Tuesday, March 31, 2020

PROTON THERAPY: CANCER TREATMENT TECHNOLOGY IN REVIEW

By: Dr. Robert L. Bard & Grace Davi
Edited by: Lennard M. Gettz / NY Cancer Resource Alliance

Medical researchers and developers have historically pursued many similar considerations in the path to improving cancer treatment solutions—much more than simply "killing cancer tumors."  The highest priority is typically given toward patient safety and well-being during and after treatment due to the use of highly powerful foreign elements like radiation and chemicals with heavy toxicity levels.

Such is the case with conventional X-ray (photon) treatments like intensity-modulated radiation therapy (IMRT), which has proven to be successful in killing targeted tumors but also can damage nearby tissue, thus causing injury to the patient.  IMRT applies high doses of irradiation in order to penetrate the body and reach the depths of the targeted tumor. This powerful beam of energy exposes all tissues along its entire path to radiation, including the normal tissues before the tumor and the normal tissues past the tumor.

 An upgrade from using x-rays in radiation therapy came with the delivery of charged (proton) particle beams (originated by Dr. Robert R. Wilson, 1946) to irradiate cancer. This dose is deposited within a controlled range of depth, affecting specific coordinates in the body so most of the dose is delivered to the actual tumor and little or no radiation is delivered to tissues beyond the tumor (called the Bragg peak). This technique, therefore, maximizes the chances of curing patients without cause debilitating side effects, as proton research shows promising results in reducing the damage to healthy tissues and better preserving patient quality of life.

The National Association for Proton Therapy (NAPT) reports that both standard radiation therapy and proton therapy to work on the same principle of damaging cellular DNA of tumor, with the major difference that proton therapy deposits the majority of the radiation dose directly into the tumor and travels no further through the body.  According to NAPT spokesperson Jennifer Maggiore, “The FDA approved this technology over 30 years ago, so it's not necessarily new, but recent advancements have made it more accessible in hospitals, and versions are also developed for single-room systems.” There are large “big scale” installations with a cyclotron that feeds three to four gantries. This takes up a big footprint of space and a major investment of time and money, which has led to the increase in smaller, single-room centers in recent years.

IMPROVING TRENDS IN CANCER TREATMENT
It is commonly observed that surgeons are increasingly using minimally invasive procedures.  Whether it's robotic or video assisted surgeries, we can identify the pattern of new treatment protocols to result in higher quality of life and a reduction in toxicity. In doing so, it allows us, in some cases, to actually improve survival through those same methods of reducing toxicities for patients.

According to Dr. Charles B. Simone II, Chief Medical Officer of the New York Proton Center, “We’re going to see more and more customized treatment; it's not a one size fits all approach to cancer. We are going to have individualized ways to deliver radiation therapy, individualized drugs or immune agents—and then, potentially more synergy between modalities such as radiation with systemic therapies.”

The concept of the pencil beam scanning or IMPT (intensity-modulated proton therapy) has grown widely accepted as the ‘new future’ in radiation therapy.  Originally recognized to treat brain tumors, proton therapy has since found global success in treating prostate, breast, liver, lung, head and neck, and other cancers.

In the recent past, proton therapy has continued to advance in its design and performance. Over the past two decades, the number of academically affiliated proton therapy centers in the United States has grown from zero to 31.  Over the past six years, newer centers have come onboard with pencil beam scanning proton therapy that has enabled IMPT. This new generation of proton therapy allows the radiation to be focused and deposited directly at the tumor, while avoiding normal tissues to an even greater extent than the first generation of proton therapy. Another unique advantage of the pencil beam scanning includes its ability to better sculpt the beam or dose.  To match the beam into the shape of the tumor (which is usually not a perfectly square, circle or rectangle shape) allows the deposit of more radiation into the tumor, as it travels into the patient, with even less radiation deposited in the normal tissues in front of and also after the tumor.

According to Dr. Simone, another recent advancement in proton therapy is the ability for physicians to apply volumetric imaging—or the ability to conduct low dose CT scans daily and immediately (in 3D) before treatment—to the targeted area. Volumetric imaging allows radiation oncologists to directly visualize the tumor, or the area that needs the treatment, without having to rely on bony anatomy as a surrogate, as most proton treatment installations do. Most proton facilities still use X-ray or KV images, rather than a cone beam CT image, limiting the ability to have millimeter precision.

Unlike devices such as the CyberKnife system with a regular linear accelerator that essentially plugs into the wall and generates its own radiation, proton therapy requires its own source of energy to generate the proton therapy. The most common model used by proton centers to generate protons, including at the New York Proton Center, is through a cyclotron—a 10-foot-wide machine that accelerates particles about two-thirds of the speed of light to generate protons. From there, the radiation gets siphoned out of the cyclotron through a beam line that's just a few inches wide, and goes into each of the clinical treatment rooms.

Proton therapy has been shown to reduce the risk of secondary cancers in patients, while decreasing the chance of any long-term complications from the treatment. For some cancers, including for most pediatric cancers, it has grown to be called the de facto standard of care, while for other cancers clinical trials are being conducted to determine it as the preferred treatment for specific patient populations.

