Book Review of The Modern Technology of Radiation Oncology (Volume 4)

The fourth volume of the book entitled “The Modern Technology of Radiation Oncology: A Compendium for Medical Physicists and Radiation Oncologists” has been edited by Prof. Jacob Van Dyk, a Professor Emeritus of Oncology and Medical Biophysics at Western University, London, Ontario, Canada, and former Manager of Physics and Engineering at the London Regional Cancer Program. He has more than a half century experience in the practical facets of radiation oncology physics. This is the fourth volume of radiation oncology reference material written by internationally renowned authors and edited by Jacob Van Dyk. This volume contains 18 chapters with comprehensive information on new technologies and related considerations that have evolved since Volume 3 was published. Together, the four books provide a complete up-to-date guidance on design, clinical needs assessment, purchase considerations, acceptance testing, commissioning, quality assurance, and practical use. In addition, chapters have been provided on financial economic issues, global medical physics considerations, and a new up-and-coming procedure known as “FLASH” radiation therapy. This book also discusses extensively the contents and prefaces of/to prior volumes. Chapter 1 deals with the Technology Evolution in Radiation Oncology: The Rapid Pace Continues. It briefly discuss the evolution of radiation treatment process, its impact in patient outcome, developments in the last decade, treatment uncertainties and robust optimization, hybrid positron emission tomography/magnetic resonance imaging (PET/MRI), magnetic resonance imaging-guided linear accelerator (MR-LINAC), automated treatment planning, artificial intelligence, machine learning, big data, radiomics, adaptive radiotherapy, radiobiology in particle radiation, high-Z nanoparticles, financial and economic considerations in radiation oncology, and trends in radiation oncology, Chapter 2 deals with the important and evolving surface guidance technique and surface-guided radiation therapy (SGRT). Section 2.1.1 discusses stereophotogrammetry. However, it would have been very useful if it had been diagrammatically explained the working principle of stereophotogrammetry. Literature does not specify the particular SGRT technique they have used in the discussion (page 28 and paragraph 2). A separate session may be required to distinguish between cone-beam computed tomography (CBCT) and SGRT while discussing SGRT techniques. Mixing information about CBCT and SGRT may mislead readers. Chapter 3 describes PET/MRI as a tool in radiation oncology. The introduction of this Chapter may require more information regarding commercial introduction of PET-computed tomography. Image shown as [Figure 3.14] in the book does not provide proper clarity of information. Chapter 4 deals with the real-time image guidance with MR. Session 4.3.2 needs more clarity on the content of the skin dose. Reference used for Formula 4.2 should be listed for better understanding. Commissioning of MR LINAC requires more discussion. Chapter 5 gives a good and clear introduction about stereotactic body radiotherapy (SBRT). Section 5.1.3 refers conventional radiotherapy as the treatment includes 2 Gy per fraction and that may not be completely true. As 1.80 Gy is also a widely used conventional dose fractionation, it may require a redefinition of conventional technique. Section 5.3.4 refers tomotherapy as SBRT LINAC. SBRT in tomotherapy is a bit limited as it requires enough time to complete the treatment. Such additional information may bring further clarity in the content. Introduction in Section 5.4 mentions that the measurement of the data for field sizes <2 cm × 2 cm is challenging. The statement may need further elaboration. For example, the limitations for the field size may be mentioned for the fields <4 cm × 4 cm. Many of the radiotherapy centers across the globe are not yet practicing small-field dosimetry effectively. Chapter 6 deals with very crucial and important topic about the uncertainties about the radiation treatment to ensure robust evaluation and optimization. The chapter briefly covers uncertainties related to imaging, dose calculation algorithms, and proton therapy. Robust treatment planning has been explained in a nice manner. Chapter 7 describes the automated treatment planning workflow of contouring, planning, quality and safety, and clinical use. However, the errors discussed in Section 7.3.1 are very limited and more information would have been useful. Chapter 8 is very important and deals with artificial intelligence in radiation oncology. It briefly discusses the overview, data source, ontologies, infrastructure, image feature extraction, machine learning, outcome prediction, etc. This chapter is really worth reading. Chapter 9 deals