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The status quo of global geriatric radiation oncology education: A scoping review 全球老年放射肿瘤学教育的现状:范围审查
Q1 Nursing Pub Date : 2024-11-10 DOI: 10.1016/j.tipsro.2024.100288
Lucinda Morris , Sandra Turner , Jane L. Phillips , Anamika Parmar , Meera Agar

Purpose

To identify potential gaps in geriatric radiation oncology (RO) education worldwide, as measured by geriatric oncology (GO) content within postgraduate RO training program (TP) curricula across 8 focus countries.

Methods and materials

The need for improved education around GO is internationally recognized and is a key strategic priority of the International Society of Geriatric Oncology (SIOG).
Two reviewers undertook a systematic scoping review from March to September 2023. Focus countries were selected using predefined selection criteria based on national radiation therapy (RT) service provision, RT access and post-graduate specialty training standards. This review is in accordance with evidence-based curriculum design methodology and represents the initial phase i.e., problem identification and needs assessment.

Results

Overall RO TP and curriculum elements varied by jurisdiction. Common elements included length of training, summative assessments and prerequisite requirements. Considerable variability exists across TPs around identified learning outcomes, content, TP organization, training networks and accreditation.
Across 6 TPs, only 2 had any documented GO curriculum content. Of these, only one contained geriatric RO content scoring moderate to high based on accepted quality benchmarks. Outside official RO TPs, there is considerable GO online education content, including face to face courses, peer-reviewed articles, learning materials and resources relevant to RO postgraduate training worldwide. However accessibility to these learning interventions may be region specific and content is not standardized.

Conclusions

As expected, this systematic scoping review has identified significant gaps in GO education within RO TPs worldwide. These findings represent an essential step in the development of evidence-based recommendations for updating standards for GO training within RO training programs and establishing a globally accepted, standardized benchmarks for minimal geriatric RO education. In turn, this will ensure future radiation oncologists are able to deliver a high standard of care to and improve outcomes for older people with cancer.
目的根据8个重点国家的放射肿瘤学研究生培训计划(TP)课程中的老年肿瘤学(GO)内容,确定全球老年放射肿瘤学(RO)教育的潜在差距。方法和材料围绕老年肿瘤学改进教育的必要性已得到国际公认,并且是国际老年肿瘤学会(SIOG)的一项关键战略重点。根据国家放射治疗(RT)服务提供情况、放射治疗普及率和研究生专业培训标准,采用预定义的选择标准选定了重点国家。本次审查符合循证课程设计方法,是问题识别和需求评估的初始阶段。共同要素包括培训时间、终结性评估和前提要求。在 6 个培训方案中,只有 2 个有记录的全球老年医学课程内容。在 6 个培训课程中,只有 2 个有记录的 GO 课程内容,其中只有一个包含老年 RO 内容,根据公认的质量基准,得分在中等到高等之间。在官方的 RO 培训课程之外,还有大量的 GO 在线教育内容,包括面对面课程、同行评审文章、学习材料以及与全球 RO 研究生培训相关的资源。然而,这些学习干预措施的可及性可能因地区而异,而且内容也没有标准化。这些发现代表了在制定循证建议方面迈出的重要一步,这些建议旨在更新区域放射治疗培训计划中的全球放射治疗培训标准,并为最低限度的老年区域放射治疗教育建立全球公认的标准化基准。反过来,这将确保未来的放射肿瘤学家能够为老年癌症患者提供高标准的治疗,并改善治疗效果。
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引用次数: 0
A systematic review of prostate bed motion and anisotropic margins in post-prostatectomy external beam radiotherapy 前列腺切除术后体外放射治疗中前列腺床运动和各向异性边缘的系统性综述
Q1 Nursing Pub Date : 2024-10-29 DOI: 10.1016/j.tipsro.2024.100287
T. Hodgins, E. Forde

Background

Prostate bed (PB) motion may lead to geographical miss of the target volume in post-prostatectomy radiotherapy (RT). Optimal clinical target volume (CTV) to planning target volume (PTV) margins prevent geographical miss and unnecessary irradiation of normal tissue. There is little data available informing appropriate CTV to PTV margins in the post-prostatectomy setting. The purpose of this review was to quantify the inter-fraction and intra-fraction motion of the PB and draw a conclusion regarding the use of anisotropic CTV to PTV margins for post-prostatectomy RT treatment.

