Radiation Oncology at RSNA: Imagings Role in Improving Cancer Care

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Lisa Fratt, Editor

Radiation oncology seems to be coming full circle and returning the model of the 1960s and 1970s, says Chung T. Chung, MD. Forty years ago, radiation oncologists and radiologists often worked together, but during the 1970s, radiation oncology morphed into a more specialized, distinct practice, divorced from diagnostic radiology.

In the last several years, as cancer treatments have become more precise, imaging has established a more prominent role in radiation oncology. “We need imaging interpretation expertise to use new technology,” affirms Chung, from SUNY Upstate Medical University in Syracuse, N.Y. Institutions are transitioning back to a more collaborative model with radiation oncologists and radiologists working together to harness imaging data to inform more accurate treatment plans.

One factor driving the change is image-guided radiation therapy (IGRT), which has become mainstream practice in the last five years. Consider recently published IMV Medical Information Division research that reported more than two-thirds of radiation therapy site employed imaged-guided radiation therapy in 2009, up from 15 percent in 2004. Nearly all sites integrate CT images into treatment, 12 percent use MRI and 8 percent utilize PET.

The newest protocols hinge on imaging during treatment and 4D gating to incorporate motion into the treatment plan. Take, for example, a study published in the September issue of Radiotherapy and Oncology that found whole-body PET/CT with respiratory gated 4D PET/CT could reduce dose margins and help deliver more effective radiation therapy to tumors affected by respiratory motion such as those in the thorax and upper abdomen.

Molecular imaging also may help better target treatment. A multicenter study published in the September issue of the American Journal of Radiology indicated that preradiotherapy PET data led physicians to modify treatment for 31 percent of non-small cell lung cancer patients with radical radiotherapy treatment plans.

The other factor expected to drive growth in molecular imaging is therapeutic monitoring as clinical experience and research supports the value of PET/CT for treatment assessment in a wider group of cancers such as lung, breast and esophageal. New criteria such as PERCIST (Positron Emission tomography Response Criteria in Solid Tumors) have introduced a framework for more quantitative analysis of solid tumors among both measurements and users. This could open the door to more accurately measure response in currently hard to assess cancer such as lymphoma, sarcoma, hepatoma, mesothelioma, and gastrointestinal stromal tumor.

On the demographic front, patient volume is expected to swell. A study published Oct. 18 in the Journal of Clinical Oncology projected a 22 percent increase in radiation therapy patient volume over the next decade. At the same time, the number of radiation oncologists may grow a mere 2 percent. As in diagnostic radiology, working smarter and leveraging IT will be key to mitigating the impact of the gap between radiation therapy supply and demand.

RSNA 2010 reflects the image-focused evolution in radiation oncology, with imaging taking center stage. What’s more, the RSNA radiation oncology and radiobiology subcommittee is repeating the BOOST sessions launched at RSNA 2009 as well as offering its regular sessions on radiation biology and scientific advances.

The day-long, cross-disciplinary BOOST sessions begin with a radiology component, an anatomic overview, which is followed by a discussion of how cancers are treated.  The afternoon features subspecialist sessions and keynote speakers.  RSNA 2010 BOOST sessions cover pediatric, lung, head and neck, central nervous system and prostrate cancers and lymphoma.

RSNA 2011 is exploring these issues and much more later this month in Chicago. Read on for the Health Imaging & IT editorial staff’s top picks of sessions to attend.

Lisa Fratt
Editor of Health Imaging & IT