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Table of Contents
Intro
Editor biography
Yu Kuang
List of contributors
Chapter 1 Overview of image-guided radiation therapy
1.1 Evolution of IGRT
1.2 2D imaging technology
1.2.1 MV
1.2.2 kV
1.2.3 Ultrasound
1.2.4 MRI
1.3 3D imaging technology
1.3.1 MV-CBCT
1.3.2 kV-CBCT
1.3.3 CT-on-rails
1.3.4 MRI
References
Chapter 2 History and future of image-guided radiation therapy in abdominal cancer
2.1 Introduction
2.2 The history
2.3 Motion management
2.3.1 4DCT, compression, gating, and breath hold
2.3.2 Interval tracking
2.4 Newer and upcoming image-guidance techniques
2.4.1 MRI Linac
2.4.2 4DMRI
2.4.3 Proton radiography and CT
2.4.4 Surface imaging in abdominal cancer treatment
2.4.5 Interplay effect evaluation in patients with abdominal cancer treated by IMPT
References
Chapter 3 Imaging simulation for abdominal cancer image-guided radiation therapy
3.1 Introduction
3.2 Motion of abdominal tumors
3.2.1 Use of fiducial or internal markers
3.3 Respiratory monitoring systems
3.3.1 Respiratory belts
3.3.2 Optical tracking systems
3.3.3 Surface guided imaging systems
3.3.4 BrainLab ExacTrac system
3.4 Respiratory motion management
3.4.1 Breath hold
3.4.2 Abdominal compression and immobilization devices
3.5 Imaging technologies
3.5.1 Breath-hold CT
3.5.2 4DCT imaging
3.5.3 4D magnetic resonance imaging
3.5.4 4D positron emission tomography-CT
3.6 Simulation strategies and clinical workflows
3.7 Clinical workflows
3.7.1 Example 1. Liver SBRT with SDX BH
3.7.2 Example 2. Pancreas SBRT with 4DCT
3.7.3 Example 3. Liver SBRT with ABC BH
3.8 Simulation setup and immobilization protocols
3.9 Conclusion
References
Chapter 4 Treatment planning for abdominal cancer
4.1 Introduction.
4.2 Image registration for treatment planning
4.2.1 CT and MRI fusion
4.2.2 CT and PET/CT fusion
4.2.3 CT and CT fusion
4.3 Target volume and OAR definition
4.3.1 Esophageal cancer
4.3.2 Gastric cancer
4.3.3 Pancreatic cancer
4.3.4 Hepatobiliary cancer
4.3.5 Metastatic liver cancer
4.3.6 Rectal and anal cancer
4.3.7 OARs in abdomen
4.3.8 Auto-segmentation of OARs in abdomen
4.4 Treatment planning techniques
4.4.1 Three-dimensional conformal radiation therapy
4.4.2 Intensity-modulated radiation therapy
4.4.3 Stereotactic body radiation therapy
4.4.4 Assisting structures for CBCT to CT alignment
4.4.5 Use of spacers in abdominal radiotherapy
4.4.6 Auto-planning for abdominal tumors
4.4.7 Re-treatment considerations
4.4.8 Proton therapy for abdominal tumors
4.5 Conclusion
References
Chapter 5 Treatment delivery and verification
5.1 Personnel requirements for a stereotactic body radiation therapy program
5.1.1 Radiation oncologist
5.1.2 Medical physicist
5.1.3 Medical dosimetrist
5.1.4 Radiation therapist
5.1.5 Others
5.2 Treatment machine
5.2.1 Isocentric delivery
5.2.2 Non-isocentric delivery
5.3 Treatment planning system
5.3.1 TPS commissioning
5.3.2 Verification
5.4 Imaging verification
5.4.1 Pre-treatment verification
5.4.2 Intrafractional monitoring
5.5 Delivery verification
5.5.1 Commissioning
5.5.2 Patient-specific delivery verification
References
Chapter 6 Quality assurance of image-guided radiation therapy
6.1 Introduction
6.2 Imaging technology in simulation
6.2.1 Motion mitigation
6.2.2 Motion assessment
6.3 Imaging technology in treatment planning
6.3.1 Target delineation and definition
6.3.2 Image registration
