Creating a Foundation for the Visualization of Intracranial Cerebrospinal Fluid Using Photon-Counting Technology in Spectral Imaging for Cranial CT.

Background: Recent advancements in computed tomography (CT), notably in photon-counting CT (PCCT), are revolutionizing the medical imaging field. PCCT's spectral imaging can better visualize tissues based on their material properties. This research aims to establish a fundamental approach for the in vivo visualization of intracranial cerebrospinal fluid (CSF) using PCCT.

Establishing a Foundation for the In Vivo Visualization of Intravascular Blood with Photon-Counting Technology in Spectral Imaging in Cranial CT.

Background: Advances in computed tomography (CT) technology, particularly photon-counting CT (PCCT), are reshaping the possibilities for medical imaging. PCCT in spectral imaging enables the high-resolution visualization of tissues with material-specific accuracy. This study aims to establish a foundational approach for the in vivo visualization of intracranial blood using PCCT, focusing on non-enhanced imaging techniques and spectral imaging capabilities.

Advanced Imaging of Shunt Valves in Cranial CT Scans with Photon-Counting Scanner.

This brief report aimed to show the utility of photon-counting technology alongside standard cranial imaging protocols for visualizing shunt valves in a patient's cranial computed tomography scan. Photon-counting CT scans with cranial protocols were retrospectively surveyed and four types of shunt valves were encountered: proGAV 2.0, M.

Cranial Computer Tomography with Photon Counting and Energy-Integrated Detectors: Objective Comparison in the Same Patients.

This study provides an objective comparison of cranial computed tomography (CT) imaging quality and radiation dose between photon counting detectors (PCCTs) and energy-integrated detectors (EIDs). We retrospectively analyzed 158 CT scans from 76 patients, employing both detector types on the same individuals to ensure a consistent comparison. Our analysis focused on the Computed Tomography Dose Index and the Dose-Length Product together with the contrast-to-noise ratio and the signal-to-noise ratio for brain gray and white matter.

Three-Dimensional Visualization of Shunt Valves with Photon Counting CT and Comparison to Traditional X-ray in a Simple Phantom Model.

This study introduces an application of innovative medical technology, Photon Counting Computer Tomography (PC CT) with novel detectors, for the assessment of shunt valves. PC CT technology offers enhanced visualization capabilities, especially for small structures, and opens up new possibilities for detailed three-dimensional imaging. Shunt valves are implanted under the skin and redirect excess cerebrospinal fluid, for example, to the abdominal cavity through a catheter.

Photon Counting Computed Tomography for Accurate Cribriform Plate (Lamina Cribrosa) Imaging in Adult Patients.

Detailed visualization of the cribriform plate is challenging due to its intricate structure. This study investigates how computed tomography (CT) with a novel photon counting (PC) detector enhance cribriform plate visualization compared to traditionally used energy-integrated detectors in patients. A total of 40 patients were included in a retrospective analysis, with half of them undergoing PC CT (Naeotom Alpha Siemens Healthineers, Forchheim, Germany) and the other half undergoing CT scans using an energy-integrated detector (Somatom Sensation 64, Siemens, Forchheim, Germany) in which the cribriform plate was visualized with a temporal bone protocol.

Organ absorbed doses in the IORT treatment of breast cancer with the INTRABEAM device: a Monte-Carlo study.

: The current prescription and the assessment of the delivered absorbed dose in intraoperative radiation therapy (IORT) with the INTRABEAM system rely mainly on depth-dose measurements in water. The accuracy of this approach is limited because tissue heterogeneity is ignored. It is also difficult to accurately determine the dose delivered to the patient experimentally as the steep dose gradient is highly sensitive to geometric errors.

An anthropomorphic pelvis phantom for MR-guided prostate interventions.

Purpose: To design and manufacture a pelvis phantom for magnetic resonance (MR)-guided prostate interventions, such as MRGB (MR-guided biopsy) or brachytherapy seed placement.

Methods: The phantom was designed to mimic the human pelvis incorporating bones, bladder, prostate with four lesions, urethra, arteries, veins, and six lymph nodes embedded in ballistic gelatin. A hollow rectum enables transrectal access to the prostate.

Multiple direction needle-path planning and inverse dose optimization for robotic low-dose rate brachytherapy.

Purpose: Robotic systems to assist needle placements for low-dose rate brachytherapy enable conformal dose planning only restricted to path planning around risk structures. We report a treatment planning system (TPS) combining multiple direction needle-path planning with inverse dose optimization algorithms.

Methods: We investigated in a path planning algorithm to efficiently locate needle injection points reaching the target volume without puncturing risk structures.

[MRI-guided minimally invasive treatment of prostate cancer].

Clinical/methodological Issue: Multiparametric magnetic resonance imaging (mpMRI) of the prostate plays a crucial role in the diagnosis and local staging of primary prostate cancer.

Standard Radiological Methods: Image-guided biopsy techniques such as MRI-ultrasound fusion not only allow guidance for targeted tissue sampling of index lesions for diagnostic confirmation, but also improve the detection of clinically significant prostate cancer.

Methodological Innovations: Minimally invasive, focal therapies of localized prostate cancer complement the treatment spectrum, especially for low- and intermediate-risk patients.

Combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) versus external beam radiotherapy (EBRT) for painful vertebral metastases - a randomized phase III study.

Background: The spine is the most frequent location of bone metastases. Local treatment aims at palliation of pain and, given the increased likelihood of long-term cancer survival, at local control. Kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provided instantaneous pain relief in 70% of patients at the first day after the intervention and resulted in local control rates of > 93% at 1 year in a recently conducted phase I/II trial.

Single-center long-term results from the randomized phase-3 TARGIT-A trial comparing intraoperative and whole-breast radiation therapy for early breast cancer.

Purpose: Partial breast irradiation using intraoperative radiotherapy (IORT) after breast-conserving surgery could be sufficient for a selected group of breast cancer patients. We report the results of a cohort of patients from a single center treated as part of the randomized phase-3 TARGIT-A trial.

Methods: Patients (≥50 years) with cT1 cN0 cM0 and invasive ductal histology on biopsy were randomized between IORT with 20 Gy (arm-A) or postoperative whole-breast RT (WBRT) up to 56 Gy in 2 Gy fractions (arm-B).

Intraoperative Radiotherapy in Newly Diagnosed Glioblastoma (INTRAGO): An Open-Label, Dose-Escalation Phase I/II Trial.

Background: The median time to recurrence of glioblastoma (GB) following multimodal treatment is ∼7 mo. Nearly all cancers recur locally, suggesting that augmenting local treatments may improve outcomes.

Objective: To investigate whether intraoperative radiotherapy (IORT) to the resection cavity is safe and effective.

System and path planning algorithm for low-kV X-ray free-form surface irradiation.

Objective: Intraoperative radiotherapy (IORT) after surgical resection using a low-kV-X-ray source is a proven method used in cancer treatment. However, the shape and size of the targeted surface area are limited to the size of the available applicators. This can lead to nonconformal and therefore suboptimal treatment for many patients.

Phase I/II trial of combined kyphoplasty and intraoperative radiotherapy in spinal metastases.

Background Context: Spinal metastases occur in 30%-50% of patients with systemic cancer. The primary goals of palliation are pain control and prevention of local recurrence.

Purpose: This study aimed to test the safety and efficacy of a combined modality approach consisting of kyphoplasty and intraoperative radiotherapy (Kypho-IORT).

Precision IORT - Image guided intraoperative radiation therapy (igIORT) using online treatment planning including tissue heterogeneity correction.

Background: To the present date, IORT has been eye and hand guided without treatment planning and tissue heterogeneity correction. This limits the precision of the application and the precise documentation of the location and the deposited dose in the tissue. Here we present a set-up where we use image guidance by intraoperative cone beam computed tomography (CBCT) for precise online Monte Carlo treatment planning including tissue heterogeneity correction.

Combined stereotactic biopsy and stepping-source interstitial irradiation of glioblastoma multiforme.

Patients diagnosed with glioblastoma multiforme receiving stereotactic biopsy only either due to tumor localization or impaired clinical status face a devastating prognosis with very short survival times. One strategy to provide an initial cytoreductive and palliative therapy at the time of the stereotactic biopsy is interstitial irradiation through the pre-defined trajectory of the biopsy channel. We designed a novel treatment planning system and evaluated the treatment potential of a fixed-source and a stepping-source algorithm for interstitial radiosurgery on non-spherical glioblastoma in direct adjacency to risk structures.

INTRAGO: intraoperative radiotherapy in glioblastoma multiforme—a phase I/II dose escalation study.

Background: Glioblastoma multiforme (GBM) is the most frequent primary malignant brain tumor in adults. Despite multimodal therapies, almost all GBM recur within a narrow margin around the initial resected lesion. Thus, novel therapeutic intensification strategies must target both, the population of dispersed tumor cells around the cavity and the postoperative microenvironment.

Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer.

Purpose: Second cancer risk after breast conserving therapy is becoming more important due to improved long term survival rates. In this study, we estimate the risks for developing a solid second cancer after radiotherapy of breast cancer using the concept of organ equivalent dose (OED).

Materials And Methods: Computer-tomography scans of 10 representative breast cancer patients were selected for this study.

A novel approach for superficial intraoperative radiotherapy (IORT) using a 50 kV X-ray source: a technical and case report.

The use of IORT as a treatment modality for patients with close or positive margins has increased over the past decade. For situations where a flat area (up to 6 cm in diameter) has to be treated intraoperatively, new applicators for superficial treatment with a miniature X-ray source (INTRABEAM system) were developed. Here we report our evaluation of the dosimetric characteristics of these new applicators and their first clinical use.

Radiation protection for an intraoperative X-ray source compared to C-arm fluoroscopy.

Background: Intraoperative radiotherapy (IORT) using the INTRABEAM(®) system promises a flexible use regarding radiation protection compared to other approaches such as electron treatment or HDR brachytherapy with (192)Ir or (60)Co. In this study we compared dose rate measurements of breast- and Kypho-IORT with C-arm fluoroscopy which is needed to estimate radiation protection areas.

Materials And Methods: C-arm fluoroscopy, breast- and Kypho-IORTs were performed using phantoms (silicon breast or bucket of water).