DIAGNOSTIC RADIOLOGY FOR ADVANCED HEAD AND NECK CANCER PLANNING

Venue: British Dental Association, LondonCPD: 6 CREDITS

26 NOVEMBER

2014

Oncology Imaging Systems

More information available soon at www.bir.org.uk

• Room1Primers for the non-specialistsSessionorganisedbyDrDavid

Wilson,ConsultantInterventional

MSKradiologist,OxfordUniversity

HospitalsNHSTrust

• Room2Radiation protectionSessionorganisedbyMrAndy

Rogers,HeadofRadiationPhysics,

NottinghamUniversityHospitals

NHSTrust

Save the date

• Room1Clinical hybrid imaging in oncologySessionorganisedbyDrGopinathGnanasegaran,ConsultantPhysicianinNuclearMedicine,StThomas’Hospital

• Room2Musculoskeletal imagingSessionorganisedbyDrRichardWakefield,ConsultantinRheumatology,StJames’sUniversityHospital

Essentials for the radiology traineeSessionorganisedbyDrHardiMadani,RadiologyRegistrar,RoyalFreeLondonHospitalandDrAusamiAbbas,CardiothoracicRadiologyPostCCTFellow,UniversityHospitalAlberta

Day 2Day 1

BIR ANNUAL CONGRESS 20154–5 NOVEMBER

LONDON

We are most grateful to

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Save the date

Day 2

Welcomeandthankyouforcomingto‘Diagnosticradiologyforadvancedheadandneckcancerplanning’organisedbytheBritishInstituteofRadiology.

Wewishyouaveryenjoyableandeducationalexperience.

Certificateofattendance

Thismeetinghasbeenawarded6RCRcategoryICPDcredits.

Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:

https://www.surveymonkey.com/s/headandneckcancerplanning

BIR Annual Congress 2015: 4–5 November, London

We are most grateful to

for supporting this conference

Oncology Imaging Systems

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Programme

08:45 Registration and refreshments

09:15 Welcome and introduction DrCharlesKelly,ConsultantClinicalOncologistandLeadfor Radiotherapy,NorthernCentreforCancerCare,FreemanHospital DrRichardSimcock,ConsultantClinicalOncologist BrightonandSussexUniversityHospitalsNHSTrust

Section 1: ‘Best’ diagnostic imaging and review of techniques

09:20 Ultrasound in treatment planning - how, when and why? DrRhodriEvans,ConsultantHeadandNeckRadiologist MorristonHospital,Swansea

09:50 DWI in staging and monitoring head and neck cancer DrSteveConnor,ConsultantHeadandNeckRadiologist King’sCollegeHospitalandGuy’sandStThomas’Hospital

10:15 PET-CT imaging in head and neck squamous cell carcinomas (HNSCC): applications, pitfalls and new horizons DrVivekRaman,ConsultantHeadandNeckRadiologistandNuclear MedicinePhysician,BrightonandSussexUniversityHospitalsTrust

10:40 Getting the best from diagnostic CT LtColMarkBallard,ConsultantRadiologist UniversityHospital,Birmingham

11:05 Sentinel node biopsy in the node negative neck MrsClareSchilling,ClinicalAcademicLecturer,SpecialistTrainee,Oraland MaxillofacialSurgery,Guy’sHospital

11:30 Refreshments

Section 2: Organs at risk: the evidence and defining them

11:45 Organs at risk - reviewing the evidence: salivary glands, oral cavity and swallowing structures DrAndrewHartley,ConsultantClinialOncologist QueenElizabethHospitalBirmingham

12:05 Organs at risk - defining muscles of mastication, salivary glands and brachial plexus DrGuyBurkill,ConsultantRadiologist BrightonandSussexUniversityHospitalsNHSTrust

12:30 New organs at risk - reviewing the evidence: carotids and cochleas DrDorothyGujral,ClinicalResearchFellow,RoyalMarsdenHospital

