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Shaheen N, Burdick R, Peña-Chávez R, Ulmschneider C, Yee J, Kurosu A, Rogus-Pulia N, Bednarz B. Use of deep learning to segment bolus during videofluoroscopic swallow studies. Biomed Phys Eng Express 2023; 10:015005. [PMID: 37948874 DOI: 10.1088/2057-1976/ad0bb3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023]
Abstract
Anatomical segmentations generated using artificial intelligence (AI) have the potential to significantly improve video fluoroscopic swallow study (VFS) analysis. AI segments allow for various metrics to be determined without additional time constraints streamlining and creating new opportunities for analysis. While the opportunity is vast, it is important to understand the challenges and limitations of the underlying AI task. This work evaluates a bolus segmentation network. The first swallow of thin or liquid bolus from 80 unique patients were manually contoured from bolus first seen in the oral cavity to end of swallow motion. The data was split into a 75/25 training and validation set and a 4-fold cross validation was done. A U-Net architecture along with variations were tested with the dice coefficient as the loss function and overall performance metric. The average validation set resulted in a dice coefficient of 0.67. Additional analysis to characterize the variability of images and performance on sub intervals was conducted indicating high variability among the processes required for training the network. It was found that bolus in the oral cavity consistently degrades performance due to misclassification of teeth and unimportant residue. The dice coefficients dependence on structure size can have substantial effects on the reported value. This work shows the efficacy of bolus segmentation and identifies key areas that are detriments to the performance of the network.
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Affiliation(s)
- Nadeem Shaheen
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Ryan Burdick
- Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, WI, United States of America
- Geriatric Research Education and Clinical Centers, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America
| | - Rodolfo Peña-Chávez
- Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, WI, United States of America
- Departamento de Ciencias de la Rehabilitación en Salud, Universidad del Bío-Bío, Chillán, Chile
| | | | - Joanne Yee
- Geriatric Research Education and Clinical Centers, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Atsuko Kurosu
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Nicole Rogus-Pulia
- Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, WI, United States of America
- Geriatric Research Education and Clinical Centers, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Bryan Bednarz
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States of America
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Bednarz B. Theranostics and Patient-Specific Dosimetry. Semin Radiat Oncol 2023; 33:317-326. [PMID: 37331786 PMCID: PMC10414757 DOI: 10.1016/j.semradonc.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Radiopharmaceutical therapy (RPT) is an invigorated form of cancer therapy that systemically delivers targeted radioactive drugs to cancer cells. Theranostics is a type of RPT that utilizes imaging, either of the RPT drug directly or a companion diagnostic, to inform whether a patient will benefit from the treatment. Given the ability to image the drug onboard theranostic treatments also lends itself readily to patient-specific dosimetry, which is a physics-based process that determines the overall absorbed dose burden to healthy organs and tissues and tumors in patients. While companion diagnostics identify who will benefit from RPT treatments, dosimetry determines how much activity these beneficiaries can receive to maximize therapeutic efficacy. Clinical data is starting to accrue suggesting tremendous benefits when dosimetry is performed for RPT patients. RPT dosimetry, which was once performed by florid and often inaccurate workflows, can now be performed more efficiently and accurately with FDA-cleared dosimetry software. Therefore, there is no better time for the field of oncology to adopt this form of personalize medicine to improve outcomes for cancer patients.
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Affiliation(s)
- Bryan Bednarz
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI.
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Kerr CP, Grudzinski JJ, Ferreira CA, Adam D, Sheehan-Klenk J, Bates AM, Jin WJ, Kwon O, Jagodinsky JC, Powers M, Sriramaneni RN, Clark PA, Zangl L, Nguyen TPT, Pinchuk AN, Choi C, Massey CF, Hernandez R, Bednarz B, Weichert JP, Morris ZS. Abstract 2828: Impact of sequencing of immune checkpoint blockade and targeted radionuclide therapy on murine tumor response. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-2828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Sequencing of immune checkpoint inhibitors (ICI) and external beam radiation therapy (EBRT) for cancer treatment has been studied, but the optimal sequencing has yet to be determined. While some studies have noted therapeutic advantages of priming the tumor immune microenvironment with EBRT prior to ICI, others have described the benefit of modulating the tumor infiltrating lymphocyte (TIL) population with ICI before EBRT. Targeted radionuclide therapy (TRT) approaches allow investigation of how irradiation by a tumor-targeted radionuclide and differences in emission type, linear energy transfer, and dose rate affect optimal timing of ICI administration. NM600 is an alkylphosphocholine analog selectively taken up by tumors capable of chelating numerous radionuclides for comparative studies.
Objective: We use two immunologically cold tumor models, MOC2 head and neck squamous cell carcinoma and B78 melanoma, to describe the influence of dose rate on type I interferon (IFN1) signaling and the effect of ICI and 90Y-, 177Lu-, and 225Ac-NM600 TRT sequences on tumor response.
Methods: 90Y, 177Lu, or 225Ac were added to culture media in activities estimated using GEANT4 Monte Carlo to deliver 12 Gy to the cell monolayer. qPCR was performed on cDNA from cells irradiated with EBRT, 90Y, 177Lu, or 225Ac, and harvested on days 1, 3, or 7. In vivo dosimetry was performed using the Monte Carlo-based RAPID platform utilizing serial PET/CT or SPECT/CT imaging and/or longitudinal biodistribution. Differences over time (days 4, 7, 14, 21, 28 after RT) in TIL and systemic immune cell populations were measured by flow cytometry following no treatment, 12 Gy EBRT, or 90Y-, 177Lu-, or 225Ac-NM600 in MOC2 tumors. Mice bearing B78 tumors received 1.5 Gy 90Y-, 177Lu-, or 225Ac-NM600, or no radiation on day 1 +/- ICI (anti-CTLA4 + anti-PDL1) on days -3/0/3 (early), 4/7/10 (middle), or 11/14/17 (late). Mice were monitored for tumor growth and survival.
Results: TRT and EBRT induced IFN1 responses in MOC2 cells. MOC2 cells treated every 24h with EBRT-matched 90Y/225Ac dose rates led to upregulation of IFN1-associated Ifnb1 and Mx1, mimicking radionuclide-induced responses. Increased tumor CD8/Treg ratios and decreased Tregs were observed at day 7 following all RT forms in MOC2 tumors. Long half-life 225Ac-NM600 (90Y: 65h; 177Lu: 161h; 225Ac: 240h) induced similar TIL changes at day 21. For 1.5 Gy 90Y-, 177Lu-, and 225Ac-NM600, B78 tumor growth delay and statistically significant overall survival benefit over respective TRT monotherapy and control groups was observed with early (day -3/0/3) dual ICI administration.
Conclusions: These studies demonstrate novel immunomodulatory effects of α- and β- emitting TRT and the capacity to achieve substantial antitumor responses with appropriate TRT + ICI sequencing. These results may inform clinical trial design of TRT + ICI regimens for patients with metastatic cancers.
Citation Format: Caroline P. Kerr, Joseph J. Grudzinski, Carolina A. Ferreira, David Adam, Julia Sheehan-Klenk, Amber M. Bates, Won Jong Jin, Ohyun Kwon, Justin C. Jagodinsky, Maria Powers, Raghava N. Sriramaneni, Paul A. Clark, Luke Zangl, Thanh Phuong T. Nguyen, Anatoly N. Pinchuk, Cynthia Choi, Christopher F. Massey, Reinier Hernandez, Bryan Bednarz, Jamey P. Weichert, Zachary S. Morris. Impact of sequencing of immune checkpoint blockade and targeted radionuclide therapy on murine tumor response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2828.
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Affiliation(s)
| | | | | | - David Adam
- 1University of Wisconsin-Madison, Madison, WI
| | | | | | | | - Ohyun Kwon
- 1University of Wisconsin-Madison, Madison, WI
| | | | | | | | | | - Luke Zangl
- 1University of Wisconsin-Madison, Madison, WI
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Nguyen TPT, Kerr CP, Grudzinski JJ, Ferreira CA, Sheehan-Klenk J, Kwon O, Powers M, Clark PA, Sriramaneni RN, Hernandez R, Bednarz B, Weichert JP, Morris ZS. Abstract 6407: Radionuclide-specific effects of90Y-,177Lu-, or225Ac-NM600 targeted radionuclide therapy on tumor immunomodulation and enhanced immunotherapy response in syngeneic murine tumors. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-6407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Targeted radionuclide therapy (TRT) delivers radiation treatment systemically to tumor sites via a therapeutic radionuclide-linked tumor-selective targeting vector. NM600 is an alkylphosphocholine analog selectively taken up and retained in murine and human tumor cells. We previously showed that low dose radiation delivery with 90Y-NM600 improves tumor response to immune checkpoint inhibitors (ICIs). Understanding the effect of different radionuclide physical properties (emission type, linear energy transfer (LET), half-life, and tissue range) on immunomodulation of metastatic cancers may guide therapy development. Here, we evaluated the type 1 interferon (IFN1) response elicited by 90Y-, 177Lu-, and 225Ac-NM600 in an immunologically cold syngeneic murine tumor model, B78 melanoma. We hypothesized that the unique physical properties of radionuclides will differentially impact immunomodulation by TRT.
