Pub Date : 2025-09-01DOI: 10.1016/j.tipsro.2025.100341
Amnuay Kleebayoon , Viroj Wiwanitkit
{"title":"Correspondence on “Custom-made, 3D-printed bolus cap for a case of scalp metastasis: A single-institution study”","authors":"Amnuay Kleebayoon , Viroj Wiwanitkit","doi":"10.1016/j.tipsro.2025.100341","DOIUrl":"10.1016/j.tipsro.2025.100341","url":null,"abstract":"","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100341"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931561","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 : 2025-09-01Epub Date: 2025-08-05DOI: 10.1016/j.tipsro.2025.100331
Kathryn Osborn , Jaymisha Davda , Rita Simoes , Michael O’Connor , Olivia Willis , Sarah Gulliford , Syed Ali Moinuddin , Turmi Patel , Sarah Petty , Mahbubl Ahmed , Thomas Richards , Sairanne Wickers
The use of proton beam therapy (PBT) for breast cancer is not currently included for standard consideration on the NHS England indication list. However, there are occasions where the use of PBT may be approved in the United Kingdom (UK), such as breast sarcoma, as part of a clinical trial or due to a photon plan meeting a threshold for significant risk of acute and late toxicities (e.g. pre-existing co-morbidities). Due to the beam characteristics, the use of PBT for breast treatment poses challenges in terms of the immobilisation, pre-treatment scanning, treatment verification and delivery. This standard operating procedure (SOP) details strategies to mitigate these that were developed as part of the implementation of breast PBT at our institution. This SOP will support existing and new PBT services when treating this patient cohort, by providing a detailed step-by-step guide to improve consistency and efficiency in the management of breast PBT.
{"title":"Standard operating procedure (SOP) for immobilisation, scanning, verification and treatment of breast cancer patients undergoing proton beam therapy","authors":"Kathryn Osborn , Jaymisha Davda , Rita Simoes , Michael O’Connor , Olivia Willis , Sarah Gulliford , Syed Ali Moinuddin , Turmi Patel , Sarah Petty , Mahbubl Ahmed , Thomas Richards , Sairanne Wickers","doi":"10.1016/j.tipsro.2025.100331","DOIUrl":"10.1016/j.tipsro.2025.100331","url":null,"abstract":"<div><div>The use of proton beam therapy (PBT) for breast cancer is not currently included for standard consideration on the NHS England indication list. However, there are occasions where the use of PBT may be approved in the United Kingdom (UK), such as breast sarcoma, as part of a clinical trial or due to a photon plan meeting a threshold for significant risk of acute and late toxicities (e.g. pre-existing co-morbidities). Due to the beam characteristics, the use of PBT for breast treatment poses challenges in terms of the immobilisation, pre-treatment scanning, treatment verification and delivery. This standard operating procedure (SOP) details strategies to mitigate these that were developed as part of the implementation of breast PBT at our institution. This SOP will support existing and new PBT services when treating this patient cohort, by providing a detailed step-by-step guide to improve consistency and efficiency in the management of breast PBT.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100331"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931559","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 : 2025-09-01Epub Date: 2025-08-20DOI: 10.1016/j.tipsro.2025.100337
Catherine Laferlita , Yiota Nicolaou , Katrina Woodford , Nicholas Hardcastle , Susan Harden , Kenton Thompson
With advancements in oncology practice, patients are living longer and returning for repeat courses of radiotherapy. Reirradiation (ReRT) is becoming a viable treatment option for patients. This single-institution, retrospective audit evaluates the number of patients with primary lung cancers who underwent radical retreatment to the thorax in 2024 and categorises them according to the European Society for Radiotherapy and Oncology (ESTRO) and European Organisation for Research and Treatment of Cancer (EORTC) consensus definition. Of the 511 patients with primary lung cancer in our institution who returned for further radiotherapy in 2024, 42 received radical retreatment to the thorax. Inconsistencies were seen in documentation across patient information platforms in relation to cumulative dose assessment and minimal documentation of radiobiological considerations such as equivalent dose in 2 Gy fraction (EQD2) were discovered. As a result of this study, recommendations were made to improve current practice.
