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Novel breath-hold liver target stereotactic ablative radiotherapy using the intrafraction diaphragm registration of kilovoltage projection streaming image with digitally reconstructed radiography of the planning computed tomography 新型屏气肝靶立体定向消融放疗,利用千伏投影流图像的抽束内隔膜配准与规划计算机断层摄影的数字重建
Q1 Nursing Pub Date : 2023-09-01 DOI: 10.1016/j.tipsro.2023.100217
Atsuto Katano , Yuki Nozawa , Masanari Minamitani , Hideomi Yamashita , Keiichi Nakagawa

Stereotactic ablative radiotherapy (SABR) is an emerging treatment option for patients with primary or metastatic liver tumors, particularly for those who are not eligible for surgery or transplantation. SABR is a high-precision radiation therapy that delivers a high dose of radiation to the tumor while minimizing the dose to the surrounding healthy tissues. However, the accurate targeting of the tumor is a crucial aspect of liver SABR, which requires real-time imaging and tracking of the liver and tumor motion during treatment. One of the motion management strategies for liver SABR is the repeated breath-hold technique, which involves the patient holding their breath multiple times during treatment delivery to reduce the movement of the liver and other organs due to breathing. This technique helps to improve the accuracy of the treatment and reduce the radiation dose to the healthy liver.

The current study proposes a novel approach for multiple breath-hold volumetric modulated arc therapy (VMAT) stereotactic ablative radiotherapy for liver tumors, which uses the intrafraction diaphragm registration in real time to improve the accuracy and precision of the treatment. The proposed approach is based on real-time comparison of the diaphragmatic surface location between the digitally reconstructed radiography (DRR) and intrafraction kilovoltage projection streaming images (kV-PSI) having the same beam angles. The image cross-correlation between the DRR and the intrafraction kV-PSI provides a measure of the similarity between the two images and can be used to identify and track the diaphragm position during VMAT delivery. The proposed methodology consists of several steps, including planning CT and treatment planning, reference image reconstruction, and patient positioning and immobilization. The proposed approach has the potential to improve the accuracy and precision of liver cancer VMAT SABR, thereby increasing the efficacy of the treatment and reducing the risk of radiation exposure to surrounding healthy tissues.

立体定向消融放疗(SABR)是原发性或转移性肝肿瘤患者的一种新兴治疗选择,特别是对于那些不适合手术或移植的患者。SABR是一种高精度的放射治疗,它向肿瘤提供高剂量的辐射,同时将对周围健康组织的剂量降至最低。然而,肿瘤的准确靶向是肝脏SABR的一个关键方面,这需要在治疗过程中实时成像和跟踪肝脏和肿瘤的运动。肝脏SABR的运动管理策略之一是重复屏气技术,该技术涉及患者在治疗过程中多次屏气,以减少因呼吸引起的肝脏和其他器官的运动。这项技术有助于提高治疗的准确性,减少对健康肝脏的辐射剂量。本研究提出了一种针对肝脏肿瘤的多重憋气体积调制弧线治疗(VMAT)立体定向消融放疗的新方法,该方法利用抽束内隔膜实时配准,提高了治疗的准确性和精密度。所提出的方法是基于具有相同光束角度的数字重建放射成像(DRR)和衍射内电压投影流图像(kV-PSI)之间膈面位置的实时比较。DRR和内压缩kV-PSI之间的图像相互关联提供了两个图像之间相似性的度量,可用于识别和跟踪VMAT交付过程中的隔膜位置。所提出的方法包括几个步骤,包括规划CT和治疗计划,参考图像重建,患者定位和固定。所提出的方法有可能提高肝癌VMAT SABR的准确性和精密度,从而提高治疗效果并降低辐射暴露于周围健康组织的风险。
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引用次数: 1
Understanding the impact of radiotherapy related insufficiency fractures and exploring satisfaction with two existing patient reported outcome measures: A qualitative interview study 了解放疗相关不全骨折的影响并探索两种现有患者报告的结果测量的满意度:一项定性访谈研究
Q1 Nursing Pub Date : 2023-09-01 DOI: 10.1016/j.tipsro.2023.100210
Sally Taylor , Prabhav Chaudhary , Fiona McCartin , Claire Higham

Introduction

Radiotherapy related insufficiency fractures (RRIFs) occur in approximately 10–15% of cancer survivors who underwent pelvic radiotherapy. Little research has been conducted to explore the impact of RRIFs on quality of life (QOL). Patient reported outcome measures (PROMs) are often used in oncology to measure side effects and QOL. The study aims to understand the influence of RRIF on QOL and to discover whether available PROMs address their needs.

