Upright patient positioning is an emerging approach in radiotherapy that may overcome current limitations in carbon ion radiotherapy (CIRT). This study evaluated upright immobilization techniques for abdominal and head-and-neck (HN) cancers in a CIRT setting.
Materials and Methods
Ten volunteers were positioned on the Chair, a demo upright positioning system (Leo Cancer Care, USA). Three setups were evaluated: no immobilization devices, vacuum bags alone (ESFORM; Engineering System Co., Japan), and vacuum bags with a thermoplastic shell (Shellfitter; Kuraray Trading Co., Japan), called the “shell” setup. Interfractional and intrafractional errors were assessed using skin markers drawn on the abdominal and HN areas. Interfractional shifts per direction and Euclidean distances were calculated by comparing reference and repeated images. Intrafractional shifts per direction and Euclidean distances were calculated from images acquired over a 15-min period. Also, volunteers rated their comfort for each setup on a scale of 1–5. Differences in the interfractional and intrafractional motion, and comfort ratings between the three setups were investigated.
Results
Significant differences (p < 0.05) in the interfractional Euclidean distances were observed between the three setups in both anatomical areas, while significant differences were observed in more shifts per direction in the abdominal case. The “shell” setup minimized intrafractional distances. No significant differences were observed in the comfort ratings between the setups.
Conclusion
Upright positioning in CIRT appears feasible. Further research is needed to refine immobilization techniques to support clinical implementation of upright positioning in CIRT.
背景与目的直立患者定位是一种新兴的放射治疗方法，可以克服目前碳离子放射治疗（CIRT）的局限性。本研究评估了在CIRT环境下直立固定腹部和头颈部（HN）癌症的技术。10名志愿者被安置在椅子上，这是一种演示直立定位系统（Leo Cancer Care， USA）。评估了三种设置：不使用固定装置，单独使用真空袋（ESFORM; Engineering System Co.，日本）和带热塑性外壳的真空袋（Shellfitter; Kuraray Trading Co.，日本），称为“外壳”设置。使用腹部和HN区域的皮肤标记物评估分数间和分数内误差。通过比较参考图像和重复图像，计算每个方向的分数间位移和欧几里得距离。从15分钟内获得的图像中计算每个方向和欧几里得距离的引力内位移。此外，志愿者们还对每种设置的舒适度进行了1-5分的评分。研究了三种设置之间的分数间和分数内运动和舒适度评分的差异。结果在这两个解剖区域，三种设置之间的分数间欧几里得距离有显著差异（p < 0.05），而在腹部病例中，每个方向的移位量有显著差异。“壳”设置最小化了引力内距离。两种设置之间的舒适度评分没有显著差异。结论CIRT直立定位是可行的。需要进一步的研究来完善固定技术，以支持CIRT直立定位的临床实施。
{"title":"Assessment of upright immobilization methods for abdominal and head-and-neck cancer treatments in a carbon ion radiotherapy setting","authors":"Maria Varnava , Motohiro Kawashima , Akihiko Matsumura , Yoshiaki Oohashi , Makoto Miyazawa , Junichi Koya , Naoto Yamaguchi , Tomoaki Ogano , Mutsumi Tashiro , Tatsuya Ohno","doi":"10.1016/j.tipsro.2025.100356","DOIUrl":"10.1016/j.tipsro.2025.100356","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Upright patient positioning is an emerging approach in radiotherapy that may overcome current limitations in carbon ion radiotherapy (CIRT). This study evaluated upright immobilization techniques for abdominal and head-and-neck (HN) cancers in a CIRT setting.</div></div><div><h3>Materials and Methods</h3><div>Ten volunteers were positioned on the Chair, a demo upright positioning system (Leo Cancer Care, USA). Three setups were evaluated: no immobilization devices, vacuum bags alone (ESFORM; Engineering System Co., Japan), and vacuum bags with a thermoplastic shell (Shellfitter; Kuraray Trading Co., Japan), called the “shell” setup. Interfractional and intrafractional errors were assessed using skin markers drawn on the abdominal and HN areas. Interfractional shifts per direction and Euclidean distances were calculated by comparing reference and repeated images. Intrafractional shifts per direction and Euclidean distances were calculated from images acquired over a 15-min period. Also, volunteers rated their comfort for each setup on a scale of 1–5. Differences in the interfractional and intrafractional motion, and comfort ratings between the three setups were investigated.</div></div><div><h3>Results</h3><div>Significant differences (<em>p</em> < 0.05) in the interfractional Euclidean distances were observed between the three setups in both anatomical areas, while significant differences were observed in more shifts per direction in the abdominal case. The “shell” setup minimized intrafractional distances. No significant differences were observed in the comfort ratings between the setups.</div></div><div><h3>Conclusion</h3><div>Upright positioning in CIRT appears feasible. Further research is needed to refine immobilization techniques to support clinical implementation of upright positioning in CIRT.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100356"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Contouring organ-at-risk structures (OARs) remains an important skill that must be developed through education and training. This study assessed variations in OAR contouring among undergraduate radiation therapy students and qualified radiation therapists (RTs).
