Presented by Vishruta Dumane, PhD, DABR
Associate Professor, Medical Dosimetry Program Director
Icahn School of Medicine at Mount Sinai
Clinical Associate Professor
School of Health Professions, Stony Brook University

The clinical rationale of stereotactic body radiation therapy (SBRT) has been well established with outcomes from several studies and trials demonstrating results comparable to surgery with reduced complications. The application of SBRT has developed and gained ground, especially over the previous decade in the treatment of thoracic and abdominal tumors. Treating tumors in these locations can be challenging due to respiratory motion, heartbeat and peristalsis. Therefore, the accuracy in the application of SBRT for these sites depends on a good understanding of sources of motion as well as techniques to mitigate these contributing factors. In this session, we will understand methodologies to quantify organ motion at patient simulation followed by incorporating the impact of motion through adequate target margins during treatment planning as well as while patient setup during treatment. Starting with a review of the basics on impacts of respiratory motion, such as distortion and artifacts, we will discuss strategies for minimizing these effects. This will be followed with a review of the literature and a discussion on the application of abdominal compression, breath hold, 4DCT (phase versus amplitude binning, retrospective versus prospective acquisition) and respiratory gating for motion management of tumors in the lung, liver and pancreas. The advantages and disadvantages of each method as it applies to each site will be discussed.

Learner Outcomes:
1. Review basic concepts of motion quantification and management.
2. Compare and contrast the different techniques on planning target volume margin selection i.e. what should the treatment planner expect?
3. Explain the differences in setup and treatment delivery for each technique.

Presenter:
Vishruta Ajitkumar Dumane, PhD, DABR, is the Medical Dosimetry Program Director at the Mount Sinai Center for Radiation Sciences Education at Stony Brook University. She is also a Medical Physicist and Associate Professor of Radiation Oncology at Icahn School of Medicine at Mount Sinai and a Clinical Associate Professor at Stony Brook University. She joined Mount Sinai after completing her training at Memorial Sloan-Kettering Cancer Center in 2005. Her research focuses on the development of treatment planning approaches that are designed to cover the cancerous tumor volumes while maintaining minimum dose to critical organs, developing knowledge-based models for automated treatment planning for various treatment sites, including mesothelioma, multiple cranial lesion stereotactic radiosurgery (SRS), gynecologic, prostate, head and neck cancer and cancers of the gastrointestinal tract. She has authored 59 peer-reviewed journal publications, conference proceedings, and invited talks. Some of her contributions are key in the use of the deep inspiration breath hold (DIBH) maneuver to reduce low doses to critical organs such as the heart and the lungs while treating breast cancer with radiation, on combining three-dimensional conformal radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT) to improve regional nodal irradiation and on reducing the dose to organs in the supraclavicular region. She has also authored a book chapter on intensity-modulated radiation therapy (IMRT) for breast cancer and an award-winning article on optimizing treatment positioning to achieve better heart sparing for left-sided breast cancer cases. She is a co-investigator on several clinical trials pertaining to the treatment of cancers related to the breast, lung, liver, and gynecologic. Dr. Dumane is a member of The American Association of Physicists in Medicine and The Radiological and Medical Physics Society of New York and is a two-time recipient of the RAMPS Young Investigator Award. In addition to her clinical and research activities, she is passionate about teaching treatment planning and medical dosimetry practices to students. 

Educational Level: Intermediate

ARRT CQR Credit Distribution

Radiation Therapy 2017:
Procedures        
   Treatments = 1.0

Radiation Therapy 2022:
Procedures   
      Treatments = 1.0