Methods: Mice bearing B78 WT or Tmem173 -/- CRISPR deletion B78 (STING KO) tumors were randomized to receive 1.5 Gy external beam radiation (EBRT), an equivalent tumor dose of 90Y-, 177Lu-, or 225Ac-NM600 determined by the Monte Carlo-based RAPID platform, or no radiation on day 1. Tumors were harvested on days 4, 7, and 10 for RT-qPCR. Mice bearing two B78 WT or Tmem173 -/- CRISPR deletion B78 (STING KO) tumors were randomized to receive 4 Gy external beam radiation therapy (EBRT), an equivalent tumor dose of 90Y- or 177Lu-NM600, 0.5 μCi 225Ac-NM600, or no radiation +/- dual ICI (anti-CTLA4 and anti-PDL1). Mice were monitored for tumor growth and survival following these treatments.
Results: Both EBRT and TRT upregulated expression of IFN1 response-associated genes (Ifnβ1, Mx1) in B78 WT tumors. Only TRT induced upregulation of Ifnβ1 and Mx1 in STING KO B78 tumors. Ddx58, which encodes RIG-I, integral to an alternative IFN1 pathway, was upregulated in both B78 WT and STING KO tumors following 225Ac-NM600, but not other treatments. TRT in B78 STING KO tumors had earlier expression of IFN1 response-associated genes than B78 WT, 225Ac-NM600 in combination with dual ICI improved overall survival over 90Y- or 177Lu-NM600 + ICI and 225Ac-NM600 monotherapy.
Conclusions: The distinct physical properties of TRT radiation, γ, β or α, affect the timing, magnitude, and molecular pathways leading to this IFN1 response. Understanding TRT effects on the tumor microenvironment may optimize TRT and immunotherapy.
Citation Format: Thanh Phuong T. Nguyen, Caroline P. Kerr, Joseph J. Grudzinski, Carolina A. Ferreira, Julia Sheehan-Klenk, Ohyun Kwon, Maria Powers, Paul A. Clark, Raghava N. Sriramaneni, Reinier Hernandez, Bryan Bednarz, Jamey P. Weichert, Zachary S. Morris. Radionuclide-specific effects of90Y-,177Lu-, or225Ac-NM600 targeted radionuclide therapy on tumor immunomodulation and enhanced immunotherapy response in syngeneic murine tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6407.
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Affiliation(s)
| | | | | | | | | | - Ohyun Kwon
- 1University of Wisconsin - Madison, Madison, WI
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Mitra J, Bhushan C, Ghose S, Mills D, Chan H, Tarasek M, Foo T, Wells S, Jupitz S, Bednarz B, Brace C, Holmes J, Yeo D. Abstract No. 49 Motion Compensation in 3D MRI-US Fusion Using Fast Deformable Registration: A Feasibility Study for Real-Time Intervention. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Kiess AP, Hobbs RF, Bednarz B, Knox SJ, Meredith R, Escorcia FE. ASTRO's Framework for Radiopharmaceutical Therapy Curriculum Development for Trainees. Int J Radiat Oncol Biol Phys 2022; 113:719-726. [PMID: 35367328 DOI: 10.1016/j.ijrobp.2022.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
Abstract
In 2017, the American Society for Radiation Oncology (ASTRO) board of directors prioritized radiopharmaceutical therapy (RPT) as a leading area for new therapeutic development, and the ASTRO RPT workgroup was created. Herein, the workgroup has developed a framework for RPT curriculum development upon which education leaders can build to integrate this modality into radiation oncology resident education. Through this effort, the workgroup aims to provide a guide to ensure robust training in an emerging therapeutic area within the context of existing radiation oncology training in radiation biology, medical physics, and clinical radiation oncology. The framework first determines the core RPT knowledge required to select patients, prescribe, safely administer, and manage related adverse events. Then, it defines the most important topics for preparing residents for clinical RPT planning and delivery. This framework is designed as a tool to supplement the current training that exists for radiation oncology residents. The final document was approved by the ASTRO board of directors in the fall of 2021.
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Affiliation(s)
- Ana P Kiess
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland.
| | - Robert F Hobbs
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Bryan Bednarz
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Susan J Knox
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Ruby Meredith
- Department of Radiation Oncology, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Freddy E Escorcia
- Molecular Imaging Branch, Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Adam DP, Grudzinski J, Bormett I, Cox BL, Marsh IR, Bradshaw TJ, Harari PM, Bednarz B. Validation of Monte Carlo 131 I radiopharmaceutical dosimetry workflow using a 3D printed anthropomorphic head and neck phantom. Med Phys 2022; 49:5491-5503. [PMID: 35607296 PMCID: PMC9388595 DOI: 10.1002/mp.15699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Approximately 50% of head and neck cancer (HNC) patients will experience loco‐regional disease recurrence following initial courses of therapy. Retreatment with external beam radiotherapy (EBRT) is technically challenging and may be associated with a significant risk of irreversible damage to normal tissues. Radiopharmaceutical therapy (RPT) is a potential method to treat recurrent HNC in conjunction with EBRT. Phantoms are used to calibrate and add quantification to nuclear medicine images, and anthropomorphic phantoms can account for both the geometrical and material composition of the head and neck. In this study, we present the creation of an anthropomorphic, head and neck, nuclear medicine phantom, and its characterization for the validation of a Monte Carlo, SPECT image‐based, 131I RPT dosimetry workflow. Methods 3D‐printing techniques were used to create the anthropomorphic phantom from a patient CT dataset. Three 131I SPECT/CT imaging studies were performed using a homogeneous, Jaszczak, and an anthropomorphic phantom to quantify the SPECT images using a GE Optima NM/CT 640 with a high energy general purpose collimator. The impact of collimator detector response (CDR) modeling and volume‐based partial volume corrections (PVCs) upon the absorbed dose was calculated using an image‐based, Geant4 Monte Carlo RPT dosimetry workflow and compared against a ground truth scenario. Finally, uncertainties were quantified in accordance with recent EANM guidelines. Results The 3D‐printed anthropomorphic phantom was an accurate re‐creation of patient anatomy including bone. The extrapolated Jaszczak recovery coefficients were greater than that of the 3D‐printed insert (∼22.8 ml) for both the CDR and non‐CDR cases (with CDR: 0.536 vs. 0.493, non‐CDR: 0.445 vs. 0.426, respectively). Utilizing Jaszczak phantom PVCs, the absorbed dose was underpredicted by 0.7% and 4.9% without and with CDR, respectively. Utilizing anthropomorphic phantom recovery coefficient overpredicted the absorbed dose by 3% both with and without CDR. All dosimetry scenarios that incorporated PVC were within the calculated uncertainty of the activity. The uncertainties in the cumulative activity ranged from 23.6% to 106.4% for Jaszczak spheres ranging in volume from 0.5 to 16 ml. Conclusion The accuracy of Monte Carlo‐based dosimetry for 131I RPT in HNC was validated with an anthropomorphic phantom. In this study, it was found that Jaszczak‐based PVCs were sufficient. Future applications of the phantom could involve 3D printing and characterizing patient‐specific volumes for more personalized RPT dosimetry estimates.
