thesis topics for radiation oncology

• Code of conduct
• Privacy Policy
• Terms of Use
• News Releases
• Press Coverage
• Publications

Radiation Oncology   

Head Start Your Radiology Residency [Online] ↗️

• Radiology Thesis – More than 400 Research Topics (2022)!

Username or Email Address

Remember Me

Introduction

A thesis or dissertation, as some people would like to call it, is an integral part of the Radiology curriculum, be it MD, DNB, or DMRD. We have tried to aggregate radiology thesis topics from various sources for reference.

Not everyone is interested in research, and writing a Radiology thesis can be daunting. But there is no escape from preparing, so it is better that you accept this bitter truth and start working on it instead of cribbing about it (like other things in life. #PhilosophyGyan!)

Start working on your thesis as early as possible and finish your thesis well before your exams, so you do not have that stress at the back of your mind. Also, your thesis may need multiple revisions, so be prepared and allocate time accordingly.

Tips for Choosing Radiology Thesis and Research Topics

Keep it simple silly (kiss).

Retrospective > Prospective

Retrospective studies are better than prospective ones, as you already have the data you need when choosing to do a retrospective study. Prospective studies are better quality, but as a resident, you may not have time (, energy and enthusiasm) to complete these.

Choose a simple topic that answers a single/few questions

Original research is challenging, especially if you do not have prior experience. I would suggest you choose a topic that answers a single or few questions. Most topics that I have listed are along those lines. Alternatively, you can choose a broad topic such as “Role of MRI in evaluation of perianal fistulas.”

You can choose a novel topic if you are genuinely interested in research AND have a good mentor who will guide you. Once you have done that, make sure that you publish your study once you are done with it.

Get it done ASAP.

In most cases, it makes sense to stick to a thesis topic that will not take much time. That does not mean you should ignore your thesis and ‘Ctrl C + Ctrl V’ from a friend from another university. Thesis writing is your first step toward research methodology so do it as sincerely as possible. Do not procrastinate in preparing the thesis. As soon as you have been allotted a guide, start researching topics and writing a review of the literature.

At the same time, do not invest a lot of time in writing/collecting data for your thesis. You should not be busy finishing your thesis a few months before the exam. Some people could not appear for the exam because they could not submit their thesis in time. So DO NOT TAKE thesis lightly.

Do NOT Copy-Paste

Reiterating once again, do not simply choose someone else’s thesis topic. Find out what are kind of cases that your Hospital caters to. It is better to do a good thesis on a common topic than a crappy one on a rare one.

Books to help you write a Radiology Thesis

Event country/university has a different format for thesis; hence these book recommendations may not work for everyone.

• Amazon Kindle Edition
• Gupta, Piyush (Author)
• English (Publication Language)
• 206 Pages - 10/12/2020 (Publication Date) - Jaypee Brothers Medical Publishers (P) Ltd. (Publisher)

In A Hurry? Download a PDF list of Radiology Research Topics!

Sign up below to get this PDF directly to your email address.

100% Privacy Guaranteed. Your information will not be shared. Unsubscribe anytime with a single click.

List of Radiology Research /Thesis / Dissertation Topics

• State of the art of MRI in the diagnosis of hepatic focal lesions
• Multimodality imaging evaluation of sacroiliitis in newly diagnosed patients of spondyloarthropathy
• Multidetector computed tomography in oesophageal varices
• Role of positron emission tomography with computed tomography in the diagnosis of cancer Thyroid
• Evaluation of focal breast lesions using ultrasound elastography
• Role of MRI diffusion tensor imaging in the assessment of traumatic spinal cord injuries
• Sonographic imaging in male infertility
• Comparison of color Doppler and digital subtraction angiography in occlusive arterial disease in patients with lower limb ischemia
• The role of CT urography in Haematuria
• Role of functional magnetic resonance imaging in making brain tumor surgery safer
• Prediction of pre-eclampsia and fetal growth restriction by uterine artery Doppler
• Role of grayscale and color Doppler ultrasonography in the evaluation of neonatal cholestasis
• Validity of MRI in the diagnosis of congenital anorectal anomalies
• Role of sonography in assessment of clubfoot
• Role of diffusion MRI in preoperative evaluation of brain neoplasms
• Imaging of upper airways for pre-anaesthetic evaluation purposes and for laryngeal afflictions.
• A study of multivessel (arterial and venous) Doppler velocimetry in intrauterine growth restriction
• Multiparametric 3tesla MRI of suspected prostatic malignancy.
• Role of Sonography in Characterization of Thyroid Nodules for differentiating benign from
• Role of advances magnetic resonance imaging sequences in multiple sclerosis
• Role of multidetector computed tomography in evaluation of jaw lesions
• Role of Ultrasound and MR Imaging in the Evaluation of Musculotendinous Pathologies of Shoulder Joint
• Role of perfusion computed tomography in the evaluation of cerebral blood flow, blood volume and vascular permeability of cerebral neoplasms
• MRI flow quantification in the assessment of the commonest csf flow abnormalities
• Role of diffusion-weighted MRI in evaluation of prostate lesions and its histopathological correlation
• CT enterography in evaluation of small bowel disorders
• Comparison of perfusion magnetic resonance imaging (PMRI), magnetic resonance spectroscopy (MRS) in and positron emission tomography-computed tomography (PET/CT) in post radiotherapy treated gliomas to detect recurrence
• Role of multidetector computed tomography in evaluation of paediatric retroperitoneal masses
• Role of Multidetector computed tomography in neck lesions
• Estimation of standard liver volume in Indian population
• Role of MRI in evaluation of spinal trauma
• Role of modified sonohysterography in female factor infertility: a pilot study.
• The role of pet-CT in the evaluation of hepatic tumors
• Role of 3D magnetic resonance imaging tractography in assessment of white matter tracts compromise in supratentorial tumors
• Role of dual phase multidetector computed tomography in gallbladder lesions
• Role of multidetector computed tomography in assessing anatomical variants of nasal cavity and paranasal sinuses in patients of chronic rhinosinusitis.
• magnetic resonance spectroscopy in multiple sclerosis
• Evaluation of thyroid nodules by ultrasound elastography using acoustic radiation force impulse (ARFI) imaging
• Role of Magnetic Resonance Imaging in Intractable Epilepsy
• Evaluation of suspected and known coronary artery disease by 128 slice multidetector CT.
• Role of regional diffusion tensor imaging in the evaluation of intracranial gliomas and its histopathological correlation
• Role of chest sonography in diagnosing pneumothorax
• Role of CT virtual cystoscopy in diagnosis of urinary bladder neoplasia
• Role of MRI in assessment of valvular heart diseases
• High resolution computed tomography of temporal bone in unsafe chronic suppurative otitis media
• Multidetector CT urography in the evaluation of hematuria
• Contrast-induced nephropathy in diagnostic imaging investigations with intravenous iodinated contrast media
• Comparison of dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging and single photon emission computed tomography in patients with little’s disease
• Role of Multidetector Computed Tomography in Bowel Lesions.
• Role of diagnostic imaging modalities in evaluation of post liver transplantation recipient complications.
• Role of multislice CT scan and barium swallow in the estimation of oesophageal tumour length
• Malignant Lesions-A Prospective Study.
• Value of ultrasonography in assessment of acute abdominal diseases in pediatric age group
• Role of three dimensional multidetector CT hysterosalpingography in female factor infertility
• Comparative evaluation of multi-detector computed tomography (MDCT) virtual tracheo-bronchoscopy and fiberoptic tracheo-bronchoscopy in airway diseases
• Role of Multidetector CT in the evaluation of small bowel obstruction
• Sonographic evaluation in adhesive capsulitis of shoulder
• Utility of MR Urography Versus Conventional Techniques in Obstructive Uropathy
• MRI of the postoperative knee
• Role of 64 slice-multi detector computed tomography in diagnosis of bowel and mesenteric injury in blunt abdominal trauma.
• Sonoelastography and triphasic computed tomography in the evaluation of focal liver lesions
• Evaluation of Role of Transperineal Ultrasound and Magnetic Resonance Imaging in Urinary Stress incontinence in Women
• Multidetector computed tomographic features of abdominal hernias
• Evaluation of lesions of major salivary glands using ultrasound elastography
• Transvaginal ultrasound and magnetic resonance imaging in female urinary incontinence
• MDCT colonography and double-contrast barium enema in evaluation of colonic lesions
• Role of MRI in diagnosis and staging of urinary bladder carcinoma
• Spectrum of imaging findings in children with febrile neutropenia.
• Spectrum of radiographic appearances in children with chest tuberculosis.
• Role of computerized tomography in evaluation of mediastinal masses in pediatric
• Diagnosing renal artery stenosis: Comparison of multimodality imaging in diabetic patients
• Role of multidetector CT virtual hysteroscopy in the detection of the uterine & tubal causes of female infertility
• Role of multislice computed tomography in evaluation of crohn’s disease
• CT quantification of parenchymal and airway parameters on 64 slice MDCT in patients of chronic obstructive pulmonary disease
• Comparative evaluation of MDCT  and 3t MRI in radiographically detected jaw lesions.
• Evaluation of diagnostic accuracy of ultrasonography, colour Doppler sonography and low dose computed tomography in acute appendicitis
• Ultrasonography , magnetic resonance cholangio-pancreatography (MRCP) in assessment of pediatric biliary lesions
• Multidetector computed tomography in hepatobiliary lesions.
• Evaluation of peripheral nerve lesions with high resolution ultrasonography and colour Doppler
• Multidetector computed tomography in pancreatic lesions
• Multidetector Computed Tomography in Paediatric abdominal masses.
• Evaluation of focal liver lesions by colour Doppler and MDCT perfusion imaging
• Sonographic evaluation of clubfoot correction during Ponseti treatment
• Role of multidetector CT in characterization of renal masses
• Study to assess the role of Doppler ultrasound in evaluation of arteriovenous (av) hemodialysis fistula and the complications of hemodialysis vasular access
• Comparative study of multiphasic contrast-enhanced CT and contrast-enhanced MRI in the evaluation of hepatic mass lesions
• Sonographic spectrum of rheumatoid arthritis
• Diagnosis & staging of liver fibrosis by ultrasound elastography in patients with chronic liver diseases
• Role of multidetector computed tomography in assessment of jaw lesions.
• Role of high-resolution ultrasonography in the differentiation of benign and malignant thyroid lesions
• Radiological evaluation of aortic aneurysms in patients selected for endovascular repair
• Role of conventional MRI, and diffusion tensor imaging tractography in evaluation of congenital brain malformations
• To evaluate the status of coronary arteries in patients with non-valvular atrial fibrillation using 256 multirow detector CT scan
• A comparative study of ultrasonography and CT – arthrography in diagnosis of chronic ligamentous and meniscal injuries of knee
• Multi detector computed tomography evaluation in chronic obstructive pulmonary disease and correlation with severity of disease
• Diffusion weighted and dynamic contrast enhanced magnetic resonance imaging in chemoradiotherapeutic response evaluation in cervical cancer.
• High resolution sonography in the evaluation of non-traumatic painful wrist
• The role of trans-vaginal ultrasound versus magnetic resonance imaging in diagnosis & evaluation of cancer cervix
• Role of multidetector row computed tomography in assessment of maxillofacial trauma
• Imaging of vascular complication after liver transplantation.
• Role of magnetic resonance perfusion weighted imaging & spectroscopy for grading of glioma by correlating perfusion parameter of the lesion with the final histopathological grade
• Magnetic resonance evaluation of abdominal tuberculosis.
• Diagnostic usefulness of low dose spiral HRCT in diffuse lung diseases
• Role of dynamic contrast enhanced and diffusion weighted magnetic resonance imaging in evaluation of endometrial lesions
• Contrast enhanced digital mammography anddigital breast tomosynthesis in early diagnosis of breast lesion
• Evaluation of Portal Hypertension with Colour Doppler flow imaging and magnetic resonance imaging
• Evaluation of musculoskeletal lesions by magnetic resonance imaging
• Role of diffusion magnetic resonance imaging in assessment of neoplastic and inflammatory brain lesions
• Radiological spectrum of chest diseases in HIV infected children High resolution ultrasonography in neck masses in children
• with surgical findings
• Sonographic evaluation of peripheral nerves in type 2 diabetes mellitus.
• Role of perfusion computed tomography in the evaluation of neck masses and correlation
• Role of ultrasonography in the diagnosis of knee joint lesions
• Role of ultrasonography in evaluation of various causes of pelvic pain in first trimester of pregnancy.
• Role of Magnetic Resonance Angiography in the Evaluation of Diseases of Aorta and its Branches
• MDCT fistulography in evaluation of fistula in Ano
• Role of multislice CT in diagnosis of small intestine tumors
• Role of high resolution CT in differentiation between benign and malignant pulmonary nodules in children
• A study of multidetector computed tomography urography in urinary tract abnormalities
• Role of high resolution sonography in assessment of ulnar nerve in patients with leprosy.
• Pre-operative radiological evaluation of locally aggressive and malignant musculoskeletal tumours by computed tomography and magnetic resonance imaging.
• The role of ultrasound & MRI in acute pelvic inflammatory disease
• Ultrasonography compared to computed tomographic arthrography in the evaluation of shoulder pain
• Role of Multidetector Computed Tomography in patients with blunt abdominal trauma.
• The Role of Extended field-of-view Sonography and compound imaging in Evaluation of Breast Lesions
• Evaluation of focal pancreatic lesions by Multidetector CT and perfusion CT
• Evaluation of breast masses on sono-mammography and colour Doppler imaging
• Role of CT virtual laryngoscopy in evaluation of laryngeal masses
• Triple phase multi detector computed tomography in hepatic masses
• Role of transvaginal ultrasound in diagnosis and treatment of female infertility
• Role of ultrasound and color Doppler imaging in assessment of acute abdomen due to female genetal causes
• High resolution ultrasonography and color Doppler ultrasonography in scrotal lesion
• Evaluation of diagnostic accuracy of ultrasonography with colour Doppler vs low dose computed tomography in salivary gland disease
• Role of multidetector CT in diagnosis of salivary gland lesions
• Comparison of diagnostic efficacy of ultrasonography and magnetic resonance cholangiopancreatography in obstructive jaundice: A prospective study
• Evaluation of varicose veins-comparative assessment of low dose CT venogram with sonography: pilot study
• Role of mammotome in breast lesions
• The role of interventional imaging procedures in the treatment of selected gynecological disorders
• Role of transcranial ultrasound in diagnosis of neonatal brain insults
• Role of multidetector CT virtual laryngoscopy in evaluation of laryngeal mass lesions
• Evaluation of adnexal masses on sonomorphology and color Doppler imaginig
• Role of radiological imaging in diagnosis of endometrial carcinoma
• Comprehensive imaging of renal masses by magnetic resonance imaging
• The role of 3D & 4D ultrasonography in abnormalities of fetal abdomen
• Diffusion weighted magnetic resonance imaging in diagnosis and characterization of brain tumors in correlation with conventional MRI
• Role of diffusion weighted MRI imaging in evaluation of cancer prostate
• Role of multidetector CT in diagnosis of urinary bladder cancer
• Role of multidetector computed tomography in the evaluation of paediatric retroperitoneal masses.
• Comparative evaluation of gastric lesions by double contrast barium upper G.I. and multi detector computed tomography
• Evaluation of hepatic fibrosis in chronic liver disease using ultrasound elastography
• Role of MRI in assessment of hydrocephalus in pediatric patients
• The role of sonoelastography in characterization of breast lesions
• The influence of volumetric tumor doubling time on survival of patients with intracranial tumours
• Role of perfusion computed tomography in characterization of colonic lesions
• Role of proton MRI spectroscopy in the evaluation of temporal lobe epilepsy
• Role of Doppler ultrasound and multidetector CT angiography in evaluation of peripheral arterial diseases.
• Role of multidetector computed tomography in paranasal sinus pathologies
• Role of virtual endoscopy using MDCT in detection & evaluation of gastric pathologies
• High resolution 3 Tesla MRI in the evaluation of ankle and hindfoot pain.
• Transperineal ultrasonography in infants with anorectal malformation
• CT portography using MDCT versus color Doppler in detection of varices in cirrhotic patients
• Role of CT urography in the evaluation of a dilated ureter
• Characterization of pulmonary nodules by dynamic contrast-enhanced multidetector CT
• Comprehensive imaging of acute ischemic stroke on multidetector CT
• The role of fetal MRI in the diagnosis of intrauterine neurological congenital anomalies
• Role of Multidetector computed tomography in pediatric chest masses
• Multimodality imaging in the evaluation of palpable & non-palpable breast lesion.
• Sonographic Assessment Of Fetal Nasal Bone Length At 11-28 Gestational Weeks And Its Correlation With Fetal Outcome.
• Role Of Sonoelastography And Contrast-Enhanced Computed Tomography In Evaluation Of Lymph Node Metastasis In Head And Neck Cancers
• Role Of Renal Doppler And Shear Wave Elastography In Diabetic Nephropathy
• Evaluation Of Relationship Between Various Grades Of Fatty Liver And Shear Wave Elastography Values
• Evaluation and characterization of pelvic masses of gynecological origin by USG, color Doppler and MRI in females of reproductive age group
• Radiological evaluation of small bowel diseases using computed tomographic enterography
• Role of coronary CT angiography in patients of coronary artery disease
• Role of multimodality imaging in the evaluation of pediatric neck masses
• Role of CT in the evaluation of craniocerebral trauma
• Role of magnetic resonance imaging (MRI) in the evaluation of spinal dysraphism
• Comparative evaluation of triple phase CT and dynamic contrast-enhanced MRI in patients with liver cirrhosis
• Evaluation of the relationship between carotid intima-media thickness and coronary artery disease in patients evaluated by coronary angiography for suspected CAD
• Assessment of hepatic fat content in fatty liver disease by unenhanced computed tomography
• Correlation of vertebral marrow fat on spectroscopy and diffusion-weighted MRI imaging with bone mineral density in postmenopausal women.
• Comparative evaluation of CT coronary angiography with conventional catheter coronary angiography
• Ultrasound evaluation of kidney length & descending colon diameter in normal and intrauterine growth-restricted fetuses
• A prospective study of hepatic vein waveform and splenoportal index in liver cirrhosis: correlation with child Pugh’s classification and presence of esophageal varices.
• CT angiography to evaluate coronary artery by-pass graft patency in symptomatic patient’s functional assessment of myocardium by cardiac MRI in patients with myocardial infarction
• MRI evaluation of HIV positive patients with central nervous system manifestations
• MDCT evaluation of mediastinal and hilar masses
• Evaluation of rotator cuff & labro-ligamentous complex lesions by MRI & MRI arthrography of shoulder joint
• Role of imaging in the evaluation of soft tissue vascular malformation
• Role of MRI and ultrasonography in the evaluation of multifidus muscle pathology in chronic low back pain patients
• Role of ultrasound elastography in the differential diagnosis of breast lesions
• Role of magnetic resonance cholangiopancreatography in evaluating dilated common bile duct in patients with symptomatic gallstone disease.
• Comparative study of CT urography & hybrid CT urography in patients with haematuria.
• Role of MRI in the evaluation of anorectal malformations
• Comparison of ultrasound-Doppler and magnetic resonance imaging findings in rheumatoid arthritis of hand and wrist
• Role of Doppler sonography in the evaluation of renal artery stenosis in hypertensive patients undergoing coronary angiography for coronary artery disease.
• Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis in ankylosing spondylitis.
• Mr evaluation of painful hip
• Role of MRI imaging in pretherapeutic assessment of oral and oropharyngeal malignancy
• Evaluation of diffuse lung diseases by high resolution computed tomography of the chest
• Mr evaluation of brain parenchyma in patients with craniosynostosis.
• Diagnostic and prognostic value of cardiovascular magnetic resonance imaging in dilated cardiomyopathy
• Role of multiparametric magnetic resonance imaging in the detection of early carcinoma prostate
• Role of magnetic resonance imaging in white matter diseases
• Role of sonoelastography in assessing the response to neoadjuvant chemotherapy in patients with locally advanced breast cancer.
• Role of ultrasonography in the evaluation of carotid and femoral intima-media thickness in predialysis patients with chronic kidney disease
• Role of H1 MRI spectroscopy in focal bone lesions of peripheral skeleton choline detection by MRI spectroscopy in breast cancer and its correlation with biomarkers and histological grade.
• Ultrasound and MRI evaluation of axillary lymph node status in breast cancer.
• Role of sonography and magnetic resonance imaging in evaluating chronic lateral epicondylitis.
• Comparative of sonography including Doppler and sonoelastography in cervical lymphadenopathy.
• Evaluation of Umbilical Coiling Index as Predictor of Pregnancy Outcome.
• Computerized Tomographic Evaluation of Azygoesophageal Recess in Adults.
• Lumbar Facet Arthropathy in Low Backache.
• “Urethral Injuries After Pelvic Trauma: Evaluation with Uretrography
• Role Of Ct In Diagnosis Of Inflammatory Renal Diseases
• Role Of Ct Virtual Laryngoscopy In Evaluation Of Laryngeal Masses
• “Ct Portography Using Mdct Versus Color Doppler In Detection Of Varices In
• Cirrhotic Patients”
• Role Of Multidetector Ct In Characterization Of Renal Masses
• Role Of Ct Virtual Cystoscopy In Diagnosis Of Urinary Bladder Neoplasia
• Role Of Multislice Ct In Diagnosis Of Small Intestine Tumors
• “Mri Flow Quantification In The Assessment Of The Commonest CSF Flow Abnormalities”
• “The Role Of Fetal Mri In Diagnosis Of Intrauterine Neurological CongenitalAnomalies”
• Role Of Transcranial Ultrasound In Diagnosis Of Neonatal Brain Insults
• “The Role Of Interventional Imaging Procedures In The Treatment Of Selected Gynecological Disorders”
• Role Of Radiological Imaging In Diagnosis Of Endometrial Carcinoma
• “Role Of High-Resolution Ct In Differentiation Between Benign And Malignant Pulmonary Nodules In Children”
• Role Of Ultrasonography In The Diagnosis Of Knee Joint Lesions
• “Role Of Diagnostic Imaging Modalities In Evaluation Of Post Liver Transplantation Recipient Complications”
• “Diffusion-Weighted Magnetic Resonance Imaging In Diagnosis And
• Characterization Of Brain Tumors In Correlation With Conventional Mri”
• The Role Of PET-CT In The Evaluation Of Hepatic Tumors
• “Role Of Computerized Tomography In Evaluation Of Mediastinal Masses In Pediatric patients”
• “Trans Vaginal Ultrasound And Magnetic Resonance Imaging In Female Urinary Incontinence”
• Role Of Multidetector Ct In Diagnosis Of Urinary Bladder Cancer
• “Role Of Transvaginal Ultrasound In Diagnosis And Treatment Of Female Infertility”
• Role Of Diffusion-Weighted Mri Imaging In Evaluation Of Cancer Prostate
• “Role Of Positron Emission Tomography With Computed Tomography In Diagnosis Of Cancer Thyroid”
• The Role Of CT Urography In Case Of Haematuria
• “Value Of Ultrasonography In Assessment Of Acute Abdominal Diseases In Pediatric Age Group”
• “Role Of Functional Magnetic Resonance Imaging In Making Brain Tumor Surgery Safer”
• The Role Of Sonoelastography In Characterization Of Breast Lesions
• “Ultrasonography, Magnetic Resonance Cholangiopancreatography (MRCP) In Assessment Of Pediatric Biliary Lesions”
• “Role Of Ultrasound And Color Doppler Imaging In Assessment Of Acute Abdomen Due To Female Genital Causes”
• “Role Of Multidetector Ct Virtual Laryngoscopy In Evaluation Of Laryngeal Mass Lesions”
• MRI Of The Postoperative Knee
• Role Of Mri In Assessment Of Valvular Heart Diseases
• The Role Of 3D & 4D Ultrasonography In Abnormalities Of Fetal Abdomen
• State Of The Art Of Mri In Diagnosis Of Hepatic Focal Lesions
• Role Of Multidetector Ct In Diagnosis Of Salivary Gland Lesions
• “Role Of Virtual Endoscopy Using Mdct In Detection & Evaluation Of Gastric Pathologies”
• The Role Of Ultrasound & Mri In Acute Pelvic Inflammatory Disease
• “Diagnosis & Staging Of Liver Fibrosis By Ultraso Und Elastography In
• Patients With Chronic Liver Diseases”
• Role Of Mri In Evaluation Of Spinal Trauma
• Validity Of Mri In Diagnosis Of Congenital Anorectal Anomalies
• Imaging Of Vascular Complication After Liver Transplantation
• “Contrast-Enhanced Digital Mammography And Digital Breast Tomosynthesis In Early Diagnosis Of Breast Lesion”
• Role Of Mammotome In Breast Lesions
• “Role Of MRI Diffusion Tensor Imaging (DTI) In Assessment Of Traumatic Spinal Cord Injuries”
• “Prediction Of Pre-eclampsia And Fetal Growth Restriction By Uterine Artery Doppler”
• “Role Of Multidetector Row Computed Tomography In Assessment Of Maxillofacial Trauma”
• “Role Of Diffusion Magnetic Resonance Imaging In Assessment Of Neoplastic And Inflammatory Brain Lesions”
• Role Of Diffusion Mri In Preoperative Evaluation Of Brain Neoplasms
• “Role Of Multidetector Ct Virtual Hysteroscopy In The Detection Of The
• Uterine & Tubal Causes Of Female Infertility”
• Role Of Advances Magnetic Resonance Imaging Sequences In Multiple Sclerosis Magnetic Resonance Spectroscopy In Multiple Sclerosis
• “Role Of Conventional Mri, And Diffusion Tensor Imaging Tractography In Evaluation Of Congenital Brain Malformations”
• Role Of MRI In Evaluation Of Spinal Trauma
• Diagnostic Role Of Diffusion-weighted MR Imaging In Neck Masses
• “The Role Of Transvaginal Ultrasound Versus Magnetic Resonance Imaging In Diagnosis & Evaluation Of Cancer Cervix”
• “Role Of 3d Magnetic Resonance Imaging Tractography In Assessment Of White Matter Tracts Compromise In Supra Tentorial Tumors”
• Role Of Proton MR Spectroscopy In The Evaluation Of Temporal Lobe Epilepsy
• Role Of Multislice Computed Tomography In Evaluation Of Crohn’s Disease
• Role Of MRI In Assessment Of Hydrocephalus In Pediatric Patients
• The Role Of MRI In Diagnosis And Staging Of Urinary Bladder Carcinoma
• USG and MRI correlation of congenital CNS anomalies
• HRCT in interstitial lung disease
• X-Ray, CT and MRI correlation of bone tumors
• “Study on the diagnostic and prognostic utility of X-Rays for cases of pulmonary tuberculosis under RNTCP”
• “Role of magnetic resonance imaging in the characterization of female adnexal  pathology”
• “CT angiography of carotid atherosclerosis and NECT brain in cerebral ischemia, a correlative analysis”
• Role of CT scan in the evaluation of paranasal sinus pathology
• USG and MRI correlation on shoulder joint pathology
• “Radiological evaluation of a patient presenting with extrapulmonary tuberculosis”
• CT and MRI correlation in focal liver lesions”
• Comparison of MDCT virtual cystoscopy with conventional cystoscopy in bladder tumors”
• “Bleeding vessels in life-threatening hemoptysis: Comparison of 64 detector row CT angiography with conventional angiography prior to endovascular management”
• “Role of transarterial chemoembolization in unresectable hepatocellular carcinoma”
• “Comparison of color flow duplex study with digital subtraction angiography in the evaluation of peripheral vascular disease”
• “A Study to assess the efficacy of magnetization transfer ratio in differentiating tuberculoma from neurocysticercosis”
• “MR evaluation of uterine mass lesions in correlation with transabdominal, transvaginal ultrasound using HPE as a gold standard”
• “The Role of power Doppler imaging with trans rectal ultrasonogram guided prostate biopsy in the detection of prostate cancer”
• “Lower limb arteries assessed with doppler angiography – A prospective comparative study with multidetector CT angiography”
• “Comparison of sildenafil with papaverine in penile doppler by assessing hemodynamic changes”
• “Evaluation of efficacy of sonosalphingogram for assessing tubal patency in infertile patients with hysterosalpingogram as the gold standard”
• Role of CT enteroclysis in the evaluation of small bowel diseases
• “MRI colonography versus conventional colonoscopy in the detection of colonic polyposis”
• “Magnetic Resonance Imaging of anteroposterior diameter of the midbrain – differentiation of progressive supranuclear palsy from Parkinson disease”
• “MRI Evaluation of anterior cruciate ligament tears with arthroscopic correlation”
• “The Clinicoradiological profile of cerebral venous sinus thrombosis with prognostic evaluation using MR sequences”
• “Role of MRI in the evaluation of pelvic floor integrity in stress incontinent patients” “Doppler ultrasound evaluation of hepatic venous waveform in portal hypertension before and after propranolol”
• “Role of transrectal sonography with colour doppler and MRI in evaluation of prostatic lesions with TRUS guided biopsy correlation”
• “Ultrasonographic evaluation of painful shoulders and correlation of rotator cuff pathologies and clinical examination”
• “Colour Doppler Evaluation of Common Adult Hepatic tumors More Than 2 Cm  with HPE and CECT Correlation”
• “Clinical Relevance of MR Urethrography in Obliterative Posterior Urethral Stricture”
• “Prediction of Adverse Perinatal Outcome in Growth Restricted Fetuses with Antenatal Doppler Study”
• Radiological evaluation of spinal dysraphism using CT and MRI
• “Evaluation of temporal bone in cholesteatoma patients by high resolution computed tomography”
• “Radiological evaluation of primary brain tumours using computed tomography and magnetic resonance imaging”
• “Three dimensional colour doppler sonographic assessment of changes in  volume and vascularity of fibroids – before and after uterine artery embolization”
• “In phase opposed phase imaging of bone marrow differentiating neoplastic lesions”
• “Role of dynamic MRI in replacing the isotope renogram in the functional evaluation of PUJ obstruction”
• Characterization of adrenal masses with contrast-enhanced CT – washout study
• A study on accuracy of magnetic resonance cholangiopancreatography
• “Evaluation of median nerve in carpal tunnel syndrome by high-frequency ultrasound & color doppler in comparison with nerve conduction studies”
• “Correlation of Agatston score in patients with obstructive and nonobstructive coronary artery disease following STEMI”
• “Doppler ultrasound assessment of tumor vascularity in locally advanced breast cancer at diagnosis and following primary systemic chemotherapy.”
• “Validation of two-dimensional perineal ultrasound and dynamic magnetic resonance imaging in pelvic floor dysfunction.”
• “Role of MR urethrography compared to conventional urethrography in the surgical management of obliterative urethral stricture.”

