4th International Conference and Exhibition on Medical Physics and Biophysics July 27-28, 2017 Rome, Italy - Hotel Holiday Inn Rome

M A Nezami is a Board Certified Physician graduated from USC and UCSF residencies and fellowship and trained in Integrative Cancer Therapy. He serves as Researcher and national and international Speaker, in Oncology and Epigenetic field. He has been involved in many research projects and publications/ presentations. He is an Inventor and Innovator and has designed a new method of treating advanced cancer, called Multi Molecular Targeted Epigenetic Therapy (MTET). With this method, over the last 7 years, he has successfully treated many patients, mostly with advanced cancer who had failed conventional methods

Patients with cancer are evaluated through different oncology laboratory markers, aiming at translation to clinical findings, both to evaluate progression of disease as well as translating to overall survival, as surrogate markers. This effort has been revolutionized as the traditional measurements of the tumor size in CT scans, and identifying cancer response by RECIST criteria, has failed to effectively translate into patient survival. Therefore establishing the prognosis in majority of patients, especially with heterogeneous tumors, has been extremely challenging. One area of most recent attention in identifying surrogate markers has been the vasculogenesis and its related serum markers. Different stages of carcinogenesis and metastasis is greatly dependent on tumor angiogenesis, as a result of vascular endothelial dysfunction. Novel ways to assess vascular function in cancer include measuring levels of circulating endothelial cells (CEC) or circulatory tumor cells (CTCs). The presence of circulating endothelial cells (CEC) has recently been recognized as a useful marker of vascular damage. That said, as of today, there is not a single biomarker used clinically for assessing vasculogenesis, or intratumoral hypoxia and the correlation between FDG-PET findings and survival has not been strong, especially in more heterogenous cancers (such as breast and lung cancer). Here we hypothesize that serum/plasma VEGF measurements, as a biomarker for vasculogenesis (and possible intratumoral hypoxia), before and after therapy independently, or in addition to, circulatory tumor cells assay, can be used as a prognostic marker correlating with FDG-PET findings. Altogether, it is a meaningful companion diagnostic tool to translate to clinical outcome, and overall survival. This is also important in therapeutic areas, as traditional chemotherapies in general (all anthracyclines, Alkylators, Platinum based chemotherapies, etc.) increase the serum circulatory tumor cells, as well as serum VEGF, by several mechanisms, including proinflammatory cytokines, disrupting the tumor vessels by disrupting endothelial dysfunction and causing tumor cell leaks. This necessitates new tools to overcome such negative measurable impact on potential survival. Accordingly, here, we present a summary of 150 cases of advanced disease and in detail, we present six cases of heterogenous stage four breast cancer who had failed several lines of chemotherapy, and were treated using anovel antiangiogenic therapy, consisting of natural and off label drugs. These are known to inhibit hypoxia induced pathways, in a protocol called multi targeted epigenetic therapy (MTET), resulting in independent and synergistic response identifiedby serum VEGF/CTC/ and FDG-PET combo findings, and translated to improved progression free, or overall survival. We conclude that this sample, although small, presents considerable effect size and can impact the current practice of oncology by providing better prognostic and therapeutic tools targeting angiogenesis in refractory heterogeneous disease

Mariusz Klimczyk has studied in Kazimierz Wielki University in Bydgoszcz, Department of Physical Education, Health and Tourism and has published many articles in the field of Sports and Physics Education. He has published more than 100 articles in reputed journals

Aim: The purpose of the study is to indicate the most accurate diagnostic factors of special fitness of athletes training pole vault aged 12 and prognostics for athletes aged 17.

 

Materials & Methods: Experimental studies conducted in 2001–2010 involved 22 athletes aged 12 and 11 athletes aged 17. Athletes participated in sports activities, training pole vault in the following clubs: “Gwardia” PiÅ‚a, GdaÅ„sk Pole Vault Center, TS “Olimpia” PoznaÅ„, SL WKS “Zawisza” Bydgoszcz, and “ÅšlÄ…sk” WrocÅ‚aw. The studies included the method of teacher’s observation. Tools applied in the studies included assessment of physical fitness and sport results, conducted during the athletic season. Basic statistical methods were used for the analysis of study results.