{"title":"Reirradiation: Evaluation of the occurrence and type in cancer treatment for lung – 2024","authors":"Catherine Laferlita , Yiota Nicolaou , Katrina Woodford , Nicholas Hardcastle , Susan Harden , Kenton Thompson","doi":"10.1016/j.tipsro.2025.100337","DOIUrl":"10.1016/j.tipsro.2025.100337","url":null,"abstract":"<div><div>With advancements in oncology practice, patients are living longer and returning for repeat courses of radiotherapy. Reirradiation (ReRT) is becoming a viable treatment option for patients. This single-institution, retrospective audit evaluates the number of patients with primary lung cancers who underwent radical retreatment to the thorax in 2024 and categorises them according to the European Society for Radiotherapy and Oncology (ESTRO) and European Organisation for Research and Treatment of Cancer (EORTC) consensus definition. Of the 511 patients with primary lung cancer in our institution who returned for further radiotherapy in 2024, 42 received radical retreatment to the thorax. Inconsistencies were seen in documentation across patient information platforms in relation to cumulative dose assessment and minimal documentation of radiobiological considerations such as equivalent dose in 2 Gy fraction (EQD2) were discovered. As a result of this study, recommendations were made to improve current practice.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100337"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885680","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}
This study evaluated dosimetric values of cone beam computed tomography (CBCT)-guided online adaptive radiotherapy (oART) in patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, accounting for interfractional and intrafractional motion.
Methods
Four patients with stage I gastric MALT lymphoma received CBCT-guided oART. For each of the 60 treatment sessions, scheduled (SCH) and adapted (ADP) plans were generated. Dosimetric evaluation focused on clinical target volume (CTV) and organs at risk (OARs). Metrics included CTV D98 % and D95 %, mean dose to the liver and left and right kidneys, maximum dose to the spinal cord, and V5Gy for bilateral kidneys. Adaptive planning CBCT-based contours were propagated to synthetic CTs of SCH and ADP plans to assess interfractional motion. Post-treatment CBCT-based contours were propagated to synthetic CTs of the ADP plan to evaluate intrafractional motion.
Results
ADP plans significantly improved CTV coverage: mean D98% increased from 94.7 % in the SCH plan to 98.6 %, and D95% from 97.3 % to 99.2 % (p < 0.001). Most OAR doses were reduced in the ADP plans, including bilateral kidney V5Gy (11.3 % vs. 8.3 %, p < 0.001) and spinal cord Dmax (9.8 Gy vs. 7.9 Gy, p < 0.001). Liver Dmean was slightly higher in the ADP plan (11.4 Gy vs. 11.1 Gy, p = 0.002). No significant differences were observed in CTV and OAR dosimetric parameters between adaptive planning and post-treatment CBCTs (e.g., CTV D98%: 98.6 % vs. 98.5 %, p = 0.629).
Conclusion
CBCT-guided oART improved target coverage and maintained post-treatment dosimetric stability in gastric MALT lymphoma, supporting clinical feasibility.