Materials and methods

Twenty-five patients randomly selected from a Tertiary Oncology Centre bone health clinic database of patients referred with RRIFs were approached. Interested patients were sent two existing PROMs and a patient information sheet. Eleven patients agreed to take part in a semi-structured interview to explore their experiences and their opinion on the existing PROMs. Telephone interviews were conducted. Interviews were audio recorded, transcribed, and analysed using thematic analysis.

Results

Four themes were identified: 1) Route to diagnosis, 2) management of RRIFs and 3) resilience all had an impact on 4) QOL. Additionally, participants discussed PROMs and how they might be integrated into clinical practice. The data highlights the wide ranging QOL impacts experienced and highlights potential areas for improvement in terms of diagnosis and management pathways.

Discussion

The impact of RRIFs on QOL is considerable. Participants highlighted key areas for improvement including the provision of more information, more access to support and improved management pathways. Participants also highlighted the potential benefits of PROMs but suggested existing measures could be improved.

放疗相关性不全骨折(RRIFs)发生在接受盆腔放疗的癌症幸存者中约10-15%。很少有研究探讨RRIFs对生活质量(QOL)的影响。患者报告结果测量(PROMs)在肿瘤学中经常用于测量副作用和生活质量。该研究旨在了解RRIF对生活质量的影响,并发现现有的prom是否满足了他们的需求。材料和方法从三级肿瘤中心骨健康临床数据库中随机选择25例RRIFs患者进行研究。感兴趣的患者被发送了两张现有的prom和一份患者信息表。11名患者同意参加一个半结构化的访谈,以探讨他们的经历和他们对现有prom的看法。进行了电话采访。访谈录音,转录,并使用专题分析进行分析。结果确定了四个主题:1)诊断途径,2)RRIFs管理和3)恢复力都对生活质量有影响。此外,与会者讨论了PROMs以及如何将其整合到临床实践中。这些数据突出了所经历的广泛的生活质量影响,并突出了在诊断和管理途径方面需要改进的潜在领域。rri对生活质量的影响是相当大的。与会者强调了需要改进的关键领域,包括提供更多信息、获得更多支持和改进管理途径。与会者也强调了prom的潜在好处,但建议可以改进现有措施。
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引用次数: 0
Changes in satisfaction and anxiety about radiotherapy for pediatric cancer by two-step audio-visual instruction 两步视听教学对儿童肿瘤放疗满意度和焦虑的影响
Q1 Nursing Pub Date : 2023-09-01 DOI: 10.1016/j.tipsro.2023.100214
Hiroshi Fuji , Tomoyasu Fujibuchi , Hideyuki Tanaka , Yuu Ogawa , Chihiro Noda , Maoko Hayakawa , Kazuaki Nakamura , Kyoko Tanaka

Objectives

Although radiotherapy is an essential component of pediatric cancer treatment, inadequate radiotherapy information for childhood cancer and unusual treatment situations can negatively affect parental perceptions and emotions. This study aims to investigate the effect of two-step audio-visual instruction system effects introduced by our institution on parent satisfaction and anxiety when initiating radiotherapy.

Methods

The two-step audio-visual instruction system comprised instructive animation using patient avatars and a live video system. The live video system has a 55-inch-wide monitor, and a no-latency sound module. Parents in the radiotherapy division can view the patient in the treatment room through the live video system. This prospective study compared satisfaction and anxiety about radiotherapy introduction before and after two-step audio-visual instruction. We enrolled 20 parents whose child underwent radiotherapy, and they completed a set of questionnaires—Client Satisfaction Questionnaire, State-Trait Anxiety Inventory, and original questionnaires about radiotherapy.

Results

Satisfaction scores improved significantly after two-step audio visual instruction (25.5 ± 3.4) compared with those before the instruction (27.7 ± 3.1) (p = <0.01). Anxiety scores also decreased significantly after the instruction (50 ± 9) compared with those before the instruction (54 ± 11) (p = 0.004). However, anxiety-related personality trait scores did not change drastically before and after viewing (48 ± 8.5 vs. 49 ± 7.5) (p = 0.419).

