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Ct Simulation For Prostate Cancer

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What You Need To Know About The Prostate Ct Simulation For Prostate Cancer

The CT Simulation Session: What You Need to Know

The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. During puberty, the body produces semen in a large number of cases, including enlarged prostate. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This is why the prostate is important to the body. It can be caused by many factors, including infection and inflammation.

A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.

While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.

Current Techniques In Three

Albert L. Wiley, Jr, MD, PhDOncology

The modern CT simulator is capable of interactive three-dimensional volumetric treatment planning this allows radiation oncology departments to operate without conventional x-ray simulators. Treatment planning is performed at the time of virtual simulation by contouring the organs or volumes of interest and determining the isocenter.

The modern CT simulator is capable of interactive three-dimensional volumetric treatment planning this allows radiation oncology departments to operate without conventional x-ray simulators. Treatment planning is performed at the time of virtual simulation by contouring the organs or volumes of interest and determining the isocenter. A digitally reconstructed radiograph provides a beam’s-eye-view display of the treatment field anatomy and contoured areas of interest. Conformal and noncoplanar teletherapy is facilitated for patients with prostate cancer, lung cancer, and brain tumors. Ongoing developments include 3D dose calculation, dose-volume histogram analysis, and tumor dose escalation.

Setting Of Conventional Pelvic Fields

On the anterior/posterior field, L5 S1 interspace was recognized as the superior border inferior border was verified based on the inferior aspect of the obturator foramen. Moreover, 1.5 cm beyond the widest part of the pelvic brim was assigned as the lateral border. The most anterior part of the symphysis pubis on the lateral was verified as the anterior border, and S2-S3 interspace was verified as the posterior border field. The superior and inferior borders were identical to those on the AP fields.

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Ct Simulation For Prostate Cancer

The only other thing I was drinking in the first 6 months after my diagnosis was green tea. I would drink about 4 glasses of green tea daily to go along with the increased water intake. I wasnt putting any other liquid into my body for the first 6 months. This was a big help in starting my road to recovery.

Once I started feeling better then I added organic soy milk to my diet as well. Soy milk isnt much like regular milk but once you get used to it then its not bad at all. To this day these are the only 3 liquids I have in my diet. To recap the 3 liquids I drink today are purified water,green tea,& organic soy milk. I put no other liquids into my body period.

Now, I want to chat a little more about meat & other aspects of a proper diet. As I said we dont need meat to live. I thought cutting or limiting meat in my diet would be to hard to accomplish. Well again my thinking was wrong. Was it easy? No! However, after a couple weeks then things were starting to get easier. I didnt cut all meats out of my diet but I did cut certain meats & eat moderate amounts of all others.

One meat that needs to be completely cut or at least very minimized is red meat . Too much Red meat consumption is not good for prostate health. I was eating a lot of fast food burgers & also red meat at home. I will say to at least cut red meat completely out of your diet until you get your prostate health back.

Mrcat Dose Virtually Identical To That Of Ct

High

TYKSs assistant chief physicist Jani Keyriläinen, PhD and medical physicists Sami Suilamo, Lic.Phil., and Pauliina Wright, PhD, led a three-phase commissioning process for MR-only simulation use in prostate radiotherapy, that began in January 2016 and concluded in March 2017. The first phase lasted eight months and consisted of CT-MRI simulation of a control group involving 74 prostate cancer patients. These first patients were planned based on CT simulation, but we also did preliminary dose calculation comparisons with both CT and MRI data sets, Dr. Keyriläinen says. In the second phase, October 2016 to February 2017, we imaged 62 patients with both CT and MRI, but these patients were planned with the MR images only.

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I was not drinking water before I started having problems. The only time Id drink water was when Id be really thirsty. That was rarely because I had quite playing sports & other activities that involved exercise. Water is a major player in prostate health & health in general terms. Did you know that water is the most natural cleanser for the body?

You should drink 8-10 glasses a day of water. If youre not getting water or enough water then this should be a change you need to make immediately. I now drink over 10 glasses of purified/bottled water daily. A lot of prostate sufferers are scared to drink more because theyre afraid it will make them go to the bathroom too much. I was there & didnt want to make things worse.