6.3.3 Treatment planning system.
6.4 Imaging technology in treatment delivery
6.4.1 Radiographic system
6.4.2 Non-radiographic system
6.4.3 Hybrid system
6.5 New evolving technologies
6.5.1 MRI-based radiation system
6.5.2 IGRT in proton treatment
References
Chapter 7 Linear accelerator image-guided radiation therapy for abdominal cancers
7.1 Introduction
7.1.1 History of abdominal cancer treatment with Linacs
7.1.2 Current market landscape of modern Linacs
7.2 Mainstream modern Linacs
7.2.1 Varian TrueBeam Linacs
7.3 Common forms of abdominal cancers treated with Linacs
7.3.1 Gastroesophageal junction and stomach cancers
7.3.2 Liver cancer
7.4 The future of Linacs in abdominal cancer treatment
References
Chapter 8 Abdominal radiotherapy with tomotherapy
8.1 System overview
8.2 On-board imaging
8.3 Treatment procedures for tomotherapy
8.3.1 Simulation
8.3.2 Treatment planning
8.3.3 Plan QA
8.3.4 Imaging guidance
8.3.5 Radiation delivery
8.3.6 Adaptive radiotherapy
8.3.7 Motion management in abdominal tomotherapy
8.4 Clinical indications of abdominal tomotherapy
8.4.1 Liver cancer
8.4.2 Pancreatic cancer
8.4.3 TBI, TMI and TMLI
References
Chapter 9 CyberKnife® in abdominal stereotactic body radiosurgery
9.1 Introduction
9.2 CyberKnife® system overview
9.3 Clinical indication of CyberKnife® in abdominal SBRT
9.4 Treatment workflow for abdominal SBRT on CyberKnife®
9.4.1 Fiducial marker insertion
9.4.2 Simulation and target delineation
9.4.3 Treatment planning
9.4.4 Treatment delivery
9.5 Quality control and treatment safety
9.6 Summary
References
Chapter 10 Varian Halcyon™
10.1 Overview of Halcyon™
10.2 Acceptance testing and commissioning of the Halcyon™ system
10.3 Clinical workflow
10.4 Clinical applications
References.
Chapter 11 VenusX™
11.1 Introduction
11.2 VenusX™ technical characteristics
11.2.1 Triple-layer MLC system
11.2.2 Built-in 3D optical surface imaging system
11.2.3 On-board x-ray imaging systems
11.3 Abdominal cancers treated with VenusX™
11.3.1 Metastasis of liver cancer to the iliac bone and T-spine
11.4 The competitive market landscape for VenusX™
References
Chapter 12 Imaging-guided proton therapy for gastrointestinal tumors
12.1 Introduction to proton beam therapy
12.1.1 Advantages
12.1.2 Disadvantages
12.2 Clinical indications of proton therapy in managing gastrointestinal cancers
12.2.1 Esophageal cancer
12.2.2 Liver cancer
12.2.3 Pancreatic cancer
12.3 Imaging and motion management
12.3.1 Imaging for simulation
12.3.2 Imaging for treatment setup
12.3.3 Imaging for plan verification and adaption
12.4 Treatment planning and delivery
12.4.1 Passive scattering
12.4.2 Pencil beam scanning
References
Chapter 13 Application of image-guided radiation therapy for abdominal stereotactic body radiotherapy
13.1 Introduction
13.2 Abdominal SBRT simulation and treatment planning
13.2.1 Immobilization/patient position
13.2.2 Four-dimensional CT/ITV
13.2.3 PRV for OARs
13.3 IGRT for SBRT (target localization)
13.3.1 CTOR
13.3.2 CBCT
13.3.3 Ultrasound
13.3.4 Body GPS
13.3.5 Implanted fiducials
13.3.6 MRI
13.4 Intrafractional motion management/monitoring
13.4.1 Direct target motion monitoring
13.4.2 Surface guidance
13.4.3 Gated treatment delivery
13.4.4 Breath hold for SBRT
13.5 Quality assurance of IGRT for SBRT
References
Chapter 14 Uncertainties of image-guided radiotherapy for abdominal cancer radiotherapy
