Technical Innovations and Patient Support in Radiation Oncology最新文献

Time toxicity in CBCT-guided radiation therapy: A retrospective analysis of unplanned imaging burden across disease sites cbct引导放射治疗的时间毒性：跨疾病部位非计划成像负担的回顾性分析

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-01-21 DOI: 10.1016/j.tipsro.2026.100379

Aydin Visanji , Winnie Li , Jeff Winter , Peter Chung , Vickie Kong

Purpose

Adaptive radiotherapy (ART) enhances treatment precision by adjusting for anatomical changes identified during a course of treatment. While ART is resource-intensive, non-adaptive workflows may also incur significant time and resource burden due to reactive interventions. This study aims to quantify the time-related burden of unplanned activities in non-adaptive CBCT-guided radiation therapy and assess their impact on patients and departmental efficiency.

Methods and Materials

A retrospective analysis was conducted on 300 patients treated with CBCT-guided radiation therapy across 20 treatment techniques, encompassing 6,887 treatment fractions. Unplanned activities—including repeated CBCT acquisitions, aborted treatment sessions, additional CT scans, and mid-course replanning—were identified through electronic medical records and imaging logs. Time burden was estimated using electronic medical record timestamps.

Results

Repeated CBCTs occurred in 55% of patients, contributing to 201.9 h of additional imaging time. Pelvic disease sites, particularly bladder and gynecologic cancers, exhibited the highest frequency of repeat imaging. Six patients required rescheduling due to unresolved anatomical discrepancies, and 15 underwent treatment plan modifications, with nine requiring repeat planning CTs. The average additional time per affected fraction was 13 min (range: 2–219 min), with some sessions extending beyond 3 h.

Conclusions

Non-adaptive CBCT-guided workflows can lead to substantial time toxicity, comparable to or exceeding the resource demands of ART. These findings underscore the need for improved documentation, selective ART implementation, and workflow optimization to enhance patient experience and institutional efficiency.

目的适应性放疗（ART）通过调整治疗过程中发现的解剖变化来提高治疗精度。虽然抗逆转录病毒治疗是资源密集型的，但由于被动干预，非适应性工作流程也可能导致大量的时间和资源负担。本研究旨在量化非适应性cbct引导放射治疗中计划外活动的时间相关负担，并评估其对患者和部门效率的影响。方法与材料对300例接受cbct引导放射治疗的患者进行回顾性分析，包括20种治疗技术，6887种治疗方案。通过电子医疗记录和成像日志确定了计划外活动，包括重复的CBCT采集，终止的治疗疗程，额外的CT扫描和中途重新计划。使用电子病历时间戳估算时间负担。结果55%的患者出现了重复的cbct，增加了201.9 h的成像时间。盆腔疾病部位，特别是膀胱和妇科肿瘤，显示出最高的重复成像频率。6例患者由于未解决的解剖差异需要重新安排，15例患者接受了治疗计划修改，9例患者需要重复计划ct检查。每个受影响部位的平均额外时间为13分钟（范围：2-219分钟），有些疗程超过3小时。结论非适应性cbct引导的工作流程可能导致大量的时间毒性，相当于或超过ART的资源需求。这些发现强调需要改进文件、选择性实施抗逆转录病毒治疗和优化工作流程，以提高患者体验和机构效率。

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引用次数: 0

Feasibility of transitioning to marker-less immobilisation using optical surface guidance in head and neck cancer treatment: a study at territory state cancer centre in a developing country 在头颈癌治疗中使用光学表面引导过渡到无标记物固定的可行性：一项在发展中国家领土国家癌症中心的研究

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-01-14 DOI: 10.1016/j.tipsro.2026.100375

Ragul Thirunavukarasu , Sharad Singh , Pramod Kumar Gupta , Sumanta Manna , Vishal Sharma

Purpose/Objective(s)

In countries such as India, where a large share of cancer patients undergoes head and neck radiotherapy, setups still rely primarily on laser alignment with surface markers on the mask. This study explores transitioning from conventional marker-based setup to markerless setups using optical surface guidance (SGRT) to determine if treatment accuracy can be maintained particularly in a territory state cancer centre setting where resources are limited.