13:00 Lunch

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Section 3: Incoporating imaging into planning with new techniques

14:00 MRI fusion in planning: the end user experience DrCharlesKelly,ConsultantClinicalOncologistandLeadfor Radiotherapy,NorthernCentreforCancerCare,FreemanHospital

14:30 PET fusion in radiotherapy planning MissLucyPike,ClinicalScientist,PETImagingCentre StThomas’Hospital

15:00 Auto-contouring software - an end user evalution DrKeithLangmack,HeadofRadiotherapyPhysics NottinghamUniversityHospitalsNHSTrust

15:45 Volume definition after neo-adjuvant chemotherapy DrTomRoques,ConsultantClinicalOncologist,Norfolkand NorwichUniversityHospitals

16:15 Debate: Who should volume? radiologist or oncologist? or both? Chair: DrRichardSimcock,ConsultantClinicalOncologist BrightonandSussexUniversityHospitalsNHSTrust

16:45 Close of event

________________________________________________________________________

Certificate of attendance

Thismeetinghasbeenawarded6RCRcategoryICPDcredits.

Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:

https://www.surveymonkey.com/s/headandneckcancerplanning

BIR Annual Congress 2015: 4–5 November, London

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Speaker profiles

Lt Col Mark BallardConsultant Radiologist, University Hospital Birmingham

MarkBallardisaconsultantradiologistworkingattheCentreforDefenceRadiologyattheQueenElizabethHospitalBirmingham.Hissub-specialistinterestsareinbothtraumaimagingandheadandneckimaging.ThepriorhasseenhimdeployedonoperationstotheCampBastionfieldhospitalinAfghanistanbutitisthelatterwhichencompassesmuchofhisdaytodayworkintheUK.TheQueenElizabethHospitalisatertiaryreferralcentreforheadandneckcancerwithabusyweeklymultidisciplinarymeeting.

MarkcompletedhisradiologyspecialisttrainingintheKent,SurreyandSussexDeaneryattheRoyalSussexCountyHospital,BrightonandundertookafellowshipinheadandneckimagingatBartsHealthNHStrustpriortohisconsultantappointment.

Dr Guy BurkillConsultant Radiologist, Brighton and Sussex University Hospitals NHS Trust

IhavebeenaconsultantRadiologistfor13yearsfollowingfellowshiptrainingatTheRoyalMarsdenHospital.Mysub-specialtyinterestisinoncologicalimaging,includingHeadandNeckCancer,havingbeenafoundermemberofourlocalMDTin2004.Thepast4yearsIhavebeenananatomyexaminerfortheRoyalCollegeofRadiologists.

Dr Steve Connor, Consultant Head and Neck RadiologistKing’s College Hospital and Guy’s and St Thomas’ Hospital

DrSteveConnorwastrainedinradiologyontheWestMidlandsschemewithsubsequentneuroradiologysubspecialtytrainingatKing’sCollegeHospital.HewasappointedasaneuroradiologyconsultantatKing’sCollegeHospitalin2001.HehasalsobeenanhonoraryconsultantinheadandneckradiologyatGuy’sandStThomas’hospitalsince2005.Hissubspecialtyinterestsareskullbase,headandneckcancerandtemporalboneimaging.Helecturesnationallyandinternationallyonheadandneckimagingtopics.Heactsasassociateeditorforthreejournalsandhasauthoredover100publications.CurrentresearchactivityincludesastudycomparingquantitativediffusionweightedMRIand18F-FDGPET-CTinthepredictionoflocoregionalresidualdiseasefollowingradiotherapyandchemoradiotherapyforheadandneckcancer.HeisthecurrentChairmanoftheBritishSocietyofHeadandNeckImaginghavingpreviouslyactedasvice-Chairman(2012-14)andsecretary(2010-2012).

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Dr Rhodri EvansConsultant Head and Neck Radiologist, Morriston Hospital, Swansea

ConsultantRadiologist-Morriston,SingletonandNeathPortTalbothospitals.ChairinMedicalImaging,ILS2,Collegeofmedicine,SwanseaUniversity.

