Radiation Oncology: A Physicists-Eye View (Biological and Medical Physics, Biomedical Engineering)

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Because the basic concept of CAD is broad and general, CAD is applicable to all imaging modalities, and to all kinds of examinations and images. In this lecture, the basic concept of CAD is first defined, and the current status of CAD research is then briefly described. In addition, the potential impact of CAD in the future is discussed and predicted. E-mail: sdmhradiology gmail. Roentgen's discovery and its subsequent revolutionary impact represent one of sciences greatest stories. In today's era, medical procedures are performed with the guidance of imaging technologies by Interventional Radiologists.

While medical imaging technology has greatly advanced in last years, the ways in which radiologists interact with these images has remained largely unchanged. Medical images can now be stored digitally in the picture archiving and communication system [PACS]. Patient can now easily store and share their medical images online.

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Patients and doctors all over the world can access these digital images any time. Direct access and control to digital medical images is the next evaluation in Radiology. Despite the ever changing health care landscape, the future of Radiology on the horizon is bright. Radiologist will continue to play an important role in the journey to value based care from improving patient outcomes to cost efficient techniques. Through the adoption of innovative technologies and solutions, radiology will not only continue to make an impact, but will drastically improve overall quality of care.

I What if Radiology was an Art? E-mail: robin. What if a radiology department was just a small society? A society of different professions, collaborating to produce an acceptable radiography, with their background and ideas on the quality of a radiograph? Based on current research, the interaction between radiologists and radiographers will be analysed within the sociology framework. After outlining the interpretative framework of current post-phenomenology, key points of human-machine interactions will be combined with the gestalt.

The combination of sociology and phenomenology leads into a more philosophical approach to image quality, maybe unconventional, but therefore not less exciting. E-mail: secgenafomp gmail. Methods: A survey was made of a number of medical physics professional societies and organizations to obtain their codes of conduct or ethics. This was initially done by searching on-line for such statements, and later most of the IOMP member organizations were approached individually for copies of their codes of conduct or ethics.

Results: It was clear that very few such statements have been developed by medical physics professional societies or organizations. Those that had been developed ranged from short outlines that covered a couple of pages to in-depth statements running to a dozen pages that set out complaint and disciplinary procedures. In some countries, medical physicists are subject to codes of conduct or codes of ethics that have been developed by government agencies to apply to all medical disciplines and employees.

Medical physicists' codes tend to follow the same principles. These principles are commonly found in the codes of many professional bodies both within and outside of the medical based professions such as engineering and teaching. It must be noted, though, that many codes of ethics focus only on the professional ethics listed above. However, as medical physicists are often involved in research and development and in education and training, then ethical behaviour in research and education are also important.

Conclusions: As AFOMP is an umbrella organization for approximately 20 medical physics national member organizations from different countries, it needs to develop a code of ethics that is acceptable to all of its members taking into consideration the different cultures involved. This does not mean that it should set low expectations for the ethical conduct of the medical physicists in those countries, but it must still specify standards that are internationally acceptable. E-mail: ypipman gmail. E-mail: raykwu gmail. In which the occupation of Medical Physicist is recognized with other professions under Group Physicists and Astronomers.

IOMP subsequently published the Policy Statements 1 and 2, which outlined the role and responsibilities of Medical Physicists, the academic qualifications, and training requirements. IOMP also provides supports through the scientific and educational programs for the benefit of certified individuals for continuing professional development purposes. Two programs had been fully accredited and the third one is being evaluated. In , the first direct certification examinations session was offered in Trieste Italy in May for Part I and Part II, followed by other examination sessions in December please refer to www.

Only the specialty of Radiation Oncology Physics is offered for examinations. It is expected that in the specialty of Diagnostic Imaging and Interventional Radiological Physics will be included in examination sessions in Prague during the World Congress and elsewhere. He will then announce the IMPCB near term plans, and explore the potential long term evolution as driven by the changes in the field and in the society.

Requirements for accreditation of local certification boards will be described in the perspectives of US, Asian Oceania, and European medical physicists. E-mail: slavik.

Brian W. Pogue

This recognition of the profession by the International Labour Organisation opens new horizons and presents new challenges in front of us. A specific horizon is the growing need of medical physicists in hospitals, as our profession is already an important part of the infrastructure of healthcare provision.

This reflects in the need of opening new university courses in medical physics. This is related to the double growth of our profession in the past 20 years and the expected triple growth of the profession in the future 20 years. One of the challenges in front of our Education is how to accommodate the constantly increasing volume of the professional knowledge in the limited space available in a post-graduate MSc teaching programme.