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Affiliation(s)
- David P Adam
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, 53705
| | - Joseph Grudzinski
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, 53705
| | - Ian Bormett
- Morgridge Institute for Research, University of Wisconsin-Madison, Madison, WI, 53705
| | - Benjamin L Cox
- Morgridge Institute for Research, University of Wisconsin-Madison, Madison, WI, 53705
| | - Ian R Marsh
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, 53705
| | - Tyler J Bradshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, 53705
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, 53705
| | - Bryan Bednarz
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, 53705
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Thakkar M, Rose A, King W, Engelman K, Bednarz B. Anterior Interosseous Nerve to Ulnar Nerve Transfer: A systematic review. JPRAS Open 2022; 32:195-210. [PMID: 35498818 PMCID: PMC9043848 DOI: 10.1016/j.jpra.2022.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background Objectives Methods Results Conclusion
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Thakkar M, Rose A, Bednarz B. Thromboelastography in Microsurgical Reconstruction: A Systematic Review. JPRAS Open 2022; 32:24-33. [PMID: 35242985 PMCID: PMC8857410 DOI: 10.1016/j.jpra.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022] Open
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Magee K, Marsh IR, Turek MM, Grudzinski J, Aluicio-Sarduy E, Engle JW, Kurzman ID, Zuleger CL, Oseid EA, Jaskowiak C, Albertini MR, Esbona K, Bednarz B, Sondel PM, Weichert JP, Morris ZS, Hernandez R, Vail DM. Safety and feasibility of an in situ vaccination and immunomodulatory targeted radionuclide combination immuno-radiotherapy approach in a comparative (companion dog) setting. PLoS One 2021; 16:e0255798. [PMID: 34383787 PMCID: PMC8360580 DOI: 10.1371/journal.pone.0255798] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/23/2021] [Indexed: 12/18/2022] Open
Abstract
Rationale Murine syngeneic tumor models have revealed efficacious systemic antitumor responses following primary tumor in situ vaccination combined with targeted radionuclide therapy to secondary or metastatic tumors. Here we present studies on the safety and feasibility of this approach in a relevant translational companion dog model (n = 17 dogs) with advanced cancer. Methods The three component of the combination immuno-radiotherapy approach were employed either separately or in combination in companion dogs with advanced stage cancer. In situ vaccination was achieved through the administration of hypofractionated external beam radiotherapy and intratumoral hu14.18-IL2 fusion immunocytokine injections to the index tumor. In situ vaccination was subsequently combined with targeted radionuclide therapy using a theranostic pairing of IV 86Y-NM600 (for PET imaging and subject-specific dosimetry) and IV 90Y-NM600 (therapeutic radionuclide) prescribed to deliver an immunomodulatory 2 Gy dose to all metastatic sites in companion dogs with metastatic melanoma or osteosarcoma. In a subset of dogs, immunologic parameters preliminarily assessed. Results The components of the immuno-radiotherapy combination were well tolerated either alone or in combination, resulting in only transient low grade (1 or 2) adverse events with no dose-limiting events observed. In subject-specific dosimetry analyses, we observed 86Y-NM600 tumor:bone marrow absorbed-dose differential uptakes ≥2 in 4 of 5 dogs receiving the combination, which allowed subsequent safe delivery of at least 2 Gy 90Y-NM600 TRT to tumors. NanoString gene expression profiling and immunohistochemistry from pre- and post-treatment biopsy specimens provide evidence of tumor microenvironment immunomodulation by 90Y-NM600 TRT. Conclusions The combination of external beam radiotherapy, intratumoral immunocytokine, and targeted radionuclide immuno-radiotherapy known to have activity against syngeneic melanoma in murine models is feasible and well tolerated in companion dogs with advanced stage, spontaneously arising melanoma or osteosarcoma and has immunomodulatory potential. Further studies evaluating the dose-dependent immunomodulatory effects of this immuno-radiotherapy combination are currently ongoing.
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Affiliation(s)
- Kara Magee
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ian R. Marsh
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Michelle M. Turek
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Joseph Grudzinski
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Eduardo Aluicio-Sarduy
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jonathan W. Engle
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ilene D. Kurzman
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Cindy L. Zuleger
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Elizabeth A. Oseid
- Office of Environment, Health and Safety, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Christine Jaskowiak
- Department of Radiology, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Mark R. Albertini
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- The Medical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
| | - Karla Esbona
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Bryan Bednarz
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Radiology, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Paul M. Sondel
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Human Oncology, School of Medicine and Public Health, Madison, Wisconsin, United States of America
- Department of Pediatrics, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Jamey P. Weichert
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Radiology, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Zachary S. Morris
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Reinier Hernandez
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Radiology, School of Medicine and Public Health, Madison, Wisconsin, United States of America
- * E-mail: (RH); . (DMV)
| | - David M. Vail
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail: (RH); . (DMV)
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Patel RB, Hernandez R, Carlson P, Grudzinski J, Bates AM, Jagodinsky JC, Erbe A, Marsh IR, Arthur I, Aluicio-Sarduy E, Sriramaneni RN, Jin WJ, Massey C, Rakhmilevich AL, Vail D, Engle JW, Le T, Kim K, Bednarz B, Sondel PM, Weichert J, Morris ZS. Low-dose targeted radionuclide therapy renders immunologically cold tumors responsive to immune checkpoint blockade. Sci Transl Med 2021; 13:13/602/eabb3631. [PMID: 34261797 DOI: 10.1126/scitranslmed.abb3631] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 02/10/2021] [Accepted: 06/24/2021] [Indexed: 12/12/2022]
Abstract
Molecular and cellular effects of radiotherapy on tumor microenvironment (TME) can help prime and propagate antitumor immunity. We hypothesized that delivering radiation to all tumor sites could augment response to immunotherapies. We tested an approach to enhance response to immune checkpoint inhibitors (ICIs) by using targeted radionuclide therapy (TRT) to deliver radiation semiselectively to tumors. NM600, an alkylphosphocholine analog that preferentially accumulates in most tumor types, chelates a radioisotope and semiselectively delivers it to the TME for therapeutic or diagnostic applications. Using serial 86Y-NM600 positron emission tomography (PET) imaging, we estimated the dosimetry of 90Y-NM600 in immunologically cold syngeneic murine models that do not respond to ICIs alone. We observed strong therapeutic efficacy and reported optimal dose (2.5 to 5 gray) and sequence for 90Y-NM600 in combination with ICIs. After combined treatment, 45 to 66% of mice exhibited complete response and tumor-specific T cell memory, compared to 0% with 90Y-NM600 or ICI alone. This required expression of STING in tumor cells. Combined TRT and ICI activated production of proinflammatory cytokines in the TME, promoted tumor infiltration by and clonal expansion of CD8+ T cells, and reduced metastases. In mice bearing multiple tumors, combining TRT with moderate-dose (12 gray) external beam radiotherapy (EBRT) targeting a single tumor augmented response to ICIs compared to combination of ICIs with either TRT or EBRT alone. The safety of TRT was confirmed in a companion canine study. Low-dose TRT represents a translatable approach to promote response to ICIs for many tumor types, regardless of location.
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Affiliation(s)
- Ravi B Patel
- Department of Radiation Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA 15213, USA.
| | - Reinier Hernandez
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Peter Carlson
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Joseph Grudzinski
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Amber M Bates
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Justin C Jagodinsky
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Amy Erbe
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Ian R Marsh
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Ian Arthur
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | | | - Raghava N Sriramaneni
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Won Jong Jin
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Christopher Massey
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | | | - David Vail
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53792, USA.,Barbara A. Suran Comparative Oncology Institute, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Johnathan W Engle
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Trang Le
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Bryan Bednarz
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Paul M Sondel
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53792, USA.,Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Jamey Weichert
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Zachary S Morris
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53792, USA.
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Schrire T, Thakkar M, Mackie I, Bednarz B. Re: "Hyperbaric Oxygen therapy for large composite grafts: An alternative in pediatric facial reconstruction". J Plast Reconstr Aesthet Surg 2021; 74:2392-2442. [PMID: 34187766 DOI: 10.1016/j.bjps.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- T Schrire
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, Bristol, United Kingdom BS10 5NB.
| | - M Thakkar
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, Bristol, United Kingdom BS10 5NB
| | - I Mackie
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, Bristol, United Kingdom BS10 5NB
| | - B Bednarz
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, Bristol, United Kingdom BS10 5NB
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Matrosic CK, Culberson W, Shepard A, Jupitz S, Bednarz B. 3D dosimetric validation of ultrasound-guided radiotherapy with a dynamically deformable abdominal phantom. Phys Med 2021; 84:159-167. [PMID: 33901860 DOI: 10.1016/j.ejmp.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The purpose of this study was to dosimetrically benchmark gel dosimetry measurements in a dynamically deformable abdominal phantom for intrafraction image guidance through a multi-dosimeter comparison. Once benchmarked, the study aimed to perform a proof-of-principle study for validation measurements of an ultrasound image-guided radiotherapy delivery system. METHODS The phantom was dosimetrically benchmarked by delivering a liver VMAT plan and measuring the 3D dose distribution with DEFGEL dosimeters. Measured doses were compared to the treatment planning system and measurements acquired with radiochromic film and an ion chamber. The ultrasound image guidance validation was performed for a hands-free ultrasound transducer for the tracking of liver motion during treatment. RESULTS Gel dosimeters were compared to the TPS and film measurements, showing good qualitative dose distribution matches, low γ values through most of the high dose region, and average 3%/5 mm γ-analysis pass rates of 99.2%(0.8%) and 90.1%(0.8%), respectively. Gel dosimeter measurements matched ion chamber measurements within 3%. The image guidance validation study showed the measurement of the treatment delivery improvements due to the inclusion of the ultrasound image guidance system. Good qualitative matching of dose distributions and improvements of the γ-analysis results were observed for the ultrasound-gated dosimeter compared to the ungated dosimeter. CONCLUSIONS DEFGEL dosimeters in phantom showed good agreement with the planned dose and other dosimeters for dosimetric benchmarking. Ultrasound image guidance validation measurements showed good proof-of-principle of the utility of the phantom system as a method of validating ultrasound-based image guidance systems and potentially other image guidance methods.
