Technical Innovations and Patient Support in Radiation Oncology最新文献

Purpose

To investigate the possibility to be able to offer left sided breast cancer patients, not suitable for DIBH, an organ at risk saving treatment.

Materials and Methods

Twenty patients receiving radiotherapy for left breast cancer in DIBH were enrolled in the study. Planning CT scans were acquired in the same supine treatment position in FB and DIBH. 3DCRT_DIBH plans were designed and optimized using two parallel opposed tangent beams (with some additional segments) for the breast and chest wall and anterior-posterior fields for regional lymph nodes irradiation. Additionally, FB helical tomotherapy plans were optimized to minimize heart and lung dose. All forty plans were optimized with at least 95% of the total CTV covered by the 95% of prescribed dose of 50 Gy in 25 fractions.

Results

HT_FB plans showed significantly better dose homogeneity and conformity compared to the 3DCRT_DIBH specially for regional nodal irradiation. The heart mean dose was almost comparable in 3DCRT_DIBH and HT_FB while the volume (%) of the heart receiving 25 Gy had a statistically significant reduction from 7.90 ± 3.33 in 3DCRT_DIBH to 0.88 ± 0.66 in HT_FB. HT_FB was also more effective in left descending artery (LAD) mean dose reduction about 100% from 30.83 ± 9.2 Gy to 9.7 ± 3.1. The ipsilateral lung volume receiving 20 Gy has a further reduction of 43 % in HT_FB compared with 3DCRT_DIBH. For low dose comparison, 3DCRT_DIBH was superior for contralateral organ sparing compared to the HT_FB due to the limited angle for dose delivery.

Conclusion

For patients who cannot be a candidate for DIBH for any reason, HT in free breathing may be a good alternative and provides heart and ipsilateral lung dose sparing, however with the cost of increased dose to contralateral breast and lung.

Background

The complexity of prostate cancer care can impact on patient understanding and participation in shared decision-making. This study used a survey-based approach to investigate patients’ recall of their prostate cancer treatment, and more broadly, to understand the perceptions of patients and the general population of prostate cancer treatment.

Method

The survey was completed by 236 patients with prostate cancer (PCa cohort) and 240 participants from the general population of Australia (GenPop cohort). Free-text comments from both cohorts were analysed using content analysis. The PCa cohort reported which treatments and image-guidance related procedures they had received. These patient-reports were compared to medical records and analysed using proportion agreement, kappa statistics and regression analysis.

Results

135 (57%) PCa and 99 (41%) GenPop respondents provided at least one comment. Five major themes were identified by both cohorts: sharing experiences of treatment; preferences insights and reflections; mindsets; general commentary on the survey; and factors missing from the survey. There was overall good treatment recall amongst the PCa cohort, with proportions of correct recall ranging from 97.3% for chemotherapy to 66.8% for hormone therapy. There was a tendency for younger patients (<70 years old) to recall their hormone treatment more correctly.

Conclusion

Participant comments suggest the complexity of prostate cancer diagnosis and treatment, and the varying perceptions and experiences of participants with prostate cancer. Patients’ recall overall was good for both treatment and image-guidance related procedures/approaches, however the poorer recall of hormone therapy requires further investigation.

Radiotherapy is typically delivered in supine position. However, upright positioning may affect organ volume, positioning, and movement, compared to supine/prone positioning which might have beneficial impacts. In this study, we report patient positioning data in an upright positioning system designed by Leo Cancer Care®.

Sixteen patients with pelvic tumors were included in this study. They had 3 setups in an upright position: an initial setup with acquisition of reference optical images, and 2 repositioning setups. The intra-fraction motion was assessed during two 20-minute chair rotation sessions. The patient comfort in supine and upright position was assessed with a 5-point Likert scale questionnaire.

Eight women and 8 men treated on regular linacs between October 2021 and June 2022 were included. Their median age and weight were 62.5 years (35 to 81 years) and 75.1 kg (41 to 107 kg). The inter-fraction shift means were −0.5 mm (SD = 2.5), −0.4 mm (SD = 1.3) and −0.9 mm (SD = 2.7) in left–right (LR), antero-posterior (AP), and cranio-caudal (CC) directions, respectively. The intrafraction shifts after 20 min were 0.0 mm (SD = 1.5), 0.2 mm (SD = 1.1) and 0.0 mm (SD = 0.3) in LR, CC, and AP directions, respectively. Average global comfort was 4.1 (3 to 5) for the upright position and 3.9 (2 to 5) for the supine position.

In conclusion, the first study on pelvic cancer patients positioned in upright position on a chair is promising, and it opens a potential new direction for the treatment of cancer patients. Evaluation of thoracic and head and neck tumors is ongoing, and imaging with vertical CT is expected to start soon.

Current medical physics graduate training in the United States seldom explicitly includes education on foundational skills necessary to produce Patient-Centered Care (PCC)-focused healthcare providers. Such abilities include effective communication, critical reflection, and ethical decision-making. In this article, we present examples of curricula used to purposefully introduce these skills into graduate training to fill this gap. Presented didactic activities include an introduction to patient communication, ethics in medical physics, and a primer in health disparities for medical physicists. Although development of new curricula is resource-intensive when left to individual programs, we here propose resource-sharing and interprofessional collaboration to overcome these barriers.