Conclusion

This single-arm prospective study indicates that two-step audio-visual instruction for radiotherapy is effective in improving parents' anxiety about radiotherapy introductions. However, large-scale and comparative studies are warranted to generalize the benefit of two-step audio visual instruction.

尽管放射治疗是儿童癌症治疗的重要组成部分,但儿童癌症放射治疗信息不足和治疗情况异常会对父母的认知和情绪产生负面影响。本研究旨在调查我院引入的两步视听教学系统效果对放疗时家长满意度和焦虑的影响。方法两步视听教学系统包括使用患者头像的指导性动画和现场视频系统。现场视频系统有一个55英寸宽的监视器和一个无延迟声音模块。放疗科的家长可以通过视频直播系统观看治疗室里的病人。这项前瞻性研究比较了两步视听指导前后对放疗介绍的满意度和焦虑度。我们招募了20名孩子接受放射治疗的父母,他们完成了一组问卷——客户满意度问卷、状态-特质焦虑量表和关于放射治疗的原始问卷。结果两步视听教学后满意度评分(25.5±3.4)较教学前(27.7±3.1)有显著提高(p=<;0.01),焦虑评分(50±9)较教学后(54±11)有显著下降(p=0.004),焦虑相关的人格特质评分在观看前后没有显著变化(48±8.5 vs.49±7.5)(p=0.419)。结论本项单臂前瞻性研究表明,两步放疗视听指导能有效改善家长对放疗介绍的焦虑。然而,有必要进行大规模的比较研究,以推广两步视听教学的好处。
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引用次数: 1
Investigating the feasibility of using Ethos generated treatment plans for head and neck cancer patients 研究使用Ethos生成的癌症头颈部患者治疗计划的可行性。
Q1 Nursing Pub Date : 2023-09-01 DOI: 10.1016/j.tipsro.2023.100216
Adam El-qmache, John McLellan

The Varian Ethos treatment platform is designed to automatically create complex RT treatment plans, reducing both workload and operator variability in plan quality. The aim of this study is to evaluate the quality of Ethos-generated head and neck (H&N) treatment plans.

Ethos plans were created for ten previous H&N patients and these were compared with the original clinical plans generated in Eclipse. Ethos automatically creates several plans with different field arrangements for each patient. All plans were compared quantitatively using: dose-volume metrics; dose conformity; dose heterogeneity and monitor units (MU). In addition, two H&N Oncologists assessed the clinical acceptability of the Ethos plans.

Consultant 1 judged there to be at least three clinically acceptable Ethos plans for 9 out of 10 patients reviewed. Consultant 2 approved of at least two Ethos plans for 5 out of 5 patients reviewed. The Ethos plans’ average dose metrics were comparable to the clinical plans. The average plan MU was similar for Eclipse and Ethos VMAT plans. The average plan MU for Ethos IMRT plans was larger with respect to all VMAT plans.

The Ethos Treatment Planning system is capable of automatically creating good quality treatment plans for a range of H&N cancer patients.

Varian Ethos治疗平台旨在自动创建复杂的RT治疗计划,减少工作量和操作员在计划质量方面的可变性。本研究的目的是评估Ethos生成的头颈部(H&N)治疗计划的质量。为之前的10名H&N患者创建了Ethos计划,并将其与Eclipse中生成的原始临床计划进行了比较。Ethos会自动为每位患者创建多个具有不同现场安排的计划。所有方案均使用以下指标进行定量比较:剂量-体积指标;剂量一致性;剂量异质性和监测单位(MU)。此外,两名H&N肿瘤学家评估了Ethos计划的临床可接受性。顾问1判断,在审查的10名患者中,有9名患者至少有三项临床可接受的Ethos计划。顾问2批准了至少两个Ethos计划,适用于审查的5名患者中的5名。Ethos计划的平均剂量指标与临床计划相当。Eclipse和Ethos VMAT计划的平均MU计划相似。Ethos IMRT计划的平均计划MU比所有VMAT计划都要大。Ethos治疗计划系统能够自动为一系列H&N癌症患者创建高质量的治疗计划。
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引用次数: 0
Practice-based training strategy for therapist-driven prostate MR-Linac adaptive radiotherapy 治疗师驱动的前列腺MR-Linac自适应放疗的实践培训策略
Q1 Nursing Pub Date : 2023-09-01 DOI: 10.1016/j.tipsro.2023.100212
Winnie Li , Jerusha Padayachee , Inmaculada Navarro , Jeff Winter , Jennifer Dang , Srinivas Raman , Vickie Kong , Alejandro Berlin , Charles Catton , Rachel Glicksman , Victor Malkov , Andrew McPartlin , Kaushik Kataki , Patricia Lindsay , Peter Chung

Purpose

To develop a practice-based training strategy to transition from radiation oncologist to therapist-driven prostate MR-Linac adaptive radiotherapy.