A number of medical physics courses already cut parts of the teaching programme in order to include newer methods. This is expected to be topped-up during the practical training, following the university education, but such training is not offered in all places. At the same time some universities are offering introductory medical physics modules at BSc level, which are very attractive for students. This has led to the beginning of formation of new under-graduate BSc programmes in Medical Physics. The lecture will present several successful examples of such BSc-level programme.

E-mail: ddatta barc. The idea of the LBM is to construct or simulate a simplified discrete dynamics of macroscopic behaviours at mesoscopic scales by implementing distributions of particles on a lattice. Literature study on several research papers suggest that LBM is a promising tool to image processing. The LBM to image processing, especially to nonlinear anisotropic diffusion of images is first time applied by Jawerth et al.

LBM for image denoising was mentioned in. Also Wang et al. An aneurysm is an abnormal bulging outward of an artery. Cerebral aneurysm is a fragile area on the wall of a blood vessel in the brain, which can rupture and cause major bleeding and cerebrovascular accidents. The segmentation of cerebral aneurysm is a primordial step for diagnosis assistance, treatment and surgery planning.

Unfortunately, manual segmentation is still an important part in clinical angiography but has become a burden given the huge amount of data generated by medical imaging systems. Automatic image segmentation techniques such as partial differential equation based segmentation provides an essential way to simplify and speed up clinical examinations, reduce the amount of manual interaction and lower inter operator variability.

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The central idea of partial differential equation based methods is to evolve an initial curve towards to the lowest potential of a cost function, where its definition reflects the task to be addressed. Mostly, the minimization of the cost functional can be expressed as geometrical constraints on the evolving curve. One of the partial differential equation based aneurysm image segmentation technique known as lattice Boltzmann based geodesic active contour method LBGACM has been applied for segmentation of cerebral aneurysm image.

Cerebral aneurysm is one of the most serious diseases forming part of the stroke, and it is estimated to occur in 1 to 6 percent of the population. Also, up to 85 percent of subarachnoid haemorrhages, which are potentially lethal events with mortality rate as high as 50 percent are caused by the rupture of cerebral aneurysms.

Computed tomography angiography CTA plays an essential role in the diagnosis, treatment evaluation, and monitoring of cerebral aneurysms. It allows us to detect narrowing or obstruction of blood vessels in time so that corrective therapy can be done, and it can also detect the minute changes in the vessel structure and anatomy. In addition, CTA images may give more precise anatomical details than either ultrasound or magnetic resonance images MRI , particularly for small blood vessels.

Now, CTA is becoming the radiological examination of choice for blood vessels diseases. The lumen appearing as a focal object of giant aneurysms and thrombus part of the same having a low contrast compared to neighbouring tissues makes it difficult to obtain the manual or automatic segmentation reasoning the segmentation of giant aneurysms of the brain from CTA imaging remains a challenge. In this talk, an innovative segmentation methodology based on the combined use of the LBM and the level set method is proposed.

The first methodology consists in extracting the group consisting of lumen and thrombus using a procedure in two steps, then refining the shape of the thrombus using the level set method. A typical experiments are performed on slices of 8 patients CTAs with different types of giant aneurysms. The results on real images showed that the proposed method is comparable to manual segmentation, and quantitatively, the matching factors obtained using the proposed method are high, demonstrating good accuracy of the segmentation.

Lattice Boltzmann models for anisotropic diffusion of images. J Math Imaging Vis; Zhao Y. Vis Comput ; Wolf-Gladrow D. A lattice Boltzmann equation for diffusion. J Stat Phys; Chang Q, Yang T. A lattice Boltzmann method for image denoising. Intracranial aneurysms: Review of current treatment options and outcomes. Front Neurol ; E-mail: ambesh iitj. MNPs provide a multifunctional platform for magnetic hyperthermia treatments acting as a localized source of heat, magnetically guided targeted drug delivery, magnetic resonance imaging MRI contrast agents and magnetic separation.

MNPs are beneficial due to their i small crystallite size few nanometer , which provides easy intravenous injection and externally controlled delivery via bloodstream to the malignant tumor that is not possible with other means; ii high surface to volume ratio for MNPs allows for surface engineering with few or multiple recognition molecules, which can assure targeting toward specific tumor tissues; and iii the remote heating of MNPs by the externally applied magnetic field allows the heat action only to the zone of accumulation of nanoparticles.

The onset of heating is either from the hysteresis losses or from Neel or Brown relaxation process and depends on geometry, composition, and magnetic moment of the MNPs in conjunction with the applied frequency and magnetic field strength. The discussion will cover the impact of magnetic nanoparticle anisotropy on magnetic properties leading to efficient magnetic hyperthermia and drug delivery.