FROM THE PATIENTS’ SIDE
After the patient’s radiation oncologist determines that they are qualified for proton therapy, patients would come in for a single preparation appointment, what's called a simulation or radiation mapping appointment.  This is generally done with an image (like a CT scan, a PET scan or an MRI), where the physician will work with a radiation physicist, as well as treatment planning dosimetrist, to map out the tumor in three or four dimensions.  This helps identify how to deliver radiation to that tumor while avoiding irradiation the normal tissues.

“There are several factors that help us determine the right form of treatment: the type of cancer, the tumor location and other patient characteristics. The length of the treatment varies depending on the case,” explained Dr. Simone. “Some patients will go through stereotactic proton therapy, which is generally between one and five day, and others will experience a more conventional treatment that's every day, Monday through Friday, for several weeks. While most treatments with proton therapy are the same number of days as with traditional x-ray therapy, because of the ability for protons to limit side effects, in some cases proton therapy can be administered to patients in high doses per day, leading to shorter treatment times, decreased cost, more patient convenience, and in some cancers better chances of cure.”


THE NEW YORK PROTON CENTER
July 2019 marked the opening of the 140,000 square ft. state of the art proton treatment facility on East 126th Street.  Managed by ProHealth medical group, the New York Proton Center was established under a joint partnership between Memorial Sloan Kettering Cancer Center, Mt. Sinai Health and Montefiore Health System. The New York Proton Center is projected to treat approximately 1,400 patients annually, receiving patients from its consortium partner institutions and from patients throughout the New York metro area and beyond who are looking for the most effective radiation care possible. The center will be one of the few worldwide that is equipped with the newest and most effective proton therapy technology, provided by globally renowned Varian Medical Systems, the worldwide leader in developing multidisciplinary, integrated cancer solutions.


ABOUT DR. SIMONE
Dr. Charles B. Simone, II is the Chief Medical Officer of the New York Proton Center. He is an internationally recognized expert in the use of proton therapy to treat thoracic malignancies and for reirradiation, and in the development of clinical trial strategies and innovative research in thoracic radiation oncology and stereotactic body radiation therapy. He is a National Institutes of Health, National Science Foundation, and Department of Defense funded investigator who performs clinical and translational research investigating the benefits of proton therapy as part of multi-modality therapy for thoracic malignancies. After years of dedication and service to the American College of Radiation Oncologists, Dr. Simone has been named a Fellow of ACRO, recognizing his highly valued contributions to the field. He has published over 340 scientific articles and chapters, given over 210 scientific lectures to national and international audiences, and is the national Principal Investigator or Co-Chair of 7 NIH-funded cooperative group trials (see complete bio- link https://www.nyproton.com/charles-simone/)


CONTRIBUTORS /  EDITORIAL TEAM

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

GRACE DAVI, Public Health Research Consultant at The RightWriters Group 
Grace dedicated her life's work to intense reporting and data analyses of Cancer-related environmental issues. In addition to content work Grace is also a public advocate for health and safety projects in professional areas and support programs for Infection Prevention branches of health care.  Grace launched her career as a researcher/reporter by pioneering collaborative lab projects in the New York waterways by providing public awareness about contaminants and leaching into county and state aquifer. She combined this experience with   4+ years working with oncologists and cancer immunologists as an editor in medical education. Today, Grace is one of the editors and co-publishers of health related publcations, websites, newsletters and journals including prevention101.org and ImmunologyFirst.org

CHERI AMBROSE, Co-editor/outreach coordinator for NYCRA
Cheri is the associate editor for various publications such as PinkSmart News, the Journal for Modern Healing and First Responders Cancer News.  She is a patient advocate for many cancer-related programs and often contributes her time in cancer research fundraising events.  As the communications director for the NY Cancer Resource Alliance, she manages community outreach, partnership missions with other cancer foundations and research organizations and attends educational functions for cancer awareness. Her latest public projects include the launch of ImplantScan.org.  She stands as the current President of the male Breast Cancer Coalition (MaleBreastCancerCoalition.org).



Special Thanks
The NY Cancer Resource Alliance writing team and AngioMedical Publishing wishes to express its deepest and most heartfelt thanks to Dr. Charles B. Simone II for his kind generosity in sharing his vast knowledge about the science and technology of Proton Therapy.  Special added appreciation also belongs to
 the staff at The NY Proton Center including Patrick Curry and Miriam Mond for their support, and also to Nathaniel Goehring of Berlin Rosen Public Relations and Jane Fort and Jennifer Maggiore of the National Association of Proton Therapy (NAPT) - without whose coordinated efforts this project would not have been possible. 


References:
1) https://www.modernhealthcare.com/providers/proton-center-set-open-new-york
2) https://www.itnonline.com/article/trends-proton-therapy-%E2%80%94-faster-therapy-delivery-single-room-installs
3) https://www.manhattantimesnews.com/proton-powerpoder-de-protones/
4) https://www.mevion.com/newsroom/press-releases/mevion-s250-becomes-first-proton-therapy-system-approved-treat-cancer
5) Video: https://www.youtube.com/watch?time_continue=7&v=MS590Xtq9M4&feature=emb_title



Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Monday, March 30, 2020

TRIAGE OF COVID-19 BY LUNG ULTRASOUND

 by Robert  Bard MD, FASL  with contributors: Dr. K. Lessnau, New York with Dr. D. Buonsenso, Rome

The use of CT lung imaging for COVID-19 has been the diagnostic standard for the last few months of the current epidemic.  CT has the disadvantage of logistics (staff, patients, transport) and radiation exposure. Respiratory distress creates motion artifacts on images that may simulate pulmonary inflammation. Since the disease mutates often, frequent imaging may be required. Viral pneumonia is not diagnostically distinguishable from other viral inflammations in the lung so the argument for a screening modality is useful to separate the critically ill from those needing outpatient treatment.  Dr. Klaus Lessnau, author of CHEST ULTRASOUND (Springer 2003), employs both CT and ultrasound imaging in clinical practice.