Methods
Four planning computed tomography datasets (Brain, Lung, Parotid, and Prostate), which included 21 clinician-validated OAR contours, were utilised as references in this contouring study. Participants included 2nd to 4th year students, as well as qualified RTs. A quantitative comparison of contours was performed using the Dice Similarity Coefficient (DICE) and Hausdorff distance (HD) metrics. Statistical analyses assessed variations across structures, tumour sites, experience levels, and contouring methods.
Results
A total of 440 OAR contours were analysed. The bladder and lung OARs achieved the highest mean DICE scores (>0.9), while structures such as the brainstem, heart, and parotid gland exhibited mean DICE scores between 0.76 and 0.89. Smaller structures, such as the lens, demonstrated very low HD95 values. A moderate positive correlation (r = 0.591) was observed between OAR volume and DICE scores (<200 cc). Statistical analyses indicated significant differences across tumour sites (P < 0.001 for DICE, HDavg, HD95, and HDmax). The comparison of manual and guided contouring showed statistically significant differences only for DICE (P < 0.001) and HDmax (P = 0.004). There were no significant differences in median scores between students and qualified groups. However, students exhibited higher variance than qualified professionals.
Conclusion
This study highlighted OARs that are challenging to contour or edit, suggesting the need for a comprehensive educational framework.
{"title":"Inter-Observer variability in organs at risk contouring among radiation therapy students and qualified radiation therapists","authors":"Crispen Chamunyonga , Kerrie Mengersen , Catriona Hargrave","doi":"10.1016/j.tipsro.2025.100362","DOIUrl":"10.1016/j.tipsro.2025.100362","url":null,"abstract":"<div><h3>Introduction</h3><div>Contouring organ-at-risk structures (OARs) remains an important skill that must be developed through education and training. This study assessed variations in OAR contouring among undergraduate radiation therapy students and qualified radiation therapists (RTs).</div></div><div><h3>Methods</h3><div>Four planning computed tomography datasets (Brain, Lung, Parotid, and Prostate), which included 21 clinician-validated OAR contours, were utilised as references in this contouring study. Participants included 2nd to 4th year students, as well as qualified RTs. A quantitative comparison of contours was performed using the Dice Similarity Coefficient (DICE) and Hausdorff distance (HD) metrics. Statistical analyses assessed variations across structures, tumour sites, experience levels, and contouring methods.</div></div><div><h3>Results</h3><div>A total of 440 OAR contours were analysed. The bladder and lung OARs achieved the highest mean DICE scores (>0.9), while structures such as the brainstem, heart, and parotid gland exhibited mean DICE scores between 0.76 and 0.89. Smaller structures, such as the lens, demonstrated very low HD95 values. A moderate positive correlation (r = 0.591) was observed between OAR volume and DICE scores (<200 cc). Statistical analyses indicated significant differences across tumour sites (P < 0.001 for DICE, HDavg, HD95, and HDmax). The comparison of manual and guided contouring showed statistically significant differences only for DICE (P < 0.001) and HDmax (P = 0.004). There were no significant differences in median scores between students and qualified groups. However, students exhibited higher variance than qualified professionals.</div></div><div><h3>Conclusion</h3><div>This study highlighted OARs that are challenging to contour or edit, suggesting the need for a comprehensive educational framework.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100362"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed to assess whether deep inspiration breath-hold (DIBH) could reduce esophageal dose by spinal stereotactic body radiotherapy (SBRT). In 25 patients with thoracic DIBH CT, the vertebral–esophageal distance significantly increased at T2–T9, greatest at Th7 (median 2.1 mm). Simulated SBRT plans showed a strong correlation between distance and esophageal dose, each 1 mm increase reducing 150 cGy. DIBH reduced the esophageal D0.03 cc dose by a median of 411 cGy while maintaining positional reproducibility within 2 mm. These findings suggest that DIBH may reduce esophageal dose and warrants further study in patients with prior high-dose esophageal exposure.