本研究评估了锥束计算机断层扫描（CBCT）引导下的在线适应性放疗（oART）在胃粘膜相关淋巴组织（MALT）淋巴瘤患者中的剂量学价值，考虑了分数间和分数内运动。方法4例I期胃MALT淋巴瘤患者行cbct引导下的oART治疗。对于60个疗程中的每一个，都生成了预定（SCH）和适应（ADP）计划。剂量学评价侧重于临床靶体积（CTV）和危险器官（OARs）。指标包括CTV d98%和d95%，肝脏和左右肾的平均剂量，脊髓的最大剂量，双侧肾脏的V5Gy。基于自适应规划cbct的轮廓被传播到SCH和ADP计划的合成ct中，以评估分数间运动。将治疗后基于cbct的轮廓传播到ADP计划的合成ct中，以评估术内运动。结果adp方案显著提高了CTV覆盖率：平均D98%由SCH方案的94.7%提高到98.6%，D95%由97.3%提高到99.2% (p <；0.001)。ADP方案中大多数OAR剂量减少，包括双侧肾V5Gy (11.3% vs. 8.3%, p <；0.001)和脊髓Dmax (9.8 Gy vs. 7.9 Gy, p <；0.001)。ADP组肝脏Dmean略高（11.4 Gy vs 11.1 Gy, p = 0.002）。适应性计划cbct和治疗后cbct的CTV和OAR剂量学参数无显著差异（例如，CTV D98%: 98.6% vs 98.5%, p = 0.629）。结论cbct引导下的oART提高了胃MALT淋巴瘤的靶标覆盖率，维持了治疗后剂量学的稳定性，支持临床可行性。
{"title":"Dosimetric evaluation of cone beam computed tomography-guided online adaptive radiotherapy in gastric mucosa-associated lymphoid tissue lymphoma","authors":"Masanori Takaki , Taka-aki Hirose , Tadamasa Yoshitake , Keiji Matsumoto , Yuko Shirakawa , Hiroaki Wakiyama , Osamu Hisano , Hikaru Imafuku , Kousei Ishigami","doi":"10.1016/j.tipsro.2025.100321","DOIUrl":"10.1016/j.tipsro.2025.100321","url":null,"abstract":"<div><h3>Introduction</h3><div>This study evaluated dosimetric values of cone beam computed tomography (CBCT)-guided online adaptive radiotherapy (oART) in patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, accounting for interfractional and intrafractional motion.</div></div><div><h3>Methods</h3><div>Four patients with stage I gastric MALT lymphoma received CBCT-guided oART. For each of the 60 treatment sessions, scheduled (SCH) and adapted (ADP) plans were generated. Dosimetric evaluation focused on clinical target volume (CTV) and organs at risk (OARs). Metrics included CTV D98 % and D95 %, mean dose to the liver and left and right kidneys, maximum dose to the spinal cord, and V5Gy for bilateral kidneys. Adaptive planning CBCT-based contours were propagated to synthetic CTs of SCH and ADP plans to assess interfractional motion. Post-treatment CBCT-based contours were propagated to synthetic CTs of the ADP plan to evaluate intrafractional motion.</div></div><div><h3>Results</h3><div>ADP plans significantly improved CTV coverage: mean D98% increased from 94.7 % in the SCH plan to 98.6 %, and D95% from 97.3 % to 99.2 % (p < 0.001). Most OAR doses were reduced in the ADP plans, including bilateral kidney V5Gy (11.3 % vs. 8.3 %, p < 0.001) and spinal cord Dmax (9.8 Gy vs. 7.9 Gy, p < 0.001). Liver Dmean was slightly higher in the ADP plan (11.4 Gy vs. 11.1 Gy, p = 0.002). No significant differences were observed in CTV and OAR dosimetric parameters between adaptive planning and post-treatment CBCTs (e.g., CTV D98%: 98.6 % vs. 98.5 %, p = 0.629).</div></div><div><h3>Conclusion</h3><div>CBCT-guided oART improved target coverage and maintained post-treatment dosimetric stability in gastric MALT lymphoma, supporting clinical feasibility.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100321"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489803","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 : 2025-09-01Epub Date: 2025-07-21DOI: 10.1016/j.tipsro.2025.100324
Helen Barnes , Sophie Alexander , Shreerang Bhide , Alex Dunlop , Amit Gupta , Kevin Harrington , Trina Herbert , Kee Howe Wong , Helen McNair
Introduction
Head and neck cancer (HNC) treatment on the Unity MR-Linac (MRL) (Elekta AB, Stockholm, Sweden) has been developed using the novel adapt-to-shape Lite (ATS-lite) method to create clinically acceptable adaptive treatments clinician-free. Here we investigate patient experience and acceptability of this technique.
