John C. Breneman, M.D., medical director of the Cincinnati Children's/UC Health Proton Therapy Center, and the principal investigator of the FAST-01 trial, explains FLASH therapy and details on the trial. This study is testing the use of a single FLASH proton therapy session, rather than weeks of fractionated doses.

FLASH and hypo fractionated therapy have been among the hottest topics in radiation oncology. The premise of FLASH is to deliver extremely high doses of radiation to a tumor in one, short dose. Lab testing has shown this actually has a healthy tissue sparing capability and may help in reducing collateral damage.  

If this and other trials show benefit and improved outcomes from FLASH, it is possible this may become the primary treatment method for many cancers in the years to come. Reducing therapy to one treatment session also would open up much more time for proton centers so many more patients could be treated. It also would be a significant time and cost savings for patients and their families, who would not be required to stay at nearby hotels for extended stays during their course of treatment.  

Cincinnati Children's/UC Health Proton Therapy Center announced the completion of enrollment in FAST-01 (FeAsibility Study of FLASH Radiotherapy for the Treatment of Symptomatic Bone Metastases) in October. This is the first human clinical trial of FLASH therapy, which centered on patients with metastases in arms and legs to avoid irradiating critical structures. If this trials shows benefits and low toxicity, followup studies will attempt more complex treatments in other parts of the body.

Related ASTRO 2021 Radiation Oncology Content:

7 Trends in Radiation Therapy at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021 

Photo Gallery of Technologies at ASTRO 2021

VIDEO: Sedating Children With Movies Rather Than Drugs for Radiation Therapy — Interview with Jeffrey T. Chapman

VIDEO: 4 Radiation Oncology Technologies to Watch — Interview with Anthony Zietman, M.D.

VIDEO: Advances in Radiopharmaceutical Therapy — Interview with Ana Kiess, M.D., Ph.D.

VIDEO: MRI-Linac and PSMA PET Imaging Technologies Aids Therapy at GenesisCare — Interview with Walter Curran, Jr. M.D., 

VIDEO: Elekta Harmony Radiotherapy System Walk-around

VIDEO Example of the Varian Noona Bidirection Oncology Patient Interface Software

VIDEO: Examples of Cherenkov Radiation Imaging During Radiation Therapy

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At RSNA 2021, Philips highlighted the launch of two new innovative CT systems – the multi-energy Spectral CT 7500 and the CT 5100 Incisive with embedded AI capabilities. ITN spoke with Wendy Winkle Lawless, CT Business Market Leader - North America, Philips, to learn more about these new systems.

With the use of contrast agents and radiotracers on the rise, GE Healthcare has seen increases in demand across their pharmaceutical diagnostics business. At RSNA 2021, Marco Campione, General Manager, Pharmaceutical Diagnostics Americas, GE Healthcare, shared how recent investments are helping to meet this increased demand.

Find more RSNA21 content here

At RSNA 2021, Fujifilm launched its new Velocity MRI system. It is designed to streamline workflow and enhance the patient experience with its open gantry, integrated RF coils and reconstruction techniques. Shawn Etheridge, Director, CT and MRI Marketing for Fujifilm, unveiled the system on the RSNA21 show floor.

Fujifilm Launches the Velocity MRI System at RSNA 2021

Additional RSNA21 content

Brian S. Bingham, M.D., chief resident in radiation oncology at the Vanderbilt University Medical Center, explains the practice-level and national cost burden of treatment-related prior authorization for academic radiation oncology practices. This was a highlighted study presented at the 2021 American Society of Radiation Oncology (ASTRO) annual meeting.

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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Bridget F. Koontz, M.D., chief medical officer at GenesisCare USA explains how to manage the complex needs of pelvic radiotherapy survivors. She offers an. overview of published evidence about the various toxicity types and approaches for managing them.