Ultrasound probes have the ability to screen the lungs for respiratory
issues and is a useful TRIAGE tool- however no radiological device
has been able to identify pulmonary viruses directly
Front line physicians in Italy and Spain are triaging with portable bedside ultrasound units that reduce logistical problems of a chaotic environment and healthcare worker exposure. Since imaging with CT or ultrasound is not diagnostic, determining who needs hospitalization is essential in a pandemic that is overwhelming medical providers and hospital resources.  Dr. Buonsenso, on the front lines in Rome, uses sonograms to decide who gets a CT scan. This is key since deep cleaning a CT room after a suspected patient shuts the room down for up to 2 hours for decontamination.

Lung ultrasound has been used in emergency rooms since it was introduced to the Mt Sinai Med School (New York) Emergency Department in 2014 and is now used nationwide to diagnose pneumonia (viral or bacterial) in children which spares them unnecessary x-rays since it is so caccurate. It is like an electronic stethoscope since lung disease and heart failure producing pulmonary fluid buildup are diagnosed or confirmed with portable ultrasound units at the bedside. This is considered the best imaging tool to diagnose a collapsed lung in seconds which has proven lifesaving as a time saver for on the spot detection. While it was assumed that children are carriers and not clinically affected, Dr. Buonsenso is actively investigating this population and there are findings that are concerning with the expanded use of lung ultrasound in this understudied group.

Disease of the lung from fluid overload-infection, 
heart failure-produces vertical white lines (B-Lines)
Ultrasound probes study the lungs via the ribs showing the lung surface (where most Covid pathology is situated) and adjacent lung tissue. The abdominal scan with the curved transducer has a larger field of view and affords a rapid assessment of B lines (Fig 1), pleural effusion and frank pneumonia (Fig 2).  Portable units have the advantage of containment within a sterile sleeve preventing accidental viral spread to imaging equipment necessitating full decontamination procedures.  Some infected European physicians are monitoring their disease at home via the B line count-few B lines suggest low grade inflamed lung tissue-increasing B line count calls for more aggressive treatment. All clinical imaging was correlated with the patient’s oxygen saturation and clinical setting.  The virus has potential cardiac toxicity so the same sonogram unit may image the heart for fluid buildup and weakened contraction. This may differentiate heart failure from pulmonary infection in some cases which may have similar clinical presentations.

REFERENCE
Bard R: 3D Imaging of Pulmonary Edema in Proceedings of 2020 Annual  American Institute of Ultrasound in Medicine ;Supplement to Journal of Ultrasound in Medicine  July 2020 (in press)

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CONTRIBUTING WRITER

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.



Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.


VIDEO CONSULTS SPIKE AMID COVID- ENTER THE AGE OF TELEMEDICINE



As the global pandemic from this novel Coronavirus continues to fill our emergency rooms, it has also brought the patient care industry to a drastically slow crawl- almost to the point of scaring away caregivers and patients alike from the risk of a lethal contact.  The record numbers of global cases from the highly contagious disease have greatly affected a vast majority of elderly patients and the immune-compromised individuals.  These are the same members of the community who visit their doctors most frequently – making them more susceptible to exposure.

Cancer patients in particular are caught in a dreadful situation where an already damaged or weakened immune system from medical treatments could makes a trip to the cancer care facility could prove to be fatal.  It is a common belief that cancer therapies (and having cancer itself) usually carries the side effect of a weakened immune system- leaving the patient defenseless from any infectious illness, especially viral infections like COVID-19.

A recent update in this medical predicament is the relaunch of the digital patient care and communication program called TELEMEDICINE.  Originally designed as a backup consultation idea for far-away patients, this concept is quickly becoming headline news in the medical field and a sound alternative to maintaining patient care without the worry of breaking the national quarantine.
Recently recognized as “the digital house call”, the use of VIDEO CONFERENCING tools like SKYPE and ZOOM are creating a parallel spike to the number of infected cases with a significant rise in installations and tech upgrades in medical offices nationwide.  Offering this option of a virtual consultation not only maintains safety for all patients and staff, but also streamlines one’s time by completely eliminating travel and time spent in the waiting room.



“Safety is now the number one concern when it comes to medical innovation”, states cancer radiologist Dr. Robert Bard at an interview with MPR news. “The age of Corona can also (someday) be known as the age of TeleMedicine.  This all came down at a time when, fortunately we have this already proven technology that responds to this very health crisis… people no longer have to fear getting sick on the commute to their doctor’s appointment or wait in a crowded room full of strangers with varying health conditions. There’s so much that we can do with our current technology- especially this web-based solution that takes away any concern for contamination or the risk of accelerating anyone’s pre-existing illnesses!”

