Pub Date : 2025-02-26DOI: 10.1016/j.tipsro.2025.100305
Madison Bush , Scott Jones , Catriona Hargrave
Introduction
Hydrogel spacers (HS) are designed to minimise the radiation doses to the rectum in prostate cancer radiation therapy (RT) by creating a physical gap between the rectum and the target treatment volume inclusive of the prostate and seminal vesicles (SV). This study aims to determine the feasibility of incorporating diagnostic MRI (dMRI) information in statistical machine learning (SML) models developed with planning CT (pCT) anatomy for dose and rectal toxicity prediction. The SML models aim to support HS insertion decision-making prior to RT planning procedures.
Methods
Regions of interest (ROIs) were retrospectively contoured on the pCT and registered dMRI scans for 20 patients. ROI Dice and Hausdorff distance (HD) comparison metrics were calculated. The ROI and patient clinical risk factors (CRFs) variables were inputted into three SML models and then pCT and dMRI-based dose and toxicity model performance compared through confusion matrices, AUC curves, accuracy performance metric results and observed patient outcomes.
Results
Average Dice values comparing dMRI and pCT ROIs were 0.81, 0.47 and 0.71 for the prostate, SV, and rectum respectively. Average Hausdorff distances were 2.15, 2.75 and 2.75 mm for the prostate, SV, and rectum respectively. The average accuracy metric across all models was 0.83 when using dMRI ROIs and 0.85 when using pCT ROIs.
Conclusion
Differences between pCT and dMRI anatomical ROI variables did not impact SML model performance in this study, demonstrating the feasibility of using dMRI images. Due to the limited sample size further training of the predictive models including dMRI anatomy is recommended.
{"title":"Evaluation of MRI anatomy in machine learning predictive models to assess hydrogel spacer benefit for prostate cancer patients","authors":"Madison Bush , Scott Jones , Catriona Hargrave","doi":"10.1016/j.tipsro.2025.100305","DOIUrl":"10.1016/j.tipsro.2025.100305","url":null,"abstract":"<div><h3>Introduction</h3><div>Hydrogel spacers (HS) are designed to minimise the radiation doses to the rectum in prostate cancer radiation therapy (RT) by creating a physical gap between the rectum and the target treatment volume inclusive of the prostate and seminal vesicles (SV). This study aims to determine the feasibility of incorporating diagnostic MRI (dMRI) information in statistical machine learning (SML) models developed with planning CT (pCT) anatomy for dose and rectal toxicity prediction. The SML models aim to support HS insertion decision-making prior to RT planning procedures.</div></div><div><h3>Methods</h3><div>Regions of interest (ROIs) were retrospectively contoured on the pCT and registered dMRI scans for 20 patients. ROI Dice and Hausdorff distance (HD) comparison metrics were calculated. The ROI and patient clinical risk factors (CRFs) variables were inputted into three SML models and then pCT and dMRI-based dose and toxicity model performance compared through confusion matrices, AUC curves, accuracy performance metric results and observed patient outcomes.</div></div><div><h3>Results</h3><div>Average Dice values comparing dMRI and pCT ROIs were 0.81, 0.47 and 0.71 for the prostate, SV, and rectum respectively. Average Hausdorff distances were 2.15, 2.75 and 2.75 mm for the prostate, SV, and rectum respectively. The average accuracy metric across all models was 0.83 when using dMRI ROIs and 0.85 when using pCT ROIs.</div></div><div><h3>Conclusion</h3><div>Differences between pCT and dMRI anatomical ROI variables did not impact SML model performance in this study, demonstrating the feasibility of using dMRI images. Due to the limited sample size further training of the predictive models including dMRI anatomy is recommended.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704988","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 : 2025-02-21DOI: 10.1016/j.tipsro.2025.100307
Milad Mirzaei , Suki Gill , Mahsheed Sabet , Martin A. Ebert , Pejman Rowshanfarzad , Jake Kendrick , Angela Jacques , Clare Herbert , Jeremy Croker , Sean Bydder , Joshua Dass , Edward Bailey , Rohen White , Catherine Moffat , Colin Tang , Adriano Polpo , Nicholas Bucknell
Purpose
Daily image-guided radiotherapy (IGRT) for prostate cancer reduces treatment-related toxicity. However, positional and anatomical variations can result in patient re-setup, increased treatment time, and additional imaging dose. A simple technique of two distinct imaging modalities was investigated: initially, an anteroposterior kilovoltage (AP-kV) planar image was acquired, followed by cone beam computed tomography (CBCT). To determine whether this dual imaging modality (DIM) can reduce repeat CBCTs with an AP-kV screening image compared to CBCT alone, i.e. a single imaging modality (SIM).