 

Results & Conclusions: The author determined inter-relation of individual special fitness tests in 12 and 17-year-old athletes and correlation of these tests with pole vault results in the studied age category. It was indicated that in age category 12, diagnostic tests are performed, in which correlation with sport result ranges between -0.45 (15-meter run) to 0.71 (standing long jump). Their purpose is to determine basic parameters justifying continuation of pole vault athletic training. Seventeenyear- old pole vaulters undergo prognostic tests in which correlation with sport results ranges between 0.64 (shot put 4 kg thrown back over the head) to 0.94 (“flying” over the bar from a backward roll); their purpose is to predict development of an athlete within training, and ultimately – sport results

Samira Al-Salehi graduated from Manchester University Dental School, UK. She was awarded PhD degree from Sheffield University, for her work on bleaching, where she received Certificate of Completion of Specialist Training (CCST). For a short time, she was Consultant at Barts and The London School of Medicine and Dentistry before taking up a Senior Lecturer/Honorary Consultant post at Manchester University Dental School. For the last 5 years, she has been working in Dubai. She is currently a Professor and Endodontic Program Director at Hamdan Bin Mohammed College of Dental Medicine

The use of Cone Beam Computed Tomography (CBCT) is rapidly increasing as it provides valuable 3D information of the area under investigation in a matter of minutes. The radiation dosage associated with CBCT images is, however, about an order of magnitude higher than that of conventional radiographic images. The dosage is still considered relatively small but due to the cumulative nature of radiation it is advisable that CBCT should be used only in cases where clinically indicated. 35 patients were selected, from primary care referrals to a specialist endodontic unit in a leading UK dental hospital, for a clinical study. Ethical approval was obtained from the appropriate UK body. For each patient, a dental and medical history, a color photographic intraoral image, parallax periapical radiographs and CBCT image data set were taken (case scenario). Observers were recruited to assess the data. One observer, subsequently, dropped out of the study and was not included in the results. A questionnaire was designed for the observers aimed to address parts III and IV of the Fryback and Thornbury model dealing with diagnostic thinking and treatment outcomes. The information for all the 35 patients was examined by the observers on two separate dates about 3 months apart. On one date, all the information was given to them but, on the other the CBCT images were withheld. The null hypothesis “there is no significant difference in treatment planning/outcome with or without CBCT images” was tested. The results showed that the availability of CBCT images made no significant difference to the observers’ judgment. In complex cases such as resorptive lesions, however, the availability of CBCT was very helpful in their diagnosis. It was concluded that CBCT images are vital for certain complex endodontic treatments but should not be used routinely for all endodontic cases

Asli Yazici has completed her MD from Institute of Nuclear Science of Ankara University. She has been working in Onko Ankara Oncology Center since 2011 as a

Medical Physicist. She has performed treatment planning (IMRT-IGRT, conformal and complex techniques), daily-weekly-yearly QA’s of LINAC and patient QA’s in routine

The aim of this study was to evaluate three-dimensional set-up errors, systematic and random set-up errors between the electronic portal imaging device (EPID) and CBCT to determine optimum planning target volume (PTV) coverage margins in our clinic. This study was performed on 25 cancer patients, treated with Siemens Artiste LINAC.EPID and CBCTprojections of set-up fields were acquired simultaneously for each patients. The systematic and random error for individual and population were calculated both portal imaging and CBCT protections. The standard deviations of systematic and random set-up errors were calculated both imaging techniques to determine CTV-PTV margins according to ICRU Report 62 recommendations, along wih Stroom’s and van Herk’s formulae. Linear regression analysis of the EPID setup data as a function of the CBCT data were performed. The paired t-test was used to evaluate whether the EPID setup data were significantly different from the CBCT setup data. Correlations between the setup difference between EPID and CBCT were tested with the Pearson correlation coefficient. According to portal imaging result, CTV to PTV margins were found less than CBCT projections results in consequence of the manuel reconstructions while using portal imaging. As compared to our traditional margin of 5 mm in our clinic, it seems that we can further increase DV direction of the CTV to PTV margin to ensure at least 95% dose to 99% of the CTV using Van Herk and Stroom equations. The regression coefficient ( ) for the LR, CC, and DV directions were 0.11 (95% confidence interval [CI]=(-0.323)-(0.648)), 0.01 (95% CI=(-0.349)-(0.495)) and 0.24 (95% CI=0.039-0.597), respectively