Search Diagnostic Imaging Research Topics

You can also search research-related resources and direct download PDFs for radiology articles on our custom radiology search engine .

Free Resources for Preparing Radiology Thesis

• Radiology thesis topics- Benha University – Free to download thesis
• Radiology thesis topics – Faculty of Medical Science Delhi
• Radiology thesis topics – IPGMER
• Fetal Radiology thesis Protocols
• Radiology thesis and dissertation topics
• Radiographics

Proofreading Your Thesis:

Make sure you use Grammarly to correct your spelling ,  grammar , and plagiarism for your thesis. Grammarly has affordable paid subscriptions, windows/macOS apps, and FREE browser extensions. It is an excellent tool to avoid inadvertent spelling mistakes in your research projects. It has an extensive built-in vocabulary, but you should make an account and add your own medical glossary to it.

Guidelines for Writing a Radiology Thesis:

These are general guidelines and not about radiology specifically. You can share these with colleagues from other departments as well. Special thanks to Dr. Sanjay Yadav sir for these. This section is best seen on a desktop. Here are a couple of handy presentations to start writing a thesis:

Read the general guidelines for writing a thesis (the page will take some time to load- more than 70 pages!

A format for thesis protocol with a sample patient information sheet, sample patient consent form, sample application letter for thesis, and sample certificate.

Resources and References:

• Guidelines for thesis writing.
• Format for thesis protocol
• Thesis protocol writing guidelines DNB
• Informed consent form for Research studies from AIIMS 
• Radiology Informed consent forms in local Indian languages.
• Sample Informed Consent form for Research in Hindi
• Guide to write a thesis by Dr. P R Sharma
• Guidelines for thesis writing by Dr. Pulin Gupta.
• Preparing MD/DNB thesis by A Indrayan
• Another good thesis reference protocol

Hopefully, this post will make the tedious task of writing a Radiology thesis a little bit easier for you. Best of luck with writing your thesis and your residency too!

More guides for residents :

• Guide for the MD/DMRD/DNB radiology exam!
• Guide for First-Year Radiology Residents
• FRCR Exam: THE Most Comprehensive Guide (2022)!
• Radiology Practical Exams Questions compilation for MD/DNB/DMRD !
• Radiology Exam Resources (Oral Recalls, Instruments, etc )!
• Tips and Tricks for DNB/MD Radiology Practical Exam
• FRCR 2B exam- Tips and Tricks !
• FRCR exam preparation – An alternative take!
• Why did I take up Radiology?
• Radiology Conferences – A comprehensive guide!
• ECR (European Congress Of Radiology)
• European Diploma in Radiology (EDiR) – The Complete Guide!
• Radiology NEET PG guide – How to select THE best college for post-graduation in Radiology (includes personal insights)!
• Interventional Radiology – All Your Questions Answered!
• What It Means To Be A Radiologist: A Guide For Medical Students!
• Radiology Mentors for Medical Students (Post NEET-PG)
• MD vs DNB Radiology: Which Path is Right for Your Career?
• DNB Radiology OSCE – Tips and Tricks

More radiology resources here: Radiology resources This page will be updated regularly. Kindly leave your feedback in the comments or send us a message here . Also, you can comment below regarding your department’s thesis topics.

Note: All topics have been compiled from available online resources. If anyone has an issue with any radiology thesis topics displayed here, you can message us here , and we can delete them. These are only sample guidelines. Thesis guidelines differ from institution to institution.

Image source: Thesis complete! (2018). Flickr. Retrieved 12 August 2018, from https://www.flickr.com/photos/cowlet/354911838 by Victoria Catterson

About The Author

Dr. amar udare, md, 9 thoughts on “radiology thesis – more than 400 research topics (2022)”.

Amazing & The most helpful site for Radiology residents…

Thank you for your kind comments 🙂

Dr. I saw your Tips is very amazing and referable. But Dr. Can you help me with the thesis of Evaluation of Diagnostic accuracy of X-ray radiograph in knee joint lesion.

Wow! These are excellent stuff. You are indeed a teacher. God bless

Glad you liked these!

happy to see this

Glad I could help :).

Greetings Dr, thanks for your constant guides. pls Dr, I need a thesis research material on “Retrieving information from scattered photons in medical imaging”

Hey! Unfortunately I do not have anything relevant to that thesis topic.

Leave a Comment Cancel Reply

Your email address will not be published. Required fields are marked *

Get Radiology Updates to Your Inbox!

This site is for use by medical professionals. To continue, you must accept our use of cookies and the site's Terms of Use. Learn more Accept!

