Use of Virtual CT and On-Treatment MRI to Reduce Radiation Dose and Anesthesia Exposure Associated With the Adaptive Workflow in Pediatric Patients Treated With Intensity Modulated Proton Therapy.

Purpose: The purpose of this study was to determine whether virtual computed tomography (vCT) derived from daily cone beam computed tomography (CBCT), or on-treatment magnetic resonance imaging (MRI) can replace quality assurance computed tomography (qCT) in our clinical workflow to minimize imaging dose and potentially anesthesia exposure in patients requiring plan adaptation.

Methods And Materials: Pediatric patients (age <24 years) treated from 2020 to 2023 with intensity modulated proton therapy with at least 1 qCT during proton therapy were eligible. For cases that required plan adaptation, the dose was recalculated on vCT and compared with same-day qCT as well as the original planning computed tomography (pCT).

The Association of Linear Energy Transfer and Dose With Radiation Necrosis After Pencil Beam Scanning Proton Therapy in Pediatric Posterior Fossa Tumors.

Purpose: Proton therapy is the preferred treatment modality for most pediatric central nervous system tumors. The risk of radiation necrosis may be increased at the distal end of the beam because of an increase in linear energy transfer (LET) and relative biological effectiveness (RBE) dose. We report on the association of LET and dose with radiation necrosis after pencil beam scanning proton therapy in pediatric posterior fossa tumors using a case-control framework.

Chemical Exchange Saturation Transfer MRI: What Neuro-Oncology Clinicians Need To Know.

Chemical exchange saturation transfer (CEST) is a relatively novel magnetic resonance imaging (MRI) technique with an image contrast designed for in vivo measurement of certain endogenous molecules with protons that are exchangeable with water protons, such as amide proton transfer commonly used for neuro-oncology applications. Recent technological advances have made it feasible to implement CEST on clinical grade scanners within practical acquisition times, creating new opportunities to integrate CEST in clinical workflow. In addition, the majority of CEST applications used in neuro-oncology are performed without the use gadolinium-based contrast agents which are another appealing feature of this technique.