Methodology

A search of PubMed and EMBASE databases was carried out using keywords (prostate bed [Title/Abstract]) AND (motion [Title/Abstract]). All study types assessing inter-fraction and/or intra-fraction motion of the PB based on imaging of soft tissue anatomy were included. Data on patient preparation, immobilisation, and image guidance was abstracted from the included studies. Magnitude of PB motion along with the estimated CTV to PTV margins calculated was also tabulated. Quality of studies was assessed using the MINORS tool.

Results

Seventeen studies were included in the analysis. The largest magnitude of inter-fraction PB motion occurs in the anterior-posterior direction. This motion is attributed to the influence of the bladder and rectal volume on the PB. The PB moves independently of bone and the magnitude of motion varies between the superior and inferior portions of the prostate bed.

Conclusion

Anisotropic CTV to PTV margins are appropriate for use in the post-prostatectomy setting and their implementation for treatment planning purposes are warranted based on the evidence reviewed.
背景前列腺床(PB)的移动可能会导致前列腺切除术后放疗(RT)靶体积的地理遗漏。最佳的临床靶体积(CTV)与计划靶体积(PTV)边缘可防止地理漏诊和对正常组织的不必要照射。关于前列腺切除术后适当的 CTV 至 PTV 边界,目前可用的数据很少。本综述旨在量化前列腺床的分段间和分段内运动,并就前列腺切除术后 RT 治疗中使用各向异性的 CTV 至 PTV 边界得出结论。所有基于软组织解剖学成像评估前列腺腺床分段间和/或分段内运动的研究类型均被纳入其中。从纳入的研究中抽取有关患者准备、固定和图像引导的数据。PB 运动的幅度以及计算出的估计 CTV 到 PTV 边界也被制成表格。研究质量采用 MINORS 工具进行评估。在前后方向上,分段间 PB 运动的幅度最大。这种运动归因于膀胱和直肠容积对 PB 的影响。结论各向异性的 CTV 至 PTV 边界适合用于前列腺切除术后的治疗,根据所回顾的证据,有必要将其用于治疗规划。
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引用次数: 0
International virtual radiation therapy professional development: Reflections on a twinning collaboration between a low/middle and high income country 国际虚拟放射治疗专业发展:中低收入国家与高收入国家结对合作的思考
Q1 Nursing Pub Date : 2024-10-28 DOI: 10.1016/j.tipsro.2024.100285
Nicole Harnett , Wongel Bekalu , Eskadmas Yinesu , Edom Seife Woldetsadik , Rebecca Wong
In response to the documented challenges to providing adequate radiotherapy services to its population, the Ethiopian government has embarked on a plan to augment such services. In tandem with the need for the required equipment is the need for qualified staff for its safe operation. Twinning collaborations between low (LIC) and high income countries (HIC) have been proven effective for improving health care services and outcomes. In this short communication, organizers of a virtual professional development program for radiation therapy staff, from Tikur Anbessa Specialized Hospital (Ethiopia, LIC) and Princess Margaret Cancer Centre (Canada, HIC) reflect on the experience and suggest ideas for increasing value and impact.
为了应对在为民众提供充分的放射治疗服务方面所面临的有据可查的挑战,埃塞俄 比亚政府已着手实施一项扩大此类服务的计划。在需要所需设备的同时,还需要合格的工作人员来保证设备的安全运行。事实证明,低收入国家(LIC)和高收入国家(HIC)之间的结对合作能够有效改善医疗服务和医疗成果。在这篇简短的通讯中,来自 Tikur Anbessa 专科医院(埃塞俄比亚,低收入国家)和玛格丽特公主癌症中心(加拿大,高收入国家)的放射治疗人员虚拟职业发展项目组织者回顾了这一经验,并提出了提高价值和影响力的建议。
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引用次数: 0
A code orange for traffic-light-protocols as a communication mechanism in IGRT 将交通灯协议作为 IGRT 通信机制的橙色代码
Q1 Nursing Pub Date : 2024-10-28 DOI: 10.1016/j.tipsro.2024.100286
Dylan Callens , Rob De Haes , Jan Verstraete , Patrick Berkovic , An Nulens , Truus Reynders , Maarten Lambrecht , Wouter Crijns

Introduction

Traffic-light protocols (TLPs) use color codes to standardize image registration and improve interdisciplinary communication in IGRT. Generally, green indicates no relevant anatomical changes, orange signals changes requiring follow-up but does not compromise the current fraction, and red flags unacceptable changes. This study examines the communication aspect, specifically the reporting accuracy for locally advanced non-small-cell lung cancer (LA-NSCLC), and identifies barriers to reporting.