Materials/Methods

A prospective study of 80 head-and-neck cancer patients, randomized into two groups was performed: open-face mask group (OM) with optical surface guidance (AlignRT) versus conventional masks with surface-marker setup. All received Volumetric Modulated Arc Therapy VMAT (60–70 Gy in 30–35 fractions). Cone Beam Computed Tomography (CBCT) verified positioning, and translational/rotational shifts were used to calculate systematic (Σ) and random (σ) errors. Group differences were analyzed with an independent t-test.

Results

Translational setup errors in both OM and CM systems were consistently below 0.2 cm across all axes, with no statistically significant differences observed (p > 0.05). Rotational deviations in pitch, roll, and yaw were generally within 1°, with OM showing slightly improved stability trends compared to CM. Weekly error analysis confirmed stable reproducibility better in OM group compared to the CM over the treatment course.

Conclusion

The open-face mask with optical surface guidance is a feasible alternative to conventional closed-face masks in head and neck cancer treatment. It offers comparable accuracy, lateral axis advantage and comparable precision in vertical and longitudinal axes. It enhances patient comfort without increasing imaging frequency or margins and improves treatment outcomes

目的/目标在印度等国家，大部分癌症患者接受头颈部放射治疗，设置仍然主要依靠激光对准面具上的表面标记。本研究探讨了从传统的基于标记物的设置过渡到使用光学表面引导（SGRT）的无标记物设置，以确定治疗准确性是否可以保持，特别是在资源有限的领土国家癌症中心设置。材料/方法对80例头颈癌患者进行前瞻性研究，随机分为两组：采用光学表面引导（AlignRT）的开放式面罩组（OM）和采用表面标记装置的常规面罩组。所有患者均接受体积调节电弧治疗VMAT （60-70 Gy，分30-35份）。锥形束计算机断层扫描（CBCT）验证了定位，并使用平移/旋转位移计算系统（Σ）和随机（Σ）误差。组间差异采用独立t检验分析。结果OM系统和CM系统在各轴上的平移设置误差均小于0.2 CM，差异无统计学意义（p > 0.05）。俯仰、横摇和偏航的旋转偏差一般在1°以内，与CM相比，OM显示出略微改善的稳定性趋势。每周误差分析证实，在整个治疗过程中，与CM组相比，OM组的稳定性重复性更好。结论光学表面引导的开放式面罩是头颈部肿瘤治疗中替代传统封闭面罩的可行方法。它提供了相当的精度，横向轴优势和相当的精度在垂直和纵向轴。它在不增加成像频率或边缘的情况下提高了患者的舒适度，改善了治疗效果

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引用次数: 0

Evaluating the dosimetric impact of intrafraction shifts on critical OAR doses for spine SBRT using an In-House simulator 使用内部模拟器评估屈光度内移位对脊柱SBRT临界桨叶剂量的剂量学影响

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-01-08 DOI: 10.1016/j.tipsro.2026.100378

Daniel A. Alexander , Ryan Scheuermann , Ian Messing , Anthony Kassaee , Emily Hubley , Brandon Koger , Shibu Anamalayil , Alvand Hassankhani , Colbey W. Freeman , Neil Malhotra , Gabrielle W. Peters , Anish A. Butala

This study evaluated the dosimetric impact of intrafraction motion during spine SBRT by developing a novel dose deviation simulator capable of analyzing translations and rotations in all six degrees of freedom. We retrospectively assessed the treatment plans from 18 spine SBRT patients treated at our institution with 24 Gy in two fractions by simulating shifts of 0.5–2 mm (translations) and 0.5-2° (rotations), and calculating changes in D0.03 cc to spinal cord, cord PRV, and thecal sac. Translational shifts, particularly in the vertical direction, produced the greatest observed deviations, with a 2 mm vertical shift yielding median increases, reported as percent of prescription dose, of 20.6% (4.93 Gy) to thecal sac D0.03 cc and 6.5% (1.55 Gy) to spinal cord D0.03 cc. Our simulator’s accuracy was validated against treatment planning system-based forward calculations, showing mean differences of −1.3% ± 3.5% between the two systems. This study provides practical reference values to assist clinicians in rapidly evaluating the clinical significance of observed intrafraction motion. These findings may streamline decision-making during treatment and highlight the importance of precise positioning and motion monitoring in spine SBRT.