I was wrong in my thinking because drinking more water actually made things much better after a while. At first upon water increase I did see a spike in symptoms but that was part of the cleansing process for a few weeks.

Homogenous Versus Heterogenous Dosing

Homogenous dosing means that you try to treat the entire prostate gland very evenly, all to the same dose, with as little dose variance as possible. This is the typical way that stereotactic radiation is planned for prostate cancer treatments.

However, prostate tumors tend to lie around the outer edges of the prostate gland in the peripheral zone, sometimes the cancer is only on one side of the gland, and sometimes we know quite confidently where the tumor is in the prostate gland. Surely we should give extra radiation dose to these areas when it makes sense to. In addition, the urethra travels through the center of the prostate so it makes sense to give the urethra less dose if possible.

Intentionally giving different radiation dosages to different regions of the prostate gland is called heterogenous dosing. This is what I prefer to do. It does require a very precise treatment machine like CyberKnife and extra computer planning time on my part and also for the dosimetrist. The way we place the dose in the prostate with heterogenous dosing also makes the plan look closer to what we can achieve with high dose rate brachytherapy. Below is a dose map achieved with brachytherapy by placing 25 catheters into a prostate gland, leaving them in place for 24 hours, and giving a series of radiation treatments by having a radioactive source go into each catheter. We think CyberKnife is a kinder gentler alternative to HDR.

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The Initial Causes How To Prepare For Ct Simulation For Prostate Cancer

One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.

Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.

If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.

After Your Planning Session

How to prepare for your prostate CT planning appointment

It can take a few days or up to 2 to 3 weeks before you start treatment. During this time the physicists and your radiotherapy doctor create your radiotherapy plan. They make sure that the area of the cancer will receive a high dose and surrounding areas receive a low dose.

  • Prostate cancer: diagnosis and managementNational Institute for Health and Care Excellence , 2019. Last updated December 2021

  • Cancer: Principles and Practice of Oncology VT DeVita, TS Lawrence, SA RosenbergWolters Kluwer, 2019

  • External Beam Therapy Peter Hoskin

  • Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow upC Parker and others

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Visualising The Proximal Urethra By Mri Voiding Scan: Results Of A Prospective Clinical Trial Evaluating A Novel Approach To Radiotherapy Simulation For Prostate Cancer

Published online by Cambridge University Press: 05 April 2021

University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Poonam Yadav
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Huaising C. Ko
Kaiser Permanente Los Angeles Medical Center, Radiation Oncology, Los Angeles, CA, USA
Aleksandra Kuczmarska-Haas
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Adam M. Burr
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Michael F. Bassetti
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Daniel J. Steinhoff
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Kailee N. Borchert
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Jason J. Meudt
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Dustin J. Hebel
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Stephanie K. Bailey
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
Zachary S. Morris
University of Wisconsin, Department of Human Oncology, Madison, WI, USA
*
Author for correspondence: Dr Grace C. Blitzer, Department of Human Oncology, 600 Highland Ave, Madison, WI53792, USA. Tel: +1 608 263 8500. E-mail:

D Ct Simulation Procedure

CT Data Acquisition

Computed tomographic scanning is performed with a 70-cm ring aperture and flat couch, which is integrated into a computer-based virtual simulator capable of 3D volumetric reconstruction and multiplanar reconstruction for treatment planning. A laser isocenter projection system is mounted in the room the system combines two fixed and one movable sagittal laser with a variance of only 2 mm over a 6-month period. Digitally reconstructed radiographs with superimposed target volume information are generated by the computer and transferred to a commercially available CT film processor. Analysis of DRRs reveals acceptable bone detail and anatomic agreement with port films taken on the treatment unit.

The best quality DRRs are obtained with a nonspiral CT slice thickness of 2 mm and table increment of 2 mm. A slice thickness of 5 mm and table increment of 3 mm also yield DRRs of excellent quality. For larger fields up to 40 cm in length, a 5-mm slice with 5-mm table increment is used most commonly, and results in lesser detail but clinically acceptable positioning accuracy and results. For patients who cannot stay in position for more than 15 to 20 minutes, a 10-mm slice and 10-mm table increment provide acceptable quality for treatment of bone metastases and other simple treatment set-ups. Plastic mask immobilization facilitates brain, head, and neck positioning and stability.