RISK MANAGEMENT AND THE IMMMUNE SYSTEM
New solutions like TeleMedicine are just some of the ways that the medical community is keeping all patients safe from harm- including the very air in health centers that were supposed to heal them. According to Dr. Aisha Hasan, Immunology research specialist in adoptive T-cell therapy at Memorial Sloan Kettering calls , the Coronavirus infection is largely  an “immune system” issue.

We now know that the most at-risk individuals are those above 65, infants under the age of one, those on immunosuppressant medications (for conditions such as arthritis, lupus, Crohns disease, ulcerative colitis) and cancer patients undergoing chemotherapy.  For anybody who has any disruption in their T-cell immunity (which is what controls viral infections), the risk of contracting the illness is much higher  because this virus appears to have a high level of pathogenicity in the respiratory tract – which is the one area  that can really take off and create havoc in the body.  The “viral dose” or number of viral particles that enter the body impacts the severity of the illness. The unchecked high viral load quickly creates severe inflammation in the lungs, necessitating the use of artificial ventilation.

New prevention measures like TeleMedicine are now being implemented worldwide as part of the social distancing measures that we are asked to follow.  The Covid-19 virus has a dual mode of transmission;  droplet infection and direct contact.  A popular area for sick people are usually places like a doctors office- where coughs and sneezes become droplets in the air that could then be taken in and breathed in by someone nearby.  In the same waiting room, direct contact can also be an easy transporter when someone sneezes or touches their hand, then touches a doorknob, a banister, an armrest, a pen or a magazine.


The majority of the public with a normal immune system can prevent this disease from its fatal effects. But due to its unusually long shelf-life, we can all be carriers that can inadvertently affect others- making this a highly contagious virus.

LEGAL PLATFORM OPTIONS OF TELEMEDICINE
Technically speaking, TeleMedicine is defined as the VIRTUAL ALTERNATIVE to the doctor-patient experience using various forms of communication technology instead of the physical face-to-face dimension.  Thanks to the information explosion of our era, a wide list of web-based platforms are available that allows a private file-sharing or audio-visual exchange.

Meanwhile, regulatory restrictions call for strict privacy and data protection when it comes to TeleMedicine. HIPAA (Health Insurance Portability and Accountability Act ) has been established with the proper safeguards for patient information.  Among its tenets, HIPAA mandates industry-wide standards for health care information on electronic billing and other processes and the protection and confidential handling of protected health information in medical community pertaining to privacy.  To respond to this, custom software, hardware, internet security programs, firewalls, web-hosts and all parts of the communication line of TeleMedicine must comply to specific security and privacy standards.

THE “WIN-WIN” OF REINVENTING PATIENT CARE 
The “virtual house call” has quickly become a seemingly forced upgrade to most medical practices. As a solution that has always been available since the early days of the internet (from paperless office to private video conferencing), the idea of a patient staying home while seeing their doctor is not a luxury at all, but a mandated law to self-quarantine for the safety of that patient and all those they come in contact with.

We can now streamline any doctor visit that means a consult, getting a prescription or a referral with TeleMedicine. Elderly patients or those with chronic conditions may find it difficult (and even precarious) to travel to their doctors' office and sit in a waiting room with other sick people with unknown conditions. Advancing this scenario to an electronic doctor's visit or TELEMEDICINE is an available reality that can easily address this concern. SO MUCH CAN BE DONE FROM HOME!

Other benefits include:  • Convenient & Cost Effective  • No Transportation needed  • No need for time off work or child care  • Eliminate the waiting room   • Quicker access to all specialists  • Improved access to files and prescriptions


POINT OF CARE ALTERNATIVE 1: TELERADIOLOGY
Of course not everything can be done over the internet.  Drawing blood, taking one’s temperature and blood, MRI’s/Ultrasound Imaging and other POINT OF CARE services continue to be done on-site in front of a physical medical professional. But this consideration is now the next growing element of the electronic upgrade trend and is being addressed individually by each service or practice type.

1) SCAN FOR EMERGENCY REMOTE LOCATIONS: 
By combining live access and use of selected portable diagnostic ultrasound technologies, your practice can easily scan many parts of the patient to help detect and diagnose countless physicological, biochemical, neurological or musculoskeletal disorders quickly, accurately and efficiently. Any visiting facility that sees patients can be a Tele-Scan -including emergent care clinics, hospital emergency rooms, PCP's office, PT's, Chiropractors, specialists, ambulatory transport vehicles etc.

TELE-SCANS provide all medical practices with access to portable digital imaging field scanners designed to safely and accurately scan a wide range of organs and issues. Tele-Scan digital ultrasound scanners are powerful enough to capture images, videos and study blood flow from just about any depth in the body. TELE-SCANNING provides effective training on the use of scanning technology for every day patient use.  The concept of TELE-SCAN program are designed to transmit all patients' scans via secure web to our central diagnostic specialists (expert imaging readers/diagnosticians) who can safely and accurately identify any and all issues.

2) TELERADIOLOGY
Through private web portals, physicians anywhere can have access to radiology specialists by enabling file transfer and retrieval of patient images electronically. Doctor-to-doctor collaboration is now made simple regardless of ones physical office location. Image files of varying sizes and applications like x-rays, CTs, Ultrasound files and MRI's are often what is shared. Teleradiology is a great benefit to patient care by allowing radiologists to diagnose, analyze and generate reports on the patient's condition REMOTELY.   TeleRadiology is 24-7 and is accessible from any location--  a major advantage to the medical community because sub-specialists like pediatric radiologists,  neuroradiologist,  MRI or musculoskeletal radiologist are usually found in major cities during daytime hours.