{"title":"Deep inspiration breath-hold reduces esophageal dose in spinal stereotactic body radiotherapy: A feasibility study","authors":"Takahiro Aoyama, Yutaro Koide, Tomoki Kitagawa, Ryoma Tomoda, Shingo Hashimoto, Hiroyuki Tachibana, Takeshi Kodaira","doi":"10.1016/j.tipsro.2025.100358","DOIUrl":"10.1016/j.tipsro.2025.100358","url":null,"abstract":"<div><div>We aimed to assess whether deep inspiration breath-hold (DIBH) could reduce esophageal dose by spinal stereotactic body radiotherapy (SBRT). In 25 patients with thoracic DIBH CT, the vertebral–esophageal distance significantly increased at T2–T9, greatest at Th7 (median 2.1 mm). Simulated SBRT plans showed a strong correlation between distance and esophageal dose, each 1 mm increase reducing 150 cGy. DIBH reduced the esophageal D<sub>0.03 cc</sub> dose by a median of 411 cGy while maintaining positional reproducibility within 2 mm. These findings suggest that DIBH may reduce esophageal dose and warrants further study in patients with prior high-dose esophageal exposure.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100358"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-15DOI: 10.1016/j.tipsro.2025.100354
Dinah Konnerth , Hidehiro Hojo , Frederik Fuchs , Mohamed A. Shouman , Diana-Coralia Dehelean , Aurélie Gaasch , Franziska Walter , Chukwuka Eze , Sebastian N. Marschner , Sina Mansoorian , Sebastian H. Maier , Vanessa da Silva Mendes , Jan Hofmaier , Maximilian Niyazi , Claus Belka , Stefanie Corradini , Paul Rogowski
Purpose
Ablative stereotactic radiotherapy for pancreatic ductal adenocarcinoma (PDAC) is limited by adjacent radiosensitive organs at risk (OAR) that exhibit significant daily positional variability. This study aims to investigate the benefit of stereotactic MRI-guided online adaptive radiotherapy (SMART) with elective fields on target coverage and OAR dose sparing in patients with PDAC.
Methods
We retrospectively analysed 62 consecutive PDAC patients treated with SMART between 2020–2024, totaling 310 fractions. For each fraction, a non-adapted plan (PLANPREDICT) was compared to its online-adapted counterpart (PLANREOPTIMIZED). We assessed planning target volume (PTV) coverage and OAR constraints. Plan-adaptation was classified as “useful” when the PLANREOPTIMIZED met all objectives or improved PTV coverage or OAR sparing by ≥ 10 %, as “futile” when PLANREOPTIMIZED failed to meet or markedly improve objectives, and as “not necessary” when PLANPREDICT already met all objectives.
Results
Prescribed doses were 40 Gy (71 %) and 33 Gy (29 %) over five fractions. A simultaneous integrated boost approach was used in 47 % of patients. The PLANPREDICT met all planning goals in 1 % of fractions, which increased to 72 % with PLANREOPTIMIZED. Adaptation yielded significant improvements in PTV coverage (p < 0.001) and reductions in V33Gy for stomach (median 0.26 cc vs. 0.01 cc), duodenum (median 1.08 cc vs. 0.07 cc) and bowel (median 2.04 cc vs. 0.06 cc), all p < 0.001. Adaptation was deemed useful in 305 (98 %), not necessary in 4 (1 %) and futile in 1 fraction (0.3 %).
Conclusion
For the vast majority of PDAC patients treated with stereotactic radiotherapy with elective fields daily online adaptation enhances target coverage and OAR sparing.