Methods
Patients were enrolled sequentially before and after the new departmental protocol for IGRT. Initially, all patients had a CBCT prior to treatment (SIM group) as usual. For the DIM group, AP-kV imaging was added to the first three fractions, and subsequent AP-kV imaging (on demand) for patients unable to maintain adequate bladder and bowel compliance. Sixty intact prostate or post-prostatectomy patients were included: 30 before the change in protocol (SIM group) and 30 after (DIM group). Bladder volume, rectal filling, and positioning errors were evaluated.
Results
In the SIM group, 30 patients underwent a total of 1116 CBCTs. In the DIM group, 30 patients had 156 AP-kV images and 1077 CBCTs. In the SIM group, 166 were repeat CBCTs with a median of 4 repeat CBCTs per patient. In DIM group, 132 were repeat CBCTs with a median of 3 repeat CBCTs per patient. We found a significant difference in incidence of repeat CBCTs due to suboptimal bladder filling (p = 0.028) and rectal gas (p = 0.045), indicating the number of repeat CBCTs was significantly lower in patients imaged with DIM.
Conclusion
The DIM technique was found to be superior to the SIM technique, as it allowed the desired bladder volume, rectal condition, and patient positioning to be achieved prior to CBCT, reducing the need for repeat CBCTs.
{"title":"Treatment efficiency and quality improvement via double imaging modality (DIM) versus single imaging modality (SIM) image-guided radiotherapy for prostate cancer","authors":"Milad Mirzaei , Suki Gill , Mahsheed Sabet , Martin A. Ebert , Pejman Rowshanfarzad , Jake Kendrick , Angela Jacques , Clare Herbert , Jeremy Croker , Sean Bydder , Joshua Dass , Edward Bailey , Rohen White , Catherine Moffat , Colin Tang , Adriano Polpo , Nicholas Bucknell","doi":"10.1016/j.tipsro.2025.100307","DOIUrl":"10.1016/j.tipsro.2025.100307","url":null,"abstract":"<div><h3>Purpose</h3><div>Daily image-guided radiotherapy (IGRT) for prostate cancer reduces treatment-related toxicity. However, positional and anatomical variations can result in patient re-setup, increased treatment time, and additional imaging dose. A simple technique of two distinct imaging modalities was investigated: initially, an anteroposterior kilovoltage (AP-kV) planar image was acquired, followed by cone beam computed tomography (CBCT). To determine whether this dual imaging modality (DIM) can reduce repeat CBCTs with an AP-kV screening image compared to CBCT alone, <em>i.e.</em> a single imaging modality (SIM).</div></div><div><h3>Methods</h3><div>Patients were enrolled sequentially before and after the new departmental protocol for IGRT. Initially, all patients had a CBCT prior to treatment (SIM group) as usual. For the DIM group, AP-kV imaging was added to the first three fractions, and subsequent AP-kV imaging (on demand) for patients unable to maintain adequate bladder and bowel compliance. Sixty intact prostate or post-prostatectomy patients were included: 30 before the change in protocol (SIM group) and 30 after (DIM group). Bladder volume, rectal filling, and positioning errors were evaluated.</div></div><div><h3>Results</h3><div>In the SIM group, 30 patients underwent a total of 1116 CBCTs. In the DIM group, 30 patients had 156 AP-kV images and 1077 CBCTs. In the SIM group, 166 were repeat CBCTs with a median of 4 repeat CBCTs per patient. In DIM group, 132 were repeat CBCTs with a median of 3 repeat CBCTs per patient. We found a significant difference in incidence of repeat CBCTs due to suboptimal bladder filling (p = 0.028) and rectal gas (p = 0.045), indicating the number of repeat CBCTs was significantly lower in patients imaged with DIM.</div></div><div><h3>Conclusion</h3><div>The DIM technique was found to be superior to the SIM technique, as it allowed the desired bladder volume, rectal condition, and patient positioning to be achieved prior to CBCT, reducing the need for repeat CBCTs.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100307"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479957","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 : 2025-02-17DOI: 10.1016/j.tipsro.2025.100306
S.E. Alexander , J. Selous-Hodges , A. Araujo , L. Booth , L. Delacroix , E. Garrad , A. Gordon , C. Graham , A. Guerra , C. Gulyaeva , C. Ockwell , S. Shire , U. Oelfke , H.A. McNair , A.C. Tree
Introduction
Bladder and rectal preparation regimes for prostate cancer (PCa) radiotherapy (RT) can heighten anxiety before and during RT. Patient’s perception of RT preparation is under-represented in the literature. To address this gap, patient’s experience of preparation with respect to understanding, comfort, anxiety, effectiveness and impact on daily life was examined.