ConsultantRadiologistsince1992.OrganiserMorristonheadandneckultrasoundworkshop,since1995(www.headandneckultrasound.co.uk).Authorof2textsonheadandneckultrasound/Imaging.ExaminerforRCSandRCR.MemberofBMUSCouncilandHon.TreasurerBMUS.HonoraryChairMedicalImaging,CollegeofMedicine,SwanseaUniversity,2013.

Dr Dorothy GujralClinical Research Fellow, Royal Marsden Hospital

DrGujralisaClinicalOncologySpRintheSouthLondonrotation.ShehasrecentlycompletedaPhDfellowshipintheHeadandNeckUnitattheRoyalMarsdenHospital.HerPhDinvestigatedtheeffectsofradiotherapyonthecarotidarteryinpatientswithheadandneckcancerusingarangeofadvancedimagingtechniques,includingcontrast-enhancedultrasoundandspeckletrackinginordertoseekearliersurrogateendpointsforradiation-inducedatherosclerosis.Inaddition,shehasbeeninvolvedinclinicaltrialmanagementintheheadandneckunitattheRoyalMarsdenHospitalandprovidedsupportfornationalheadandheckradiotherapytrialsintermsofradiotherapyqualityassurance.

Dr Andrew HartleyConsultant Clinial Oncologist, Queen Elizabeth Hospital, Birmingham

AndrewHartleyhasbeenaConsultantRadiationOncologistinheadandneckcancerattheQueenElizabethHospitalsince2002.HeteachesRadiobiologyattheUniversityofBirmingham.

Dr Charles KellyConsultant Clinical Oncologist and Lead for RadiotherapyNorthern Centre for Cancer Care, Freeman Hospital

CharlesKelly,isaConsultantClinicalOncologist,specialisinginheadandneckcancer,skincancermelanomaandisClinicalLeadforRadiotherapy,attheNorthernCentreforCancerCareinNewcastle.HealsoinitiatedandisoneofthedirectorsoftheNewcastleUniversityonlineMSc/diplomainPartwhichhasbeenrunningsuccessfullyforoveradecadenow,andatpresentisNewcastleUniversity’smostsuccessfulonlinecourse.

HehasaninterestinqualityoflifeinheadneckcancerandisPIonseveralheadneckcancerstudiesatpresent.HeisalsoactiveindevelopingradiotherapyresearchwithinNCCC,especiallyinpromotingadvancedimagingtechniquesinradiotherapyplanning.

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Dr Keith LangmackHead of Radiotherapy Physics, Nottingham University Hospitals NHS Trust

AftergraduationwithadoctorateinmolecularbiophysicsfromOxford,KeithjoinedtheRadiotherapyPhysicsTeamatAddenbrooke’sHospitalinCambridge.Hespentover10yearstheredevelopingspecificinterestsinbrachytherapyandimaging.AfterabriefspellinLincolnasDeputyHeadofRadiotherapyPhysicshemovedtoNottinghamin2002.Hehasbeenthereeversince.Hiscurrentinterestsareimagingandimprovingtheefficiencyoftheradiotherapyprocess.

Miss Lucy PikeClinical Scientist, PET Imaging Centre, St Thomas’ Hospital

LucyPikeisaClinicalScientistattheKing’sCollegeLondonandGuy’sandStThomas’PETCentre,London.HercurrentroleinvolvesprovidingsupportforclinicalandresearchapplicationsofPET-CTincludingtheuseofnovelPETtracersandcompleximagingtechniques.Inaddition,shemanagestheNCRIPETCoreLab,whichprovidestechnicalsupportanddevelopsstandardsforPETimaginginmulti-centreclinicaltrials.