Other Point-of-Care programs will be discussed in PART 2 of this article about “Satellite POC Centers”. 

For more information, visit: http://telemedscans.com/



REFERENCES

https://www.webmd.com/lung/news/20200325/covid-19-may-delay-some-cancer-treatments#1

https://en.wikipedia.org/wiki/Teleradiology


Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Surgeon Uses TeleMedicine for Real-Time Patient Care

By: Dr. Stephen Chagares

Some of the benefits of TeleMedicine conferencing and consulting are that it keeps our social distancing intact while still being able to have a doctor/patient relationship. I can meet patients, we can talk through things, they can have their family there. I can be in my office and show them the computers and posters and show them everything they need, without needing to have a personal interaction and the risk associated with that in this day and age of the Coronavirus.

Some of the examples of TeleMedicine that have been very useful are in the elderly population. Many of them have never used the video function on their phones. And we, as my office helped them learn how to use that function, either bring an app onto the phone or using an indwelling app like FaceTime, and show the patient how easy it is to use it. Many times the first time I click on with the patient, I will implant them onto the video conference. I'll tell them to hit the accept button on the bottom right, and they hit it. And their face, pops back and they're like, "Oh. Oh, there you are." And they are so shocked that it was one click away. That's literally the first thing they always say is, "Oh, this is such a nice way that I can go see my grandchildren or my great grandchildren and not just have it be audio, but be able to physically see them," which really helps a lot in the personal psyche of at all, especially in this era of quarantining everyone.

Yes. I saw a hashtag which was #alonetogether, which really hit exactly what everyone's feeling. Everyone is alone in their homes, but we want everyone to feel that we're all still together. This teleconferencing and TeleMedicine consulting allows patients to not feel isolated. They can see that they can see other people, see their doctors, and keep taking care of themselves, both mentally and medically.

The big picture in the change of everything is that from a surgeon's standpoint, yes, I can follow my post-ops, see their wounds, see pre-op patients, talk about surgery, get everything set up for an operation. And the surgery side of everything right now is really emergencies like appendixes and acute cholecystitis, gallbladder attacks, semi-emergent operations like incarcerated hernias and cancer operations.

From a surgeon perspective, we're still doing some of the surgery, but still doing a lot of the consults. For my fellow medical physicians in other fields, it's equally as important for them. The internal medicine doctors are taking care of all of the COVID patients and all of the patients with flus and all that. But they also have all their maintenance patients, all their hypertension patients, diabetes patients. All of these patients have to make sure they keep having their maintenance healthcare, have to make sure they're keeping up on their blood pressure medicines, their blood sugars. There are blood tests that have to still be drawn.

All these things have to keep still being taken care of, in this era where all the national focus is on COVID-19. So, TeleMedicine consulting for the internal medicine doctors is helping them because they're able to follow their chronic patients, keep them at home, not have them get exposure to the COVID virus, but still have their medical maintenance and still make sure that their diabetes and hypertension, and all of the other medical conditions, are still being tracked. The big issue is that we don't want those controlled chronic medical issues to get out of control, because then that can spiral into an ER visit or even a hospitalization that then becomes much more risky with respect to exposure to the Coronavirus.




..................................................................................................................................................................
STEPHEN CHAGARES, MD FACS 

Stephen A. Chagares, MD, FACS, is a board certified general, laparoscopic, robotic and breast surgeon in Monmouth County, NJ.   Dr. Chagares obtained specialty training in breast surgery at Memorial Sloan Kettering Cancer Center. In addition to breast surgery, Dr. Chagares regularly performs hernia repairs of all types, including open, laparoscopic and robotic repairs.  He was the first surgeon in his region to perform a robotic hernia repair and remains on the cutting edge of all advanced surgical techniques.  He routinely performs multiple other abdominal procedures, including laparoscopic gallbladder removal.  Dr. Chagares is also a specialist in surgical resection of skin and soft tissue cancers.  He has received numerous awards for excellence and academic teaching, Top Doctors Awards and Patients’ Choice Awards.  His philosophy is to provide quality care with a personal touch. He respects the art of surgery and feels honored to treat patients every day. For more information, visit  www.drchagares.com


This article is sponsored by:
www.TeleMedScans.com

http://prevention101.org/









Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Wednesday, March 25, 2020

WHY TELEMEDICINE?

Written by: Dr. Robert L. Bard

The communication features of TeleMed can also be used to
train other doctors in remote locations on new equipment
or modalities in patient care-
One of the current updates in patient care is the advancement of TELEMEDICINE. Thanks to the expansion of our web-based means of communication, doctors and patients are now able to convert the standard office visit to a virtual consultation or a remote, face-to-digital face exchange. Patients enjoy the benefits of the complete elimination of costly travel time and the potential viral exposure of sitting in a busy waiting room.

By definition, TeleMedicine is the implementing of any health-related services and information through the use of electronic and telecommunication technologies. It allows for REMOTE patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.