Photo Gallery of Technologies at ASTRO 2021

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7 Trends in Radiation Therapy at ASTRO 2021

Sun Nuclear highlighted two resources for CT Quality Assurance at RSNA 2021. ITN visited their booth to learn more about the Mercury 4.0 Phantom and the Multi-Energy CT Phantom from Thomas Webb, Global Product Marketing Manager

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Marc Succi, M.D., an emergency radiologist at MGH and executive director of the MESH Incubator, an in-house innovation and entrepreneurship center, and  Ottavia Zattra, a fourth-year medical student at Harvard Medical School, explain a study they authored showing there might be higher cancer rates due to lower numbers of CT scans during COVID-19. They presented this study as a late-breaker at the Radiological Society of North America (RSNA) 2021 annual meeting.

COVID caused many people to delay seeing their doctors. Their study found a corresponding 82% drop in CT imaging for cancer screening. CT is also used for initial cancer workups, to monitor active cancer and post procedure surveillance, which all also showed decline since the start of the pandemic.

Read more about the study COVID-19 Fallout May Lead to More Cancer Deaths

Mahadevappa Mahesh, Ph.D., chief physicist, Johns Hopkins Hospital, and professor of radiology and radiological science, explains the basics involved in quality assurance (QA) of radiology imaging systems. He spoke to ITN at the Radiological Society of North America (RSNA) 2021 annual meeting.

He explains the role of the medical physicist in keeping X-ray imaging systems such as CT, angiography and mammography calibrated and checking the device output of radiation. This is performed by imaging phantoms that mimic a simplified representation of the human body. 

Artificial intelligence (AI) use is growing in imaging and medical physics and QA of these systems might also become a duty of the medical physicist in some AI imaging applications.  

Find more content on QA systems

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Rik Primo, principle at Primo Medical Imaging Informatics Consultants and former health IT developer with Siemens, Philips and Agfa, explains the difference cloud-native versus cloud-enabled PACS and radiology enterprise imaging systems. He spoke with ITN during RSNA 2021.the Radiological Society of North America (RSNA) 2021 annual meeting.

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Here are two examples of artificial intelligence (AI) driven pulmonary embolism (PE) response team apps featured by vendors Aidoc and Viz.AI at the 2021 Radiological Society of North America (RSNA) 2021 meeting.

The AI scans computed tomography (CT) image datasets as they came off the imaging system and looked for evidence of PE. If detected by the algorithm, it immediately sends an alert to the stroke care team members via smartphone messaging. This is done before the images are even loaded into the PACS. The radiologist on the team can use a link on the app to open the CT dataset and has basic tools for scrolling, windowing and leveling to determine if there is a PE and the severity. The team can then use the app to send messages, access patient information, imaging and reports. This enabled them all to be on the same page and can communicate quickly via mobile devices, rather than being required to use dedicated workstations in the hospital. 

Both vendors showed similar apps for stroke at RSNA 2019. That idea for rapid alerts, diagnosis and communications for acute care teams has now expanded to PE and also for aortic dissection and abdominal aortic aneurysms (AAA). AI.Viz and Aidoc are looking at expanding this type of technology for other acute care team rolls, including heart failure response. 

Read more about this technology in the article AI Can Facilitate Automated Activation of Pulmonary Embolism Response Teams.

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Jean Jeudy, M.D., professor of radiology and vice chair of informatics at the University of Maryland School of Medicine, presented a late-breaking study at the 2021 Radiological Society of North America (RSNA) meeting on COVID-19 linked myocarditis in college athletes. 

A small but significant percentage of college athletes with COVID-19 develop myocarditis, a potentially dangerous inflammation of the heart muscle, that can only be seen on cardiac MRI, according to the study Jeudy presented. Myocarditis, which typically occurs as a result of a bacterial or viral infection, can affect the heart’s rhythm and ability to pump and often leaves behind lasting damage in the form of scarring to the heart muscle. It has been linked to as many as 20% of sudden deaths in young athletes. The COVID-19 pandemic raised concerns over an increased incidence of the condition in student-athletes.