Materials & Methods

We conducted a retrospective study on 1997 CBCTs from 74 LA-NSCLC patients. Each scan was in retrospect assessed blinded using the tailored TLP by an IGRT-RTT and subsequently by a second RTT for a subset of fractions. The assessment included both CBCTs from current clinical practice (TLP2023) and from the TLP implementation period (TLP2019). Accuracy of image registration was not evaluated. Reporting barriers were identified through focus group discussions with RTTs.

Results

During TLP2023, 22 of the 63 (35%) patients received at least one code orange during therapy, with 2 of them having a systematic code orange, totaling 43 (2%) fractions with at least one code orange. The IGRT-RTT assigned code orange or red in 59 (94%) patients, 38 (60%) of which had systematic codes orange. In total, the IGRT-RTT reported 684 (40%) fractions with code orange and 13 with code red. During TLP2019, similar numbers are observed. In the subset reviewed by two IGRT-RTTs, reports matched in 77% of cases. Various factors contribute to a low reporting rate, originating both during the decision-making process such as lack of online reporting tools and within offline processes such as divergent feedback expectations.

Conclusion

While our TLP has successfully promoted the widespread adoption of CBCT-based RTT-led IGRT, it has not succeeded in establishing interdisciplinary communication. Our study reveals significant underreporting of flagged LA-NSCLC fractions in clinical practice using a TLP. This underreporting stems from multifactorial origins.
导言交通灯协议(TLP)使用颜色代码来规范图像登记并改善 IGRT 的跨学科交流。一般来说,绿色表示没有相关的解剖变化,橙色表示需要随访但不影响当前分数的变化,红色表示不可接受的变化。本研究探讨了沟通方面的问题,特别是局部晚期非小细胞肺癌(LA-NSCLC)的报告准确性,并找出了报告的障碍。每次扫描都由一名 IGRT-RTT 使用定制的 TLP 进行盲法评估,随后由第二名 RTT 对部分分数进行评估。评估包括当前临床实践中的 CBCT(TLP2023)和 TLP 实施期间的 CBCT(TLP2019)。未对图像登记的准确性进行评估。结果在TLP2023期间,63名患者中有22名(35%)在治疗过程中至少收到一次橙色代码,其中2名患者收到系统性橙色代码,总共有43个(2%)分段收到至少一次橙色代码。IGRT-RTT为59例(94%)患者分配了橙色或红色代码,其中38例(60%)有系统性橙色代码。IGRT-RTT 总共报告了 684 次(40%)有橙色代码的分次,13 次有红色代码。在 TLP2019 期间,也观察到了类似的数字。在两个 IGRT-RTT 审查的子集中,77% 的病例报告相符。导致报告率低的因素有很多,既有决策过程中的因素,如缺乏在线报告工具,也有离线过程中的因素,如对反馈的不同期望。我们的研究揭示了在临床实践中使用 TLP 时对标记的 LA-NSCLC 分数的严重漏报。这种漏报源于多种因素。
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引用次数: 0
On the trail of CBCT-guided adaptive rectal boost radiotherapy, does daily delineation require a radiation oncologist? 在 CBCT 引导的自适应直肠提升放疗过程中,日常划线是否需要放射肿瘤专家?
Q1 Nursing Pub Date : 2024-10-22 DOI: 10.1016/j.tipsro.2024.100284
Julien Pierrard , David Dechambre , Christel Abdel Massih , Sophie Cvilic , Ana Da Silva Chambel Roma , Pascale Henderickx , Sofie Heylen , Eleonore Longton , Romain Mony , Mohamed Amine Tenabene , Thaïs Tison , Ad Vandermeulen , Loïc Vander Veken , Aniko Wale Etume , Anne-Emmanuella Yeo , Geneviève Van Ooteghem

Introduction

Dose-escalation radiotherapy for rectal tumours is increasingly considered as a non-operative approach, with online-adaptive radiotherapy (oART) supporting this approach by correcting inter-fraction tumour position errors. However, using cone-beam computed tomography (CBCT)-guided oART requires daily target volume delineation by different operators, leading to inter-operator delineation variability and potential dosimetric issues. This study aims to compare and quantify the inter-operator and inter-professional delineation variability of the rectal boost volume on CBCT, including volumes by an automatically delineated oART treatment planning system.