Methods and materials

In phase 1, 7 therapists independently contoured the prostate and organs-at-risk on T2-weighted MR images from 11 previously treated MR-Linac prostate patients. Contours were evaluated quantitatively (i.e. Dice similarity coefficient [DSC] calculated against oncologist generated online contours) and qualitatively (i.e. oncologist using a 5-point Likert scale; a score ≥ 4 was deemed a pass, a 90% pass rate was required to proceed to the next phase). Phase 2 consisted of supervised online workflow with therapists required no intervention from the oncologist on 10 total cases to advance. Phase 3 involved unsupervised therapist-driven workflow, with offline support from oncologists prior to the next fraction.

Results

In phase 1, the mean DSC was 0.92 (range 0.85–0.97), and mean Likert score was 3.7 for the prostate. Five therapists did not attain a pass rate (3–5 cases with prostate contour score < 4), underwent follow-up one-on-one review, and performed contours on a further training set (n = 5). Each participant completed a median of 12 (range 10–13) cases in phase 2; of 82 cases, minor direction were required from the oncologist on 5 regarding target contouring. Radiation oncologists reviewed 179 treatment fractions in phase 3, and deemed 5 cases acceptable but with suggestions for next fraction; all other cases were accepted without suggestions.

Conclusion

A training stepwise program was developed and successfully implemented to enable a therapist-driven workflow for online prostate MR-Linac adaptive radiotherapy.

目的:建立一套以实践为基础的培训策略,以实现从放射肿瘤学家到治疗师驱动的前列腺MR-Linac适应性放疗的转变。方法和材料在第1期中,7名治疗师独立绘制了11名先前治疗过的MR- linac前列腺患者的t2加权MR图像上的前列腺和危险器官的轮廓。对轮廓进行定量评估(即根据肿瘤学家生成的在线轮廓计算骰子相似系数[DSC])和定性评估(即肿瘤学家使用5点李克特量表;分数≥4被认为是通过,通过率达到90%才能进入下一阶段)。第二阶段包括有监督的在线工作流程,治疗师不需要肿瘤学家的干预,总共有10个病例可以推进。第三阶段涉及无监督的治疗师驱动的工作流程,在接下来的部分之前有肿瘤学家的离线支持。结果1期平均DSC为0.92(范围0.85-0.97),前列腺平均Likert评分为3.7。5名治疗师没有达到通过率(3-5例前列腺轮廓评分<4),接受一对一的随访评估,并对进一步的训练集(n = 5)进行轮廓分析。在第二阶段,每位参与者完成的中位数为12例(范围为10-13);在82例病例中,有5例需要肿瘤学家对目标轮廓进行次要指导。放射肿瘤学家回顾了第三阶段的179个治疗方案,认为5例可以接受,但对下一个方案提出了建议;所有其他的案例都被接受了,没有任何建议。结论制定并成功实施了逐步培训计划,使在线前列腺MR-Linac自适应放疗成为治疗师驱动的工作流程。
{"title":"Practice-based training strategy for therapist-driven prostate MR-Linac adaptive radiotherapy","authors":"Winnie Li ,&nbsp;Jerusha Padayachee ,&nbsp;Inmaculada Navarro ,&nbsp;Jeff Winter ,&nbsp;Jennifer Dang ,&nbsp;Srinivas Raman ,&nbsp;Vickie Kong ,&nbsp;Alejandro Berlin ,&nbsp;Charles Catton ,&nbsp;Rachel Glicksman ,&nbsp;Victor Malkov ,&nbsp;Andrew McPartlin ,&nbsp;Kaushik Kataki ,&nbsp;Patricia Lindsay ,&nbsp;Peter Chung","doi":"10.1016/j.tipsro.2023.100212","DOIUrl":"10.1016/j.tipsro.2023.100212","url":null,"abstract":"<div><h3>Purpose</h3><p>To develop a practice-based training strategy to transition from radiation oncologist to therapist-driven prostate MR-Linac adaptive radiotherapy.</p></div><div><h3>Methods and materials</h3><p>In phase 1, 7 therapists independently contoured the prostate and organs-at-risk on T2-weighted MR images from 11 previously treated MR-Linac prostate patients. Contours were evaluated quantitatively (i.e. Dice similarity coefficient [DSC] calculated against oncologist generated online contours) and qualitatively (i.e. oncologist using a 5-point Likert scale; a score ≥ 4 was deemed a pass, a 90% pass rate was required to proceed to the next phase). Phase 2 consisted of supervised online workflow with therapists required no intervention from the oncologist on 10 total cases to advance. Phase 3 involved unsupervised therapist-driven workflow, with offline support from oncologists prior to the next fraction.</p></div><div><h3>Results</h3><p>In phase 1, the mean DSC was 0.92 (range 0.85–0.97), and mean Likert score was 3.7 for the prostate. Five therapists did not attain a pass rate (3–5 cases with prostate contour score &lt; 4), underwent follow-up one-on-one review, and performed contours on a further training set (n = 5). Each participant completed a median of 12 (range 10–13) cases in phase 2; of 82 cases, minor direction were required from the oncologist on 5 regarding target contouring. Radiation oncologists reviewed 179 treatment fractions in phase 3, and deemed 5 cases acceptable but with suggestions for next fraction; all other cases were accepted without suggestions.</p></div><div><h3>Conclusion</h3><p>A training stepwise program was developed and successfully implemented to enable a therapist-driven workflow for online prostate MR-Linac adaptive radiotherapy.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/82/21/main.PMC10230256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9939984","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}
引用次数: 0
Synchronization of light flash with the irradiation pulse in proton beam therapy: A case report 质子束治疗中闪光与照射脉冲同步1例
Q1 Nursing Pub Date : 2023-09-01 DOI: 10.1016/j.tipsro.2023.100218
Takashi Saito , Masashi Mizumoto , Yoshiko Oshiro , Toshio Miyamoto , Satoshi Kamizawa , Masatoshi Nakamura , Toshiki Ishida , Hirokazu Makishima , Haruko Numajiri , Kei Nakai , Takeji Sakae , Hideyuki Sakurai

