Pub Date : 2023-06-26DOI: 10.1017/S1460396923000237
Sheena Joy, J. Aaron, J. Joseph, Biju P. Thomas, Johny Joseph, J. Tom
Abstract Context: Haematological toxicities are seen in rectal cancer patients receiving concurrent chemoradiotherapy (CRT) with capecitabine. Aims: To compare dose volume histogram (DVH) parameters and acute haematological toxicities using RapidArc with or without bone marrow constraints for rectal cancer patients receiving pelvic chemoradiation as part of curative treatment. Setting and designs: This is a prospective randomised controlled study including patients with rectal cancer initiated on chemoradiation. Patients were stratified into two arms, bone marrow sparing (BMS) arm and non-bone marrow sparing arm (NBMS). Materials and methods: DVH parameters and weekly toxicity data were collected. Grade 2 or more anaemia, leucopenia, neutropenia, or thrombocytopenia, any blood transfusions, colony-stimulating factor injection, platelet transfusions were considered as an event in acute haematological toxicity (HT). Statistical analysis: Independent t-test was used to compare quantitative parameters, and Mann–Whitney U-test was used for ordinal parameters between groups. Results: A total of 43 patients were enrolled. Bone marrow constraints were achieved without compromising the target coverage. There was a significant reduction in the bone marrow dose with BMS technique (p < 0·05). A 16·7% reduction in the HT (33·3% versus 50%) and a 21·9% reduction in the grade 2 or more anaemia (19% versus 40·9%) were noted in the BMS arm when compared to NBMS arm, though not statistically significant. However, in the preoperative setting, a significant reduction in grade 2/more anaemia (7·1% versus 41·1%, p = 0·035) was noticed in the BMS arm. Conclusions: Pelvic BMS radiotherapy may benefit patients receiving chemoradiation for locally advanced carcinoma rectum as part of curative treatment.
{"title":"Bone marrow sparing RapidArc treatment in locally advanced rectal cancer – can it reduce haematological toxicity?","authors":"Sheena Joy, J. Aaron, J. Joseph, Biju P. Thomas, Johny Joseph, J. Tom","doi":"10.1017/S1460396923000237","DOIUrl":"https://doi.org/10.1017/S1460396923000237","url":null,"abstract":"Abstract Context: Haematological toxicities are seen in rectal cancer patients receiving concurrent chemoradiotherapy (CRT) with capecitabine. Aims: To compare dose volume histogram (DVH) parameters and acute haematological toxicities using RapidArc with or without bone marrow constraints for rectal cancer patients receiving pelvic chemoradiation as part of curative treatment. Setting and designs: This is a prospective randomised controlled study including patients with rectal cancer initiated on chemoradiation. Patients were stratified into two arms, bone marrow sparing (BMS) arm and non-bone marrow sparing arm (NBMS). Materials and methods: DVH parameters and weekly toxicity data were collected. Grade 2 or more anaemia, leucopenia, neutropenia, or thrombocytopenia, any blood transfusions, colony-stimulating factor injection, platelet transfusions were considered as an event in acute haematological toxicity (HT). Statistical analysis: Independent t-test was used to compare quantitative parameters, and Mann–Whitney U-test was used for ordinal parameters between groups. Results: A total of 43 patients were enrolled. Bone marrow constraints were achieved without compromising the target coverage. There was a significant reduction in the bone marrow dose with BMS technique (p < 0·05). A 16·7% reduction in the HT (33·3% versus 50%) and a 21·9% reduction in the grade 2 or more anaemia (19% versus 40·9%) were noted in the BMS arm when compared to NBMS arm, though not statistically significant. However, in the preoperative setting, a significant reduction in grade 2/more anaemia (7·1% versus 41·1%, p = 0·035) was noticed in the BMS arm. Conclusions: Pelvic BMS radiotherapy may benefit patients receiving chemoradiation for locally advanced carcinoma rectum as part of curative treatment.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47603438","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 : 2023-06-22DOI: 10.1017/S1460396923000213
Felix Fels, E. Okonkwo, J. G. Grossmann, Thomas H Schadt, S. Laschke, G. Lövey, Dieter Lansing, U. Freund, Reiner Steurer, F. Momm
Abstract Introduction: Low-dose-rate brachytherapy (LDR brachytherapy) with Iodine-125-seeds is an established treatment modality for low- and favourable intermediate-risk prostate cancer. Our single institution experience in this field was retrospectively studied. Methods: Two-hundred sixty consecutive patient records were reviewed for demographic, disease, therapy and side effect data. The patients were divided into subgroups by pre- and post-implant prostate-specific antigen (PSA) levels and by different LDR brachytherapy techniques used, that is, preoperative planning technique (PPT) versus intraoperative real-time planning (IOR). Data were analysed by Kaplan–Meier method and appropriate testing was conducted for PSA biochemical recurrence (BCR) and for toxicities. Results: After median follow-up of 65·0 months, 94·0% of all patients were free from BCR. This endpoint showed no significant differences by patient age, initial PSA, PSA decrease over time, Gleason score and implanted total activity. Patients with IOR were free of BCR in 98·9% (180/182) versus 76·9% (40/52) with PPT. All patients with a PSA nadir of <0·1 ng/mL were free from BCR. Six patients (2·5%) reported an incontinence grade 1. Transient nocturia/urge and dysuria appeared in 54·7% and 22·6% of patients. Conclusions: Consistent with literature, LDR brachytherapy for low- and intermediate-risk prostate cancer appeared highly effective for freedom from BCR with mild side effects.