Materials and methods

A rectal boost volume, defined as the primary tumour extended to the entire adjacent rectal wall, was delineated on 10 CBCTs from 5 patients by 15 operators: 4 expert radiation oncologists (ROs), 4 radiation therapists (RTTs) and 7 non-expert ROs. These contours were compared between the different professional groups. A comparison to the average volume of the group (ROs, RTTs, or non-expert ROs) with the lowest delineation variability was also performed for each individual volume including the volume automatically generated by an oART treatment planning system.

Results

Delineation variability was the highest in the superior (range: 2.3–6.0 mm), and inferior (2.3–12.4 mm) directions, compared to the left (0.2–4.4 mm), right (0.3–2.0 mm), anterior (0.1–2.9 mm), and posterior (0.5–4.0 mm) directions. Non-expert ROs, RTTs, and automatic oART volume showed similar ranges of delineation errors when compared to the expert ROs’ volume, which was chosen as reference volume since this professional group showed the lowest variability.

Discussion

Expert ROs showed consistent results. Other professional groups exhibit similar variability, comparable to the automatic oART volume. Therefore, RTTs could safely perform the rectal boost delineation without non-expert ROs supervision in the absence of expert ROs during CBCT-based oART. Moreover, these findings provide quantitative data to compute accurate margins for the rectal boost planning target volume in a CBCT-guided oART workflow.
导言:直肠肿瘤的剂量递增放疗越来越多地被认为是一种非手术治疗方法,而在线自适应放疗(oART)通过纠正分次间肿瘤位置误差来支持这种方法。然而,使用锥束计算机断层扫描(CBCT)引导的 oART 需要不同操作者每天进行靶区划分,从而导致操作者之间的划分差异和潜在的剂量学问题。本研究旨在比较并量化 CBCT 上直肠增量的操作者间和专业间划定差异,包括由自动划定的 oART 治疗计划系统划定的体积。材料与方法15 名操作者在 5 名患者的 10 张 CBCT 上划定了直肠增量,定义为原发肿瘤扩展到整个邻近直肠壁:15名操作者包括4名放射肿瘤专家(RO)、4名放射治疗专家(RTT)和7名非放射肿瘤专家。这些轮廓在不同专业组之间进行了比较。此外,还对每个单个容积(包括 oART 治疗计划系统自动生成的容积)与划线变异性最小的组别(放射治疗专家、放射治疗技师或非放射治疗专家)的平均容积进行了比较。结果 与左侧(0.2-4.4 毫米)、右侧(0.3-2.0 毫米)、前侧(0.1-2.9 毫米)和后侧(0.5-4.0 毫米)相比,上侧(范围:2.3-6.0 毫米)和下侧(2.3-12.4 毫米)方向的划线变异性最高。与专家ROs的容积相比,非专家ROs、RTTs和自动oART容积显示出相似的划线误差范围,由于该专业组显示出最低的变异性,因此选择专家ROs的容积作为参考容积。其他专业群体也表现出类似的变异性,与自动光学显微镜的体积相当。因此,在基于 CBCT 的 oART 过程中,如果没有专家 RO,RTT 可以在没有非专业 RO 监督的情况下安全地进行直肠隆突划定。此外,这些研究结果为在 CBCT 引导的 oART 工作流程中计算直肠提升规划目标体积的精确边缘提供了定量数据。
{"title":"On the trail of CBCT-guided adaptive rectal boost radiotherapy, does daily delineation require a radiation oncologist?","authors":"Julien Pierrard ,&nbsp;David Dechambre ,&nbsp;Christel Abdel Massih ,&nbsp;Sophie Cvilic ,&nbsp;Ana Da Silva Chambel Roma ,&nbsp;Pascale Henderickx ,&nbsp;Sofie Heylen ,&nbsp;Eleonore Longton ,&nbsp;Romain Mony ,&nbsp;Mohamed Amine Tenabene ,&nbsp;Thaïs Tison ,&nbsp;Ad Vandermeulen ,&nbsp;Loïc Vander Veken ,&nbsp;Aniko Wale Etume ,&nbsp;Anne-Emmanuella Yeo ,&nbsp;Geneviève Van Ooteghem","doi":"10.1016/j.tipsro.2024.100284","DOIUrl":"10.1016/j.tipsro.2024.100284","url":null,"abstract":"<div><h3>Introduction</h3><div>Dose-escalation radiotherapy for rectal tumours is increasingly considered as a non-operative approach, with online-adaptive radiotherapy (oART) supporting this approach by correcting inter-fraction tumour position errors. However, using cone-beam computed tomography (CBCT)-guided oART requires daily target volume delineation by different operators, leading to inter-operator delineation variability and potential dosimetric issues. This study aims to compare and quantify the inter-operator and inter-professional delineation variability of the rectal boost volume on CBCT, including volumes by an automatically delineated oART treatment planning system.</div></div><div><h3>Materials and methods</h3><div>A rectal boost volume, defined as the primary tumour extended to the entire adjacent rectal wall, was delineated on 10 CBCTs from 5 patients by 15 operators: 4 expert radiation oncologists (ROs), 4 radiation therapists (RTTs) and 7 non-expert ROs. These contours were compared between the different professional groups. A comparison to the average volume of the group (ROs, RTTs, or non-expert ROs) with the lowest delineation variability was also performed for each individual volume including the volume automatically generated by an oART treatment planning system.