Special_Issue_Teaching_and_Training_Future_Health_Informaticians: Managing the transition from tradition to innovation of the Heidelberg/Heilbronn Medical Informatics Master's Program.

Background: To keep pace with the developments in the medical informatics field, the curriculum of the Heidelberg/Heilbronn Medical Informatics Master of Science program is continuously updated. In its latest revision we restructured our program to allow more flexibility to accommodate updates and include current topics and to enable students' choices.

Objectives: To present our new concepts for graduate medical informatics education, share our experiences, and provide insights into the perception of these concepts by advanced students and graduates.

Strategy for automatic ultrasound (US) probe positioning in robot-assisted ultrasound guided radiation therapy.

. As part of image-guided radiotherapy, ultrasound-guided radiotherapy is currently already in use and under investigation for robot assisted systems Ipsen 2021. It promises a real-time tumor localization during irradiation (intrafractional) without extra dose.

Development of a robot-assisted ultrasound-guided radiation therapy (USgRT).

Purpose: Radiation treatment is improved by the use of image-guided workflows. This work pursues the approach of using ultrasound (US) as a real-time imaging modality. The primary focus of this study is to develop and test a breathing and motion control for a robotic-guided US transducer.

Analyzing human decisions in IGRT of head-and-neck cancer patients to teach image registration algorithms what experts know.

Background: In IGRT of deformable head-and-neck anatomy, patient setup corrections are derived by rigid registration methods. In practice, experienced radiation therapists often correct the resulting vectors, thus indicating a different prioritization of alignment of local structures. Purpose of this study is to transfer the knowledge experts apply when correcting the automatically generated result (pre-match) to automated registration.

Construction of a biomechanical head and neck motion model as a guide to evaluation of deformable image registration.

The use of deformable image registration methods in the context of adaptive radiotherapy leads to uncertainties in the simulation of the administered dose distributions during the treatment course. Evaluation of these methods is a prerequisite to decide if a plan adaptation will improve the individual treatment. Current approaches using manual references limit the validity of evaluation, especially for low-contrast regions.

Comparison of Safety Margin Generation Concepts in Image Guided Radiotherapy to Account for Daily Head and Neck Pose Variations.

Purpose: Intensity modulated radiation therapy (IMRT) of head and neck tumors allows a precise conformation of the high-dose region to clinical target volumes (CTVs) while respecting dose limits to organs a risk (OARs). Accurate patient setup reduces translational and rotational deviations between therapy planning and therapy delivery days. However, uncertainties in the shape of the CTV and OARs due to e.

Evaluation of inter- and intrafractional motion of liver tumors using interstitial markers and implantable electromagnetic radiotransmitters in the context of image-guided radiotherapy (IGRT) - the ESMERALDA trial.

Background: With the development of more conformal and precise radiation techniques such as Intensity-Modulated Radiotherapy (IMRT), Stereotactic Body Radiotherapy (SBRT) and Image-Guided Radiotherapy (IGRT), patients with hepatic tumors could be treated with high local doses by sparing normal liver tissue. However, frequently occurring large HCC tumors are still a dosimetric challenge in spite of modern high sophisticated RT modalities. This interventional clinical study has been set up to evaluate the value of different fiducial markers, and to use the modern imaging methods for further treatment optimization using physical and informatics approaches.

Real-time markerless lung tumor tracking in fluoroscopic video: Handling overlapping of projected structures.

Purpose: Fluoroscopic imaging is a well-suited technique for online visualization of tumor motion in the thoracic region. Template-based approaches for tumor tracking in such images are commonly used. However, overlapping of different structures, mainly bones, can lead to limited visibility of the projected tumor shape, which in turn can negatively affect the performance of the tracking method.

Changes in Gross Tumor Volume and Organ Motion Analysis During Neoadjuvant Radiochemotherapy in Patients With Locally Advanced Pancreatic Cancer Using an In-House Analysis System.

Background And Purpose: During radiation treatment, movement of the target and organs at risks as well as tumor response can significantly influence dose distribution. This is highly relevant in patients with pancreatic cancer, where organs at risk lie in close proximity to the target.

Material And Methods: Data sets of 10 patients with locally advanced pancreatic cancer were evaluated.

The frequency of re-planning and its variability dependent on the modification of the re-planning criteria and IGRT correction strategy in head and neck IMRT.

Background: To analyse the frequency of re-planning and its variability dependent on the IGRT correction strategy and on the modification of the dosimetric criteria for re-planning for the spinal cord in head and neck IG-IMRT.

Methods: Daily kV-control-CTs of six head and neck patients (=175 CTs) were analysed. All volumes of interest were re-contoured using deformable image registration.

Assessing treatment response of osteolytic lesions by manual volumetry, automatic segmentation, and RECIST in experimental bone metastases.

Rationale And Objectives: Aim of the study was to compare between volumetric and unidimensional approaches for treatment response monitoring in a nude rat model of experimental bone metastases. For the volumetric approach, an automated segmentation algorithm of osteolytic lesions was introduced and compared to manual volumetry.

Material And Methods: Nude rats bearing osteolytic metastases were treated with zoledronate and sunitinib and compared to controls.

The medical simulation markup language - simplifying the biomechanical modeling workflow.

Modeling and simulation of the human body by means of continuum mechanics has become an important tool in diagnostics, computer-assisted interventions and training. This modeling approach seeks to construct patient-specific biomechanical models from tomographic data. Usually many different tools such as segmentation and meshing algorithms are involved in this workflow.

Five-year experience with setup and implementation of an integrated database system for clinical documentation and research.