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Affiliation(s)
- Charles K Matrosic
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States.
| | - Wesley Culberson
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrew Shepard
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Sydney Jupitz
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Bryan Bednarz
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
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Thakkar M, Bednarz B. Response to "Re: Should WALANT surgery be included in the training curriculum?". J Plast Reconstr Aesthet Surg 2021; 74:1633-1701. [PMID: 33820743 DOI: 10.1016/j.bjps.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Affiliation(s)
- M Thakkar
- Department of Plastic and Reconstructive Surgery, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom.
| | - B Bednarz
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB, United Kingdom
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Affiliation(s)
- M Thakkar
- Department of Plastic and Reconstructive Surgery, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom.
| | - B Bednarz
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB, United Kingdom
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Affiliation(s)
- M Thakkar
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB, United Kingdom
| | - B Bednarz
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB, United Kingdom
| | - J Henderson
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB, United Kingdom
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Bednarz B, Thakkar M. Re "Management and outcomes of mammalian bite injuries during COVID-19 and implications for future practice". J Plast Reconstr Aesthet Surg 2020; 74:1355-1401. [PMID: 33317984 DOI: 10.1016/j.bjps.2020.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Affiliation(s)
- B Bednarz
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road BS10 5NB, England
| | - M Thakkar
- Department of Plastic and Reconstructive Surgery, St Mary's Hospital, Praed Street, London, England.
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Roncali E, Capala J, Benedict SH, Akabani G, Bednarz B, Bhadrasain V, Bolch WE, Buchsbaum JC, Coleman NC, Dewaraja YK, Frey E, Ghaly M, Grudzinski J, Hobbs RF, Howell RW, Humm JL, Kunos CA, Larson S, Lin FI, Madsen M, Mirzadeh S, Morse D, Pryma D, Sgouros G, St. James S, Wahl RL, Xiao Y, Zanzonico P, Zukotynski K. Overview of the First NRG Oncology–National Cancer Institute Workshop on Dosimetry of Systemic Radiopharmaceutical Therapy. J Nucl Med 2020; 62:1133-1139. [DOI: 10.2967/jnumed.120.255547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
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Bednarz B, Thakkar M. Letter comments on: "Impact of MSLT-II on lymph node clearance surgery in a tertiary plastic surgery centre". J Plast Reconstr Aesthet Surg 2020; 73:2239-2260. [PMID: 32888865 DOI: 10.1016/j.bjps.2020.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/01/2020] [Indexed: 11/16/2022]
Affiliation(s)
- B Bednarz
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB, United Kingdom.
| | - M Thakkar
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB, United Kingdom
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Sosa GA, Bates AM, Patel R, Hernandez R, Grudzinski JJ, Marsh I, Bednarz B, Pieper A, Nystuen E, Emma S, Sumiec EG, Weichert JP, Morris ZS. Abstract 903: In vivo efficacy of bempegaldesleukin, immune checkpoint inhibition, and targeted radionuclide therapy in immunocompetent murine model of head and neck cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In preclinical studies, we have demonstrated that delivering low dose radiation therapy to all sites of metastatic cancer using targeted radionuclide therapy (TRT) can improve the response to immune checkpoint blockade. NM600 is a tumor-targeting alkylphosphocholine radiolabeled with 90Y. Following intravenous administration, NM600 is selectively taken up and retained in most murine and human cancer cells. Bempegaldesleukin (NKTR-214) is a first in class, CD122-preferential interleukin-2 (IL2) pathway agonist being studied for its ability to influence the IL2 pathway and selectively stimulate an immune response. The primary objective of this study was to test the hypothesis that NKTR-214 and 90Y-NM600 would increase the response to immune checkpoint blockade in the immunologically “cold” MOC2 syngeneic mouse model of head and neck squamous cell carcinoma (HNSCC). C57BL/6 female mice were engrafted with MOC2, a murine HNSCC cell line, in the right flank. When mean tumor volume reached ~100mm3, mice were randomized into eight treatment groups using a 2 × 2 × 2 study design for combinations of NKTR-214, 90Y-NM600, and anti-CTLA4. 100 µCi 90Y-NM600 was administered intravenously (IV, treatment day 1). Prior in vivo dosimetry performed using the Monte Carlo based RAPID platform following serial 86Y-NM600 PET/CT imaging demonstrated that this activity delivered ~8Gy to the MOC2 tumor. 200 µg anti-CTLA4 was delivered by intraperitoneal injection on days 4, 7, and 10. 16 µg NKTR-214 was given IV on days 6, 15, and 24. Tumor growth was monitored. In a parallel study, cohorts of mice were treated with PBS (control), NKTR-214, 90Y-NM600, or NKTR-214 + 90Y-NM600, and tumors were collected at day 14 for flow cytometry analysis. In the spontaneously metastatic, immunologically “cold” MOC2 HNSCC tumor model, 62.5% of mice treated with the combination of 90Y-NM600, NKTR-214, and anti-CTLA4 experienced complete tumor response, and these mice showed no observable primary or metastatic disease 60 days after treatment initiation. No mice receiving single or dual therapy combinations exhibited complete tumor response (p = <0.01). Treatment with NKTR-214 + 90Y-NM600 resulted in increased tumor infiltration by CD8+ T cells. Intriguingly, 90Y-NM600 triggered increased expression of the IL-2β receptor, CD122, on the surface of tumor infiltrating CD8+ T cells, suggesting a novel mechanism of synergy with NKTR-214. Combination therapy with NKTR-214, 90Y-NM600, and anti-CTLA4 resulted in complete and durable tumor response in a difficult to treat murine model of HNSCC. Therapeutic interaction between TRT and NKTR-214 may be a result from low dose radiation increasing the expression of CD122 on tumor infiltrating lymphocytes. Further preclinical and early phase clinical investigations are warranted to evaluate the therapeutic potential of such combinations.
Citation Format: Gustavo A. Sosa, Amber M. Bates, Ravi Patel, Reinier Hernandez, Joseph J. Grudzinski, Ian Marsh, Bryan Bednarz, Alexander Pieper, Erin Nystuen, Sarah Emma, Elizabeth G. Sumiec, Jamey P. Weichert, Zachary S. Morris. In vivo efficacy of bempegaldesleukin, immune checkpoint inhibition, and targeted radionuclide therapy in immunocompetent murine model of head and neck cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 903.
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Affiliation(s)
- Gustavo A. Sosa
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Amber M. Bates
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Ravi Patel
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Reinier Hernandez
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Joseph J. Grudzinski
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Ian Marsh
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Bryan Bednarz
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Alexander Pieper
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Erin Nystuen
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Sarah Emma
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Elizabeth G. Sumiec
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Jamey P. Weichert
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Zachary S. Morris
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
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St James S, Bednarz B, Benedict S, Buchsbaum JC, Dewaraja Y, Frey E, Hobbs R, Grudzinski J, Roncali E, Sgouros G, Capala J, Xiao Y. Current Status of Radiopharmaceutical Therapy. Int J Radiat Oncol Biol Phys 2020; 109:891-901. [PMID: 32805300 DOI: 10.1016/j.ijrobp.2020.08.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/06/2020] [Indexed: 02/02/2023]
Abstract
In radiopharmaceutical therapy (RPT), a radionuclide is systemically or locally delivered with the goal of targeting and delivering radiation to cancer cells while minimizing radiation exposure to untargeted cells. Examples of current RPTs include thyroid ablation with the administration of 131I, treatment of liver cancer with 90Y microspheres, the treatment of bony metastases with 223Ra, and the treatment of neuroendocrine tumors with 177Lu-DOTATATE. New RPTs are being developed where radionuclides are incorporated into systemic targeted therapies. To assure that RPT is appropriately implemented, advances in targeting need to be matched with advances in quantitative imaging and dosimetry methods. Currently, radiopharmaceutical therapy is administered by intravenous or locoregional injection, and the treatment planning has typically been implemented like chemotherapy, where the activity administered is either fixed or based on a patient's body weight or body surface area. RPT pharmacokinetics are measurable by quantitative imaging and are known to vary across patients, both in tumors and normal tissues. Therefore, fixed or weight-based activity prescriptions are not currently optimized to deliver a cytotoxic dose to targets while remaining within the tolerance dose of organs at risk. Methods that provide dose estimates to individual patients rather than to reference geometries are needed to assess and adjust the injected RPT dose. Accurate doses to targets and organs at risk will benefit the individual patients and decrease uncertainties in clinical trials. Imaging can be used to measure activity distribution in vivo, and this information can be used to determine patient-specific treatment plans where the dose to the targets and organs at risk can be calculated. The development and adoption of imaging-based dosimetry methods is particularly beneficial in early clinical trials. In this work we discuss dosimetric accuracy needs in modern radiation oncology, uncertainties in the dosimetry in RPT, and best approaches for imaging and dosimetry of internal radionuclide therapy.
