1. IMRT: Where next? Image guided Radiotherapy Dr. A. W. Beavis PhD Principal Physicist, Hull and East Yorkshire Hospitals (NHS) Trust (Hon) Senior Research Fellow, University of Hull

5. CMS:Focal FUSION used to fuse T2-weighted images with CT data set Use of T2 weighted images routine in our department for planning purposes

7. GE Lightspeed CT-PET combined scanner Should we obtain images at same point in time? So we KNOW the anatomy is registered.

14. Tumor Necrosis Normal NAA Cr Cho Cho Combination of MRI and 3D-MRSI >>> acquisition of an “image of spectra” MR-Spectroscopy Imaging (MRSI) Courtesy of Prof. Lynn Verhay, UCSF

15. Voxel size 1cc MRSI 3D contours Abnormality-Index 2 , 3 , 4 Courtesy of Prof. Lynn Verhay, UCSF

20. 1’38’’ 2’10’’ 4’53’’ t = 0 Enhancement factor, EF(t) Tumour (volume) in PZ Benign disease in CG: BPH Normal tissue i.e. RHS of PZ shows no/little uptake T1 weighted images at different time intervals post contrast injection. Don’t use rectal probe for Radiotherapy sequences!

21. Transfer of information into the Radiotherapy Treatment planning process 2 The data obtained from ‘tracking’ the progress of the Contrast during the T 1 scan (the DCE scan) can be analysed in several ways to extract spatial information to provide the treatment planning process. The simplest is to threshold the data set to identify all pixels that ‘enhanced’ above a certain (pre-determined) value. Plot of enhancement factor .v. time for a T 1 -DCE sequence obtained for a RT patient. A threshold analysis has identified those pixels in the shaded area as being viable tumour

23. Threshold the pixels that indicate tumour, XiO/ FOCAL contouring tools can pick it out T2-Weighted FSE Image overlay generated from DCE analysis added on Can now contour the tumour without further expert Radiology knowledge Use automatic contouring tools to pick these areas out and delineate them Transfer the information into the Radiotherapy Treatment planning system

24. Plot of enhancement factor .v. time 1 2 3 1 2 3 ROI 3 (orange) Dark bit of PZ on T2 image – could have interpreted as tumour – but DCE indicates it’s a benign problem T2 image with an overlay generated from the DCE fused on

29. Role of DCE in verification of (conventional) radiotherapy efficacy? Enhancement factor plots .v. time for a patient before conventional radiotherapy. Plots after treatment Plot of PSA level .v. time. A represents the time of the pre-Radiotherapy MRI-DCE scan and B the post-treatment scan. A B A B

32. 7.2 % 29.6 % 34.6 % MC (IMRT_OAR) MC (IMRT_noOAR) MC (Conv) Dose Volume Histogram

33. Reproducibility fMRI Series 2 Series 1 Series 3 0.605 0.605 0.572 Correlation Coefficient