Real-Time Radiation Tracking Unlocks Safer Cancer Treatment:
Radiation therapy, also called radiotherapy, is one of the most commonly utilized forms of cancer treatment. In a nutshell, radiotherapists use high-energy particles and waves (often X-rays) to damage or destroy cancer cells, which prevents those cells from multiplying and spreading across the body. But a lack of precision subverts radiotherapy's efficiency: Healthy cells often bear the brunt of those high-energy waves, too, resulting in uncomfortable side effects and even future cancers.
Thanks to new research, medical experts might soon be able to fine-tune radiation delivery to avoid the treatment's less desirable outcomes. A team at the University of Michigan has developed a way to visualize radiotherapy delivery via precise 3D imaging. Their method, described Monday in the journal Nature Biotechnology, takes advantage of thermal energy within the human body to map radiotherapy's effects in real time.
[...] The team's system uses an array of ultrasonic transducers placed at the cancer patient's side to detect sound waves associated with radiotherapy. Once the transducers receive a wave, they amplify it and communicate it to an ultrasound that constructs it into a 3D image. The image is what allows radiotherapists to monitor the radiation's physical path and adjust delivery in real time. These adjustments would not only help radiotherapists avoid damaging healthy tissues, but also allow them to accommodate for differences in organ size and placement from patient to patient.
"In future applications, this technology can be used to personalize and adapt each radiation treatment to assure normal tissues are kept to a safe dose and that the tumor receives the dose intended," Kyle Cuneo, associate professor of radiation oncology, said in a university statement. "This technology would be especially beneficial in situations where the target is adjacent to radiation-sensitive organs such as the small bowel or stomach."
Journal Reference:
Zhang, Wei, Oraiqat, Ibrahim, Litzenberg, Dale, et al. Real-time, volumetric imaging of radiation dose delivery deep into the liver during cancer treatment [open], Nature Biotechnology (DOI: 10.1038/s41587-022-01593-8)
(Score: 3, Informative) by JoeMerchant on Thursday January 05, @08:57PM (6 children)
Although mistakes are made all the time, most radiotherapy treatments are reasonably accurate in the amount of dose they deliver, and have been since the 1960s.
What's relatively new is tracking where in your flabby, squishy, breathing, movable carcass that dose is going. I worked with this crew for a while: https://viewray.com/ [viewray.com] they do simultaneous MRI with radiotherapy so they know better if your tumor is getting the dose they expect it to, or not.
All in all, I think it's preferable to avoid use of ionizing radiation at all, when possible: https://www.medtronic.com/us-en/healthcare-professionals/products/neurological/laser-ablation/visualase.html [medtronic.com]
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(Score: 2) by RS3 on Thursday January 05, @11:01PM (5 children)
Not spam nor shill- I have nothing to gain by mentioning this, but an incredible radiation therapy is CyberKnife [cyberknife.com]. It's kind of a dumb name, but it's highly focused, less than 1mm accuracy, x-ray treatment. Typically only 3 - 5 treatments are needed, and the treatment is only a few, maybe 10 minutes (could be more, but not long).
There's also proton-beam therapy, which might be very powerful last resort, but it can take 20 - 40 treatments, which can be a big problem if patient doesn't live near one of the very few (iirc 7 in the US) proton-beam centers. (Yes, there's a syncrotron under the treatment room).
My dad had developed a tumor in one of his lower vertebra. I still have the images from the MRI- unbelievable that he could function. He was taking up to 4,000 acetaminophen (paracetamol) (yes, the max) a day. His healthcare providing hospital network did not (and does not) have CyberKnife, but I knew of it, got him in to an appt, and got them to do the treatment (it was a no-brainer of course).
First treatment all pain was gone.
The system uses very high resolution combination MRI & CT images of the patient, so it can "see" the tumor and in a sort of AI way, keeps track of everything as it's moving around the patient and delivering the x-ray beam.
Also, they place fiducial markers [radiologyinfo.org] on and / or in the patient, and the computer follows movement, so as the patient breathes or moves a little, the system follows and keeps accurate aim.
It's commonly used for prostate problems, but can apply to almost any solid-mass tumor, and many cancers.
(Score: 3, Informative) by JoeMerchant on Friday January 06, @12:22AM (4 children)
As always, do your own research before pursuing a course of treatment for yourself or a loved one...
Cyber knife was really cool 20 years ago, and still has good applications, but in brain surgery it has a not so great side effect called "necrotic fringe.". It originates in the zone between the tumor that is killed and the tissue that is left healthy, and unfortunately it can spread, slowly but... unendingly. Better than living with an aggressive tumor, but less than ideal.
An alternative called thermal ablation can also kill target tissue but it does not leave a necrotic fringe. In fact a lot of the early applications of MRI guided laser thermal ablation were "cleaning up" necrotic fringe so it wouldn't spread further. Downside vs cyber knife is that the laser heat is delivered via fiber optics, so the equivalent of a biopsy needle needs to be inserted through a small hole in the skull, and there is a small risk of a big problem if that fiber hits a vessel branch and ruptures it.
Further disclaimers: I am not a MD, this is not medical advice, consult your doctor(s) about your personal situation(s) and importantly I don't even know what I don't know about any of this.
Still, with what little I do know, if I ever have the misfortune to be recommended cyber knife for anything, I would definitely investigate the thermal ablation option.