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Affiliation(s)
- Sara St James
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
| | - Bryan Bednarz
- Department of Medical Physics and Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stanley Benedict
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland
| | - Yuni Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Eric Frey
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Robert Hobbs
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Emilie Roncali
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - George Sgouros
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Jacek Capala
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland
| | - Ying Xiao
- Hospital of the University of Pennsylvania
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Abstract
A dynamically compressible phantom of the human abdomen that simulates organ motion with breathing is being developed for possible testing of image-gated beam delivery in radiotherapy. The polyvinyl chloride plastisol (PVCP) phantom features a cavity that can contain a deformable normoxic polyacrylamide gel (nPAG) dosimeter that is intended for use with MRI to provide dosimetric data. The phantom has been improved by the inclusion of new components that are more realistic anatomically and exhibit CT values similar to those of the tissues they mimic. Component organs were made from 3D-printed molds developed from CT contours of a real patient and their radiodensities adjusted by varying the mass ratios of the PVCP hardener and softener during manufacture. To make the phantom more compatible with ultrasound imaging a graphite scatterer was mixed into some of the phantom components to produce a background speckle pattern. This provided contrast between the body and a moving anatomical target intended for motion tracking. Phantom insert motion magnitude and repeatibility was assessed using CT by imaging two phantom inserts, one containing fiducial markers and the other containing iodinated gelatin, at the same position after repeated cycles of deformation. The maximum motion of a phantom fiducial at the position of the phantom treatment target was found to be 12.2 mm. The phantom design resulted in dosimeter motion with a point-to-point repatability within 0.3 mm on average and contour repeatability resulting in Dice coefficients exceeding 0.98 on average.
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Affiliation(s)
- Charles K Matrosic
- School of Medicine and Public Health Department of Medical Physics, University of Wisconsin, Madison, WI, United States of America. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States of America
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Bednarz B, Thakkar M, Henderson J. Re "Endoscopic retrieval of retracted flexor tendons: An atraumatic technique". J Plast Reconstr Aesthet Surg 2020; 73:983-1007. [PMID: 32037075 DOI: 10.1016/j.bjps.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Affiliation(s)
- B Bednarz
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
| | - M Thakkar
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom.
| | - J Henderson
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
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Ellison PA, Olson AP, Barnhart TE, Hoffman SLV, Reilly SW, Makvandi M, Bartels JL, Murali D, DeJesus OT, Lapi SE, Bednarz B, Nickles RJ, Mach RH, Engle JW. Improved production of 76Br, 77Br and 80mBr via CoSe cyclotron targets and vertical dry distillation. Nucl Med Biol 2019; 80-81:32-36. [PMID: 31575457 DOI: 10.1016/j.nucmedbio.2019.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/11/2019] [Accepted: 09/04/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The radioisotopes of bromine are uniquely suitable radiolabels for small molecule theranostic radiopharmaceuticals but are of limited availability due to production challenges. Significantly improved methods were developed for the production and radiochemical isolation of clinical quality 76Br, 77Br, and 80mBr. The radiochemical quality of the radiobromine produced using these methods was tested through the synthesis of a novel 77Br-labeled inhibitor of poly (ADP-ribose) polymerase-1 (PARP-1), a DNA damage response protein. METHODS 76Br, 77Br, and 80mBr were produced in high radionuclidic purity via the proton irradiation of novel isotopically-enriched Co76Se, Co77Se, and Co80Se intermetallic targets, respectively. Radiobromine was isolated through thermal chromatographic distillation in a vertical furnace assembly. The 77Br-labeled PARP inhibitor was synthesized via copper-mediated aryl boronic ester radiobromination. RESULTS Cyclotron production yields were 103 ± 10 MBq∙μA-1∙h-1 for 76Br, 88 ± 10 MBq∙μA-1∙h-1 for 80mBr at 16 MeV and 17 ± 1 MBq∙μA-1∙h-1 for 77Br at 13 MeV. Radiobromide isolation yields were 76 ± 11% in a small volume of aqueous solution. The synthesized 77Br-labeled PARP-1 inhibitor had a measured apparent molar activity up to 700 GBq/μmol at end of synthesis. CONCLUSIONS A novel selenium alloy target enabled clinical-scale production of 76Br, 77Br, and 80mBr with high apparent molar activities, which was used to for the production of a new 77Br-labeled inhibitor of PARP-1. ADVANCES IN KNOWLEDGE New methods for the cyclotron production and isolation of radiobromine improved the production capacity of 77Br by a factor of three and 76Br by a factor of six compared with previous methods. IMPLICATIONS FOR PATIENT CARE Preclinical translational research of 77Br-based Auger electron radiotherapeutics, such as those targeting PARP-1, will require the production of GBq-scale 77Br, which necessitates next-generation, high-yielding, isotopically-enriched cyclotron targets, such as the novel intermetallic Co77Se.
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Affiliation(s)
- Paul A Ellison
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Aeli P Olson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Todd E Barnhart
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sabrina L V Hoffman
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sean W Reilly
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Mehran Makvandi
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jennifer L Bartels
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dhanabalan Murali
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Onofre T DeJesus
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Suzanne E Lapi
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bryan Bednarz
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Engineering Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert J Nickles
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert H Mach
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jonathan W Engle
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Marsh I, Besemer A, Bednarz B. Patient-Specific Alpha Particle Dosimetry Using Radiopharmaceutical Assessment Platform for Internal Dosimetry (RAPID). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Adam D, Schweitzer N, Hoffman S, Bednarz B. Development of a Monte Carlo-Based Microdosimetry Platform for the Analysis of Targeted Radionuclide Therapy Agents in Vitro. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Matrosic CK, Hull J, Palmer B, Culberson W, Bednarz B. Deformable abdominal phantom for the validation of real-time image guidance and deformable dose accumulation. J Appl Clin Med Phys 2019; 20:122-133. [PMID: 31355997 PMCID: PMC6698755 DOI: 10.1002/acm2.12687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/03/2019] [Accepted: 07/06/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE End-to-end testing with quality assurance (QA) phantoms for deformable dose accumulation and real-time image-guided radiotherapy (IGRT) has recently been recommended by American Association of Physicists in Medicine (AAPM) Task Groups 132 and 76. The goal of this work was to develop a deformable abdominal phantom containing a deformable three-dimensional dosimeter that could provide robust testing of these systems. METHODS The deformable abdominal phantom was fabricated from polyvinyl chloride plastisol and phantom motion was simulated with a programmable motion stage and plunger. A deformable normoxic polyacrylamide gel (nPAG) dosimeter was incorporated into the phantom apparatus to represent a liver tumor. Dosimeter data were acquired using magnetic resonance imaging (MRI). Static measurements were compared to planned dose distributions. Static and dynamic deformations were used to simulate inter- and intrafractional motion in the phantom and measurements were compared to baseline measurements. RESULTS The statically irradiated dosimeters matched the planned dose distribution with an average γ pass rates of 97.0 ± 0.5% and 97.5 ± 0.2% for 3%/5 mm and 5%/5 mm criteria, respectively. Static deformations caused measured dose distribution shifts toward the phantom plunger. During the dynamic deformation experiment, the dosimeter that utilized beam gating showed an improvement in the γ pass rate compared to the dosimeter that did not. CONCLUSIONS A deformable abdominal phantom apparatus which incorporates a deformable nPAG dosimeter was developed to test real-time IGRT systems and deformable dose accumulation algorithms. This apparatus was used to benchmark simple static irradiations in which it was found that measurements match well to the planned distributions. Deformable dose accumulation could be tested by directly measuring the shifts and blurring of the target dose due to interfractional organ deformation and motion. Dosimetric improvements were achieved from the motion management during intrafractional motion.