Dr Vivek RamanConsultant Head and Neck Radiologist and Nuclear Medicine Physician Brighton and Sussex University Hospitals Trust

DrRamanisaRadionuclideRadiologistatBrightonandSussexUniversityHospital.HeperformedhismedicaltrainingatKingsCollegeLondonandhisRadiologyatGuy’sandStThomas’HospitalLondon.Hewasappointedasaconsultantin2006atConquestHospitalHastingsbeforemovingin2009toBrightonandSussexUniversityHospitalsNHStrusttopursuehisinterestsinPET/CT,HeadandNeckImagingandCardiacimaging.Heworkswithinboththenuclearmedicineandradiologydepartmentswithinthetrust.HeisinvolvedinteachingbothundergraduateandpostgraduatestudentsatBrightonandSussexUniversity.Hehaspaperspublishedinpeerreviewjournalsandhaspresentedresearchatinternationalmeetings.

Dr Tom RoquesConsultant Clinical Oncologist, Norfolk and Norwich University Hospitals

Tomqualifiedasadoctorin1994andtrainedasaclinicaloncologistinLondonandVancouverbeforebecomingaconsultantinNorwichin2004.HespecializesinheadandneckandthyroidcancersbutalsotreatsavarietyofothertumoursitesincludingupperGIandhepatobiliarycancers.Hehasparticularinterestsintechnicalradiotherapyandindoctor-patientdecision-making.HeleadstheAngliaEastheadandneckcancermultidisciplinaryteamhasbeenclinicaldirectorforoncologyandpalliativemedicineinNorwichsince2009.Hehaswrittenandspokenwidelyabouttargetvolumedefinitioninheadandneckcancerandispartofthequalityassuranceteamfortwointernationalradiotherapy-basedtrials.

AlifelongNorwichCityfan,hewouldprefernottoengageinconversationaboutthecanariesgivenhowthisseasonisturningout.

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Mrs Clare SchillingClinical Academic Lecturer, Specialist Trainee, Oral and Maxillofacial Surgery Guy’s Hospital

ClareSchillingisaClinicalAcademicLectureandSpecialistTraineeinOralandMaxillofacialSurgerybasedatGuy’sHospitalinLondon.HerPhDisinsmartsurgicaltechniqueswithaparticularinterestinsentinelnodebiopsy.Clare,alongwithProfessorMarkMcGurk,rantheSentinelEuropeanNodeTrial(SENT),thelargesttrialtodatelookingatsentinelnodebiopsyinoralcancer.ClarehaswonnumerousprizesforherworkincludingtheBritishAssociationofOralandMaxillofacialSurgeryprizeforresearch.Sheisaco-authoroftheOxfordHandbookofOralandMaxillofacialSurgery.

Dr Richard SimcockConsultant Clinical OncologistBrighton and Sussex University Hospitals NHS Trust

ConsultantClinicalOncologistattheSussexCancerCentresince2003treatingheadandneckcancer.HehasinterestsinsurvivorshipissuesinheadandneckcancerandhasledtrialsinxerostomiaandiscurrentlycollaboratingonastudyonpsychosocialissuesinHPV+patients.Heisoneoftheco-editorsof‘TheABCofCancerCare’publishedin2013.ThisyearhebecameaMacmillanConsultantMedicalAdviserworkingwiththecharitytodevelopsurvivorshipissues.In2014incollaborationwithradiationoncologistsintheUS,AustraliaandSpainhelaunchedthefirstRadiationOncologyjournalclubsonTwitter.

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Abstracts

Ultrasound in treatment planning - how, when and why?Dr Rhodri Evans

Ultrasoundincombinationwitheitherafineneedleaspirationoracorebiopsyisaprerequisiteskillforradiologistswhowanttostagepatientswithcarcinomaefficientlyandeffectively.Thistalkwillconcentrateonthevarioustechniquesofbiopsy,signstolookforandtipsondecision-makingthatwillenableradiologiststostagetheirpatientsmoreeffectively.

