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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Prospectively registered

Titles & IDs
Public title
Investigating computed tomography ventilation as a functional imaging modality for lung cancer radiotherapy
Scientific title
Investigating computed tomography ventilation as a functional imaging modality for lung cancer radiotherapy in minimising radiation toxicity
Secondary ID [1] 280340 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Radiotherapy toxicity in lung cancer radiotherapy 286300 0
Condition category
Condition code
Cancer 286545 286545 0 0
Lung - Non small cell

Study type
Description of intervention(s) / exposure
This is a validation study of utilising respiratory correlated computed tomography (CT) imaging (e.g, four dimensional CT) in obtaining the distribution of lung ventilation. The CT ventilation imaging will be validated with the gold standard in ventilation imaging, nuclear medicine ventilation imaging. The study participants will undergo (1) a CT imaging session where a four dimensional CT, a static end-inspiration breath hold CT and an end-expiration breath hold CT will be acquired and (2) a nuclear medicine imaging session where a PET-Galligas (alternative will be SPECT-Technegas) ventilation scan will be acquired. The CT ventilation images will then be used to create a functional based radiotherapy treatment plan. A standard anatomical based treatment plan will also be created which the functional based treatment plan will be compared to. We will estimate the difference in dose to the functional lungs (toxicity) between the standard of care anatomical based treatment plan used in radiotherapy planning and the study's functional based treatment plans. Neither of these plans will be used in the any of the study participants' treatments. Summary of imaging scans to be collected per study participant: Two static breath hold CT scans one collected after inhalation and the other after exhalation, One four-dimensional-CT (4D-CT) scan, One Nuclear Medicine ventilation scan (PET-Galligas or SPECT-Technegas). All CT scans will be obtained on the same day in one session on a dual modality PET/CT machine taking approximately 1.5 hour in total to complete. These scans will be collected only once in the study. The static breath hold CT scans will require the patient to hold their breath for 20 seconds during the scan acquisition. Each of the static breath hold CT scans will take less than 1 minute to complete. The 4D-CT scan will take approximately 3 minutes to complete. The nuclear medicine scan will take approximately 15 minutes to complete. In all the scans outlined above the participant will be asked to lie on their back with their arms above their head for the duration the scans. All the scans will be acquired with the use of a respiratory regulator system called the Audiovisual Biofeedback system. The Audiovisual Biofeedback system requires the participant to wear electronic goggles which will display their breathing pattern in the shape of a wave and they will be guided to maintain regular breathing by following the wave pattern during the image acquisitions. The total dose received from all scans in study will be approximately 50 - 70 mSv. The study will be accrue 30 patients over the period of 3 years. This study is specifically aimed at lung cancer patients. As this is not a treatment based study and the data is collected in the treatment phase, the study is open to non-RT treated lung cancer patients, chemotherapy patients. Patients will fall into two groups, the majority of study patients will fall into the RT group (i.e., patients that are to be treated with RT) and a small number of patients will fall into the Non-RT group (i.e., patients treated with chemotherapy). RT Group: Stage I - IV Non-RT Group: Stage IIIB, IV (patients greater than or equal to 65 years old)
Intervention code [1] 284769 0
Diagnosis / Prognosis
Intervention code [2] 284771 0
Treatment: Other
Comparator / control treatment
A standard treatment plan (anatomical based) will be generated for each patient which will be compared to the functional based radiotherapy plan created using the CT ventilation images.
Control group

Primary outcome [1] 286977 0
The physiological accuracy of CT ventilation imaging. This is going to be assessed via an imaging voxel-based correlation study between CT ventilation images and the nuclear medicine ventilation images (PET-Galligas or SPECT-Technegas), where SPECT-Technegas is recognised as being the gold standard in ventilation imaging. Deformable image registration (DIR) algorithms will be used to optimise the CT ventilation images to best match the nuclear medicine ventilation image. A correlation criteria of atleast 0.8 will be sought if possible which will signify physiological accuracy.
Timepoint [1] 286977 0
Within 2 weeks of initial consultation from medical specialist (Respiratory Physicians or Radiation Oncologists) at Royal North Shore Hospital.
Secondary outcome [1] 297095 0
The dosimetric impact of CT ventilation imaging in radiotherapy. The mean dose to the functional lung regions for each treatment plan will be estimated and will be compared to the mean dose estimated from a standard anatomical based radiotherapy plan. We hypothesise that a significant reduction in dose will be achieved using functional based planning from CT ventilation imaging.
Timepoint [1] 297095 0
Anytime after imaging sessions are complete within the 3 yr time frame of the overall study duration.

Key inclusion criteria
This study is specifically aimed at lung cancer patients. Patients will fall into two groups, the majority of study patients will fall into the RT group (i.e, patients that are to be treated with radiotherapy) and a small number of patients will fall into the Non-RT group (i.e., patients that are not going to receive RT treatment and therefore will most probably be receiving chemotherapy).
RT Group: Stage I - IV patients treated with any type of RT
Non-RT group: Stage IIIB, IV (patients greater than or equal to 65 years old)

The ability to understand and willingness to sign a written informed consent document.
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
1. No pregnant women
2. children or young people <18 yrs
3.Curative intent patients for radiotherapy (other than SBRT treated)
4. Curative intent non-radiotherapy patients
5. No decisionally challenged individuals
6. People highly dependent on medical care

Study design
Purpose of the study
Allocation to intervention
Non-randomised trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Patients fitting the eligibility criteria will be identified by the treating physicians who are investigators in this study. The treating physicians will introduce the patients to the study. Interested patients will be referred to principal investigator who will provide further study information to patients including procedures and risks of study imaging scans. The patients will be given ample time to completely read the informed consent form and ask any questions. The patients will be contacted by the principal investigator with regards to their decision in partaking in the study. Patients that agree to partake in the study will be asked to sign an informed consent form at their next hospital visit.
The participant will receive a study enrolment number and this will be documented in the participant’s medical record and on all study documents. Patients who agree to participate will be contacted by principal investigator to organize times for to the study scans to be conducted.