The field of radiation oncology is rapidly advancing through technological and biomedical innovation backed by robust research evidence. In addition, cancer professionals are notoriously time-poor, meaning there is a need for high quality, accessible and tailored oncological education programs. Digital learning (DL) is well-placed to cater to these needs, as it provides teaching options that can be delivered flexibly and on-demand from anywhere in the world. The evidence for usage of these techniques in medical education has expanded rapidly in recent years. However, there remains many reservations in the oncological community to adopting and developing DL, largely due to a poor familiarity with the pedagogical evidence base.

This article will review the application of the screen-based DL tools that are at educators’ disposal. It will summarize best-practice in developing tailored, made-for-screen videos, gamification, and infographics. It also reviews data behind the following practical tips of 1) strategically combining text with graphics to decrease cognitive load, 2) engaging users through use of interactive elements in digital content, and 3) maximizing impact through thoughtful organization of animations/images.

Overall, the digital space evolving is well placed to cater to the evolving educational needs of oncology learners. This review and its practical tips aim to inspire further development in this arena, production of high-yield educational products, use of engaging delivery methods and programs that are tailored to individual learning needs.

Background

Radiation therapy (RT) is a common modality of treatment in patients with head and neck cancer, and can cause several oral complications. These mainly include radiomucitis, oral pain, hyposalivation, limitation of mouth opening, and osteoradionecrosis.

There are different intraoral devices aimed at reducing these complications. It can be used in association with the therapy of RT. They are used to protect healthy tissues surrounding the site to be irradiated, carry the radiation source, move away from certain anatomical structures, position certain devices, and to allow tissue remodeling.

The collaboration between the maxillofacial prosthodontist specialist and the radiotherapist is necessary for the design and realization of these devices which differ according to each clinical situation.

This work aims to review and illustrate the different radiation devices used in combination with head and neck radiotherapy and introduce a new device design to protect and remove non-radiation-targeted structures.

Conclusion

The use of maxillofacial devices as a protective and positioning stent during radiotherapy is beneficial and should be systematic if indicated in collaboration with the oncological team.

The field of radiation oncology is rapidly advancing through technological and biomedical innovation backed by robust research evidence. However, cancer professionals are notoriously time-poor, meaning there is a need for high quality, accessible and tailored oncologic education programs. While traditional teaching methods including lectures and other in-person delivery formats remain important, digital learning (DL) has provided additional teaching options that can be delivered flexibly and on-demand from anywhere in the world.

While evidence of this digital migration has been evident for some time now, it has not always been met with the same enthusiasm by the teaching community, in part due to questions about its pedagogical effectiveness. Many of these reservations have been driven by a rudimentary utilisation of the medium and inexperience with digital best-practice. With increasing familiarity and understanding of the medium, increasingly sophisticated and pedagogically-driven learning solutions can be produced.

This article will review the application of immersive digital learning tools in radiation oncology education. This includes first and second-generation Virtual Reality (VR) environments and Augmented Reality (AR). It will explore the data behind, and best-practice application of, each of these tools as well as giving practical tips for educators who are looking to implement (or refine) their use of these learning methods. It includes a discussion of how to match the digital learning methods to the content being taught and ends with a horizon scan of where the digital medium may take us in the future. This article is the second in a two-part series, with the companion piece being on Screen-Based Digital Learning Methods in Radiation Oncology.

Overall, the digital space is well-placed to cater to the evolving educational needs of oncology learners. Further uptake over the next decade is likely to be driven by the desire for flexible on demand delivery, high-yield products, engaging delivery methods and programs that are tailored to individual learning needs. Educational programs that embrace these principles will have unique opportunities to thrive in this space.

Purpose

To document experiences with one year of clinical implementation of the first Cherenkov imaging system and share the methods that we developed to utilize Cherenkov imaging to improve treatment delivery accuracy in real-time.

Methods

A Cherenkov imaging system was installed commissioned and calibrated for clinical use. The optimal room lighting conditions and imaging setup protocols were developed to optimize both image quality and patient experience. The Cherenkov images were analyzed for treatment setup and beam delivery verification.

Results

We have successfully implemented a clinical Cherenkov imaging system in a community-based hospital. Several radiation therapy patient setup anomalies were found in 1) exit dose to the contralateral breast, 2) dose to the chin due to head rotation for a supraclavicular field, 3) intrafractional patient motion during beam delivery, and 4) large variability (0.5 cm to 5 cm) in arm position between fractions. The system was used to deliver deep inspiration breath hold (DIBH) treatment delivery of an electron treatment beam. Clinical process and procedures were improved to mitigate the identified issues to ensure treatment delivery safety and to improve treatment accuracy.

Conclusion

The Cherenkov imaging system has proven to be a valuable clinical tool for the improvement of treatment delivery safety and accuracy at our hospital. With only minimal training the therapists were able to adjust or correct treatment positions during treatment delivery as needed. With future Cherenkov software developments Cherenkov imaging systems could provide daily surface guided radiotherapy (SGRT) and real time treatment delivery quality control for all 3D and clinical setup patients without adding additional radiation image dose as in standard kV, MV and CBCT image verifications. Cherenkov imaging can greatly improve clinical efficiency and accuracy, making real time dose delivery consistency verification and SGRT a reality.