïRh-1 and 87.75+91.87 ïRh-1 respectively, and without patients 1.17+8.84 ïSvh-1 and 32.92+12,98 ïRh-1 respectively.
Bengul Gunalp
Title: The role of 18F-FDG-PET/CT in primary staging and restaging of breast cancer- The impact of findings on therapeutic management of patients
Time : 12:05-12:25
Biography:
Bengul Gunalp graduated from Hacettepe University Medical Faculty and completed nuclear medicine residency and received Associate Professor degree in Gulhane Military Academy and Faculty. She is still working in Gulhane Military Faculty Hospital, Department of Nuclear Medicine. She has published more than 35 papers in reputed journals.
Abstract:
Accurate staging of breast carcinoma is important for determining prognosis and planning treatment of patient. Although the clinical role of PET/CT for initial staging of breast carcinoma still controversial and the guidelines recommendations haven’t been changed yet, there is robust evidence on superiority of PET/CT to conventional imaging modalities for the detection of local and distant metastases. We discuss the importance of FDG PET/CT findings, especially axillary/extra-axillary nodal and distant metastases, in different categories of breast cancer and also performance of FDG PET/CT on restaging of patients with suspected disease recurrence.
Ken W D Ledingham
University of Strathclyde, UK
Title: Towards Laser Driven Hadron Cancer Radiotherapy: What Progress has been made?
Time : 12:55-13:15
Biography:
Ken W. D. Ledingham has completed his PhD at the age of 26 years from University of Glasgow and postdoctoral studies from University of Glasgow. He is the professor of Physics at University of Strathclyde. He is also recognized as William Penney Professor of Laser Nuclear Physics AWE plc.
Abstract:
It has been known for about sixty years that proton and heavy ion therapy is a very powerful radiation procedure for treating tumours. It has an innate ability to irradiate tumours with greater doses and spatial selectivity compared with electron and photon therapy and hence is a tissue sparing procedure. For more than twenty years powerful lasers have generated high energy beams of protons and heavy ions and hence it has been frequently speculated that lasers could be used as an alternative to RF accelerators to produce the particle beams necessary for cancer therapy. The present talk discusses the progress made towards laser driven hadron cancer therapy and what has still to be accomplished to realise its inherent enormous potential. In addition the use of lasers for cancer diagnostics will also be discussed
Maciej Budzanowski
Institute of Nuclear Physics Polish Academy of Sciences, Poland
Title: Occupational doses from ionizing radiation in nuclear medicine in Poland
Time : 13:15-13:35
Biography:
Maciej Budzanowski has completed his PhD in 2001 from Institute of Nuclear Physics Polish Academy of Sciences and Postdoctoral studies in 2012. He has started working as an Associate Professor in 2014. He has published more than 80 papers in JCR journals. He is a Scientific and Technical Director of the Institute of Nuclear Physics in Krakow, Poland.
Abstract:
Based on statistical data from the Laboratory of Individual and Environmental Dosimetry at the Institute of Nuclear Physics (IFJ) in Krakow nuclear medicine is the main source of occupational doses for medical staff in Poland. More than 1000 occupational persons working in nuclear medicine in Poland are wearing dosimeters from our dosimetry service. Only during industrial use of radiation the higher dose levels are recorded. According to statistic only about 65% individual doses for whole body and 55% individual doses for extremity ring dosimetry in nuclear medicine in Poland are on the level of the natural radiation background, while for conventional radiology this parameter reaches ca. 90%. In nuclear medicine staff could be divided into doctors, nurses, technicians. Also regarding to different procedures and applications of beta, gamma or positron emitters and place (laboratories of scintigraphy, isotope therapy or department of PET-CT) different dose levels are observed. The doses to medical staff in are measured in terms of the personal dose equivalent Hp(10) for whole body, Hp(0.07) for hands and Hp(3) for eyes. The doses are measured using thermolumiescent detectors placed in individual dosimetry badges. The study includes analysis of the doses for whole body, extremity ring and eye lens for medical staff (technical staff, nurses and doctors) exposed to radiation in nuclear medicine.