with adaptive radiotherapy with details on clinical motivation, historical perspective, adaptive techniques, and tools. Chapter 10 deals with again a very important topic of machine learning in radiation oncology. Section 10.3.3 is very useful and deals with the differences between intelligent automation and predictive analytics. Chapter 11 deals with application of “big data” in radiation oncology. It briefs the big data sources, automation, better outcomes, and the barriers to use the big data. However, [Figure 11.1] quoted in the book may be improved further with a proper schematic order to illustrate a good workflow. Information about challenges to big data by virus attacks, its safety, and privacy of information would have given more weightage to this chapter. Chapter 12 deals with quantitative radiomics in radiation oncology. It briefs the state-of-art radiomics, workflow, standards, and emerging techniques. Chapter 13 deals with the evolving particle therapy and is about radiobiological updates in particle therapy. It speaks extensively about relative biological effectiveness. It seems that that further information on the technical aspects of particle radiotherapy would have increased the value of this chapter. Chapter 14 deals with the radiation oncology using nanoparticles with high atomic numbers. It briefs the design and delivery, beam, and treatment planning considerations of nanoparticles. Chapter 15 is very different and unique dealing with a novel and crucial topic about financial and economic considerations in radiation oncology. It is worth reading. It deals with the cost of radiotherapy, appraisal of the health economics balancing cost and the outcomes, evidence generation, and value-based healthcare. Chapter 16 deals with the global considerations for the practice of medical physics in radiation oncology. It discusses the medical physics education and training, issues, international outreach considerations, etc. Chapter 17 deals with emerging technologies for improving access to radiation oncology. It briefs about the situational analysis, barriers and general framework, minimal requirement for radiotherapy facilities, etc. Chapter 18 is the last chapter which deals about an evolving technique called FLASH therapy. It tells about the brief history, radiation sources and delivery, clinical implementations, etc. It is again worth reading. Overall, new topics such as artificial intelligence in radiotherapy, FLASH radiotherapy, and surface guidance discussed in this book are scarcely available in other books. That way, this is a valuable book which discusses extensively the various aspects of these untouched areas. Further elaboration on brachytherapy and the treatment planning in the various chapters would add further value. Similarly, the elaboration of the challenges and limitations of various technologies would have given the readers the balanced perspectives. Certain additional topics such as advancement in dose calculation algorithms, biological optimization, new brachytherapy applicators, small-field dosimetry, and various novel quality assurance tools may be considered by the authors to include in the next volume of the book. Although a few topics are repeated and overlapping, it is required to maintain the continuity of the inter-related topics. The extensive list of references provided at the end of each chapter will be valuable to the readers who wish to investigate more into a specific area of interest. The illustrations, flowcharts, graphical representations figures, and tables provided in the book are appropriate and justify the purpose of the chapter. The appendices, future developments, and summary provided at the end of the chapter are quite useful. While this book is primarily written for medical physicists and radiation oncologists who are involved with the clinical implementation and use of new technologies for radiation treatment, it is also an important learning resource for the residents in medical physics and radiation oncology, radiation technologists, dosimetrists, research students, biomedical engineers, and ancillary professionals related with radiotherapy. It is also a useful reference for administrators and the scientists affiliated with the practice of radiation therapy. This resourceful book has aimed to serve as a comprehensive textbook for the practicing radiotherapy professionals. I would like to congratulate the authors and the Editor for such a high-quality scientific feast and strongly recommend fourth volume of the book “The Modern Technology of Radiation Oncology” to the clinical medical physicists and radiation oncology professionals involved with the rapidly evolving radiotherapy. Acknowledgments I would like to acknowledge Libin Scaria, Medical Physicist, TMH, for his inputs as well.

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