Breast CT as a Platform for ImageGuided Therapies of Breast Cancer
John M Boone, Nicolas Prionas, George W Burkett,
Nathan J Packard, and Kai Yang
University of California Davis Medical Center
with thanks to Drs. Robin Stern, Jim Clayton,
Stavros Prionas, and Kwan-Liu Ma for data and
discussion
Disclosures:
Varian Imaging Systems, Paid Consultant
• Artemis, Paid Consultant
• Varian Imaging Systems, Research Funding
• Hologic Corporation, Research Funding
• Fuji Medical Systems, Research Funding
Acknowledgements:
California BCRP 7EB-0075
NCI CA89260
California BCRP 11I-0114
NIBIB EB002138-06 (BRP)
Susan G. Komen Foundation
Breast CT as a Platform for ImageGuided Therapies of Breast Cancer
Introduction
Breast CT Imaging
Robotic Biopsy
Radiofrequency Ablation
External Beam Radiation Therapy
Summary
Mammography
Breast CT
Breast CT scanner: Excellent device for Rx
Breast CT as a Platform for ImageGuided Therapies of Breast Cancer
Introduction
Breast CT Imaging
Robotic Biopsy
Radiofrequency Ablation
External Beam Radiation Therapy
Summary
Albion
Bodega
bCT scanner design & fabrication
PRE CONTRAST
POST CONTRAST
PRE CONTRAST
POST CONTRAST
SUBTRACTION
PRE CONTRAST
POST CONTRAST
17 sec scan
Same dose as mammo
204 patients (UCD)
49 Contrast enhanced
PRE CONTRAST
CONTRAST MRI
POST CONTRAST
CONTRAST bCT
Mag MAMMO
PRE
POST
CT technology development
64 320 slice CT
(state of the art)
14o
768 slice CT
>200 pts since 2004
PET / CT for dedicated breast imaging
ramsey badawi
simon cherry
abhijit chaudhari
spencer bowen
Breast CT as a Platform for ImageGuided Therapies of Breast Cancer
Introduction
Breast CT Imaging
Robotic Biopsy
Radiofrequency Ablation
External Beam Radiation Therapy
Summary
Patient comfortably prone on table
CT images have high spatial accuracy
Good access to breast
No magnetic field issues
Excellent opportunity for Bx / IGI
From a DD patient (201)
Robotic
guidance with
fluoroscopic
monitoring
bCT guided biopsy
breast biopsy needle
breast CT image guidance
to pathology
Breast CT as a Platform for ImageGuided Therapies of Breast Cancer
Introduction
Breast CT Imaging
Robotic Biopsy
Radiofrequency Ablation
External Beam Radiation Therapy
Summary
bCT guided RFA
radiofrequency ablation needle
breast CT image guidance
Radio-Frequency Electrocautery Ablation of
Mammary Tissue in Swine, McGahan JP, et al
Radiology 217: 471-476, 2000
Coagulation > 3 cm diameter
Coagulation volume up to 29 cc
A phase II trial of image-guided RFA of small invasive breast
carcinomas: use of saline-colled tip electrode, Khatri,
McGahan, et al, Ann Surg Oncol 14:1644-52 (2007)
17 pts, 14 pts finished procedure with path findings
μ= 12.8 mm diameter
mean time = 21 minutes (35.5 Watts)
13/14 pts (93%) showed no evidence of malignancy
Ultrasound guided RFA
OR setting before lumpectomy
Breast CT as a Platform for ImageGuided Therapies of Breast Cancer
Introduction
Breast CT Imaging
Robotic Biopsy
Radiofrequency Ablation
External Beam Radiation Therapy
Summary
conventional whole-breast radiation therapy
fractionated radiation therapy
Week 1
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Week 2
Week 3
Week 4
Week 5
A Dinkler, MC Kirk, et al, “A dosimetric
comparison of MammoSite HDR brachytherapy and Xoft Axxent electronic brachytherapy”, Brachytherapy 6, 164-168 (2007)
partial-breast
radiation therapy
Courtesy Dr.