Abdulkarim Jamal
George Eliot Hospital/ Warwick Medical School UK
Title: A reduced dose of iodinated contrast medium can be used in CT pulmonary angiography without adversely affecting image quality.
Time : 13:35-13:55
Biography:
Dr. Jamal Abdulkarim finished his radiology training in university hospitals of Leicester UK and obtained the FRCR, Currently he is a consultant Radiologist at George Eliot Hospital, He has interest in research particularly in the field of intravenous iodinated contrast media where he had published and presented several papers over the last few years.
Abstract:
A good quality negative CT pulmonary angiogram (CTPA) can reliably exclude the presence of pulmonary emboli. In order to obtain good quality studies without unduly increasing the risk of contrast mediated nephrotoxicity one must aim to achieve optimal opacification of the pulmonary arteries using the minimum dose of contrast medium. This study aims to demonstrate that a smaller volume of a more concentrated contrast medium can be used to achieve a lower iodine dose without adversely affecting the quality of the images obtained. The CTPA images for 69 consecutive patients who received 100mL of Optiray 300 and 70 patients who received 75mL of Optiray 350 were reviewed. The degree of opacification in the pulmonary trunk and right and left main pulmonary arteries was measured in terms of Hounsfield Units (HU). Data regarding patient’s age, sex and weight was obtained from the hospital records. The groups did not differ significantly in terms of age, sex distribution or weight. Mean opacification in the pulmonary trunk was greater in the 75mL group (365 HU vs 331 HU) although this was not quite statistically significant (p=0.0546). This was despite the mean dose of iodine being lower in this group (26.2g vs 29.5, p=0.0001). There was no increase in the number of investigations considered non-diagnostic (defined as opacification of less than 250HU in pulmonary trunk) in the 75mL group. Use of the low dose technique, whilst conferring patient safety and cost saving benefits, is not associated with a deterioration in the pulmonary artery opacification of CTPA investigations or an increase in the number of suboptimal studies.
Mahmoud Elsherif
Children’s Cancer Hospital 57357, Egypt
Title: Initiation of Nuclear Pharmacy for Pediatric Oncology at Developing Count
Time : 13:55-14:15
Biography:
Mahmoud Elsherif has completed his studies of Pharmaceutical Sciences at Helwan University. He joined the Hospitals of the Egyptian Armed Forces for one year then joined Children’s Cancer Hospital 57357 as a clinical pharmacist since March 2014. He is a radiology and nuclear pharmacy specialist since Sep. 2015 and is a candidate of a training program for the use of radioactive materials and Radiation protection procedures, enrolled by The Egyptian Atomic Energy Authority (March 2016) .
Abstract:
Nuclear Pharmacy for Pediatric Oncology at Developing Countries: Radiopharmaceuticals are not treated with the same care and focus as chemotherapy and other supportive care medication. For expanding the pharmaceutical services at a pediatric oncology hospital to Nuclear Medicine Department, Basic Knowledge about radiopharmaceutical and their use should be present. Advanced information about commonly used radiopharmaceuticals at your hospital should be gained, including Preparation procedures, Dosing, Precautions, Drug-Drug interactions, Drug-Chemotherapy interactions, Drug-Food interactions and also Radiation protection issues. Standards of medication ordering process, order reviewing and verifying, dose preparation and dispensing should be applied to radiopharmaceuticals management and use. Nuclear Pharmacist should also has an active role at Patient Education Process. All these considerations should be taken in mind in a relation with the fact of dealing with a pediatric cancer patient
B Ravi Shankar
Gitam Institute of Medical Sciences, India
Title: Role of PET-CT in Modern Radiotherapy Planning Process of Solid Tumours
Time : 14:15-14:35
Biography:
Regarded as an eminent oncologist and having experience of visiting renowned cancer hospitals around the world, Dr. B. Ravi Shankar is presently working as a senior consultant and a clinical oncologist at Queen's NRI Institute of Oncology. Dr. B. Ravi Shankar is one of the most renowned Cancer Specialist (Oncologist) of Visakhapatnam.Gold medalist in MBBS and has a Post Graduate Masters Degree in Radiation Oncology.