本研究通过开发一种新型剂量偏差模拟器来评估脊柱SBRT期间屈光度运动对剂量学的影响，该模拟器能够分析所有六个自由度的平移和旋转。通过模拟0.5-2 mm（平移）和0.5-2°（旋转）的位移，我们回顾性评估了在我院接受24 Gy治疗的18例脊柱SBRT患者的治疗方案，并计算了D0.03 cc对脊髓、脊髓PRV和鞘囊的变化。平移位移，特别是垂直方向的平移位移，产生了最大的观察偏差，2毫米的垂直位移产生的中位数增加，以处方剂量的百分比报告，对鞘囊D0.03 cc的增加为20.6% (4.93 Gy)，对脊髓D0.03 cc的增加为6.5% （1.55 Gy）。我们的模拟器的准确性通过基于治疗计划系统的正向计算得到验证，显示两个系统之间的平均差异为- 1.3%±3.5%。本研究为临床医生快速评估观察到的屈光内运动的临床意义提供了实用的参考价值。这些发现可以简化治疗过程中的决策，并强调在脊柱SBRT中精确定位和运动监测的重要性。

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引用次数: 0

A reirradiation workflow for managing patients with treatments planned in a multi-TPS environment 在多tps环境中管理计划治疗的患者的再照射工作流程

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-01-07 DOI: 10.1016/j.tipsro.2026.100377

Jason Vickress , Anders Celinski , Barbara Millman , David A. Palma , Donna H. Murrell

Reirradiation is becoming more common. Safe and effective implementation relies on accurate dose accumulation methodology, complex treatment planning, and multidisciplinary communication. Clinical workflow guidance to address these challenges is needed. Herein we report a TPS-agnostic reirradiation workflow, developed at our institution, that facilitates comprehensive cumulative dose evaluation and can improve safety and efficiency in reirradiation programs.

再照射正变得越来越普遍。安全有效的实施依赖于准确的剂量累积方法、复杂的治疗计划和多学科交流。需要临床工作流程指导来应对这些挑战。在此，我们报告了一个由我们的机构开发的与tps无关的再照射工作流程，它促进了全面的累积剂量评估，并可以提高再照射计划的安全性和效率。

引用次数: 0

Radiation therapist led treatment of lung stereotactic ablative body radiation therapy patients in the absence of the radiation oncologist – An image matching consistency comparison study 在放射肿瘤学家缺席的情况下，放射治疗师主导肺立体定向消融体放射治疗患者的治疗——一项图像匹配一致性比较研究

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-01-07 DOI: 10.1016/j.tipsro.2026.100376

Menglei Chao , Kylie Unicomb , Maryam Hazem , Shamira Cross , Gary Low , Roland Yeghiaian-Alvandi

Introduction

The aim of this study was to evaluate the consistency of day 1 cone-beam computed tomography (CBCT) image registration in lung stereotactic ablative body radiation therapy (SABR) among radiation oncologists (RO), radiation therapists (RTT) and paired RTTs, negating the need for RO to attend day 1 lung SABR treatment.

Methods

Day 1 pre-treatment CBCT data sets were restored for ten lung SABR patients for offline image registration. All participants (2 ROs, 27 RTTs and 5 RTT pairs) performed image matches on three different days. The deviations between each offline match and day 1 reference data were analysed to assess the consistency of image registration among the three study groups. Other variables such as patient respiratory motion management method, RTT SABR experience, and time spent on image registration were evaluated.

Results

All three study groups showed excellent consistency in CBCT matching results when compared to reference data. Average differences in all translational and rotational directions for each group were ΔTx 0.02 cm, ΔTy 0.04 cm, ΔTz 0.02 cm, ΔRx 0.43°, ΔRy 0.43°, ΔRz 0.47° for RT, ΔTx 0.02 cm, ΔTy 0.04 cm, ΔTz 0.04 cm, ΔRx 0.54°, ΔRy 0.66°, ΔRz 0.48° for RO and ΔTx 0.02 cm, ΔTy 0.06 cm, ΔTz 0.04 cm, ΔRx 0.39°, ΔRy 0.47°, ΔRz 0.49° for RTT pair. All deviations were within the study tolerance.

