The American Association of Physicists delimited via Medicine (AAPM) will grab its 46th annual crowd by the edge of July 25-29 in Pittsburgh, PA at the David L. Lawrence Convention Center. Approximately 1,000 abstract will be presented on a miscellanea of subject at the intersection of physics and drug. Many of these topic agreement beside the perfection of state-of-the-art imaging and useful devices, and the untried technique that stir along with them.
CONTENTS This memo emanation launch sour by summarizing several business of the meeting, after allot a terse preamble to medical physics (including its intersection to ultimate year's Nobel Prize all for charming resonance imaging) and in the long race contain detailed highlights of seven papers/sessions at the meeting.
SUMMARY: THIS YEAR'S MEETING Highlights at the meeting contain: the preparatory 3D pictures from a neutron-based imaging technique; an MRI-based manoeuvre that television a drug's rate in combating a tumor's blood foot; and a technique for target a tumor that move in place of a uncomplaining inhale. Some frequent themes at this year's meeting include: the emergence of "4D scans" to cultivate the imaging and usage of cancer; the development of high-ranking "fusion imaging" that can all in pacifier verify an organ's shop and run; and a far-ranging symposium on the reliable frontiers of medical imaging and the anticipated of radiation analysis. Additional highlights include a symposium, directed by Ehsan Samei of Duke University (samei@duke.edu), on how medical physicists can recovered apply their thoughtful culture of physics theory to the science of medical diagnosis ("From Physics To Medicine," Tuesday, 10AM-12PM); and a computer-aided diagnosis symposium, directed by Maryellen Giger of the University of Chicago (m-giger@uchicago.edu), which will showcase example of how software involuntarily help detect cancer and other bug ("CAD," Tuesday, 4:00-5:00 PM).
INTRODUCTION: PHYSICS AND MEDICINE Physics and medicine be dear allies. Ever since the exposure of X rays and their latent for medical imaging, physicists hold be major to the advancement of medicine. Fundamental research in optics, acoustics, electromagnetism, and atom and nuclear physics have front to an variety of indispensable medical tools. Magnetic resonance imagery (using microwaves), CAT scan (using X rays), PET scans (using gamma rays), ultrasound scans (using groan waves) and dappled type of radiotherapy are among the physics-based devices that lend a hand doctors diagnose and happiness ailments range from useless bones to cancer. Modern medicine has positive aspect by far from medical physics research, which in hence doing far has led to three Nobel Prizes in Medicine/Physiology.
AAPM include beyond 5,000 member faithful to advance medical technology. Medical physicists in a job in radiation therapy commission and develop new therapeutic techniques; collaborate with radiation oncologists to decoration chief cancer-treatment procedure; and calibrate and out of this world therapeutic machinery to ensure that both patient receive rightly the prescribed dose of radiation at the precise base forces camp. Medical physicists partake to the effectiveness of radiological imaging procedures by surfacing new imaging procedures, shooting up present techniques, and give your word radiation safekeeping of imaging procedures. Physicists working in medical imaging examine, model and try-out equipment to ensure that images are acquire at the utmost viable aspect for certain diagnosis of possible abnormality.
MRI NOBEL PRIZE: THE MEDICAL PHYSICS CONNECTION Last year's Nobel Prize in Physiology/Medicine be award for discovery principal to magnetic resonance imaging (MRI). What role do medical physics stage show in the birth of this immediately pervasive imaging technique? The discovery and development of MRI come in the region of in colossal sector from years of prior research that by today's definition falls resourcefully inwardly the heart of the skill of medical physics.
Furthermore, medical physicists jubilantly cultured MRI instrumentation and software, and integrated it into real-world medical environment such as hospital. When commercial machines become at your disposal in the reckless 1980s, medical physicists literary thousands of physician on how to exploitation MRI through workshops and unbeaten magazine article.
They led MRI society and committee that help to develop truly well-designed clinical candidature of the technique. Medical physicists bear the lead in defining and developing quality-assurance standards for both the instruments and the individuals who operate MRI equipment. Today, medical physicists manual vocation in medical surroundings to ensure that MRI images are as palpable, instructive, and high-resolution as possible. As part of team, they develop new imaging method, design state-of-the-art machines, and ensure the safety and solace of the MRI subway.
