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Article ; Online: Global democratisation of proton radiotherapy.

Yan, Susu / Ngoma, Twalib A / Ngwa, Wilfred / Bortfeld, Thomas R

2023 Volume 24, Issue 6, Page(s) e245–e254

Abstract: Proton radiotherapy is an advanced treatment option compared with conventional x-ray treatment, delivering much lower doses of radiation to healthy tissues surrounding the tumour. However, proton therapy is currently not widely available. In this Review, ...

Abstract	Proton radiotherapy is an advanced treatment option compared with conventional x-ray treatment, delivering much lower doses of radiation to healthy tissues surrounding the tumour. However, proton therapy is currently not widely available. In this Review, we summarise the evolution of proton therapy to date, together with the benefits to patients and society. These developments have led to an exponential growth in the number of hospitals using proton radiotherapy worldwide. However, the gap between the number of patients who should be treated with proton radiotherapy and those who have access to it remains large. We summarise the ongoing research and development that is contributing to closing this gap, including the improvement of treatment efficiency and efficacy, and advances in fixed-beam treatments that do not require an enormously large, heavy, and costly gantry. The ultimate goal of decreasing the size of proton therapy machines to fit into standard treatment rooms appears to be within reach, and we discuss future research and development opportunities to achieve this goal.
MeSH term(s)	Humans ; Protons ; Proton Therapy ; Neoplasms/radiotherapy ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy Dosage ; Radiotherapy
Chemical Substances	Protons
Language	English
Publishing date	2023-05-30
Publishing country	England
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	2049730-1
ISSN	1474-5488 ; 1470-2045
ISSN (online)	1474-5488
ISSN	1470-2045
DOI	10.1016/S1470-2045(23)00184-5
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Article ; Online: The societal impact of ion beam therapy.

Bortfeld, Thomas R / Viana, Matthew Fernandez de / Yan, Susu

Zeitschrift fur medizinische Physik

2020 Volume 31, Issue 2, Page(s) 102–104

MeSH term(s)	Heavy Ion Radiotherapy ; Monte Carlo Method
Keywords	covid19
Language	English
Publishing date	2020-07-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1104517-6
ISSN	1876-4436 ; 0939-3889 ; 0040-5973
ISSN (online)	1876-4436
ISSN	0939-3889 ; 0040-5973
DOI	10.1016/j.zemedi.2020.06.007
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Article ; Online: Three ways to make proton therapy affordable.

Bortfeld, Thomas R / Loeffler, Jay S

Nature

2017 Volume 549, Issue 7673, Page(s) 451–453

Language	English
Publishing date	2017-09-25
Publishing country	England
Document type	Journal Article
ZDB-ID	120714-3
ISSN	1476-4687 ; 0028-0836
ISSN (online)	1476-4687
ISSN	0028-0836
DOI	10.1038/549451a
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Article: Breast imaging with an ultra-low field MRI scanner: a pilot study.

Shen, Sheng / Koonjoo, Neha / Longarino, Friderike K / Lamb, Leslie R / Villa Camacho, Juan C / Hornung, Torben P P / Ogier, Stephen E / Yan, Susu / Bortfeld, Thomas R / Saksena, Mansi A / Keenan, Kathryn E / Rosen, Matthew S

medRxiv : the preprint server for health sciences

2024

Abstract: Breast cancer screening is necessary to reduce mortality due to undetected breast cancer. Current methods have limitations, and as a result many women forego regular screening. Magnetic resonance imaging (MRI) can overcome most of these limitations, but ... ...

Abstract	Breast cancer screening is necessary to reduce mortality due to undetected breast cancer. Current methods have limitations, and as a result many women forego regular screening. Magnetic resonance imaging (MRI) can overcome most of these limitations, but access to conventional MRI is not widely available for routine annual screening. Here, we used an MRI scanner operating at ultra-low field (ULF) to image the left breasts of 11 women (mean age, 35 years ±13 years) in the prone position. Three breast radiologists reviewed the imaging and were able to discern the breast outline and distinguish fibroglandular tissue (FGT) from intramammary adipose tissue. Additionally, the expert readers agreed on their assessment of the breast tissue pattern including fatty, scattered FGT, heterogeneous FGT, and extreme FGT. This preliminary work demonstrates that ULF breast MRI is feasible and may be a potential option for comfortable, widely deployable, and low-cost breast cancer diagnosis and screening.
Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Preprint
DOI	10.1101/2024.04.01.24305081
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Article: The societal impact of ion beam therapy

Bortfeld, Thomas R / Viana, Matthew Fernandez de / Yan, Susu

Z. med. Phys

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #654416
Database	COVID19

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Article ; Online: Automated clinical target volume delineation using deep 3D neural networks in radiation therapy of Non-small Cell Lung Cancer.