Wish to be a BETTER Radiologist? Join 14000 Radiology Colleagues !

Enter your email address below to access HIGH YIELD radiology content, updates, and resources.

No spam, only VALUE! Unsubscribe anytime with a single click.

Clinical Radiation Oncology

Section edited by Stephanie Combs, Pirus Ghadjar, Matthias Guckenberger, Daniel Habermehl, Silke Nachbichler, Maximilian Niyazi, and Falk Roeder

The Clinical Radiation Oncology section aims to provide a platform for clinical research in radiation oncology. Research includes innovative early phase and later stage clinical trials, technical approaches, review articles on “burning” clinical questions, invited key reviews, RT planning studies, multimodal therapy, data mining from retrospective cohorts in a hypothesis-generating manner, interconnection between imaging and improved target delineation, and intensity modulation/high precision techniques. The section addresses current, timely and cutting- edge research and reviews about clinically relevant issues in radiation oncology, while offering a fast review process.

Page 1 of 27

May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy?

One of the main limiting factors of whole-brain radiation therapy (WBRT) for primary central nervous system lymphoma (PCNSL) is the impairment of neurocognitive functions (NCFs), which is mainly caused by radi...

• View Full Text

A review of diffusion-weighted magnetic resonance imaging in head and neck cancer patients for treatment evaluation and prediction of radiation-induced xerostomia

The incidence of head and neck cancers (HNC) is rising worldwide especially with HPV-related oropharynx squamous cell carcinoma. The standard of care for the majority of patients with locally advanced pharynge...

Dosimetric evaluation of VMAT and helical tomotherapy techniques comparing conventional volumes with clinical target volumes based on new ESTRO ACROP post-mastectomy with immediate implant reconstruction contouring guidelines

The ESTRO-ACROP Consensus Guideline (EACG) recommends implant excluded clinical target volume (CTVp) definitions for post-mastectomy radiation therapy after implant-based immediate breast reconstruction (IBR)....

Selection and validation of chemotherapy beneficiaries among elderly nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT): a large real-world study

Using real-world evidence, this study aimed to identify elderly nasopharyngeal carcinoma (NPC) patients who would benefit from chemotherapy.

Chemo-radiotherapy plus durvalumab for loco-regional relapse of resected NSCLC

tumor recurrence after NSCLC surgical resection is the most common cause of treatment failure that sharply reduces the patient’s life expectancy. The optimal treatment strategy for loco-regional recurrences de...

Locally advanced NSCLC: a plea for sparing the ipsilateral normal lung—prospective, clinical trial with DART-bid (dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily) by VMAT

In radiation treatment of locally advanced non-small cell lung cancer (LA-NSCLC), ‘margins’ from internal target volumes to planning target volumes in the range of 12 to 23 mm are reported, and avoiding exposu...

Effect of postoperative radiotherapy in women with localized pure mucinous breast cancer after lumpectomy: a population-based study

Pure mucinous breast cancer is a rare subtype of invasive breast cancer with favorable prognosis, in which the effect of postoperative radiotherapy remains unclear. We aimed to investigate the prognostic value...

Postoperative recurrent patterns of gallbladder cancer: possible implications for adjuvant therapy

Gallbladder cancer (GBC) is an uncommon malignancy with high recurrent rate and poor prognosis. This study investigates the recurrent patterns of postoperative GBC, with the aim to guide the adjuvant treatment...

High-dose stereotactic radiotherapy boost in the treatment of squamous cell carcinoma of the head and neck region

Surgical resection with adjuvant concurrent radiochemotherapy is the standard of care for stage III–IV oral cavity cancer. In some cases, the dynamic course of the disease is out of the prepared schedule of tr...

Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer

We investigated the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced rectal cancer (LARC) and whether modifiable factors in radiotherapy (RT) influenced the NLR.

High dose chemoradiotherapy increases chance of organ preservation with satisfactory functional outcome for rectal cancer

High dose chemoradiotherapy offers a curative chance for patients with rectal cancer that are unfit or unwilling to undergo surgical resection, yet its long-term survival and functional outcomes have been rare...

Protective ileostomy increased the incidence of rectal stenosis after anterior resection for rectal cancer

In most of the views, rectal stenosis after anterior resection for rectal cancer results from pelvic radiotherapy. However, patients without receiving radiotherapy also suffer stenosis. In this study, we evalu...

30-day mortality in patients treated for brain metastases: extracranial causes dominate

Established prognostic models, such as the diagnosis-specific graded prognostic assessment, were not designed to specifically address very short survival. Therefore, a brain metastases-specific 30-day mortalit...

The prognostic significance of pretreatment squamous cell carcinoma antigen levels in cervical cancer patients treated by concurrent chemoradiation therapy and a comparison of dosimetric outcomes and clinical toxicities between tomotherapy and volumetric modulated arc therapy

To analyze the prognostic factors associated with stage IB-IVA cervical cancer in patients who underwent concurrent chemoradiation therapy (CCRT) and to compare the clinical toxicities and dosimetric parameter...

Early-onset adverse events after stereotactic radiosurgery for jugular foramen schwannoma: a mid-term follow-up single-center review of 46 cases

Recently, stereotacitc radiosurgery (SRS) has been in the spotlight as an alternative therapeutic option for jugular foramen schwannomas (JFS). While most reported studies focus on the long-term efficacy and s...

Assessment of therapeutic outcome and role of reirradiation in patients with radiation-induced glioma

We sought to clarify the optimal follow-up, therapeutic strategy, especially the role of reirradiation, and the diagnostic impact of isocitrate dehydrogenase ( IDH ) 1 and 2 mutation status in patients with radiati...

Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis

To gain insight into the treatment outcomes for anal cancer a retrospective analysis was performed with a special emphasis on trends in outcome and toxicities over time and on treatment of elderly patients.

Applicability of a pathological complete response magnetic resonance-based radiomics model for locally advanced rectal cancer in intercontinental cohort

Predicting pathological complete response (pCR) in patients affected by locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (nCRT) is a challenging field of investigation, but many ...

Transparency in quality of radiotherapy for breast cancer in the Netherlands: a national registration of radiotherapy-parameters

Radiotherapy (RT) is part of the curative treatment of approximately 70% of breast cancer (BC) patients. Wide practice variation has been reported in RT dose, fractionation and its treatment planning for BC. T...

Direct comparison of low-dose-rate brachytherapy versus radical prostatectomy using the surgical definition of biochemical recurrence for patients with intermediate-risk prostate cancer

We compared the oncological outcomes of patients who received seed brachytherapy (SEED-BT) with those who received radical prostatectomy (RP) for intermediate-risk prostate cancer.

Correlation between changes of pelvic bone marrow fat content and hematological toxicity in concurrent chemoradiotherapy for cervical cancer

To quantify the pelvic bone marrow (PBM) fat content changes receiving different radiation doses of concurrent chemoradiotherapy for cervical cancer and to determine association with peripheral blood cell counts.

A phase II trial of stereotactic body radiotherapy in 4 fractions for patients with localized prostate cancer

To report results from our phase II study of stereotactic body radiotherapy (SBRT) delivering 36 Gy in 4 fractions for patients with localized prostate cancer.

Safety of stereotactic body radiation therapy for localized prostate cancer without treatment planning MRI

The use of treatment planning prostate MRI for Stereotactic Body Radiation Therapy (SBRT) is largely a standard, yet not all patients can receive MRI for a variety of clinical reasons. Thus, we aim to investig...

Explainable AI for CNN-based prostate tumor segmentation in multi-parametric MRI correlated to whole mount histopathology

Automatic prostate tumor segmentation is often unable to identify the lesion even if multi-parametric MRI data is used as input, and the segmentation output is difficult to verify due to the lack of clinically...

Efficacy and safety of re-irradiation for locoregional esophageal squamous cell carcinoma recurrence after radiotherapy: a systematic review and meta-analysis

There is currently no standard treatment for locoregional recurrence of esophageal squamous cell carcinoma (ESCC) previously treated with radiotherapy. This study aimed to assess the efficacy and safety of re-...

Chemoradiotherapy is an alternative choice for patients with primary mediastinal seminoma

The low incidence of primary mediastinal seminomas has precluded the development of clinical trials on mediastinal seminomas. We investigated the clinicopathologic characteristics, prognosis of patients with p...

Predictors of radiation-induced hypothyroidism in nasopharyngeal carcinoma survivors after intensity-modulated radiotherapy

The aim of the study is to identify clinical and dosimetric factors that could predict the risk of hypothyroidism in nasopharyngeal carcinoma (NPC) patients following intensity-modulated radiotherapy (IMRT).

Outcomes of proton therapy for non-small cell lung cancer in patients with interstitial pneumonia

Interstitial pneumonia (IP) is a disease with a poor prognosis. In addition, IP patients are more likely to develop lung cancer. Since IP patients frequently develop toxicities during cancer treatment, minimal...

Dosimetric benefit of MR-guided online adaptive radiotherapy in different tumor entities: liver, lung, abdominal lymph nodes, pancreas and prostate

Hybrid magnetic resonance (MR)-Linac systems have recently been introduced into clinical practice. The systems allow online adaption of the treatment plan with the aim of compensating for interfractional anato...

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

To summarize the characteristics of local invasion and distribution of metastatic lymph nodes in unilateral nasopharyngeal carcinoma (NPC) by magnetic resonance imaging (MRI) to provide references for the opti...

Optimal management of recurrent and metastatic upper tract urothelial carcinoma: Implications of intensity modulated radiation therapy

Upper tract urothelial carcinoma (UTUC) is rare and the treatment for recurrent or metastatic UTUC is unclear. We evaluated the outcomes of salvage and palliative radiotherapy (RT) and prognostic factors in UT...

Photobiomodulation as a treatment for dermatitis caused by chemoradiotherapy for squamous cell anal carcinoma: case report and literature review

In-field dermatitis is a severe and common adverse effect of radiation therapy, that can cause significant pain and treatment interruptions in patients with squamous cell anal carcinoma (SCAC) being treated wi...

Dosimetric parameters and absolute monocyte count can predict the prognosis of acute hematologic toxicity in cervical cancer patients undergoing concurrent chemotherapy and volumetric-modulated arc therapy

To explore clinical and dosimetric predictors of acute hematologic toxicity (HT) in cervical cancer patients treated with concurrent chemotherapy and volumetric-modulated arc therapy (VMAT).

Postoperative lymphatic recurrence distribution and delineation of the radiation field in lower thoracic squamous cell esophageal carcinomas: a real-world study

To study lymphatic recurrence distribution after radical surgery in the real world and guide clinical tumor volume delineation for regional lymph nodes during postoperative radiotherapy for lower thoracic squa...

Establishment of prognostic models for adenocarcinoma of oesophagogastric junction patients with neoadjuvant chemoradiotherapy: a real-world study

Multimodal therapies based on surgical resection have been recommended for the treatment of adenocarcinoma of the oesophagogastric junction (AEG). We aimed to evaluate prognostic factors in AEG patients receiv...

MR-guided radiotherapy in node-positive non-small cell lung cancer and severely limited pulmonary reserve: a report proposing a new clinical pathway for the management of high-risk patients

Online MR-guided radiotherapy (MRgRT) is a relatively novel advancement in the field of radiation oncology, ensuring superior soft-tissue visualisation, allowing for online plan adaptation to anatomical and fu...

A prospective comparison of adaptive and fixed boost plans in radiotherapy for glioblastoma

To analyze the efficacy of adaptive radiotherapy (ART) for glioblastoma.

Generation of ozone during irradiation using medical linear accelerators: an experimental study

Some patients have noted a foul odor during radiation therapy sessions, but the cause of the odor remains unknown. Since we suspected that this phenomenon is due to ozone generated by ionizing radiation, this ...

Response assessment after stereotactic body radiation therapy for spine and non-spine bone metastases: results from a single institutional study

The use of stereotactic body radiation therapy (SBRT) for tumor and pain control in patients with bone metastases is increasing. We report response assessment after bone SBRT using radiological changes through...

Radiotherapy interruption due to holidays adversely affects the survival of patients with nasopharyngeal carcinoma: a joint analysis based on large-scale retrospective data and clinical trials

The impact of radiotherapy interruption due to the Spring Festival holidays in China on the survival of patients with nasopharyngeal carcinoma (NPC) is unclear.

Preoperative spirometry and BMI in deep inspiration breath-hold radiotherapy: the early detection of cardiac and lung dose predictors without radiation exposure

This study aimed to investigate preoperative spirometry and BMI as early predictors of the mean heart and lung dose (MHD, MLD) in deep inspiration breath-hold (DIBH) radiotherapy.

Hypofractionated radiation leads to more rapid bleeding cessation in women with vaginal bleeding secondary to gynecologic malignancy

Vaginal bleeding (VB) is common in women with gynecologic (GYN) malignancies. Radiation therapy (RT) is used for the definitive treatment of GYN cancers and palliation of bleeding. The historical dogma is that...

Adjuvant postmastectomy radiotherapy might be associated with better survival in women with heart failure receiving total mastectomy

To date, no data on the effect of adjuvant postmastectomy radiotherapy (PMRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available in women ...

Factors associated with long-term survival in gemcitabine-concurrent proton radiotherapy for non-metastatic locally advanced pancreatic cancer: a single-center retrospective study

Factors associated with long-term survival in gemcitabine-concurrent proton radiotherapy (GPT) for non-metastatic, locally advanced pancreatic cancer (LAPC) remain unclear. This study aimed to determine the fa...

Patient-related risk factors for late rectal bleeding after hypofractionated radiotherapy for localized prostate cancer: a single-center retrospective study

Several studies have reported patient-related risk factors for late rectal bleeding following conventionally fractionated radiotherapy for prostate cancer. We investigated patient-related risk factors for late...

PET/CT-based adaptive radiotherapy of locally advanced non-small cell lung cancer in multicenter yDEGRO ARO 2017-01 cohort study

Stage III non-small cell lung cancer (NSCLC) represents a highly heterogeneous disease and treatment burden. Advances in imaging modality show promising results for radiotherapy planning. In this multicentric ...

Comparison of the distribution of lymph node metastases compared to healthy lymph nodes in breast cancer

Current literature lacks a comparison of lymph node metastases and non-pathological lymph nodes distribution in breast cancer patients. The aim of the current retrospective study was to generate a comprehensiv...

Survival impact of prophylactic cranial irradiation in small-cell lung cancer in the modern era of magnetic resonance imaging staging

In the modern era of magnetic resonance imaging (MRI) staging, the benefit of prophylactic cranial irradiation (PCI) in patients with small-cell lung cancer (SCLC) has been controversial. This study evaluated ...

Clinical evaluation of two AI models for automated breast cancer plan generation

Artificial intelligence (AI) shows great potential to streamline the treatment planning process. However, its clinical adoption is slow due to the limited number of clinical evaluation studies and because ofte...

Assessment and validation of the internal gross tumour volume of gastroesophageal junction cancer during simultaneous integrated boost radiotherapy

Respiratory motion may introduce errors during radiotherapy. This study aims to assess and validate internal gross tumour volume (IGTV) margins in proximal and distal borders of gastroesophageal junction (GEJ)...

• Editorial Board
• Manuscript editing services
• Instructions for Editors
• Editor’s Profile
• Sign up for article alerts and news from this journal
• Follow us on Twitter

Annual Journal Metrics

Citation Impact 2023 Journal Impact Factor: 3.3 5-year Journal Impact Factor: 3.6 Source Normalized Impact per Paper (SNIP): 1.197 SCImago Journal Rank (SJR): 1.033

Speed 2023 Submission to first editorial decision (median days): 12 Submission to acceptance (median days): 132

Usage 2023 Downloads: 1,958,690 Altmetric mentions: 605

• More about our metrics

Radiation Oncology

ISSN: 1748-717X

• General enquiries: [email protected]

• Bibliography
• More Referencing guides Blog Automated transliteration Relevant bibliographies by topics
• Automated transliteration
• Relevant bibliographies by topics
• Referencing guides

Dissertations / Theses on the topic 'Radiotherapy, radiation therapy,oncology'

Create a spot-on reference in apa, mla, chicago, harvard, and other styles.

Consult the top 50 dissertations / theses for your research on the topic 'Radiotherapy, radiation therapy,oncology.'

Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.

You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.

Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.

Abdelhamid, S. "Respiratory motion modelling and predictive tracking for adaptive radiotherapy." Thesis, Coventry University, 2010. http://curve.coventry.ac.uk/open/items/f135cb12-e9f9-1e4f-9c57-6de2fc378069/1.

Van, Jaarsveld Albert. "The role of adjuvant radiotherapy for breast cancer patients with axillary node negative or limited nodal disease after total mastectomy, axillary nodal clearance and systemic therapy." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/5931.

Reddy, Bhiskar. "Dosimetric comparison of volumetric modulated arc therapy and three dimensional conformal radiotherapy in the adjuvant setting for the management of gastric cancer : target volume coverage and normal tissue sparing." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/12943.

Cutter, David J. "Radiation-related cardiovascular disease following cancer therapy." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:3f02ca87-530d-4ee7-9382-4b457bec62b5.

Bham, Saif Ahmed Shahab. "Role of delta-like 4 in solid tumours and response to radiation therapy." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:f977581c-a460-4876-9ce4-dcbe9494aa1e.

Jackson, Mark Richard. "The identification and validation of Auger electron-emitting radiopharmaceuticals targeting telomerase for cancer therapy." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:040d10f6-c69b-41d3-b73f-7c47c4053db2.

Orvehed, Hiltunen Erik. "Robust optimization of radiotherapy treatment plans considering time structures of the delivery." Thesis, Uppsala universitet, Avdelningen för datalogi, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-355628.