DWI in staging and monitoring head and neck cancerDr Steve Connor

DiffusionimagingisaMRItechniquewhichdepictstheBrownianmotionofwatermoleculesinbiologicaltissues.Acellulartumourintheheadandneckwillresultinimpededdiffusion,andisdemonstratedasincreasedsignalondiffusionweightedimaging(DWI)withacorrespondingdecreasedsignalonanapparentdiffusioncoefficient(ADC)map.Therearetechnicalchallengestoperformingdiffusionimagingintheheadandneck.Diffusionimagingmaybeinterpretedonaqualitativeorquantitativebasis.Qualitativeanalysiscanbeusefulfordetectinganddelineatingcertaintumoursandrecurrentdisease,howeveritshouldberememberedthatothernormalstructures(e.g.lymphoidtissue)andpathology(e.g.abscesses)arealsoofincreasedDWIsignal.

QuantitativeanalysisrequirescalculationofADCbyplacingregionsofinterestontheADCmap.Thishasbeenusedtocharacteriseheadandnecktumours(e.g.benignversusmalignant,squamouscellversuslymphomaandhighgradeversuslowgrade),andtodistinguishbenignfrommalignantlymphnodes.ThereshouldbecautioninutilisingADCthresholdsfromtheliteratureforthesepurposes,astheymaynotbeapplicableacrossdifferentcentres.ThegreatestimpactofDWIinheadandneckcancerislikelytobeintherapymonitoringandtheearlydetectionoftreatmentfailure.Thereisongoinginvestigationintoitsrolebothintheearlystagesofchemo-radiotherapy(inordertopredicttreatmentresponseandguidetherapeuticoptions),andat6-12weeksposttherapy(inordertodetectresidualviabletumourforsalvagesurgeryorstagedneckdissection).Thereislikelytobestandardisationoftechniquesandnewerformsofdataanalysisinthefuture.

Educationalaims:• Tounderstandthebasisofthediffusionweightedimagingsequenceand

themeaningofthetermsdiffusionweightedimaging/apparentdiffusioncoefficient.

• Toappreciatethemajorrolesofqualitativeandquantitativeinterpretationinheadandneckcancerdiffusionimaging.

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PET-CT imaging in head and neck squamous cell carcinomas (HNSCC): applications, pitfalls and new horizonsDr Vivek Raman

LearningObjectives:• 18F-FDGPET/CTimaging:technique/interpretation/pitfalls• Impactandevidencebaseduseof18F-FDGPET/CTindiagnosis/staging• Treatmentresponse• Prognostication• OtherPETTracers

Thereisaweightofevidence-baseddatasupportingtheuseof18F-FDGPET-CTinthemanagementofheadandnecksquamouscellcancerssuchthatitsusewithinthisfieldisnowcommonplace.Inparticular,applicationsdemonstratingsignificantclinicalimpactincludelocationoftheprimaryinpatientspresentingwithmetastaticlymphnodedisease,distantmetastasis/secondprimarydetectionandinthepostchemo-radiotherapytreatmentscenario,toidentifypatientswithcompletetreatmentresponse,thusobviatingtheneedforsubsequentneckdissection.TherearealsoanumberofnewPETtracersthathaveshownpromiseinidentifyingcertaintumourcharacteristicstohelpguidetherapyandalsoinassessingearlytreatmentresponseandbutnonehavereachedtheclinicalarena.

Getting the best from diagnostic CTLt Col Mark Ballard

ThetalkwilldiscusstheoptimalimagingtechniquesforCTacquisitionintheneckaddressingissuesincludingcontrastadministration,scantimingandmanagementofartefact.Examplesofgoodandbadtechniquewillbedemonstratedaswellasmethodsforimagereconstructiontoaidreporting.