Conceptually, TeleMed technologies are used as an alternative means of communication, resulting in a more efficient use of the doctors' and patients' time.  By communicating on a video-conferencing platform, TeleMedicine allows the physician to easily share files, records and imaging on the same screen that the doctor and patient are conducting a private consultation. TeleMed has been recognized to expand the practitioner's ability to reach more patients geographically and in less time- thus growing the medical practice this way.

To date, many new advancements have been added to this growing concept of remote patient care - including REAL-TIME INTERACTIVE SERVICES or "mHEALTH", REMOTE MONITORING (RPM), VIRTUAL CONSULTS (a form of live video conferencing) and STORE-AND-FORWARD (also known as 'asychronous video').Whether it's to reduce medical costs, save time or stay safe from potential (or advancing) health risks, methods of patient care continues to evolve toward better performance and efficiency for the convenience of the patient as well as improved use of time for the provider. This includes the smart use of internet technology and online private portals to offer a virtual alternative to the doctor's office visit.


PATIENTS WITH CHRONIC CONDITIONS & ALL IMMUNO-COMPROMISED ARE AT HIGH RISK
Chronic conditions like lung and heart disease, lupus, and diabetes directly affect the immune system. Also patients diagnosed with auto-immune disorders and cancers (including those currently undergoing chemotherapy treatments) can leave a person immuno-compromised. This makes them a very high risk of contracting deadly viruses like the Coronavirus. Anyone with weakened immune systems are highly advised to stay indoors and prevent any contact with the public. To battle this pandemic the right way, we all need a strong IMMUNE SYSTEM to recover from contamination. Also, ask any of your doctors if they subscribe to TeleMedicine as an alternative to any upcoming office visits.

THE FUTURE OF HOUSE CALLS: A SMART UPGRADE TO DOCTORS VISITS
Within the past several decades, the medical community has been put into overdrive to come up with new solutions (or modify existing ones) to implement safer, more efficient and cost-effective ways of working with the public. From the global demand for active medical personnel, to the rising wave of safety concerns that of the many at-risk patients, we face a great need to upgrade patient care.

Elderly patients or those with chronic conditions may find it difficult (and even precarious) to travel to their doctors' office and sit in a waiting room with other sick people with unknown conditions. Advancing this scenario to an electronic doctor's visit or TELEMEDICINE is an available reality that can easily address this concern. SO MUCH CAN BE DONE FROM HOME!

TELEMED BENEFITS FOR THE PATIENT
• Convenient & cost effective
• No Transportation needed
• No need for time off work or child care
• Eliminate the waiting room
• Quicker access to all specialists
• Improved access to files and prescriptions


Additional Articles (also see):
• Coronavirus Prompts Spike in TeleMedicine Use- By: Dr. Stephen Chagares
• Surviving a Pandemic with Perspective - By: Lennard Gettz
................................................................................................................................................................
CONTRIBUTING WRITER

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.



Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Tuesday, March 10, 2020

DEVELOPING CYBERKNIFE® AND THE ERA OF ETHICS IN ENGINEERING

Co-written by: Dr. Robert Bard & the NY Cancer Resource Alliance editorial staff
Based on an interview with Accuray Chief Marketing Officer Ms. Birgit Fleurent


By now, most people recognize the name 'CyberKnife' from 20+ years of local radio commercials or an occasional news article about Radiotherapy (RT) for cancer care. But to understand its impact on the war against cancer, we also need to view the many ways that such inventions have shaped the direction of future medical technologies.

Since the introduction of the x-ray in 1895 [1], European and American scientists [2] have flocked to the study of radiation for its therapeutic potential. The "race for a cure" brought us into the fast track with many new devices and technological advancements from non-invasive cellular imaging to the use of surgical robotics and the many integrated applications of AI (Artificial Intelligence) in computerized micro-treatment solutions.

Our tech review series brought us on a tour of Accuray Incorporated – one of the top names in the development of cutting edge radiotherapy systems for the treatment of cancer.  Accuray has introduced innovations to the market that include the CyberKnife®, TomoTherapy® and Radixact® Systems.  The Accuray headquarters in Sunnyvale, California directed us off shore to one of the company's top educators about these products for an exclusive interview with Chief Marketing Officer Ms. Birgit Fleurent in Morges, Switzerland.


HARNESSING RADIATION: THE 100-YEAR ROAD TO "PATIENT FIRST"
We have truly come a long way since the early days of clinical application of the x-ray (electromagnetic radiation) by Marie Curie in the late 1890’s. From the discovery of radioactive isotopes in the 1920’s to the use of the radium-based interstitial irradiation called brachytherapy and stereotactic radiosurgery (SRS) in the 50’s to the introduction of early devices that delivered the first proton beam in the 1970’s.

By the early 1990’s, a revolutionary form of treatment classified as SBRT or Stereotactic Body Radiation Therapy was launched in Stockholm, Sweden.  SBRT was defined as “an external beam radiation therapy method used to very precisely deliver a high dose of radiation to an extracranial target within the body, using either a single dose or a small number of fractions.” The multiple radiation beams intersect to deliver an accurate, high dose of radiation to a carefully defined location. [7]  This may result in a significant reduction in side effects from radiation exposure that patients typically experience from the wide un-focused beam of conventional RT. 

