Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.08.008
Mu-Han Lin PhD , Lindsey Olsen PhD , James A. Kavanaugh PhD , Dustin Jacqmin PhD , Eric Lobb MS , Sua Yoo PhD , Sean L. Berry PhD , Jose C. Pichardo PhD , Carlos E. Cardenas PhD , Justin Roper PhD , Maura Kirk MS , Stephanie Bennett PhD , Joey P. Cheung PhD , Timothy D. Solberg PhD , Kevin L. Moore PhD , Minsun Kim PhD
Treatment plan quality is a crucial component for a successful outcome of radiation therapy treatments. As the complexity of radiation therapy planning and delivery techniques increases, the role of the medical physicist in assessing treatment plan quality becomes more critical. Integrating plan quality review throughout the treatment planning process allows improvements without delaying treatment or rushing to produce changes at the last minute. In this work, we aim to provide practical check items for physicists to reference when assessing treatment plan quality with a critical eye, asking questions such as “is this the best dose distribution feasible for this patient?,” “could we change any planning parameters to improve plan quality?,” and “could we change the planning strategy for this particular patient or for future patients?”; and to work with planners and physicians to create a multidisciplinary collaborative culture that achieves the best plan feasible for every patient. We tabulate the features that affect plan quality in each process step and check details for individual items. This report is aimed at medical physicists, planners, radiation oncologists, and other professionals who are involved in treatment planning.
{"title":"Ensuring High Quality Treatment Plans with a Plan Quality Review Checklist","authors":"Mu-Han Lin PhD , Lindsey Olsen PhD , James A. Kavanaugh PhD , Dustin Jacqmin PhD , Eric Lobb MS , Sua Yoo PhD , Sean L. Berry PhD , Jose C. Pichardo PhD , Carlos E. Cardenas PhD , Justin Roper PhD , Maura Kirk MS , Stephanie Bennett PhD , Joey P. Cheung PhD , Timothy D. Solberg PhD , Kevin L. Moore PhD , Minsun Kim PhD","doi":"10.1016/j.prro.2024.08.008","DOIUrl":"10.1016/j.prro.2024.08.008","url":null,"abstract":"<div><div>Treatment plan quality is a crucial component for a successful outcome of radiation therapy treatments. As the complexity of radiation therapy planning and delivery techniques increases, the role of the medical physicist in assessing treatment plan quality becomes more critical. Integrating plan quality review throughout the treatment planning process allows improvements without delaying treatment or rushing to produce changes at the last minute. In this work, we aim to provide practical check items for physicists to reference when assessing treatment plan quality with a critical eye, asking questions such as “is this the best dose distribution feasible for this patient?,” “could we change any planning parameters to improve plan quality?,” and “could we change the planning strategy for this particular patient or for future patients?”; and to work with planners and physicians to create a multidisciplinary collaborative culture that achieves the best plan feasible for every patient. We tabulate the features that affect plan quality in each process step and check details for individual items. This report is aimed at medical physicists, planners, radiation oncologists, and other professionals who are involved in treatment planning.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e82-e87"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.09.009
Christopher Brett MD
The time that elapses between a patient's ablative tumor resection and indicated adjuvant radiation has a significant impact on an individual's local tumor control and survival, and its optimization is in the best interest of the patient. Furthermore, it is a recognized treatment-related quality metric that can have bearing on future provider compensation. Despite these important driving considerations, compliance rates with established goals are low, recently measured to be <50%. Making meaningful and lasting improvements in this requires a system-based approach. This article seeks to provide clinicians practical tools to apply lean health care and flow management principles to identify chief obstacles to timely care in their systems, and effective strategies to overcome common bottlenecks.