Conclusions

Following appropriate education and training, lung SABR credentialed RTTs demonstrated the ability to perform high quality and consistent day1 pre-treatment CBCT matching potentially negating the need for routine approval from ROs.

本研究的目的是评估放射肿瘤学家（RO）、放射治疗师（RTT）和配对RTT在肺立体定向消融体放射治疗（SABR）中第1天锥束计算机断层扫描（CBCT）图像配准的一致性，从而消除RO参加第1天肺SABR治疗的必要性。方法对10例SABR患者于1月1日恢复治疗前CBCT数据集进行离线图像配准。所有参与者（2个ro， 27个RTT和5对RTT）在三个不同的天进行图像匹配。分析每次离线匹配与第1天参考数据之间的偏差，以评估三个研究组之间图像配准的一致性。其他变量如患者呼吸运动管理方法、RTT SABR经验和图像配准时间进行了评估。结果与参考数据相比，三个研究组的CBCT匹配结果均具有良好的一致性。平均每个组的所有平移和旋转方向的差异ΔTx 0.02厘米,Δ泰0.04厘米,ΔTz 0.02厘米,ΔRx 0.43°,ΔRy 0.43°,ΔRz 0.47°RT,ΔTx 0.02厘米,Δ泰0.04厘米,ΔTz 0.04厘米,ΔRx 0.54°,ΔRy 0.66°,ΔRz 0.48°ROΔTx 0.02厘米,Δ泰0.06厘米,ΔTz 0.04厘米,ΔRx 0.39°,ΔRy 0.47°,ΔRz 0.49°RTT一对。所有偏差均在研究容许范围内。经过适当的教育和培训，经肺SABR认证的rtt有能力进行高质量和一致的第1天治疗前CBCT匹配，可能不需要ro的常规批准。

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引用次数: 0

Advancements in radiation dose reduction for pediatric CT head Imaging: A scoping review of emerging Technologies, Protocols, and optimization strategies 儿童CT头部成像放射剂量降低的进展：对新兴技术、方案和优化策略的范围审查

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-01-06 DOI: 10.1016/j.tipsro.2026.100374

Nandini B Patil , Priyanka , Priya P S , Rajagopal Kadavigere , Saikiran Pendem

Computed tomography (CT) is an important imaging modality that provides cross-sectional images, aiding in the detailed visualization of internal structures for accurate diagnosis and treatment. The pediatric population is more sensitive to radiation than adults, making radiation dose (RD) optimization an important concern in pediatric CT imaging. This scoping review emphasizes advanced RD reduction methods used in pediatric CT head imaging for diagnosing various clinical conditions with optimum RD and diagnostic image quality (IQ). A detailed search was conducted across five databases, such as PubMed, Scopus, CINAHL, Web of Science (WOS) and Embase using relevant keywords. A total of 24 articles were included in the final review. RD parameters and IQ related data were extracted from each article. Conventional RD reduction techniques in CT such as reducing the tube voltage, tube current and other scanning parameters, face limitations particularly in the pediatric population. These techniques lead to a trade-off between a lower RD and poor IQ which might obfuscate diagnostic details due to decreased contrast resolution with greater image noise and artifacts. To balance RD and diagnostic IQ, advanced technologies such as iterative reconstruction (IR) and deep learning image reconstruction (DLIR) algorithms with ultra-low dose protocols are increasingly being used. Hence, the review concludes that, compared with conventional dose reduction techniques, artificial intelligence based DLIR algorithms enhance IQ even for ultra-low dose protocols across various clinical domains in pediatric CT imaging.

