Biomedical subjects

H Treuer

Publications and source records attributed to H Treuer.

27 records · Page 2Linked to original sources

PubMed1995

[Dosage inhomogeneities in the matching of opposing photon fields and electron fields in head-neck tumors ].

PURPOSE: Head and neck tumors are often treated by a multiple-field technique, using a combination of opposing photon fields and electron beams in order to stay within the limit of the myelon tolerance dose. Dose inhomogeneities at field margins must be minimalized to avoid an increased rate of local recurrences or late complications. METHODS: A polystyrene phantom with a base of 12 x 16 cm was used to investigate the optimal conditions of field matching, using 9 MV photon beams and 8 to 10 MeV electron beams. The evaluation was performed by using an automatic video-densitometer and digital image processing. Dose distributions are presented as 3-dimensional plots and as dose profiles in a depth of 1.2 and 2.5 cm. RESULTS: In the neck region photon and electron fields cannot exceed a field width of 6 to 7 cm. With unmodified electron fields and opposing photon fields with a 5 mm penumbra optimal geometrical matching is achieved by using an overlap of 2 mm referring to the field margins. Related to a reference dose of 100% the dose in 1.2 and 2.5 cm depth varied between 90% and 115%. Geometrical variations at the field margins, using a gap of 3 mm or an overlap of 5 mm, result in a local underdosage of 75 to 80%, respectively an overdosage of 135 to 150% referring to the reference dose. This dose inhomogeneity occurs at a width of 1 cm around the field margins. CONCLUSIONS: Regarding clinical and physical aspects the matching of unmodified beams seems to have an advantage compared to the matching of fields with broadened penumbras. For the treatment of patients an immobilisation technique and a precise daily set up is required.

Electrons↗

PubMed1994

Linac radiosurgery in brain metastases.

Brain metastases are usually well-circumscribed and more or less spherical lesions. These conditions meet the criteria for radiosurgery (RS). A pilot study initiated by our group in 1983, demonstrated the effectiveness of Linac-RS in the treatment of solitary brain metastases with low radiosensitivity. A second trial including patients with 1-3 metastases started in 1990. By April 1993, 46 patients had been treated in this series. The radiation doses delivered to the tumour margin ranged from 10 to 25 Gy, and were chosen with respect to size, number and location of the tumours or previous whole brain radiotherapy (WBRT), decreasing mainly with increasing tumour volumes. 34/46 patients had a follow-up of more than 12 weeks. In 7/46 patients the disease progressed rapidly during the first weeks after RS and follow-up examinations were not performed. 5/46 patients had a follow-up of less than 6 weeks and follow-up CT/MR-examinations were not available. 14/46 patients received WBRT before RS. The regularly performed follow-up examinations (clinical status, CT-/MR-examinations in 6 or 12 weekly intervals) revealed tumour progression in 5/34 patients. Permanent cessation of the growth (11/34), tumour shrinkage (18/34) and decrease of surrounding oedema together with clinical amelioration have been observed a few weeks after radiosurgery. The median follow-up was 50 weeks. 14/46 patients died due to generalized progression of their disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Linac-accelerator-radiosurgery.

A survey is given of the actual possibilities and limitations of the use of linear accelerators (Linac radiosurgery systems) for intra = cranial radiosurgery. Depending on the collimator size, spherical fields from 5-54 mm in diameter can be irradiated with dose gradients from 10% (large fields) to 20% (small fields) per millimeter distance between surface and treatment volume. This is comparable to the possibilities of Gamma-Knife and Proton-irradiation. Optimal mechanical adjustment of gantry and linac table are necessary for the required stability of the isocenter. Mechanical inaccuracy should be smaller than 0.8 mm. Advanced computerized 3D-treatment planning systems are indispensable prerequisites for accurate treatment and use of the flexibility of the linac system. Future developments are outlined.

Brain↗

PubMed1993

Interstitial irradiation of cerebral gliomas with stereotactically implanted iodine-125 seeds.