HIGHLIGHTS OF THE SCIENTIFIC PROGRAM The follow-on be a sampling of some of the overflowing intriguing conference that medical physicists will offering at the meeting.
I. NEUTRON-IMAGING TECHNIQUE MAY LEAD TO EARLIER BREAST CANCER DIAGNOSIS II. COMBATING TUMORS BY UNDERSTANDING THEIR VASCULATURE III. FIRST, DO NO HARM IV. THE BEST OF BOTH WORLDS FOR IMAGING BREAST CANCER V. 4D PET SCANS PROMISE BETTER LUNG CANCER TREATMENT VI. HOW TO HIT A MOVING TUMOR VII. THE FUTURE OF MEDICAL PHYSICS I. NEUTRON-IMAGING TECHNIQUE MAY LEAD TO EARLIER BREAST CANCER DIAGNOSIS To shoot the article, medical professionals conventionally use X rays, magnetic pasture (MRI), ultrasound, and in some cases, radioactive isotopes (PET scans). Now, Duke University physicists and radiologists have produced the first 3D pictures from a new technique that draft elementary particle call neutrons.
Why use neutrons for medical imaging? Compared to other particles, neutrons are fabled incisive, and therefore can impersonation effectively dug in body structure that cannot be crush by other probe. In knick-knack, neutrons can confidently identify almost every readily occurring chemical component in the body. Called Neutron Stimulated Emission Computed Tomography (NSECT), the technique involve illuminating the body with briskly neutrons (those with energies involving 1 and 10 MeV). The neutrons motivation the nucleus of facet part and molecules in the body to expel gamma-ray photons with distinctive energies that depend on the specific chemical identity of the atoms and molecules to which the nuclei belong.
At the AAPM meeting, Carey Floyd (cef@deckard.duhs.duke.edu) will present the first 3-D images ever remake from the energy of emblematic gamma rays stimulated by fast neutrons.
The images, of an iron-copper taste, illustrate the technique's facility to flawlessly recognize between the iron and copper that made in the air the carp.
With further development, NSECT could potentially diagnose breast cancer early by investigate difference in the reinforcement of air elements that are specified to survive between benign and malignant tissue. NSECT could identify cancer by the gizmo it relocate concentration of chemical elements in tissue extended back the cancer has begin to cause the anatomical changes (such as the foundation of squashed tumors or microcalcifications) that are detect by time-honoured methods. The researchers wild arithmetic that an NSECT clinical association, if successfully manufacturing, could worth a limb of a archetypal clinical CT system.
While an exceptional neutron is more wounding to the body than a lone x watercourse of correspondent make necessary, the researchers' preliminary calculation designate that an accurate test for breast cancer could be make at a dose resembling that of a general mammography experiment. As an intermediate tread towards this objective, the band subsequent plans to develop a outline system that can image the dissemination of iron in the liver pick over to diagnose hemochromatosis (iron pass off in the liver) undersupplied the name for for a biopsy. (Paper WE-D-315-6, Wednesday, July 28, 2:45 PM.) II. COMBATING TUMORS BY UNDERSTANDING THEIR VASCULATURE is a specialty of Jeffrey Evelhoch, who works at the Pfizer labs in Ann Arbor, Michigan. Compared with the blood supply system of vigorous tissue, a tumor's vasculature is more anarchic in its geometry and its vessel are wider and leakier. Knowing this, a canvasser can perchance tailor an anti-cancer remedy aimed at holding downstairs angiogenesis, the formation of new blood vessels in the tumor, i.e. smaller integer venomous (because it target the more affecting tumor) than elder drugs.
The method Evelhoch (jeffrey.evelhoch@pfizer.com) in the departed exceptional to judge drugs designed to extract the spinelessness in the tumor vasculature is a modus operandi called dynamic contrast-enhanced (DCE) MRI, where on earth MRI scan is performed before, during and after the immunisation of a assessment agent. From this a quantitative even of the pharmacodynamic effectiveness of the treatment can be pull off. (Paper WE-D-305-2, Wednesday, July 28, 2 PM.) III. FIRST, DO NO HARM is the injunction follow by medical doctors. In the sovereignty of treat the body with radiotherapy the conflicting subtitle may perhaps be "Do the smallest harm to healthy tissue while doing maximum injury to tumors." Since healthy tissue cannot always be spared harm during treatment, it is assiduous to know which healthy tissue is the peak famous to the subsistence of the patient, so that the deliver radiation can be steered away. Conversely, the important part of tumors can be singled out for focus. To accomplish all of this, functional PET and MRI imaging---medical imaging that provides word of mouth not of tardy about the spatial location of tissue but also its function---is vital.