计算机断层扫描（CT）是一种重要的成像方式，它提供了横断面图像，有助于内部结构的详细可视化，以进行准确的诊断和治疗。儿童人群对辐射的敏感性高于成人，因此辐射剂量（RD）的优化是儿童CT成像的一个重要问题。这篇综述强调了先进的RD降低方法在儿童CT头部成像中用于诊断各种临床疾病，具有最佳的RD和诊断图像质量（IQ）。利用相关关键词在PubMed、Scopus、CINAHL、Web of Science （WOS）和Embase等5个数据库中进行了详细的检索。最终评审共纳入24篇文章。从每篇文章中提取RD参数和IQ相关数据。传统的CT RD降低技术，如降低管电压、管电流和其他扫描参数，尤其在儿童人群中面临局限性。这些技术导致较低的RD和较差的IQ之间的权衡，这可能会混淆诊断细节，因为对比度分辨率降低，图像噪声和伪影更大。为了平衡RD和诊断IQ，迭代重建（IR）和深度学习图像重建（DLIR）算法等先进技术正在越来越多地使用超低剂量协议。因此，该综述得出结论，与传统的剂量减少技术相比，基于人工智能的DLIR算法即使在各种临床领域的超低剂量方案中也能提高儿童CT成像的IQ。

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引用次数: 0

Direct-to-treatment MRI-guided prostate radiotherapy using a generic patient-agnostic reference plan 直接到治疗的mri引导前列腺放疗使用一个通用的病人不可知的参考计划

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2025-12-31 DOI: 10.1016/j.tipsro.2025.100370

Georgios Tsekas, Lisa Wiersema, Sanne Conijn, Jega Sundaram, Uulke A. van der Heide, Tomas Janssen

Background:

Background and Purpose: Offline plan preparation is a time-consuming step in MRI-guided radiotherapy (MRIgRT). This work explores the use of a patient-agnostic reference plan and delineations for direct-to-treatment (DtT) MRI-guided prostate RT, without any patient-specific treatment preparations.

Material and Methods:

The data of ten prostate cancer patients were used to simulate a (DtT) workflow: During fraction 1, patient-specific contour adaptations were performed and a treatment plan was created, which was used for the rest of the fractions. The DtT treatment plans were evaluated against the clinical RT plans using the clinical delineations.

Results:

All DtT plans reached sufficient PTV coverage (V_3444cGy > 99%), while resulting in comparable OAR dose distributions to the clinical plans.

Conclusion:

Our DtT workflow resulted in adequate PTV coverage at the cost of small increase to the dose of some organs-at-risk and a high overall efficiency gain.

背景与目的：在mri引导放射治疗（MRIgRT）中，离线计划的制定是一个耗时的步骤。这项工作探讨了在没有任何患者特异性治疗准备的情况下，使用患者不可知的参考计划和直接治疗（DtT） mri引导前列腺RT的描述。材料和方法：使用10名前列腺癌患者的数据来模拟（DtT）工作流程：在部分1中，执行患者特定的轮廓调整并创建治疗计划，该计划用于其余部分。使用临床描述对DtT治疗方案与临床RT方案进行评估。结果：所有DtT方案均达到足够的PTV覆盖率（V3444cGy > 99%），同时OAR剂量分布与临床方案相当。结论：我们的DtT工作流程以少量增加某些高危器官的剂量为代价，获得了足够的PTV覆盖范围和较高的总体效率增益。

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引用次数: 0

Generative AI for patient education in cancer care: A scoping review of evaluation practices and emerging trends 癌症护理患者教育的生成人工智能：评估实践和新兴趋势的范围审查

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2025-12-28 DOI: 10.1016/j.tipsro.2025.100373

Aidan Leong , Keita Ormsby

Background

Generative AI (GenAI) tools, particularly Large Language Models (LLMs), are increasingly used across clinical contexts; including to support patient information needs. As these technologies become more prevalent, understanding their utilisation and evaluation in practice is critical. This scoping review aimed to map existing literature on GenAI applications in education for patients with cancer and identify trends in evaluation practices.

Methods

A scoping review was conducted following PRISMA-ScR guidelines. PubMed and Medline databases were searched for studies published between January 2019 and November 2024. Fifty-four eligible articles were analysed for GenAI models used, treatment modalities, education contexts, prompt sources, and evaluation domains and metrics.