Methods
Ten HNC patients treated to 65 Gy in 30 fractions with MRI-guided adaptive radiotherapy (MRIgART) within the PERMIT trial (NCT03727698), were included. Data collected comprised patient demographics, treatment time, and patient experience, using an established MRL questionnaire.
Back-up plans were created for use on the conventional linac with CT guidance, to prevent missed fractions. The frequency of use was collected and categorised to reflect the cause.
Results
The median total treatment time for ATS-lite method was 39 min. The percentage of treatments under 60 mins was 98.8 %.
Questionnaire response rate was 85% and individual question response rate was 99%. Ninety-six percent of responses scored 2 or 3 on the Likert scale, a positive answer. The lowest scoring question was “I forced myself to manage the situation,” with a mean (SD) of 2.4 (0.9).
The MRL delivered 84.7 % of treatments. The back-up plan was used for 46 fractions, 7 attributed to patient tolerance (n = 2 patients).
Conclusion
Average treatment times for the ATS-lite HNC MRIgART are acceptable and faster than reported ATP treatment times. Patient-reported experience was extremely positive. Use of back-up plans attributable to lack of patient tolerance was low. This technique can used with the confidence that patient experience is not negatively impacted.
{"title":"Patient experience of head and neck treatment on a 1.5 T MR-Linac: is the ATS-lite adaptive solution tolerable?","authors":"Helen Barnes , Sophie Alexander , Shreerang Bhide , Alex Dunlop , Amit Gupta , Kevin Harrington , Trina Herbert , Kee Howe Wong , Helen McNair","doi":"10.1016/j.tipsro.2025.100324","DOIUrl":"10.1016/j.tipsro.2025.100324","url":null,"abstract":"<div><h3>Introduction</h3><div>Head and neck cancer (HNC) treatment on the Unity MR-Linac (MRL) (Elekta AB, Stockholm, Sweden) has been developed using the novel adapt-to-shape Lite (ATS-lite) method to create clinically acceptable adaptive treatments clinician-free. Here we investigate patient experience and acceptability of this technique.</div></div><div><h3>Methods</h3><div>Ten HNC patients treated to 65 Gy in 30 fractions with MRI-guided adaptive radiotherapy (MRIgART) within the PERMIT trial (NCT03727698), were included. Data collected comprised patient demographics, treatment time, and patient experience, using an established MRL questionnaire.</div><div>Back-up plans were created for use on the conventional linac with CT guidance, to prevent missed fractions. The frequency of use was collected and categorised to reflect the cause.</div></div><div><h3>Results</h3><div>The median total treatment time for ATS-lite method was 39 min. The percentage of treatments under 60 mins was 98.8 %.</div><div>Questionnaire response rate was 85% and individual question response rate was 99%. Ninety-six percent of responses scored 2 or 3 on the Likert scale, a positive answer. The lowest scoring question was “I forced myself to manage the situation,” with a mean (SD) of 2.4 (0.9).</div><div>The MRL delivered 84.7 % of treatments. The back-up plan was used for 46 fractions, 7 attributed to patient tolerance (n = 2 patients).</div></div><div><h3>Conclusion</h3><div>Average treatment times for the ATS-lite HNC MRIgART are acceptable and faster than reported ATP treatment times. Patient-reported experience was extremely positive. Use of back-up plans attributable to lack of patient tolerance was low. This technique can used with the confidence that patient experience is not negatively impacted.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100324"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704012","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}
Prospective studies on reirradiation are limited, with most available data being retrospective, resulting in challenges in standardising protocols, interpreting outcomes, and facilitating informed patient decisions. Advanced radiotherapy planning and delivery have increased treatment possibilities for complex cases, including reirradiation. However, considerable gaps and variability in reirradiation image-guided radiotherapy (IGRT) and treatment delivery exist. The aim of this work was to identify ways to optimise reirradiation IGRT protocols based on RTT feedback.
