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Related Concept Videos

Computed Tomography01:10

Computed Tomography

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Tomography refers to imaging by sections. Computed tomography (CT) is a non-invasive imaging technique that uses computers to analyze several cross-sectional X-rays to reveal minute details about structures in the body.
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
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Related Experiment Video

Updated: Jun 11, 2025

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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A Four-dimensional Computed Tomography Generated Internal Target Volume Approach to Paediatric High Risk

N A Lavan1, G Smyth2, D McQuaid2

  • 1Department of Radiotherapy, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Sutton, UK.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|October 6, 2024
PubMed
Summary

An internal target volume (ITV) approach significantly reduces planning target volumes (PTV) in pediatric neuroblastoma radiotherapy. This method maintains target coverage while lowering radiation dose to healthy organs, improving treatment outcomes.

Keywords:
Dosimetryfour-dimensional computed tomography 4D-CTinternal target volume ITVneuroblastomarotational intensity modulated radiotherapy IMRT

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Whole-body PET/MRI of Pediatric Patients: The Details That Matter
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Area of Science:

  • Pediatric Oncology
  • Radiation Oncology
  • Medical Imaging

Background:

  • Upper abdominal organ motion in children can lead to overestimation of target volumes in radiotherapy.
  • Four-dimensional computed tomography (4DCT)-derived internal target volume (ITV) is used in adults to account for respiratory motion.
  • Standard planning target volumes (PTV) may not optimally account for motion in pediatric patients.

Purpose of the Study:

  • To investigate the dosimetric consequences of an ITV approach versus standard PTV margins in pediatric high-risk neuroblastoma.
  • To compare target coverage and organ at risk doses between the two planning methods.
  • To assess the impact of ITV on PTV volume reduction.

Main Methods:

  • 14 pediatric patients with high-risk neuroblastoma were included (median age 4.1 years).
  • Two volumetric modulated arc therapy (VMAT) plans were generated for each patient: one using an ITV approach (5mm expansion) and one with standard PTV margins (10mm expansion).
  • Differences in PTV volume and organ at risk doses were analyzed.

Main Results:

  • The ITV approach significantly reduced absolute PTV size by 38% (p<0.0001).
  • A statistically significant reduction in mean kidney dose (0.8 Gy, p=0.01) was observed for midline targets with the ITV approach.
  • Mean heart and lung doses were reduced by approximately 1 Gy, and non-PTV integral dose decreased.

Conclusions:

  • An ITV approach effectively manages respiratory motion in pediatric neuroblastoma radiotherapy.
  • This method significantly reduces PTV volumes, ensures target coverage, and spares surrounding normal tissues.
  • Implementing ITV is crucial for maximizing benefits of conformal radiotherapy techniques like VMAT and future proton therapy in children.