Pirovano, Giacomo Maria. "TOPK as a novel determinant of radiosensitivity." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:a2b05e51-7f21-433f-8d28-51ac1a72a503.

Rhodes, Charles Ray III. "Development of an Automated Program for Calculating Radiation Shielding in a Radiotherapy Vault." University of Toledo Health Science Campus / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=mco1331557547.

Short, Wesley A. "Evaluating the Dosimetric Accuracy of Small Gating Windows in Radiotherapy." University of Toledo Health Science Campus / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=mco152538625156708.

Vos, Andre. "Determination of an optimal treatment margin for intracranial tumours treated with radiotherapy at Groote Schuur Hospital." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33076.

Vedam, Subrahmanya. "Management of Respiratory Motion in Radiation Oncology." VCU Scholars Compass, 2002. http://scholarscompass.vcu.edu/etd_retro/162.

Dial, Christian W. "Adaptive Radiation Therapy for Lung Cancer." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3579.

Fakie, Nazia. "Advanced breast cancer: A retrospective review comparing two palliative radiotherapy protocols used at Groote Schuur Hospital between 2010 and 2013." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/24483.

Sansourekidou, Patricia. "Accessibility of Innovative Services in Radiation Oncology." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7738.

Lind, Pehr. "Short-term pulmonary side-effects following radiation therapy in breast cancer /." Stockholm, 1999. http://diss.kib.ki.se/1999/91-628-3508-4/.

Shin, Naomi. "Modeling secondary cancer risk following paediatric radiotherapy: a comparison of intensity modulated proton therapy and photon therapy." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=106431.

Taylor, Carolyn W. "Breast cancer radiotherapy and heart disease." Thesis, University of Oxford, 2008. http://ora.ox.ac.uk/objects/uuid:c9dda3ca-8cb3-4a38-938d-0b75b4f6471d.

Riddick, Alison. "Clinical symptoms and volumetric radiological responses of acoustic neuroma patients, treated with hypo-fractionated image guided radiotherapy (IGRT) at Groote Schuur hospital between 2013 and 2016." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30174.

Adhikary, Kalyan. "Development of Graphical User Interfaces (GUI) software and database for radiation therapy applications." Connect to full-text via OhioLINK ETD Center, 2005. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=mco1160398346.

Twiss, Megan Margaret Jean. "Multimodality approach to predicting response of vestibular schwannomas to radiation therapy." Thesis, University of British Columbia, 2009. http://hdl.handle.net/2429/3803.

Walker, Charlotte Anne. "Feasibility of selective multiple boosting in the planning of intracranial radiation therapy." Thesis, University of Hull, 2007. http://hydra.hull.ac.uk/resources/hull:578.

Costa, Ferreira Brigida da. "Biological optimization of angle of incidence and intensity modulation in breast and cervix cancer radiation therapy /." Stockholm : Division of medical radiation physics, Karolinska Institutet and Stockholm University, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-313.

Fan, Qiyong. "Emission guided radiation therapy: a feasibility study." Thesis, Georgia Institute of Technology, 2010. http://hdl.handle.net/1853/37277.

Chiu, Siu-hau, and 招兆厚. "A search for optimal radiation therapy technique for lung tumours stereotactic body radiation therapy (SBRT) : dosimetric comparison of 3D conformal radiotherapy, static gantry intensity modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) with flattening filter (FF) or flattening filter-free (FFF) beams." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/196549.

Engelbeen, Céline. "The segmentation problem in radiation therapy." Doctoral thesis, Universite Libre de Bruxelles, 2010. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210107.

Cowen, Mark Andrew. "An investigation into the potential benefits and detriments of image-guided radiotherapy." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.610223.

Cullen, Ashley James. "Strip detector for high spatial resolution dosimetry in radiation therapy." Centre for Medical Radiation Physics - Faculty of Engineering, 2009. http://ro.uow.edu.au/theses/848.

Fong, Raymond, and 方思行. "Effects of different radiation therapy techniques on swallowing function in individuals with nasopharyngeal cancer." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/196497.

Gozbasi, Halil Ozan. "Optimization approaches for planning external beam radiotherapy." Diss., Georgia Institute of Technology, 2010. http://hdl.handle.net/1853/34726.

Fulcher, TJ. "The development of an interlock and control system for a clinical proton therapy system." Thesis, Cape Technikon, 1995. http://hdl.handle.net/20.500.11838/1483.

Tangboonduangjit, Puangpen. "Intensity-modulated radiation therapy dose maps the matchline effect /." Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20060724.095712/index.html.

Meyer, Jurgen. "Accommodating practical constraints for intensity-modulated radiation therapy by means of compensators." Thesis, Coventry University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369972.

Ntentas, Georgios. "Radiation dosimetry for studying the late effects of radiotherapy." Thesis, University of Oxford, 2018. http://ora.ox.ac.uk/objects/uuid:7fb38ff2-9618-4f38-9953-106d832ab7db.

Scott, Jacob G. "Mathematical modelling of tumour evolution and radiation response : the impact of heterogeneity." Thesis, University of Oxford, 2016. http://ora.ox.ac.uk/objects/uuid:a318d567-9f5c-4632-8fab-0ec3f4229a5e.

Hack, Joshua. "Development and implementation of quality-assurance standards for external beam intensity modulated radiation therapy." Toledo, Ohio : University of Toledo, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=mco1265034762.

suh, yelin. "DEVELOPMENT AND INVESTIGATION OF INTENSITY-MODULATED RADIATION THERAPY TREATMENT PLANNING FOR FOUR-DIMENSIONAL ANATOMY." VCU Scholars Compass, 2009. http://scholarscompass.vcu.edu/etd/1827.

Gyenes, Gábor. "Cardiac side-effects of adjuvant radiotherapy for early breast cancer /." [Budapest] ; Stockholm, 1997. http://diss.kib.ki.se/1997/963-9106-04-6.

Abbasinejad, Enger Shirin. "Dosimetry Studies of Different Radiotherapy Applications using Monte Carlo Radiation Transport Calculations." Doctoral thesis, Uppsala University, Department of Oncology, Radiology and Clinical Immunology, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9277.

Developing radiation delivery systems for optimisation of absorbed dose to the target without normal tissue toxicity requires advanced calculations for transport of radiation. In this thesis absorbed dose and fluence in different radiotherapy applications were calculated by using Monte Carlo (MC) simulations.

In paper I-III external neutron activation of gadolinium (Gd) for intravascular brachytherapy (GdNCB) and tumour therapy (GdNCT) was investigated. MC codes MCNP and GEANT4 were compared. MCNP was chosen for neutron capture reaction calculations. Gd neutron capture reaction includes both very short range (Auger electrons) and long range (IC electrons and gamma) products. In GdNCB the high-energetic gamma gives an almost flat absorbed dose delivery pattern, up to 4 mm around the stent. Dose distribution at the edges and inside the stent may prevent stent edge and in-stent restenosis. For GdNCT the absorbed dose from prompt gamma will dominate over the dose from IC and Auger electrons in an in vivo situation. The absorbed dose from IC electrons will enhance the total absorbed dose in the tumours and contribute to the cell killing.

In paper IV a model for calculation of inter-cluster cross-fire radiation dose from β-emitting radionuclides in a breast cancer model was developed. GEANT4 was used for obtaining absorbed dose. The dose internally in cells binding the isotope (self-dose) increased with decreasing β-energy except for the radionuclides with substantial amounts of conversion electrons and Auger electrons. An effective therapy approach may be a combination of radionuclides where the high self-dose from nuclides with low β-energy should be combined with the inter-cell cluster cross-fire dose from high energy β-particles.

In paper V MC simulations using correlated sampling together with importance sampling were used to calculate spectra perturbations in detector volumes caused by the detector silicon chip and its encapsulation. Penelope and EGSnrc were used and yielded similar results. The low energy part of the electron spectrum increased but to a less extent if the silicon detector was encapsulated in low z-materials.

Campbell, Patricia A. "Therapeutic self-care demands perceived by out-patients receiving external radiation therapy." Virtual Press, 1990. http://liblink.bsu.edu/uhtbin/catkey/722453.

Fullerton, Natasha Eileen. "Gene therapy and targeted radiotherapy applied to bladder and prostate cancer : examination of radiation-induced bystander effects in targeted radiotherapy." Thesis, University of Glasgow, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.438687.

Satterfield, Megan E. "Application of a heterogeneous coarse-mesh transport method (COMET) to radiation therapy problems." Thesis, Available online, Georgia Institute of Technology, 2006, 2006. http://etd.gatech.edu/theses/available/etd-11192006-213749/.

Price, Ryan Glen. "Toward magnetic resonance only treatment planning| Distortion mitigation and image-guided radiation therapy validation." Thesis, Wayne State University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10153444.

While MR-only treatment planning has shown promise, there are still several well-known challenges that are currently limiting widespread clinical implementation. Firstly, MR images are affected by both patient-induced and system-level geometric distortions that can significantly degrade treatment planning accuracy. In addition, the availability of comprehensive distortion analysis software is currently limited. Also while many groups have been working toward a synthetic CT solution, further study is needed on the implementation of synCTs as the reference datasets for linac-based image-guided radiation therapy (IGRT) to help determine their robustness in an MR-only workflow.

To determine candidate materials for phantom and software development, 1.0 T MR and CT images were acquired of twelve urethane foam samples of various densities and strengths. Samples were precision machined to accommodate 6 mm diameter paintballs used as landmarks. Final material candidates were selected by balancing strength, machinability, weight, and cost. Bore sizes and minimum aperture width resulting from couch position were tabulated from the literature. Bore geometry and couch position were simulated using MATLAB to generate machine-specific models to optimize the phantom build. Previously developed software for distortion characterization was modified for several magnet geometries, compared against previously published 1.0 T results, and integrated into the 3DSlicer application platform.

To evaluate the performance of synthetic CTs in an image guided workflow, magnetic resonance simulation and CT simulation images were acquired of an anthropomorphic skull phantom and 12 patient brain cancer cases. SynCTs were generated using fluid attenuation inversion recovery, ultrashort echo time, and Dixon data sets through a voxel-based weighted summation of 5 tissue classifications. The DRRs were generated from the phantom synCT, and geometric fidelity was assessed relative to CT-generated DRRs through bounding box and landmark analysis. An offline retrospective analysis was conducted to register cone beam CTs to synCTs and CTs using automated rigid registration in the treatment planning system. Planar MV and KV images were rigidly registered to synCT and CT DRRs using an in-house script. Planar and volumetric registration reproducibility was assessed and margin differences were characterized by the van Herk formalism.

Over the sampled FOV, non-negligible residual gradient distortions existed as close as 9.5 cm from isocenter, with a maximum distortion of 7.4mm as close as 23 cm from isocenter. Over 6 months, average gradient distortions were -0.07±1.10 mm and 0.10±1.10 mm in the x and y-directions for the transverse plane, 0.03±0.64 and -0.09±0.70 mm in the sagittal plane, and 0.4±1.16 and 0.04±0.40 mm in the coronal plane. After implementing 3D correction maps, distortions were reduced to < 1 pixel width (1mm) for all voxels up to 25 cm from magnet isocenter.

Bounding box and landmark analysis of phantom synCT DRRs were within 1 mm of CT DRRs. Absolute planar registration shift differences ranged from 0.0 to 0.7 mm for phantom DRRs on all treatment platforms and from 0.0 to 0.4 mm for volumetric registrations. For patient planar registrations, the mean shift differences were 0.4±0.5 mm, 0.0±0.5 mm, and 0.1±0.3 mm for the superior-inferior (S-I), left-right (L-R), and anterior-posterior (A-P) axes, respectively. The mean shift differences in volumetric registrations were 0.6±0.4 mm (range, 0.2 to 1.6 mm), 0.2±0.4 mm, and 0.2±0.3 mm for the S-I, L-R, and A-P axes, respectively. The CT-SIM and synCT derived margins were <0.3mm different.

This work has characterized the inaccuracies related to GNL distortion for a previously uncharacterized MR-SIM system at large FOVs, and established that while distortions are still non-negligible after current vendor corrections are applied, simple post-processing methods can be used to further reduce these distortions to less than 1mm for the entire field of view. Additionally, it was important to not only establish effective corrections, but to establish the previously uncharacterized temporal stability of these corrections. This work also developed methods to improve the accessibility of these distortion characterizations and corrections. We first tested the application of a more readily available 2D phantom as a surrogate for 3D distortion characterization by stepping the table with an integrated batch script file. Later we developed and constructed a large modular distortion phantom using easily obtainable materials, and showed and constructed a large modular distortion phantom using easily obtainable materials, and used it to characterize the distortion on several widely available MR systems. To accompany this phantom, open source software was also developed for easy characterization of system-dependent distortions. Finally, while the dosimetric equivalence of synCT with CT has been well established, it was necessary to characterize any differences that may exist between synCT and CT in an IGRT setting. This work has helped to establish the geometric equivalence of these two modalities, with some caveats that have been discussed at length. (Abstract shortened by ProQuest.)

Reilly, Andrew James. "Uniform framework for the objective assessment and optimisation of radiotherapy image quality." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/5589.

Fokas, Emmanouil. "Targeting the PI3K/mTOR and ATK/Chk1 pathways to improve radiation efficacy for cancer therapy." Thesis, University of Oxford, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.572788.

Warren, Daniel Rosevear. "Proton radiotherapy uncertainties arising from computed tomography." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:ab59f596-e277-490a-a7c1-1cb81b47b9a9.

Delaney, Geoffrey Paul SWSAHS Clinical School UNSW. "The Development of a New Measure of Linear Accelerator Throughput in Radiation Oncology Treatment Delivery - The Basic Treatment Equivalent (B.T.E.)." Awarded by:University of New South Wales. SWSAHS Clinical School, 2001. http://handle.unsw.edu.au/1959.4/33381.

Mandelli, Elena. "Ionizing radiation detectors and their innovative application in proton therapy." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2020. http://amslaurea.unibo.it/21880/.

Peszynski, Ruth Iris. "A Procedure to Verify the Accuracy of Delivery of Prescribed Radiation Doses in Radiotherapy." Thesis, University of Canterbury. Physics and Astronomy, 2008. http://hdl.handle.net/10092/1962.

Handley, Stephen Michael. "Monte Carlo simulations using MCNPX of proton and anti-proton beam profiles for radiation therapy." Oklahoma City : [s.n.], 2010.

An official website of the United States government

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Publications
• Account settings
• Advanced Search
• Journal List

Recent advances in radiation oncology

Cristina garibaldi, barbara alicja jereczek-fossa, giulia marvaso, samantha dicuonzo, damaris patricia rojas, federica cattani, anna starzyńska, delia ciardo, alessia surgo, maria cristina leonardi, rosalinda ricotti.

• Author information
• Article notes
• Copyright and License information

Correspondence to: Giulia Marvaso. [email protected]

Received 2017 May 2; Collection date 2017.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Radiotherapy (RT) is very much a technology-driven treatment modality in the management of cancer. RT techniques have changed significantly over the past few decades, thanks to improvements in engineering and computing. We aim to highlight the recent developments in radiation oncology, focusing on the technological and biological advances. We will present state-of-the-art treatment techniques, employing photon beams, such as intensity-modulated RT, volumetric-modulated arc therapy, stereotactic body RT and adaptive RT, which make possible a highly tailored dose distribution with maximum normal tissue sparing. We will analyse all the steps involved in the treatment: imaging, delineation of the tumour and organs at risk, treatment planning and finally image-guidance for accurate tumour localisation before and during treatment delivery. Particular attention will be given to the crucial role that imaging plays throughout the entire process. In the case of adaptive RT, the precise identification of target volumes as well as the monitoring of tumour response/modification during the course of treatment is mainly based on multimodality imaging that integrates morphological, functional and metabolic information. Moreover, real-time imaging of the tumour is essential in breathing adaptive techniques to compensate for tumour motion due to respiration.

Brief reference will be made to the recent spread of particle beam therapy, in particular to the use of protons, but also to the yet limited experience of using heavy particles such as carbon ions.

Finally, we will analyse the latest biological advances in tumour targeting. Indeed, the effectiveness of RT has been improved not only by technological developments but also through the integration of radiobiological knowledge to produce more efficient and personalised treatment strategies.

Keywords: image guided radiotherapy, adaptive radiotherapy, stereotactic body radiotherapy, intensity-modulated radiotherapy, radiogenomics

Introduction

Radiotherapy (RT) plays a crucial role in the care of cancer with approximately 50% of all patients benefiting from RT in the management of their disease [ 1 – 3 ].

Radiation oncologists work with medical and surgical oncologists to coordinate a multidisciplinary approach to the management of cancer.

In the curative setting, RT can be offered as the sole radical treatment. It can also be combined with surgery, being given during (intra-operative), before (neoadjuvant) or after resection (adjuvant), or with systemic therapy, sometimes for organ preservation (such as larynx, breast, urinary bladder, etc) [ 4 – 6 ]. Moreover, it can provide symptom relief in cancers that are locally advanced or disseminated by reducing or eliminating pain from bone metastases in 60% of cases [ 7 – 9 ].

RT also has an effect on the dissemination of the tumour in that local/regional therapies are, in effect, ‘stopping metastases at their source’ [ 10 ]. More recently, the possibility of the abscopal effect has been raised on the basis of a remission in out-target lesions after localised RT [ 11 ].