{"title":"Improved PTV coverage and OAR sparing with stereotactic MRI-guided online adaptive radiotherapy with elective fields in pancreatic cancer","authors":"Dinah Konnerth , Hidehiro Hojo , Frederik Fuchs , Mohamed A. Shouman , Diana-Coralia Dehelean , Aurélie Gaasch , Franziska Walter , Chukwuka Eze , Sebastian N. Marschner , Sina Mansoorian , Sebastian H. Maier , Vanessa da Silva Mendes , Jan Hofmaier , Maximilian Niyazi , Claus Belka , Stefanie Corradini , Paul Rogowski","doi":"10.1016/j.tipsro.2025.100354","DOIUrl":"10.1016/j.tipsro.2025.100354","url":null,"abstract":"<div><h3>Purpose</h3><div>Ablative stereotactic radiotherapy for pancreatic ductal adenocarcinoma (PDAC) is limited by adjacent radiosensitive organs at risk (OAR) that exhibit significant daily positional variability. This study aims to investigate the benefit of stereotactic MRI-guided online adaptive radiotherapy (SMART) with elective fields on target coverage and OAR dose sparing in patients with PDAC.</div></div><div><h3>Methods</h3><div>We retrospectively analysed 62 consecutive PDAC patients treated with SMART between 2020–2024, totaling 310 fractions. For each fraction, a non-adapted plan (PLAN<sub>PREDICT</sub>) was compared to its online-adapted counterpart (PLAN<sub>REOPTIMIZED</sub>). We assessed planning target volume (PTV) coverage and OAR constraints. Plan-adaptation was classified as “useful” when the PLAN<sub>REOPTIMIZED</sub> met all objectives or improved PTV coverage or OAR sparing by ≥ 10 %, as “futile” when PLAN<sub>REOPTIMIZED</sub> failed to meet or markedly improve objectives, and as “not necessary” when PLAN<sub>PREDICT</sub> already met all objectives.</div></div><div><h3>Results</h3><div>Prescribed doses were 40 Gy (71 %) and 33 Gy (29 %) over five fractions. A simultaneous integrated boost approach was used in 47 % of patients. The PLAN<sub>PREDICT</sub> met all planning goals in 1 % of fractions, which increased to 72 % with PLAN<sub>REOPTIMIZED</sub>. Adaptation yielded significant improvements in PTV coverage (p < 0.001) and reductions in V33Gy for stomach (median 0.26 cc vs. 0.01 cc), duodenum (median 1.08 cc vs. 0.07 cc) and bowel (median 2.04 cc vs. 0.06 cc), all p < 0.001. Adaptation was deemed useful in 305 (98 %), not necessary in 4 (1 %) and futile in 1 fraction (0.3 %).</div></div><div><h3>Conclusion</h3><div>For the vast majority of PDAC patients treated with stereotactic radiotherapy with elective fields daily online adaptation enhances target coverage and OAR sparing.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100354"},"PeriodicalIF":2.8,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1016/j.tipsro.2025.100355
Laura Barry , Melanie Clarkson , Erica Bennett
Advanced practice is not a new concept in Irish healthcare, having been established in nursing for decades. However, there is limited clinical career progression for radiation therapists as advanced practice roles have not been formalised within radiotherapy. The same factors driving other jurisdictions worldwide to implement advanced practice roles in radiotherapy are the reasons for change in Ireland today: an ageing population, new technology, recruitment, retention, task-shifting, and optimisation of patient-centred care. A national framework in Ireland has not yet been established.
To identify the key barriers and enablers of implementing advanced practice in radiotherapy in Ireland, a qualitative study was undertaken, which consisted of semi-structured interviews of 10 key senior stakeholders.
The key themes identified were: training/education, professional development, governance and workplace culture. Ethics approval and participant consent were sought in advance.
Participants across both public and private sectors acknowledged the potential of advanced practice in radiation therapy roles to tackle recruitment and retention issues, enhance patient care and optimise service efficiency. Key findings included the need for funded education in addition to frustration around slow implementation despite widespread clinical support.
The recommendations based on the study findings are:
–
Creation of an Irish AP implementation steering group
–
Create a specific APRT guidance framework document.