Further, it is important to take to mean how all county of a ordinary organ responds to radiation, such that prediction can be made about the anticipated amount of normal tissue injury. At the meeting, Lawrence Marks of Duke University (marks@radonc.duke.edu) will sneak on his work using functional imaging to minimize and monitor radiation-induced normal tissue injury. The Duke grades, base on several hundred patients, is one of the largest experience exploit this outlook. (Paper WE-D-305-1, Wednesday, July 28, 1:30 PM.) IV. THE BEST OF BOTH WORLDS: COMBINING TWO BREAST-IMAGING TECHNIQUES MAY DELIVER SIGNIFICANT IMPROVEMENTS Breast cancer is the second leading cause of cancer extermination in American women. To better detect and diagnose breast cancer, Tao Wu of Massachusetts General Hospital/Harvard Medical School (twu2@partners.org) and his colleagues are merging two breast-imaging techniques: contrast development and digital breast tomosynthesis. The combined method can also potentially improve the ability to detect breast lesion, also as distinguish between benign and malignant lesions.
An emerging 3D imaging technique, digital breast tomosynthesis (DBT) has just now been shown in study of over and done with 400 women at the Massachusetts General Hospital to provide a great deal clearer images than conventional 2D mammography. DBT unmasks cancers that are ordinarily obscured by normal tissue on orthodox 2D mammograms. Contrast imaging involves the injection of an agent, such as iodine (in x-ray imaging) or gadolinium (in MRI), that compact in extraordinary breast tissue and "lights up" those region in subsequent images.
Combining 3D DBT and contrast-enhanced imaging in recent experiment, Wu and colleagues obtain DBT images of a breast tissue specimen before and after it was inject with an iodine-based contrast agent. The pre-injection image was subtract from the contrast-enhanced image, simply informative the perfect distribution of the contrast agent. Contrast-enhanced regions of the specimen be more clearly display and structures more tartly defined on DBT images.
To reach the goal of clinical in vivo imaging, some hard-nosed issues need to be studied, such as the effect of breast compression and making definite pre- and post-injection images are properly aligned with one another so that the latter can be well subtracted from the one-time. (Paper TU-E-317-4, Tuesday, July 27, 4 PM.) V. 4D PET SCANS PROMISE BETTER LUNG CANCER TREATMENT To ferment cancer patients for radiation therapy, medical physicists have developed a new contraption called the "4D scan," which abandon a 3D image of a tumor while track a patient's motion in the fourth dimension---time. A 4D scan provides a precise, sturdy location of a tumor--since the circumstance from the "fourth dimension" can correct for image make unclear and other insult cause by a patient's breathing and general aerobics. 4D imaging has recently been train for CT scans, but has not been available for other immensely important imaging methods.
Speaking at the meeting will be two self-sufficient group that are trialling 4D version of positron emission tomography (PET), an imaging technique mainly useful for boil lung tumors.
By using a radioactive tracer to breed images internal the body, PET distinguish regions within a collapsed lung that are cancerous and that would otherwise materialize as a uniform gray expanse on CT. PET also detect lymph nodes that are entangled in the cancer; such "involved" nodes may be as well slight to detect with CT.
The two independent groups, from the Washington University School of Medicine in St. Louis (Dan Low, low@wustl.edu) and the MD Anderson Cancer Center in Houston (Osama Mawlawi, omawlawi@mdanderson.org) use hybrid PET-CT machines. A CT scanner first map the motion of all organs and the tumor while the patient is breathing, then a PET scanner find detailed information on the tumor. Because the researchers know the motion of the organs and tumor from the CT scan, they can reposition the data in the PET scans to motion-correct the image. While differences exist in the two groups' approach, the teams have together validate the 4D PET approach in poltergeist (materials that simulate tissue) and in small-scale patient studies.
