Vai trò cộng hưởng từ trong lập kế hoạch xạ trị bệnh lý u não tại Bệnh viện Trung ương Huế

Author(s):  
Nguyen Tuong Pham

Mục tiêu: Đánh giá vai trò của cộng hưởng từ (Magnetic Resonance Imaging - MRI) trong mô phỏng lập kế hoạch xạ trị cho bệnh lý u não tại Bệnh viện Trung Ương Huế, đánh giá sự tối ưu, lợi ích của vai trò MRI, các giá trị liều lượng mà u và các cơ quan lành nhận được. Đối tượng và phương pháp: Nghiên cứu 38 bệnh nhân u não được chỉ định xạ trị có chụp cắt lớp vi tính (Computed Tomography-CT) 16 lát cắt Philips và cộng hưởng từ(MRI) 1.5 Tesla Philips tại Trung tâm Ung bướu - Bệnh viện Trung Ương Huế từ tháng 01/2018-07/2019. Lập kế hoạch xạ trị gia tốc bằng phần mềm XiO 5.10 đối với kỹ thuật xạ trị 3D-CRT (Three Dimensional - Conformal Radiation Therapy), và phần mềm Monaco 5.11 đối với các kỹ thuật xạ trị hình cung điều biến liều theo thể tích khối u (Volumetric Modulated Arc Therapy-VMAT), Xạ phẫu gồm SRS và SRT (Stereotactic radiosurgery, Stereotactic radiotherapy). Chụp Cone beam CT kiểm tra trước khi điều trị bởi thiết bị hướng dẫn hình ảnh XVI. Điều trị trên máy gia tốc AXESSE (Elekta). Kết quả và bàn luận: 38 bệnh nhân có khối u ở não (u nguyên phát và u di căn) MRI giúp phát hiện thêm các tổn thương 39,5% và 55,3% phát hiện rõ ranh giới u, tất cả những thương tổn u mà CT rất khó phân biệt với mô lành và tổn thương phù não. Kết luận: Ứng dụng hình ảnh MRI trong mô phỏng lập kế hoạch xạ trị gia tốc cho các bệnh lý u não giúp phát hiện và xác định kích thước, thể tích u tốt hơn so với CT mô phỏng. Từ đó sẽ làm thay đổi kế hoạch xạ trị đem lại kết quả điều trị tốt hơn và cải thiện chất lượng sống tốt hơn cho bệnh nhân

2021 ◽  
Author(s):  
Michael H. Wang ◽  
Anthony Kim ◽  
Mark Ruschin ◽  
Hendrick Tan ◽  
Hany Soliman ◽  
...  

Abstract Background Magnetic Resonance Imaging (MRI)-Linear Accelerator (MR-Linac) radiotherapy requires special consideration for secondary electron interactions within the magnetic field, which can alter dose deposition at air-tissue interfaces. Methods Thirty-seven consecutive glioma patients treated during their radiotherapy course with at least one fraction delivered on MR-Linac or Cone Beam CT (CBCT)-guided Linac, were analyzed. Treatment planning for both systems were completed prior to radiotherapy initiation and approved for clinical delivery using commercial treatment planning systems (TPS): a Monte Carlo calculation-based or convolution calculation-based TPS for MR-Linac or CBCT-Linac, respectively. Dosimetric parameters for planning target volume (PTV), organs-at-risk (OARs), and air-tissue interface were compared. In vivo skin dose during a single fraction of MR-Linac and CBCT-Linac treatment was measured using an Optically Stimulated Luminescent Dosimeter (OSLD) and correlated with TPS skin dose. Results Monte Carlo-based MR-Linac plans and convolution-based CBCT-Linac plans exhibited minimal differences in PTV and OAR parameters. However, MR-Linac plans had greater doses within tissues surrounding air cavities (1.52 Gy higher mean Dmean, p < 0.0001) and skin (1.10 Gy higher mean Dmean, p < 0.0001). In vivo OSLD skin readings were 14.5% greater for MR-Linac treatments (p = 0.0027), and were more accurately predicted by Monte Carlo-based calculation (ρ = 0.95, p < 0.0001) vs. convolution-based (ρ = 0.80, p = 0.0096). Conclusions The magnetic field’s dosimetric impact was minimal for PTV and OARs in glioma as compared to standard CBCT-Linac treatment plans. However, skin doses were significantly greater with the MR-Linac and correlated with in vivo measurements. Future MR-Linac planning processes are being designed to account for skin dosimetry and treatment delivery.


2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Kenshiro Shiraishi ◽  
Masahiko Futaguchi ◽  
Akihiro Haga ◽  
Akira Sakumi ◽  
Katsutake Sasaki ◽  
...  

Time-averaged intreatment prostate localization errors were calculated, for the first time, by three-dimensional prostate image cross-correlation between planning CT and intrafraction kilovoltage cone-beam CT (CBCT) during volumetric modulated arc therapy (VMAT). The intrafraction CBCT volume was reconstructed by an inhouse software after acquiring cine-mode projection images during VMAT delivery. Subsequently, the margin between a clinical target volume and a planning target volume (PTV) was obtained by applying the van Herk and variant formulas using the calculated localization errors. The resulting PTV margins were approximately 2 mm in lateral direction and 4 mm in craniocaudal and anteroposterior directions, which are consistent with the margin prescription employed in our facility.


