Anticipating the onset, location and severity of radiation dermatitis before radiotherapy can aid in dermatological care. This study developed a method for creation of a prediction diagram for dermatitis and conducted a comparative verification between the prediction diagram and actual patient condition. The prediction diagram involved converting skin doses into 2 Gy fractionated equivalent doses using α/β of 10.0, defining regions of interest (ROIs) from 20-50 Gy at 10 Gy intervals. Overlaps between these ROIs at each dose level and the skin (external) was sequentially color-coded as blue, yellow, red, and purple. The study included four patients: two underwent head and neck treatment and two received neck and chest treatment. This approach involved a visual assessment comparing the prediction diagram with skin photographs captured at the end of treatment. Nurses marked skin sites corresponding to grades 1 and 2 on photographs, assessing their correlation with the predicted range. Visual assessment results were largely positive, although one patient exhibited slightly lower scores. Results revealed a correlation between grade 1 skin reactions and the 20 Gy regions. Grade 2 reactions were observed in regions near 30 and 40 Gy. Although discrepancies between prediction diagram and actual skin symptoms were observed in patients, a broad agreement was evident. The prediction diagram cannot accurately predict radiation dermatitis, as it does not account for skin symptoms unrelated to the dose. However, the diagram is significant as it provides physicians, nurses, and patients with concise and visually comprehensible information regarding the location of dermatitis.
{"title":"Comparison of predicted and actual dermatitis generated from computed tomography images and dose distribution maps","authors":"Yasuhide Miyabe , Saori Oshiro , Hiroto Seki , Yusuke Muroi , Eriko Kawashima , Megumi Hosoda , Kento Ohashi , Hiromu Yamanaka , Mingliang Shao , Hiromi Sugawara , Jyunetsu Mizoe , Ritsuko Komaki","doi":"10.1016/j.tipsro.2024.100294","DOIUrl":"10.1016/j.tipsro.2024.100294","url":null,"abstract":"<div><div>Anticipating the onset, location and severity of radiation dermatitis before radiotherapy can aid in dermatological care. This study developed a method for creation of a prediction diagram for dermatitis and conducted a comparative verification between the prediction diagram and actual patient condition. The prediction diagram involved converting skin doses into 2 Gy fractionated equivalent doses using α/β of 10.0, defining regions of interest (ROIs) from 20-50 Gy at 10 Gy intervals. Overlaps between these ROIs at each dose level and the skin (external) was sequentially color-coded as blue, yellow, red, and purple. The study included four patients: two underwent head and neck treatment and two received neck and chest treatment. This approach involved a visual assessment comparing the prediction diagram with skin photographs captured at the end of treatment. Nurses marked skin sites corresponding to grades 1 and 2 on photographs, assessing their correlation with the predicted range. Visual assessment results were largely positive, although one patient exhibited slightly lower scores. Results revealed a correlation between grade 1 skin reactions and the 20 Gy regions. Grade 2 reactions were observed in regions near 30 and 40 Gy. Although discrepancies between prediction diagram and actual skin symptoms were observed in patients, a broad agreement was evident. The prediction diagram cannot accurately predict radiation dermatitis, as it does not account for skin symptoms unrelated to the dose. However, the diagram is significant as it provides physicians, nurses, and patients with concise and visually comprehensible information regarding the location of dermatitis.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100294"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722428","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}
Pub Date : 2024-11-17DOI: 10.1016/j.tipsro.2024.100293
Ntumsi Akundoh Tontu , William W.Y. Cheung , Marcus Jones , Linda Grossheim , Dennis Palmer , Earnest Chukwudi N. Okonkwo , Eric Moore , Keith Streatfield , Laurie Elit
Although radiotherapy is critical for cancer cure and palliation, access to such expensive and sophisticated technology is very limited in low- and middle-income countries (LMIC). Cancer incidence in Africa is currently 1.5 million case per year, thus urgent and innovative solutions are required to build necessary infrastructure needed to address this global health challenge. We describe our approach and challenges as a faith based non-government organization in setting up a modern radiotherapy department in a rural hospital in Cameroon to mitigate this unmet need. We highlite our engagement with international bodies and individuals for fund raising and volunteerism, local radiotherapy workforce development and training (radiation oncology, dosimetrists, radiation therapist and medical physicists) and the expertise required for construction of the bunker and installation of the Linac machine.