{"title":"Permanent interstitial low-dose-rate brachytherapy for prostate cancer: institutional experience with implementation and predictive factors for outcome and side effects","authors":"Felix Fels, E. Okonkwo, J. G. Grossmann, Thomas H Schadt, S. Laschke, G. Lövey, Dieter Lansing, U. Freund, Reiner Steurer, F. Momm","doi":"10.1017/S1460396923000213","DOIUrl":"https://doi.org/10.1017/S1460396923000213","url":null,"abstract":"Abstract Introduction: Low-dose-rate brachytherapy (LDR brachytherapy) with Iodine-125-seeds is an established treatment modality for low- and favourable intermediate-risk prostate cancer. Our single institution experience in this field was retrospectively studied. Methods: Two-hundred sixty consecutive patient records were reviewed for demographic, disease, therapy and side effect data. The patients were divided into subgroups by pre- and post-implant prostate-specific antigen (PSA) levels and by different LDR brachytherapy techniques used, that is, preoperative planning technique (PPT) versus intraoperative real-time planning (IOR). Data were analysed by Kaplan–Meier method and appropriate testing was conducted for PSA biochemical recurrence (BCR) and for toxicities. Results: After median follow-up of 65·0 months, 94·0% of all patients were free from BCR. This endpoint showed no significant differences by patient age, initial PSA, PSA decrease over time, Gleason score and implanted total activity. Patients with IOR were free of BCR in 98·9% (180/182) versus 76·9% (40/52) with PPT. All patients with a PSA nadir of <0·1 ng/mL were free from BCR. Six patients (2·5%) reported an incontinence grade 1. Transient nocturia/urge and dysuria appeared in 54·7% and 22·6% of patients. Conclusions: Consistent with literature, LDR brachytherapy for low- and intermediate-risk prostate cancer appeared highly effective for freedom from BCR with mild side effects.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49362204","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 : 2023-06-19DOI: 10.1017/S1460396923000249
O. Nhila, M. Talbi, M. El Mansouri, M. A. Youssoufi, M. Erraoudi, E. Chakir, Mohamed Azougagh
Abstract Introduction: This work aims to evaluate the effect of Hitachi 16-slice scanner reconstruction filters on Hounsfield unit (HU) variations. In the literature, there is a lack of information from a wide variety of scanners in this regard. In addition, not all studies have investigated the effect of reconstruction filters on HU in an exhaustive way. Methods: The computerised imaging reference system electron density phantom (model 062M) was scanned with different substitute materials of different density from Hitachi 16-slice computed tomography. The raw images were obtained with four tube voltage settings: 80 kVp, 100 kVp, 120 kVp and 140 kVp. The raw images for each energy level were then reconstructed using different reconstruction filters. Results: The HU values of dense bone were significantly different when changing the reconstruction filters without beam hardening correction (BHC). Nevertheless, when selecting the BHC, this variation decreases heavily for 80 kVp and decreases slightly for 140 kVp, but it remains outside the tolerance of ±50 HU. However, for 100 kVp and 120 kVp, the differences in HU values become within the tolerances indicated for dense bone. Conclusions: Changing image reconstruction filters during a dosimetric scan had a significant effect on HU in dense bone. Therefore, it is recommended to evaluate this effect during the commissioning phase. As a result, this study provides a methodology to comprehensively investigate the effect of reconstruction filters on HU.