2017 ◽  
Vol 14 (3) ◽  
pp. 69-74
Author(s):  
Elżbieta Czajka

Wykorzystanie rezonansu magnetycznego (ang. magnetic resonance imaging, MRI) w radioterapii jest często poruszanym zagadnieniem w ostatnich latach. Osobny blok wystąpień poświęcony temu tematowi pojawił się również w części programu dedykowanej elektroradiologom na 3rd ESTRO FORUM. Podczas wystąpień omówiono trzy obszary, w których możliwe jest wykorzystanie rezonansu magnetycznego w radioterapii, tj. 1) akwizycja obrazów niezbędnych do planowania leczenia 2) planowanie leczenia w systemie komputerowym w oparciu o obrazowanie rezonansem magnetycznym oraz 3) realizacja leczenia na aparacie terapeutycznym. Zastąpienie w łańcuchu terapeutycznym przede wszystkim tomografii komputerowej (ang. computed tomography, CT) ale również w dalszym etapie innych metod obrazowania, wykorzystujących promieniowanie rentgenowskie np. CBCT (ang. cone beam CT), MVCT (ang. mega voltage CT) lub kVCT (ang. kilo voltage CT) rezonansem magnetycznym, wprowadza do radioterapii tzw. „full-MR workflow”, czyli koncepcję radioterapii opartej wyłącznie o obrazowanie rezonansem magnetycznym. Analiza wybranych doniesień ma na celu przybliżenie czytelnikowi tego zagadnienia, omówienie jego zalet i potencjalnych ograniczeń, ale również umiejscowienie elektroradiologia w całym procesie radioterapeutycznym opartym o rezonans magnetyczny.


2021 ◽  
Author(s):  
Michael H. Wang ◽  
Anthony Kim ◽  
Mark Ruschin ◽  
Hendrick Tan ◽  
Hany Soliman ◽  
...  

Abstract Magnetic Resonance Imaging (MRI)-Linear Accelerator (MR-Linac) radiotherapy is an innovative technology that requires special consideration for secondary electron interactions within the magnetic field, which can alter dose deposition at air-tissue interfaces. Thirty-seven consecutive glioma patients had treatment planning completed and approved prior to radiotherapy initiation using commercial treatment planning systems (TPS): a Monte Carlo-based or convolution-based TPS for MR-Linac or Cone Beam CT (CBCT)-guided Linac, respectively. In vivo skin dose was measured using an Optically Stimulated Luminescent Dosimeter (OSLD) and correlated with TPS skin dose. We found that Monte Carlo-based MR-Linac plans and convolution-based CBCT-Linac plans had similar dosimetric parameters for target volumes and organs-at-risk. However, MR-Linac plans had 1.52 Gy higher mean dose to air cavities (p<0.0001) and 1.10 Gy higher mean dose to skin (p<0.0001). In vivo skin dose was 14.5% greater for MR-Linac (p=0.0027), and were more accurately predicted by Monte Carlo-based calculation (ρ=0.95, p<0.0001) vs. convolution-based (ρ=0.80, p=0.0096). This is the first prospective dosimetric comparison of glioma patients clinically treated on both MR-Linac and CBCT-guided Linac. Skin doses were significantly greater with MR-Linac and correlated with in vivo measurements. Future MR-Linac planning processes are being designed to account for skin dosimetry and treatment delivery.


Author(s):  
Luke Cascarini ◽  
Clare Schilling ◽  
Ben Gurney ◽  
Peter Brennan

This chapter discusses radiology in oral and maxillofacial surgery, including Guidelines for dental radiology, Dental radiography, Panoramic radiography, Ultrasonography, Computed Tomography (CT), Cone beam CT, Magnetic Resonance Imaging (MRI), Nuclear medicine imaging and Sialography


2021 ◽  
Vol 10 (23) ◽  
pp. 5546
Author(s):  
Franz Schwindling ◽  
Sophia Boehm ◽  
Christopher Herpel ◽  
Dorothea Kronsteiner ◽  
Lorenz Vogel ◽  
...  

This study aimed to investigate the geometric reproducibility of three-dimensional (3D) implant planning based on magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT). Four raters used a backward-planning approach based on CBCT imaging and standard software to position 41 implants in 27 patients. Implant planning was repeated, and the first and second plans were analyzed for geometric differences regarding implant tip, entry-level, and axis. The procedure was then repeated for MRI data of the same patients. Thus, 656 implant plans were available for analysis of intra-rater reproducibility. For both imaging modalities, the second-round 3D implant plans were re-evaluated regarding inter-rater reproducibility. Differences between the modalities were analyzed using paired t-tests. Intra- and inter-rater reproducibility were higher for CBCT than for MRI. Regarding intra-rater deviations, mean values for MRI were 1.7 ± 1.1 mm/1.5 ± 1.1 mm/5.5 ± 4.2° at implant tip/entry-level/axis. For CBCT, corresponding values were 1.3 ± 0.8 mm/1 ± 0.6 mm/4.5 ± 3.1°. Inter-rater comparisons revealed mean values of 2.2 ± 1.3 mm/1.7 ± 1 mm/7.5 ± 4.9° for MRI, and 1.7 ± 1 mm/1.2 ± 0.7 mm/6 ± 3.7° for CBCT. CBCT-based implant planning was more reproducible than MRI. Nevertheless, more research is needed to increase planning reproducibility—for both modalities—thereby standardizing 3D implant planning.


Author(s):  
Hongzhang Zhu ◽  
Shi-Ting Feng ◽  
Xingqi Zhang ◽  
Zunfu Ke ◽  
Ruixi Zeng ◽  
...  

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.


2009 ◽  
Vol 90 (3) ◽  
pp. 422-423 ◽  
Author(s):  
Keiichi Nakagawa ◽  
Akihiro Haga ◽  
Kenshiro Shiraishi ◽  
Hideomi Yamashita ◽  
Hiroshi Igaki ◽  
...  

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