Methods
A quantitative and qualitative service improvement approach was selected, using a plan, do, check approach. RTT participants working in a single RT centre participated in focus group/nominal group technique sessions. Sessions were used to generate themes, challenges and solutions, which were then scored using Likert scale scoring criteria by all participants.
Results
Eleven IGRT team members each with > 6 years experience participated in the sessions, (4 senior specialist clinical RTT, 2 team leader specialist RTT, 2 IGRT specialist RTT, 1 consultant RTT and 2 research RTT). Eight themes, 19 challenges and 35 solutions were identified. These included communication challenges and multi-professional team (MPT) involvement, RTT role and development, clinical information and treatment intent, standards and guidelines, individualised approach, technical planning considerations, imaging and verification techniques, and anatomical site-specific considerations.
Conclusion
The themes identified provide valuable insights that will inform future IGRT processes and inform future research collaborations on an international level, working towards improving reirradiation treatment for patients who would benefit. There are many opportunities for the RTT within the MPT, and advanced practice (AP) can provide the framework required to develop this for the benefit of patients.
{"title":"Radiation therapist (RTT) perspectives on developing image-guided radiotherapy (IGRT) protocols for reirradiation","authors":"Aileen Duffton , Lynsey Devlin , Aoife Williamson , Derek Grose , Eilidh Tolmie , Linda MacLaren , Sharon McFadden , Rebecca Muirhead","doi":"10.1016/j.tipsro.2025.100335","DOIUrl":"10.1016/j.tipsro.2025.100335","url":null,"abstract":"<div><h3>Introduction</h3><div>Prospective studies on reirradiation are limited, with most available data being retrospective, resulting in challenges in standardising protocols, interpreting outcomes, and facilitating informed patient decisions. Advanced radiotherapy planning and delivery have increased treatment possibilities for complex cases, including reirradiation. However, considerable gaps and variability in reirradiation image-guided radiotherapy (IGRT) and treatment delivery exist. The aim of this work was to identify ways to optimise reirradiation IGRT protocols based on RTT feedback.</div></div><div><h3>Methods</h3><div>A quantitative and qualitative service improvement approach was selected, using a plan, do, check approach. RTT participants working in a single RT centre participated in focus group/nominal group technique sessions. Sessions were used to generate themes, challenges and solutions, which were then scored using Likert scale scoring criteria by all participants.</div></div><div><h3>Results</h3><div>Eleven IGRT team members each with > 6 years experience participated in the sessions, (4 senior specialist clinical RTT, 2 team leader specialist RTT, 2 IGRT specialist RTT, 1 consultant RTT and 2 research RTT). Eight themes, 19 challenges and 35 solutions were identified. These included communication challenges and multi-professional team (MPT) involvement, RTT role and development, clinical information and treatment intent, standards and guidelines, individualised approach, technical planning considerations, imaging and verification techniques, and anatomical site-specific considerations.</div></div><div><h3>Conclusion</h3><div>The themes identified provide valuable insights that will inform future IGRT processes and inform future research collaborations on an international level, working towards improving reirradiation treatment for patients who would benefit. There are many opportunities for the RTT within the MPT, and advanced practice (AP) can provide the framework required to develop this for the benefit of patients.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100335"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893564","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 : 2025-09-01Epub Date: 2025-08-22DOI: 10.1016/j.tipsro.2025.100338
Grace Lee , Michael Velec , Hedi Mohseni , Tara Rosewall , Yat Tsang , Jennifer Croke
Background
Tattoos help guide field placement in breast re-irradiation. This study evaluates the stability of medial tattoos in patients with prior breast radiotherapy (RT) to determine their reliability as surface markers.
Materials and methods
We retrospectively identified patients who had breast/chest wall re-irradiation between January 2022 and December 2023 (RT2) and prior breast RT (RT1) at our institution. Planning CTs for both RT courses were registered using rigid image registration. The medial tattoo, sternum, and internal perforating branches of the internal thoracic vessels were contoured on both CT1 and CT2, and POIs were placed at the respective centers to assess shifts and 3D distances reported as target registration errors (TRE).
