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}
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.
{"title":"A data-driven approach to solve the RT scheduling problem","authors":"Mruga Gurjar , Jesper Lindberg , Thomas Björk-Eriksson , Caroline Olsson","doi":"10.1016/j.tipsro.2024.100282","DOIUrl":"10.1016/j.tipsro.2024.100282","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods and Materials</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100282"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527428","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}
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.
{"title":"Interstitial brachytherapy for periocular nonmelanoma skin cancers: Impact on organ and function preservation","authors":"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","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":"32 ","pages":"Article 100280"},"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}
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.
{"title":"From novice to Expert: Reducing Breast Imaging rejection rates through physician mentorship in Advanced Practice Radiation therapy","authors":"Clodagh Starrs , Sima Rabinowitz , Erin Moshier , Sheryl Green","doi":"10.1016/j.tipsro.2024.100279","DOIUrl":"10.1016/j.tipsro.2024.100279","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 %.</div></div><div><h3>Conclusions</h3><div>The mentorship proved successful in elevating the RTT’s skills and image approval rates, while contributing to improvements in departmental imaging best practices.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100279"},"PeriodicalIF":0.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416367","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 : 2024-09-25DOI: 10.1016/j.tipsro.2024.100277
Julien Pierrard , Sofie Heylen , Ad Vandermeulen , Geneviève Van Ooteghem
Introduction
Intra- and inter-fraction rectum motion is important for pelvic radiotherapy (RT). This study assesses how RT session duration, the presence or the absence of an intra-rectal tumour, and the distance from the anorectal junction (ARJd) impact rectal motion.
Materials and methods
Analyses used cone-beam computed tomographies (CBCTs) from RT patients treated for rectal and prostate cancer. Three structures were evaluated: (1) the entire rectum in patients without a rectal tumour (RectumProstate); (2) the non-invaded portion (RectumRectum) and (3) the tumour-invaded portion (RectumTumour) in rectal cancer patients.
Intrafraction motion was assessed using the Hausdorff distance 95% and the Mean distance-to-agreement between structures delineated on the first CBCT and the 2 subsequent CBCTs within a same RT session. Interfraction motion was quantified by comparing structures delineated on the planning-CT and the first CBCT of each session.
Linear mixed model evaluated rectum motion in relation to time, tumour presence, and ARJd, respectively.
Results
We included 10 patients with and 10 without rectal cancer, collecting 385 CBCTs. A significant correlation (p < 0.05) between rectum motion and RT session duration was found. Intrafraction motion was significantly higher in prostate cancer patients (RectumProstate motion > RectumRectum and RectumTumour, p < 0.01). For interfraction motion, only the mean distance to agreement was significantly higher for RectumProstate (p < 0.05). Motion increased significantly with ARJd for all three structures (p < 0.001).
Conclusions
Session duration, absence of a tumour, and ARJd are associated with larger intra- and interfraction rectal motion. This highlights the need for tailored RT treatment, including online-adaptive RT, to manage intra- and interfraction variations. Rectal motion should be handled differently for patients with prostate cancer and those with rectal cancer.
{"title":"Dealing with rectum motion during radiotherapy: How can we anticipate it?","authors":"Julien Pierrard , Sofie Heylen , Ad Vandermeulen , Geneviève Van Ooteghem","doi":"10.1016/j.tipsro.2024.100277","DOIUrl":"10.1016/j.tipsro.2024.100277","url":null,"abstract":"<div><h3>Introduction</h3><div>Intra- and inter-fraction rectum motion is important for pelvic radiotherapy (RT). This study assesses how RT session duration, the presence or the absence of an intra-rectal tumour, and the distance from the anorectal junction (ARJd) impact rectal motion.</div></div><div><h3>Materials and methods</h3><div>Analyses used cone-beam computed tomographies (CBCTs) from RT patients treated for rectal and prostate cancer. Three structures were evaluated: (1) the entire rectum in patients without a rectal tumour (Rectum<sub>Prostate</sub>); (2) the non-invaded portion (Rectum<sub>Rectum</sub>) and (3) the tumour-invaded portion (Rectum<sub>Tumour</sub>) in rectal cancer patients.</div><div>Intrafraction motion was assessed using the Hausdorff distance 95% and the Mean distance-to-agreement between structures delineated on the first CBCT and the 2 subsequent CBCTs within a same RT session. Interfraction motion was quantified by comparing structures delineated on the planning-CT and the first CBCT of each session.</div><div>Linear mixed model evaluated rectum motion in relation to time, tumour presence, and ARJd, respectively.</div></div><div><h3>Results</h3><div>We included 10 patients with and 10 without rectal cancer, collecting 385 CBCTs. A significant correlation (p < 0.05) between rectum motion and RT session duration was found. Intrafraction motion was significantly higher in prostate cancer patients (Rectum<sub>Prostate</sub> motion > Rectum<sub>Rectum</sub> and Rectum<sub>Tumour</sub>, p < 0.01). For interfraction motion, only the mean distance to agreement was significantly higher for Rectum<sub>Prostate</sub> (p < 0.05). Motion increased significantly with ARJd for all three structures (p < 0.001).</div></div><div><h3>Conclusions</h3><div>Session duration, absence of a tumour, and ARJd are associated with larger intra- and interfraction rectal motion. This highlights the need for tailored RT treatment, including online-adaptive RT, to manage intra- and interfraction variations. Rectal motion should be handled differently for patients with prostate cancer and those with rectal cancer.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100277"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326870","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}
Radiotherapy (RT) relies on devices like thermoplastic masks (TMs), that are made up of specialized thermoplastic polymers, and used as an immobilization tool. The study aims to assess the practice of usage and reuse of TMs among radiation therapy technologists (RTTs) in India and explore their awareness of environmental impact during disposal.