Ahad Zeinli is the Head of Medical Physics Department, Urmia Medical Science University, Meysam Dadgar, Iran. He is also currently working as Associate Professor. He has completed his PhD from Tarbiat Modares University. He has many publications, abstracts and presentations combined. His research interests include both Medical Physics and Nuclear Medicine Education

The goal of this simulation study is to assess and compare Parallax error with different scintillator crystals in Positron Emission Tomography (PET). For this simulation study we use GEANT4 Application for Tomographic Emission (GATE). The crystals which act as simulators in this study are LSO, GSO, BGO and LYSO. In this work we simulate PET scanner with two ring and hexagonal geometries. Full ring PET scanner which consists of 26 detectors block where each block consists of 96 crystal blocks. In each crystal block there are 25 crystals. For hexagonal geometry in each head we simulate 620 blocks, each one consist 25 crystals. In both the geometries, a cylindrical shaped pancreas phantom is used for this simulation. We set 350 KeV threshold and 750 KeV upholder. The coincidence window for both geometry is 10 nanoseconds. Also we evaluate effect of gantry rotation on parallax error. To extract parallax of each case, we analyze simulation output via ROOT Tree

Abdoul Karim Mamadou Saidou has completed his Master’s degree in Biomedical Engineering from University of Hassan II Casablanca in Morocco and is currently enrolled in a PhD position in the same university. He is a Member of Spectroscopy and Dosimetry team, and his field of research is Medical/Radiation Physics and Dosimetry for Radiotherapy. He has attended many scientific meetings with publications in conference proceedings and journals

Radiotherapy treatment delivers low dose radiation beams to the patient to destroy the tumor with energy deposition in the matter. Thus it requires effective dosimetry for dose assessment in the clinical environment and the patient body. Among many dosimetric systems, EPR method is interesting with substantial advantages such as its reliability, accuracy and its non-destructive asset. In this proposed study, alanine irradiated by 6 MeV and 18 MeV electron beams delivered by a linear accelerator CLINAC 2300DHX was analyzed by EPR method to determine its dosimetric potentialities and compare the effect of energy. Samples were irradiated at doses ranging from 0 to 20Gy. EPR measurements performed with optimized parameters (microwave power = 1 mW, amplitude modulation = 0.5 mT) show a good radiation sensitivity of this material: threshold measurable dose is 1 Gy for both the energies of irradiation. Also the concentration of free radicals induced is proportional to the absorbed dose. Indeed, alanine is slightly more sensitive to 18 MeV beam than to 6 MeV beam. Furthermore, the free radicals created after irradiation are stable during 12 months of storage which allows multiple alanine dosimeter reading. Finally, a small quantity of alanine is efficient for pellets elaboration

Yuan-Hao Lee has completed her PhD from University of Texas Health Science Center at San Antonio and Postdoctoral studies from Mitchell Cancer Institite (Univ. of South Alabama) and University of Hawaii Cancer Center. She is currently being trained in the field of Medical Physics at the Wanfang Hospital, a JCR-accrediated medical center. She has published more than 10 peer-review and proceeding papers as well as served as an Editorial Board Member of Journal of Medical and Clinical Oncology

 

Background Computed tomography (CT) scan of the brain is a good method for investigating cranial lesions. Given that chronic accumulation of oxidative stress in the eyes induces carcinogenesis and cataract, we aimed to protect the eyes during CT scans by understanding the effects of non-latex barium sulfate shields on image quality and radiation dose to lens of the eye.

 

Materials & Methods: A human head phantom was scanned either by a 16-slice CT scanner at a fixed tube current of 300 mAs or by a 256-slice Dual-Source CT (DSCT) scanner with automatic tube current modulation. For the assessment of image quality

and radiation dose, various tube voltages were applied with or without eye shielding under clinical settings. Pencil-shaped ionization chambers were implemented for measuring air kerma close to the eye. CT images at slices that exibit zygomatic, orbital and nasal bones were used for the calculation of signal-to-noise and contrast-to-noise ratios.

 

Results: The signal-to-noise and contrast-to-noise ratios of DSCT images maintained relatively consistent with the increasing number of barium sulfate shield(s). On the contrary, the ratios of 16-slice CT images deviated or elevated along with the shield increment, leading to greater reduction in image quality upon the application of one shield. Similarly, radiation dose decreased with decreasing tube voltage and the increasing number of shields. The application of two shields on the 16-slice CT scan

reduced up to 52% of dose close to the eye.