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Affiliation(s)
- Charles K. Matrosic
- School of Medicine and Public Health, Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Jennifer Hull
- School of Medicine and Public Health, Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Benjamin Palmer
- School of Medicine and Public Health, Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Wesley Culberson
- School of Medicine and Public Health, Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Bryan Bednarz
- School of Medicine and Public Health, Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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Grudzinski JJ, Hernandez R, Marsh I, Patel RB, Aluicio-Sarduy E, Engle J, Morris Z, Bednarz B, Weichert J. Preclinical Characterization of 86/90Y-NM600 in a Variety of Murine and Human Cancer Tumor Models. J Nucl Med 2019; 60:1622-1628. [PMID: 30954941 DOI: 10.2967/jnumed.118.224808] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/26/2019] [Indexed: 11/16/2022] Open
Abstract
We characterize the in vivo biodistribution and tumor selectivity of 86Y-NM600, a theranostic alkylphosphocholine radiometal chelate with broad tumor selectivity, in a variety of preclinical cancer models. Methods: Mice bearing flank tumors (representative of lung, pancreatic, prostate, liver, skin, and lymphoid cancers) were injected intravenously with 9.25 MBq of 86Y-NM600 and imaged longitudinally over 4-5 d using small-animal PET/CT. Percentage injected activity per gram (%IA/g) for each volume of interest was measured at each time point for the organs of interest. Mice were euthanized after the final time point, and the tumor and organs of interest were counted with an automatic γ-counter. Absorbed doses delivered by 90Y-NM600 per injected activity (Gy/MBq) were estimated. Mice bearing B78 flank tumors were injected with a prescription of 90Y-NM600 that delivered 2.5 Gy of absorbed tumor dose and was compared with an equivalent absorbed dose delivered via external-beam radiotherapy using tumor volume as a measure of response. Histology and complete blood counts were analyzed in naïve C57BL/6 mice that were injected with 9.25 MBq of 90Y-NM600 at 5, 10, and 28 d after injection. Results: PET imaging showed consistent tumor accumulation and retention across all tumor models investigated, with little off-target retention of NM600 except in the liver, as is characteristic of hepatobiliary metabolism. The tumor uptake was highest in the pancreatic and lymphoid cancer models, reaching peak concentrations of 9.34 ± 2.66 %IA/g (n = 3) and 9.10 ± 0.13 %IA/g (n = 3), respectively, at approximately 40-48 h after injection. These corresponded to tumor dose estimates of 2.72 ± 0.33 Gy/MBq and 2.67 ± 0.32 Gy/MBq, respectively. In the toxicity study, there were no visible signs of acute toxicity by histology, and perturbation of hematologic parameters was transient when observed, returning to pretherapy levels after 28 d. Conclusion: NM600 is a theranostic agent with a unique ability to selectively target a variety of cancer types, presenting a unique opportunity for PET image-guided targeted radionuclide therapy and combination with immunotherapies.
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Affiliation(s)
- Joseph J Grudzinski
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Reinier Hernandez
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Ian Marsh
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ravi B Patel
- Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin; and
| | | | - Jon Engle
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Zachary Morris
- Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin; and
| | - Bryan Bednarz
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Radiology, University of Wisconsin, Madison, Wisconsin.,Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin; and
| | - Jamey Weichert
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Radiology, University of Wisconsin, Madison, Wisconsin.,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
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Grudzinski J, Marsh I, Titz B, Jeffery J, Longino M, Kozak K, Lange K, Larrabee J, Weichmann A, Moser A, Bednarz B. CLR 125 Auger Electrons for the Targeted Radiotherapy of Triple-Negative Breast Cancer. Cancer Biother Radiopharm 2018; 33:87-95. [PMID: 29641256 DOI: 10.1089/cbr.2017.2376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Auger electrons emitted by radioisotopes such as 125I have a high linear energy transfer and short mean-free path in tissue (<10 μm), making them suitable for treating micrometastases while sparing normal tissues. The authors developed and subsequently investigated a cancer cell-selective small molecule phospholipid ether analog to deliver 125I to triple-negative breast cancer (TNBC) cells in vivo. METHODS A Current Good Manufacturing Practice (cGMP) method to radiolabel 125I-CLR1404 (CLR 125) with >95% radiochemical purity was established. To estimate CLR 125 in vivo dosimetry and identify dose-limiting organs, the biodistribution of the analog compound 124I-CLR1404 (CLR 124) was investigated using micro-positron emission tomography (PET)/computed tomography (CT) in conjunction with a Monte Carlo dosimetry platform to estimate CLR 125 dosimetry. In vivo antitumor efficacy was tested by injecting nude mice bearing either MDA-MB-231-luc orthotopic xenografts or lung metastases with 74 MBq (3.7 GBq/kg) of CLR 125 or an equivalent mass amount of nonradiolabeled CLR 125. Longitudinal tumor measurements using calipers and bioluminescence imaging were obtained for the xenografts and lung metastases, respectively. RESULTS Dosimetry analysis estimated that CLR 125 would impart the largest absorbed dose to the tumor per injected activity (0.261 ± 0.023 Gy/MBq) while the bone marrow, which is generally the dose-limiting organ for CLR1404, appears to have the lowest (0.063 ± 0.005 Gy/MBq). At administered activities of up to 74 MBq (3.7 GBq/kg), mice did not experience signs of toxicity. In addition, a single dose of CLR 125 reduced the volume of orthotopic primary TNBC xenografts by ∼60% compared to control vehicle (p < 0.001) and significantly extended survival. In addition, CLR 125 was efficacious against preclinical metastatic TNBC models by inhibiting the progression of micrometastases (p < 0.01). CONCLUSIONS Targeted radionuclide therapy with CLR 125 displayed significant antitumor efficacy in vivo, suggesting promise for treatment of TNBC micrometastases.
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Affiliation(s)
- Joseph Grudzinski
- 1 Department of Medical Physics, University of Wisconsin-Madison , Madison, Wisconsin
| | - Ian Marsh
- 1 Department of Medical Physics, University of Wisconsin-Madison , Madison, Wisconsin
| | | | - Justin Jeffery
- 3 University of Wisconsin Carbone Cancer Center , Madison, Wisconsin
| | - Marc Longino
- 2 Cellectar Biosciences, Inc. , Madison, Wisconsin
| | - Kevin Kozak
- 2 Cellectar Biosciences, Inc. , Madison, Wisconsin
| | | | | | - Ashley Weichmann
- 3 University of Wisconsin Carbone Cancer Center , Madison, Wisconsin
| | - Amy Moser
- 3 University of Wisconsin Carbone Cancer Center , Madison, Wisconsin.,4 Department of Human Oncology, University of Wisconsin-Madison , Madison, Wisconsin
| | - Bryan Bednarz
- 1 Department of Medical Physics, University of Wisconsin-Madison , Madison, Wisconsin.,3 University of Wisconsin Carbone Cancer Center , Madison, Wisconsin.,4 Department of Human Oncology, University of Wisconsin-Madison , Madison, Wisconsin
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Lee D, Li M, Bednarz B, Schultz MK. Modeling Cell and Tumor-Metastasis Dosimetry with the Particle and Heavy Ion Transport Code System (PHITS) Software for Targeted Alpha-Particle Radionuclide Therapy. Radiat Res 2018; 190:236-247. [PMID: 29944461 DOI: 10.1667/rr15081.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The use of targeted radionuclide therapy for cancer is on the rise. While beta-particle-emitting radionuclides have been extensively explored for targeted radionuclide therapy, alpha-particle-emitting radionuclides are emerging as effective alternatives. In this context, fundamental understanding of the interactions and dosimetry of these emitted particles with cells in the tumor microenvironment is critical to ascertaining the potential of alpha-particle-emitting radionuclides. One important parameter that can be used to assess these metrics is the S-value. In this study, we characterized several alpha-particle-emitting radionuclides (and their associated radionuclide progeny) regarding S-values in the cellular and tumor-metastasis environments. The Particle and Heavy Ion Transport code System (PHITS) was used to obtain S-values via Monte Carlo simulation for cell and tumor metastasis resulting from interactions with the alpha-particle-emitting radionuclides, lead-212 (212Pb), actinium-225 (225Ac) and bismuth-213 (213Bi); these values were compared to the beta-particle-emitting radionuclides yttrium-90 (90Y) and lutetium-177 (177Lu) and an Auger-electron-emitting radionuclide indium-111 (111In). The effect of cellular internalization on S-value was explored at increasing degree of internalization for each radionuclide. This aspect of S-value determination was further explored in a cell line-specific fashion for six different cancer cell lines based on the cell dimensions obtained by confocal microscopy. S-values from PHITS were in good agreement with MIRDcell S-values (cellular S-values) and the values found by Hindié et al. (tumor S-values). In the cellular model, 212Pb and 213Bi decay series produced S-values that were 50- to 120-fold higher than 177Lu, while 225Ac decay series analysis suggested S-values that were 240- to 520-fold higher than 177Lu. S-values arising with 100% cellular internalization were two- to sixfold higher for the nucleus when compared to 0% internalization. The tumor dosimetry model defines the relative merit of radionuclides and suggests alpha particles may be effective for large tumors as well as small tumor metastases. These results from PHITS modeling substantiate emerging evidence that alpha-particle-emitting radionuclides may be an effective alternative to beta-particle-emitting radionuclides for targeted radionuclide therapy due to preferred dose-deposition profiles in the cellular and tumor metastasis context. These results further suggest that internalization of alpha-particle-emitting radionuclides via radiolabeled ligands may increase the relative biological effectiveness of radiotherapeutics.