{"title":"The effect of CT reconstruction filter selection on Hounsfield units in radiotherapy treatment planning","authors":"O. Nhila, M. Talbi, M. El Mansouri, M. A. Youssoufi, M. Erraoudi, E. Chakir, Mohamed Azougagh","doi":"10.1017/S1460396923000249","DOIUrl":"https://doi.org/10.1017/S1460396923000249","url":null,"abstract":"Abstract Introduction: This work aims to evaluate the effect of Hitachi 16-slice scanner reconstruction filters on Hounsfield unit (HU) variations. In the literature, there is a lack of information from a wide variety of scanners in this regard. In addition, not all studies have investigated the effect of reconstruction filters on HU in an exhaustive way. Methods: The computerised imaging reference system electron density phantom (model 062M) was scanned with different substitute materials of different density from Hitachi 16-slice computed tomography. The raw images were obtained with four tube voltage settings: 80 kVp, 100 kVp, 120 kVp and 140 kVp. The raw images for each energy level were then reconstructed using different reconstruction filters. Results: The HU values of dense bone were significantly different when changing the reconstruction filters without beam hardening correction (BHC). Nevertheless, when selecting the BHC, this variation decreases heavily for 80 kVp and decreases slightly for 140 kVp, but it remains outside the tolerance of ±50 HU. However, for 100 kVp and 120 kVp, the differences in HU values become within the tolerances indicated for dense bone. Conclusions: Changing image reconstruction filters during a dosimetric scan had a significant effect on HU in dense bone. Therefore, it is recommended to evaluate this effect during the commissioning phase. As a result, this study provides a methodology to comprehensively investigate the effect of reconstruction filters on HU.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45994467","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 : 2023-06-09DOI: 10.1017/S1460396923000110
A. Mousli, Hadhemi Ayadi, A. Yousfi, R. Abidi, C. Nasr
Abstract Introduction: Neuroma of the facial nerve (NFN) is an extremely rare benign tumour that can involve any segment of the facial nerve. It is revealed by facial weakness with or without hearing loss and has commonly been managed by microsurgery. Our purpose is to systematically review the literature about the role of fractionated stereotactic radiotherapy (FSRT) on the treatment of NFN. Clinical case: We report the case of a 70-year-old-woman who presented progressively worsening facial paralysis associated with mild conductive hearing loss and dizziness. The multimodal magnetic resonance imaging (MRI) was very suggestive of an intrapetrous neuroma, centred on the tract of the VII nerve and the left geniculate ganglion. She was treated by FSRT at the dose of 18 Gy in three fractions on the isodose line 80 %. After 18-month follow-up, she reported a facial weakness improvement. The MRI revealed a stable disease. Conclusion: The clinical presentation of the schwannoma of the facial nerve depends essentially on its location. It is therefore very variable, ranging from an isolated mild hearing loss to a vestibular syndrome with facial paralysis. Through this observation with literature review, we reported a long-term tumour control with improvement of pre-treatment symptomatology with FSRT.