</div></div><div><h3>Results</h3><div>Delineation variability was the highest in the superior (range: 2.3–6.0 mm), and inferior (2.3–12.4 mm) directions, compared to the left (0.2–4.4 mm), right (0.3–2.0 mm), anterior (0.1–2.9 mm), and posterior (0.5–4.0 mm) directions. Non-expert ROs, RTTs, and automatic oART volume showed similar ranges of delineation errors when compared to the expert ROs’ volume, which was chosen as reference volume since this professional group showed the lowest variability.</div></div><div><h3>Discussion</h3><div>Expert ROs showed consistent results. Other professional groups exhibit similar variability, comparable to the automatic oART volume. Therefore, RTTs could safely perform the rectal boost delineation without non-expert ROs supervision in the absence of expert ROs during CBCT-based oART. Moreover, these findings provide quantitative data to compute accurate margins for the rectal boost planning target volume in a CBCT-guided oART workflow.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Best practice in radiation oncology: A project to train the trainers: Review of 2008–2023 放射肿瘤学的最佳实践:培训培训师的项目:2008-2023 年回顾
Q1 Nursing Pub Date : 2024-10-19 DOI: 10.1016/j.tipsro.2024.100281
Mary Coffey , Colleen Dickie , Elena Fidarova , Velimir Karadža , Philipp Scherer , Michelle Leech
The European Society of Radiotherapy and Oncology (ESTRO) and the International Atomic Energy Agency (IAEA) project on ‘best practice in radiation oncology: a project to train the radiation therapist trainers’ commenced in 2008.
The aim of the project was to influence education programmes throughout, mainly, eastern Europe to increase the radiation therapy-specific education of their programmes. This is to enable graduates of these programmes to be radiation therapists that are fit for purpose in the clinic. This paper provides an update on the successes of the project to date, the challenges that remain and the new approaches to project delivery by the faculty over this period.
欧洲放射治疗与肿瘤学会(ESTRO)和国际原子能机构(IAEA)的 "放射肿瘤学最佳实践:放射治疗师培训项目 "于 2008 年启动。该项目的目的是影响主要是东欧地区的教育课程,增加其课程中针对放射治疗的教育内容,从而使这些课程的毕业生成为能够胜任临床工作的放射治疗师。本文介绍了该项目迄今为止所取得的成功、面临的挑战以及在此期间教员们在项目实施方面所采取的新方法。
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引用次数: 0
ASPRONET: A facilitated online education project for radiation therapists in the Asia-Pacific region ASPRONET:亚太地区放射治疗师在线教育项目
Q1 Nursing Pub Date : 2024-10-18 DOI: 10.1016/j.tipsro.2024.100283
Craig Opie , Aidan Leong , Chetana Vartak , Iain Ward , Sandra Ndarukwa
In 2019, the International Atomic Energy Agency approved a technical co-operation project, aimed at supporting clinical decision making and continuing professional education of radiation oncologists, medical physicists and radiation therapists (RTs) in Low-and-Middle Income Countries (LMICs) in the Asia Pacific region. From this, the Asia-Pacific Radiation Oncology Network (ASPRONET) was formed in 2020. An RT co-ordination group administered 16 online, one-hour seminars between December 2021 and November 2023 for an RT audience. Analysis of online registration and attendance data from each seminar was used to co-ordinate group review meetings, improve seminar proceedings, and promote attendance and engagement. 772 attendees from 20 different countries were recorded in total across the seminars. Gathered data and observations indicated the success of the seminars and supported their continuation.
2019 年,国际原子能机构批准了一个技术合作项目,旨在支持亚太地区中低收入国家(LMICs)的放射肿瘤学家、医学物理学家和放射治疗师(RTs)的临床决策和继续职业教育。在此基础上,亚太放射肿瘤学网络(ASPRONET)于 2020 年成立。2021 年 12 月至 2023 年 11 月期间,一个 RT 协调小组为 RT 受众举办了 16 场在线研讨会,每次一小时。通过分析每次研讨会的在线注册和出席数据,协调小组审查会议,改进研讨会程序,提高出席率和参与度。根据记录,共有来自 20 个不同国家的 772 人参加了各次研讨会。收集的数据和观察结果表明,研讨会取得了成功,并支持继续举办下去。
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引用次数: 0
A data-driven approach to solve the RT scheduling problem 解决 RT 调度问题的数据驱动方法
Q1 Nursing Pub Date : 2024-10-15 DOI: 10.1016/j.tipsro.2024.100282
Mruga Gurjar , Jesper Lindberg , Thomas Björk-Eriksson , Caroline Olsson