 

Conclusion: Results of this study indicate that tube current modulation should be considered for acquiring better image quality with eye shielding

Anil Kumar Khambampati received his PhD from Department of Electronics Engineering, Jeju National University. He has published more than 30 papers and has been working as a Research Professor in the Institute for Nuclear Science and Technology, Jeju National University, South Korea

Information regarding the amount of urine or size of the bladder can help in the medical diagnosis of patients with paraplegia or overactive bladder. The bladder volume increases with amount of urine, thus it displaces the surrounding tissues and extends upward towards the abdomen wall. It is necessary to find an accurate and efficient method for estimating bladder volume by considering the impedance and movement of surrounding organ tissues. Electrical impedance tomography is a non intrusive and radiation free method that can provide the bladder size at a given time from the measurements recorded on the surface of the pelvis. The electrodes are placed around the pelvic region and current is injected into the body through these electrodes. The corresponding voltage is measured that quantifies the internal impedance distribution. This paper presents an analytical boundary element method for detecting changes in the size of the bladder. The boundary is represented using truncated Fourier Series and the changes in boundary voltages are measured for full and empty bladder. Numerical results with pelvic shaped boundary are performed and the results show that with bladder size change the boundary voltage is changed and it can be used to detect the size and shape of bladder boundary

Farzad Dehghani Sani is a Nuclear Medicine Technologist at Razavi Hospital, Iran. He did his MS and BSc in Nuclear Medicine Technology, and MSc of Biophysics at Islamic Azad University of Mashhad in December 2016. His research interests include both Nuclear Imaging Physics and Nuclear Medicine Education. He has many publications, abstracts and presentations combined

FDG is an available PET tracer for brain imaging. Malignant brain tumors show increased glucose metabolism reflected on FDG-PET imaging. FDG-PET imaging of brain tumors provides information on tumor grade and prognosis. Moreover, FDG-PET imaging has limitations for brain tumor detection because of the high background glucose metabolism of normal gray matter structures. MRI combined FDG-PET images is essential for accurate evaluation of brain tumors. FDG-PET is also useful for evaluating residual or recurrent tumor. One limitation of FDG-PET is the occasional inability to distinguish radiation necrosis from recurrent high-grade tumor. A second limitation is that FDG-PET is less sensitive than contrast-enhanced MRI for detecting intracranial metastases. Meanwhile, other radiotracers such as 11C-MET and FET can accumulate in brain tumors and have the advantage of low background cortical activity. The aim of the current study was to compare the diagnostic value of PET using 18F-FDG and 18F-FET in patients with brain lesions of gliomas. Numerous studies have demonstrated that gliomas has increased 18F-FET uptake in 86% and increased 18F-FDG uptake in 35% of the lesions. 18F-FET PET provided useful delineation of tumor while this was impractical with 18F-FDG due to high tracer uptake in the gray matter. 18F-FET PET is superior to 18F-FDG for biopsy lesions and also grading of gliomas. Therefore, amino acids like 18F-FET are the preferred PET tracers for the clinical management of gliomas

Mkimel Mounir has research interest in Medical/Radiation Physics and Dosimetry for Radiotherapy. He has attended many scientific meetings with publications in conference proceedings and journals

Nowadays, medical physics becomes a research field of a growing importance at Moroccan universities. This fact can be explained on one hand by the increasing number of purchases in medical imaging devices by the hospitals and of the number of PhD students and researchers becoming interested to medical physics studies on the other hand. Computed tomography (CT) is a medical imaging modality that produces cross-sectional images representing the X-ray attenuation properties of the body. However, it still represents the most irradiating technique used in radio-diagnostic that can increase cancer likelihood. It is therefore imperative to have a good estimation of the dose based on the acquisition parameters and the morphology of the patients (diameter). To achieve this goal, a CTDI phantom was used to calculate the doses. This phantom represents a standard PMMA phantom for head and body. Monte Carlo simulation methods represent an important tool for the study of processes involved in emission tomography and the development of devices dedicated to this purpose. GATE

(GEANT4 Application for Tomographic Emission) is a Monte Carlo based platform which allows simulating accurately a large range medical applications. In this paper, we exhibit the validation of a GATE model of CT Siemens SOMATOM Emotion 16 Slices using the CTDI phantom. In one hand, the comparison between the simulated and experimental data shows a good agreement. On the other hand, we observe that the values of CTDI increase when the kV and mAs increase. However when we increase the phantom diameter the CTDI values decrease

Background: Lu Dotatate therapy has established its role in the management of patients with inoperable or metastasized neuroendocrine tumours. To our knowledge the clinical stability of Lu Dotatate therapy doses prepared at a centralized radiopharmacy and transported to a remote therapy centre has never been analysed or reported.