For the new study, clinicians at schools in the highly competitive Big Ten athletic conference collaborated to collect data on the frequency of myocarditis in student-athletes recovering from COVID-19 infection. Conference officials had required all athletes who had COVID-19 to get a series of cardiac tests before returning to play, providing a unique opportunity for researchers to collect data on the athletes’ cardiac status.

Thirty-seven of the athletes, or 2.3%, were diagnosed with COVID-19 myocarditis, a percentage on par with the incidence of myocarditis in the general population. However, an alarmingly high proportion of the myocarditis cases were found in athletes with no clinical symptoms. Twenty of the patients with COVID-19 myocarditis (54%) had neither cardiac symptoms nor cardiac testing abnormalities. Only cardiac MRI identified the problem.

Read more details in the article COVID-19 Linked to Heart Inflammation in College Athletes.

Find more RSNA news and video

Related COVID-19 Imaging and Myocarditis Content:

Overview of Myocarditis Cases Caused by the COVID-19 Vaccine

COVID-19 Linked to Heart Inflammation in College Athletes — RSNA 2021 late-breaker

Cardiac MRI of Myocarditis After COVID-19 Vaccination in Adolescents

Large International Study Reveals Spectrum of COVID-19 Brain Complications - RSNA 2021 late-breaker

COVID-19 During Pregnancy Doesn’t Harm Baby’s Brain

VIDEO: Large Radiology Study Reveals Spectrum of COVID-19 Brain Complications — Interview with Scott Faro, M.D.

FDA Adds Myocarditis Warning to COVID mRNA Vaccine Clinician Fact Sheets

Small Number of Patients Have Myocarditis-like Illness After COVID-19 Vaccination

Elizabeth Hawk, M.D., Ph.D., director of innovation Engagement at Rad Partners, a regional president for Matrix Teleradiology, and assistant professor of medicine at Stanford, explains how the COVID-19 pandemic has helped advance home reading and changed radiology.

While teleradiology and remote reading is not new, its expansion was greatly accelerated in 2020-2021 due to COVID. Early in the pandemic, hospitals tried to get as many of their employees as possible to work remotely, and radiologists who wanted to read from home were allowed to do so in large numbers. The past two years has taught many people that remote reading from home is possible and it also can aid the balance between work and family life. Hawk said remote reading will likely be the new normal even after the pandemic.

Hawk presented in a session on this topic at the 2021 Radiological Society of North America (RSNA) annual meeting. She said many radiologists from her practice were already reading from home prior to the pandemic, so they had the experience to quickly ramp up expansion during COVID. She offers advice to hospitals that want to introduce or expand home radiology reading. 

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Kate Hanneman, M.D., MPH, FRCPC, director of cardiac imaging research JDMI, and the medical imaging site director at Toronto General Hospital, Women’s College Hospital, was an author on a recent overview of cardiac MRI assessments of non-ischemic myocardial inflammation caused by the COVID-19 vaccine. She presented this study and other related data at the 2021 Radiological Society of North America (RSNA) meeting. 

The rare side effect from the COVID vaccine is seen mainly in young men between ages 12-29. It appears to resolve on its own after a couple days, but longer term monitoring is needed to show if there is any lasting cardiac damage. A small number of single cases with follow up MRI imaging so far have not shown long term damage. 

Hanneman noted the incidence of vaccine-related myocarditis is very rare and people have a much high probability of getting much more serious COVID-viral myocarditis is they are not vaccinated. She said so the risk-vs-benefit analysis currently shows it is better to get vaccinated to prevent or lessen the effects of COVID. 

Related COVID-19 Imaging Content:

VIDEO: COVID-19 Linked to Heart Inflammation in College Athletes — Interview with Jean Jeudy, M.D.