In radiation oncology, where treatment concepts are elaborated in interdisciplinary collaborations, handling distributed, large heterogeneous amounts of data efficiently is very important, yet challenging, for an optimal treatment of the patient as well as for research itself. This becomes a strong focus, as we step into the era of modern personalized medicine, relying on various quantitative data information, thus involving the active contribution of multiple medical specialties. Hence, combining patient data from all involved information systems is inevitable for analyses.

Development and validation of automatic tools for interactive recurrence analysis in radiation therapy: optimization of treatment algorithms for locally advanced pancreatic cancer.

Background: In radiation oncology recurrence analysis is an important part in the evaluation process and clinical quality assurance of treatment concepts. With the example of 9 patients with locally advanced pancreatic cancer we developed and validated interactive analysis tools to support the evaluation workflow.

Methods: After an automatic registration of the radiation planning CTs with the follow-up images, the recurrence volumes are segmented manually.

Accuracy quantification of a deformable image registration tool applied in a clinical setting.

The purpose of this study was to test the accuracy of a commercially available deformable image registration tool in a clinical situation. In addition, to demonstrate a method to evaluate the resulting transformation of such a tool to a reference defined by multiple experts. For 16 patients (seven head and neck, four thoracic, five abdominal), 30-50 anatomical landmarks were defined on recognizable spots of a planning CT and a corresponding fraction CT.

A quantification strategy for missing bone mass in case of osteolytic bone lesions.

Purpose: Most of the patients who died of breast cancer have developed bone metastases. To understand the pathogenesis of bone metastases and to analyze treatment response of different bone remodeling therapies, preclinical animal models are examined. In breast cancer, bone metastases are often bone destructive.

An optimised IGRT correction vector determined from a displacement vector field: a proof of principle of a decision-making aid for re-planning.

Background: To present a new method that determines an optimised IGRT couch correction vector from a displacement vector field (DVF). The DVF is computed by a deformable image registration (DIR) method. The proposed method can improve the quality of volume-of-interest (VOI) alignment in image guided radiation therapy (IGRT), and can serve as a decision-making aid for re-planning.

Regional cumulative maximum dose to the spinal cord in head-and-neck cancer: considerations for re-irradiation.

Purpose: To present a new method that assesses the delivered maximum dose of different spinal cord sections in head-and-neck cancer treated with intensity-modulated radiation therapy (IMRT). This allows a more accurate estimation of the remaining cord dose tolerance in case of a later re-irradiation treatment planning.

Materials And Methods: The suggested workflow is demonstrated using daily acquired kilo-voltage control-CTs of four head-and-neck cancer patients (118 control-CTs).

IGRT versus non-IGRT for postoperative head-and-neck IMRT patients: dosimetric consequences arising from a PTV margin reduction.

Background: To evaluate the impact of image-guided radiation therapy (IGRT) versus non-image-guided radiation therapy (non-IGRT) on the dose to the clinical target volume (CTV) and the cervical spinal cord during fractionated intensity-modulated radiation therapy (IMRT) for head-and-neck cancer (HNC) patients.

Material And Methods: For detailed investigation, 4 exemplary patients with daily control-CT scans (total 118 CT scans) were analyzed. For the IGRT approach a target point correction (TPC) derived from a rigid registration focused to the high-dose region was used.

Connection of European particle therapy centers and generation of a common particle database system within the European ULICE-framework.

Background: To establish a common database on particle therapy for the evaluation of clinical studies integrating a large variety of voluminous datasets, different documentation styles, and various information systems, especially in the field of radiation oncology.

Methods: We developed a web-based documentation system for transnational and multicenter clinical studies in particle therapy. 560 patients have been treated from November 2009 to September 2011.

A clinical concept for interfractional adaptive radiation therapy in the treatment of head and neck cancer.

Purpose: To present an approach to fast, interfractional adaptive RT in intensity-modulated radiation therapy (IMRT) of head and neck tumors in clinical routine. Ensuring adequate patient position throughout treatment proves challenging in high-precision RT despite elaborate immobilization. Because of weight loss, treatment plans must be adapted to account for requiring supportive therapy incl.

Local setup errors in image-guided radiotherapy for head and neck cancer patients immobilized with a custom-made device.

Purpose: To evaluate the local positioning uncertainties during fractionated radiotherapy of head-and-neck cancer patients immobilized using a custom-made fixation device and discuss the effect of possible patient correction strategies for these uncertainties.

Methods And Materials: A total of 45 head-and-neck patients underwent regular control computed tomography scanning using an in-room computed tomography scanner. The local and global positioning variations of all patients were evaluated by applying a rigid registration algorithm.

Local setup reproducibility of the spinal column when using intensity-modulated radiation therapy for craniospinal irradiation with patient in supine position.

Purpose: To evaluate local positioning errors of the lumbar spine during fractionated intensity-modulated radiotherapy of patients treated with craniospinal irradiation and to assess the impact of rotational error correction on these uncertainties for one patient setup correction strategy.

Methods And Materials: 8 patients (6 adults, 2 children) treated with helical tomotherapy for craniospinal irradiation were retrospectively chosen for this analysis. Patients were immobilized with a deep-drawn Aquaplast head mask.

Quantitative assessment of image-guided radiotherapy for paraspinal tumors.

Purpose: To evaluate stereotactic positioning uncertainties of patients with paraspinal tumors treated with fractionated intensity-modulated radiotherapy; and to determine whether target-point correction via rigid registration is sufficient for daily patient positioning.

Patients And Methods: Forty-five patients with tumors at the cervical, thoracic, and lumbar spine received regular control computed-tomography (CT) scans using an in-room CT scanner. All patients were immobilized with the combination of Scotch cast torso and head masks.