{"title":"Management of a facial nerve schwannoma with fractionated stereotactic radiotherapy: a case report","authors":"A. Mousli, Hadhemi Ayadi, A. Yousfi, R. Abidi, C. Nasr","doi":"10.1017/S1460396923000110","DOIUrl":"https://doi.org/10.1017/S1460396923000110","url":null,"abstract":"Abstract Introduction: Neuroma of the facial nerve (NFN) is an extremely rare benign tumour that can involve any segment of the facial nerve. It is revealed by facial weakness with or without hearing loss and has commonly been managed by microsurgery. Our purpose is to systematically review the literature about the role of fractionated stereotactic radiotherapy (FSRT) on the treatment of NFN. Clinical case: We report the case of a 70-year-old-woman who presented progressively worsening facial paralysis associated with mild conductive hearing loss and dizziness. The multimodal magnetic resonance imaging (MRI) was very suggestive of an intrapetrous neuroma, centred on the tract of the VII nerve and the left geniculate ganglion. She was treated by FSRT at the dose of 18 Gy in three fractions on the isodose line 80 %. After 18-month follow-up, she reported a facial weakness improvement. The MRI revealed a stable disease. Conclusion: The clinical presentation of the schwannoma of the facial nerve depends essentially on its location. It is therefore very variable, ranging from an isolated mild hearing loss to a vestibular syndrome with facial paralysis. Through this observation with literature review, we reported a long-term tumour control with improvement of pre-treatment symptomatology with FSRT.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45089494","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 : 2023-05-31DOI: 10.1017/S1460396923000201
A. Shaaer, E. Osei, J. Darko, D. Gopaul
Abstract Introduction: Volumetric-modulated arc therapy (VMAT) has emerged as a promising radiation treatment technique. One of the challenges in VMAT planning for lung carcinoma is the lack of consistency among different institutions with respect to what is considered an acceptable treatment plan in terms of target coverage and doses to the organs at risk (OAR). Additionally, the accuracy of dose calculations in the presence of heterogeneous medium (i.e. air) is another challenge in lung VMAT planning. Our objective is to develop an institutional criteria for non-stereotactic body radiotherapy (non-SBRT) lung treatment plans by evaluating the dosimetric impact of plan normalisation and dose calculation algorithms, including the Anisotropic Analytical Algorithm (AAA), AcurosXB (AXB) and Monte Carlo (MC) simulation, on VMAT plans for non-small cell lung cancer (NSCLC). Methods: The CT dataset of 20 patients with NSCLC was randomly selected to ensure a spectrum of target sizes and locations. All treatment planning was accomplished with 2–3 VMAT arcs and a prescription of 60 Gy in 30 fractions. Two plan normalisation methods were employed: (i) planning target volume (PTV) V100% = 95% and (ii) PTV V95% = 95%. Results: All three dose calculation algorithms revealed heterogeneous and conformal plans irrespective of plan normalisations. The PTV and OARs dose–volume constraints were met using both normalisation methods. However, we observed that AAA overestimated the minimum PTV doses by 2–5% regardless of plan normalisation. The mean PTV-V100% was lower for AAA in comparison with AXB and MC algorithms. Conclusions: VMAT is an effective radiotherapy technique for achieving greater target dose conformity, heterogeneity and dose fall-off from the PTV for the treatment of NSCLC. The results of this study can provide the basis for the development of local plan acceptability criteria for NSCLC VMAT plans, and the clinical implementation can be achieved with minimal or no imposition on resources and time constraints. Occasionally, plan normalisation of PTV-V95% = 95% may be required to ensure that the OAR dose tolerances are not exceeded.
{"title":"Dosimetric evaluation of VMAT treatment plans for patients with stage IIB or III non-small cell lung carcinomas","authors":"A. Shaaer, E. Osei, J. Darko, D. Gopaul","doi":"10.1017/S1460396923000201","DOIUrl":"https://doi.org/10.1017/S1460396923000201","url":null,"abstract":"Abstract Introduction: Volumetric-modulated arc therapy (VMAT) has emerged as a promising radiation treatment technique. One of the challenges in VMAT planning for lung carcinoma is the lack of consistency among different institutions with respect to what is considered an acceptable treatment plan in terms of target coverage and doses to the organs at risk (OAR). Additionally, the accuracy of dose calculations in the presence of heterogeneous medium (i.e. air) is another challenge in lung VMAT planning. Our objective is to develop an institutional criteria for non-stereotactic body radiotherapy (non-SBRT) lung treatment plans by evaluating the dosimetric impact of plan normalisation and dose calculation algorithms, including the Anisotropic Analytical Algorithm (AAA), AcurosXB (AXB) and Monte Carlo (MC) simulation, on VMAT plans for non-small cell lung cancer (NSCLC). Methods: The CT dataset of 20 patients with NSCLC was randomly selected to ensure a spectrum of target sizes and locations. All treatment planning was accomplished with 2–3 VMAT arcs and a prescription of 60 Gy in 30 fractions. Two plan normalisation methods were employed: (i) planning target volume (PTV) V100% = 95% and (ii) PTV V95% = 95%. Results: All three dose calculation algorithms revealed heterogeneous and conformal plans