Stavros Prionas
dose
partial breast
(hypo-fractionated)
whole breast
(fractionated)
position
bCT Rad Therapy Hypotheses:
prone, not supine
better re-positioning accuracy
more patient dignity
CT imaging during treatment
high kVp x-ray beams
linac-based radiation therapy
bCT guided radiation therapy
bCT guided radiation therapy
dynamically adjustable collimators needed
Breast CT as a Platform for ImageGuided Radiation Therapy of Breast Cancer
Physical Experiments
Monte Carlo simulations
Analytical computations
linear attenuation coefficient
polyethylene is a reasonable
surrogate for breast adipose tissue
measurement holes
at various radii
r1
r6
r2
r5
r3
24 mm Farmer chamber
r4
used existing
bCT with max
120 kVp
120 kVp results
Measured
Monte Carlo results
Breast CT as a Platform for ImageGuided Radiation Therapy of Breast Cancer
Physical Experiments
Monte Carlo simulations
Analytical computations
2 mm Cu
4 mm Cu
6 mm Cu
typical orthovoltage tubes
320 kVp W-anode spectrum*
~178 keV monoenergetic beam
depth-dose curve in polyethylene
*thanks to Dr Jim Clayton at
Varian for this spectrum
Monte Carlo results for different diameter collimations
data from various collimated fields (last slide)
~3.5%
Monte Carlo S/P (dose) across field of view
Breast CT as a Platform for ImageGuided Radiation Therapy of Breast Cancer
Physical Experiments
Monte Carlo simulations
Analytical computations
Analytical
Monte Carlo
Analytical = primary only
Monte Carlo = prim + scat
Analytical
Monte Carlo
2D dose distribution
10%
20%
2 cm beam
14 cm diameter
breast
40%
60%
7 cm beam
inverted dose
distribution
100%
60%
14 cm beam
1%
5%
10%
5 mm beam
10%
20%
20%
5 mm & 10 mm
diameter beamlets
10%
15%
multiple 5 mm
diameter beamlets
14 cm diameter breast
10%
A Dinkler, MC Kirk, et al, “A dosimetric comparison of MammoSite HDR brachytherapy and
Xoft Axxent electronic brachytherapy”, Brachytherapy 6, 164-168 (2007)
10%
15%
multiple 5 mm
diameter beamlets
dose
partial breast
(hypo-fractionated)
whole breast
(fractionated)
position
Breast CT as a Platform for ImageGuided Therapies of Breast Cancer
Introduction
Breast CT Imaging
Robotic Biopsy
Radiofrequency Ablation
External Beam Radiation Therapy
Summary
breast CT platform
enhanced localization
and targeting
breast CT data (5123)
3D volume display & analysis
breast CT platform
robotic biopsy
ablation (RFA, cryo, x-ray)
radiation therapy
John
Boone
Alex
Kwan
Martin
Yaffe
Karen
Lindfors
Hong
Zhou
Jeff
Siewerdsen
Tony
Seibert
Kai
Yang
Loren
Niklason
Ramsey
Badawi
Simon
Cherry
Orlando
Velazquez
Clare
Huang
John
McGahan
Nathan
Packard
Carey
Floyd
Tom
Nelson
Craig
Abbey
Katie
Metheany
Lin
Chen
Norbert
Pelc
Elizabeth
Krupinski
Bruce
Hasegawa
Dandan
Zheng
Shonket
Ray
Anita
Nosratieh
Sarah
McKenny
Nicolas
Prionas
Jessie
Xia
Fareedah
Simon
John
Brock
Varian Imaging Systems
Larry Partain
Gary Vishup
John Pavkovich
Hussan Mostafavi
Gerhard Roos
Ed Seppi
Cesar Proano
Linda
Phelps
Laurie
Boling
George
Burkett
Whit
Miller
deceased