Introduction

There is an increase in demand for Radiotherapy (RT) and it is a time critical treatment with a complex scheduling process. RT workflow is inter-dependent and involves various steps including pre-treatment and treatment-related tasks which adds to these challenges. Globally, scheduling delays are reported as one of the most common issues in RT. We aim to create and evaluate an automated strategy which generates a patient allocation list to assist the scheduling staff to create an efficient scheduling process.

Methods and Materials

We used historical data from a large RT department in Sweden from January to December 2022 with 11–13 operational linear accelerators. The algorithm was developed in C# language. It utilizes patient and treatment-related characteristics including the patient timeline (referral date, preferred treatment start dates), booking category, diagnosis group and intent. Based on this, the algorithm assigns patient priority individually.

Results

The algorithm’s output resulted in a scheduling list sorted by high to low patient priority per week. We evaluated the algorithm with historical manual allocations from the same year. The comparison between manual and algorithm allocations showed that the number of delayed patients reduced by 10 % in the algorithm suggestion with an average delay reduction of 2 weeks. Furthermore, the focus on patient-related characteristics resulted in diagnosis groups being better balanced.

Conclusion

The algorithm’s ability to produce quick results may save significant time that the scheduling staff otherwise need to assess individual patient profiles. RT departments can incorporate such algorithms to accelerate their scheduling decisions and enhance their overall scheduling performance before going through major organizational changes.
导言放疗(RT)的需求不断增加,它是一种时间紧迫、调度过程复杂的治疗方法。放疗工作流程相互依赖,涉及各种步骤,包括治疗前和治疗相关任务,这增加了这些挑战。据报道,全球范围内,排程延误是 RT 中最常见的问题之一。我们的目标是创建并评估一种自动生成患者分配列表的策略,以协助排班人员创建高效的排班流程。方法和材料我们使用了瑞典一个大型 RT 部门 2022 年 1 月至 12 月的历史数据,该部门有 11-13 台运行中的直线加速器。该算法使用 C# 语言开发。它利用了患者和治疗相关的特征,包括患者时间轴(转诊日期、首选治疗开始日期)、预约类别、诊断组和意向。在此基础上,该算法逐一分配患者的优先级。结果该算法的输出结果是每周按患者优先级从高到低排序的排班列表。我们将该算法与同年的历史手动分配进行了评估。人工排班与算法排班的比较结果表明,算法排班的延误病人数量减少了 10%,平均延误时间减少了 2 周。此外,对患者相关特征的关注使诊断组之间更加平衡。在进行重大组织变革之前,急诊科可以采用这种算法来加快排班决策,提高整体排班绩效。
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引用次数: 0
Interstitial brachytherapy for periocular nonmelanoma skin cancers: Impact on organ and function preservation 治疗眼周非黑色素瘤皮肤癌的间质近距离放射治疗:对器官和功能保存的影响
Q1 Nursing Pub Date : 2024-10-04 DOI: 10.1016/j.tipsro.2024.100280
Ashwini Budrukkar , Maneesh Singh , Monali Swain , Sarbani Ghosh Laskar , Vedang Murthy , Shrikant Kale , Rituraj Upreti , Shwetabh Sinha , Anuj Kumar , Samarpita Mohanty , Tejpal Gupta , Jai Prakash Agarwal

Purpose

To study the local control, toxicity, organ and functional preservation and cosmetic outcomes after interstitial brachytherapy for periocular nonmelanoma skin cancers.