Sentinel node biopsy in the node negative neckMrs Clare Schilling

Sentinelnodebiopsyisatechniquewellsuitedtooralsquamouscellcarcinoma,atumourthatpredictablymetastasizestothecervicallymphnodes.Despitebestimagingtechniquesthereisanoccultmetastasisrateofupto30%intheradiologicallyN0neck.Commonlyheldsurgicaldictumisthatifthereisa>20%riskofmetastasisthenelectiveneckdissectionshouldbeperformed.Thismeansthatupto80%ofpatientsareundergoingunnecessarysurgerywithconsequentmorbidityandtreatmentcost.Bymappingthelymphaticdrainageofeachindividualtumourwecanofferapatientspecificsurgicalapproachtoretrievejusttheatrisk(sentinel)lymphnodes.Thisisamuchsmalleroperationthanelectivenodalclearance,andmanypatientscanbedischargedthedayaftersurgery.TheSentinelEuropeanNodeTrial,whichprospectivelystaged420patientswithoralcancer,showedthat>70%ofpatientsavoidedaneckdissectionwithoutcompromisingoutcome.Thetechniquehadaverylowcomplicationrateandcostanalysissuggestsasavingwhencomparedtostandardtreatmentbyelectiveneckdissection.

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Organs at risk - reviewing the evidence: salivary glands, oral cavity and swallowing structuresDr Andrew Hartley

Despitetechnicaladvancesinradiationoncology,chemoradiotherapytotheheadandneckremainsamorbidtreatment.Whendecidingwhichstructurestospareduringtheplanningprocess,thefollowingfactorsrequireconsideration:thesignificancetothepatientofaparticularacuteorlateside-effect;themostappropriateendpointforthisside-effect;themostpracticalwayofmeasuringthisendpoint;theidentityoftheorganatriskassociatedwiththisendpoint;theevidenceforadoseresponsetothisendpoint;theinfluenceofnon-dosimetricparametersonthisendpoint.

Theexamplesoflatexerostomia,acuteandlatemucosalreactionandlatedysphagiawillbeusedtoillustratetheconsiderationofthesefactors.Inaddition,newmodellingwhichquestionstheclassicalradiobiologicaldeterminantsofacuteandlatesideeffectswillbepresentedusingtheexamplesoflatemucosalreactionandlongtermfeedingtubedependence.

Organs at risk - defining muscles of mastication, salivary glands and brachial plexusDr Guy Burkill

Theneckisanatomicallycomplex.Itcanbeunderstoodindifferentways.Necklevelsisawell-establishedroadmapforlymphnodedivisionallowingbothstagingandinter-disciplinarycommunication.Fasciaandspacesprovidebarriersandpathwaysfordiseasespread.Organsbecomerelevantindefininglikelypathologiesaswellaspreservationoffunction.Althoughmodifiedbydiseaseandinterventionsanatomyisstatic.Howeverourabilitytorepresentitinvivohasimprovedgreatlyinrecentdecades.Furthermorehybridimagingmoreaccuratelydefinesdiseaseextentwhilstavailabletherapeuticoptionscontinuetoevolve.Collaborationbetweenspecialtiestoharnessthisknowledgeisourbestopportunityfortreatmentoptimisation,whichbecomesevermorepertinentwithimprovedsurvival.

New organs at risk - reviewing the evidence: carotids and cochleasDr Dorothy Gujral

Thistalkdiscussesthecarotidarteriesandcochleasinradiotherapyplanningasorgansatriskandreviewstheliteratureforevidenceofradiationdamage,discussinglikelydoseconstraintsandtheuseofintensitymodulatedradiotherapytoreduceradiationdosetothesestructures.