RT is very much a technology-driven treatment modality. RT techniques have changed significantly over the past few decades due to the improvements in engineering and computing, evolving from conventional irradiation using simple treatment fields towards highly conformal RT techniques, such as intensity-modulated RT (IMRT), intensity-modulated arc therapy (IMAT) and stereotactic RT (SRT), which aim to improve the outcome by escalating the dose to the target and minimizing the toxicity to normal tissue and critical organs. So, nowadays, certain tumours (i.e. breast and prostate cancer) receive shorter courses of RT as a safe and well-tolerated alternative to the longer conventional schemes; this is a big advantage for patients and also for healthcare costs [ 12 ]. Indeed, high-precision extremely hypo-fractionated RT has been called virtual surgery, since in many situations it can have a radical curative effect locally that is similar to surgery. From the biological point of view, such a high dose per fraction induces different radiobiological mechanisms of cell killing and therefore introduces a new concept of radio ablation.

Technological advances have mainly been the result of integration of imaging information in every phase of the treatment, from simulation to planning to delivery. Indeed, treatment planning systems (TPS) provide sophisticated image registration and fusion algorithms [ 13 ]. Moreover, treatment planning optimisation is becoming more radiobiology-oriented, integrating local radiation damage models [ 14 ].

At present, the precise identification of target volumes for treatment planning is mainly based on the integration of radiological/metabolic imaging, such as magnetic resonance imaging (MRI) or positron emission tomography (PET), with computed tomography (CT) scan simulation [ 15 – 20 ]. Tumour localisation immediately before and during treatment delivery by means of image-guided techniques is becoming a part of clinical practice and is a fundamental prerequisite for high-precision RT [ 21 – 24 ]. As part of a comprehensive RT treatment process, adaptive RT (ART) techniques make it possible to modify the treatment plan during the course of RT in order to account for anatomical and biological changes [ 13 , 25 ].

However, technological advances seem likely to reach a plateau in the near future. Indeed, if the tendency towards ever-more cost-effective treatments is to be continued, these must be linked to a better understanding of tumour biology. Although DNA damage is generally considered the primary event leading to radiation-induced cell lethality, numerous non-DNA-related mechanisms have recently been implicated in cellular response to radiation (i.e. the bystander effect and the radiation-induced signalling of epidermal growth factor receptor [ 26 – 28 ].

Many of the developments in understanding the effects of radiation are now leading to a new vision of targeted therapeutics, creating a challenge which we will probably be facing in the near future [ 29 , 30 ].

In this article, we will review some of the advances that have led to modern high-precision RT as it is today, focusing on the discoveries that have been made in terms of new technology and cancer biology.

Principle of radiotherapy

In RT, high-energy radiation is used to destroy cancer cells, by depositing energy that damages the genetic material of cells and blocks their ability to divide and proliferate further [ 31 ].

Photon beams, produced by linear accelerators (LINACs), are characterised by a high deposit of energy near to the body surface with an exponential decrease of energy release as a function of depth. One of the major limitations of photon RT is that the cells of solid tumours become deficient in oxygen. Tumour cells in a hypoxic environment may be as much as 2–3 times more resistant to radiation damage than those in a normal oxygen environment, and much research has been devoted to overcoming hypoxia [ 32 ].

In particle therapy, or hadrontherapy, radiation is propagated by travelling corpuscles such as protons or boron, carbon, neon ions [ 33 ] that have an antitumour effect independent of tumour oxygen supply because they act mostly via direct energy transfer that causes double-stranded DNA breaks. Compared to photons, charged particles have an inverted depth dose profile; that is, low incident energy deposition with a spike at the tail-end of its dose distribution (the Bragg peak) and essentially no dose beyond the end range. Consequently, hadrontherapy spares the uninvolved tissue distal to the target and generally deposits a lower dose to the tissue proximal to the target than do photons.

The goal of RT is to maximise the radiation dose to cancer cells while minimizing exposure to adjacent normal cells, hence achieving a high probability of local tumour control [tumour control probability (TCP)] with a low risk of normal tissue complications [normal tissue complication probability (NTCP)] [ 34 ]. RT is based on the idea that the DNA repair capacity is generally greater in healthy cells than in cancerous cells [ 35 , 36 ].

Cell survival after RT is modelled by an exponential function that accounts for both direct, called alpha, and indirect, called beta, mechanisms of DNA damage. The alpha/beta ratio of these types of damage expresses the ability of the tissue to repair the damage. This repair ability is inversely proportional to the alpha/beta ratio. Historically, the RT schedules conceived exploited the difference in damage repair between tumour and normal tissue by delivering small doses of radiation over a prolonged period of time. The rationale for fractionated RT is based on the four Rs of RT: re-assortment, repair, re-oxygenation and repopulation [ 37 ], to which radiosensitivity was later added [ 38 ]. Tissue with a high alpha/beta ratio is less sensitive to a high dose per fraction or hypo-fractionated RT compared to tissue with a low alpha/beta ratio. Most tumours have a high alpha/beta ratio (about 10 Gy) and are therefore treated with the standard fractionation of 2 Gy/fraction, or with a hyper-fractionated regimen (dose/fraction < 2 Gy, usually given twice a day). In the past decade, experimental and clinical data have suggested that prostate and breast cancer may actually have a lower alpha/beta ratio than previously suspected [ 39 – 43 ]. This may be due not only to different tumour characteristics but also to cell variability within the tumour or to uncontrolled confounding factors, such as the presence of tumour hypoxia, repopulation or patient-to-patient variability [ 14 ].

Recent technological advances have made it possible to safely escalate the dose/fraction, which improves the therapeutic ratio of RT, that is, it increases the cure rate and reduces toxicity [ 43 , 44 ].

Technological advances

In the following, we will briefly present the high-precision RT techniques currently available in clinical practice together with the fundamental prerequisite to accurately localise the target volume during treatment planning and delivery. Finally, ART is introduced within the framework of personalised medicine.

Treatment techniques: state of the art

Intensity-modulated radiotherapy.

Intensity modulation [ 45 ] was introduced in the early 1990s as a further refinement in the delivery of three-dimensional conformal radiation therapy (3D-CRT). IMRT was made possible by use of computer-controlled multi-leaf collimators (MLCs) and advanced treatment planning optimisation algorithms that are able to create the desired dose variation inside the radiation field. As opposed to standard planning techniques, where the dose distribution can only be modified by means of a try and error approach (changing for instance the field weight, angle and shape), with IMRT, the radiation oncologist designates the doses and dose/volume constraints for the tumour and the surrounding normal organs and the TPS determines the optimal fluence of each field resulting in a tailored dose distribution (inverse planning).

In the past, IMRT was usually delivered using a conventional LINAC with a static field geometry. Developments in IMRT techniques have focused on reducing treatment times with arc therapy by converting multiple static field IMRT into continuously rotating gantry intensity modulation [ 46 ].

Examples of IMAT solutions include TomoTherapy Hi-Art (Accuray, Inc., Sunnyvale, CA, USA) [ 47 ], and volumetric-modulated arc therapy (RapidArc, Varian Medical Systems, Inc., Paolo Alto, CA, USA and VMAT, Elekta, AB, Stockholm, Sweden) [ 48 ].

IMRT/IMAT techniques make it possible to deliver different levels of dose to different parts of the tumour (for instance, a hypoxic area of the tumour, identified by means of functional imaging, may receive a boost dose). Approaches using a simultaneous integrated boost (SIB) and the delivery of dose-escalated conventionally fractionated or hypo-fractionated RT using IMRT techniques are now being investigated as an alternative to conventional RT for different anatomical sites: breast [ 49 , 50 ], head and neck [ 51 , 52 ] prostate [ 53 , 54 ]. Examples, using tomotherapy, of SIBs delivered to the breast tumour bed and to the dominant intra-prostatic lesions (DILs) are shown in Figures 1 and 2 .

Figure 1. Axial view of a treatment plan for whole breast irradiation with SIB delivered with TomoTherapy. The colour green corresponds to 95% of the prescribed dose to the breast, and the colour red to 95% of the boost dose.

Figure 2. Axial view of a volumetric arc therapy (VMAT) treatment plan for prostate cancer delivered with RapidArc, with SIB to DILs.

However, with IMAT techniques, a larger volume of normal tissue receive a low radiation dose (dose bath) compared to static IMRT with a potential increase in induced second malignancies. Hall and Wuu [ 55 ] reported a theoretically increased risk of second malignancy from 1% to 1.75%. It is important to note that numerous epidemiological studies estimate that a large proportion of second cancers are related to other factors, such as lifestyle (smoking, alcohol, obesity, physical inactivity and diet), infections, (human papilloma virus, hepatitis C virus, etc) or genetics [ 56 ].

Stereotactic body radiotherapy

Stereotactic body RT (SBRT) is very much a technology-driven treatment modality [ 57 ]. SBRT systems are capable of producing very conformal treatment plans with a steep dose gradient outside the target. This technique makes possible safe and efficacious treatment across a broad array of anatomic locations, in proximity to critical organs, and even adjacent to or within prior RT fields. Essential requirements for SBRT are the accuracy of target delineation (see ‘Tumour Localisation in Treatment Planning’ section), and the implementation of inter- and intra-fraction tumour motion compensation strategies (especially for tumours in the lung and in the upper abdomen). The wider availability of in-room imaging and advanced treatment delivery systems means that more institutions are now offering SBRT (see ‘Tumour Localisation in Treatment Delivery’ section) [ 58 ]. At present, there are a variety of systems available for SBRT. Some of them are based on the traditional LINAC gantry, for example, Versa HD (Elekta, AB, Stockholm, Sweden) [ 59 ] and TrueBeam STx (Varian Medical Systems, Inc., Paolo Alto, CA, USA) [ 60 ], whereas others have moved away from this design in search of greater non-coplanar beam arrangements, for example, CyberKnife® (Accuray, Inc., Sunnyvale, CA, USA) [ 61 ] and VERO (Mitsubishi Heavy Industries, Ltd., Japan, and BrainLAB AG, Feldkirchen, Germany) [ 62 , 63 ]. An example of a stereotactic treatment plan delivered with CyberKnife® for early-stage non-small cell lung carcinoma is shown in Figure 3 .

Figure 3. Axial view of a stereotactic treatment plan delivered with CyberKnife for an early stage non-small cell lung carcinoma.

The local ablative capability of SBRT challenges surgery as the gold standard and could become the standard for patients with early stage lung cancer, who are operable but are at high risk of morbidity [ 64 ]. Indeed, SBRT has been called virtual surgery or radio ablation as in many cases, such as lung, it can have a radical curative effect locally that is similar to surgery.

Particle beam therapy

The past decade has seen an increasing use of particle therapy, particularly protons [ 65 ]. Radiation dose distributions for proton therapy often appear to be better than those for IMRT photon-based treatments, particularly in that they reduce the low and intermediate radiation dose to normal tissue. Proton therapy is new and although it has dosimetric advantages theoretically, independent evaluation is still to be made in order to assess its strengths and weaknesses [ 66 , 67 ]. Indeed, prospective clinical trials to compare proton therapy to photon IMRT need to be carried out. Moreover, proton therapy is in the midst of a significant technological development at the level of motion management, evolving from passively scattered beams towards actively scanned ones [ 68 – 70 ]. Finally, proton therapy could be of use in a stereotactic regimen, but at the moment there is no clinical series that supports this hypothesis.

Proton therapy has been used internationally for cancers of the eye, base of skull and spine, particularly in paediatric patients [ 66 , 71 – 73 ]. Indeed, proton therapy in children has been shown to have a lower incidence of vision and hearing impairment, of neurocognitive degeneration and of second cancers, than is the case with other RT modalities.

Moreover, heavy particles, such as carbon ions, are particularly indicated for severely radio-resistant tumours because their biological effectiveness is greater than that of photons and protons [ 74 ]. According to the Particle Therapy Co-Operative Group (PTCOG, www.ptcog.com ), which constantly updates the statistics on cancer treatment with particle therapy, ten carbon ion therapy facilities are in operation to date (July 2017): five in Japan, two in China and five in Europe (Austria, Germany and Italy). The National Institute of Radiological Sciences Chiba, Japan, has been treating cancer with high-energy carbon ions since 1994, with more than 10,000 patients treated by August 2016 and, thus, is the centre with the greatest experience in carbon ion treatment worldwide [ 75 , 76 ]. For the first time, at the National Centre for Oncological Hadrontherapy in Pavia, Italy, carbon ions delivered with active scanning together with breathing synchronisation and rescanning modalities have been used to treat patients with tumours of the liver and pancreas [ 77 ].

Advances in treatment planning

The advent of sophisticated treatment delivery techniques has made it necessary to develop advanced TPSs.

Techniques that can integrate images acquired at different times is becoming a part of common clinical practice for accurate tumour localisation, 4D treatment planning and ART (see ‘Tumour Localisation in Treatment Planning’ and ‘Tumour Localisation in Treatment Delivery’ sections). Image registration and fusion, that is, the ability to identify corresponding spatial locations in two or more image volumes and to visualise the result by superimposing the images, is essential in a modern TPS [ 13 ]. A crucial aspect, when using registration techniques, is the accuracy of image realignment. Rigid registration algorithms perform translations, rotations and affine image transformations and are widely used in the clinical setting. However, since the human body is intrinsically deformable, rigid techniques often provide insufficient registration accuracy. Thus, elastic or deformable methods are required to cope with local differences between images [ 78 ]. These methods are capable of warping the target image locally to align it with the reference image. Non-rigid image registration is a challenging issue as a large number of parameters describing the spatial correspondence of images are needed. Most TPSs now support both rigid and deformable image registration and fusion [ 79 ].

The advances in technology have led to an escalation of the prescription dose or a change in the number of fractions. In recent years, increased attention has been paid to the radiobiological optimisation of the treatment plan, using TCP and NTCP models [ 14 ]. Even though dose–volume optimisation techniques are a mainstay of current TPSs, the biological optimisation used in IMRT planning is able to reduce radiation-induced toxicity [ 80 – 91 ].

In addition, although advanced inverse-planning techniques have led to the development of more automated approaches, plan optimisation is still a very time-consuming task with output varying greatly according to the experience of the operator. At the moment, the move towards using fully automated TPSs clinically is slow and debates are ongoing [ 84 ]. The arguments against automated treatment planning have concentrated on the examples of those treatments that are difficult to do automatically, such as bilateral post-implant chest wall irradiation.

Tumour localisation in treatment planning

As mentioned earlier, the more precise radiation delivery becomes, the more important it is to accurately identify the extension of both the tumour mass and also the normal tissue and critical organs involved in the neoplastic degeneration. This is essential in order to optimise irradiation geometry by delivering the radiation dose to the tumour itself while minimizing the dose delivered to surrounding tissue and organs at risk (OARs).

The integration of radiological/metabolic imaging, such as MRI and PET, with the CT scan simulation can provide useful information for accurately visualizing the tumour volume [ 16 , 17 ]. The integration of these images is made possible by image registration algorithms incorporated into the TPS. Technological developments mean that MRI has become increasingly useful in identifying and characterizing lesions within the prostate as well as detecting local disease recurrence following primary definitive prostate treatment. The inclusion of multiple MRI parameters is known as multiparametric MRI (mpMRI). Overlapping modalities in mpMRI corrects for deficiencies inherent in any individual sequence. Combining advanced techniques of functional MRI, including T2 weighted (T2W), dynamic contrast enhanced and diffusion weighted imaging (DWI), improves visualisation and the accurate detection of intra-prostatic lesions and differentiates between low and intermediate/high-grade disease [ 18 , 44 ]. PET with different tracers has made it possible to obtain metabolic information and identify the most radio-resistant sub-volumes within the tumour [ 19 , 20 ]. Adequate contouring is the fundamental pre-requisite for an effective and safe treatment plan. However, it is a process prone to errors and inter- and intra-operator variability [ 85 , 86 ]. The delineation of tumour volumes is based on a complex process of data interpretation (clinical history, pathology and imaging). To improve the consistency of contouring among radiation oncologists, several working groups have provided consensus instructions and atlases [ 87 – 91 ]. However, it should be noted that no one guideline can be adopted as the perfect recipe for all patients. These protocols are often derived from ‘expert opinion’ and consensus as well as objective evidence, so it is not surprising that there can be variation between groups. Besides, the possibility of microscopic spread of the tumour beyond the anatomic borders defined by the atlases should be carefully considered by radiation oncologists, especially when high-precision techniques are used.

Generally, with the introduction of IMRT techniques into the clinical scenario, a large number of OARs is delineated to assess the low-dose bath. A recent development in RT is the use of automated atlas-based auto-segmentation algorithms to support contouring OARs [ 92 , 93 ]. Several studies have demonstrated that inter-observer variability decreases when the automatic atlas-based segmented structures are used as a base and then modified [ 94 – 97 ]. Automatic or semi-automatic (needing manual revision) segmentation algorithms can speed up the delineation of OARs and they offer reliability and repeatability in delineating the structures.

Tumour localisation in treatment delivery

The increasingly conformal dose distributions that are possible with modern RT make it even more important that the patient’s position is the same for the simulation and for the treatment. The sensitivity to treatment uncertainties due to organ motion and inaccurate patient positioning is even more worrying when high-precision techniques are combined with dose escalation and hypo-fractionation schemes.

Image-guided radiotherapy

Technological innovations have made possible the direct integration of imaging technology into the radiation treatment device to increase the precision and accuracy of radiation delivery by controlling the placement of the dose within the body [ 22 , 98 ].

A broad range of image-guided radiotherapy (IGRT) modalities is now available and generally used. There are several methods for localizing the target for each treatment fraction: by localizing surrogates, including implanted fiducial markers, external surface markers or anatomical features (through planar imaging, fluoroscopy, kilovoltage CT (kV-CT) or megavoltage CT (MV-CT), MRI, ultrasound and x-ray imaging, electromagnetic localisation, optical surface imaging and so on. Depending on the imaging methods used, the IGRT systems may broadly be divided into radiation based, non-radiation based and hybrid systems [ 21 , 99 , 100 ].