Materials and Methods
A cross-sectional survey was conducted among RTTs working in different healthcare settings. A structured questionnaire designed by a team of RTTs and radiation oncologists was used to collect responses. Questionnaire encompassed data pertaining to demographics, existing patient load, daily utilisation and reuse practice of TMs, preferred method of disposal and awareness of RTTs regarding environmental consequences associated with TM disposal.
Results
A total of 430 RTTs participated in the study, with a median age of 31 years and a median professional experience of 8 years. Among the participants, 213 (49.6 %) reported daily TM utilization in more than 50 patients. TM reuse was reported by 350 (81.1 %) RTTs, with 257 (60 %) reusing TMs in both curative and palliative treatments. Reuse of TMs was observed more commonly in RTTs working in government facilities (81.2 %).
Regarding disposal preferences, 381 (88.6%) participants preferred discarding used TMs in biomedical waste and 64.8% of these ultimately ended up as discarded scrap. Awareness regarding adverse environmental impact associated with TM disposal was reported by 320 (74.4%) participant RTTs.
Conclusion
The study highlights the prevalent practice of reuse of TMs, especially in curative treatments, government-run facilities and busy treatment settings. Additionally, it emphasises the imperative for enhanced bio-medical waste management practices to facilitate more effective handling and disposal of used TMs.
{"title":"Assessment of usage, reuse and disposal of thermoplastic masks among radiotherapy technologists in India: A nationwide perspective","authors":"M. Nagesh, Rohit Vadgaonkar, K.K. Sreelakshmi, Raghavendra Hajare, Pritam Parab, Subhabrat Dash, Ramesh Reddy, Vaishali Shende, Ankita Nawar, Rahul Biswas, Sandeep Ratna Bula, Shubham Gagare, Darshani Belekar, Raviteja Miriyala, Umesh Mahantshetty","doi":"10.1016/j.tipsro.2024.100278","DOIUrl":"10.1016/j.tipsro.2024.100278","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiotherapy (RT) relies on devices like thermoplastic masks (TMs), that are made up of specialized thermoplastic polymers, and used as an immobilization tool. The study aims to assess the practice of usage and reuse of TMs among radiation therapy technologists (RTTs) in India and explore their awareness of environmental impact during disposal.</div></div><div><h3>Materials and Methods</h3><div>A cross-sectional survey was conducted among RTTs working in different healthcare settings. A structured questionnaire designed by a team of RTTs and radiation oncologists was used to collect responses. Questionnaire encompassed data pertaining to demographics, existing patient load, daily utilisation and reuse practice of TMs, preferred method of disposal and awareness of RTTs regarding environmental consequences associated with TM disposal.</div></div><div><h3>Results</h3><div>A total of 430 RTTs participated in the study, with a median age of 31 years and a median professional experience of 8 years. Among the participants, 213 (49.6 %) reported daily TM utilization in more than 50 patients. TM reuse was reported by 350 (81.1 %) RTTs, with 257 (60 %) reusing TMs in both curative and palliative treatments. Reuse of TMs was observed more commonly in RTTs working in government facilities (81.2 %).</div><div>Regarding disposal preferences, 381 (88.6%) participants preferred discarding used TMs in biomedical waste and 64.8% of these ultimately ended up as discarded scrap. Awareness regarding adverse environmental impact associated with TM disposal was reported by 320 (74.4%) participant RTTs.</div></div><div><h3>Conclusion</h3><div>The study highlights the prevalent practice of reuse of TMs, especially in curative treatments, government-run facilities and busy treatment settings. Additionally, it emphasises the imperative for enhanced bio-medical waste management practices to facilitate more effective handling and disposal of used TMs.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"32 ","pages":"Article 100278"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326933","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}
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