The associated physics and challenges will be covered in realizing the in vivo clinical trials for both magnetic hyperthermia and drug delivery. E-mail: paul cmcvellore. Though there are several algorithms that have been developed to get accurate dose calculation, Monte Carlo MC simulation is known to be the most accurate method for radiotherapy. In MC simulation, one computes how a particle propagates step by step according to fundamental physics principles. A number of MC algorithms have been developed, viz. In this work we describe the implementation of EGSnrc in our clinic. Modelling linac for EGSnrc: BEAMnrc is a general purpose EGSnrc user code for simulating radiation sources and modelling radiation transport through various structures, such as alinac treatment head.

In the case of linac, the simulation is based on the geometry model of the treatment head. The user specifies the various parts of the treatment head using the component modules CMs where each structure of the linac head is entered as a CM and the accelerator model thus built with various input parameters and cross-section data is compiled prior to simulation. The output data of the EGSnrc is collected on a user-specified plane, to a phase space file, in which the energy, position, direction, weight and charge of each particle are recorded which serves as an input for the DOSXYZnrc for generating the dose distribution in the phantom.

For IX models linacs, the treatment head geometry and material information are provided by Varian, but for TrueBeam, the IAEA phase space files at the level of the collimator is provided which could be used as input to obtain the phase space file at the phantom surface.

The depth dose, beam profile and the output factor data could be derived using the Matlab code. Conclusion: Implementation of Monte Carlo: One of the issues in MC simulation is the long computational time and porting MC packages onto parallel computing architectures is a direct way for increasing their efficiency. The other method to further increase the processing speed is to distribute jobs over a number of computers in a cluster and we hope to implement this in future. E-mail: dimitris. In addition, recently published dosimetry data on electrons beams bring up the question of how would one need to modify the widely used TG that originally was based on TG calibration protocol?

The answer to the question is given by the recently published TG This new protocol operates as supplement and update to TG on issues that need to be modified because of TG approach to electron dosimetry and because of newer data on clinical electron beams. It describes in detail the procedure of converting measured depth-ionization curves with ion chambers into depth-dose curves, making use of recently published stopping-power ratios and other conversion factors.

It also describes the use of water equivalent phantoms to perform relative electron dosimetry based on recently published conversions factors. The report discusses small and irregularly shaped electron field dosimetry using the concept of lateral buildup ratio LBR as an avenue to evaluate electronic equilibrium and compute dose per MU for those fields.

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Finally, it gives some common clinical examples where electron beam dosimetry are applied. This presentation will try to provide assistance to better understanding the methods and recommendations in TG In addition, how to link the absolute dose calibration recommendations of TG to the relative dose measurements of TG E-mail: bagarwal phoebehealth. Management of radiotherapy patients with modern technology cardiac implantable electronic devices CIEDs has been widely published in literature without the provision of a new comprehensive and concise set of recommendations.

This need is clearly supported by the numerous publications in literature on effects of different irradiation modalities on pacemakers and defibrillators, the last 10 years. As such, this session will provide updated guidance for caring for radiotherapy patients with CIEDs.

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Risk of failure associated with these doses will be discussed. Louis, St. Louis, Missouri, USA. E-mail: lsantan gmail. Intra fraction motion is an issue that needs to be addressed during simulation, planning and treatment delivery. During simulation, a surrogate device is used that correlates the position of the tumor to the respiratory cycle to generate a 4DCT. Depending on the method chosen for treatment delivery, the target delineation can be restricted to individual phases like exhale, inhale or part or entire tumor motion envelope Internal Tumor Volume ITV.

Average or Helical CT can be used for treatment planning. Treatment Delivery during tumor motion causes blurring of the dose distribution. Various motion management techniques like breath hold, active breathing control ABC , self-controlled breathing, forced shallow breathing or automated respiratory synchronized techniques like gating or tracking and the quality assurance recommendations from TG76 and TG will be discussed.

Learning Objectives: 1 Understand the methods to acquire a 4D CT scan and its use in treatment planning and treatment delivery. E-mail: nidhionco gmail. The revolution in radiation therapy has made the results comparable to standard surgical techniques in some cases. But every leap and progress in science has to pay some price and so have the technological advances in RT. These challenges could be technical, psychological, economical and ethical.

Technical challenges include lack of experience and training in using the high precision radiation techniques. One has to constantly keep abreast not only about the sophisticated RT techniques but has to keep pace with the evolving sister modalities-chemotherapy and surgery.