The correlation between sensory light flash and proton beam delivery was evaluated by measuring the timing of pulse beam delivery and light flash sensing using an event recorder in an 83-year-old patient receiving proton beam therapy (PBT) for nasopharyngeal adenoid cystic carcinoma. The treatment dose was 65 Gy (RBE) in 26 fractions with 2 ports, and both beams included the visual pathway (retina, optic nerve, chiasma). Measurements were obtained in 13 of the 26 fractions. The patient sensed a light flash in all 13 fractions and pressed the recorder button for 426 of the 430 pulsed beam deliveries, giving a sensing rate of 99.1%. The median duration of button-pressing of 0.3 s was almost the same as that of the beam pulse of 0.2 s, with a reaction time lag of 0.35 s. These results suggest a consistency between light flash during PBT and the timing of irradiation.

对一位83岁鼻咽腺样囊性癌接受质子束治疗(PBT)的患者,使用事件记录仪测量脉冲束的传送时间和光闪感应时间,评估感觉光闪与质子束传送之间的相关性。治疗剂量为65 Gy (RBE),分26段2端口,两束均包括视通路(视网膜、视神经、交叉)。在26个分数中有13个得到了测量值。患者在所有13个部分中都感应到了闪光,并按下了记录按钮,430次脉冲光束输送中有426次,感应率为99.1%。按键的中位持续时间为0.3 s,与光束脉冲的中位持续时间为0.2 s基本一致,反应滞后时间为0.35 s。这些结果表明PBT期间的闪光与照射时间之间存在一致性。
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引用次数: 0
Are liver contour and bone fusion comparable to fiducials for IGRT in liver SBRT? 肝脏轮廓和骨融合是否与肝脏SBRT中IGRT的基准相当?
Q1 Nursing Pub Date : 2023-09-01 DOI: 10.1016/j.tipsro.2023.100215
C. de la Pinta , D. Sevillano , R. Colmenares , S. Barrio , A. Olavarria , A. Palomera , R. Romera , J. Cobos , A. Muriel , E. Fernández , LC. Perna , A. Albillos , S. Sancho

Introduction

Liver stereotactic body radiotherapy (SBRT) is increasingly being used to treat tumours. The purpose of this study was to compare the differences in patient positioning when using implanted fiducials as surrogates compared to alternative methods based on liver contour or bone registration.