14.1 Uncertainty overview
14.1.1 Random and systematic errors and uncertainties.
14.1.2 IGRT to reduce geometric uncertainty
14.1.3 Uncertainty in abdominal IGRT
14.2 Uncertainty in image acquisition
14.2.1 CBCT
14.2.2 US
14.2.3 MRI
14.3 Uncertainty in image matching
14.4 Uncertainty in couch motion
14.5 Uncertainty due to intra-fractional motion
14.5.1 Motion and uncertainties in free breathing-based treatment
14.5.2 Motion and uncertainties in breath hold-based treatment
14.5.3 Uncertainties from peristaltic motion, gradual organ filling, etc.
14.6 Margin recipe
14.6.1 The margin concept
14.6.2 Margin recipe
14.7 Final remarks and conclusion
References
Chapter 15 Advances in simulation imaging for abdominal radiotherapy
15.1 Introduction
15.2 Principles of advanced imaging systems for radiotherapy simulation
15.2.1 Principle of dual-energy CT and multi-energy CT
15.2.2 Principle of MRI simulators
15.2.3 Principle of digital PET/CT
15.3 Recent advances in CT simulation technology
15.3.1 Metal artifact reduction
15.3.2 Iterative and artificial intelligence-based image reconstruction
15.3.3 Iodine contrast enhancement and virtual non-contrast imaging
15.3.4 Direct electron density generation
15.3.5 Proton stopping-power imaging
15.4 Recent advances in MR simulation technology
15.4.1 Imaging in treatment positions
15.4.2 4D MRI
15.4.3 Compressed sensing MRI
15.4.4 MR-based synthetic CT
15.4.5 Automatic segmentation
15.5 Recent advances in PET imaging for guiding radiotherapy
15.5.1 Correcting respiratory motion
15.5.2 On-board PET imaging for biology-guided radiotherapy
15.6 Clinical applications of advanced imaging for abdominal radiotherapy
15.7 Conclusion and outlook
References
Chapter 16 Advances in treatment planning
16.1 Automatic planning
16.1.1 Data-driven and knowledge-based planning.
16.1.2 Template-based planning.
Editor biography
Yu Kuang
List of contributors
Chapter 1 Overview of image-guided radiation therapy
1.1 Evolution of IGRT
1.2 2D imaging technology
1.2.1 MV
1.2.2 kV
1.2.3 Ultrasound
1.2.4 MRI
1.3 3D imaging technology
1.3.1 MV-CBCT
1.3.2 kV-CBCT
1.3.3 CT-on-rails
1.3.4 MRI
References
Chapter 2 History and future of image-guided radiation therapy in abdominal cancer
