By Hannah Denauer and Naomi Gitlin

For lung cancer patients, the simple act of breathing poses a challenge to successful radiation treatment. 

“Because the tumor is moving as the patient breathes, it’s like shooting at a moving target,” said John Roeske, PhD, the Bahman Emami, MD Endowed Professor, Department of Radiation Oncology, Stritch School of Medicine. 

With his National Cancer Institute grant-funded research on marker-less motion-tracking of lung cancer tumors using dual-energy (DE) imaging, Roeske set out in 2017 to address this problem and breathe new life into lung cancer treatment. As the Program Leader of the Cardinal Bernardin Cancer Center’s Radiation Oncology, Imaging, and Technology Program, Roeske’s research strives to merge clinical, basic science, and computational approaches to improve lung tumor control with DE imaging. 

“Dr. Roeske's research in DE imaging is so exciting because it has the rare potential to improve lung cancer targeting during radiation treatment and improve control of disease while also decreasing risk of side effects,” said Matthew Harkenrider, MD, associate professor and vice chair of Clinical Operations and Education, Department of Radiation Oncology, Stritch.  

With traditional chest x-rays, bones are visible, and tumors hidden behind bone are more difficult to see and treat. Roeske compares these tumors tucked behind bones to the sun hidden behind clouds. DE imaging allows Roeske to “part the clouds” and create visibility by taking an x-ray of the chest at two different energies, subtracting the bone to reveal the tumor hidden beneath. Just as removing the clouds allows someone to know “precisely where the sun is in the sky,” eliminating bone shows a tumor’s precise location.  

Typically, lung cancer treatment requires expanding the radiation field to account for the tumor’s motion as the patient breathes. However, in studies with phantoms (substitutes for human tissue), Roeske demonstrated the ability to identify and track tumors more accurately with DE imaging than with conventional radiation treatment. According to Roeske, DE imaging “may allow us to shrink the radiation field and reduce the volume of normal lung that is irradiated.” 

As the study transitioned from phantoms to patients, Roeske observed similar trends. Reviewing the first patient images was Roeske’s favorite moment of this study to date. 

“The phantoms are nice… but they don’t exactly represent human anatomy,” he said, describing how exciting it is to see the tumor revealed after the bone subtraction. In the next three to four years, Roeske and his lab, which includes postdoctoral fellows and other student mentees, want to incorporate this imaging technology directly into patient treatment. 

Early-stage lung cancer patients often receive stereotactic body radiotherapy (SBRT), a type of external beam radiation therapy that delivers high, focused doses of radiation. Since patients receive fewer but higher doses of radiation, it’s especially crucial to hit the tumor every time. By providing a clearer tumor image, DE imaging could help better target it and shrink the radiation field to prevent damage to healthy tissue. Roeske hopes that limiting the radiation field will help reduce complications such as radiation pneumonitis — a lung inflammation caused by radiation therapy.

Beyond Roeske’s three-to-four-year goals, his study’s larger vision: make DE imaging technology for lung-cancer-targeted therapy widely available worldwide. In the United States, more people die from lung cancer than any other cancer. Roeske carries this statistic with him as he works to improve cancer treatment, patient care, and survival rates. Working with Varian Medical Systems (a radiation therapy equipment manufacturer), Roeske hopes to realize his larger vision of improving outcomes to help patients and their families all breathe a little easier. 

A Brief Profile of Bahman Emami, MD

Loyola University Chicago’s Stritch School of Medicine recently honored Radiation Oncology Chair Emeritus Bahman Emami, MD, for establishing an Endowed Professorship in his name.  

"Dr Emami is one of the fathers of modern radiotherapy and it is a tremendous honor to have this endowed professorship in his name," said John C. Roeske, PhD, the inaugural recipient and professor, Radiation Oncology and Medical Physics.   

Throughout his distinguished career, Emami has made significant contributions to the field, as a scholar and clinician.  In 1991, he published the “Emami Paper,” recognized as one of the most seminal publications in the history of radiation oncology.  He has made an immeasurable impact caring for patients living with cancer and mentoring physicians-in-training, residents, colleagues, and staff.  Today, at the age of 80, he continues to be in demand as a speaker after lecturing throughout the globe.

Nearly 50 years ago, after completing his medical education and early training in Iran, Emami came to the U.S. and completed his residency at Boston’s Tufts University/New England Medical Center Hospital.  He moved to Washington University in St. Louis where he was instrumental in incorporating 3D Conformal Radiation Therapy, a treatment that allows physicians to direct radiation beams to conform to tumor shapes, minimizing the exposure of healthy tissue to radiation.  In 1996, he joined Loyola as professor and chair, Department of Radiation Oncology.   

His legacy at Loyola will prosper not only through this Endowed Professorship, but also through specific projects he completed during his tenure.  He oversaw a $4 million renovation of the Edward Hines, Jr. VA hospital clinic as well as the design and construction of the Department of Radiation Oncology at Loyola University Medical Center, which opened nearly 20 years ago.  Under Emami’s leadership, the Department received American College of Radiology accreditation in 2009.  To train the next generation, he created a formal residency curriculum.   

Among the various accolades Emami has received are fellowships in three professional societies.  He is the recipient of the prestigious Gold Medal from the American College of Radiation Oncology in recognition of his tremendous contributions to the field.  

“I have known Bahman since my early days of training, reading his work and truly inspired by his efforts,” said William Small, Jr., MD, professor and chair, Department of Radiation Oncology and director, Cardinal Bernardin Cancer Center, Stritch.    

“When I was contemplating the move to Loyola, Bahman was Loyola’s biggest cheerleader and tenacious recruiter.  He is a gracious and humble individual whose guidance and friendship has been invaluable,” said Small.  

June 2023