–
Recognition of master’s level education requirement for the role to be undertaken and completed in post in a candidacy style
{"title":"Avoiding a crisis: A national review of implementing the role of advanced practice in radiation therapists in Ireland","authors":"Laura Barry , Melanie Clarkson , Erica Bennett","doi":"10.1016/j.tipsro.2025.100355","DOIUrl":"10.1016/j.tipsro.2025.100355","url":null,"abstract":"<div><div>Advanced practice is not a new concept in Irish healthcare, having been established in nursing for decades. However, there is limited clinical career progression for radiation therapists as advanced practice roles have not been formalised within radiotherapy. The same factors driving other jurisdictions worldwide to implement advanced practice roles in radiotherapy are the reasons for change in Ireland today: an ageing population, new technology, recruitment, retention, task-shifting, and optimisation of patient-centred care. A national framework in Ireland has not yet been established.</div><div>To identify the key barriers and enablers of implementing advanced practice in radiotherapy in Ireland, a qualitative study was undertaken, which consisted of semi-structured interviews of 10 key senior stakeholders.</div><div>The key themes identified were: training/education, professional development, governance and workplace culture. Ethics approval and participant consent were sought in advance.</div><div>Participants across both public and private sectors acknowledged the potential of advanced practice in radiation therapy roles to tackle recruitment and retention issues, enhance patient care and optimise service efficiency. Key findings included the need for funded education in addition to frustration around slow implementation despite widespread clinical support.</div><div>The recommendations based on the study findings are:<ul><li><span>–</span><span><div>Creation of an Irish AP implementation steering group</div></span></li><li><span>–</span><span><div>Create a specific APRT guidance framework document.</div></span></li><li><span>–</span><span><div>Recognition of master’s level education requirement for the role to be undertaken and completed in post in a candidacy style</div></span></li></ul></div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100355"},"PeriodicalIF":2.8,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-08DOI: 10.1016/j.tipsro.2025.100353
Deondre Do , Christopher Conlin , Madison Baxter , John Christodouleas , Robert Dess , Irena Dragojevic , Mukesh Harisinghani , Sophia Kamran , Vitali Moiseenko , Himanshu Nagar , Nabih Nakrour , Lily Nguyen , Rhea Rupareliya , Steven Seyedin , Yuze Song , Anders M Dale , Tyler M Seibert
Background
Accurate image registration between magnetic resonance imaging (MRI) and computed tomography (CT) is required for precise radiation therapy of prostate cancer. Manual registration methods have been identified as a significant barrier to the implementation of advanced treatment techniques such as focal boost therapy.
Purpose
To evaluate the accuracy of PrecisionPro Fusion—an automated, rigid, prostate-specific MRI-CT registration pipeline— compared to manual registration by experienced radiation oncologists.
Materials and Methods
We conducted a prospective, multi-institutional validation study involving six genitourinary radiation oncologists from three institutions who performed registrations on 20 patient cases. The study used a two-round design with a one-month washout period, where physicians conducted MRI-CT registrations with and without PrecisionPro Fusion. We compared PrecisionPro Fusion to practical accuracy limits of manual registration, defined by intra-physician variability (distance between a physician’s two MRI-CT registrations of the same patient case) and inter-physician variability (maximum distance between a physician’s registration and the physician consensus— average of all physicians’ registrations of that patient case). Physician participants reported on the PrecisionPro Fusion user experience using a System Usability Scale questionnaire.
Results
Intra-physician variability for manual subspecialist registrations was median 2.9 mm (IQR: 1.9, 5.4); inter-physician variability was median: 4.7 mm (4.3, 5.7). PrecisionPro Fusion registrations had median distance from the physician consensus of 1.3 mm (IQR: 0.9, 2.7). The system received high usability scores (median 81; IQR: 74, 88).
Conclusion
PrecisionPro Fusion provides prostate MRI-CT registration accuracy comparable to manual physician registration. Automated, rigid, prostate-specific MRI-CT registration could enable faster delineation of structures visible on MRI, including the urethra and intraprostatic tumors.