Xie, Yunhe / Kang, Kongbin / Wang, Yi / Khandekar, Melin J / Willers, Henning / Keane, Florence K / Bortfeld, Thomas R

Physics and imaging in radiation oncology

2021 Volume 19, Page(s) 131–137

Abstract: Background and purpose: Clinical targeted volume (CTV) delineation accounting for the patient-specific microscopic tumor spread can be a difficult step in defining the treatment volume. We developed an intelligent and automated CTV delineation system ... ...

Abstract	Background and purpose: Clinical targeted volume (CTV) delineation accounting for the patient-specific microscopic tumor spread can be a difficult step in defining the treatment volume. We developed an intelligent and automated CTV delineation system for locally advanced non-small cell lung carcinoma (NSCLC) to cover the microscopic tumor spread while avoiding organs-at-risk (OAR). Materials and methods: A 3D UNet with a customized loss function was used, which takes both the patients' respiration-correlated ("4D") CT scan and the physician contoured internal gross target volume (iGTV) as inputs, and outputs the CTV delineation. Among the 84 identified patients, 60 were randomly selected to train the network, and the remaining as testing. The model performance was evaluated and compared with cropped expansions using the shape similarities to the physicians' contours (the ground-truth) and the avoidance of critical OARs. Results: On the testing datasets, all model-predicted CTV contours followed closely to the ground truth, and were acceptable by physicians. The average dice score was 0.86. Our model-generated contours demonstrated better agreement with the ground-truth than the cropped 5 mm/8 mm expansion method (median of median surface distance of 1.0 mm vs 1.9 mm/2.0 mm), with a small overlap volume with OARs (0.4 cm Conclusions: The CTVs generated by our CTV delineation system agree with the physician's contours. This approach demonstrates the capability of intelligent volumetric expansions with the potential to be used in clinical practice.
Language	English
Publishing date	2021-08-23
Publishing country	Netherlands
Document type	Journal Article
ISSN	2405-6316
ISSN (online)	2405-6316
DOI	10.1016/j.phro.2021.08.003
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Article ; Online: Toward MR-integrated proton therapy: modeling the potential benefits for liver tumors.

Moteabbed, Maryam / Smeets, Julien / Hong, Theodore S / Janssens, Guillaume / Labarbe, Rudi / Wolfgang, John A / Bortfeld, Thomas R

Physics in medicine and biology

2021 Volume 66, Issue 19

Abstract: Magnetic resonance imaging (MRI)-integrated proton therapy (MRiPT) is envisioned to improve treatment quality for many cancer patients. However, given the availability of alternative image-guided strategies, its clinical need is yet to be justified. This ...

Abstract	Magnetic resonance imaging (MRI)-integrated proton therapy (MRiPT) is envisioned to improve treatment quality for many cancer patients. However, given the availability of alternative image-guided strategies, its clinical need is yet to be justified. This study aims to compare the expected clinical outcomes of MRiPT with standard of practice cone-beam CT (CBCT)-guided PT, and other MR-guided methods, i.e. offline MR-guided PT and MR-linac, for treatment of liver tumors. Clinical outcomes were assessed by quantifying the dosimetric and biological impact of target margin reduction enabled by each image-guided approach. Planning target volume (PTV) margins were calculated using random and systematic setup, delineation and motion uncertainties, which were quantified by analyzing longitudinal MRI data for 10 patients with liver tumors. Proton treatment plans were created using appropriate PTV margins for each image-guided PT method. Photon plans with margins equivalent to MRiPT were generated to represent MR-linac. Normal tissue complication probabilities (NTCP) of the uninvolved liver were compared. We found that PTV margin can be reduced by 20% and 40% for offline MR-guided PT and MRiPT, respectively, compared with CBCT-guided PT. Furthermore, clinical target volume expansion could be largely alleviated when delineating on MRI rather than CT. Dosimetric implications included decreased equivalent mean dose of the uninvolved liver, i.e. up to 24.4 Gy and 27.3 Gy for offline MR-guided PT and MRiPT compared to CBCT-guided PT, respectively. Considering Child-Pugh score increase as endpoint, NTCP of the uninvolved liver was significantly decreased for MRiPT compared to CBCT-guided PT (up to 48.4%,
MeSH term(s)	Humans ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/radiotherapy ; Magnetic Resonance Imaging/methods ; Particle Accelerators ; Proton Therapy ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Image-Guided/methods ; Radiotherapy, Intensity-Modulated/methods
Language	English
Publishing date	2021-09-23
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	208857-5
ISSN	1361-6560 ; 0031-9155
ISSN (online)	1361-6560
ISSN	0031-9155
DOI	10.1088/1361-6560/ac1ef2
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Article ; Online: Mathematical Optimization of Treatment Schedules.

Gorissen, Bram L / Unkelbach, Jan / Bortfeld, Thomas R

International journal of radiation oncology, biology, physics

2016 Volume 96, Issue 1, Page(s) 6–8

MeSH term(s)	Adult ; Clinical Protocols ; Glioblastoma ; Humans ; Mathematics ; Models, Theoretical
Language	English
Publishing date	2016-08-10
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2016.04.012
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Article ; Online: Combined clinical and research training in medical physics in a multi-institutional setting: 13-year experience of Harvard Medical Physics Residency Program.