The CyberKnife System enables stereotactic targeting without a stereotactic
frame. Simple immobilization devices such as thermoplastic masks, a foam
cradle or vacuum bags keep the patient comfortably in treatment position and
prevent large displacements that cannot be compensated for by the
robotic arm.
The CyberKnife System became the next advancement of SBRT, earning FDA acceptance in 1999 as the first robotic image-guided radiosurgery treatment. Its unique architecture is comprised of a linear accelerator delivering a dose rate of 1000 MU/minute, mounted on a 6 axis robotic manipulator (arm developed by KUKA) and orthogonal kV imaging system. The system represented a trend in treatment technology designed to attack (and target) tumors more accurately without irradiating the surrounding healthy tissue. Today, there are over 930 Accuray radiotherapy systems installed globally. The CyberKnife System is in use at hospitals worldwide, reflecting its success and standardized acceptance in the medical community.

The ability to accurately target the photon-based x-ray beam to exact coordinates in the body enables clinicians to deliver SBRT and SRS.  For the patient, these treatment methods may provide a safer alternative (and potential replacement) to invasive surgery by eliminating the many hazards that come with the 'scalpel-to-body' paradigm.  These considerations and the CyberKnife System’s ability to track, detect and automatically synchronize the radiation beam to target motion, make it a true game-changer. Clinicians can confidently treat most tumors in the body including the brain or the spine, where invasive surgery may bring long-term injury to the body and risks to the patient.

TECHNOETHICS
Today's engineering and medical technology (from the late 1980s) show significant evidence of ethical standards and major consideration for patient response.  Ethics in treatment engineering covers all angles considered about the innovation including: the way it is built, the materials applied, the engagement of the operator and the aftermath of the patient. [11]  

Each year, Accuray presents at the American Society for Radiation Oncology (ASTRO) with the flagship tagline "Patient-First" underscoring the design philosophy of their team's prime directive.[8] “Historically, radiation CAUSED cancer, but that's because you didn't have precision then. You were basically irradiating healthy tissue. That's what you want to avoid at all costs. So the more precise you can be, the better - and we (Accuray) pride ourselves on exquisite and unparalleled precision,” says Ms. Fleurent.


THE ORGANIC NATURE OF UPGRADES
A virtual tour of the Accuray manufacturing plant in Madison Wisconsin would illustrate an impressive portion of the development flow of each CyberKnife System assembly. From the component designers to the hardware and software engineers to the army of expert assemblers, each device and model has (seemingly) countless parts dedicated to responding as one intelligent beam of light.

TomoTherapy System gantry in the Accuray Madison
manufacturing facility
But even deeper behind the scenes are the concept people - what is regarded as the solutionists. This includes the product strategy teams that take on the voice of the customers sourced on a regular basis. In other words, a vast amount of information is gathered from end users that steer the next set of upgrades cast by the engineering team. 

Next is the development of a prototype to conduct an extensive amount of beta-testing on phantom cases.  “We're not going to give a System to a customer unless we feel it's absolutely ready to treat a patient. And they, in advance of that, will do all of their pre-qualification. In addition, when we introduce a significant product upgrade, both Accuray and our customers will conduct extensive QC testing prior to the initiation of any patient treatments.”


REAL-TIME MOTION SYNCHRONIZATION
In its lifetime, Accuray developers have designed various upgrade models to the CyberKnife line. This includes the G3, G4, VSI (2009) and M6 (2012).  Recently, the company introduced the Accuray Precision® Treatment Planning System (TPS) with the CyberKnife VOLO™ Optimizer (2018) which enables clinicians to reduce both the time to create high quality treatment plans and the time it takes to deliver patient treatments.  “With this software upgrade clinicians can create optimal treatment plans up to 90 percent faster than before and deliver the treatment up to an estimated 50 percent faster than before.”

Each model reflected a set of specific feature upgrades that were designed based on user demand and the company’s continued innovations in R&D. One remarkable feature advancement was over 15 years ago with the development of Synchrony® Respiratory Tracking System. This real-time motion synchronization technology enables treatment of a lung tumor while the patient is breathing normally -- uncomfortable patient restraints or breath-hold techniques are not required, nor does the clinician need to turn the radiation beam on and off as the tumor moves in and out of the specified treatment window.  

The CyberKnife System uses proprietary anatomy-specific
algorithms to track tumor motion. These specialized image
guidance algorithms enable sub-millimeter precision
and accuracy without the need for an invasive and
cumbersome stereotactic frame.
Accuray originally designed and patented Synchrony, its ‘adaptive delivery’ software, to track, detect and automatically adapt the radiation beam for tumors that moved with respiration. The technology expands on the CyberKnife System’s unique motion synchronization capabilities that are inherently part of the system architecture. It is comprised of a unique image guidance system that locks the radiation beam onto the tumor while calculating, self-adjusting and moving it in sync with the patient's chest movement while breathing. This unique feature adds major advantages to the success of the treatment process and is available only with Accuray products like the CyberKnife and now the Radixact Systems.  According to Ms. Fleurent, “…our future is really moving on an increasing basis to treatment planning and treatment delivery adapted in real time. You have to create a plan, then you have to deliver the plan. The more you can automate that, and the more you can do it while the patient is on the treatment table, the better. The other focus is in the direction of adaptive therapy in a way that is efficient --with exceptional imaging capabilities -- and to the extent that we can automate (including the software and the integrated system) . . . that is a priority to help ensure patient-first treatment. We are focused on providing clinicians with confidence in delivering safe, hypofractionated radiation therapy with unparalled precision. Precision is especially important with hypofractionated radiation therapy, which involves the delivery of higher doses of radiation over a smaller number of treatment sessions compared to conventional radiation therapy.”