背景磁共振成像（MRI）和计算机断层扫描（CT）之间的精确图像配准是前列腺癌精确放射治疗的必要条件。人工登记方法已被确定为实施先进治疗技术（如局灶增强治疗）的重大障碍。目的：与经验丰富的放射肿瘤学家手动注册相比，评估PrecisionPro fusion（一种自动化、刚性、前列腺特异性MRI-CT注册管道）的准确性。材料和方法我们进行了一项前瞻性、多机构验证性研究，涉及来自三家机构的六名泌尿生殖系统放射肿瘤学家，他们对20例患者进行了登记。该研究采用两轮设计，有一个月的洗脱期，其中医生进行了使用PrecisionPro Fusion和不使用PrecisionPro Fusion的MRI-CT注册。我们将PrecisionPro Fusion与手工注册的实际准确性限制进行了比较，手工注册的实际准确性限制由医生内部变异性（同一患者病例的医生两次MRI-CT注册之间的距离）和医生之间的变异性（医生注册与医生共识之间的最大距离-该患者病例的所有医生注册的平均值）定义。医生参与者使用系统可用性量表问卷报告PrecisionPro Fusion的用户体验。结果手工亚专科注册的医师间变异中位数为2.9 mm (IQR: 1.9, 5.4)；医师间变异的中位数为4.7 mm （4.3 mm, 5.7 mm）。PrecisionPro Fusion注册与医生共识的中位距离为1.3 mm （IQR: 0.9, 2.7）。该系统获得了很高的可用性分数（中位数81；IQR: 74,88）。结论precisionpro Fusion提供的前列腺MRI-CT注册精度可与手动医师注册相媲美。自动化、刚性、前列腺特异性MRI- ct登记可以更快地描绘MRI上可见的结构，包括尿道和前列腺内肿瘤。
{"title":"PrecisionPro Fusion: Clinical validation of an automated, rigid, Prostate-Specific MRI-CT Fusion system for prostate radiotherapy planning","authors":"Deondre Do , Christopher Conlin , Madison Baxter , John Christodouleas , Robert Dess , Irena Dragojevic , Mukesh Harisinghani , Sophia Kamran , Vitali Moiseenko , Himanshu Nagar , Nabih Nakrour , Lily Nguyen , Rhea Rupareliya , Steven Seyedin , Yuze Song , Anders M Dale , Tyler M Seibert","doi":"10.1016/j.tipsro.2025.100353","DOIUrl":"10.1016/j.tipsro.2025.100353","url":null,"abstract":"<div><h3>Background</h3><div>Accurate image registration between magnetic resonance imaging (MRI) and computed tomography (CT) is required for precise radiation therapy of prostate cancer. Manual registration methods have been identified as a significant barrier to the implementation of advanced treatment techniques such as focal boost therapy.</div></div><div><h3>Purpose</h3><div>To evaluate the accuracy of PrecisionPro Fusion—an automated, rigid, prostate-specific MRI-CT registration pipeline— compared to manual registration by experienced radiation oncologists.</div></div><div><h3>Materials and Methods</h3><div>We conducted a prospective, multi-institutional validation study involving six genitourinary radiation oncologists from three institutions who performed registrations on 20 patient cases. The study used a two-round design with a one-month washout period, where physicians conducted MRI-CT registrations with and without PrecisionPro Fusion. We compared PrecisionPro Fusion to practical accuracy limits of manual registration, defined by intra-physician variability (distance between a physician’s two MRI-CT registrations of the same patient case) and inter-physician variability (maximum distance between a physician’s registration and the physician consensus— average of all physicians’ registrations of that patient case). Physician participants reported on the PrecisionPro Fusion user experience using a System Usability Scale questionnaire.</div></div><div><h3>Results</h3><div>Intra-physician variability for manual subspecialist registrations was median 2.9 mm (IQR: 1.9, 5.4); inter-physician variability was median: 4.7 mm (4.3, 5.7). PrecisionPro Fusion registrations had median distance from the physician consensus of 1.3 mm (IQR: 0.9, 2.7). The system received high usability scores (median 81; IQR: 74, 88).</div></div><div><h3>Conclusion</h3><div>PrecisionPro Fusion provides prostate MRI-CT registration accuracy comparable to manual physician registration. Automated, rigid, prostate-specific MRI-CT registration could enable faster delineation of structures visible on MRI, including the urethra and intraprostatic tumors.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100353"},"PeriodicalIF":2.8,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-28DOI: 10.1016/j.tipsro.2025.100351
Caroline Marr , Tara Rosewall , Helen A McNair , Maddalena M.G. Rossi , Yat Tsang
Purpose
Radiation Therapist (RTT) research culture is essential for driving innovation and informing evidence-based practice. This study aimed to assess RTT research output and institutional capacity-building initiatives across international clinical academic cancer centres.
Methods
This was a retrospective analysis of RTT research activities and capacity-building initiatives from 2013 to 2022 at three centres located in Canada (CA), the Netherlands (NL) and the United Kingdom (UK). Data was collected on research output by identifying all RTT author publications (first, second, or senior author). Institutional capacity-building initiatives were captured from each centre and described using full-time equivalents (FTEs). A qualitative analysis was conducted on all RTT publications to identify common research topics.