Materials and methods
A novel patient preparation survey was created and validated, it contained 12 original questions related to general, bladder and rectal preparation. Plus, the Patient Health Questionnaire 4 (PHQ4) and question 15 of the Expanded Prostate Cancer Index Composite (EPIC).
Eligible patients were individuals referred for prostate or prostate bed +/− pelvic lymph node RT from March-May 2024. Surveys were issued immediately after the patient’s planning scan, those completing the survey at this timepoint were asked to repeat it in their first and final weeks of RT.
Results
The survey was completed by 103/125 eligible patients at their planning scan, 47/103 in the first and 52/103 in the final week of RT. Perception of preparation was largely positive. For general and bladder preparation positive question response rate ranged from 55 to 98 % and negative from 0 to 26 %. Rectal preparation response rate was 59–100 % positive and 0–35 % negative. Difficulty maintaining a full bladder and using enemas was greatest at the end of RT.
No significant difference in experience was found for participants using or not using enemas for preparation. Anxiety and depression (PHQ4) affected 12–13 % of respondents, and significantly more patients reported bowel toxicity (EPIC), in the last week of RT compared to earlier timepoints.
Conclusion
The authors conclude that the preparation needs of their patients are well met. However, a considerable number did find preparation difficult, disruptive and ineffective, more so at the end of treatment. Further qualitative analysis of patient’s experience is needed to better understand why individuals experience varies.
{"title":"Patient experience preparing for prostate cancer radiotherapy","authors":"S.E. Alexander , J. Selous-Hodges , A. Araujo , L. Booth , L. Delacroix , E. Garrad , A. Gordon , C. Graham , A. Guerra , C. Gulyaeva , C. Ockwell , S. Shire , U. Oelfke , H.A. McNair , A.C. Tree","doi":"10.1016/j.tipsro.2025.100306","DOIUrl":"10.1016/j.tipsro.2025.100306","url":null,"abstract":"<div><h3>Introduction</h3><div>Bladder and rectal preparation regimes for prostate cancer (PCa) radiotherapy (RT) can heighten anxiety before and during RT. Patient’s perception of RT preparation is under-represented in the literature. To address this gap, patient’s experience of preparation with respect to understanding, comfort, anxiety, effectiveness and impact on daily life was examined.</div></div><div><h3>Materials and methods</h3><div>A novel patient preparation survey was created and validated, it contained 12 original questions related to general, bladder and rectal preparation. Plus, the Patient Health Questionnaire 4 (PHQ4) and question 15 of the Expanded Prostate Cancer Index Composite (EPIC).</div><div>Eligible patients were individuals referred for prostate or prostate bed +/− pelvic lymph node RT from March-May 2024. Surveys were issued immediately after the patient’s planning scan, those completing the survey at this timepoint were asked to repeat it in their first and final weeks of RT.</div></div><div><h3>Results</h3><div>The survey was completed by 103/125 eligible patients at their planning scan, 47/103 in the first and 52/103 in the final week of RT. Perception of preparation was largely positive. For general and bladder preparation positive question response rate ranged from 55 to 98 % and negative from 0 to 26 %. Rectal preparation response rate was 59–100 % positive and 0–35 % negative. Difficulty maintaining a full bladder and using enemas was greatest at the end of RT.</div><div>No significant difference in experience was found for participants using or not using enemas for preparation. Anxiety and depression (PHQ4) affected 12–13 % of respondents, and significantly more patients reported bowel toxicity (EPIC), in the last week of RT compared to earlier timepoints.</div></div><div><h3>Conclusion</h3><div>The authors conclude that the preparation needs of their patients are well met. However, a considerable number did find preparation difficult, disruptive and ineffective, more so at the end of treatment. Further qualitative analysis of patient’s experience is needed to better understand why individuals experience varies.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100306"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465278","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 : 2025-02-05DOI: 10.1016/j.tipsro.2025.100304
Meegan Shepherd , Elizabeth Joyce , Bethany Williams , Siobhan Graham , Winnie Li , Jeremy Booth , Helen A. McNair