(Papers MO-E-315-2, Monday, July 26, 4:15 PM, and TU-D-BRB-1, Tuesday, July 27, 1:30 PM.) VI. HOW TO HIT A MOVING TUMOR Oncologists have a new way to invent cancer-fighting radiation treatment: with the advent of 4D CT scans that show how a tumor moves as a patient breathes, cancer can now be targeted more precisely and proficiently. By tracking a tumor's motion, doctors may before long know how to adjust the radiation dose during treatment. A group of researchers from Massachusetts General Hospital, plus Alexei Trofimov (atrofimov@partners.org), developed software to conceive cancer treatment plans based on 4D CT, deliver the select few whip of possible methods.
In one radiation treatment approach, preset apart dose may be created for different phase of a patient's breathing motion, synchronize the transfer with the motion of the target tumor, so that the dose is individual delivered when the tumor uncap a "gate" by poignant to a clear in your mind position--for nightmare, only when the patient exhale. The downside of a "gated" treatment is that it would take a significantly longer circumstance to deliver the needed radiation. Or, organ motion could work to the patient's benefit--if the tumor's boardwalk is marvellously known, treatment could be adapted to the motion of the tumor. Having a moving target would truly improve the corollary of treatment, which is as a matter of course not the grip with conventional plans.
If the treatment is based on the belief that a tumor will remove in a certain way and it do not, "the result may be just as barren as when we inaccurately claim that there's no motion," said Trofimov. With motion-adaptation, the dose can become stronger if the tumor moves according to plan. "It's sort of akin to spray-painting in the coil -- one has to aim differently," said Trofimov, whose work has win AAPM's Jack Fowler Junior Investigator Award, given to a researcher who has been in the field less than four years.
The group's preliminary calculations show that a assortment of "gating" and "motion-adaptation" might be the best approach for a physician to plan each treatment, case-by-case. (Paper TU-C-BRA-2, Tuesday, July 27, 10:10 AM.) VII. THE FUTURE OF MEDICAL PHYSICS A accentuate of every annual AAPM meeting, the President's Symposium features prophetic speaker who bicycle throw future trend in medical physics. The 1982 symposium incorporated a narration by Paul Lauterbur, who go on to helping last year's Nobel Prize for magnetic resonance imaging. This year, Andrew Maidment of the University of Pennsylvania (Andrew.Maidment@uphs.upenn.edu) will present a settle called "Nine Orders of Magnitude: Imaging from Man to Molecules." Describing how medical imaging has repositioning from the clamber of the organism to the scale of the organ, Maidment will question how medical physicists will shift their focus from imaging cancerous lesions the largeness of a cubic centimeter, or a billion cell, to identify single tumor cells.
"The future of medical physics will be tied to such finance," he say. Describing the impressive mechanical change over the last 10 years in how radiologists read the results of an imaging scan, Eliot Siegel of the University of Maryland (esiegel@umaryland.edu) will develop how the shift from reading 2D films to viewing 3D computer reconstructions offer new freedoms but also contains potential insolence. For example, the gush of information from 3D imaging may net it easier to not disturb with important parts of the image data. Finally, in a tabloid called "The Future of Radiotherapy," T. Rockwell Mackie of the University of Wisconsin (trmackie@wisc.edu) presage that the use of protons and lighting ions such as carbon ions in radiation therapy will develop, as the costs of services with those tools is anticipated to be ignominy. (Session MO-C-BRB, Monday, July 26, 10 AM-12 PM.) HOW TO COVER THE MEETING The AAPM meeting webpage (/meetings/04AM /) contains links to the in depth program, plus a Virtual Pressroom with more information on the solid program as well as announcements by the many medical-physics exhibitors at the meeting. Reporters interested in getting a complimentary grasp decoration for the meeting should compress out a registration method by July 16 at /meetings/04AM/documents/PressReg.pdf Even if you can't make it to Pittsburgh, the discern information and Virtual Pressroom will help you to lid meeting highlights from your escritoire. For aid in contact researchers and setting up interview, humour live out not wane to contact Ben Stein.
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