Results
Over the 10 years, the total number of RTT-authored publications was 445 across the centres (CA:291; UK:79; NL:75). RTTs as first authors ranged from 14.7 % to 44.3 % and RTTs as senior authors ranged from 0 % to 27.8 % of publications. Centres with increasing FTEs demonstrated increasing research productivity, with publications changing from 21 to 34 in CA and from 3 to 15 in the UK centre. Multidisciplinary collaboration was common among all centres. Prominent RTT research themes included technological applications, RTT professional development and quality assurance, clinical outcomes, dosimetry, and patient care. Common strategies to build research capacity included educational initiatives, the creation of dedicated research roles, and promoting research dissemination.
Conclusion
This study highlighted the contributions of RTTs to radiation oncology research and how a comprehensive approach to building research capacity results in high RTT research output and collaboration.
{"title":"Radiation therapist research capacity and output: a multicentre retrospective study of authorship, collaboration, and institutional strategies (2013–2022)","authors":"Caroline Marr , Tara Rosewall , Helen A McNair , Maddalena M.G. Rossi , Yat Tsang","doi":"10.1016/j.tipsro.2025.100351","DOIUrl":"10.1016/j.tipsro.2025.100351","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation Therapist (RTT) research culture is essential for driving innovation and informing evidence-based practice. This study aimed to assess RTT research output and institutional capacity-building initiatives across international clinical academic cancer centres.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of RTT research activities and capacity-building initiatives from 2013 to 2022 at three centres located in Canada (CA), the Netherlands (NL) and the United Kingdom (UK). Data was collected on research output by identifying all RTT author publications (first, second, or senior author). Institutional capacity-building initiatives were captured from each centre and described using full-time equivalents (FTEs). A qualitative analysis was conducted on all RTT<!--> <!-->publications to identify common research topics.</div></div><div><h3>Results</h3><div>Over the 10 years, the total number of RTT-authored publications was 445 across the centres (CA:291; UK:79; NL:75). RTTs as first authors ranged from 14.7 % to 44.3 % and RTTs as senior authors ranged from 0 % to 27.8 % of publications. Centres with increasing FTEs demonstrated increasing research productivity, with publications changing from 21 to 34 in CA and from 3 to 15 in the UK centre. Multidisciplinary collaboration was common among all centres. Prominent RTT research themes included technological applications, RTT professional development and quality assurance, clinical outcomes, dosimetry, and patient care. Common strategies to build research capacity included educational initiatives, the creation of dedicated research roles, and promoting research dissemination.</div></div><div><h3>Conclusion</h3><div>This study highlighted the contributions of RTTs to radiation oncology research and how a comprehensive approach to building research capacity results in high RTT research output and collaboration.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100351"},"PeriodicalIF":2.8,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-23DOI: 10.1016/j.tipsro.2025.100352
Sarah Barrett , Laure Marignol , Gerard G Hanna , Conor K McGarry , Gerard M Walls
Delineating the gross tumour volume (GTV) in non-small cell lung cancer (NSCLC) can be challenging due to anatomical complexities and imaging artefacts. This study evaluates a semi-automated workflow using commercial software for target volume (TV) delineation on cone-beam CT (CBCT) in patients undergoing radical radiotherapy. Seventy-six patients with 553 scans (n = 76 planning CT, n = 477 CBCT) were included. Auto-contours were adjusted by a senior Radiation Therapist and reviewed for accuracy. The majority (59.1 %) required only minor revisions, with median adjustment time of CBCT auto-contours of 83 (range 0–460) seconds. The findings support the feasibility of this approach, offering a pragmatic solution for adaptive radiotherapy workflows in NSCLC.