Overview of Myocarditis Cases Caused by the COVID-19 Vaccine

COVID-19 Linked to Heart Inflammation in College Athletes — RSNA 2021 late-breaker

Cardiac MRI of Myocarditis After COVID-19 Vaccination in Adolescents

Large International Study Reveals Spectrum of COVID-19 Brain Complications - RSNA 2021 late-breaker

COVID-19 During Pregnancy Doesn’t Harm Baby’s Brain

VIDEO: Large Radiology Study Reveals Spectrum of COVID-19 Brain Complications — Interview with Scott Faro, M.D.

FDA Adds Myocarditis Warning to COVID mRNA Vaccine Clinician Fact Sheets

Small Number of Patients Have Myocarditis-like Illness After COVID-19 Vaccination

Jeffrey T. Chapman, a medical student at the University of Texas Southwestern Medical Center, Explains how watching movies can be used to help sedate pediatric radiation therapy patients. He presented the results of the Pediatric Radiation Oncology With Movie Induced Sedation Effect (PROMISE) study at the 2021 American Society of Radiation Oncology (ASTRO) annual meeting.

Children usually have to be sedated with anesthesia to keep them immobile each day for weeks for their daily fractions of radiotherapy. This presents problems because the child will have side effects from the anesthesia and face issues with eating only at certain times. UTSW developed a system where the child can watch a movie and if they move the movie and the radiation beam both immediately shut off. This trains the child to stay still during treatments without the need for anesthesia.

7 Trends in Radiation Therapy at ASTRO 2021

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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The Elekta Harmony radiotherapy system gained FDA clearance in the summer of 2021 and was on display for the first time at the American Society of Radiation Oncology (ASTRO) 2021 meeting. It offers fast treatments and the ability to track and treat multiple metastases at the same time. 

It has a large round screen on the machine so the patient's information is immediately available table side. It uses facial recognition to verify the correct patient is in the room for treatment.

The speed of the treatment delivery increased over that of prior systems, so the time a patient spends in the treatment room for lung SBRT went from 30 minutes down to less than 2 minutes. SBRT prostate went down from 5 minutes to 90 seconds. It also can perform hypofractionation lung therapy in a single 20 minute treatment.

Read more on the Harmony system. 

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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Walter Curran, Jr. M.D., FACR, FASCO, GenesisCare global chief medical officer, discusses three technologies that are helping advance radiation oncology care during the American Society of Radiation Oncology (ASTRO) 2021 meeting. These technology advances include:

   • Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging for prostate cancer.

   • MRI-linear accelerator (Linac) systems that allow real-time imaging during radiation therapy.

   • Remote treatment planning to help radiation treatment centers that are in rural areas.

Prostate cancer is one of the most common cancers in men. The new PSMA PET imaging is expected to significantly improve how prostate cancer is detected and treated. The FDA approved the drug for PET nuclear imaging of PSMA-positive lesions in men with prostate cancer. 68Ga-PSMA-11 is a radioactive imaging agent that binds to prostate cancer cells to help localize prostate cancer cells.

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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Anthony Zietman, M.D., interim chief, radiation oncology, Mass General Cancer Center, and former president of the American Society of Radiation Oncology (ASTRO), explains some of the recent technology trends to watch in radiation oncology at the ASTRO 2021 meeting.

He said four technologies to watch include:
   • Proton therapy
   • FLASH therapy
   • Image guided radiotherapy
   • PET guided radiotherapy

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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An example of the Varian Noona software used by clinicians to interface with oncology patients demonstrated at the American Society of Radiation Oncology (ASTRO) 2021 meeting. It allows bi-direction communication between the care team and the patient’s smartphone. This included reporting complains about side effects, pain, questions for the physician and surveys. The data the interfaces with the patient record so anyone on the care team can access it or reach out to the patient.

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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An example of flexible bolus made from silicone on molds that were 3-D printed from patient CT scans. These are very flexible, so more comfortable for the patient than 3D printed plastic. These are used to attenuate electron beam radiation therapy (EBRT) doses in treating skin cancers. This a new product, FlexiBol,  from Decimal shown for the first time at the American Society of Radiation Oncology (ASTRO) 2021 meeting. 

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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