Methods and Materials

Patients with skin cancers of upper and lower eyelid, medial and lateral canthus and the infra-orbital region treated with high dose rate (HDR) interstitial brachytherapy (ISBT) using 192-Iridium (192Ir) between December 2010 and July 2022 were included and data collected from a prospectively maintained database. Local control, survival outcomes, acute and late RTOG toxicity, functional and cosmetic outcomes were analysed.

Results

Sixteen patients were included. Nine patients had lower eyelid tumors, 5 patients had tumors in canthi and two patients had skin tumor in the infra-orbital region. The median dose for definitive ISBT was 49 Gy in 14 fractions. After a median follow up of 73 months, all patients treated with definitive and adjuvant ISBT were locally controlled. Three of the four patients who received salvage ISBT for post-surgical failure had local recurrences and all were effectively managed with salvage re-surgery. Of the two deaths, none were disease related. Organ and function preservation was achieved in 15 (93.7 %) and 13 (81.2 %), respectively, with one patient being lost to follow up. Excellent, good, fair and poor cosmesis was seen in 6 (40 %) patients, 6 (40 %) patients, 2 (14 %) patients and 1(6 %) patient, respectively.

Conclusion

HDR-ISBT was safe and effective for skin tumors around the eye and resulted in excellent local control and survival outcomes preserving organ and function in majority of patients with good-excellent cosmesis.
方法和材料纳入2010年12月至2022年7月期间使用192-铱(192Ir)进行高剂量率(HDR)间质近距离放射治疗(ISBT)的上下眼睑、内侧和外侧眦部以及眶下区皮肤癌患者,并从前瞻性维护的数据库中收集数据。对局部控制、生存结果、急性和晚期 RTOG 毒性、功能和美容结果进行了分析。9名患者为下眼睑肿瘤,5名患者为蝶窦肿瘤,2名患者为眶下皮肤肿瘤。最终ISBT的中位剂量为49 Gy,分14次进行。中位随访时间为 73 个月,所有接受最终和辅助 ISBT 治疗的患者均得到了局部控制。因手术后失败而接受 ISBT 挽救治疗的四名患者中,有三名出现了局部复发,他们都通过挽救性再手术得到了有效控制。两例死亡病例均与疾病无关。分别有 15 名(93.7%)和 13 名(81.2%)患者的器官和功能得到了保留,其中一名患者失去了随访机会。结论HDR-ISBT治疗眼周皮肤肿瘤安全有效,局部控制和生存效果极佳,大多数患者的器官和功能得以保留,外观良好。
{"title":"Interstitial brachytherapy for periocular nonmelanoma skin cancers: Impact on organ and function preservation","authors":"Ashwini Budrukkar ,&nbsp;Maneesh Singh ,&nbsp;Monali Swain ,&nbsp;Sarbani Ghosh Laskar ,&nbsp;Vedang Murthy ,&nbsp;Shrikant Kale ,&nbsp;Rituraj Upreti ,&nbsp;Shwetabh Sinha ,&nbsp;Anuj Kumar ,&nbsp;Samarpita Mohanty ,&nbsp;Tejpal Gupta ,&nbsp;Jai Prakash Agarwal","doi":"10.1016/j.tipsro.2024.100280","DOIUrl":"10.1016/j.tipsro.2024.100280","url":null,"abstract":"<div><h3>Purpose</h3><div>To study the local control, toxicity, organ and functional preservation and cosmetic outcomes after interstitial brachytherapy for periocular nonmelanoma skin cancers.</div></div><div><h3>Methods and Materials</h3><div>Patients with skin cancers of upper and lower eyelid, medial and lateral canthus and the infra-orbital region treated with high dose rate (HDR) interstitial brachytherapy (ISBT) using 192-Iridium (<sup>192</sup>Ir) between December 2010 and July 2022 were included and data collected from a prospectively maintained database. Local control, survival outcomes, acute and late RTOG toxicity, functional and cosmetic outcomes were analysed.</div></div><div><h3>Results</h3><div>Sixteen patients were included. Nine patients had lower eyelid tumors, 5 patients had tumors in canthi and two patients had skin tumor in the infra-orbital region. The median dose for definitive ISBT was 49 Gy in 14 fractions. After a median follow up of 73 months, all patients treated with definitive and adjuvant ISBT were locally controlled. Three of the four patients who received salvage ISBT for post-surgical failure had local recurrences and all were effectively managed with salvage re-surgery. Of the two deaths, none were disease related. Organ and function preservation was achieved in 15 (93.7 %) and 13 (81.2 %), respectively, with one patient being lost to follow up. Excellent, good, fair and poor cosmesis was seen in 6 (40 %) patients, 6 (40 %) patients, 2 (14 %) patients and 1(6 %) patient, respectively.</div></div><div><h3>Conclusion</h3><div>HDR-ISBT was safe and effective for skin tumors around the eye and resulted in excellent local control and survival outcomes preserving organ and function in majority of patients with good-excellent cosmesis.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
From novice to Expert: Reducing Breast Imaging rejection rates through physician mentorship in Advanced Practice Radiation therapy 从新手到专家:通过高级放射治疗实践中的医生指导降低乳腺成像拒绝率
Q1 Nursing Pub Date : 2024-09-29 DOI: 10.1016/j.tipsro.2024.100279
Clodagh Starrs , Sima Rabinowitz , Erin Moshier , Sheryl Green