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Affiliation(s)
- Dongyoul Lee
- a Interdisciplinary Graduate Program in Human Toxicology, The University of Iowa, Iowa City, Iowa
| | - Mengshi Li
- a Interdisciplinary Graduate Program in Human Toxicology, The University of Iowa, Iowa City, Iowa
| | - Bryan Bednarz
- b Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Michael K Schultz
- a Interdisciplinary Graduate Program in Human Toxicology, The University of Iowa, Iowa City, Iowa.,c Stead Family Department of Pediatrics, Carver College of Medicine, The University of Iowa, Iowa City, Iowa.,d Department of Radiology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa.,e Department of Radiation Oncology (Free Radical and Radiation Biology Program), Carver College of Medicine, The University of Iowa, Iowa City, Iowa.,f Department of Chemistry, The University of Iowa, Iowa City, Iowa.,g Viewpoint Molecular Targeting, LLC, Coralville, Iowa
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Bednarz B, Grudzinski J, Marsh I, Besemer A, Baiu D, Weichert J, Otto M. Murine-specific Internal Dosimetry for Preclinical Investigations of Imaging and Therapeutic Agents. Health Phys 2018; 114:450-459. [PMID: 29481536 PMCID: PMC5831541 DOI: 10.1097/hp.0000000000000789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is a growing need to estimate the absorbed dose to small animals from preclinical investigations involving diagnostic and therapeutic radiopharmaceuticals. This paper introduces a Monte Carlo-based dosimetry platform called RAPID, which is capable of calculating murine-specific three-dimensional (3D) dose distributions. A comparison is performed between absorbed doses calculated with RAPID and absorbed doses calculated in a commonly used reference mouse phantom called MOBY. Four test mice containing different xenografts underwent serial PET/CT imaging using a novel diagnostic therapy (theranostic) agent NM404, which can be labeled with I for imaging or I for therapy. Using the PET/CT data, 3D dose distributions from I-NM404 were calculated in the mice using RAPID. Mean organ doses in these four test mice were compared to mean organ doses derived by using two previously published I S-values datasets in MOBY. In addition, mean tumor doses calculated in RAPID were compared to mean organ doses derived from unit density spheres. Large differences were identified between mean organ doses calculated in the test mice using RAPID and those derived in the MOBY phantom. Mean absorbed dose percent errors in organs ranged between 0.3% and 333%. Overall, mass scaling improved agreement between MOBY phantom calculations and RAPID, where percent errors were all less than 26%, with the exception of the lung in which percent errors reached values of 48%. Percent errors in mean tumor doses in the test mice and unit density spheres were less pronounced but still ranged between 8% and 23%. This work demonstrates the limitations of using pre-computed S-values in computational phantoms to predict organ doses in small animals from theranostic procedures. RAPID can generate accurate 3D dose distributions in small animals and in turn offer much greater insight on the ability of a given theranostic agent to image and treat diseases.
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Lee W, Chan H, Chan P, Fiorillo T, Fiveland E, Foo T, Mills D, Patel A, Sabatini J, Shoudy D, Smith S, Bednarz B. A Magnetic Resonance Compatible E4D Ultrasound Probe for Motion Management of Radiation Therapy. IEEE Netw 2017; 2017:10.1109/ULTSYM.2017.8092223. [PMID: 31452579 PMCID: PMC6709705 DOI: 10.1109/ultsym.2017.8092223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We developed a magnetic resonance compatible real-time, three-dimensional imaging ultrasound probe for motion management of radiation therapy for liver cancer. The probe contains an 18,000-element, 46.8 mm × 21.5 mm matrix array constructed from three tiled transducer modules with integrated beamforming ASICs. The center frequency and -6 dB fractional bandwidth of the probe was 3.6 MHz and 85 percent respectively. Ferromagnetic materials in the acoustic stack, flex interconnect and electronics boards were greatly minimized for magnetic resonance compatibility. The probe and cable were shielded to minimize the impact of radiofrequency noise on both the ultrasound and magnetic resonance images. The probe's low-profile, side-viewing design allows it to be strapped to a patient so that images may be acquired hands-free. We present simultaneously acquired ultrasound and 3 Tesla magnetic resonance images with minimal artifacts in both images.
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Affiliation(s)
- Warren Lee
- General Electric Global Research Center, Niskayuna, NY, USA
| | - Heather Chan
- General Electric Global Research Center, Niskayuna, NY, USA
| | - Pong Chan
- General Electric Global Research Center, Niskayuna, NY, USA
| | | | - Eric Fiveland
- General Electric Global Research Center, Niskayuna, NY, USA
| | - Thomas Foo
- General Electric Global Research Center, Niskayuna, NY, USA
| | - David Mills
- General Electric Global Research Center, Niskayuna, NY, USA
| | - Aqsa Patel
- General Electric Global Research Center, Niskayuna, NY, USA
| | - James Sabatini
- General Electric Global Research Center, Niskayuna, NY, USA
| | - David Shoudy
- General Electric Global Research Center, Niskayuna, NY, USA
| | - Scott Smith
- General Electric Global Research Center, Niskayuna, NY, USA
| | - Bryan Bednarz
- Departments of Medical Physics and Human Oncology, University of Wisconsin-Madison, Madison, WI, USA
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Kry SF, Bednarz B, Howell RM, Dauer L, Followill D, Klein E, Paganetti H, Wang B, Wuu CS, George Xu X. AAPM TG 158: Measurement and calculation of doses outside the treated volume from external-beam radiation therapy. Med Phys 2017; 44:e391-e429. [DOI: 10.1002/mp.12462] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Stephen F. Kry
- Department of Radiation Physics; MD Anderson Cancer Center; Houston TX 77054 USA
| | - Bryan Bednarz
- Department of Medical Physics; University of Wisconsin; Madison WI 53705 USA
| | - Rebecca M. Howell
- Department of Radiation Physics; MD Anderson Cancer Center; Houston TX 77054 USA
| | - Larry Dauer
- Departments of Medical Physics/Radiology; Memorial Sloan-Kettering Cancer Center; New York NY 10065 USA
| | - David Followill
- Department of Radiation Physics; MD Anderson Cancer Center; Houston TX 77054 USA
| | - Eric Klein
- Department of Radiation Oncology; Washington University; Saint Louis MO 63110 USA
| | - Harald Paganetti
- Department of Radiation Oncology; Massachusetts General Hospital and Harvard Medical School; Boston MA 02114 USA
| | - Brian Wang
- Department of Radiation Oncology; University of Louisville; Louisville KY 40202 USA
| | - Cheng-Shie Wuu
- Department of Radiation Oncology; Columbia University; New York NY 10032 USA
| | - X. George Xu
- Department of Mechanical, Aerospace, and Nuclear Engineering; Rensselaer Polytechnic Institute; Troy NY 12180 USA
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Abstract
Normoxic Polyacrylamide Gels, or nPAGs, are 3D gel dosimeters that measure dose through the process of radiation-induced polymerization. Two nPAG formulae are DEFGEL and PAGAT, which are very similar, but differ mainly due to different weight fractions of monomers. The dosimetric resolutions of the two formulae when paired with a Spin-Echo (SE) MRI sequence and a monoexponential fit were compared over a range of 0-15 Gy. It was found that in the dose range 0-6 Gy the PAGAT formula generally showed a much finer dose resolution, while the DEFGEL formula showed a finer resolution from 8-15 Gy.