Allocation of treatment: N/A
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?

Intervention assignment
Single group
Other design features
Phase 1
Type of endpoint(s)
Statistical methods / analysis

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)

Funding & Sponsors
Funding source category [1] 285119 0
Name [1] 285119 0
University of Sydney
Address [1] 285119 0
Radiation Physics Laboratory- Sydney Medical School
Room 475, Blackburn Building D06
Camperdown, NSW, 2006
Country [1] 285119 0
Primary sponsor type
University of Sydney
Radiation Physics Laboratory- Sydney Medical School
Room 475, Blackburn Building D06
Camperdown, NSW, 2006
Secondary sponsor category [1] 283975 0
Name [1] 283975 0
Royal North Shore Hospital
Address [1] 283975 0
Department of Radiation Oncology,
St Leanards, NSW, 2065
Country [1] 283975 0
Other collaborator category [1] 260746 0
Name [1] 260746 0
Stanford Cancer Center
Address [1] 260746 0
Radiation Physics Division
Department of Radiation Oncology
Stanford Cancer Center
1501 S California Ave, Rm 2415
Palo Alto
Country [1] 260746 0
United States of America
Other collaborator category [2] 260747 0
Commercial sector/Industry
Name [2] 260747 0
Philips Research Europe Hamburg
Address [2] 260747 0
Department of Digital Imaging
Rontgenstrasse 24-26
Country [2] 260747 0

Ethics approval
Ethics application status
Ethics committee name [1] 287135 0
Northern Health Human Research Ethics Committee
Ethics committee address [1] 287135 0
The Research Office, Level 13, Kolling Building
Royal North Shore Hospital, Pacific Hwy
St Leonards NSW 2065
Ethics committee country [1] 287135 0
Date submitted for ethics approval [1] 287135 0
Approval date [1] 287135 0
Ethics approval number [1] 287135 0

Brief summary
This study looks at whether we can obtain information about lung function (showing us areas of lung that work well and areas that do not) from a type of computed tomography scan (CT scan) known as four dimension computed tomography scan (4D-CT scan). Unlike other types of CT scans, 4D-CT scans have the potential to provide lung function information as well as the usual anatomical information. It is hoped that we can then include this lung function information in the planning of radiotherapy treatment to reduce the chances of irradiating the functioning lung areas. This has the potential to minimise side-effects.

4D-CT scans are mainly used for early stage lung cancer patients where it provides highly accurate anatomical information, however, we are testing its use in providing additional information, lung function information, for all stages of lung cancer. If this study shows that 4D-CT scans can provide accurate lung function information, it will be used for the treatment planning of all stages of lung cancer which will allow better treatment delivery and hopefully better treatment outcomes.

Who is it for?

You may be eligible for this study if you are 18 and over and have been diagnosed with lung cancer and scheduled or not scheduled for treatment with radiotherapy. Further inclusion details for this trial can be found in the Inclusion Criteria section of this form.

Trial details

This is a 30 lung cancer patient clinical imaging study in assessing the accuracy of a new type of imaging data from computed tomography (CT) known as CT ventilation imaging. Patients will undergo CT scans, data from which will be used to create a ventilation image which will be compared to their ventilation image acquired from a nuclear medicine scan, considered to be the 'gold standard'. If CT ventilation imaging is found to be physiologically accurate, its great advantage lies in its easy implementation in radiotherapy planning to minimise radiation induced lung toxicity.
Trial website
Trial related presentations / publications
T. Yamamoto, S. Kabus, J. von Berg, C. Lorenz and P. J. Keall, "Impact of four-dimensional computed tomography pulmonary ventilation imaging-based functional avoidance for lung cancer radiotherapy" Int. J. Radiat. Oncol. Biol. Phys. 79, 279-288 (2010).

T. Y. T. Yamamoto, S. Kabus, T. Klinder, C. Lorenz, J. von Berg, T. Blaffert, B. W. Loo and P. J. Keall, "Investigation of four-dimensional computed tomography-based pulmonary ventilation imaging in patients with emphysematous lung regions," Phys. Med. Biol. 56, 2279-2298 (2011).
Public notes

Principal investigator
Name 34076 0
Dr Enid Eslick
Address 34076 0
The University of Sydney
Radiation Physics Laboratory - Sydney Medical School Rm 475, Blackburn Building, D06 Camperdown, NSW, 2006
Country 34076 0
Phone 34076 0
+61 478 403 572
Fax 34076 0
+61 2 9351 4018
Email 34076 0
Contact person for public queries
Name 17323 0
Dr Enid Eslick
Address 17323 0
Radiation Physics Laboratory - Sydney Medical School
Rm 475, Blackburn Building, D06
Camperdown, NSW, 2006
Country 17323 0
Phone 17323 0
+61 478 403 572
Fax 17323 0
Email 17323 0
Contact person for scientific queries
Name 8251 0
Dr Enid Eslick
Address 8251 0
Radiation Physics Laboratory - Sydney Medical School
Rm 475, Blackburn Building, D06
Camperdown, NSW, 2006
Country 8251 0
Phone 8251 0
+61 478 403572
Fax 8251 0
Email 8251 0

No information has been provided regarding IPD availability
Summary results
No Results