{"title":"Developing a modern radiotherapy department in a rural hospital in Cameroon: The Mbingo experience","authors":"Ntumsi Akundoh Tontu , William W.Y. Cheung , Marcus Jones , Linda Grossheim , Dennis Palmer , Earnest Chukwudi N. Okonkwo , Eric Moore , Keith Streatfield , Laurie Elit","doi":"10.1016/j.tipsro.2024.100293","DOIUrl":"10.1016/j.tipsro.2024.100293","url":null,"abstract":"<div><div>Although radiotherapy is critical for cancer cure and palliation, access to such expensive and sophisticated technology is very limited in low- and middle-income countries (LMIC). Cancer incidence in Africa is currently 1.5 million case per year, thus urgent and innovative solutions are required to build necessary infrastructure needed to address this global health challenge. We describe our approach and challenges as a faith based non-government organization in setting up a modern radiotherapy department in a rural hospital in Cameroon to mitigate this unmet need. We highlite our engagement with international bodies and individuals for fund raising and volunteerism, local radiotherapy workforce development and training (radiation oncology, dosimetrists, radiation therapist and medical physicists) and the expertise required for construction of the bunker and installation of the Linac machine.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100293"},"PeriodicalIF":0.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701654","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}
Pub Date : 2024-11-16DOI: 10.1016/j.tipsro.2024.100290
Amani A. Chowdhury , Steve Bolton , Gerry Lowe , Eliana Vasquez Osorio , William Hamblyn , Peter J Hoskin
Brachytherapy is a key treatment for gynaecological malignancies, delivering high doses to the tumour volume whilst sparing nearby normal tissues due to its steep dose gradient. Accuracy is imperative as small shifts can lead to clinically significant under- or over-dosing of the target volume or organs at risk (OARs), respectively. Independent verification of dose delivered during brachytherapy is not routinely performed but it is important to identify gross errors and define action thresholds to guide inter-fraction treatment decisions. In vivo dosimetry (IVD) is one strategy for improving accuracy and identifying potential errors. Despite promising phantom work, clinical application of IVD is lacking. A literature search was performed using Medline and EMBASE without date limits and based on the PICO framework to evaluate the clinical application of IVD in gynaecological brachytherapy. After screening of titles and abstracts, full text papers were reviewed and 28 studies were identified. Several dosimeters were utilised and measurements were typically taken from the rectum, bladder, vagina and within interstitial catheters. Significant differences between calculated and measured dose were attributed to geometric shifts. The studies reviewed demonstrated the feasibility of IVD in brachytherapy for dose verification but further work is required before IVD can be used to optimise treatment. The purpose of this scoping review is to investigate the clinical application of IVD in gynaecological brachytherapy, understand its challenges and identify the steps required to facilitate integration into everyday clinical practice.