 

Aim & Objectives: To assess the stability in using Lu Dotatate prepared from a centralized radiopharmacy then transported to a remote therapy centre. This may create therapy opportunities for many remote centres in different countries with no direct access to onsite production.

 

Methods: The current radiopharmacy, NTP Radioisotopes, is situated in Pelindaba, 634.5 km (approximately 394 miles) from the Therapy Centre (Umhlanga, Kwa-Zulu Natal). Pelindaba receives the Lu-177 on a Wednesday morning (from ITG in Germany), labels it with Dotatate using protocols obtained from two sources in Germany. The protocols are adapted to suit our conditions and the product is then suitably stabilised. This process is usually completed by 09h00. Standard doses of 7400 MBq are prepared. The doses are then taken by NTP Logistics to the airport (OR Tambo International Airport) for clearance for the scheduled flight (duration of flight one hour). In Durban (King Shaka International airport), NTP logistics wait on site for the labelled product to be cleared and it is taken directly to the practice for administration. We analysed 19 therapies to determine the stability of the product from preparation to injection. The following were used for analysis: biodistribution of post therapy imaging vs diagnostic scan lesion uptake, and clinical therapeutic response. Injection, therapy and imaging protocols were standardized.

 

Results: The mean time from production to injection was 4.93 hours (+/- 1.07 SD). The mode was 4.5 hours. The longest time between preparation and injection was 7.33 hours. The interim clinical evaluation of 6 patients who received Lu Dotatate therapy: 16% complete response (CR), 33% partial response (PR), 50% stable disease (SD).

 

Conclusion: Our Centre experience with Lu Dotatate received from a central radiopharmacy suggests that the labelled compound remains stable both in vivo and in vitro with good target delivery and effective clinical outcomes

Simeon Chinedu Aruah graduated in 2004 from University of Nigeria Nsukka (UNN) where he obtained MBBS Nigeria, and enrolled for residency training in Radiation Oncology at the National Hospital Abuja, Nigeria, qualified in 2014 and got inducted as a Fellow of West African College of Surgeons (FWACS) Radiation Oncology in March 2015. He won National Hospital Abuja Research Grant 2013 during his dissertation work. He has a Master’s degree in Public Health (MPH) from University of Nigeria Nsukka (UNN). He found an NGO Pathfinder Healthcare Foundation (PHF) to create cancer awareness among rural dwellers. He is currently working at the National Hospital Abuja, Nigeria as a Researcher and Consultant Radiation Oncologist with interest in Public Health

Introduction: Anemia is a common complication of myelo-suppressive chemotherapy. Severe anemia is usually treated with red blood cell transfusion, however, mild-to-moderate anemia most often are managed conservatively. There is no universally established benchmark of hemoglobin of patients selected for cancer chemotherapy to inform a global best practice and increase patients treatment outcome and quality of life.

 

Objective: The objective of this study is to examine the change in Hb level of cancer patients undergoing chemotherapy using serial Hb measurement.

 

Materials & Methods: A total of 100 voluntary patients with solid malignancies were recruited within a period of eight months. Baseline demographic characteristics and type of tumors were obtained. Pre-treatment Hb level was measured on first day of consultation and repeated every 2 weeks during the therapy until after three consecutive Hb readings.

 

Results & Analysis: Data collected was analyzed using SPSS version 10. Out of the 100 cancer patients, 88% were female. Breast 68% (68) was commonest site of tumour. Prevalence of anemia in the study was 72%, and majority of patients had their Hb at the end of therapy within the range of 9.60 g/dl to 10.62 g/dl. At P-value>0.05, there was no statistical significance on distribution of mean hemoglobin, standard deviation based on sex and treatment type.

