AAPM Task Group Report 238: 3D C-arms with volumetric imaging capability.

This report reviews the image acquisition and reconstruction characteristics of C-arm Cone Beam Computed Tomography (C-arm CBCT) systems and provides guidance on quality control of C-arm systems with this volumetric imaging capability. The concepts of 3D image reconstruction, geometric calibration, image quality, and dosimetry covered in this report are also pertinent to CBCT for Image-Guided Radiation Therapy (IGRT). However, IGRT systems introduce a number of additional considerations, such as geometric alignment of the imaging at treatment isocenter, which are beyond the scope of the charge to the task group and the report. Section 1 provides an introduction to C-arm CBCT systems and reviews a variety of clinical applications. Section 2 briefly presents nomenclature specific or unique to these systems. A short review of C-arm fluoroscopy quality control (QC) in relation to 3D C-arm imaging is given in Section 3. Section 4 discusses system calibration, including geometric calibration and uniformity calibration. A review of the unique approaches and challenges to 3D reconstruction of data sets acquired by C-arm CBCT systems is give in Section 5. Sections 6 and 7 go in greater depth to address the performance assessment of C-arm CBCT units. First, Section 6 describes testing approaches and phantoms that may be used to evaluate image quality (spatial resolution and image noise and artifacts) and identifies several factors that affect image quality. Section 7 describes both free-in-air and in-phantom approaches to evaluating radiation dose indices. The methodologies described for assessing image quality and radiation dose may be used for annual constancy assessment and comparisons among different systems to help medical physicists determine when a system is not operating as expected. Baseline measurements taken either at installation or after a full preventative maintenance service call can also provide valuable data to help determine whether the performance of the system is acceptable. Collecting image quality and radiation dose data on existing phantoms used for CT image quality and radiation dose assessment, or on newly developed phantoms, will inform the development of performance criteria and standards. Phantom images are also useful for identifying and evaluating artifacts. In particular, comparing baseline data with those from current phantom images can reveal the need for system calibration before image artifacts are detected in clinical practice. Examples of artifacts are provided in Sections 4, 5, and 6.

The case for personalized medicine.

Personalized medicine may be considered an extension of traditional approaches to understanding and treating disease, but with greater precision. Physicians may now use a patient's genetic variation or expression profile as well as protein and metabolic markers to guide the selection of certain drugs or treatments. In many cases, the information provided by molecular markers predicts susceptibility to conditions. The added precision introduces the possibility of a more preventive, effective approach to clinical care and reductions in the duration and cost of clinical trials. Here, we make the case, through real-world examples, that personalized medicine is delivering significant value to individuals, to industry, and to the health care system overall and that it will continue to grow in importance if we can lift the barriers that impede its adoption and build incentives to encourage its practice.

Nanotechnology for cancer diagnostics: promises and challenges.

Despite recent progress in the treatment of cancer, the majority of cases are still diagnosed only after tumors have metastasized, leaving the patient with a grim prognosis. However, there may be an opportunity to drastically reduce the burden of cancer, if the disease can be detected early enough. Nanotechnology is in a unique position to transform cancer diagnostics and to produce a new generation of biosensors and medical imaging techniques with higher sensitivity and precision of recognition. This review examines the in vitro and in vivo diagnostic applications of nanoparticles, and other nanodevices that are likely to have an impact on the field in the future. Future developments that may lead to the realization of multifunctional detection and treatment nanoparticle platforms are also discussed.

The Personalized Medicine Coalition: goals and strategies.

The concept of personalized medicine--that medical care can be tailored to the genomic and molecular profile of the individual--has repercussions that extend far beyond the technology that makes it possible. The adoption of personalized medicine will require changes in healthcare infrastructure, diagnostics and therapeutics business models, reimbursement policy from government and private payers, and a different approach to regulatory oversight. Personalized medicine will shift medical practices upstream from the reactive treatment of disease, to proactive healthcare management including screening, early treatment, and prevention, and will alter the roles of both physician and patient. It will create a greater reliance on electronic medical records and decision support systems in an industry that has a long history of resistance to information technology. Personalized medicine requires a systems approach to implementation. But in a healthcare economy that is highly decentralized and market driven, it is incumbent upon the stakeholders themselves to advocate for a consistent set of policies and legislation that pave the way for the adoption of personalized medicine. To address this need, the Personalized Medicine Coalition (PMC) was formed as a nonprofit umbrella organization of pharmaceutical, biotechnology, diagnostic, and information technology companies, healthcare providers and payers, patient advocacy groups, industry policy organizations, major academic institutions, and government agencies. The PMC provides a structure for achieving consensus positions among these stakeholders on crucial public policy issues, a role which will be vital to translating personalized medicine into widespread clinical practice. In this article, we outline the goals of the PMC, and the strategies it will take to foster communication, debate, and consensus on issues such as genetic discrimination, the reimbursement structures for pharmacogenomic drugs and diagnostics, regulation, physician training and medical school curricula, and public education.