由于解剖复杂性和成像伪影，非小细胞肺癌（NSCLC）的总肿瘤体积（GTV）的描绘具有挑战性。本研究评估了在接受根治性放疗的患者中，使用商业软件在锥束CT （CBCT）上进行靶体积（TV）划定的半自动工作流程。纳入76例患者553次扫描（n = 76次计划CT， n = 477次CBCT）。自动轮廓由高级放射治疗师调整，并检查其准确性。大多数（59.1%）只需要轻微的修改，CBCT自动轮廓的中位调整时间为83（范围0-460）秒。研究结果支持该方法的可行性，为非小细胞肺癌的适应性放疗工作流程提供了实用的解决方案。
{"title":"Monitoring lung tumour volume on daily cone beam CT; is it achievable in a real-world setting?","authors":"Sarah Barrett , Laure Marignol , Gerard G Hanna , Conor K McGarry , Gerard M Walls","doi":"10.1016/j.tipsro.2025.100352","DOIUrl":"10.1016/j.tipsro.2025.100352","url":null,"abstract":"<div><div>Delineating the gross tumour volume (GTV) in non-small cell lung cancer (NSCLC) can be challenging due to anatomical complexities and imaging artefacts. This study evaluates a semi-automated workflow using commercial software for target volume (TV) delineation on cone-beam CT (CBCT) in patients undergoing radical radiotherapy. Seventy-six patients with 553 scans (n = 76 planning CT, n = 477 CBCT) were included. Auto-contours were adjusted by a senior Radiation Therapist and reviewed for accuracy. The majority (59.1 %) required only minor revisions, with median adjustment time of CBCT auto-contours of 83 (range 0–460) seconds. The findings support the feasibility of this approach, offering a pragmatic solution for adaptive radiotherapy workflows in NSCLC.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100352"},"PeriodicalIF":2.8,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/j.tipsro.2025.100350
Taeyoon Kim, Nicola Bizzocchi
{"title":"Advancing proton therapy together: insights on practice, technology, and implementation","authors":"Taeyoon Kim, Nicola Bizzocchi","doi":"10.1016/j.tipsro.2025.100350","DOIUrl":"10.1016/j.tipsro.2025.100350","url":null,"abstract":"","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100350"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-12DOI: 10.1016/j.tipsro.2025.100349
Aria Malhotra , Andrew K.H. Robertson , Ian Sun , Samantha A.M. Lloyd
Background and purpose
Surface guided radiation therapy (SGRT) is a new approach for patient setup that can replace tattoo-based positioning. The permanent body markings that come with this long-standing standard of care can have a lasting negative emotional impact on cancer survivors. This study evaluates surface guidance as an alternative positioning modality, comparing speed, accuracy, and cost of the two techniques.
Methods
Setup time and positional accuracy prior to radiographic localization for patients receiving radiation therapy for breast cancer were compared between two linear accelerators, one with and one without surface guidance technology. A Wilcoxon rank sum test was used to determine statistically significant differences in setup time and positional shifts. Cost projections per fraction and per patient for both modalities were conducted.
Results
SGRT positional accuracy and setup time were equivalent to or better than tattoo-based setup. SGRT setup was faster for all photon treatments by 11 s. Deep inspiration breath hold setup times were equivalent for both positioning modalities, but SGRT was faster by 23 s for free breathing setups. There were no statistically significant differences in the magnitude of positional shifts on pre-treatment imaging. SGRT costs are broken down into item costs and staffing costs, with final estimates dependent on a center’s capacity for treatments per day.
Conclusions
Surface guided patient positioning for breast radiotherapy is fiscally feasible and non-inferior to permanent tattoos in terms of set up time and accuracy.
{"title":"Operational assessment of tattooless breast radiotherapy using AlignRT surface guidance","authors":"Aria Malhotra , Andrew K.H. Robertson , Ian Sun , Samantha A.M. Lloyd","doi":"10.1016/j.tipsro.2025.100349","DOIUrl":"10.1016/j.tipsro.2025.100349","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Surface guided radiation therapy (SGRT) is a new approach for patient setup that can replace tattoo-based positioning. The permanent body markings that come with this long-standing standard of care can have a lasting negative emotional impact on cancer survivors. This study evaluates surface guidance as an alternative positioning modality, comparing speed, accuracy, and cost of the two techniques.</div></div><div><h3>Methods</h3><div>Setup time and positional accuracy prior to radiographic localization for patients receiving radiation therapy for breast cancer were compared between two linear accelerators, one with and one without surface guidance technology. A Wilcoxon rank sum test was used to determine statistically significant differences in setup time and positional shifts. Cost projections per fraction and per patient for both modalities were conducted.</div></div><div><h3>Results</h3><div>SGRT positional accuracy and setup time were equivalent to or better than tattoo-based setup. SGRT setup was faster for all photon treatments by 11 s. Deep inspiration breath hold setup times were equivalent for both positioning modalities, but SGRT was faster by 23 s for free breathing setups. There were no statistically significant differences in the magnitude of positional shifts on pre-treatment imaging. SGRT costs are broken down into item costs and staffing costs, with final estimates dependent on a center’s capacity for treatments per day.</div></div><div><h3>Conclusions</h3><div>Surface guided patient positioning for breast radiotherapy is fiscally feasible and non-inferior to permanent tattoos in terms of set up time and accuracy.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"36 ","pages":"Article 100349"},"PeriodicalIF":2.8,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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