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(Score: 2) by RS3 on Friday January 06, @12:58AM (3 children)
Wow, thank you, I hadn't heard of that problem with brain tumors. So maybe after CyberKnife or other energy-beam therapy, tumor removal would be strongly advised?
Nor am I an MD or DO, but in addition to your advice / disclaimer, I'd say if someone has any kind of brain tumor, get the very top help and treatment.
Part of what I was trying to say is that my dad's doctors, and that entire hospital system: at least 5 hospitals, several urgent care centers, some very large outpatient treatment centers, many many Dr.s offices, and none talked about CyberKnife, which was the best for him. Well, again, proton beam but very many long trips needed for that.
I didn't want to type up a storm in the previous post so I cut this: a good friend of mine works as an R&D scientist / engineer in acoustic transducers. He's one of a few people on earth that can build very tiny sensors / transducers.
10 or so years ago he was building some transducers for use in tumor treatment- specifically prostate, but to be used wherever it can. Not sure if it would be called ablation, but as you hinted, heat tends to shrink or even kill tumors.
Aforementioned friend's company's transducers would be inserted trans-urethrally to heat prostate using sound. Transducers were smaller than a grain of rice, so essentially no side effects.
Generally called HIFU [clevelandclinic.org], most often used in prostate treatment but could be used almost anywhere.
I don't know how the clinical trials went, but generally thermal tumor treatment and hopefully reduction is a thing now.
There are also treatments, similarly to CyberKnife, that use many ultrasonic transducers all focused on one area to heat a tumor or cancerous organ. Effectiveness varies widely, but, again, not a Dr., but it seems worth adding to any other treatment regimen because it's pretty safe and pretty much has no side effects. They've approved it in Canada, but last I checked, not officially in the US, but it's being done.
(Score: 3, Informative) by JoeMerchant on Friday January 06, @01:42AM (2 children)
Generally, you use Cyber knife to reach areas where you don't want a surgeon digging around with a scalpel, deep in the brain is a biggie for that, so removal of anything isn't really a great option there.
The magic sauce in MRI guided laser thermal ablation is that the MRI can track changes in temperature in 3d just like the images it is more well known for. So place the fiber probe in the center of the tumor as you would for a biopsy, then starting at normal body temperature, you turn on the laser and watch the tissue cook. Based on the heating profile, they can tell which tissue will live and which will die to within 1mm resolution, combined with traditional MRI imagery (taken at the same time) they can literally watch the tumor die then shut off the heat before any nearby structures are damaged.
It has potential applications all over the body, but the calibration of the heating coefficient is easier in relatively homogeneous brain tissue, and on the business side of things treating inoperable brain tumors and curing certain cases of epilepsy (through destruction of the epileptic foci) is far more lucrative than something like prostate cancer that has so many other viable options for treatment. As far as I know it is only being used for brain surgery applications at this time.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 2) by RS3 on Friday January 06, @04:00AM (1 child)
Thanks man, I had never heard of that treatment. Yes, thermal ablation, yes fMRI, etc. Well, I've heard of the laser / fiber but didn't know they did it under MRI. If I ever wanted to go back and become a Dr., interventional radiology is pretty interesting.
Back in the mid 90s I worked for an EEG company, and epilepsy studies / treatment was our biggest market. We didn't make the electrodes, but we made up to 128 channel systems. In very difficult cases, doctors would use an electrode array that would be applied directly to meninges, often down within the folds to localize the problem area. The purpose, of course, was to pinpoint the problem area for excision and minimize collateral damage. It's amazing what they can do, but equally sad what some people have to go through.
(Score: 3, Insightful) by JoeMerchant on Friday January 06, @11:09AM
Yeah, I have worked for a few epilepsy related companies, people with the disease will do just about anything for a chance to just reduce their seizures.
The MRI guided thermal ablation (when applicable) is the best intervention I know of... Similar cure and improvement rates as surgical removal of the foci, basically zero side effects (very much unlike the scalpel based approach, and also better than gamma knife, particularly for younger patients like you get in epilepsy). Really minimal recovery time for "brain surgery", like get the procedure one day, outpatient monitoring for surprise swelling (very rate, but...) for one day and on a plane traveling globally the day after that if you like.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 3, Insightful) by DannyB on Thursday January 05, @09:09PM (2 children)
What if you could have a portable therac 25 type device worn on the body sort of like an insulin pump or pace maker?
How often should I have my memory checked? I used to know but...
(Score: 4, Informative) by JoeMerchant on Thursday January 05, @09:45PM
Fun fact: there's a "radioactive seed" treatment for prostate cancer, little radioactive pellets are ... inserted ... for prescribed periods of time.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 2) by RS3 on Thursday January 05, @10:43PM
You probably know that sadly, back somewhere around 1900 (1890s - 1920s IIRC) before they understood the dangers of radiation, many products were made and sold with radium and uranium in them, including pills, water, etc.
This link is _not_ for the feint of heart:
https://www.vintag.es/2021/08/radium-water.html [vintag.es] yummy! Added bonus: you can eat in the dark and still see your food! (sorry, that was sarcasm for those who don't understand sardonic humor...)
Besides the cesium-containing (IIRC) implanted pellets and grains that JoeMerchant mentioned, there are many therapies where they try to put anti-cancer things, like chemo, directly into a tumor, typically into the arteries that feed the tumor (done in the "Interventional Radiology" department), rather than "carpet-bomb" the entire person. Your health provider may not do, or know of, these therapies, so you may need to seek it out.