Abstract:
Background: Positron emission tomography (PET) allows functional imaging of structures by virtue of their ability to metabolise glucose and concentrate specific molecules which are labelled with positron emitting Radionuclides. Integrated computed tomography (CT) and PET more accurately characterise the metabolically active tissue. Together PET-CT has shown more sensitivity and specificity for diagnosis, staging, response assessment, during follow up for early detection of recurrence and target volume delineation in radiotherapy planning. Aim: Aim of the study is to evaluate the technical challenges in the image registration of PET/CT and planning CT done in our hospital. Methods & Materials: Our study included the patients who have attended OPD and received Radiotherapy (RT) during year 2014-2015 for various sub-sites. We have patients received RT for head and neck region, abdominal region, thorax and pelvis. The PET/CT images of the respective sub-sites were fused with the planning CT images using rigid registration fusion software and the target was delineated using the fused images. Conclusion: Apart from few technical difficulties, rigid registration fusion algorithms of PET/CT images to the planning images after careful patient positioning helps the radiation oncologist in proper delineation of target volume.
Jawa Zabah Muhammad
National hospital Abuja, Nigeria
Title: Pneumocystis pneumonia mimicking lung metastasis in a HIV- positive patient with metastatic follicular thyroid cancer
Time : 14:35-14:55
Biography:
Dr. Jawa is a senior consultant in Nuclear Medicine and European board certified in Nuclear medicine. He has dual specialist qualifications in Nuclear Medicine and Radiology and received his training at the Stellenbosch University. He is a fellow of the college of Radiologist of Nigeria, fellow of the South African college of Nuclear Physicians, fellow of the European board of Nuclear Medicine. He has presented papers at various national and international conferences. In 2013, his research presentation received an award of distinction at the IMIC conference in Vienna, Austria. He is the Chief Editor of the MDCAN journal of medical sciences.
Abstract:
The lung is a common site for metastasis from follicular thyroid cancer. Pneumocystis pneumonia is a fungal lung infection commonly seen in HIV-positive patients. The clinical presentation and radiological features of pneumocystis pneumonia and lung metastasis from follicular thyroid cancer are very similar and often indistinguishable, however, their management differs. Pneumocystis pneumonia is treated with a simple course of antibiotics, while lung metastasis from follicular thyroid cancer requires high dose therapy with radioactive I-131. In patients with metastatic follicular thyroid cancer that are HIV-positive presenting with lung infiltrations, it is important to make a proper diagnosis in order to institute appropriate and prompt treatment. We present an unusual case of a pneumocystis pneumonia mimicking lung metastasis in a HIV-positive patient with stage-IV follicular thyroid cancer. To our knowledge, this is the first documented case of a HIV-positive patient with metastatic follicular thyroid cancer presenting with pneumocystis pneumonia mimicking lung metastasis. The rarity of this case and the importance of creating awareness among clinician of the existence of this disease are emphasized.
- Special Session On Laser Driven Proton Therapy
Session Introduction
Ken W D Ledingham
University of Strathclyde, UK
Title: Towards Laser Driven Hadron Cancer Radiotherapy: What Progress has been made?
Time : 15:30-16:00
Biography:
Ken W. D. Ledingham has completed his PhD at the age of 26 years from University of Glasgow and postdoctoral studies from University of Glasgow. He is the professor of Physics at University of Strathclyde. He is also recognized as William Penney Professor of Laser Nuclear Physics AWE plc.
Abstract:
It has been known for about sixty years that proton and heavy ion therapy is a very powerful radiation procedure for treating tumours. It has an innate ability to irradiate tumours with greater doses and spatial selectivity compared with electron and photon therapy and hence is a tissue sparing procedure. For more than twenty years powerful lasers have generated high energy beams of protons and heavy ions and hence it has been frequently speculated that lasers could be used as an alternative to RF accelerators to produce the particle beams necessary for cancer therapy. The present talk discusses the progress made towards laser driven hadron cancer therapy and what has still to be accomplished to realise its inherent enormous potential. In addition the use of lasers for cancer diagnostics will also be discussed.