Treatment Planning

Digitally Reconstructed Radiograph

3D Dose Calculations

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Clinical Results Of Conformal Radiation Therapy

Prostate Cancer

Investigators have utilized conformal radiation therapy for the treatment of localized prostate cancer. Soffen, Hanks, and colleagues reported a reduction in acute morbidity with conformal therapy, as compared with nonconformal techniques . Hanks et al further noted an average 14% reduction in rectal and bladder dose exposure with conformal therapy. Their experience using conformal therapy in 108 patients with localized prostate carcinoma revealed only 1% with Radiation Therapy Oncology Group grade 3 or 4 complications over a median follow-up of 16 months . A recent report on this experience showed a 30% reduction in grade 2 urinary complications in the group receiving conformal therapy, as compared with a conventionally treated control group. Dose escalation to 75 to 79 Gy was achieved in 20 patients .

Leibel and coworkers described dose escalation using conformal therapy for localized prostate carcinoma in 123 patients. Doses ranged from 64.8 to 75.6 Gy. Only one patient experienced RTOG grade 4 toxicity, 67% of patients had normalized serum prostate-specific antigen levels within 14 months of treatment , and the early disease-free rate was 89% .

Lung Cancer

Other Carcinomas

An NCI multi-institutional dose escalation study is currently evaluating the patient tolerance to higher doses of irradiation given with conformal techniques.

What Happens After Simulation

Steve Gives a Hand to the CT Radiation Simulation Scanner

After CT-Simulaton, you can take dates for radiotherapy treatment and go home. If there are special markings placed in your skin, you may have to save it. Doctors may ask you for MRI or PET-Scan images in CD ROM or DICOM format for more precise radiotherapy planning .You are given date for your first Radiotherapy session. Head and neck patient may need to get dental appointment for oral checkup and dental prophylaxis.Meanwhile, your oncologists will analyze these images in special computer software called Treatment planning system. We use MIM software and MONACO TPS. if you have undergone MRI or PET CT, those images are also imported to TPS and they are fused for better target mapping. Radiation oncologist will map your tumor and important organs in CT -simulation images.

Then Medical Physicist will decide how to give prescribed amount of radiation precisely and safely to the target that is the tumor.All these planning and dose calculation are done in computer and your treatment is planned. Finally the planned treatment is approved by your cancer doctor.

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Omitting Ct In Workflow Helps Save Time And Eliminates Registration Errors

With the omission of a CT scan and CT-MR image registration, MR-only simulation has simplified and shortened TYKSs prostate radiotherapy workflow. In the TYKS workflow, the initial diagnosis is made with ultrasound-guided biopsy and urological examination. Typically, the MR simulation scan is the first clinical MRI scan the patient receives. There is a strong collaboration with radiologist Terhi Tuokkola, MD, who spends half of her time in the radiotherapy department.

The Initial Causes Ct Simulation For Prostate Cancer

One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.

Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.

If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.

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External Beam Radiation Therapy

A planning process makes sure that the amount and location where radiation is delivered are very precise.

Radiation simulation: A few days before this appointment, a radiologist will insert several marker seeds into your prostate to help locate it during treatment. Then, during radiation simulation, the therapy team will make marks on your body to help align the linear accelerator during treatment. The team will use special devices to hold you in place to make sure you donât move during this process.

Planning scans: A computerized tomography scan will identify the precise area of your body to be treated. The information gathered during these planning sessions will help determine the type and dose of radiation you receive.

Treatment: Depending on the type of radiation and your specific diagnosis, you will usually get outpatient treatment 5 days a week for 7-9 weeks.

To make sure your prostate is in the same position for each session, an hour before treatment, your doctor may have you follow a few simple steps to make sure your bladder is full and your rectum is empty. This ensures that the radiation can be focused precisely and accurately.

For treatment, you will lie down in the position that was determined during radiation simulation. Then the linear accelerator may rotate around you to deliver radiation from all the planned angles and directions. Your therapy team will be in a different room, but you can talk to each other through audio and video connections.

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