irrespective of plan normalisations. The PTV and OARs dose–volume constraints were met using both normalisation methods. However, we observed that AAA overestimated the minimum PTV doses by 2–5% regardless of plan normalisation. The mean PTV-V100% was lower for AAA in comparison with AXB and MC algorithms. Conclusions: VMAT is an effective radiotherapy technique for achieving greater target dose conformity, heterogeneity and dose fall-off from the PTV for the treatment of NSCLC. The results of this study can provide the basis for the development of local plan acceptability criteria for NSCLC VMAT plans, and the clinical implementation can be achieved with minimal or no imposition on resources and time constraints. Occasionally, plan normalisation of PTV-V95% = 95% may be required to ensure that the OAR dose tolerances are not exceeded.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49639041","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 : 2023-05-22DOI: 10.1017/S1460396923000183
Iqbal Al Amri, Rohit Inippully Somasundaran, Mahmoud Al Fishawy, N. Babu, Hajir Sulaiman Al Siyabi, M. Al Ghafri
Abstract Introduction: A patient with Down’s syndrome, with dermatofibrosarcoma protuberans, was intended for adjuvant radiotherapy. The lesion was on the parietal region of the head of the patient. Given the proximity of the lesion to the brain, the curvature of the lesion, and potential complications of anaesthesia for a Down’s syndrome patient, brachytherapy was the appropriate treatment. Anaesthesia complications for patients with Down’s syndrome are airway infections, atlanto-occipital dislocation and bradycardia. Method: Instead of sedating the patient in order to prepare a mould applicator, a 3D-printed model of the patient’s head was used. This allowed us greater time to prepare the applicator in a more relaxed environment. Result: The fit of the mould applicator on the patient was satisfactory. Minimum air gaps were observed. The treatment could be completed with sedation only. Conclusion: We were able to achieve an equivalent dose of 44·69 Gy in 5 sessions of brachytherapy, significantly reducing the anaesthesia sessions and the associated risks. A drawback of 3D printing is that it takes several hours to print the model.
{"title":"Case report: 3D-printed model for surface mould preparation on a patient with Down’s syndrome","authors":"Iqbal Al Amri, Rohit Inippully Somasundaran, Mahmoud Al Fishawy, N. Babu, Hajir Sulaiman Al Siyabi, M. Al Ghafri","doi":"10.1017/S1460396923000183","DOIUrl":"https://doi.org/10.1017/S1460396923000183","url":null,"abstract":"Abstract Introduction: A patient with Down’s syndrome, with dermatofibrosarcoma protuberans, was intended for adjuvant radiotherapy. The lesion was on the parietal region of the head of the patient. Given the proximity of the lesion to the brain, the curvature of the lesion, and potential complications of anaesthesia for a Down’s syndrome patient, brachytherapy was the appropriate treatment. Anaesthesia complications for patients with Down’s syndrome are airway infections, atlanto-occipital dislocation and bradycardia. Method: Instead of sedating the patient in order to prepare a mould applicator, a 3D-printed model of the patient’s head was used. This allowed us greater time to prepare the applicator in a more relaxed environment. Result: The fit of the mould applicator on the patient was satisfactory. Minimum air gaps were observed. The treatment could be completed with sedation only. Conclusion: We were able to achieve an equivalent dose of 44·69 Gy in 5 sessions of brachytherapy, significantly reducing the anaesthesia sessions and the associated risks. A drawback of 3D printing is that it takes several hours to print the model.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43832916","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 : 2023-05-22DOI: 10.1017/S1460396923000195
Muhammad Shahban, Nazia Shahzadi, Saeed Ur Rahman, Muhammad Faheem
Abstract Introduction: Measurement of off-centre ratios (OCRs) is a requirement for the commissioning of cyberknife. The fixed source to axis distance (SAD) technique is required for the measurement of OCRs which is time-consuming and tedious. The fixed source to surface distance (SSD) technique, on the other hand, is easy to set up and requires less time. The OCRs have been measured with SAD and SSD setup and compared to assess the difference between each other. Material and Methods: The research is carried out on an Accuracy cyberknife M6, installed at NORI Cancer Hospital Islamabad. The OCRs are measured with Sun Nuclear ‘EDGE’ diode detector on a Sun Nuclear SNC 3D dosimetry system. The OCRs were measured for 12 cones and at three depths. Each OCR measured with the SAD setup is compared with the corresponding OCR measured with SSD setup using % dose distance and distance to agreement (2%/0·2mm). Results: For the within-the-beam and out-of-the beam regions, both OCRs are matching with each other. The percentage difference is in the order of less than 1% while the distance-to-agreement results in 100% matching for all cones and all depths. For the penumbra region, the percentage difference is higher than the other two regions. The maximum percentage difference is 2·96%. Generally, the percentage difference is higher for small cones and for OCRs measured at larger depths. Conclusion: The OCRs on a cyberknife system measured with a fixed SSD setup and fixed SAD setup coincide within an acceptable limit and can be measured with both setups with similar accuracy.