2.1 Introduction
2.2 The history
2.3 Motion management
2.3.1 4DCT, compression, gating, and breath hold
2.3.2 Interval tracking
2.4 Newer and upcoming image-guidance techniques
2.4.1 MRI Linac
2.4.2 4DMRI
2.4.3 Proton radiography and CT
2.4.4 Surface imaging in abdominal cancer treatment
2.4.5 Interplay effect evaluation in patients with abdominal cancer treated by IMPT
References
Chapter 3 Imaging simulation for abdominal cancer image-guided radiation therapy
3.1 Introduction
3.2 Motion of abdominal tumors
3.2.1 Use of fiducial or internal markers
3.3 Respiratory monitoring systems
3.3.1 Respiratory belts
3.3.2 Optical tracking systems
3.3.3 Surface guided imaging systems
3.3.4 BrainLab ExacTrac system
3.4 Respiratory motion management
3.4.1 Breath hold
3.4.2 Abdominal compression and immobilization devices
3.5 Imaging technologies
3.5.1 Breath-hold CT
3.5.2 4DCT imaging
3.5.3 4D magnetic resonance imaging
3.5.4 4D positron emission tomography-CT
3.6 Simulation strategies and clinical workflows
3.7 Clinical workflows
3.7.1 Example 1. Liver SBRT with SDX BH
3.7.2 Example 2. Pancreas SBRT with 4DCT
3.7.3 Example 3. Liver SBRT with ABC BH
3.8 Simulation setup and immobilization protocols
3.9 Conclusion
References
Chapter 4 Treatment planning for abdominal cancer
4.1 Introduction.
4.2 Image registration for treatment planning
4.2.1 CT and MRI fusion
4.2.2 CT and PET/CT fusion
4.2.3 CT and CT fusion
4.3 Target volume and OAR definition
4.3.1 Esophageal cancer
4.3.2 Gastric cancer
4.3.3 Pancreatic cancer
4.3.4 Hepatobiliary cancer
4.3.5 Metastatic liver cancer
4.3.6 Rectal and anal cancer
4.3.7 OARs in abdomen
4.3.8 Auto-segmentation of OARs in abdomen
4.4 Treatment planning techniques
4.4.1 Three-dimensional conformal radiation therapy
4.4.2 Intensity-modulated radiation therapy
4.4.3 Stereotactic body radiation therapy
4.4.4 Assisting structures for CBCT to CT alignment
4.4.5 Use of spacers in abdominal radiotherapy
4.4.6 Auto-planning for abdominal tumors
4.4.7 Re-treatment considerations
4.4.8 Proton therapy for abdominal tumors
4.5 Conclusion
References
Chapter 5 Treatment delivery and verification
5.1 Personnel requirements for a stereotactic body radiation therapy program
5.1.1 Radiation oncologist
5.1.2 Medical physicist
5.1.3 Medical dosimetrist
5.1.4 Radiation therapist
5.1.5 Others
5.2 Treatment machine
5.2.1 Isocentric delivery
5.2.2 Non-isocentric delivery
5.3 Treatment planning system
5.3.1 TPS commissioning
5.3.2 Verification
5.4 Imaging verification
5.4.1 Pre-treatment verification
5.4.2 Intrafractional monitoring
5.5 Delivery verification
5.5.1 Commissioning
5.5.2 Patient-specific delivery verification
References
Chapter 6 Quality assurance of image-guided radiation therapy
6.1 Introduction
6.2 Imaging technology in simulation
6.2.1 Motion mitigation
6.2.2 Motion assessment
6.3 Imaging technology in treatment planning
6.3.1 Target delineation and definition
6.3.2 Image registration
6.3.3 Treatment planning system.
6.4 Imaging technology in treatment delivery
6.4.1 Radiographic system
6.4.2 Non-radiographic system
6.4.3 Hybrid system
6.5 New evolving technologies
6.5.1 MRI-based radiation system
6.5.2 IGRT in proton treatment
References
Chapter 7 Linear accelerator image-guided radiation therapy for abdominal cancers
7.1 Introduction
7.1.1 History of abdominal cancer treatment with Linacs
7.1.2 Current market landscape of modern Linacs
7.2 Mainstream modern Linacs
7.2.1 Varian TrueBeam Linacs
7.3 Common forms of abdominal cancers treated with Linacs
7.3.1 Gastroesophageal junction and stomach cancers
7.3.2 Liver cancer
7.4 The future of Linacs in abdominal cancer treatment
References
Chapter 8 Abdominal radiotherapy with tomotherapy
8.1 System overview
8.2 On-board imaging
8.3 Treatment procedures for tomotherapy
8.3.1 Simulation
8.3.2 Treatment planning
8.3.3 Plan QA
8.3.4 Imaging guidance
8.3.5 Radiation delivery
8.3.6 Adaptive radiotherapy
8.3.7 Motion management in abdominal tomotherapy
8.4 Clinical indications of abdominal tomotherapy
8.4.1 Liver cancer
8.4.2 Pancreatic cancer
8.4.3 TBI, TMI and TMLI
References
Chapter 9 CyberKnife® in abdominal stereotactic body radiosurgery
9.1 Introduction
9.2 CyberKnife® system overview
9.3 Clinical indication of CyberKnife® in abdominal SBRT
9.4 Treatment workflow for abdominal SBRT on CyberKnife®
9.4.1 Fiducial marker insertion
9.4.2 Simulation and target delineation
9.4.3 Treatment planning
9.4.4 Treatment delivery
9.5 Quality control and treatment safety
9.6 Summary
References
Chapter 10 Varian Halcyon™
10.1 Overview of Halcyon™
10.2 Acceptance testing and commissioning of the Halcyon™ system
10.3 Clinical workflow
10.4 Clinical applications
References.