This commentary discusses the implementation of online adaptive radiation therapy (oART) in cancer treatment within the context of current challenges faced by radiation therapy professionals. oART enables modifications to treatment plans based on daily imaging, enhancing target accuracy while minimising harm to surrounding organs. Despite its potential to improve patient outcomes, the application of oART is hindered by notable barriers, particularly in human resources. A global shortage of skilled radiation professionals such as radiation therapists or therapeutic radiographers (RTTs), medical physicists and radiation oncologists, along with training challenges in online adaptive techniques, hinders oART implementation and sustainability. Moreover, geographical disparities limit access to advanced training programs, leaving RTTs and their patients in underserved regions at a disadvantage. There is growing global evidence that RTTs are being successfully trained to lead adaptive fractions in both cone-beam computed tomography and magnetic resonance imaging guided oART. This commentary proposes the notion of standards for a global training curriculum to address barriers and expand RTT capabilities in delivering oART. By leveraging artificial intelligence and fostering interdisciplinary collaboration, the radiation therapy field can enhance efficiency and accuracy in oART. Successful training models from leading institutions illustrate the importance of hands-on experience and ongoing mentorship. A coordinated effort among stakeholders is essential to establish a comprehensive global training framework, ultimately improving patient access to oART and elevating standards of care worldwide.
{"title":"Training for tomorrow: Establishing a worldwide curriculum in online adaptive radiation therapy","authors":"Meegan Shepherd , Elizabeth Joyce , Bethany Williams , Siobhan Graham , Winnie Li , Jeremy Booth , Helen A. McNair","doi":"10.1016/j.tipsro.2025.100304","DOIUrl":"10.1016/j.tipsro.2025.100304","url":null,"abstract":"<div><div>This commentary discusses the implementation of online adaptive radiation therapy (oART) in cancer treatment within the context of current challenges faced by radiation therapy professionals. oART enables modifications to treatment plans based on daily imaging, enhancing target accuracy while minimising harm to surrounding organs. Despite its potential to improve patient outcomes, the application of oART is hindered by notable barriers, particularly in human resources. A global shortage of skilled radiation professionals such as radiation therapists or therapeutic radiographers (RTTs), medical physicists and radiation oncologists, along with training challenges in online adaptive techniques, hinders oART implementation and sustainability. Moreover, geographical disparities limit access to advanced training programs, leaving RTTs and their patients in underserved regions at a disadvantage. There is growing global evidence that RTTs are being successfully trained to lead adaptive fractions in both cone-beam computed tomography and magnetic resonance imaging guided oART. This commentary proposes the notion of standards for a global training curriculum to address barriers and expand RTT capabilities in delivering oART. By leveraging artificial intelligence and fostering interdisciplinary collaboration, the radiation therapy field can enhance efficiency and accuracy in oART. Successful training models from leading institutions illustrate the importance of hands-on experience and ongoing mentorship. A coordinated effort among stakeholders is essential to establish a comprehensive global training framework, ultimately improving patient access to oART and elevating standards of care worldwide.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100304"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377909","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 : 2025-01-31DOI: 10.1016/j.tipsro.2025.100303
Amanda Moreira , Tara Rosewall , Yat Tsang , Patricia Lindsay , Peter Chung , Winnie Li
Purpose
Adaptive radiation therapy (ART) is a close-looped process where anatomic changes observed during treatment are identified, leading to plan modification prior to treatment delivery. The aim of this study was to explore the status of ART across Canada and review the impact of adaptive technologies on the roles and responsibilities of Radiation Therapists (RTTs).
Materials and Methods
Study information and a link to a 30-question survey was sent via email to the RTT manager of all cancer centres across Canada (n = 48). The survey questions included centre demographics, presence of offline and/or online ART activities as standard of care, corresponding roles and responsibilities of the multidisciplinary team, and training activities. The survey was administered electronically and closed after a 3-week accrual period. Responses were analyzed using descriptive statistics.