Results

Most studies (81.5 %) were published in 2024, with over half (55.6 %) originating from the USA. ChatGPT-3.5 and ChatGPT-4 were the most frequently used models. Decision-making and general disease information were the predominant education contexts. Evaluation of GenAI outputs was reported in 96 % of studies, with accuracy (61.1%), readability (42.6 %), and quality (29.6 %) as the most common domains. More than half (50.8 %) of evaluation metrics were custom scales, indicating limited use of standardised tools. Patient-centred frameworks were rarely applied.

Conclusion

GenAI shows promise in enhancing patient education for cancer care, but evaluation practices lack standardisation and cultural responsiveness. Future research should prioritise validated frameworks, patient-centred metrics, and prompt engineering strategies to ensure safe, equitable and effective integration of GenAI in clinical care.

生成式人工智能（GenAI）工具，特别是大型语言模型（llm），越来越多地用于临床环境；包括支持患者的信息需求。随着这些技术变得越来越普遍，了解它们在实践中的利用和评估是至关重要的。本综述旨在绘制GenAI在癌症患者教育中应用的现有文献，并确定评估实践的趋势。方法按照PRISMA-ScR指南进行范围审查。检索了2019年1月至2024年11月期间发表的PubMed和Medline数据库。对54篇符合条件的文章进行分析，包括使用的GenAI模型、治疗方式、教育背景、提示来源、评估领域和指标。结果大部分研究（81.5%）发表于2024年，其中超过一半（55.6%）来自美国。ChatGPT-3.5和ChatGPT-4是使用频率最高的型号。决策和一般疾病信息是主要的教育背景。96%的研究报告了GenAI输出的评估，其中准确性（61.1%）、可读性（42.6%）和质量（29.6%）是最常见的领域。超过一半（50.8%）的评估指标是自定义量表，表明标准化工具的使用有限。很少采用以患者为中心的框架。结论genai在加强癌症护理的患者教育方面表现出良好的前景，但评估实践缺乏标准化和文化响应性。未来的研究应该优先考虑经过验证的框架、以患者为中心的指标和及时的工程策略，以确保GenAI在临床护理中的安全、公平和有效的整合。

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引用次数: 0

From BERT to GPT-4: A systematic review of AI-Driven toxicity extraction and grading in radiation oncology 从BERT到GPT-4：人工智能驱动的放射肿瘤学毒性提取和分级的系统综述

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2025-12-18 DOI: 10.1016/j.tipsro.2025.100372

Federico Mastroleo , Mariana Borras-Osorio , Shiv P. Patel , Sarah Peterson , Renthony Wilson , Mohammad Javad Namazi , Mi Zhou , Satomi Shiraishi , Andrew Y.K. Foong , David M. Routman , Mark R. Waddle

Background

Toxicity assessment is a fundamental component of radiation therapy patient management. Natural language processing (NLP) and large language models (LLMs) are transforming clinical practice by efficiently extracting and synthesizing information from electronic health records (EHRs). This systematic review evaluates the current literature on the use of NLP and LLMs to extract toxicity data from radiation oncology records.

Methods

Three databases were systematically searched on 14 March 2025 for English-language studies. Two reviewers screened the articles and extracted available data. Discrepancies were resolved by a third reviewer. The review adhered to PRISMA guidelines.

Results

We identified 246 manuscripts; after screening, five studies were included. Four studies focused on identifying toxicity terms and linking them to CTCAE terms, while severity grading or longitudinal tracking of toxicities was addressed by two studies. One study explored the summarization capabilities of LLM to convert free text or patient surveys into concise clinician notes/chatbot responses. Included studies utilized transformer models (BERT, BioBERT, Clinical Longformer) for recognition and grading tasks; rule-based systems (Apache cTAKES, IDEAL-X) used dictionaries and negation detection rules for toxicity identification. GPT-4 demonstrated zero-shot summarization and response capabilities for patient-reported outcomes. All included studies were single-center. Common challenges identified were limited generalizability, difficulty recognizing rare or negated toxicities, privacy concerns, and substantial computing requirements for fine-tuning transformer-based models.