Of all soft-tissue based IGRT techniques, cone beam CT (CBCT) is the most widely used. It consists of acquiring multiple projection radiographs (for head and neck imaging ~350, for thoracic/pelvic imaging up to 600) before the RT fraction and within a gantry rotation of 180°–360°. A volumetric image with high spatial resolution and sufficient soft-tissue contrast is reconstructed and registered to the reference planning CT to determine the correct target position. Translational and rotational positioning errors can be corrected online before irradiation [ 23 , 24 , 101 – 103 ].

To mitigate the effects of tumour motion due to respiration on image quality and registration uncertainty, CBCT can be acquired in conjunction with breath-hold strategies [ 104 ] or in a respiratory triggered approach (4D-CBCT) [ 105 ]. Moreover, ultrafast ‘snapshot’ volume imaging is ready to be deployed clinically [ 106 ].

Surface imaging devices, either based on passive infrared markers or active markers, can be used as a complementary positioning device, providing intra-fraction patient surveillance which further improves the overall precision of the treatment [ 107 – 114 ].

IGRT has been improved by the development of devices making it possible to reposition the patient using MRI. MRI yields superb soft-tissue visualisation and provides several imaging modalities for identifying movement, function and physiology without delivering any additional dose to the patient. Various integrated MRI-guided radiation therapy systems have been developed, such as the hybrid MRI–LINAC [ 115 , 116 ], which is still a prototype, and the Viewray system (MRIdian System, ViewRay, Inc., Cleveland Oakwood Village, OH, USA) [ 117 ], which has been in clinical use for the last couple of years.

IGRT not only makes it possible to improve the accuracy of the treatment by minimizing the inter-fractional position uncertainties, but it is also able to monitor systematic changes in the shape and position of tumour volume and of normal tissue (weight loss and tumour regression), which means that the plan can be suitably modified.

Breathing adaptive radiotherapy

Real-time monitoring of patient position significantly reduces intra-fraction movement, due either to physiological movement as in the case of the prostate, or due to respiration when tumours are located in the lung or upper abdomen. Electromagnetic technologies such as implanted radiofrequency markers have been successfully used for the prostate [ 118 , 119 ]. Marker-based real-time image guidance has been in clinical use in the CyberKnife systems for over a decade. For its use to become widespread, real-time IGRT will probably need markerless solutions. A variety of kilovolt-based and MV-based possibilities have been proposed [ 120 ]. Cine MRI, which is available with the new MRI-guided radiation therapy systems, is able to provide non-invasive target localisation during RT treatment [ 121 , 122 ].

The American Association of Physicists in Medicine Task group 76 [ 123 ] recommends caution when using IMRT techniques in regions where respiratory motion may jeopardise treatment. At least two intra-fraction motion effects may be present in the intensity-modulated treatment of a target subject to respiratory-induced motion: the dose blurring and the interplay effect. Planning studies show that during IMRT treatments a cyclic breathing motion with a 5–30-mm amplitude has a significant effect on dosimetry [ 124 – 126 ].

Several techniques have been proposed to reduce the effects of respiratory motion, from simple motion-encompassing, respiratory gating, either in free-breathing or in breath hold, to dynamic tumour tracking (DTT) [ 116 , 127 ]. With the motion-encompassing technique, the mean position and the range of tumour motion are estimated from fluoroscopy or four-dimensional CT (4D-CT) data to define the internal target volume (ITV). However, a large ITV is required to accommodate tumour motion, which may lead to an increase in normal tissue complications. Respiratory gating, in free-breathing or in breath-hold, reduces the size of the ITV, but it increases the overall treatment time since the irradiation is delivered only in a predefined phase of the respiratory cycle, usually end expiration or end inspiration (in the case of deep inspiration breath hold), and it might be uncomfortable for the patient [ 127 ]. However, deep inspiration breath hold reduces the dose to the heart and left lung in the case of irradiation to the left breast [ 128 ]. The most sophisticated and efficient technique to reduce the size of the ITV is DTT, which makes it possible to reposition the beam dynamically according to the position of the tumour once the real-time IGRT system has determined tumour location. This can be done by repositioning the radiation beam to the target using a dynamic MLC [ 128 ], a robotic LINAC (CyberKnife) [ 130 ] or a linac mounted on two orthogonal gimbals allowing pan and tilt rotation of the beam, VERO [ 113 , 131 ]. Another method, which has been discussed in several studies but has yet to be clinically implemented, consists of repositioning the patient to the beam by means of a dynamic couch [ 132 ]. A recently published comparison of the four tracking technologies showed that all systems are capable of highly accurate target delivery in the presence of motion, and that large treatment errors resulted when motion was not explicitly accounted for [ 133 ].

Adaptive radiotherapy

ART and dose painting strategies are the most recent tailored treatments.

ART is a closed-loop radiation treatment process where the treatment plan can be adjusted using measurement feedback. The term ART usually refers to: 1) changing the treatment plan during a course of RT to account for temporal changes in anatomy (e.g. tumour shrinkage, weight loss, internal motion or change of OARs), 2) adjustment of the delivered dose based on early tumour response and 3) adaptation of the treatment strategy based on early response (e.g. adding chemotherapy or hypoxic sensitisers).

ART is very much dependent on the anatomical information provided by IGRT and relies on deformable image registration algorithms now incorporated in several TPSs [ 13 ]. Image-guidance cannot fully correct for non-rigid changes and, in general, a single plan produced before treatment is not sufficient to describe the actual delivered doses and often leads to suboptimal treatment. Treatment delivery can be changed daily or weekly to compensate for changes in patient anatomy (e.g. tumour shrinkage, weight loss or internal motion) as seen on the images acquired daily at the treatment unit. Various techniques have been put forward, from the simple off-line strategies based on a limited number of imaging data to the more sophisticated ‘plan of the day’ approach which makes it possible to compensate for day-by-day variations in the target volume and position.

The distribution of the delivered dose can be adapted to changes in tumour biology/function (e.g. hypoxia) as measured by functional imaging acquired during the course of treatment [ 25 ].

This technique requires advanced TPSs that are able to perform deformable image registration to take into account the changes in the target volume and surrounding OARs and the dose accumulation algorithm. The latter makes it possible to calculate the dose distribution on each imaging set (CT or CBCT) and then to calculate the delivered dose distribution as the accumulation of the single treatment plans.

A more appealing approach is the integration of molecular imaging into the anatomical information with the aim of identifying radiation-resistant regions within the tumour, such as high clonogen density, proliferation or hypoxia, as different tumour regions have a different radiosensitivity, which may make a heterogeneous dose distribution desirable in order to obtain greater tumour control.

There are two methods of achieving dose painting to biologic image-defined regions within a target: dose painting by contours and dose painting by numbers [ 134 , 135 ]. The first prescribes the dose within biological image-defined contours of the target, while the second prescribes dose to voxels throughout the target as a function of signal intensity of the corresponding voxel in a biologic image. One critical issue is the ability to accurately visualise in space and time the exact location of those areas expressing a phenotype that may require the delivery of a higher radiation dose. This raises not only the availability of specific tracers for the various biologic pathways of interest but also the spatial resolution of the available imaging modalities. Furthermore, the dynamics of tumour biology with its temporal and spatial changes have to be taken into account.

The implementation of ART schemes presents several challenges. It requires the acquisition of repeated anatomical and/or functional images during treatment and the use of deformable image registration algorithms for target volume propagation and plan summation. It is still therefore rarely used in clinical practice because it is so time-consuming.

Biological advances in tumour targeting

RT is moving towards the era of personalised medicine and away from the wrong assumption that ‘one size fits all’ and is offering individualised treatment strategies. The focus on individual variability will lead to a paradigm shift from common population based medicine to personalised and participative medicine [ 136 , 137 ].

As we know, the efficacy of RT is limited by the intrinsic radioresistance of tumour cells, which means an increased risk of local tumour recurrence, so the need to overcome radioresistance and improve radiosensitivity explains why there is such great interest in identifying new molecules that have a synergistic effect with radiation.

One way to enhance the efficacy of RT that is already in use is to give chemotherapy or targeted agents concomitantly in order to modify the radiosensitivity of the tumour cells at the molecular level [ 138 ]. This field of radiation and cancer biology is rapidly expanding to provide a selective improvement in the tumour response to radiation, including T-cell checkpoint inhibitors, hypoxic radiosensitisers and cytotoxins, antiangiogenic agents, DNA repair inhibitors, signal transduction blockers, chemokine inhibitors and oxygen metabolism modifiers. Thus, there is a huge gap between the many exciting ideas emerging from pre-clinical studies in modern radiation and tumour biology and the lack of clinical trials testing these new concepts [ 139 ].

Furthermore, the immunotherapy field offers exciting prospects, with a drastic increase in immunotherapeutic protocols within the standard anticancer regimens. Similar progress is being made in radiobiological knowledge, as reported in a recently published review on the relation between RT and immunotherapy. What appears clear is that: 1) RT not only has a direct cytotoxic effect on tumour cells, but also reprograms the tumour microenvironment to exert a potent antitumour immune response, 2) RT enhances antitumour immunity, but also induces immunosuppressive responses and 3) the combination of immunotherapy and RT presents a multimodal treatment approach that involves stimulating and suppressing various pathways [ 140 ].

While numerous pre-clinical studies on RT-immunotherapy combination regimens have been reported, it is obviously necessary to carry out clinical and translational studies to explore what are the optimal RT doses, fractionation, timing and sequencing, and how they interact with various kinds of immunotherapy. Moreover, therapeutic success depends on the careful selection of immunotherapy agents and suitable patients [ 141 ].

At the same time, attempts are being made to identify the factors which might help to predict patients’ response to RT treatment. Predicting the response to RT by distinguishing between radioresistant and radiosensitive patients could be useful in minimising the risk of unnecessary treatment and the related side effects. Identifying biomarkers that can predict the sensitivity or resistance of tumours to radiation therapy and the risk of developing toxicity is another promising area of research [ 142 ].

Several investigators are attempting to apply the field of ‘omics’ to tailor individual treatment in order to obtain a better outcome in cancer therapy by means of the expression of genes, proteins and metabolites [ 143 ]. In radiation oncology, ‘omics’ may be able to predict the treatment response by screening for genetic polymorphism or by gene expression analysis, and assessing the potential of epigenetic factors, posttranslational modification, signal transduction and metabolism. An example in the plethora of ‘omics studies’ was published recently: a patient-specific molecular signature of radiation sensitivity used to identify the optimum RT dose; a gene expression-based radiation-sensitivity index and the linear quadratic model to derive the genomic-adjusted radiation dose (GARD) [ 144 ].

Besides the above mentioned ‘radiogenomics’, another promising area of ongoing research is ‘radiomics’ which aims to identify non-invasive imaging biomarkers. Radiomics analyses numerous medical imaging features, to which are added critical and interchangeable information regarding tumour phenotype [ 145 ]. In addition, radiomic features provide a complete and full representation of the entire tumour and capture intra-tumour heterogeneity. Radiomic features have been shown to be related to tumour histology, tumour grade/stage, patient survival, metabolism and other clinical features. Furthermore, some radiogenomic studies have reported an association between radiomic features and the underlying gene expression patterns [ 146 ].

It is thought that intra-tumour heterogeneity has potentially profound implications for clinical prediction (i.e. treatment response, survival outcomes, disease progression, etc) and consequently it is deemed to be an essential element of precision oncology.

In conclusion, RT has undergone tremendous progress over the years, realising technological developments that have revolutionised its clinical use, but we must not forget the multifaceted nature of this discipline that makes it an interface between physics, chemistry, biology and medicine [ 147 ]. Only by exploring all these aspects will we manage to produce individualised radiation therapy with better target delineation, avoidance of normal tissue, dose escalation, dose fractionation and better prediction of treatment response.

Author contributions

Cristina Garibaldi and Barbara Alicja Jereczek-Fossa equally contributed to the work and should be considered as first authors.

Acknowledgments

This study was partly supported by the Associazione Italiana per la Ricerca sul Cancro, project IG-13218 ‘Short-term high precision RT for early PC with concomitant boost to the dominant lesion’, registered at ClinicalTrials.gov ( NCT01913717 ), approved by the Instituto Europeo di Oncologia S768/113; by a research grant from Accuray Inc. titled ‘Data collection and analysis of Tomotherapy and CyberKnife breast clinical studies, breast physics studies and prostate study’ and by the Fondazione Umberto Veronesi project title ‘AXILL-ART: Biology-based RT volume definition for 1-2 macrometastatic sentinel lymph nodes without further dissection in breast cancer conservative surgery’. The authors would like to thank Mrs. Verlie Anne Jones, dosimetrist in our department, for her valuable contribution towards editing the paper.