Results
Thirty-two out of 48 centres responded across all ten provinces (67 % response rate). Twenty-five centres (78 %) currently perform ART, all of which practiced offline ART while 5 practiced online ART. Most common responses for lack of ART were ‘technical limitations’ and ‘lack of resources’. RTTs are responsible for 50 % (offline) versus 58 % (online) ART respectively, with the most notable change being the addition of target delineation to their daily practice.
Conclusions
The status of ART varies across Canada. Offline ART is commonly practiced, but online ART remains an infrequent process due to technical limitations and lack of resources. As centres move towards implementing online ART, the role of the RTT will need to be redefined with corresponding upskilling to support the emergent treatment paradigm.
{"title":"Pan-Canadian assessment of image guided adaptive radiation therapy and the role of the radiation therapist","authors":"Amanda Moreira , Tara Rosewall , Yat Tsang , Patricia Lindsay , Peter Chung , Winnie Li","doi":"10.1016/j.tipsro.2025.100303","DOIUrl":"10.1016/j.tipsro.2025.100303","url":null,"abstract":"<div><h3>Purpose</h3><div>Adaptive radiation therapy (ART) is a close-looped process where anatomic changes observed during treatment are identified, leading to plan modification prior to treatment delivery. The aim of this study was to explore the status of ART across Canada and review the impact of adaptive technologies on the roles and responsibilities of Radiation Therapists (RTTs).</div></div><div><h3>Materials and Methods</h3><div>Study information and a link to a 30-question survey was sent via email to the RTT manager of all cancer centres across Canada (n = 48). The survey questions included centre demographics, presence of offline and/or online ART activities as standard of care, corresponding roles and responsibilities of the multidisciplinary team, and training activities. The survey was administered electronically and closed after a 3-week accrual period. Responses were analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>Thirty-two out of 48 centres responded across all ten provinces (67 % response rate). Twenty-five centres (78 %) currently perform ART, all of which practiced offline ART while 5 practiced online ART. Most common responses for lack of ART were ‘technical limitations’ and ‘lack of resources’. RTTs are responsible for 50 % (offline) versus 58 % (online) ART respectively, with the most notable change being the addition of target delineation to their daily practice.</div></div><div><h3>Conclusions</h3><div>The status of ART varies across Canada. Offline ART is commonly practiced, but online ART remains an infrequent process due to technical limitations and lack of resources. As centres move towards implementing online ART, the role of the RTT will need to be redefined with corresponding upskilling to support the emergent treatment paradigm.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100303"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172487","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 : 2025-01-13DOI: 10.1016/j.tipsro.2025.100302
Boaz Kalkhoven , Marjolein N. Hilberts , Melissa A.L. Verdonk , An-Sofie E. Verrijssen , Peter-Paul G. van der Toorn , Tom C.G. Budiharto , Patricia F.C. Bronius , Diana Geerts , Coen W. Hurkmans , Shyama U. Tetar , Rob H.N. Tijssen
Background & purpose
Magnetic resonance guided adaptive radiotherapy (MRgART) enables hypofractionated prostate radiotherapy by daily contour adaptation. The MRgART workflow, however, is labour intensive and in many institutes still requires the presence of the radiation oncologist (RO). Transferring the online contour adaptation task to the radiation therapist (RTT) will release the clinician from attending each treatment fraction making MRgRT more efficient and cost effective. In this study we investigate the viability of RTT-led prostate MRgART on a low-field MR-linac, by assessing the interobserver variations of RTT- and RO-generated CTV contour adaptations as well as the resulting dosimetric effects.
Materials & methods
Four RTTs and four ROs performed CTV contour adaptations on first fraction data in ten patients. Delineations were compared against a gold standard contour using target volume, Dice similarity coefficient (DSC), and 95th percentile Hausdorff distance. In addition, a dosimetric evaluation was performed on all first fractions by performing plan adaptations based on all RTT contour adaptation and comparing these to the clinically delivered plan. Finally, a full-treatment simulation was performed in four patients to investigate the dosimetric effects of the RTTs’ contour adaptations throughout an entire treatment.
Results
RTTs with no experience in prostate delineation prior to this study spent more time on CTV contour adaptations. The geometric and dosimetric analyses, however, showed no statistically significant differences between both groups.
Conclusions
This study confirmed that RTTs perform similarly to ROs in carrying out online contour adaptations. These results indicate the feasibility of initiating a transition in contour adaptation tasks from ROs to RTTs.
