Bioanatomic Imaging and Treatment Program

from Clinical Update, Fall 2005

Abstract: With its new Bioanatomic Imaging and Treatment Program, the Comprehensive Cancer Center at Wake Forest Baptist is one of the first medical centers in the nation to combine anatomic and biologic imaging using MRI and CT/PET for radiation therapy treatment planning and delivery. The process allows for a new level of individualization in radiation treatment and is expected to reduce potential acute and long-term side effects associated with radiation.

For patients undergoing radiation therapy for cancer, simulation is the initial and most important component of the treatment planning process. An accurate definition of the target volume — the tumor and any surrounding tissues at risk for harboring cancer cells — is essential for a successful outcome.

Over the last decade, imaging technologies have progressed in two ways — through improvements in anatomic imaging and, more recently, the development of biologic imaging.

With the opening of its Bioanatomic Imaging and Treatment Program this autumn, the Comprehensive Cancer Center at Wake Forest Baptist has become one of the first medical centers in the country to combine both anatomic and biologic imaging using MRI and CT/PET in radiation therapy treatment planning and delivery process.

Bioanatomic imaging technology, specifically Positron Emission Tomography (PET), detects and locates tumors in tissues by measuring metabolic, biochemical and functional activity in living tissue. While PET’s use in the early detection and staging of cancer is growing rapidly, it is now emerging as a technology for radiation therapy treatment planning. Magnetic resonance spectroscopy (MRS) is a biochemical analysis of a region of tissue otherwise imaged by a conventional anatomic MRI scan. MRS produces a chemical spectrum with a series of peaks and valleys that reflect the quantity of certain metabolites of normal and cancerous tissues. MRS can detect the presence of cancer in anatomically normal appearing tissues, and in addition can disprove the presence of cancer in anatomically abnormal tissues.

Using these biologic imaging modalities, the most biologically or radiation resistant portions of a tumor can be imaged and then targeted with additional radiation dose, a biologically specific drug or both.

“The addition of bioanatomic technology takes us to a whole new level of sophistication and capability in providing the most effective and accurate radiation therapy for our patients,” said Edward G. Shaw, M.D., chair of Radiation Oncology. “Since bioanatomic imaging will help focus the areas where the highest doses of radiation are needed, normal tissues adjacent to the tumor will receive less dose, which should reduce the potential acute and long-term side effects associated with radiation. We are truly now able to provide individualized radiation treatment in ways we never could before.

“Just as CT and MRI have become the standards of care for the anatomic imaging of cancer and PET a standard for the early detection and staging of cancer, bioanatomic imaging will become the new standard of care for treatment planning," Shaw said.