THERE IS MORE THAN ONE ANSWER TO CANCER
Part of the necessary education for cancer patients and doctors is staying on top of all the available treatment options and their respective benefits. From a “quality of life” perspective, the CyberKnife System was designed and has been recognized to be so much more patient-friendly. Also, the reduction in the number of treatment sessions provides the economic benefit of reduced work days lost and increased productivity.

Radiation therapy is often done in conjunction with another type of therapy. Between 50 and 60% of cancer patients would benefit from having radiation therapy, and not even close to that number of patients are getting access to or realize that they have this option.  Sometimes, surgery is followed by radiation therapy while other cases call on chemotherapy with radiation therapy. There's some data that suggests immunotherapy works more effectively when done in conjunction with radiotherapy. 


THE NON-INVASIVE OPTIONS
The CyberKnife System was developed by Dr. John Adler, neurosurgeon, with the intended use for intracranial and spine treatment.  Where tumors in the brain or the spine once called for some of the highest surgical risks and complexity, targeted image-guided radiation delivery has become a true game-changer for disorders in these areas of the body. CyberKnife has numerous applications from brain to liver to lung to pancreas and prostate tumors. You can treat most indications with the CyberKnife System.

Accuray manufactures other cancer radiation therapy treatment solutions like the TomoTherapy System and the latest evolution called Radixact, a device with different architecture (from CyberKnife), designed to treat via IG-IMRT or Image-Guided, Intensity-Modulated Radiation Therapy. It also does SBRT. There are some indications that could be treated by both Systems, so there is some overlap, but they're not competing. These options are made available depending on the type of cancer center, the types of cases you treat, and whether you're a community or an academic teaching hospital.

.............................................................................................................................................







Dr. Jesse Stoff is a renowned cancer immunologist and the medical director of the Integrative Medicine of New York in Garden City, NY (located minutes from NYU/Winthrop Hospital- one of the top CyberKnife facilities in the country). In this separate report, Dr. Stoff shares his related experiences with cancer patients, his professional insights and statements about the CyberKnife system from the perspective of a referring practitioner.


WHY ONE CANCER SPECIALIST SENDS PATIENTS FOR CYBERKNIFE? 
By Dr. Jesse Stoff

On occasion, I send patients for CyberKnife treatment to receive focused and highly precise radiation therapy- including a recent patient with mets (metastases) to the brain. I Did a PET scan to see what still lights up because if there are persistent little spots then, CyberKnife could potentially target them and help her achieve a durable remission, which, so far, it did.
Dr. Jesse Stoff (l) and Dr. Robert Bard (r)-
cancer diagnostics team at NYCRA's
First Responders Cancer Support event

Another use for CyberKnife is that it has a minimal negative impact on the immune system and it's a much shorter treatment course while giving you a big release of cancer proteins, from the dead cancer cells, into the bloodstream in a very short period of time. Those proteins are antigens, which the immune system can recognize and potentially react against.

I time my CyberKnife referrals to a specific point during the patient’s immunotherapy treatments where it makes the best sense. As I up-regulate the immune system and set it looking for targets, CyberKnife is one of several therapies that gives you antigen shedding or a sudden spike of antigens. The therapies that do that are things that are very focal- like radio frequency ablation, cryotherapy, HiFU and CyberKnife. Everything else is more broad-based and you don't get that big spike. Timing the immunotherapy with CyberKnife gives me a much better response to the overall treatment of the patient than just the local spot that they're  targeting. 

Now, when you get that sort of radiation amplification of an immune response, that's called the abscopal effect. That's something I try to create because if you can achieve that, then immunotherapy plus focused radiation can equal a positive result in terms of the immune response and higher chance for patients going into remission. If you can get the abscopal response going, what can happen is that tumor(s) may shrink that have nothing to do with what they targeted with the CyberKnife or the RFA or the cryo(therapy) because now you have a generalized immune response against the cancer. This is one of the main reasons why I like CyberKnife. You don't normally get this with chemotherapy because it usually takes too long for the tumor to breakdown and release the antigens and the chemotherapy is immunosuppressive, which defeats the whole strategy.


I've done this with a number of patients where I've gotten them into remission.  On the flip side, if you don't have one good target for CyberKnife, but you have a zillion mets in the liver (as an example) and you have an area with a lot of a bulky tumors, then I send them for what's called a hypofractionated SBRT- which is low dose regular radiation therapy, a low enough dose that is not designed to kill the cancer during zapping. It's designed to stimulate the tumor infiltrating lymphocytes that are infiltrating into that bulky tumor and raise their level of activity. That's another way of generating an abscopal effect. So, there's two ways of doing it. One is with CyberKnife or RFA or cryotherapy. The other is with low dose hypofractionated SBRT. 



REFERENCES:

1) An Overview on Radiotherapy: From Its History to Its Current Applications in Dermatology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535674/








Videos




Astro 2018 Patient First Awards

Technology vs Science

Accuray Showcases CyberKnife® and Radixact™ Systems at ASTRO 2017

Artificial Intelligence in Medicine and Radiation Oncology

Technoethics


Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.