Chapter 11 VenusX™
11.1 Introduction
11.2 VenusX™ technical characteristics
11.2.1 Triple-layer MLC system
11.2.2 Built-in 3D optical surface imaging system
11.2.3 On-board x-ray imaging systems
11.3 Abdominal cancers treated with VenusX™
11.3.1 Metastasis of liver cancer to the iliac bone and T-spine
11.4 The competitive market landscape for VenusX™
References
Chapter 12 Imaging-guided proton therapy for gastrointestinal tumors
12.1 Introduction to proton beam therapy
12.1.1 Advantages
12.1.2 Disadvantages
12.2 Clinical indications of proton therapy in managing gastrointestinal cancers
12.2.1 Esophageal cancer
12.2.2 Liver cancer
12.2.3 Pancreatic cancer
12.3 Imaging and motion management
12.3.1 Imaging for simulation
12.3.2 Imaging for treatment setup
12.3.3 Imaging for plan verification and adaption
12.4 Treatment planning and delivery
12.4.1 Passive scattering
12.4.2 Pencil beam scanning
References
Chapter 13 Application of image-guided radiation therapy for abdominal stereotactic body radiotherapy
13.1 Introduction
13.2 Abdominal SBRT simulation and treatment planning
13.2.1 Immobilization/patient position
13.2.2 Four-dimensional CT/ITV
13.2.3 PRV for OARs
13.3 IGRT for SBRT (target localization)
13.3.1 CTOR
13.3.2 CBCT
13.3.3 Ultrasound
13.3.4 Body GPS
13.3.5 Implanted fiducials
13.3.6 MRI
13.4 Intrafractional motion management/monitoring
13.4.1 Direct target motion monitoring
13.4.2 Surface guidance
13.4.3 Gated treatment delivery
13.4.4 Breath hold for SBRT
13.5 Quality assurance of IGRT for SBRT
References
Chapter 14 Uncertainties of image-guided radiotherapy for abdominal cancer radiotherapy
14.1 Uncertainty overview
14.1.1 Random and systematic errors and uncertainties.
14.1.2 IGRT to reduce geometric uncertainty
14.1.3 Uncertainty in abdominal IGRT
14.2 Uncertainty in image acquisition
14.2.1 CBCT
14.2.2 US
14.2.3 MRI
14.3 Uncertainty in image matching
14.4 Uncertainty in couch motion
14.5 Uncertainty due to intra-fractional motion
14.5.1 Motion and uncertainties in free breathing-based treatment
14.5.2 Motion and uncertainties in breath hold-based treatment
14.5.3 Uncertainties from peristaltic motion, gradual organ filling, etc.
14.6 Margin recipe
14.6.1 The margin concept
14.6.2 Margin recipe
14.7 Final remarks and conclusion
References
Chapter 15 Advances in simulation imaging for abdominal radiotherapy
15.1 Introduction
15.2 Principles of advanced imaging systems for radiotherapy simulation
15.2.1 Principle of dual-energy CT and multi-energy CT
15.2.2 Principle of MRI simulators
15.2.3 Principle of digital PET/CT
15.3 Recent advances in CT simulation technology
15.3.1 Metal artifact reduction
15.3.2 Iterative and artificial intelligence-based image reconstruction
15.3.3 Iodine contrast enhancement and virtual non-contrast imaging
15.3.4 Direct electron density generation
15.3.5 Proton stopping-power imaging
15.4 Recent advances in MR simulation technology
15.4.1 Imaging in treatment positions
15.4.2 4D MRI
15.4.3 Compressed sensing MRI
15.4.4 MR-based synthetic CT
15.4.5 Automatic segmentation
15.5 Recent advances in PET imaging for guiding radiotherapy
15.5.1 Correcting respiratory motion
15.5.2 On-board PET imaging for biology-guided radiotherapy
15.6 Clinical applications of advanced imaging for abdominal radiotherapy
15.7 Conclusion and outlook
References
Chapter 16 Advances in treatment planning
16.1 Automatic planning
16.1.1 Data-driven and knowledge-based planning.
16.1.2 Template-based planning.