Material and methods

Eighteen patients treated with SBRT who underwent a fiducial placement procedure were included. Fiducial guidance was our gold standard to guide treatment in this study. After recording the displacements, when fusing the planning CT and CBCT performed in the treatment unit using fiducials, liver contour and bone reference, the differences between fiducials and liver contour and bone reference were calculated. Data from 88 CBCT were analyzed. The correlation between the displacements found with fiducials and those performed based on the liver contour and the nearest bone structure as references was determined. The mean, median, variance, range and standard deviation of the displacements with each of the fusion methods were obtained. μ, Ʃ, and σ values and margins were obtained.

Results

Lateral displacements of less than 3 mm with respect to the gold standard in 92% vs. 62.5% of cases using liver contour and bone references, respectively, with 93.2% vs. 65.9% in the AP axis and SI movement in 69.3% vs. 51.1%. The errors μ, σ and Ʃ of the fusions with hepatic contour and bone reference in SI were 0.26 mm, 4 mm and 3 mm, and 0.8 mm, 5 mm and 3 mm respectively.

Conclusion

Our study showed that displacements were smaller with the use of hepatic contour compared to bone reference and comparable to those obtained with the use of fiducials in the lateral, AP and SI motion axes. This would justify that hepatic contouring can be a guide in the treatment of patients in the absence of fiducials.

简介:肝脏立体定向放射治疗(SBRT)越来越多地被用于治疗肿瘤。本研究的目的是比较使用植入的基准作为替代物时,与基于肝脏轮廓或骨骼配准的替代方法相比,患者定位的差异。材料和方法:包括18名接受SBRT治疗的患者,他们接受了基准放置程序。在本研究中,信托指导是我们指导治疗的金标准。在记录位移后,当使用基准点、肝脏轮廓和骨骼参考融合在治疗单元中执行的计划CT和CBCT时,计算基准点与肝脏轮廓和骨参考之间的差异。对88例CBCT的数据进行分析。确定了用基准点发现的位移与基于肝脏轮廓和最近的骨骼结构作为参考进行的位移之间的相关性。获得了每种融合方法的位移的平均值、中值、方差、范围和标准差。μ、 获得了σ值和裕度。结果:在使用肝脏轮廓和骨骼参考的病例中,相对于金标准,92%和62.5%的病例的横向位移小于3mm,AP轴和SI运动的横向位移分别为93.2%和65.9%,69.3%和51.1%。在SI中,与肝脏轮廓和骨参考的融合的误差μ、σ和Ʃ分别为0.26mm、4mm和3mm,以及0.8mm、5mm和3mm。结论:我们的研究表明,与骨参考相比,使用肝脏轮廓获得的位移更小,与使用横向、AP和SI运动轴基准获得的位移相当。这将证明,在没有基准的情况下,肝脏轮廓可以作为治疗患者的指南。
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引用次数: 0
Community socioeconomic status and rural/racial disparities in HPV−/+ head and neck cancer HPV−/+头颈癌的社区社会经济地位和农村/种族差异
Q1 Nursing Pub Date : 2023-06-01 DOI: 10.1016/j.tipsro.2023.100205
Jason Semprini , Jessica C. Williams

Background

Head and Neck Cancer (HNC) is a major cause of cancer morbidity and mortality in the United States, but the burden is not evenly distributed. Rural and racial disparities are obvious across the HNC continuum. Most HNC disparities research have emphasized individual factors perpetuating rural and racial disparities, ignoring the role of community-level factors.

Methods

We analyzed data from the Surveillance Epidemiology and End Results (SEER) program’s “Specialized HNC-Human Papillomavirus (HPV) Census-Tract SES” datafile (2010–2016). In addition to cancer patient characteristics, this data includes a socioeconomic status (SES) quintile based on the patient’s census-tract. Our outcome variables included whether the HNC patient 1) was diagnosed at a distant stage, 2) received initial treatment two or more months after diagnosis, 3) received radiation therapy, 4) survived two years after diagnosis. We tested for differences across SES quintiles, in the full sample and then within rural/racial categories. We then tested for differences between each rural/racial category conditional on SES quintile.