Lyatskaya, Yulia / Winey, Brian / Kiger, W S / Hurwitz, Martina / Zygmanski, Piotr / Makrigiorgos, G Mike / Bortfeld, Thomas R / Doppke, Karen P / Lu, Xing-Qi / Chin, Lee M / Biggs, Peter / Gierga, David P

Journal of applied clinical medical physics

2022 Volume 24, Issue 1, Page(s) e13806

Abstract: Purpose: This manuscript describes the structure, management and outcomes of a multi-institutional clinical and research medical physics residency program (Harvard Medical Physics Residency Program, or HMPRP) to provide potentially useful information to ...

Abstract	Purpose: This manuscript describes the structure, management and outcomes of a multi-institutional clinical and research medical physics residency program (Harvard Medical Physics Residency Program, or HMPRP) to provide potentially useful information to the centers considering a multi-institutional approach for their training programs. Methods: Data from the program documents and public records was used to describe HMPRP and obtain statistics about participating faculty, enrolled residents, and graduates. Challenges associated with forming and managing a multi-institutional program and developed solutions for effective coordination between several clinical centers are described. Results: HMPRP was formed in 2009 and was accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) in 2011. It is a 3-year therapy program, with a dedicated year of research and the 2 years of clinical training at three academic hospitals. A CAMPEP-accredited Certificate Program is embedded in HMPRP to allow enrolled residents to complete a formal didactic training in medical physics if necessary. The clinical training covers the material required by CAMPEP. In addition, training in protons, CyberKnife, MR-linac, and at network locations is included. The clinical training and academic record of the residents is outstanding. All graduates have found employment within clinical medical physics, mostly at large academic centers and graduates had a 100% pass rate at the oral American Board of Radiology exams. On average, three manuscripts per resident are published during residency, and multiple abstracts are presented at conferences. Conclusions: A multi-institutional medical physics residency program can be successfully formed and managed. With a collaborative administrative structure, the program creates an environment for high-quality clinical training of the residents and high productivity in research. The main advantage of such program is access to a wide variety of resources. The main challenge is creating a structure for efficient management of multiple resources at different locations. This report may provide valuable information to centers considering starting a multi-institutional residency program.
MeSH term(s)	Humans ; United States ; Internship and Residency ; Education, Medical, Graduate ; Accreditation ; Health Physics/education ; Health Facilities
Language	English
Publishing date	2022-11-08
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1002/acm2.13806
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Article ; Online: Inter-patient variations of radiation-induced normal-tissue changes in Gd-EOB-DTPA-enhanced hepatic MRI scans during fractionated proton therapy.

Richter, Christian / Andronesi, Ovidiu C / Borra, Ronald J H / Voigt, Felix / Löck, Steffen / Duda, Dan G / Guimaraes, Alexander R / Hong, Theodore S / Bortfeld, Thomas R / Seco, Joao

Clinical and translational radiation oncology

2019 Volume 18, Page(s) 113–119

Abstract: Background and purpose: Previous MRI studies have shown a substantial decrease in normal-tissue uptake of a hepatobiliary-directed contrast agent 6-9 weeks after liver irradiation. In this prospective clinical study, we investigated whether this effect ... ...

Abstract	Background and purpose: Previous MRI studies have shown a substantial decrease in normal-tissue uptake of a hepatobiliary-directed contrast agent 6-9 weeks after liver irradiation. In this prospective clinical study, we investigated whether this effect is detectable during the course of proton therapy. Material and methods: Gd-EOB-DTPA enhanced MRI was performed twice during hypo-fractionated proton therapy of liver lesions in 9 patients (plus two patients with only one scan available). Dose-correlated signal changes were qualitatively scored based on difference images from the two scans. We evaluated the correlation between the MRI signal change with the planned dose map. The GTV was excluded from all analyses. In addition, were examined timing, irradiated liver volume, changes in liver function parameters as well as circulating biomarkers of inflammation. Results: Strong, moderate or no dose-correlated signal changes were detected for 2, 3 and 5 patients, respectively. Qualitative scoring was consistent with the quantitative dose to signal change correlation. In an exploratory analysis, the strongest correlation was found between the qualitative scoring and pretreatment IL-6 concentration. For all patients, a clear dose-correlated signal decrease was seen in late follow-up scans. Conclusion: Radiation-induced effects can be detected with Gd-EOB-DTPA enhanced MRI in a subgroup of patients within a few days after proton irradiation. The reason for the large inter-patient variations is not yet understood and will require validation in larger studies.
Language	English
Publishing date	2019-04-26
Publishing country	Ireland
Document type	Journal Article
ISSN	2405-6308
ISSN (online)	2405-6308
DOI	10.1016/j.ctro.2019.04.013
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