Satyabrata Kar
Queen’s University of Belfast,UK
Title: Laser driven ion acceleration towards medical applications: current status of the A-SAIL project
Time : 16:00-16:30
Biography:
S. Kar obtained his Ph.D. in 2005 from Queens University Belfast and is currently employed as a lecturer at QUB since 2013. He holds a Career Acceleration Fellowship from EPSRC, UK (2012-2016) and an honorary joint appointment with Central Laser Facility of STFC, UK (2017-2018). His track record includes 96 publications including 1 Nature Physics, 2 Nature communications and 19 Physical Review Letters (h-index 23 and total citation-2200).
Abstract:
A-SAIL (Advanced Strategies for Accelerating Ions with Lasers) is a UK-wide consortium aimed to the development of ion acceleration towards medical applications. The main objective of the project, which is funded by an EPSRC Programme Grant (2013-2019), is to assess the potential of the laser-driven ion approach as an alternative source for cancer therapy, by demonstrating controlled, all-optical acceleration of dense bunches of protons and other low-Z ion species in the 60- 300 MeV/nucleon range of interest for therapy of deep-seated cancer. Radiation Pressure Acceleration approaches are highly promising for this purpose and currently pursued by the consortium at UK and international facilities. A novel scheme of guided post-acceleration of the laser driven ion beams was recently developed within the team which brings the all-optical scheme one step closer to the realization of compact beam lines. Achieving this objective requires a coordinated effort involving development of new target media, understanding and controlling the physical processes of the relevant interaction regimes, and developing innovative solutions to a number of technical bottlenecks. The ultrashort duration is a distinctive property of laser-driven ion beams, as ions are emitted in bursts of picosecond duration at the source and their therapeutic use may result in dose rates up to many orders of magnitude higher than normally used in therapy. In parallel to the source development, the consortium is therefore pursuing a programme of investigations of the dynamics of cellular response to ion irradiation at these unprecedented dose rates. The talk will discuss the aim and structure of the project, will review the progress so far and discuss the next developments and project outlook.
Elke Beyreuther
Helmholtz-Zentrum Dresden – Rossendorf, Germany
Title: Radiobiological Characterization of Laser Driven Particles
Time : 16:30-17:00
Biography:
Elke Beyreuther has completed her PhD at the age of 28 years and postdoctoral studies from Helmholtz-Zentrum Dresden. She has published more than 15 papers in reputed journals.
Abstract:
The long-term aim of developing laser based particle acceleration towards clinical application requires not only substantial technological progress, but also new technical solutions for dose delivery and quality assurance as well as comprehensive research on the radiobiological consequences of ultra-short radiation pulses with high pulse dose. During the last years the laser driven technology was developed at such a rate that cell samples and small animals can be irradiated. Within the joint research project “onCOOPtics” extensive in vitro studies with several human tumor and normal tissue cells were already performed revealing comparable radiobiological effects of laser driven and conventional electron and proton beams1,2. Using the same cell lines, these results were substantiated comparing the radiobiological response to ultra-short pulsed electron bunches (pulse dose rates of ≤1012 Gy/min) and continuous electron delivery at the radiation source ELBE3. In a second translational step, in vivo experiments were established. Although the experiments were motivated by future proton trials, first attempts were performed with electrons at the laser system JETI4, since the delivery of prescribed homogeneous doses to a 3D target volume is easier for electrons than for protons. A full scale animal experiment was realized for the HNSCC FaDu grown on nude mice ear. The radiation induced tumor growth delay was determined and compared to those obtained after similar treatment at a conventional clinical LINAC. Again, no significant difference in the radiation response to both radiation qualities was revealed, whereas the successful performance of such a comprehensive experiment campaign underlines the stability and reproducibility of all implemented methods and setup components5. During this experiment campaign the changing tumour take rate and a high rate of secondary tumours were identified as limitations of the model that have to be improved before proton experiments and tumour control studies can be performed. In order to optimize the model Matrigel as medium for tumor cell injection and the glioblastoma cell line LN229 as interesting entity for proton treatment were introduced. Results of this optimization process and the status of the experiments with laser driven protons at the laser system DRACO will be presented. The work was supported by the German Government, Federal Ministry of Education and Research, grant nos. 03ZIK445 and 03Z1N511.