Results

For both HPV(−) and HPV + HNCs, patients in higher SES census-tracts have 8–10% lower rates of distant stage diagnoses and delayed treatment initiation, and 12.0–14.5% higher survival rates than patients in lower SES census-tracts. Radiation treatment only varied across SES quintiles in HPV + HNC patients. We find little evidence of rural–urban differences within each socioeconomic quintile. However, within lower SES quintiles, we found significant racial disparities in delayed detection and treatment. These differences were largest in the lowest SES quintile, as non-Hispanic Black patients reported 10–11% higher rates of delayed detection and treatment initiation than non-Hispanic White patients.

Conclusions

Our research illustrates the value and constraints in leveraging community-level factors in health disparities research that can ultimately assist in designing effective policies that address and achieve rural and racial cancer equity.

背景癌症是美国癌症发病率和死亡率的主要原因,但其负担并不均匀。农村和种族差异在整个HNC连续体中是明显的。大多数HNC差异研究都强调了使农村和种族差异长期存在的个人因素,而忽视了社区层面因素的作用。方法我们分析了监测流行病学和最终结果(SEER)项目的“专门HNC人类乳头瘤病毒(HPV)普查区SES”数据文件(2010-2016)中的数据。除了癌症患者特征外,该数据还包括基于患者症状的社会经济地位(SES)五分位数。我们的结果变量包括HNC患者是否1)在远处被诊断,2)在诊断后两个月或两个月以上接受了初步治疗,3)接受了放射治疗,4)在确诊后存活了两年。我们测试了SES五分位数、全样本以及农村/种族类别之间的差异。然后,我们测试了以SES五分位数为条件的每个农村/种族类别之间的差异。结果对于HPV(−)和HPV+HNCs,SES普查区较高的患者的远处阶段诊断率和延迟治疗开始率比SES普查区域较低的患者低8-10%,生存率高12.0-14.5%。放射治疗仅在HPV+HNC患者的SES五分位数中存在差异。我们几乎没有发现每个社会经济五分之一人口中存在城乡差异的证据。然而,在社会经济地位较低的五分位数中,我们发现在延迟检测和治疗方面存在显著的种族差异。这些差异在SES最低的五分之一人群中最大,因为非西班牙裔黑人患者报告的延迟检测和治疗开始率比非西班裔白人患者高10-11%。结论我们的研究说明了在健康差异研究中利用社区层面因素的价值和限制因素,这些因素最终有助于制定有效的政策,解决和实现癌症农村和种族公平。
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引用次数: 0
Comparison of the output of a deep learning segmentation model for locoregional breast cancer radiotherapy trained on 2 different datasets 局部区域乳腺癌放疗深度学习分割模型在2个不同数据集上的输出比较
Q1 Nursing Pub Date : 2023-06-01 DOI: 10.1016/j.tipsro.2023.100209
Nienke Bakx , Maurice van der Sangen , Jacqueline Theuws , Hanneke Bluemink , Coen Hurkmans

Introduction

The development of deep learning (DL) models for auto-segmentation is increasing and more models become commercially available. Mostly, commercial models are trained on external data. To study the effect of using a model trained on external data, compared to the same model trained on in-house collected data, the performance of these two DL models was evaluated.

Methods

The evaluation was performed using in-house collected data of 30 breast cancer patients. Quantitative analysis was performed using Dice similarity coefficient (DSC), surface DSC (sDSC) and 95th percentile of Hausdorff Distance (95% HD). These values were compared with previously reported inter-observer variations (IOV).

Results

For a number of structures, statistically significant differences were found between the two models. For organs at risk, mean values for DSC ranged from 0.63 to 0.98 and 0.71 to 0.96 for the in-house and external model, respectively. For target volumes, mean DSC values of 0.57 to 0.94 and 0.33 to 0.92 were found. The difference of 95% HD values ranged 0.08 to 3.23 mm between the two models, except for CTVn4 with 9.95 mm. For the external model, both DSC and 95% HD are outside the range of IOV for CTVn4, whereas this is the case for the DSC found for the thyroid of the in-house model.

Conclusions

Statistically significant differences were found between both models, which were mostly within published inter-observer variations, showing clinical usefulness of both models. Our findings could encourage discussion and revision of existing guidelines, to further decrease inter-observer, but also inter-institute variability.