{"title":"Geometric and dosimetric evaluation of CTV contour adaptations by radiation therapists for adaptive prostate radiotherapy on a 0.35 T MR-Linac","authors":"Boaz Kalkhoven , Marjolein N. Hilberts , Melissa A.L. Verdonk , An-Sofie E. Verrijssen , Peter-Paul G. van der Toorn , Tom C.G. Budiharto , Patricia F.C. Bronius , Diana Geerts , Coen W. Hurkmans , Shyama U. Tetar , Rob H.N. Tijssen","doi":"10.1016/j.tipsro.2025.100302","DOIUrl":"10.1016/j.tipsro.2025.100302","url":null,"abstract":"<div><h3>Background & purpose</h3><div>Magnetic resonance guided adaptive radiotherapy (MRgART) enables hypofractionated prostate radiotherapy by daily contour adaptation. The MRgART workflow, however, is labour intensive and in many institutes still requires the presence of the radiation oncologist (RO). Transferring the online contour adaptation task to the radiation therapist (RTT) will release the clinician from attending each treatment fraction making MRgRT more efficient and cost effective. In this study we investigate the viability of RTT-led prostate MRgART on a low-field MR-linac, by assessing the interobserver variations of RTT- and RO-generated CTV contour adaptations as well as the resulting dosimetric effects.</div></div><div><h3>Materials & methods</h3><div>Four RTTs and four ROs performed CTV contour adaptations on first fraction data in ten patients. Delineations were compared against a gold standard contour using target volume, Dice similarity coefficient (DSC), and 95th percentile Hausdorff distance. In addition, a dosimetric evaluation was performed on all first fractions by performing plan adaptations based on all RTT contour adaptation and comparing these to the clinically delivered plan. Finally, a full-treatment simulation was performed in four patients to investigate the dosimetric effects of the RTTs’ contour adaptations throughout an entire treatment.</div></div><div><h3>Results</h3><div>RTTs with no experience in prostate delineation prior to this study spent more time on CTV contour adaptations. The geometric and dosimetric analyses, however, showed no statistically significant differences between both groups.</div></div><div><h3>Conclusions</h3><div>This study confirmed that RTTs perform similarly to ROs in carrying out online contour adaptations. These results indicate the feasibility of initiating a transition in contour adaptation tasks from ROs to RTTs.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100302"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172486","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 : 2025-01-05DOI: 10.1016/j.tipsro.2025.100300
Caroline Marr , Yat Tsang
Introduction
In recent years, artificial intelligence (AI) technology has played an evolving role in radiation science, influencing the clinical practice of radiation therapists. This study aimed to explore the knowledge, attitude, clinical applications, and learning needs from the perspective of radiation therapists.
Materials and Methods
This study used a cross-sectional online survey with a population of radiation therapists from a single institution. The survey was developed iteratively and was based on past literature. The questions were constructed to measure perception using four themes: knowledge of AI, perceived utilization, job impact, clinical applications, learning needs, and educational support. The data was analyzed using descriptive statistics according to the key themes.
Results
Between 22nd December 2023 and 17th January 2024, 74 radiation therapists completed the survey. The majority (55.4 %) were 44 years or older (Baby Boomers and Generation X). Additionally, 37.8 % rated their knowledge of AI as none or limited, but 93.2 % expressed interest in learning more about AI. Many (79.7 %) perceived AI not to be fully used in radiation therapy but has increased its effectiveness in image registration, reconstruction, and contouring. With the increasing use of AI in healthcare, 96.0 % feel that AI may affect their role, and 82.4 % believe it may impact their job satisfaction. Educational supports indicated to be the most advantageous for their job were online modules (36.5 %) and in-person workshops (35.1 %).
Conclusion
Exploring the perspectives of radiation therapists has shown a strong interest in learning about AI and its role in radiation therapy. This information can help in understanding how to develop tailored strategies to mitigate potential barriers, leading to the successful implementation of AI in clinical radiation therapy practice.
