Professor, Department of Radiation Oncology
Director of Medical Physics, Institute for Onco-Physics at the Albert Einstein College of Medicine
A) Bioeffects of focused ultrasound.
B) Use functional MR to define high-risk volumes for risk adaptive radiotherapy. Risk adaptive radiotherapy is a biological optimization strategy that is based on the possible risk characteristics for local recurrence in tumor sub-volumes rather than individual tumor voxels and treatment plans are optimized using biological objective functions that are region specific, rather than voxel specific. Risk Adaptive optimization can be employed in the generation of treatment plans based on biological objective functions.
C) Use functional MR imaging to assess treatment response of tumors to therapy.
D) Hippocampal Avoidance Whole Brain Radiotherapy (HAWBRT): While whole brain radiotherapy (WBRT) combined with Stereotatic radiosurgery offers effective palliation in many inoperable cases, it has been speculated that adverse effects on neurocognitve function might outweigh its benefits. WBRT aims to preserve neurocognitive function and quality of life, and the Risk to Benefit ratio will have to be optimized with respect to these endpoints. Results from our work involving patients receiving focal fractionated stereotactic radiotherapy for benign and low grade brain neoplasms, we have established a hippocampal dosimetric threshold of 7.3 Gy in 2 Gy fraction equivalents to 40% of the hippocampus that is associated with subsequent risk of impairment in delayed recall. Patients receiving a dose of higher than 7.3 Gy in 2 Gy fraction equivalents to 40% of the hippocampus are 19 times more likely to exhibit impairment in list learning than patients that receive less than 7.3 Gy in 2 Gy fraction equivalents to 40% of the hippocampus. As demonstrated by us this dosimetric threshold can be achieved with currently available IMRT techniques and it may therefore, be desirable to spare a patient’s hippocampus during WBRT to achieve a durable palliative effect with decreased neurocognitive side effects in the memory domain. Using animal models we are intersted in futher investigating the link between hippocampal irradiation and neurocognitive impairment.
E) Use of deformable image registration techniques to accumulate the dose delivered to both the treatment target as well as the organs at risk on a fraction-by-fraction basis. In the case of treatment targets this will lead to better Tumor control probability predictions and in case of OAR this will lead to a more accurate prediction of expected normal tissue toxicity predictions. In particular use patient specific information to build a comprehensive database that contains the final delivered DVH together with the incurred normal tissue toxicities. All future DVHs can be compared against this database as treatment delivery occurs.
F) Use of nonlinear systems theory to predict and eventually control (i.e. stabilize) the breathing pattern and hence the tumor motion based on fast intratreatment fraction MR imaging using real time MR radiotherapy systems. Develop realtime adaptive RT techniques that can correct for changes on the fly.
G) Further development of proton CT stopping power images for daily Bragg Peak prediction prior to the delivery of IMPT.
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