Purpose

The study’s goal was to evaluate the impact of a Radiation Oncologist (RO)—Radiation Therapist (RTT) mentorship on image approval rates for a breast population undergoing radiation therapy in a high-volume practice. The mentorship was undertaken within a large health system in partial fulfillment of the Expert Practice Module for a Masters (MSc) in Advanced Practice Radiotherapy and Oncology.

Methods

Images were retrieved from the MOSAIQ EMR on breast diagnostic code. 1,295 images/115 patients were reviewed pre-mentorship (October 2019-March 2020) and compared with 1,047 images/91patients during/post-mentorship (April 2020-September 2020). The Anderson-Gill (AG) model was used to estimate the hazard ratio for image rejection. Rejected images were classified by reason and compared using Fisher’s exact test. Concordance data (RO/RTT image rejection) were collected during Phase Three of the mentorship.

Results

Of 115 patients assessed pre-mentorship, 16 (14 %) had at least 1 image rejected at any session. Of 91 patients assessed post-mentorship, 8 (9 %) had at least 1 image rejected. Likelihood of image rejection decreased by 54 %, with a hazard ratio of 0.46 [95 % CI: 0.24, 0.88]; p = 0.0195. Reasons for image rejection differed pre- and post-mentorship. Poor imaging technique accounted for rejection of 9 of 24 images (37.5 %) before compared to 0 of 11 images (0 %) post-mentorship. Other reasons for image rejection: depth at isocenter (25 % pre-mentorship; 18 % post-mentorship), supraclavicular medial border position (12.5 % vs. 9.09 %), isocenter location (12.5 % vs. 0 %), arm position (4.17 % vs. 54.55 %); hip alignment (8.33 % vs. 18.18 %). Concordance rate was 100 %.

Conclusions

The mentorship proved successful in elevating the RTT’s skills and image approval rates, while contributing to improvements in departmental imaging best practices.
目的 该研究旨在评估放射肿瘤学家(RO)-放射治疗师(RTT)导师制对接受放射治疗的大量乳腺患者的图像批准率的影响。这项指导工作是在一个大型医疗系统内进行的,部分完成了放射治疗和肿瘤学高级实践硕士(MSc)的专家实践模块。对导师指导前(2019 年 10 月至 2020 年 3 月)的 1,295 张图像/115 名患者进行了审查,并与导师指导期间/后(2020 年 4 月至 2020 年 9 月)的 1,047 张图像/91 名患者进行了比较。安德森-吉尔(Anderson-Gill,AG)模型用于估算图像拒绝的危险比。根据拒收原因对拒收图像进行分类,并使用费雪精确检验进行比较。结果 在接受指导前评估的 115 名患者中,有 16 人(14%)在任何一次治疗中至少有一幅图像被拒绝。在导师指导后进行评估的 91 名患者中,有 8 人(9%)至少有一张图像被拒绝。图像被拒的可能性降低了 54%,危险比为 0.46 [95 % CI: 0.24, 0.88];P = 0.0195。图像被拒的原因在指导前和指导后有所不同。在接受指导前,24 张图像中有 9 张(37.5%)因成像技术不佳而被拒绝,而在接受指导后,11 张图像中有 0 张(0%)因成像技术不佳而被拒绝。其他拒绝成像的原因包括:等中心深度(指导前 25%;指导后 18%)、锁骨上内侧边界位置(12.5% 对 9.09%)、等中心位置(12.5% 对 0%)、手臂位置(4.17% 对 54.55%);髋关节对齐(8.33% 对 18.18%)。结论事实证明,导师制成功地提高了 RTT 的技能和图像批准率,同时有助于改善科室的成像最佳实践。
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Technical Innovations and Patient Support in Radiation Oncology
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