 

Conclusion/Recommendation: Chemotherapy has no significant effect on Hb especially in patients with high baseline Hb level between 11 g/dl to 12 g/dl in our study. Prevalence of anemia in the studied patients was 72%. We recommend a benchmark of Hb of 11 g/dl minimum for any patient being selected for chemotherapy in Nigeria

Hamody Agbaria has completed his MSc from Beer-Sheva, Israel, Dept. of Physics, Faculty of Natural Sciences under the supervision of Prof. Ilana Bar with the title of thesis: "Studying Photodissociation of Molecules by Velocity Map Imaging of Ions via Electrostatic Lenses". He is pursuing his PhD in Ben-Gurion University of the Negev, under the supervision of Prof. Daniel H Rich, Prof. Shaul Mordechai and Prof. Mahmud Hulihel

Viral and bacterial infections are responsible for variety of diseases. These infections have similar symptoms. Thus, physicians may encounter difficulties in distinguishing between viral and bacterial infections based on these symptoms. Bacterial infections differ from viral infections in many other important respects regarding the response to various medications and the structure of the organisms. In many cases, it is difficult to know the origin of the infection. The physician orders a "culture test" methods to diagnose the infection type when it is necessary. Using these methods to diagnose the infection type is typically too long (> 24 hours). Blood was collected from 80 patients with confirmed viral infection and 80 with confirmed bacterial infection. White blood cells (WBCs) and plasma were isolated and deposited on a zinc selenide slide, dried and measured under a Fourier transform infrared (FTIR) microscope to obtain their infrared absorption spectra. The obtained spectra of WBCs and plasma were analyzed to differentiate between the two groups of infections. In this study, the potential of FTIR microscopy in tandem with multivariate analysis, was evaluated for the identification of the agent that causes the human infection during 20-30 minutes (including blood separation preparation). The differentiating between the investigated groups were obtained due to minute spectral changes in several bands of the FTIR spectra of WBCs. Employing feature extraction with linear discriminant analysis (LDA), a accuracy of ~92% and sensitivity of ~87% for infection type diagnosis was achieved. This study suggest that FTIR spectroscopy of WBCs is a feasible tool for the diagnosis of infection type

Ati Moncef is a student from the University Hospital, Algeria. His research interests include both Medical Physics and Nuclear Medicine Education. He has many publications, abstracts and presentations combined

Internal absorbed dose in kidneys in the case of bone scintigraphy studies has been estimated for 14 patients in two different groups with 20 patients in each group respectively. The first group is administrated with an activity equal to 20 mCi of 99mTc- MDA radiopharmaceutical. In the second group, patients are benefited with a protocol of optimization for the administrated activity under a range of (10 mCi to 19 mCi) was used as a function of the width for each patient. The measurement data in the

present study was acquired with an e-cam gamma camera under a Low Energy High Resolution (LEHR) collimator. Finally, results of the kidney organ absorbed dose were compared to the previous techniques. Our preliminary results suggest that the optimization protocol decreases the absorbed dose in the different organs by a factor that tends towards ~2. In another case, a good image quality obtained with the proposed optimization is compared to the standard administrated on the used activity. That may be the best radiation safety to patient and staff in the nuclear medicine studies

Poorya Heydari is pursuing her BS in Biomedical Engineering at Sahand University of Technology, Tabriz. His research interests include both Meidal Physics and cyberknife and tomotherapy Education. He has many publications, abstracts and presentations combined

Taking advantage of science and technology to improve human life is one of the best and most beautiful knowledge applications. In today's world there are humanitarian applications of high-tech knowledge in the whole world, especially the developed countries. In this case, the health and treatment field is so important. To use the increasing development of technology for the treatment of chronic diseases, many efforts have been made. Cancer is one among them. With several years of efforts by researchers and scientists, today a small number of patients lose their lives due to cancer. Creating advanced equipment such as Linear Accelerators for the non-invasive treatment of tumors is a great achievement to treatment of cancer. With the passage of time and researcher’s activities, high-tech equipment such as cyberknife and tomotherapy system, have come to help cancer patients. The advent of these equipment is so effective and successful step in the treatment of cancer. In this project addition of the cancer and the treatment options such as Brachytherapy, Gamma Knife, X-Knife, Radiotherapy and Stereotactic Radiosurgery, etc., tried to investigate completely the function principle of modern Radiation therapy system. As well as the Synchrony–Cyberknife Respiratory Technology, Monte Carlo Dose Calculation and Automated Patient Positioning System (RoboCouch) are such important parts of the project