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Affiliation(s)
- Charles Matrosic
- The University of Wisconsin School of Medicine and Public Health, University of Wisconsin - Madison, Department of Medical Physics, Madison, WI
| | - Alan McMillan
- The University of Wisconsin School of Medicine and Public Health, University of Wisconsin - Madison, Department of Radiology, Madison, WI
| | - James Holmes
- The University of Wisconsin School of Medicine and Public Health, University of Wisconsin - Madison, Department of Radiology, Madison, WI
| | - Bryan Bednarz
- The University of Wisconsin School of Medicine and Public Health, University of Wisconsin - Madison, Department of Medical Physics, Madison, WI
| | - Wesley Culberson
- The University of Wisconsin School of Medicine and Public Health, University of Wisconsin - Madison, Department of Medical Physics, Madison, WI
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Han B, Bednarz B, Danon Y, Block R, Xu XG. Evaluation of Nuclear Activation of Tungsten Plates for Future Modeling of a Medical Accelerator. NUCL TECHNOL 2017. [DOI: 10.13182/nt09-a9246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Bin Han
- Rensselaer Polytechnic Institute Nuclear Engineering and Engineering Physics, Troy, New York 12180
| | - Bryan Bednarz
- Rensselaer Polytechnic Institute Nuclear Engineering and Engineering Physics, Troy, New York 12180
| | - Yaron Danon
- Rensselaer Polytechnic Institute Nuclear Engineering and Engineering Physics, Troy, New York 12180
| | - Robert Block
- Rensselaer Polytechnic Institute Nuclear Engineering and Engineering Physics, Troy, New York 12180
| | - X. George Xu
- Rensselaer Polytechnic Institute Nuclear Engineering and Engineering Physics, Troy, New York 12180
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Bednarz B, Chen G, Paganetti H, Han B, Ding A, Xu XG. COMPARISON OF PARTICLE-TRACKING FEATURES IN GEANT4 AND MCNPX CODES FOR APPLICATIONS IN MAPPING OF PROTON RANGE UNCERTAINTY. NUCL TECHNOL 2017; 175:2-5. [PMID: 22389531 DOI: 10.13182/nt11-a12260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The accuracy of proton therapy is partially limited by uncertainties that result from changing pathological conditions in the patient such as tumor motion and shrinkage. These uncertainties can be minimized with the help of a time-resolved range telescope. Monte Carlo methods can help improve the performance of range telescopes by tracking proton interactions on a particle-by-particle basis thus broadening our understanding on the behavior of protons within the patient and the detector. This paper compared the proton multiple coulomb scattering algorithms in the Monte Carlo codes MCNPX and Geant4 to well-established scattering theories. We focus only on beam energies associated with proton imaging. Despite slight discrepancies between scattering algorithms, both codes appear to be capable of providing useful particle-tracking information for applications such as the proton range telescope.
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Affiliation(s)
- Bryan Bednarz
- Massachusetts General Hospital, Department of Radiation Oncology Boston, Massachusetts 02114
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Depauw N, Danto S, Bednarz B, Paganetti H, Fink Y, Seco J. Preliminary Study of Proton Radiography Imaging Qualities Using GEANT4 Monte Carlo Simulations. NUCL TECHNOL 2017. [DOI: 10.13182/nt11-a12261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nicolas Depauw
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02116
| | - Sylvain Danto
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02116
| | - Bryan Bednarz
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02116
| | - Harald Paganetti
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02116
| | - Yoel Fink
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02116
| | - Joao Seco
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02116
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Lin H, Liu T, Su L, Bednarz B, Caracappa P, Xu XG. Modeling of Radiotherapy Linac Source Terms Using ARCHER Monte Carlo Code: Performance Comparison for GPU and MIC Parallel Computing Devices. EPJ Web Conf 2017. [DOI: 10.1051/epjconf/201715304010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yang YM, Svatos M, Zankowski C, Bednarz B. Concurrent Monte Carlo transport and fluence optimization with fluence adjusting scalable transport Monte Carlo. Med Phys 2016; 43:3034-3048. [PMID: 27277051 DOI: 10.1118/1.4950711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The future of radiation therapy will require advanced inverse planning solutions to support single-arc, multiple-arc, and "4π" delivery modes, which present unique challenges in finding an optimal treatment plan over a vast search space, while still preserving dosimetric accuracy. The successful clinical implementation of such methods would benefit from Monte Carlo (MC) based dose calculation methods, which can offer improvements in dosimetric accuracy when compared to deterministic methods. The standard method for MC based treatment planning optimization leverages the accuracy of the MC dose calculation and efficiency of well-developed optimization methods, by precalculating the fluence to dose relationship within a patient with MC methods and subsequently optimizing the fluence weights. However, the sequential nature of this implementation is computationally time consuming and memory intensive. Methods to reduce the overhead of the MC precalculation have been explored in the past, demonstrating promising reductions of computational time overhead, but with limited impact on the memory overhead due to the sequential nature of the dose calculation and fluence optimization. The authors propose an entirely new form of "concurrent" Monte Carlo treat plan optimization: a platform which optimizes the fluence during the dose calculation, reduces wasted computation time being spent on beamlets that weakly contribute to the final dose distribution, and requires only a low memory footprint to function. In this initial investigation, the authors explore the key theoretical and practical considerations of optimizing fluence in such a manner. METHODS The authors present a novel derivation and implementation of a gradient descent algorithm that allows for optimization during MC particle transport, based on highly stochastic information generated through particle transport of very few histories. A gradient rescaling and renormalization algorithm, and the concept of momentum from stochastic gradient descent were used to address obstacles unique to performing gradient descent fluence optimization during MC particle transport. The authors have applied their method to two simple geometrical phantoms, and one clinical patient geometry to examine the capability of this platform to generate conformal plans as well as assess its computational scaling and efficiency, respectively. RESULTS The authors obtain a reduction of at least 50% in total histories transported in their investigation compared to a theoretical unweighted beamlet calculation and subsequent fluence optimization method, and observe a roughly fixed optimization time overhead consisting of ∼10% of the total computation time in all cases. Finally, the authors demonstrate a negligible increase in memory overhead of ∼7-8 MB to allow for optimization of a clinical patient geometry surrounded by 36 beams using their platform. CONCLUSIONS This study demonstrates a fluence optimization approach, which could significantly improve the development of next generation radiation therapy solutions while incurring minimal additional computational overhead.
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Affiliation(s)
- Y M Yang
- Department of Medical Physics, Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, Wisconsin 53703
| | - M Svatos
- Varian Medical Systems, 3120 Hansen Way, Palo Alto, California 94304
| | - C Zankowski
- Varian Medical Systems, 3120 Hansen Way, Palo Alto, California 94304
| | - B Bednarz
- Department of Medical Physics, Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, Wisconsin 53703
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Adam D, Bednarz B. SU-F-T-140: Assessment of the Proton Boron Fusion Reaction for Practical Radiation Therapy Applications Using MCNP6. Med Phys 2016. [DOI: 10.1118/1.4956276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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42
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Matrosic C, McMillan A, Holmes J, Bednarz B, Culberson W. SU-F-T-477: Investigation of DEFGEL Dosimetry Using MRI. Med Phys 2016. [DOI: 10.1118/1.4956662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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43
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Aima M, Viscariello N, Patton T, Bednarz B. SU-F-J-09: Radioactive Seed Localization for Breast Lumpectomy - Towards Optimization. Med Phys 2016. [DOI: 10.1118/1.4955917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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44
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Prajapati S, Mo X, Bednarz B, Lawless M, Hammer C, Flynn R, Westerly D, Jeraj R, Mackie T. SU-F-T-667: Development and Validation of Dose Calculation for An Open-Source KV Treatment Planning System for Small Animal Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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45
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Bednarz B, Culberson W, Bassetti M, McMillan A, Matrosic C, Shepard A, Zagzebski J, Smith S, Lee W, Mills D, Cao K, Wang B, Fiveland E, Darrow R, Foo T. SU-G-BRA-01: A Real-Time Tumor Localization and Guidance Platform for Radiotherapy Using US and MRI. Med Phys 2016. [DOI: 10.1118/1.4956925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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46
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Liu T, Lin H, Su L, Shi C, Tang X, Bednarz B, Xu X. TU-AB-BRC-10: Modeling of Radiotherapy Linac Source Terms Using ARCHER Monte Carlo Code: Performance Comparison of GPU and MIC Computing Accelerators. Med Phys 2016. [DOI: 10.1118/1.4957404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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47
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Besemer A, Marsh I, Bednarz B. WE-DE-201-06: Impact of Temporal Image Coregistration Methods On 3D Internal Dose Calculations in Targeted Radionuclide Therapy. Med Phys 2016. [DOI: 10.1118/1.4957811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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48
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Shepard A, Bednarz B. SU-G-BRA-02: Development of a Learning Based Block Matching Algorithm for Ultrasound Tracking in Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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49
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Marsh I, Otto M, Weichert J, Baiu D, Bednarz B. SU-G-TeP3-08: Pre-Clinical Radionuclide Therapy Dosimetry in Several Pediatric Cancer Xenografts. Med Phys 2016. [DOI: 10.1118/1.4957088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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50
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Shepard A, Matrosic C, Zagzebski J, Bednarz B. SU-G-JeP1-07: Development of a Programmable Motion Testbed for the Validation of Ultrasound Tracking Algorithms. Med Phys 2016. [DOI: 10.1118/1.4956982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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