Results
Eighteen patients were included, average sternum 3D TRE was 0.8 mm(SD0.8), within CT voxel thickness. The average medial tattoo 3D TRE was 9.2 mm(SD5.4). Significantly greater 3D TRE was observed in patients whose arm positions varied between scans (Same: 4.7 mm vs Different: 10.9 mm, p = 0.002). The largest 3D TRE was 22.1 mm, observed in a patient who had a mastectomy before RT2. The average vessels 3D TRE was 4.1 mm (SD2.3) and impacted by arm position (Different = 4.4 mm vs Same = 2.9 mm, p = 0.009).
Conclusion
Relying solely on previous medial tattoos as indicators of the previous RT field border can be inaccurate due to arm positioning and surgical procedure changes that impact surface anatomy over time. Reproducing the patient’s original setup and arm positioning is essential to reducing registration errors in breast re-irradiation. If varying arm positions are unavoidable, internal thoracic perforator vessels may provide more robust registration.
背景纹身有助于指导乳房再照射的部位放置。本研究评估了既往乳房放疗（RT）患者内侧纹身的稳定性，以确定其作为表面标记物的可靠性。材料和方法回顾性研究了2022年1月至2023年12月期间在我院接受过乳房/胸壁再照射（RT2）和既往乳房放疗（RT1）的患者。两个RT课程的计划ct使用严格的图像配准进行注册。在CT1和CT2上勾画内侧纹身、胸骨和胸腔内血管的内部穿孔分支，并将poi放置在各自的中心，以评估移位和3D距离，报告为目标配准误差（TRE）。结果本组患者18例，胸骨三维三维立体扫描平均为0.8 mm(SD0.8)，在CT体素厚度范围内。平均内侧纹身3D TRE为9.2 mm（SD5.4）。在两次扫描之间手臂位置不同的患者中，观察到明显更大的3D TRE（相同：4.7 mm vs不同：10.9 mm, p = 0.002）。在RT2前进行乳房切除术的患者中观察到最大的3D TRE为22.1 mm。血管三维TRE平均为4.1 mm (SD2.3)，受臂位影响（差异= 4.4 mm vs相同= 2.9 mm, p = 0.009）。结论：由于手臂定位和手术方式的改变会随着时间的推移影响体表解剖结构，单纯依靠以前的内侧纹身作为以前RT野界的指标可能不准确。再现患者的原始设置和手臂的位置是必要的，以减少在乳房再照射登记错误。如果改变手臂位置是不可避免的，胸腔内穿支血管可以提供更强健的定位。
{"title":"Evaluation of tattoo reliability in breast cancer re-irradiation","authors":"Grace Lee , Michael Velec , Hedi Mohseni , Tara Rosewall , Yat Tsang , Jennifer Croke","doi":"10.1016/j.tipsro.2025.100338","DOIUrl":"10.1016/j.tipsro.2025.100338","url":null,"abstract":"<div><h3>Background</h3><div>Tattoos help guide field placement in breast re-irradiation. This study evaluates the stability of medial tattoos in patients with prior breast radiotherapy (RT) to determine their reliability as surface markers.</div></div><div><h3>Materials and methods</h3><div>We retrospectively identified patients who had breast/chest wall re-irradiation between January 2022 and December 2023 (RT<sub>2</sub>) and prior breast RT (RT<sub>1</sub>) at our institution. Planning CTs for both RT courses were registered using rigid image registration. The medial tattoo, sternum, and internal perforating branches of the internal thoracic vessels were contoured on both CT<sub>1</sub> and CT<sub>2</sub>, and POIs were placed at the respective centers to assess shifts and 3D distances reported as target registration errors (TRE).</div></div><div><h3>Results</h3><div>Eighteen patients were included, average sternum 3D TRE was 0.8 mm(SD0.8), within CT voxel thickness. The average medial tattoo 3D TRE was 9.2 mm(SD5.4). Significantly greater 3D TRE was observed in patients whose arm positions varied between scans (Same: 4.7 mm vs Different: 10.9 mm, p = 0.002). The largest 3D TRE was 22.1 mm, observed in a patient who had a mastectomy before RT<sub>2</sub>. The average vessels 3D TRE was 4.1 mm (SD2.3) and impacted by arm position (Different = 4.4 mm vs Same = 2.9 mm, p = 0.009).</div></div><div><h3>Conclusion</h3><div>Relying solely on previous medial tattoos as indicators of the previous RT field border can be inaccurate due to arm positioning and surgical procedure changes that impact surface anatomy over time. Reproducing the patient’s original setup and arm positioning is essential to reducing registration errors in breast re-irradiation. If varying arm positions are unavoidable, internal thoracic perforator vessels may provide more robust registration.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100338"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903108","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 : 2025-09-01Epub Date: 2025-07-13DOI: 10.1016/j.tipsro.2025.100322
E. van Weerd , J.J. Jacobs , A.M. Moerman , C. Xavier , I.T. Kuijper , N. de Nie , H. Bijwaard , M.S. Hoogeman
