This special supplement to Decisions in Axis Imaging News touches on the world of clinical adaptation during oncology intervention. This broad concept has seen accelerated development using three-dimensional (3D) imaging with radiation therapy to establish increasingly sophisticated levels of feedback.

Within the chain of external beam radiotherapy, adaptation during the course of intervention represents a very logical progression. Siemens has significantly advanced two other links in this chain: target definition and conformal delivery, with molecular imaging and intensity-modulated radiation therapy, respectively. It is natural that precision and accuracy continue to be maintained at the actual point-of-care in order to propagate these benefits into positive patient outcomes.

The most common currently deployed adaptive technologies are two-dimensional images from ultrasound or planar radiography. Although these garner reimbursement in an unambiguous fashion, both have displayed severe limitations in the ability to provide adequate information in many clinical situations. This has led to a variety of approaches that demonstrate how various types of 3D image volumes enable different levels of adaptation. Thus, two important factors now determine the value of effort expended: the type/quality of the information and the level of adaptation. Both factors must be studied and reflected in financial policies for long-term sustainability.

The articles that follow give a flavor of how adaptation may occur for static targets with regard to location, morphology, and even radiation dose. At another level (intrafractional) for dynamic targets, all three may be changing significantly during actual beam delivery. Monitoring these changes at different time scales and subsequently implementing worthwhile clinical decisions represents an exciting challenge for all of us. Whether it involves pursuit of the highest in-room image quality with PRIMATOM or adaptation to the back-projected dose with megavoltage cone-beam imaging (currently in development at Siemens), the multifaceted nature of the work is clear. We hope to convey the spirit and breadth of adaptive radiotherapy with Siemens and its partners, and invite you to join our quest for premium oncology health care.

Ajit Singh is president of Siemens Oncology Care Systems