{"title":"Radiation therapists’ perspectives on artificial intelligence: Insights from a single institution on Improving effectiveness and educational supports","authors":"Caroline Marr , Yat Tsang","doi":"10.1016/j.tipsro.2025.100300","DOIUrl":"10.1016/j.tipsro.2025.100300","url":null,"abstract":"<div><h3>Introduction</h3><div>In recent years, artificial intelligence (AI) technology has played an evolving role in radiation science, influencing the clinical practice of radiation therapists. This study aimed to explore the knowledge, attitude, clinical applications, and learning needs from the perspective of radiation therapists.</div></div><div><h3>Materials and Methods</h3><div>This study used a cross-sectional online survey with a population of radiation therapists from a single institution. The survey was developed iteratively and was based on past literature. The questions were constructed to measure perception using four themes: knowledge of AI, perceived utilization, job impact, clinical applications, learning needs, and educational support. The data was analyzed using descriptive statistics according to the key themes.</div></div><div><h3>Results</h3><div>Between 22nd December 2023 and 17th January 2024, 74 radiation therapists completed the survey. The majority (55.4 %) were 44 years or older (Baby Boomers and Generation X). Additionally, 37.8 % rated their knowledge of AI as none or limited, but 93.2 % expressed interest in learning more about AI. Many (79.7 %) perceived AI not to be fully used in radiation therapy but has increased its effectiveness in image registration, reconstruction, and contouring. With the increasing use of AI in healthcare, 96.0 % feel that AI may affect their role, and 82.4 % believe it may impact their job satisfaction. Educational supports indicated to be the most advantageous for their job were online modules (36.5 %) and in-person workshops (35.1 %).</div></div><div><h3>Conclusion</h3><div>Exploring the perspectives of radiation therapists has shown a strong interest in learning about AI and its role in radiation therapy. This information can help in understanding how to develop tailored strategies to mitigate potential barriers,<!--> <!-->leading to the successful implementation of AI in clinical radiation therapy practice.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100300"},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081443","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 : 2025-01-05DOI: 10.1016/j.tipsro.2025.100301
Brennan Diedrich, Justin Roper, Benjamin Hopkins, Sibo Tian, Shadab Momin, Eduard Schreibmann, Aparna H. Kesarwala, Kirk Luca
Background
Recent patient studies have linked higher immune cell doses with worse quality of life and survival. For thoracic radiotherapy, heart dose is a major contributor to the effective dose to immune cells (EDIC).
Purpose
This study investigates heart and immune cell doses for plans optimized using a cardiac-sparing knowledge-based planning (KBP) model and the impact of carefully crafted beam geometry.
Methods
Sixteen stage III NSCLC patients previously treated to 60 Gy in 30 fractions using coplanar VMAT arcs were replanned using a cardiac-sparing KBP model with either the clinical field arrangement or noncoplanar oblique arcs that prioritize heart sparing. The cardiac-sparing KBP model consisted of fifteen substructures, all of which were used during optimization. All plans were normalized to 95% PTV coverage at 60 Gy. Statistical significance was assessed for EDIC (Jin Model), along with mean doses to the heart, lungs, body, and both the mean dose and D0.03 cc values for cardiac substructures, using the Wilcoxon signed-rank test.
Results
Compared to the clinically treated plans with the same beam geometry, cardiac-sparing KBP reduced mean heart dose from 8.50 Gy to 4.09 Gy and EDIC from 4.27 Gy to 3.81 Gy (p < 0.001). For the novel arcs, the mean heart dose was reduced to 3.70 Gy, significantly lower than KBP with clinical beam geometry (p = 0.001). EDIC, however, was equivalent. No statistically meaningful differences were observed for the remaining organs at risk, and all plans met institutional planning goals.
Conclusion
Cardiac-sparing RapidPlan is a valuable tool for reducing heart dose and lowering EDIC in NSCLC patients. Additional heart sparing is possible by strategically crafting noncoplanar oblique beams to minimize heart dose.