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PET fusion in radiotherapy planningMiss Lucy Pike

PETisincreasinglyusedfordiseasestaging,therapymonitoringandfollowupforarangeoftumourtypesinroutineclinicalmanagement.InmanytumourtypesPETcanprovidegreatersensitivityandspecificityfornodalstagingthanCTorMRandcandetectfunctionalchangesmuchearlierthananatomicalchanges.TheadditionalfunctionalinformationfromPETcancomplementtheanatomicaldataprovidedbyCTandthereismuchinterestinincorporatingthisintoradiotherapyplanningtohelpmoreaccuratelydefinetreatmentvolumesandpotentiallyreduceradiationdosestohealthytissue.ThereisanincreasingcasetosupporttheinclusionofFDG-PETinradiotherapyplanningforsometumourtypes,butinappropriateuseofPETtoreducetreatmentvolumescouldimpairratherthanimprovepatientoutcomes.ItisimportantthereforethatasolidevidencebaseisestablishedthroughclinicaltrialstodeterminehowPETimagingisbestutilisedinradiotherapyplanning.

EvaluationofvolumedelineationtechniquesincorporatingPETversusconventionalcontouringtechniquesinradiotherapyshouldbecarefullyplannedandexecutedthroughclinicaltrialsincorporatingrigorousandconsistentqualitycontrolandimagingprotocols.ThistalkaimstooutlinetheprocessesinvolvedinincorporatingPETintoradiotherapyplanninganddiscussessomeofthetechnicalchallengesthatmaybeencountered.InparticularthisdrawsonourownexperienceofdevelopingPET-CTprotocolsandthepatientpathwayforaphaseIFDG-guideddoseescalationstudy.

Educationalaimsandlearningoutcomes:• TogainanunderstandingoftherequirementsforincorporatingPET-CTinto

radiotherapyplanning• TogainanappreciationofthepracticalissuesofincorporatingPET-CTinto

radiotherapyplanning

Auto-contouring software - an end user evaluation.Dr Keith Langmack

Auto-contouringsoftwareisusedtosegmentanewpatient’sanatomyusingpreviousexamples.Thecontoursproducedarethenmanuallyedited.InNottinghamwehavetwosuchsystemsinclinicaluse(ABAS,Elekta,forheadandneckandprostate;MIM,MIMSoftware,forlungSABR).Themethodologyusedbyeachofthesesystemsforauto-contouringwillbeexplained,andsomeguidancegivenonatlasbuilding.

ThemotivationforusingsuchsoftwareisthatIMRTrequiresmorecontouringthantraditionalradiotherapy.Thisisverytimeconsuming.Inthistalktheevidencefortimessavingsoftheorderof50%beingachievedbyusingauto-contouringwillbereviewed.Thisrequirestheeditingtimeforcontourstobelessthanthetimeforthemtobeproducedfromscratch.Someevidencewillbepresentedtoshowthatthisisnotalwaysthecaseand,wherethereisgreatinter-observervariabilityincontouring,unaidedcontouringismoreefficient.

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Anotherproposedadvantageofauto-contouringisthatdelineationuncertaintywillbereduced.Theevidenceforthisisreviewedalongwiththemetricsusedtomeasurecontouringagreement.Finallytherewillbeashortdiscussionoftheclinicalimpactofdelineationuncertainty.

Educationalaimsandlearningoutcomes• Beawareofauto-outliningandhow2particularsystemswork• Knowthatuseofsuchsystemscansavetime• Statetheconditionsinwhichsignificanttimesavingscanbeachieved• Beawareofdelineationagreementmetricsandtheirlimitations• Beawareofdelineationuncertaintyandsomeofitsimpactontreatment

planning

Volume definition after neo-adjuvant chemotherapyDr Tom Roques

Thepotentialbenefitsofneo-adjuvantchemotherapyinheadandneckcancerremainhotlydebatedbutthereisnotdoubtthatmanytumoursshrinkwhenchemotherapyisgivenbeforecurativeradiation.Thispresentsachallengeastargetvolumeshavetobedefinedatatimewhentheprimarysiteandinvolvednodesmaybesmallerthanatdiagnosisorevennotvisibleatall.Thistalkwillexploretheevidencebasefordecidinghowtocontourafterneo-adjuvantchemotherapyandwillsuggestmethodsforensuringthatanypotentialbenefitsofneo-adjuvantchemotherapyaremaximizedwhilstensuringthattheradiotherapyisnotcompromised.

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