With the increasing number of proton therapy centers worldwide, particularly in Europe, proton therapy is becoming a more established treatment option. However, education and guidelines, specifically tailored to radiation therapists (RTTs) and dosimetrists, are lacking. Through the “Towards a Sustainable RTT Network” (TaSeRnet) project, efforts are underway to harmonize proton therapy practices among RTTs and dosimetrists across Europe. This scoping review aims to identify and summarize existing guidelines relevant to RTTs and dosimetrists working in proton therapy, providing a necessary first step toward the future development of specific guidelines and education for these professions. Ten articles were identified that include guidelines covering certain aspects of proton therapy workflows in several clinical indications. However, significant gaps remain regarding the specific tasks performed by RTTs and dosimetrists. In particular, no guidelines were found addressing treatment execution, a workflow typically performed by RTTs. Moreover, the limited involvement of RTTs and dosimetrists in the development of existing guidelines may result in the exclusion of essential practical knowledge and expertise. As they play a critical role in the daily delivery of proton therapy, their input is vital to ensure comprehensive and applicable guidelines. In conclusion, this review underscores the need for developing guidelines specifically for RTTs and dosimetrists in collaboration with the broader multidisciplinary team. Developing such guidelines will support the standardization of clinical practice and contribute to improved quality of care.
{"title":"Towards proton therapy guidelines for radiation therapists and dosimetrists: A scoping review","authors":"E. van Weerd , J.J. Jacobs , A.M. Moerman , C. Xavier , I.T. Kuijper , N. de Nie , H. Bijwaard , M.S. Hoogeman","doi":"10.1016/j.tipsro.2025.100322","DOIUrl":"10.1016/j.tipsro.2025.100322","url":null,"abstract":"<div><div>With the increasing number of proton therapy centers worldwide, particularly in Europe, proton therapy is becoming a more established treatment option. However, education and guidelines, specifically tailored to radiation therapists (RTTs) and dosimetrists, are lacking. Through the “Towards a Sustainable RTT Network” (TaSeRnet) project, efforts are underway to harmonize proton therapy practices among RTTs and dosimetrists across Europe. This scoping review aims to identify and summarize existing guidelines relevant to RTTs and dosimetrists working in proton therapy, providing a necessary first step toward the future development of specific guidelines and education for these professions. Ten articles were identified that include guidelines covering certain aspects of proton therapy workflows in several clinical indications. However, significant gaps remain regarding the specific tasks performed by RTTs and dosimetrists. In particular, no guidelines were found addressing treatment execution, a workflow typically performed by RTTs. Moreover, the limited involvement of RTTs and dosimetrists in the development of existing guidelines may result in the exclusion of essential practical knowledge and expertise. As they play a critical role in the daily delivery of proton therapy, their input is vital to ensure comprehensive and applicable guidelines. In conclusion, this review underscores the need for developing guidelines specifically for RTTs and dosimetrists in collaboration with the broader multidisciplinary team. Developing such guidelines will support the standardization of clinical practice and contribute to improved quality of care.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100322"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672205","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 : 2025-09-01Epub Date: 2025-08-08DOI: 10.1016/j.tipsro.2025.100334
Kenton Thompson , Phillip Moloney , Nigel Cristofaro , Drew Smith , Dominic Davis , Chris James , Vaughan Geddes , Vanessa Panettieri
Data availability remains a major challenge for radiation therapy dose accumulation for patients’ re-treatment and re-irradiation. When a patient moves between radiation therapy providers it is particularly challenging. To address this challenge, a solution was developed for departments in Victoria, Australia, with the ability to request and receive files of any size and type from other providers, supported by a workflow system, an independent security model and a highly secure platform. In the first 5 years there have been 3911 requests for previous treatment details. Of these 2937 (75 %) involved transfer of DICOM data to enable higher quality dose accumulation assessment.
