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
1
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
4
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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