• 1. Barton MB, Frommer M, Shafiq J. Role of radiotherapy in cancer control in low-income and middle-income countries. Lancet Oncol. 2006;7:584–595. doi: 10.1016/S1470-2045(06)70759-8. [ DOI ] [ PubMed ] [ Google Scholar ]
• 2. Barton MB, Jacob S, Shafiq J, et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol. 2014;112:140–144. doi: 10.1016/j.radonc.2014.03.024. [ DOI ] [ PubMed ] [ Google Scholar ]
• 3. Tyldesley S, Delaney G, Foroudi F, et al. Estimating the need for radiotherapy for patients with prostate, breast, and lung cancers: verification of model estimates of need with radiotherapy utilization data from British Columbia. Int J Radiat Oncol Biol Phys. 2011;79:1507–1515. doi: 10.1016/j.ijrobp.2009.12.070. [ DOI ] [ PubMed ] [ Google Scholar ]
• 4. Alterio D, Franco P, Numico G, et al. Non-surgical organ preservation strategies for locally advanced laryngeal tumors: What is the Italian attitude? Results of a national survey on behalf of AIRO and AIOM. Med Oncol. 2016;33:76. doi: 10.1007/s12032-016-0781-5. [ DOI ] [ PubMed ] [ Google Scholar ]
• 5. Gerardi MA, Jereczek-Fossa BA, Zerini D, et al. Bladder preservation in non-metastatic muscle-invasive bladder cancer (MIBC): a single-institution experience. Ecancermedicalscience. 2016;10:657. doi: 10.3332/ecancer.2016.657. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 6. Mak RH, Zietman AL, Heney NM, et al. Bladder preservation: optimizing radiotherapy and integrated treatment strategies. BJU Int. 2008;102:1345–1353. doi: 10.1111/j.1464-410X.2008.07981.x. [ DOI ] [ PubMed ] [ Google Scholar ]
• 7. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456–1461. doi: 10.1056/NEJM199511303332203. [ DOI ] [ PubMed ] [ Google Scholar ]
• 8. Salvador-Coloma C, Cohen E. Multidisciplinary care of laryngeal cancer. J Oncol Pract. 2016;12:717–724. doi: 10.1200/JOP.2016.014225. [ DOI ] [ PubMed ] [ Google Scholar ]
• 9. Chow E, Zeng L, Salvo N, et al. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol) 2012;24:112–124. doi: 10.1016/j.clon.2011.11.004. [ DOI ] [ PubMed ] [ Google Scholar ]
• 10. Hellman S. Stopping metastases at their source. N Engl J Med. 1997;337:996–997. doi: 10.1056/NEJM199710023371408. [ DOI ] [ PubMed ] [ Google Scholar ]
• 11. Golden EB, Chhabra A, Chachoua A, et al. Local radiotherapy and granulocyte-macrophage colony-stimulating factor to generate abscopal responses in patients with metastatic solid tumours: a proof-of-principle trial. Lancet Oncol. 2015;16:795–803. doi: 10.1016/S1470-2045(15)00054-6. [ DOI ] [ PubMed ] [ Google Scholar ]
• 12. Budach W, Bölke E, Matuschek C. Hypofractionated radiotherapy as adjuvant treatment in early breast cancer: a review and meta-analysis of randomized controlled trials. Breast Care (Basel) 2015;10:240–245. doi: 10.1159/000439007. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 13. Brock KK, Mutic S, McNutt TR, et al. Use of image registration and fusion algorithms and techniques in radiotherapy: Report of the AAPM Radiation Therapy Committee Task Group No. 132. Med Phys. 2017. [ DOI ] [ PubMed ]
• 14. Nahum AE, Uzan J. (Radio) biological optimization of external-beam radiotherapy. Comput Math Methods Med. 2012. p. 329214. [ DOI ] [ PMC free article ] [ PubMed ]
• 15. Metcalfe P, Liney GP, Holloway L, et al. The potential for an enhanced role for MRI in radiation-therapy treatment planning. Technol Cancer Res Treat. 2013;12:429–446. doi: 10.7785/tcrt.2012.500342. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 16. Giezen M, Kouwenhoven E, Scholten AN, et al. Magnetic resonance imaging – versus computed tomography–based – target volume delineation of the glandular breast tissue (clinical target volume breast) in breast-conserving therapy: an exploratory study. Int J Radiat Oncol Biol Phys. 2011;81:804–811. doi: 10.1016/j.ijrobp.2010.07.004. [ DOI ] [ PubMed ] [ Google Scholar ]
• 17. Cho O, Chun M, Oh YT, et al. Can initial diagnostic PET-CT aid to localize tumor bed in breast cancer radiotherapy: feasibility study using deformable image registration. Radiat Oncol. 2013;8:163. doi: 10.1186/1748-717X-8-163. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 18. Dulaney CR, Osula DO, Yang ES, et al. Prostate radiotherapy in the era of advanced imaging and precision medicine. Prostate Cancer. 2016. p. 4897515. [ DOI ] [ PMC free article ] [ PubMed ]
• 19. Ashamalla H, Rafla S, Parikh K, et al. The contribution of integrated PET/CT to the evolving definition of treatment volumes in radiation treatment planning in lung cancer. Int J Radiat Oncol Biol Phys. 2005;63:1016–1023. doi: 10.1016/j.ijrobp.2005.04.021. [ DOI ] [ PubMed ] [ Google Scholar ]
• 20. De Ruysscher D, Nestle U, Jeraj R, et al. PET scans in radiotherapy planning of lung cancer. Lung Cancer. 2012;75:141–145. doi: 10.1016/j.lungcan.2011.07.018. [ DOI ] [ PubMed ] [ Google Scholar ]
• 21. Franzone P, Fiorentino A, Barra S, et al. Image-guided radiation therapy (IGRT): practical recommendations of Italian Association of Radiation Oncology (AIRO) Radiol Med. 2016;121:958–965. doi: 10.1007/s11547-016-0674-x. [ DOI ] [ PubMed ] [ Google Scholar ]
• 22. Jaffray DA. Image-guided radiotherapy: from current concept to future perspectives. Nat Rev Clin Oncol. 2012;9:688–699. doi: 10.1038/nrclinonc.2012.194. [ DOI ] [ PubMed ] [ Google Scholar ]
• 23. Nabavizadeh N, Elliott DA, Chen Y, et al. Image guided radiation therapy (IGRT) practice patterns and IGRT’s impact on workflow and treatment planning: results from a national survey of American Society for Radiation Oncology members. Int J Radiat Oncol Biol Phys. 2016;94:850–857. doi: 10.1016/j.ijrobp.2015.09.035. [ DOI ] [ PubMed ] [ Google Scholar ]
• 24. Ariyaratne H, Chesham H, Alonzi R. Image-guided radiotherapy for prostate cancer in the United Kingdom: a national survey. Br J Radiol. 2017;90:20160059. doi: 10.1259/bjr.20160059. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 25. Grau C, Muren LP, Høyer M, et al. Image-guided adaptive radiotherapy–integration of biology and technology to improve clinical outcome. Acta Oncol. 2008;47:1182–1185. doi: 10.1080/02841860802282802. [ DOI ] [ PubMed ] [ Google Scholar ]
• 26. Mothersill C, Seymour C. Radiation-induced bystander effects: past history and future directions. Radiat Res. 2001;155:759–767. doi: 10.1667/0033-7587(2001)155[0759:RIBEPH]2.0.CO;2. [ DOI ] [ PubMed ] [ Google Scholar ]
• 27. Turesson I, Carlsson J, Brahme A, et al. Biological response to radiation therapy. Acta Oncol. 2003;42:92–106. doi: 10.1080/02841860310004959. [ DOI ] [ PubMed ] [ Google Scholar ]
• 28. Huang SM, Bock JM, Harari PM. Epidermal growth factor receptor blockade with C225 modulates proliferation, apoptosis, and radiosensitivity in squamous cell carcinomas of the head and neck. Cancer Res. 1999;59:1935–1940. [ PubMed ] [ Google Scholar ]
• 29. Spalding AC, Lawrence TS. New and emerging radiosensitizers and radioprotectors. Cancer Invest. 2006;24:444–456. doi: 10.1080/07357900600705706. [ DOI ] [ PubMed ] [ Google Scholar ]
• 30. Shewach DS, Lawrence TS. Antimetabolite radiosensitizers. J Clin Oncol. 2007;25:4043–4050. doi: 10.1200/JCO.2007.11.5287. [ DOI ] [ PubMed ] [ Google Scholar ]
• 31. Jackson SP, Bartek J. The DNA-damage response in human biology and disease. Nature. 2009;461:1071–1078. doi: 10.1038/nature08467. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 32. Sheehan JP, Shaffrey ME, Gupta B, et al. Improving the radiosensitivity of radioresistant and hypoxic glioblastoma. Future Oncol. 2010;6:1591–1601. doi: 10.2217/fon.10.123. [ DOI ] [ PubMed ] [ Google Scholar ]
• 33. Khan FM. The Physics of Radiation Therapy. 4th. Philadelphia: Lippincott Williams & Wilkins; 2009. pp. 6–7. [ Google Scholar ]
• 34. Baumann M, Petersen C. TCP and NTCP: a basic introduction. Rays. 2005;30:99–104. [ PubMed ] [ Google Scholar ]
• 35. Hubenak JR, Zhang Q, Branch CD, et al. Mechanisms of injury to normal tissue after radiotherapy: a review. Plast Reconstr Surg. 2014;133:49e–56e. doi: 10.1097/01.prs.0000440818.23647.0b. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 36. Begg AC, Stewart FA, Vens C, et al. Strategies to improve radio-therapy with targeted drugs. Nat Rev Cancer. 2011;11:239–253. doi: 10.1038/nrc3007. [ DOI ] [ PubMed ] [ Google Scholar ]
• 37. Withers HR. The four R’s of radiotherapy. In: Lett JT, Adler H, editors. Advances in Radiation Biology. New York: Academic Press; 1975. pp. 241–271. [ DOI ] [ Google Scholar ]
• 38. Steel GG, McMillan TJ, Peacock JH. The 5Rs of radiobiology. Int J Radiat Biol. 1989;56:1045–1048. doi: 10.1080/09553008914552491. [ DOI ] [ PubMed ] [ Google Scholar ]
• 39. Miralbell R, Roberts SA, Zubizarreta E, et al. Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: a/b = 1.4 (0.9–2.2) Gy. Int J Radiat Oncol Biol Phys. 2012;82:17–24. doi: 10.1016/j.ijrobp.2010.10.075. [ DOI ] [ PubMed ] [ Google Scholar ]
• 40. Brenner DJ, Hall EJ. Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys. 1999;43:1095–1101. doi: 10.1016/S0360-3016(98)00438-6. [ DOI ] [ PubMed ] [ Google Scholar ]
• 41. Whelan TJ, Kim DH, Sussman J. Clinical experience using hypofractionated radiation schedules in breast cancer. Semin Radiat Oncol. 2008;18:257–264. doi: 10.1016/j.semradonc.2008.04.008. [ DOI ] [ PubMed ] [ Google Scholar ]
• 42. Owen JR, Ashton A, Bliss JM, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol. 2006;7:467–471. doi: 10.1016/S1470-2045(06)70699-4. [ DOI ] [ PubMed ] [ Google Scholar ]
• 43. Ray KJ, Sibson NR, Kiltie AE. Treatment of breast and prostate cancer by hypofractionated radiotherapy: potential risks and benefits. Clin Oncol (R Coll Radiol) 2015;27:420–426. doi: 10.1016/j.clon.2015.02.008. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 44. De Bari B, Arcangeli S, Ciardo D, et al. Extreme hypofractionation for early prostate cancer: biology meets technology. Cancer Treat Rev. 2016;50:48–60. doi: 10.1016/j.ctrv.2016.08.005. [ DOI ] [ PubMed ] [ Google Scholar ]
• 45. Veldeman L, Madani I, Hulstaert F, et al. Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol. 2008;9:367–375. doi: 10.1016/S1470-2045(08)70098-6. [ DOI ] [ PubMed ] [ Google Scholar ]
• 46. Jin JY, Wen N, Ren L, et al. Advances in treatment techniques: arc-based and other intensity modulated therapies. Cancer J. 2011;17:166–176. doi: 10.1097/PPO.0b013e31821f8318. [ DOI ] [ PubMed ] [ Google Scholar ]
• 47. Mackie TR, Holmes T, Swerdloff S, et al. Tomotherapy: a new concept for the delivery of dynamic conformal radiotherapy. Med Phys. 1993;20:1709–1719. doi: 10.1118/1.596958. [ DOI ] [ PubMed ] [ Google Scholar ]
• 48. Otto K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys. 2008;35:310–317. doi: 10.1118/1.2818738. [ DOI ] [ PubMed ] [ Google Scholar ]
• 49. Hamilton DG, Bale R, Jones C, et al. Impact of tumour bed boost integration on acute and late toxicity in patients with breast cancer: a systematic review. Breast. 2016;27:126–135. doi: 10.1016/j.breast.2016.03.002. [ DOI ] [ PubMed ] [ Google Scholar ]
• 50. Nitsche M, Dunst J, Carl UM, et al. Emerging role of hypofractionated radiotherapy with simultaneous integrated boost in modern radiotherapy of breast cancer. Breast Care (Basel) 2015;10:320–324. doi: 10.1159/000436951. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 51. Franceschini D, Paiar F, Meattini I, et al. Simultaneous integrated boost–intensity-modulated radiotherapy in head and neck cancer. Laryngoscope. 2013;123:E97–E103. doi: 10.1002/lary.24257. [ DOI ] [ PubMed ] [ Google Scholar ]
• 52. Orlandi E, Palazzi M, Pignoli E, et al. Radiobiological basis and clinical results of the simultaneous integrated boost (SIB) in intensity modulated radiotherapy (IMRT) for head and neck cancer: a review. Crit Rev Oncol Hematol. 2010;73:11–25. doi: 10.1016/j.critrevonc.2009.03.003. [ DOI ] [ PubMed ] [ Google Scholar ]
• 53. Timon G, Ciardo D, Bazani A, et al. Rationale and protocol of AIRC IG-13218, short-term radiotherapy for early prostate cancer with concomitant boost to the dominant lesion. Tumori. 2016;102:536–540. doi: 10.5301/tj.5000547. [ DOI ] [ PubMed ] [ Google Scholar ]
• 54. Fonteyne V, Villeirs G, Speleers B, et al. Intensity-modulated radiotherapy as primary therapy for prostate cancer: report on acute toxicity after dose escalation with simultaneous integrated boost to intraprostatic lesion. Int J Radiat Oncol Biol Phys. 2008;72:799–807. doi: 10.1016/j.ijrobp.2008.01.040. [ DOI ] [ PubMed ] [ Google Scholar ]
• 55. Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys. 2003;56:83–88. doi: 10.1016/S0360-3016(03)00073-7. [ DOI ] [ PubMed ] [ Google Scholar ]
• 56. Berrington de Gonzalez A, Curtis RE, Kry SF, et al. Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries. Lancet Oncol. 2011;12:353–360. doi: 10.1016/S1470-2045(11)70061-4. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 57. Potters L, Kavanagh B, Galvin J. American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the performance of stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2010;76:326–332. doi: 10.1016/j.ijrobp.2009.09.042. [ DOI ] [ PubMed ] [ Google Scholar ]
• 58. Aznar M, Romero AM, Heijmen BJM. The role of technology in clinical trials using stereotactic body radiotherapy. Br J Radiol. 2017;90:20160930. doi: 10.1259/bjr.20160930. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 59. Narayanasamy G, Saenz D, Cruz W, et al. Commissioning an Elekta Versa HD linear accelerator. J Appl Clin Med Phys. 2016;17:179–191. doi: 10.1120/jacmp.v17i1.5799. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 60. Glide-Hurst C, Bellon M, Foster R, et al. Commissioning of the Varian TrueBeam linear accelerator: a multi-institutional study. Med Phys. 2013;40:031719. doi: 10.1118/1.4790563. [ DOI ] [ PubMed ] [ Google Scholar ]
• 61. Adler JR, Jr, Chang SD, Murphy MJ, et al. The Cyberknife: a frameless robotic system for radiosurgery. Stereotact Funct Neurosurg. 1997;69:124–128. doi: 10.1159/000099863. [ DOI ] [ PubMed ] [ Google Scholar ]
• 62. Solberg TD, Medin PM, Ramirez E, et al. Commissioning and initial stereotactic ablative radiotherapy experience with Vero. J Appl Clin Med Phys. 2014;15:4685. doi: 10.1120/jacmp.v15i2.4685. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 63. Orecchia R, Surgo A, Muto M, et al. VERO® radiotherapy for low burden cancer: 789 patients with 957 lesions. Ecancermedicalscience. 2016;10:677. doi: 10.3332/ecancer.2016.677. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 64. Abbas G, Danish A, Krasna MJ. Stereotactic body radiotherapy and ablative therapies for lung cancer. Surg Oncol Clin N Am. 2016;25:553–566. doi: 10.1016/j.soc.2016.02.008. [ DOI ] [ PubMed ] [ Google Scholar ]
• 65. Durante M, Orecchia R, Loeffler JS. Charged-particle therapy in cancer: clinical uses and future perspectives. Nat Rev Clin Oncol. 2017;14(8):483–495. doi: 10.1038/nrclinonc.2017.30. doi: 0.1038/nrclinonc.2017.30. Epub 2017 Mar 14. Review. [ DOI ] [ PubMed ] [ Google Scholar ]
• 66. Mohan R, Grosshans D. Proton therapy–present and future. Adv Drug Deliv Rev. 2017;109:26–44. doi: 10.1016/j.addr.2016.11.006. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 67. Fossati P, Vavassori A, Deantonio L, et al. Review of photon and proton radiotherapy for skull base tumours. Rep Pract Oncol Radiother. 2016;21:336–355. doi: 10.1016/j.rpor.2016.03.007. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 68. Kubiak T. Particle therapy of moving targets—the strategies for tumour motion monitoring and moving targets irradiation. Br J Radiol. 2016;89:20150275. doi: 10.1259/bjr.20150275. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 69. Bert C, Durante M. Motion in radiotherapy: particle therapy. Phys Med Biol. 2011;56:R113–R144. doi: 10.1088/0031-9155/56/16/R01. [ DOI ] [ PubMed ] [ Google Scholar ]
• 70. Ciocca M, Mirandola A, Molinelli S, et al. Commissioning of the 4-D treatment delivery system for organ motion management in synchrotron-based scanning ion beams. Phys Med. 2016;32:1667–1671. doi: 10.1016/j.ejmp.2016.11.107. [ DOI ] [ PubMed ] [ Google Scholar ]
• 71. Matloob SA, Nasir HA, Choi D. Proton beam therapy in the management of skull base chordomas: systematic review of indications, outcomes, and implications for neurosurgeons. Br J Neurosurg. 2016;30:382–7. doi: 10.1080/02688697.2016.1181154. [ DOI ] [ PubMed ] [ Google Scholar ]
• 72. Mishra K, Daftari IK. Proton therapy for the management of uveal melanoma and other ocular tumors. Chin Clin Oncol. 2016;5:50. doi: 10.21037/cco.2016.07.06. [ DOI ] [ PubMed ] [ Google Scholar ]
• 73. Leroy R, Benahmed N, Hulstaert F, et al. Proton therapy in children: a systematic review of clinical effectiveness in 15 pediatric cancers. Int J Radiat Oncol Biol Phys. 2016;95:267–278. doi: 10.1016/j.ijrobp.2015.10.025. [ DOI ] [ PubMed ] [ Google Scholar ]
• 74. Ebner DK, Kamara T. The emerging role of carbon-ion radiotherapy. Front Oncol. 2016;7(6):140. doi: 10.3389/fonc.2016.00140.. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 75. Kamada T, Tsujii H, Blakely EA, et al. Carbon ion radiotherapy in Japan: an assessment of 20 years of clinical experience. Lancet Oncol. 2015;16(2):e93–e100. doi: 10.1016/S1470-2045(14)70412-7. doi: 10.1016/S1470-2045(14)70412-7. [ DOI ] [ PubMed ] [ Google Scholar ]
• 76. Matsufuji N. Overview summary of clinical heavier-ion progress in Japan. J Phys Conf Ser. 2017;860(1) doi: 10.1088/1742-6596/860/1/012027. art. no. 012027. [ DOI ] [ Google Scholar ]
• 77. Rossi S. The National Centre for Oncological Hadrontherapy (CNAO): status and perspectives. Phys Med. 2015;31:333–351. doi: 10.1016/j.ejmp.2015.03.001. [ DOI ] [ PubMed ] [ Google Scholar ]