{"title":"Analysis of OCRs measured with SSD and SAD setups; a step to speed up cyberknife commissioning","authors":"Muhammad Shahban, Nazia Shahzadi, Saeed Ur Rahman, Muhammad Faheem","doi":"10.1017/S1460396923000195","DOIUrl":"https://doi.org/10.1017/S1460396923000195","url":null,"abstract":"Abstract Introduction: Measurement of off-centre ratios (OCRs) is a requirement for the commissioning of cyberknife. The fixed source to axis distance (SAD) technique is required for the measurement of OCRs which is time-consuming and tedious. The fixed source to surface distance (SSD) technique, on the other hand, is easy to set up and requires less time. The OCRs have been measured with SAD and SSD setup and compared to assess the difference between each other. Material and Methods: The research is carried out on an Accuracy cyberknife M6, installed at NORI Cancer Hospital Islamabad. The OCRs are measured with Sun Nuclear ‘EDGE’ diode detector on a Sun Nuclear SNC 3D dosimetry system. The OCRs were measured for 12 cones and at three depths. Each OCR measured with the SAD setup is compared with the corresponding OCR measured with SSD setup using % dose distance and distance to agreement (2%/0·2mm). Results: For the within-the-beam and out-of-the beam regions, both OCRs are matching with each other. The percentage difference is in the order of less than 1% while the distance-to-agreement results in 100% matching for all cones and all depths. For the penumbra region, the percentage difference is higher than the other two regions. The maximum percentage difference is 2·96%. Generally, the percentage difference is higher for small cones and for OCRs measured at larger depths. Conclusion: The OCRs on a cyberknife system measured with a fixed SSD setup and fixed SAD setup coincide within an acceptable limit and can be measured with both setups with similar accuracy.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47958814","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 : 2023-05-01DOI: 10.1017/S1460396923000171
K. O’Sullivan, C. Lyons
Abstract Introduction: Radiotherapy is an ever-changing field with constant technological advances. It is for this reason that risk management strategies are regularly updated in order to remain optimal. Methodology: A retrospective audit of all reported incidents and near misses in the audited department between 1 November 2020 and 30 April 2021 was performed. The root cause of each radiotherapy error (RTE), safety barrier (SB) and the causative factor (CF) would be defined by the Public Health England (PHE) coding system. The data will then be analysed to determine if there are any frequently occurring errors and if there are any existing relationships between multiple error. Results: 670 patients were treated during the study period along with 35 reports generated. 77·1% (n = 27) were incidents, and 22·9% (n = 8) were near misses. 2·8% (n = 1) were reportable incidents. The ratio of RTEs to prescriptions was 0·052:1 (5·2%). 37% of RTEs were associated with image production. Slips and lapses were involved in 54·2%. Adherence to procedures/protocols was a factor in 48·5% (n = 17). Communication was a factor in 11·4% (n = 4). Discussion: The proportion of Level 1 incidents was higher in this department (2·8%) than in the PHE report (0·9%). Almost one-third, 31·4% (n = 11) of errors stemmed from one technical fault in image production. SB breaches were prevalent at the pre-treatment planning stage of the pathway. A relationship between slips/lapses and non-conformance to protocols was identified. Conclusion: The rate of reported radiotherapy incidents in the UK is lower when compared with this department; this could be improved with the implementation of the quality improvement plan outlined above.