Conclusions

Current research primarily focused on three basic tasks and three categories of models. Multi-center datasets and secure, lightweight deployment methods are needed before widespread integration into routine radiation oncology practice can be considered.

背景：毒性评估是放射治疗患者管理的基本组成部分。自然语言处理（NLP）和大型语言模型（llm）通过有效地从电子健康记录（EHRs）中提取和合成信息，正在改变临床实践。本系统综述评估了目前使用NLP和llm从放射肿瘤学记录中提取毒性数据的文献。方法于2025年3月14日系统检索三个数据库的英语研究。两位审稿人筛选了文章并提取了可用数据。差异由第三位审稿人解决。审查遵循PRISMA准则。结果共鉴定出246篇稿件；筛选后，纳入5项研究。四项研究侧重于确定毒性术语并将其与CTCAE术语联系起来，而两项研究涉及严重程度分级或毒性的纵向跟踪。一项研究探索了LLM的总结能力，将自由文本或患者调查转换为简明的临床医生笔记/聊天机器人回复。纳入的研究使用变压器模型（BERT、BioBERT、临床Longformer）进行识别和分级任务；基于规则的系统（Apache cTAKES, IDEAL-X）使用字典和否定检测规则进行毒性识别。GPT-4展示了对患者报告结果的零射击总结和反应能力。所有纳入的研究均为单中心研究。确定的共同挑战是有限的通用性，难以识别罕见或否定的毒性，隐私问题，以及微调基于变压器的模型的大量计算需求。结论目前的研究主要集中在三个基本任务和三类模型上。在广泛整合到常规放射肿瘤学实践之前，需要多中心数据集和安全、轻量级的部署方法。

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引用次数: 0

Comparative dosimetric analysis of deep inspiration breath-hold versus free breathing radiotherapy in lung cancer: special emphasis on cardiac and subcardiac structure protection 深吸气屏气与自由呼吸放射治疗肺癌的剂量学比较分析：特别强调心脏和心下结构的保护

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2025-12-15 DOI: 10.1016/j.tipsro.2025.100371

Biney Pal Singh , Ahmed Ali Chughtai , Jennifer Stock , Philipp Bruners , Michael J. Eble , Ahmed Allam Mohamed

Background

Radiation therapy (RT) plays a central role in the treatment of lung cancer. However, cardiac and pulmonary toxicities remain major concerns. Deep inspiration breath-hold (DIBH) has been shown to improve target stability and reduce organ-at-risk (OAR) exposure, but data in lung cancer, particularly regarding cardiac substructures, remain limited.

Materials and methods

We retrospectively analysed 32 patients with lung cancer treated with RT at our institution between 2020 and 2021. Each patient underwent planning CTs in both DIBH and free breathing (FB), generating a total of 64 treatment plans using VMAT (60 Gy in 30 fractions). Contouring followed ESTRO ACROP guidelines, including detailed segmentation of cardiac chambers and coronary arteries. Dosimetric endpoints included Dmean, D2%, and VxGy for lung, heart, and subcardiac structures. Statistical comparisons between DIBH and FB plans were performed.

Results

DIBH significantly increased lung volume and improved all lung dosimetric parameters, including Dmean (13.13 vs. 14.49 Gy, p < 0.001) and V20Gy (24.37 % vs. 27.28 %, p < 0.001). Cardiac sparing was evident, with lower heart D2% (39.91 vs. 41.67 Gy, p = 0.012) and V45Gy (2.23 % vs. 2.53 %, p = 0.005). Notably, significant reductions were observed in the LAD (Dmean: 5.59 vs. 6.57 Gy, p = 0.004), LCX, and LV. Subgroup analyses demonstrated consistent dosimetric advantages across tumor laterality and level 7 nodal involvement.

Conclusions

DIBH offers substantial and consistent dosimetric benefits in lung cancer RT, reducing radiation burden to pulmonary, cardiac, and coronary structures. Given the known association between cardiac dose and long-term morbidity, these findings support the broader implementation of DIBH, especially in anatomically challenging cases involving subcarinal nodes or left-sided tumors.

