Patients were immobilized in the supine position using a customized thermoplastic mask secured to a carbon fiber plate with four clamp bases covering the head and neck. The carbon fiber plate was placed on the linac treatment couch shared with online CT of CTVision. Positioning scans were performed by online CT of CTVision. The slice thickness was 3 mm and the matrix was 512 × 512
Pinnacle system
Manufactured by Philips
Sourced in United States
The Pinnacle system is a lab equipment product manufactured by Philips. It is designed to perform essential laboratory functions, but a detailed description cannot be provided while maintaining an unbiased and factual approach without interpretation or extrapolation.
Automatically generated - may contain errors
6 protocols using pinnacle system
1
IMRT Immobilization for Precision Radiotherapy
2
CT-Guided Tumor Sphere Positioning
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Each patient was placed in the supine position and underwent CT scanning for planning. For the head and neck, the patient was scanned with a 3-mm slice thickness with a Brilliance Big Bore CT Scanner (Philips, Amsterdam, Netherlands). For the thorax, abdomen, and pelvis, the slice thickness was 5 mm. The CT data were then transmitted to the Pinnacle treatment planning system (Philips), and the S-M_OPS treatment planning system. All patients’ therapy plans were generated by the Philips Pinnacle system. We obtained the position of the real tumor center (denoted as the real tumor center T0, as shown in Figure 3 ) from the therapy plan. S-M_OPS delineated the positions of the spheres and calculated the associated parameters, which was the relative 3D spatial relationship between spheres and the tumor, denoted as the sphere-tumor relative relationship.
3
PET/CT Simulation and Fusion for Radiotherapy
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All patients underwent PET/CT simulation in the supine position, while immobilized with a customized thermoplastic mask and using the Biograph 16 HI-REZ PET/CT scanner (Siemens Healthcare, Hoffman Estates, IL, USA). The PET component was a high-resolution scanner with a spatial resolution of 4.7 mm and no septa, thus allowing 3D-only acquisitions. The CT component used was the Somatom Sensation 16-slice CT (Siemens Healthcare). The CT scanner was used for attenuation correction of the PET results and for localization of FDG uptake in the PET images. All patients were advised to fast for ≥6 h prior to PET/CT examination. Following injection of ~5 MBq FDG per kg of body weight, the patients were rested for a period of ~60 min in a comfortable chair. Emission images ranging from the proximal femur to the base of the skull were acquired for 2–3 min per bed position. The field of view was 50 cm, with a matrix of 512×512 pixels for CT and 128×128 pixels for PET. The processed images were exhibited in coronal, transverse and sagittal planes. Following image acquisition, PET and CT data sets were sent to the treatment planning system, Pinnacle system (Philips Medical Systems, Milpitas, CA, USA), through compact discs. The CT and PET images were subsequently fused by means of a dedicated RT planning system image fusion tool based on a mutual information algorithm.
4
Dosimetric Impact of Contrast-Enhancing CT Scans
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VMAT plans were designed using double arcs (181°−180° and 180°−181°) with the Pinnacle system (Philips Healthcare, Andover, MA, USA) with an adaptive convolution algorithm. An isotropic 4-mm dose calculation grid and a 6 MV photon beam from a linear accelerator (Synergy®; Elekta, Sweden) were employed. The prescription dose (Dp) for the PTV was 95% of the volume receiving 50 Gy at 2 Gy per fraction. The dose constraints on ROIs complied with our institutional criteria. For each patient in groups 2 and 3, the plans were first designed using the original CT images and then recalculated after DENS over-ride using non-enhanced values. During the recalculation, all the other parameters were unchanged, such as beam weight, MU number, prescription dose, and leaf motions. The doses of the PTV, bowels, and other organs at risk between the original and modified plans were compared to determine the impact of OCA and ICA. For OCA alone, only the DENS values of the OCA-enhanced bowels were overridden in groups 2 and 3 [Figure 1 ]. For ICA alone, the DENS values of intravenously enhanced organs were overridden in the 10 patients who received both CAs. To improve the interpretability of the differences and establish clinical significance, we reported the relative change Δ%, as follows:
5
Radiotherapy-based Treatment for Esophageal Cancer
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All patients underwent a radiotherapy-based treatment plan. Based on their individual condition, patients underwent dRT or dCRT to a total of 50–70 Gy by either intensity-modulated radiotherapy (IMRT) or 3-dimensional conventional radiotherapy (3D-CRT). All treatment plans were carried out using the Philips Pinnacle system, and the radiation techniques were delivered with 6-MV X-ray accelerators with a daily fraction of 1.8–2.0 Gy and five fractions each week. Target volumes and Organs at risk (OAR) were defined in accordance with the 2019 guidelines of the National Comprehensive Cancer Network. 65% of patients were treated with chemotherapy. The common protocol for chemotherapy was as follows: 5-FU (D1-2) / cisplatin (D2) regimen, docetaxel (D1) or paclitaxel (D1) + cisplatin (D2), nedaplatin (D2), carboplatin (D2), or lobaplatin (D2) regimen.
To monitor therapy-related toxicities and the patient’s general condition, all patients were checked weekly during treatment. Following completion of dRT or dCRT, patients were followed up every three months for the first two years and then every six months thereafter. Physical examination, chest computed tomography (CT), barium swallow, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and tumor indicators were included in the follow-up evaluation.
To monitor therapy-related toxicities and the patient’s general condition, all patients were checked weekly during treatment. Following completion of dRT or dCRT, patients were followed up every three months for the first two years and then every six months thereafter. Physical examination, chest computed tomography (CT), barium swallow, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and tumor indicators were included in the follow-up evaluation.
6
Multi-modal Imaging Fusion for Radiotherapy Planning
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Following image acquisition, MR images were registered with the CT acquired for treatment planning system (Pinnacle system, Philips Medical Systems, Milpitas, CA). The MR (including DWI, T1- and T2-weighted image) and CT images were subsequently fused by means of a dedicated RT planning system image fusion tool based on a mutual information algorithm.
The pathological lymph nodes were specified by an experienced MR specialist without knowledge of the CT scan data, and by an experienced CT specialist without knowledge of the MR scan data, respectively. After separate reading of CT and MR images, fusion image sets were read according to CT and MR information. A final conclusion was reached in agreement between both readers. If the MR scan was negative in the mediastinum and the CT scan positive, the mediastinum was considered negative and was hence not included in the GTVCT/MR. On the other hand, if the lymph nodes were positive on MR scan but negative on CT scan, the whole pathological anatomical region of the mediastinum was taken as GTVCT/MR. If patients were complicated by atelectasis, GTVCT/MR were delineated on DWI CT/MR maps.
The pathological lymph nodes were specified by an experienced MR specialist without knowledge of the CT scan data, and by an experienced CT specialist without knowledge of the MR scan data, respectively. After separate reading of CT and MR images, fusion image sets were read according to CT and MR information. A final conclusion was reached in agreement between both readers. If the MR scan was negative in the mediastinum and the CT scan positive, the mediastinum was considered negative and was hence not included in the GTVCT/MR. On the other hand, if the lymph nodes were positive on MR scan but negative on CT scan, the whole pathological anatomical region of the mediastinum was taken as GTVCT/MR. If patients were complicated by atelectasis, GTVCT/MR were delineated on DWI CT/MR maps.
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