{"title":"A clinical audit of patient safety in an Irish radiotherapy department","authors":"K. O’Sullivan, C. Lyons","doi":"10.1017/S1460396923000171","DOIUrl":"https://doi.org/10.1017/S1460396923000171","url":null,"abstract":"Abstract Introduction: Radiotherapy is an ever-changing field with constant technological advances. It is for this reason that risk management strategies are regularly updated in order to remain optimal. Methodology: A retrospective audit of all reported incidents and near misses in the audited department between 1 November 2020 and 30 April 2021 was performed. The root cause of each radiotherapy error (RTE), safety barrier (SB) and the causative factor (CF) would be defined by the Public Health England (PHE) coding system. The data will then be analysed to determine if there are any frequently occurring errors and if there are any existing relationships between multiple error. Results: 670 patients were treated during the study period along with 35 reports generated. 77·1% (n = 27) were incidents, and 22·9% (n = 8) were near misses. 2·8% (n = 1) were reportable incidents. The ratio of RTEs to prescriptions was 0·052:1 (5·2%). 37% of RTEs were associated with image production. Slips and lapses were involved in 54·2%. Adherence to procedures/protocols was a factor in 48·5% (n = 17). Communication was a factor in 11·4% (n = 4). Discussion: The proportion of Level 1 incidents was higher in this department (2·8%) than in the PHE report (0·9%). Almost one-third, 31·4% (n = 11) of errors stemmed from one technical fault in image production. SB breaches were prevalent at the pre-treatment planning stage of the pathway. A relationship between slips/lapses and non-conformance to protocols was identified. Conclusion: The rate of reported radiotherapy incidents in the UK is lower when compared with this department; this could be improved with the implementation of the quality improvement plan outlined above.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41421147","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 : 2023-04-28DOI: 10.1017/S1460396923000158
Ellis Parker, M. Kirby, P. Bridge
Abstract Introduction: The Virtual Environment for Radiotherapy Training (VERT) is a simulator used to train radiotherapy students cost-effectively with limited risk. VERT is available as a two-dimensional (2D) and a more costly three-dimensional (3D) stereoscopic resource. This study aimed to identify the specific benefits afforded by stereoscopic visualisation for student training in skin apposition techniques. Method: Eight participants completed six electron skin apposition setups in both 2D and 3D views of VERT using a 7 cm × 10 cm rectangular applicator setup to 100 cm focus skin distance (FSD). The standard deviation (SD) of the mean distance from each corner of the applicator to the virtual patient’s skin surface [which we define as apposition precision (AP)] was measured along with the time taken to achieve each setup. Participants then completed a four-question Likert-style questionnaire concerning their preferences and perceptions of the 2D and 3D views. Results: There was little difference in mean setup times with 218·43 seconds for 2D and 211·29 seconds for 3D (3·3% difference). There was a similarly small difference in AP with a mean SD of 5·61 mm for 2D and 5·79 mm for 3D (3·2% difference) between views. The questionnaire results showed no preference for the 3D view over the 2D. Conclusion: These findings suggest that the 2D and 3D views result in similar setup times and precision, with no user preference for the 3D view. It is recommended that the 2D version of VERT could be utilised in similar situations with a reduced logistical and financial impact.
{"title":"The impact of 3D stereoscopic visualisation on performance in electron skin apposition techniques using VERT","authors":"Ellis Parker, M. Kirby, P. Bridge","doi":"10.1017/S1460396923000158","DOIUrl":"https://doi.org/10.1017/S1460396923000158","url":null,"abstract":"Abstract Introduction: The Virtual Environment for Radiotherapy Training (VERT) is a simulator used to train radiotherapy students cost-effectively with limited risk. VERT is available as a two-dimensional (2D) and a more costly three-dimensional (3D) stereoscopic resource. This study aimed to identify the specific benefits afforded by stereoscopic visualisation for student training in skin apposition techniques. Method: Eight participants completed six electron skin apposition setups in both 2D and 3D views of VERT using a 7 cm × 10 cm rectangular applicator setup to 100 cm focus skin distance (FSD). The standard deviation (SD) of the mean distance from each corner of the applicator to the virtual patient’s skin surface [which we define as apposition precision (AP)] was measured along with the time taken to achieve each setup. Participants then completed a four-question Likert-style questionnaire concerning their preferences and perceptions of the 2D and 3D views. Results: There was little difference in mean setup times with 218·43 seconds for 2D and 211·29 seconds for 3D (3·3% difference). There was a similarly small difference in AP with a mean SD of 5·61 mm for 2D and 5·79 mm for 3D (3·2% difference) between views. The questionnaire results showed no preference for the 3D view over the 2D. Conclusion: These findings suggest that the 2D and 3D views result in similar setup times and precision, with no user preference for the 3D view. It is recommended that the 2D version of VERT could be utilised in similar situations with a reduced logistical and financial impact.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44447281","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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