{"title":"The clinical application of in vivo dosimetry for gynaecological brachytherapy: A scoping review","authors":"Amani A. Chowdhury , Steve Bolton , Gerry Lowe , Eliana Vasquez Osorio , William Hamblyn , Peter J Hoskin","doi":"10.1016/j.tipsro.2024.100290","DOIUrl":"10.1016/j.tipsro.2024.100290","url":null,"abstract":"<div><div>Brachytherapy is a key treatment for gynaecological malignancies, delivering high doses to the tumour volume whilst sparing nearby normal tissues due to its steep dose gradient. Accuracy is imperative as small shifts can lead to clinically significant under- or over-dosing of the target volume or organs at risk (OARs), respectively. Independent verification of dose delivered during brachytherapy is not routinely performed but it is important to identify gross errors and define action thresholds to guide inter-fraction treatment decisions. In vivo dosimetry (IVD) is one strategy for improving accuracy and identifying potential errors. Despite promising phantom work, clinical application of IVD is lacking. A literature search was performed using Medline and EMBASE without date limits and based on the PICO framework to evaluate the clinical application of IVD in gynaecological brachytherapy. After screening of titles and abstracts, full text papers were reviewed and 28 studies were identified. Several dosimeters were utilised and measurements were typically taken from the rectum, bladder, vagina and within interstitial catheters. Significant differences between calculated and measured dose were attributed to geometric shifts. The studies reviewed demonstrated the feasibility of IVD in brachytherapy for dose verification but further work is required before IVD can be used to optimise treatment. The purpose of this scoping review is to investigate the clinical application of IVD in gynaecological brachytherapy, understand its challenges and identify the steps required to facilitate integration into everyday clinical practice.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100290"},"PeriodicalIF":0.0,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972447","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}
Pub Date : 2024-11-10DOI: 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。
{"title":"The status quo of global geriatric radiation oncology education: A scoping review","authors":"Lucinda Morris , Sandra Turner , Jane L. Phillips , Anamika Parmar , Meera Agar","doi":"10.1016/j.tipsro.2024.100288","DOIUrl":"10.1016/j.tipsro.2024.100288","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods and materials</h3><div>The need for improved education around GO is internationally recognized and is a key strategic priority of the International Society of Geriatric Oncology (SIOG).</div><div>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.</div></div><div><h3>Results</h3><div>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.</div><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100288"},"PeriodicalIF":0.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142657275","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}
Pub Date : 2024-10-29DOI: 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.
{"title":"A systematic review of prostate bed motion and anisotropic margins in post-prostatectomy external beam radiotherapy","authors":"T. Hodgins, E. Forde","doi":"10.1016/j.tipsro.2024.100287","DOIUrl":"10.1016/j.tipsro.2024.100287","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methodology</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100287"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572526","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}
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.
{"title":"International virtual radiation therapy professional development: Reflections on a twinning collaboration between a low/middle and high income country","authors":"Nicole Harnett , Wongel Bekalu , Eskadmas Yinesu , Edom Seife Woldetsadik , Rebecca Wong","doi":"10.1016/j.tipsro.2024.100285","DOIUrl":"10.1016/j.tipsro.2024.100285","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100285"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552862","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}
Pub Date : 2024-10-28DOI: 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.
{"title":"A code orange for traffic-light-protocols as a communication mechanism in IGRT","authors":"Dylan Callens , Rob De Haes , Jan Verstraete , Patrick Berkovic , An Nulens , Truus Reynders , Maarten Lambrecht , Wouter Crijns","doi":"10.1016/j.tipsro.2024.100286","DOIUrl":"10.1016/j.tipsro.2024.100286","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials & Methods</h3><div>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 (TLP<sub>2023</sub>) and from the TLP implementation period (TLP<sub>2019</sub>). Accuracy of image registration was not evaluated. Reporting barriers were identified through focus group discussions with RTTs.</div></div><div><h3>Results</h3><div>During TLP<sub>2023</sub>, 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 TLP<sub>2019</sub>, 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100286"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572525","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}
Pub Date : 2024-10-22DOI: 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.
{"title":"On the trail of CBCT-guided adaptive rectal boost radiotherapy, does daily delineation require a radiation oncologist?","authors":"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","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":"32 ","pages":"Article 100284"},"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}
Pub Date : 2024-10-19DOI: 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.
{"title":"Best practice in radiation oncology: A project to train the trainers: Review of 2008–2023","authors":"Mary Coffey , Colleen Dickie , Elena Fidarova , Velimir Karadža , Philipp Scherer , Michelle Leech","doi":"10.1016/j.tipsro.2024.100281","DOIUrl":"10.1016/j.tipsro.2024.100281","url":null,"abstract":"<div><div>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.</div><div>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.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100281"},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537506","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}
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.
{"title":"ASPRONET: A facilitated online education project for radiation therapists in the Asia-Pacific region","authors":"Craig Opie , Aidan Leong , Chetana Vartak , Iain Ward , Sandra Ndarukwa","doi":"10.1016/j.tipsro.2024.100283","DOIUrl":"10.1016/j.tipsro.2024.100283","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100283"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527429","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号