放射治疗（RT）在肺癌的治疗中起着核心作用。然而，心脏和肺毒性仍然是主要问题。深吸气屏气（DIBH）已被证明可以提高靶标稳定性并减少器官风险（OAR）暴露，但肺癌的数据，特别是关于心脏亚结构的数据仍然有限。材料和方法我们回顾性分析了2020年至2021年在我院接受放疗的32例肺癌患者。每位患者在DIBH和自由呼吸（FB）中都进行了计划ct检查，使用VMAT（30份60 Gy）共产生64个治疗计划。轮廓遵循ESTRO ACROP指南，包括心室和冠状动脉的详细分割。剂量学终点包括肺、心脏和心下结构的Dmean、D2%和VxGy。对DIBH方案和FB方案进行统计学比较。结果dibh显著增加肺容量，改善肺剂量学参数，包括Dmean （13.13 vs. 14.49 Gy, p < 0.001）和V20Gy （24.37% vs. 27.28%, p < 0.001）。心脏保留明显，心脏d2降低（39.91比41.67 Gy, p = 0.012）， V45Gy降低（2.23%比2.53%,p = 0.005）。值得注意的是，LAD （Dmean: 5.59 Gy vs. 6.57 Gy, p = 0.004）、LCX和LV显著降低。亚组分析表明，放射剂量学在肿瘤侧边和7级淋巴结受累方面具有一致的优势。结论：dibh在肺癌放射治疗中提供了实质性和一致的剂量学益处，减少了肺、心脏和冠状动脉结构的辐射负担。鉴于心脏剂量与长期发病率之间的已知关联，这些发现支持更广泛地实施DIBH，特别是在涉及隆突下淋巴结或左侧肿瘤的解剖挑战性病例中。

{"title":"Comparative dosimetric analysis of deep inspiration breath-hold versus free breathing radiotherapy in lung cancer: special emphasis on cardiac and subcardiac structure protection","authors":"Biney Pal Singh , Ahmed Ali Chughtai , Jennifer Stock , Philipp Bruners , Michael J. Eble , Ahmed Allam Mohamed","doi":"10.1016/j.tipsro.2025.100371","DOIUrl":"10.1016/j.tipsro.2025.100371","url":null,"abstract":"<div><h3>Background</h3><div>Radiation therapy (RT) plays a central role in the treatment of lung cancer. However, cardiac and pulmonary toxicities remain major concerns. Deep inspiration breath-hold (DIBH) has been shown to improve target stability and reduce organ-at-risk (OAR) exposure, but data in lung cancer, particularly regarding cardiac substructures, remain limited.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analysed 32 patients with lung cancer treated with RT at our institution between 2020 and 2021. Each patient underwent planning CTs in both DIBH and free breathing (FB), generating a total of 64 treatment plans using VMAT (60 Gy in 30 fractions). Contouring followed ESTRO ACROP guidelines, including detailed segmentation of cardiac chambers and coronary arteries. Dosimetric endpoints included Dmean, D2%, and VxGy for lung, heart, and subcardiac structures. Statistical comparisons between DIBH and FB plans were performed.</div></div><div><h3>Results</h3><div>DIBH significantly increased lung volume and improved all lung dosimetric parameters, including Dmean (13.13 vs. 14.49 Gy, p < 0.001) and V20Gy (24.37 % vs. 27.28 %, p < 0.001). Cardiac sparing was evident, with lower heart D2% (39.91 vs. 41.67 Gy, p = 0.012) and V45Gy (2.23 % vs. 2.53 %, p = 0.005). Notably, significant reductions were observed in the LAD (Dmean: 5.59 vs. 6.57 Gy, p = 0.004), LCX, and LV. Subgroup analyses demonstrated consistent dosimetric advantages across tumor laterality and level 7 nodal involvement.</div></div><div><h3>Conclusions</h3><div>DIBH offers substantial and consistent dosimetric benefits in lung cancer RT, reducing radiation burden to pulmonary, cardiac, and coronary structures. Given the known association between cardiac dose and long-term morbidity, these findings support the broader implementation of DIBH, especially in anatomically challenging cases involving subcarinal nodes or left-sided tumors.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100371"},"PeriodicalIF":2.8,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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