{"title":"Developing and sustaining a secure application for transfer of previous radiation therapy treatment details","authors":"Kenton Thompson , Phillip Moloney , Nigel Cristofaro , Drew Smith , Dominic Davis , Chris James , Vaughan Geddes , Vanessa Panettieri","doi":"10.1016/j.tipsro.2025.100334","DOIUrl":"10.1016/j.tipsro.2025.100334","url":null,"abstract":"<div><div>Data availability remains a major challenge for radiation therapy dose accumulation for patients’ re-treatment and re-irradiation. When a patient moves between radiation therapy providers it is particularly challenging. To address this challenge, a solution was developed for departments in Victoria, Australia, with the ability to request and receive files of any size and type from other providers, supported by a workflow system, an independent security model and a highly secure platform. In the first 5 years there have been 3911 requests for previous treatment details. Of these 2937 (75 %) involved transfer of DICOM data to enable higher quality dose accumulation assessment.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100334"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841317","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 : 2025-09-01Epub Date: 2025-08-30DOI: 10.1016/j.tipsro.2025.100336
Madalyne Day, Jonas Willmann, Panagiotis Balermpas, Riccardo Dal Bello, Anja Joye, Laura Motisi, Jens von der Grün, Crystal Sulaiman, Lotte Wilke, Nazanin Rahnama, Matthias Guckenberger, Stephanie Tanadini-Lang, Nicolaus Andratschke
As cancer patients survive longer, the number of radiotherapy retreatments is steadily increasing [1], requiring laborious review of previous treatments, decisions regarding image registration, dose accumulation and assessment of such composite dose distributions. This work presents the development, and implementation of a standardised dedicated workflow for reirradiation (reRT) and radiotherapy retreatment based on the EORTC/ESTRO consensus on reRT.
{"title":"A standardised workflow to manage the complexity of reirradiation and radiotherapy retreatments in clinical practice","authors":"Madalyne Day, Jonas Willmann, Panagiotis Balermpas, Riccardo Dal Bello, Anja Joye, Laura Motisi, Jens von der Grün, Crystal Sulaiman, Lotte Wilke, Nazanin Rahnama, Matthias Guckenberger, Stephanie Tanadini-Lang, Nicolaus Andratschke","doi":"10.1016/j.tipsro.2025.100336","DOIUrl":"10.1016/j.tipsro.2025.100336","url":null,"abstract":"<div><div>As cancer patients survive longer, the number of radiotherapy retreatments is steadily increasing [<span><span>1</span></span>], requiring laborious review of previous treatments, decisions regarding image registration, dose accumulation and assessment of such composite dose distributions. This work presents the development, and implementation of a standardised dedicated workflow for reirradiation (reRT) and radiotherapy retreatment based on the EORTC/ESTRO consensus on reRT.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100336"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931560","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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