Ninety-seven consecutive patients with primarily inoperable or only partially resectable gliomas have been analysed retrospectively. Mean tumour surface doses of 70 Gy (low grade gliomas) and 56 Gy (high grade gliomas) have been applied with stereotactically implanted Iodine-125 seeds at low dose rates. Patients with a glioma grade III or grade IV and permanent seed implantation additionally received a fractionated external beam irradiation. With mean follow-up times of 55.8 months (glioma grade I), 51 months (glioma grade II) and 59.6 months (glioma grade III) the estimated mean survival probabilities are 105 months, 102 months and 65.7 months respectively. In the glioma grade IV group the estimated mean survival time has been 15.6 months after continuous interstitial irradiation (response rate: 36%). Temporary interstitial irradiation in cases with a glioma grade IV (dose rate: 2.1 Gy/day) caused initial tumour shrinkage in 77%. Neurological deficits following radiation induced vasogenic oedema were reversible in 2 patients and irreversible in another 2 patients. 6 years after the Iodine-125 implantation and continuous interstitial irradiation 1 patient developed a severe localised radiation necrosis.

Adolescent↗

PubMed1993

CT-guided and computer assisted stereotactic biopsy. Technique, results, indications.

On the base of a stereotactic device originally described by Riechert and Mundinger a three-dimensional localization and treatment planning system for CT-guided computer assisted stereotactic procedures has been developed. The experience with 338 patients, in which image guided stereotaxy has been used for the assessment of various intracerebral lesions, is presented. In 54 of these patients the cannula was introduced with a 20 MHz Doppler-probe positioned at the tip of the needle. A comparison of tissue specimens taken stereotactically with tissue material after tumour resection and/or autopsy was performed in 35 patients. The accuracy of the histological diagnosis was 88%. Bleeding as a complication due to the stereotactic intervention occurred in 8 patients (2.4%). Two of these patients had a fatal outcome (mortality: 0.6%). The morbidity (transient and permanent deterioration of the clinical status) was 1.2%.

Adolescent↗

PubMed1993

Correlation of glucose consumption and tumor cell density in astrocytomas. A stereotactic PET study.

To determine histological correlates of the variability of glucose consumption in astrocytomas, the authors performed positron emission tomography (PET) with 18F-2-fluoro-2-deoxy-D-glucose (FDG) and matched the PET scans three-dimensionally with computerized tomography scans obtained in a stereotactic frame before biopsy. Ten patients with astrocytomas of World Health Organization Grade 2 or 3 were studied; patients with glioblastomas, oligodendrogliomas, or oligoastrocytomas were excluded from the study to avoid any confounding effects of different cell types and necroses. In samples of pure tumor, glucose consumption correlated significantly with cell density, but not with nuclear polymorphism. It is concluded that tumor cell density is a major determinant of glucose consumption in astrocytomas. The use of PET with FDG may help to locate the highest cell density and thus improve the diagnostic yield of stereotactic biopsy.

Adult↗

PubMed1992

Optimization and evaluation of landmark-based image correlation.

Image correlation methods enable the complementary use of information from different medical images of a patient. These images can be obtained from different imaging devices (CT, MR, PET), or, from one imaging device taken at different times. Unfortunately, there are few cases in which the requirements for later image correlation are taken into account at the time of image acquisition. There is therefore a need for correlation techniques requiring no preparation in advance. We have developed two correlation methods, both based on three or more anatomical or artificial landmarks, to be defined in corresponding image data sets. These methods have been evaluated with phantom data as well as with patient data. We have improved these correlation methods by using more landmarks and special selection criteria. They are applicable to all medical tomograms and to x-ray pictures taken under stereotactical conditions. The results obtained have error ranges in the order of the three-dimensional image resolution.

Diagnostic Imaging↗

PubMed1991

Radiosurgical treatment of cerebral metastases. Method, indications and results.

Stereotactically guided single-dose irradiation of brain metastases with low radiosensitivity has been performed in a series of 30 patients. Clinical symptoms improved in 18 of 27 evaluated patients and remained stable in another 7. Tumour regression was achieved in 13 of 22 patients, and arrest of tumour growth in 7 other patients. The treatment was usually well tolerated. The incidence of side effects was low. Thus, radiosurgery seems to be a valuable alternative to microsurgical extirpation of solitary brain metastases with low radiosensitivity.

Adult↗

PubMed1989

Stereotactically guided convergent beam irradiation with a linear accelerator: localization-technique.

A stereotactic convergent beam irradiation technique using a linear accelerator has been developed in order to precisely apply single high doses of up to 50 gray and more to brain lesions (radiosurgery). Accurate positioning of the patient and the target point of irradiation is an absolute requirement for this method. The stereotactic localization system developed for this purpose is described.

Humans↗