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Medical Physics

The Medical Physics unit uses basic science and clinical research to improve patient outcomes. The key focus of our research is on radiation oncology treatment and related imaging techniques. Our major research project is the development of a Magnetic Resonance Imaging – Linear Accelerator (MRI-Linac) headed by Professor Paul Keall. This is one of only three other similar developments worldwide and will enable real time imaging of patient anatomy during radiotherapy treatment and the potential of improved cancer targeting and a reduction in treatment side effects. Improved cancer targeting will be possible through increased soft tissue contrast available with MRI and the potential of incorporating physiological cancer targeting through advanced MRI pulse sequences.

Supporting this research are other projects assessing the benefits of MRI and other imaging modalities for radiotherapy treatment planning and delivery, the use of advanced radiation dosimeters for treatment verification and the impact of uncertainties in radiotherapy delivery. This work is undertaken within the cancer therapy centres at Liverpool and Macarthur and other collaborating centres. Component projects are focused on specific clinical sites such as lung, breast and prostate.

 Group Leader:

 A/Prof Lois Holloway

E: Lois.Holloway@swsahs.nsw.gov.au

P: +61 (0)2 87389218

Program of Research

The Ingham Institute is one of only four institutions in the world developing MRI-Linac technology. The Australian innovation includes many design and technology features unique to this device: it is the first high-field ‘inline’ system.

The program is enabling researchers to develop world-class solutions that will improve the effectiveness of radiation therapy for people living with cancer.

Click here to learn more about The Australian MRI-Linac.

MRI has a number of advantages for the simulation of treatment plans, over the current gold standard of CT. Its excellent and variable soft-tissue contrast has been shown to improve the delineation accuracy of both the tumour and surrounding organs-at-risk; a range of functional techniques are able to measure and display tumour physiology in the same examination, potentially revealing sub-regions that could receive a boost in radiation dose; and the absence of ionising radiation means the patient may be scanned any number of times before, during and after treatment, giving the clinician the ability to assess and adapt plans on an individual basis.

Cancer is one of the most common causes of death, both in Australia and worldwide. Radiotherapy plays a significant role in the treatment of cancer. Recently, a number of technology advances have enabled higher radiation doses to be safely delivered to tumours without causing unacceptable damage to normal structures. However, delivery uncertainties are not well understood for advanced radiotherapy methods, resulting in loss of treatment efficacy. A better understanding of the impact of delivery uncertainties for specific radiotherapy techniques and clinical sites will provide guidelines on the choice of appropriate advanced technique for individual patients. This would improve tumour control and cancer survival, whilst reducing normal tissue toxicities.

In clinical radiotherapy practice, uncertainties in treatment planning and delivery are unavoidable. In the modern setting, it is of paramount importance for contouring uncertainties to be understood and accounted for. This is due to the implementation of increasingly conformal techniques including IMRT and image guided RT, which enable dose distributions to be highly conformed to the contoured treatment volumes. Accurate target volumes are therefore crucial in order to avoid geographic miss and to produce favourable treatment outcomes.

Electronic Portal Imaging Devices (EPIDs) are digital x-ray imaging systems that use the megavoltage treatment beam to acquire projection images of radiotherapy patients. For the past few decades EPIDs have been used to accurately position radiotherapy patients immediately prior to treatment, and to provide a record of treatment for physicians to review. EPID imaging systems are integrated into the treatment delivery hardware and software systems and are a standard feature of modern medical linear accelerators. EPIDs have also been demonstrated for dosimetry applications, with various models of calibrating the image signal to dose.

Dosimetry is vital in radiation therapy for verification of the dose delivered to patients, as well as monitoring the machine output for commissioning and daily quality assurance.

Currently only 2-3% of cancer patients receiving radiotherapy are involved in clinical trials, hence only this proportion of patient data is used to improve care of future patients. However cancer centres record lots of electronic-data on all patient treatments. This project’s aim is to use anonymised electronic medical records and images to learn mathematical models that predict treatment outcomes. This can then help doctors and patients to select the best approach.

Therapy Equipment

Liverpool Cancer Therapy Centre Equipment

Linacs

5 Elekta (Synergy with Agility MLC), 1 Siemens (Oncor with MVCB), 1 Tomotherapy

Treatment Planning System/s

Philips Pinnacle SmartEnterprise, CMS XiO & Focal, Raystation, Tomotherpy, Nucletron Oncentra (brachy)

CT Scanner

Philips Big Bore (includes bellows system for 4DCT)

MRI

Siemens Magnetom 3T Skyra

Brachytherapy

Nucletron HDR

Dosimetry equipment and software

Range of standard radiotherapy ion chambers, diode detectors, electrometers, solid water and mini-water phantoms

Wellhoefer Blue water tank

OmniPro s/w (Accept and IMRT)

Sun Nuclear ArcCheck diode array

ImRT MatriXX ion chamber array

DQA3 (Sun Nuclear)

Profiler (Sun Nuclear)

CIRS IMRT phantom

Harshaw TLD system

Anthropomorphic phantoms

Gafchromic Film dosimetry system

Dynamic CIRS phantom (4D dosimetry studies)

Various image quality and IGRT QA phantoms

RIT s/w

MATLAB, SigmaPlot scientific software

Research equipment and software

MR-Linac program: Varian Linatron with MLC

EPID program:

Portable Perkin Elmer flat panel and control systems

LineSpreadFunction Apparatus

MRsim program:

Siemens OncoTreat software

Contouring uncertainties program:

Milxview software

In-house software to calculate radiobiology and dose metrics

In-house software to calculate contour similarity metrics

Delivery uncertainties program:

In-house software to simulate delivery errors

Miscellaneous clinical equipment

Rectafix for prostate SBRT

ABC2 and ABC 3 for DIBH treatments

Hidden in a bunker in Liverpool is a world-first medical device

VIDEO: Hidden in a bunker in Liverpool is a world-first medical device

This clip can be viewed here.

Connection key to vital treatment

Team makes cancer progress

This clip can be viewed here.

Researchers

Lois Holloway

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Paul Keall

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Gary Liney

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Philip Vial

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Peter Metcalfe

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Michael Jameson

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Gary Goozee

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Sankar Arumugam

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Bin Dong

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Jarrad Begg

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Shrikant Deshpande

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Tony Young

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Elise Pogson

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Kylie Dundas

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Matthew Field

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Mohamed Samir
Barakat

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Sam Blake

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Shivani Kumar

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Vikneswary Batumalai

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Amy Walker

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Brendan Whelan

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Dj Wijesekera

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Lauren Bell

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Dale Roach

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Sarah Alnaghy

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Trent Causer

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Tariro Ndoro

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Thahabah Alharthi

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