• 78. Crum WR, Hartkens T, Hill DL. Non-rigid image registration: theory and practice. Br J Radiol. 2004;77:140–153. doi: 10.1259/bjr/25329214. [ DOI ] [ PubMed ] [ Google Scholar ]
• 79. Keszei AP, Berkels B, Deserno TM. Survey of non-rigid registration tools in medicine. J Digit Imaging. 2017;30:102–116. doi: 10.1007/s10278-016-9915-8. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 80. Qi XS, Semenenko VA, Li XA. Improved critical structure sparing with biologically based IMRT optimization. Med Phys. 2009;36:1790–1799. doi: 10.1118/1.3116775. [ DOI ] [ PubMed ] [ Google Scholar ]
• 81. Das S. A role for biological optimization within the current treatment planning paradigm. Med Phys. 2009;36:4672–4682. doi: 10.1118/1.3220211. [ DOI ] [ PubMed ] [ Google Scholar ]
• 82. Doit Q, Kavanagh B, Timmerman R, et al. Biological-based optimization and volumetric modulated arc therapy delivery for stereotactic body radiation therapy. Med Phys. 2012;39:237–245. doi: 10.1118/1.3668059. [ DOI ] [ PubMed ] [ Google Scholar ]
• 83. Liang X, Penagaricano J, Zheng D, et al. Radiobiological impact of dose calculation algorithms on biologically optimized IMRT lung stereotactic body radiation therapy plans. Radiat Oncol. 2016;11:10. doi: 10.1186/s13014-015-0578-2. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 84. Sharpe MB, Moore KL, Orton CG. Within the next ten years treatment planning will become fully automated without the need for human intervention. Med Phys. 2014;41:120601. doi: 10.1118/1.4894496. [ DOI ] [ PubMed ] [ Google Scholar ]
• 85. Vinod SK, Min M, Jameson MG, et al. A review of interventions to reduce inter-observer variability in volume delineation in radiation oncology. J Med Imaging Radiat Oncol. 2016;60:393–406. doi: 10.1111/1754-9485.12462. [ DOI ] [ PubMed ] [ Google Scholar ]
• 86. Vinod SK, Jameson MG, Min M, et al. Uncertainties in volume delineation in radiation oncology: a systematic review and recommendations for future studies. Radiother Oncol. 2016;121:169–179. doi: 10.1016/j.radonc.2016.09.009. [ DOI ] [ PubMed ] [ Google Scholar ]
• 87. White J, Tai A, Arthur D, et al. Breast cancer atlas for radiation therapy planning: consensus definitions. 2016. Available at: www.rtog.org/
• 88. Offersen BV, Boersma LJ, Kirkove C, et al. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol. 2015;114:3–10. doi: 10.1016/j.radonc.2014.11.030. [ DOI ] [ PubMed ] [ Google Scholar ]
• 89. Nielsen MH, Berg M, Pedersen AN, et al. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group. Acta Oncol. 2013;52:703–710. doi: 10.3109/0284186X.2013.765064. [ DOI ] [ PubMed ] [ Google Scholar ]
• 90. Gentile MS, Usman AA, Neuschler EI, et al. Contouring guidelines for the axillary lymph nodes for the delivery of radiation therapy in breast cancer: evaluation of the RTOG breast cancer atlas. Int J Radiat Oncol Biol Phys. 2015;93:257–265. doi: 10.1016/j.ijrobp.2015.07.002. [ DOI ] [ PubMed ] [ Google Scholar ]
• 91. Michalski JM, Lawton CA, El-Naqa I, et al. Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;76:361–368. doi: 10.1016/j.ijrobp.2009.02.006. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 92. Iglesias JE, Sabuncu MR. Multi-atlas segmentation of biomedical images: a survey. Med Image Anal. 2015;24:205–219. doi: 10.1016/j.media.2015.06.012. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 93. Lim JY, Leech M. Use of auto-segmentation in the delineation of target volumes and organs at risk in head and neck. Acta Oncol. 2016;55:799–806. doi: 10.3109/0284186X.2016.1173723. [ DOI ] [ PubMed ] [ Google Scholar ]
• 94. Reed VK, Woodward WA, Zhang L, et al. Automatic segmentation of whole breast using atlas approach and deformable image registration. Int J Radiat Oncol Biol Phys. 2009;73:1493–1500. doi: 10.1016/j.ijrobp.2008.07.001. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 95. Daisne JF, Blumhofer A. Atlas-based automatic segmentation of head and neck organs at risk and nodal target volumes: a clinical validation. Radiat Oncol. 2013;8:154. doi: 10.1186/1748-717X-8-154. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 96. Stapleford LJ, Lawson JD, Perkins C, et al. Evaluation of automatic atlas-based lymph node segmentation for head and neck cancer. Int J Radiat Oncol Biol Phys. 2010;77:959–966. doi: 10.1016/j.ijrobp.2009.09.023. [ DOI ] [ PubMed ] [ Google Scholar ]
• 97. Ciardo D, Gerardi MA, Vigorito S, et al. Atlas-based segmentation in breast cancer radiotherapy: evaluation of specific and generic-purpose atlases. Breast. 2017;32:44–52. doi: 10.1016/j.breast.2016.12.010. [ DOI ] [ PubMed ] [ Google Scholar ]
• 98. Verellen D, De Ridder M, Linthout N, et al. Innovations in image-guided radiotherapy. Nat Rev Cancer. 2007;7:949–960. doi: 10.1038/nrc2288. [ DOI ] [ PubMed ] [ Google Scholar ]
• 99. Bissonnette JP, Balter PA, Dong L, et al. Quality assurance for image-guided radiation therapy utilizing CT-based technologies: a report of the AAPM TG-179. Med Phys. 2012;39:1946–1963. doi: 10.1118/1.3690466. [ DOI ] [ PubMed ] [ Google Scholar ]
• 100. Willoughby T, Lehmann J, Bencomo JA, et al. Quality assurance for nonradiographic radiotherapy localization and positioning systems: report of Task Group 147. Med Phys. 2012;39:1728–1747. doi: 10.1118/1.3681967. [ DOI ] [ PubMed ] [ Google Scholar ]
• 101. Garibaldi C, Piperno G, Ferrari A, et al. Translational and rotational localization errors in cone-beam CT based image-guided lung stereotactic radiotherapy. Phys Med. 2016;32:859–865. doi: 10.1016/j.ejmp.2016.05.055. [ DOI ] [ PubMed ] [ Google Scholar ]
• 102. Garibaldi C, Russo S, Ciardo D, et al. Geometric and dosimetric accuracy and imaging dose of the real-time tumour tracking system of a gimbal mounted linac. Phys Med. 2015;31:501–509. doi: 10.1016/j.ejmp.2015.04.001. [ DOI ] [ PubMed ] [ Google Scholar ]
• 103. Bian J, Sharp GC, Park YK, et al. Investigation of cone-beam CT image quality trade-off for image-guided radiation therapy. Phys Med Biol. 2016;61:3317–3346. doi: 10.1088/0031-9155/61/9/3317. [ DOI ] [ PubMed ] [ Google Scholar ]
• 104. Josipovic M, Persson GF, Bangsgaard JP, et al. Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance. Br J Radiol. 2016;89:20160544. doi: 10.1259/bjr.20160544. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 105. O’Brien RT, Cooper BJ, Shieh CC, et al. The first implementation of respiratory triggered 4DCBCT on a linear accelerator. Phys Med Biol. 2016;61:3488–3499. doi: 10.1088/0031-9155/61/9/3488. [ DOI ] [ PubMed ] [ Google Scholar ]
• 106. Blessing M, Stsepankou D, Wertz H, et al. Breath-hold target localization with simultaneous kilovoltage/megavoltage cone-beam computed tomography and fast reconstruction. Int J Radiat Oncol Biol Phys. 2010;78:1219–1226. doi: 10.1016/j.ijrobp.2010.01.030. [ DOI ] [ PubMed ] [ Google Scholar ]
• 107. Moser T, Habl G, Uhl M, et al. Clinical evaluation of a laser surface scanning system in 120 patients for improving daily setup accuracy in fractionated radiation therapy. Int J Radiat Oncol Biol Phys. 2013;85:846–853. doi: 10.1016/j.ijrobp.2012.05.026. [ DOI ] [ PubMed ] [ Google Scholar ]
• 108. Fassi A, Schaerer J, Riboldi M, et al. An image-based method to synchronize cone-beam CT and optical surface tracking. J Appl Clin Med Phys. 2015;16:5152. doi: 10.1120/jacmp.v16i2.5152. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 109. Apicella G, Loi G, Torrente S, et al. Three-dimensional surface imaging for detection of intra-fraction setup variations during radiotherapy of pelvic tumors. Radiol Med. 2016;121:805–810. doi: 10.1007/s11547-016-0659-9. [ DOI ] [ PubMed ] [ Google Scholar ]
• 110. Crop F, Pasquier D, Baczkiewic A, et al. Surface imaging, laser positioning or volumetric imaging for breast cancer with nodal involvement treated by helical TomoTherapy. J Appl Clin Med Phys. 2016;17:1–12. doi: 10.1120/jacmp.v17i5.6041. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 111. Ricotti R, Ciardo D, Fattori G, et al. Intra-fraction respiratory motion and baseline drift during breast Helical Tomotherapy. Radiother Oncol. 2017;122:79–86. doi: 10.1016/j.radonc.2016.07.019. [ DOI ] [ PubMed ] [ Google Scholar ]
• 112. Garibaldi C, Catalano G, Baroni G, et al. Deep inspiration breath-hold technique guided by an opto-electronic system for extracranial stereotactic treatments. J Appl Clin Med Phys. 14:4087. doi: 10.1120/jacmp.v14i4.4087. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 113. Garibaldi C, Jereczek-Fossa BA, Zerini D, et al. Image-guided radiotherapy for prostate cancer using 3 different techniques: localization data of 186 patients. Tumori. 2015;101:273–280. doi: 10.5301/tj.5000322. [ DOI ] [ PubMed ] [ Google Scholar ]
• 114. Fontana G, Riboldi M, Gianoli C, et al. MRI quantification of pancreas motion as a function of patient setup for particle therapy – a preliminary study. J Appl Clin Med Phys. 2016;17:1–16. doi: 10.1120/jacmp.v17i5.6236. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 115. Lagendijk JJ, Raaymakers BW, Raaijmakers AJ, et al. MRI/linac integration. Radiother Oncol. 2008;86:25–29. doi: 10.1016/j.radonc.2007.10.034. [ DOI ] [ PubMed ] [ Google Scholar ]
• 116. Jia X, Tian Z, Xi Y, et al. New concept on an integrated interior magnetic resonance imaging and medical linear accelerator system for radiation therapy. J Med Imaging (Bellingham) 2017;4:015004. doi: 10.1117/1.JMI.4.1.015004. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 117. Yang Y, Cao M, Sheng K, et al. Longitudinal diffusion MRI for treatment response assessment: preliminary experience using an MRI-guided tri-cobalt 60 radiotherapy system. Med Phys. 2016;43:1369–1373. doi: 10.1118/1.4942381. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 118. Giandini T, Panaino CM, Avuzzi B, et al. An accurate method to quantify breathing-induced prostate motion for patients implanted with electromagnetic transponders. Tumori. 2017;103:136–142. doi: 10.5301/tj.5000609. [ DOI ] [ PubMed ] [ Google Scholar ]
• 119. Kupelian P, Willoughby T, Mahadevan A, et al. Multi-institutional clinical experience with the Calypso System in localization and continuous, real-time monitoring of the prostate gland during external radiotherapy. Int J Radiat Oncol Biol Phys. 2007;67:1088–1098. doi: 10.1016/j.ijrobp.2006.10.026. [ DOI ] [ PubMed ] [ Google Scholar ]
• 120. Richter A, Wilbert J, Baier K, et al. Feasibility study for markerless tracking of lung tumors in stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78:618–627. doi: 10.1016/j.ijrobp.2009.11.028. [ DOI ] [ PubMed ] [ Google Scholar ]
• 121. Van Heijst TC, Philippens ME, Charaghvandi RK, et al. Quantification of intra-fraction motion in breast radiotherapy using supine magnetic resonance imaging. Phys Med Biol. 2016;61:1352–1370. doi: 10.1088/0031-9155/61/3/1352. [ DOI ] [ PubMed ] [ Google Scholar ]
• 122. Seregni M, Paganelli C, Lee D, et al. Motion prediction in MRI-guided radiotherapy based on interleaved orthogonal cine-MRI. Phys Med Biol. 2016;61:872–887. doi: 10.1088/0031-9155/61/2/872. [ DOI ] [ PubMed ] [ Google Scholar ]
• 123. Keall PJ, Mageras GS, Balter JM, et al. The management of respiratory motion in radiation oncology: report of AAPM Radiation Therapy Committee Task Group No. 76. Med Phys. 2006;33:3874–3900. doi: 10.1118/1.2349696. [ DOI ] [ PubMed ] [ Google Scholar ]
• 124. Kanagaki B, Read PW, Molloy JA, et al. A motion phantom study on helical tomotherapy: The dosimetric impacts of delivery technique and motion. Phys Med Biol. 2007;52:243–255. doi: 10.1088/0031-9155/52/1/016. [ DOI ] [ PubMed ] [ Google Scholar ]
• 125. Kissick MW, Boswell SA, Jeraj R, et al. Confirmation, refinement, and extension of a study in intrafraction motion interplay with sliding jaw motion. Med Phys. 2005;32:2346–2350. doi: 10.1118/1.1935774. [ DOI ] [ PubMed ] [ Google Scholar ]
• 126. Cao J, Roeske JC, Chmura SJ, et al. Calculation and prediction of the effect of respiratory motion on whole breast radiation therapy dose distributions. Med Dosim. 2009;34:126–132. doi: 10.1016/j.meddos.2008.07.002. [ DOI ] [ PubMed ] [ Google Scholar ]
• 127. Verellen D, Depuydt T, Gevaert T, et al. Gating and tracking, 4D in thoracic tumors. Cancer Radiother. 2010;14:446–454. doi: 10.1016/j.canrad.2010.06.002. [ DOI ] [ PubMed ] [ Google Scholar ]
• 128. Boda-Heggemann J, Knopf AC, Simeonova-Chergou A, et al. Deep inspiration breath hold-based radiation therapy: a clinical review. Int J Radiat Oncol Biol Phys. 2016;94:478–492. doi: 10.1016/j.ijrobp.2015.11.049. [ DOI ] [ PubMed ] [ Google Scholar ]
• 129. Pepin EW, Wu H, Shirato H. Use of dMLC for implementation of dynamic respiratory-gated radiation therapy. Med Phys. 2013;40:101708. doi: 10.1118/1.4820534. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 130. Hoogeman M, Prévost JB, Nuyttens J, et al. Clinical accuracy of the respiratory tumor tracking system of the cyberknife: assessment by analysis of log files. Int J Radiat Oncol Biol Phys. 2009;74:297–303. doi: 10.1016/j.ijrobp.2008.12.041. [ DOI ] [ PubMed ] [ Google Scholar ]
• 131. Kamino Y, Takayama K, Kokubo M, et al. Development of four-dimensional image guided radiotherapy system with gimbaled x-ray head. Int J Radiat Oncol Biol Phys. 2006;66:271–278. doi: 10.1016/j.ijrobp.2006.04.044. [ DOI ] [ PubMed ] [ Google Scholar ]
• 132. Souza W, Naqvi S, Yu C. Real-time intra-fraction-motion tracking using the treatment couch: a feasibility study. Phys Med Biol. 2005;50:4021–4033. doi: 10.1088/0031-9155/50/17/007. [ DOI ] [ PubMed ] [ Google Scholar ]
• 133. Colvill E, Booth J, Nill S, et al. A dosimetric comparison of real-time adaptive and non-adaptive radiotherapy: a multi-institutional study encompassing robotic, gimbaled, multileaf collimator and couch tracking. Radiother Oncol. 2016;119:159–165. doi: 10.1016/j.radonc.2016.03.006. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 134. Jentsch C, Beuthien-Baumann B, Troost EGC, et al. Validation of functional imaging as a biomarker for radiation treatment response. Br J Radiol. 2015;88:20150014. doi: 10.1259/bjr.20150014. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 135. Galvin JM, De Neve W. Intensity modulating and other radiation therapy devices for dose painting. J Clin Oncol. 2007;25:924–930. doi: 10.1200/JCO.2007.10.6716. [ DOI ] [ PubMed ] [ Google Scholar ]
• 136. Lambin P, Zindler J, Vanneste BG, et al. Decision support systems for personalized and participative radiation oncology. Adv Drug Deliv Rev. 2016;109:131–153. doi: 10.1016/j.addr.2016.01.006. [ DOI ] [ PubMed ] [ Google Scholar ]
• 137. Leonardi MC, Ricotti R, Dicuonzo S, et al. From technological advances to biological understanding: the main steps toward high-precision RT in breast cancer. Breast. 2016;29:213–222. doi: 10.1016/j.breast.2016.07.010. [ DOI ] [ PubMed ] [ Google Scholar ]
• 138. Torres-Roca JF. A molecular assay of tumor radiosensitivity: a roadmap towards biology-based personalized radiation therapy. Per Med. 2012;9:547–557. doi: 10.2217/pme.12.55. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 139. Brown JM, Adler JR., Jr Is equipment development stifling innovation in radiation oncology? Int J Radiat Oncol Biol Phys. 2015;92:713–714. doi: 10.1016/j.ijrobp.2015.03.005. [ DOI ] [ PubMed ] [ Google Scholar ]
• 140. Weichselbaum RR, Liang H, Deng L, et al. Radiotherapy and immunotherapy: a beneficial liaison? Nat Rev Clin Oncol. 2017. [ DOI ] [ PubMed ]
• 141. Ishihara D, Pop L, Takeshima T, et al. Rationale and evidence to combine radiation therapy and immunotherapy for cancer treatment. Cancer Immunol Immunother. 2017;66:281–298. doi: 10.1007/s00262-016-1914-6. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 142. Herskind C, Talbot CJ, Kerns SL, et al. Radiogenomics: a systems biology approach to understanding genetic risk factors for radiotherapy toxicity? Cancer Lett. 2016;382:95–109. doi: 10.1016/j.canlet.2016.02.035. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 143. Chung CH, Wong S, Ang KK, et al. Strategic plans to promote head and neck cancer translational research within the radiation therapy oncology group: a report from the translational research program. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):67–78. doi: 10.1016/j.ijrobp.2007.04.090. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 144. Scott JG, Berglund A, Schell MJ, et al. A genome-based model for adjusting radiotherapy dose (GARD): a retrospective, cohort-based study. Lancet Oncol. 2017;18:202–211. doi: 10.1016/S1470-2045(16)30648-9. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 145. Aerts HJ, Velazquez ER, Leijenaar RT, et al. Decoding tumour phenotype by noninvasive imaging using a quantitative radiomics approach. Nat Commun. 2014;5:4006. doi: 10.1038/ncomms5006. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 146. Nicolasjilwan M, Hu Y, Yan C, et al. Addition of MR imaging features and genetic biomarkers 2048 strengthens glioblastoma survival prediction in TCGA patients. J Neuroradiol. 2015;42:212–221. doi: 10.1016/j.neurad.2014.02.006. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 147. Allen C, Her S, Jaffray DA. Radiotherapy for cancer: present and future. Adv Drug Deliv Rev. 2017;109:1–2. doi: 10.1016/j.addr.2017.01.004. [ DOI ] [ PubMed ] [ Google Scholar ]
• View on publisher site
• PDF (792.1 KB)
• Collections

Similar articles

Cited by other articles, links to ncbi databases.

• Download .nbib .nbib
• Format: AMA APA MLA NLM

Add to Collections