引言用于自动分割的深度学习(DL)模型的开发越来越多,越来越多的模型可以商业化。大多数情况下,商业模型都是根据外部数据进行训练的。为了研究使用根据外部数据训练的模型的效果,与根据内部收集的数据训练的同一模型相比,评估了这两个DL模型的性能。方法对30例癌症患者的临床资料进行评价。使用Dice相似系数(DSC)、表面DSC(sDSC)和Hausdorff距离的第95百分位(95%HD)进行定量分析。将这些值与先前报道的观察者间变异(IOV)进行比较。结果对于许多结构,两个模型之间存在统计学上的显著差异。对于有风险的器官,内部和外部模型的DSC平均值分别为0.63至0.98和0.71至0.96。对于目标体积,发现平均DSC值为0.57至0.94和0.33至0.92。除了9.95 mm的CTVn4外,两种型号之间95%HD值的差异范围为0.08至3.23 mm。对于外部型号,DSC和95%HD都在CTVn5的IOV范围之外,而内部型号甲状腺的DSC则是这样。结论两种模型之间存在统计学显著差异,主要在已发表的观察者间变异范围内,表明两种模型的临床实用性。我们的研究结果可以鼓励对现有指南进行讨论和修订,以进一步减少观察者之间以及研究机构之间的可变性。
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引用次数: 1
Validation testing of a language translation device for suitability in assisting Australian radiation therapists to communicate with Mandarin-speaking patients 一种语言翻译设备的验证测试,以帮助澳大利亚放射治疗师与讲普通话的患者进行沟通
Q1 Nursing Pub Date : 2023-06-01 DOI: 10.1016/j.tipsro.2023.100207
Darren Hunter , Richard Oates , Nigel Anderson , David Kok , Daniel Sapkaroski , Caroline Wright

Introduction

Clear, timely communication between practitioners and patients is key in ensuring equitable access to health services and optimal care. Australia’s linguistically diverse population adds complexity to healthcare provision. This paper describes a validation study to assess clinical suitability of a language translation device, intended for use with Mandarin speaking patients undergoing radiotherapy (RT).

Materials and methods

After a comprehensive device selection process, common phrases used in RT practice were curated within one clinical center and translated by interpreters. Phrases were categorized by conversation type and readability (according to Flesch-Kincaid and FORCAST scores). Validation of device performance was undertaken by purposely selected radiation therapists (RTTs) who tested and evaluated the device using a survey with 5-point Likert scale responses. Statistical analysis was undertaken on Excel using Pearson’s chi-square, z-test, interrater reliability/agreement and linear regression analyses.

Results

Six RTTs and two interpreters volunteered to participate in this study. 188 common phrases were spoken verbatim into the device and scored on a 5-point Likert scale, yielding an overall output accuracy of 66%. A z-test confirmed significance against prior comparative research and Linear regression analysis observed improved output between consecutive participants. 62.7% of interpreter scores were identical; a further 29.1% constituted a single point scoring variation. Poorer outcomes were observed with colloquial English and lower readability.

Conclusions

This study found the device produced suitable translation accuracy and identified language styles that should be avoided with use. Further research could consider clinical application, expanded languages and/or health disciplines, and development of a national RTT phrase list.

引言医生和患者之间清晰、及时的沟通是确保公平获得医疗服务和最佳护理的关键。澳大利亚语言多样的人口增加了医疗服务的复杂性。本文描述了一项验证研究,以评估语言翻译设备的临床适用性,该设备适用于接受放疗的普通话患者。材料和方法经过全面的设备选择过程,在一个临床中心内策划并由口译员翻译放疗实践中使用的常见短语。短语按会话类型和可读性进行分类(根据Flesch-Kincaid和FORCAST评分)。设备性能的验证是由有意选择的放射治疗师(RTT)进行的,他们使用5点Likert量表反应的调查对设备进行了测试和评估。在Excel上使用Pearson卡方、z检验、评估者间信度/一致性和线性回归分析进行统计分析。结果6名RTT和2名口译员自愿参与本研究。188个常见短语被逐字逐句地说出到设备中,并在5分的Likert量表上得分,总输出准确率为66%。z检验证实了与先前的比较研究相比的显著性,线性回归分析观察到连续参与者之间的产出有所改善。62.7%的口译员成绩相同;另外29.1%构成了单点得分变化。在口语化和可读性较低的情况下观察到较差的结果。结论本研究发现,该设备产生了合适的翻译准确性,并确定了使用时应避免的语言风格。进一步的研究可以考虑临床应用、扩展语言和/或健康学科,以及制定国家RTT短语列表。
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引用次数: 0
期刊
Technical Innovations and Patient Support in Radiation Oncology
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