{"title":"Integrating knowledge-based planning and noncoplanar oblique VMAT arcs: A study of dose to the heart and immune cells in thoracic radiotherapy","authors":"Brennan Diedrich, Justin Roper, Benjamin Hopkins, Sibo Tian, Shadab Momin, Eduard Schreibmann, Aparna H. Kesarwala, Kirk Luca","doi":"10.1016/j.tipsro.2025.100301","DOIUrl":"10.1016/j.tipsro.2025.100301","url":null,"abstract":"<div><h3>Background</h3><div>Recent patient studies have linked higher immune cell doses with worse quality of life and survival. For thoracic radiotherapy, heart dose is a major contributor to the effective dose to immune cells (EDIC).</div></div><div><h3>Purpose</h3><div>This study investigates heart and immune cell doses for plans optimized using a cardiac-sparing knowledge-based planning (KBP) model and the impact of carefully crafted beam geometry.</div></div><div><h3>Methods</h3><div>Sixteen stage III NSCLC patients previously treated to 60 Gy in 30 fractions using coplanar VMAT arcs were replanned using a cardiac-sparing KBP model with either the clinical field arrangement or noncoplanar oblique arcs that prioritize heart sparing. The cardiac-sparing KBP model consisted of fifteen substructures, all of which were used during optimization. All plans were normalized to 95% PTV coverage at 60 Gy. Statistical significance was assessed for EDIC (Jin Model), along with mean doses to the heart, lungs, body, and both the mean dose and D0.03 cc values for cardiac substructures, using the Wilcoxon signed-rank test.</div></div><div><h3>Results</h3><div>Compared to the clinically treated plans with the same beam geometry, cardiac-sparing KBP reduced mean heart dose from 8.50 Gy to 4.09 Gy and EDIC from 4.27 Gy to 3.81 Gy (p < 0.001). For the novel arcs, the mean heart dose was reduced to 3.70 Gy, significantly lower than KBP with clinical beam geometry (p = 0.001). EDIC, however, was equivalent. No statistically meaningful differences were observed for the remaining organs at risk, and all plans met institutional planning goals.</div></div><div><h3>Conclusion</h3><div>Cardiac-sparing RapidPlan is a valuable tool for reducing heart dose and lowering EDIC in NSCLC patients. Additional heart sparing is possible by strategically crafting noncoplanar oblique beams to minimize heart dose.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100301"},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068162","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 : 2024-12-31DOI: 10.1016/j.tipsro.2024.100298
Yolanda Surjan , Sandra Ndarukwa
{"title":"Global professional issues in radiation therapy: Collaboration, adaptation and innovation","authors":"Yolanda Surjan , Sandra Ndarukwa","doi":"10.1016/j.tipsro.2024.100298","DOIUrl":"10.1016/j.tipsro.2024.100298","url":null,"abstract":"","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100298"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172500","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}
This study investigates whether an Image-Guided Radiation Therapy (IGRT) workbook and Cone Beam Computed Tomography (CBCT) case studies enhances Radiation Therapists’ (RTTs) confidence analysing Proton Beam Therapy (PBT) CBCTs. An 11-participant questionnaire-based study was conducted to assess pre- and post-training confidence. Prior to training, RTTs exhibited higher confidence in photon CBCT decision-making over proton CBCT, highlighting the need for PBT-specific IGRT training, irrespective of prior photon experience. After completing the PBT IGRT workbook and case studies, RTTs experienced increased confidence in analysing PBT CBCTs. The workbook was particularly beneficial for junior RTTs, while experienced staff desired clearer guidance and real-life scenarios. The results show the IGRT workbook and CBCT case studies enhance RTTs’ confidence in PBT CBCT analysis. PBT departments should consider these results for RTT led IGRT. Future work could involve adjusting training to account for participants’ prior IGRT experience and conducting larger-scale studies to validate our results.
{"title":"Proton beam therapy image-guided radiotherapy training for RTTs – Experience from a single institution","authors":"Jannath Shirin Kottakunnan , Samaneh Shoraka , Amy Dodd , Maria Kilkenny , Sarah Petty , Kathryn Osborn , Amanda Webster","doi":"10.1016/j.tipsro.2024.100299","DOIUrl":"10.1016/j.tipsro.2024.100299","url":null,"abstract":"<div><div>This study investigates whether an Image-Guided Radiation Therapy (IGRT) workbook and Cone Beam Computed Tomography (CBCT) case studies enhances Radiation Therapists’ (RTTs) confidence analysing Proton Beam Therapy (PBT) CBCTs. An 11-participant questionnaire-based study was conducted to assess pre- and post-training confidence. Prior to training, RTTs exhibited higher confidence in photon CBCT decision-making over proton CBCT, highlighting the need for PBT-specific IGRT training, irrespective of prior photon experience. After completing the PBT IGRT workbook and case studies, RTTs experienced increased confidence in analysing PBT CBCTs. The workbook was particularly beneficial for junior RTTs, while experienced staff desired clearer guidance and real-life scenarios. The results show the IGRT workbook and CBCT case studies enhance RTTs’ confidence in PBT CBCT analysis. PBT departments should consider these results for RTT led IGRT. Future work could involve adjusting training to account for participants’ prior IGRT experience and conducting larger-scale studies to validate our results.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100299"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030009","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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