With the advent of volumetric RT planning the knowledge of anatomy has become very pertinent. Contouring, verification of plans and QA checks consume lot of time but they have become an integral part of life of a modern radiation oncologist. In high tech RT, the margins around targets have tightened and there is a gradual shift from conventional fractionation to hypo fractionation.

Dose escalation is being experimented because of sub millimeter precision. Radiation oncologists have to be more vigilant than ever before about geographic miss of target and dose to OARS because with high doses per fraction and tight margins these lapses could be hazardous. With the easy access to technology we are now dealing with more educated and aware patients and their families.

Their expectations have gone up. One has to customize treatment for every patient. Counseling has become even more important as one has to explain the patient and family why a particular modality which may not necessarily be the most expensive one will be optimum. Availability and access to high tech facility, trained personnel and funds for above remain an unmet need in ever growing cancer population in a developing country like ours.

The cancer treatment is becoming expensive day by day as there is a cost for high tech RT, newer chemotherapeutic and targeted drugs and advanced surgical procedures. Often we face dilemma of choosing a better modality which is more apt or the modality the one which the patient can afford.

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Though health insurance is coming up but still it has a long way to go. With the existing market forces, pressure from the employees who have invested huge sum in high tech RT equipments, colleagues who may advertise that a particular technique is the only way to cure, the pressure to overuse the high tech RT is tremendous. To follow evidence based treatment and maintain ethnical practice is a tough task for a radiation oncologist in high tech RT era. In a world of constant progress the driving force for changing our perspective must arise from within if we wish to be a part of the mainstream.

Krishna Murthy, P. Prasad, K. Kaviarasu, T. E-mail: kammarikm yahoo. This principle has evolved many technical advances in the field and is achieved by integrating image modalities for contouring, numerical algorithms for planning, IGRT systems for delivery verification and software and networking systems to manage quality assurance of the treatments. Technological innovations continue to progress and improve the accuracy and precision both in the delivery and quality assurance of RT. The increasing complexity of radiation therapy planning and delivery posing many challenges to Medical Physicists in quality management of high tech radiation therapy.

To meet the challenges a Medical Physicist must understand the complexity of using new and emerging technologies and implement thorough QA protocols, possibly driven by increased regulations. Provide web based training and focused workshops on quality and safety in radiation. In this talk, the challenges posed to a Medical Physicist in high tech radiotherapy planning, delivery, implementation of QA and need for the changes required to meet them are discussed.

E-mail: kaul. In addition to technological developments there has been a parallel advances in imaging technology and computer software that has led to significant improvement in the Radiation Therapy treatment accuracy. These technological development have provided improved outcomes and better quality of life for cancer patients.

What is MEDICAL PHYSICS? What does MEDICAL PHYSICS mean? MEDICAL PHYSICS meaning & explanation

However there are chances which may result in unintended harm if not used properly. It is, therefore essential that adoption of these new Technologies be evidence based and should be implemented in clinical practice cautiously. Cerenkoscopy monitors breast treatments Medical Physics Web February 3, Imaging scheme tracks tumour oxygenation Institute of Physics September 26, A weird glow in nuclear power plants is proving valuable when aiming cancer treatment The Telegraph Nashua March 3, Thayer prof. Tracking oxygenation during radiotherapy Medical Physics Web October 1, Investigator Spotlights Dartmouth Now June 5, College names search committee The Dartmouth May 29, The Graduate Forum July 25, Medical lasers: diagnose, treat, cure physicsworld.

Could function prove better than form? Dartmouth Medicine December 22, Radiation Oncology: A Physicist's-Eye View was written for both physicists and medical oncologists with the aim of helping them approach the used of radiation in the treatment of cancer with understanding, confidence, and imagination. The book will let practitioners in one field understand the problems of, and find solutions for, practitioners in the other. It will help them to know "why" certain approaches are fruitful while, at the same time, encouraging them to ask the question "Why not?

Unlike a textbook, formal and complete developments of the topics are not among the goals. Instead, the reader will develop a foundation for understanding what the author has found to be matters of importance in radiation oncology during over thirty years of experience. Presentations cover, in largely non-technical language, the principal physical and biological aspects of radiation treatment and address practical clinical considerations in planning and delivering therapy.

The importance of the assessment of uncertainties is emphasized. Topics include: an overview of the physics of the interactions of radiation with matter; the definition of the goals and the design of radiation therapy approaches; living with uncertainty; biophysical models of radiation damage; computer-based optimization of treatments; and proton therapy. Formulae and quantitation in general have been avoided in the belief that an understanding of the majority of important medical and biological issues in radiation oncology generally cannot be achieved through mathematical relationships.