{"title":"Improving the Timely Delivery of Postoperative Radiation in Head and Neck Cancer","authors":"Christopher Brett MD","doi":"10.1016/j.prro.2024.09.009","DOIUrl":"10.1016/j.prro.2024.09.009","url":null,"abstract":"<div><div>The time that elapses between a patient's ablative tumor resection and indicated adjuvant radiation has a significant impact on an individual's local tumor control and survival, and its optimization is in the best interest of the patient. Furthermore, it is a recognized treatment-related quality metric that can have bearing on future provider compensation. Despite these important driving considerations, compliance rates with established goals are low, recently measured to be <50%. Making meaningful and lasting improvements in this requires a system-based approach. This article seeks to provide clinicians practical tools to apply lean health care and flow management principles to identify chief obstacles to timely care in their systems, and effective strategies to overcome common bottlenecks.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 69-73"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.08.003
Shufei Lai BSc , Shaohong Luo MSc , Shen Lin MSc , Xiaoting Huang MSc , Xiangzhen Wang BSc , Xiongwei Xu MD , Xiuhua Weng MD
Background
Bevacizumab has been demonstrated to have superior efficacy in the treatment of cerebral radiation necrosis (CRN), but its high cost may exacerbate the disease burden. This study aimed to assess the cost-effectiveness of bevacizumab in comparison to corticosteroids for treating CRN from the US payers’ perspective.
Methods
Decision tree models were constructed to simulate the process of bevacizumab and corticosteroids in CRN short-term and long-term therapy. Critical clinical data were derived from the NCT01621880 trial. Costs and utility values were obtained from the US official websites and published literature. The main outcomes were total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to assess the robustness of the models.
Results
In the short-term and long-term models, bevacizumab added 0.11 (0.46 vs 0.35) and 0.16 (0.54 vs 0.38) QALYs compared with corticosteroids therapy, with corresponding incremental costs of $12,351 and $23,253, respectively. The resultant ICERs were $112,987/QALY and $150,245/QALY for short-term and long-term treatment, respectively. The one-way sensitivity analysis indicated that utility value of nonrecurrence status, body weight, and bevacizumab price per cycle were the most influential factors for ICER of both models. At the willingness-to-pay threshold of $150,000/QALY in the United States, the probabilities of bevacizumab being cost-effective for CRN short and long-term treatment were 63.9% and 49%, respectively.
Conclusions
Compared with corticosteroids, bevacizumab is an economical alternative for CRN short-term treatment from the US payers’ perspective, whereas long-term therapy draws an opposite conclusion.
{"title":"Is Bevacizumab a Cost-Effective Regimen for Treating Cerebral Radiation Necrosis in the United States?","authors":"Shufei Lai BSc , Shaohong Luo MSc , Shen Lin MSc , Xiaoting Huang MSc , Xiangzhen Wang BSc , Xiongwei Xu MD , Xiuhua Weng MD","doi":"10.1016/j.prro.2024.08.003","DOIUrl":"10.1016/j.prro.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Bevacizumab has been demonstrated to have superior efficacy in the treatment of cerebral radiation necrosis (CRN), but its high cost may exacerbate the disease burden. This study aimed to assess the cost-effectiveness of bevacizumab in comparison to corticosteroids for treating CRN from the US payers’ perspective.</div></div><div><h3>Methods</h3><div>Decision tree models were constructed to simulate the process of bevacizumab and corticosteroids in CRN short-term and long-term therapy. Critical clinical data were derived from the NCT01621880 trial. Costs and utility values were obtained from the US official websites and published literature. The main outcomes were total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to assess the robustness of the models.</div></div><div><h3>Results</h3><div>In the short-term and long-term models, bevacizumab added 0.11 (0.46 vs 0.35) and 0.16 (0.54 vs 0.38) QALYs compared with corticosteroids therapy, with corresponding incremental costs of $12,351 and $23,253, respectively. The resultant ICERs were $112,987/QALY and $150,245/QALY for short-term and long-term treatment, respectively. The one-way sensitivity analysis indicated that utility value of nonrecurrence status, body weight, and bevacizumab price per cycle were the most influential factors for ICER of both models. At the willingness-to-pay threshold of $150,000/QALY in the United States, the probabilities of bevacizumab being cost-effective for CRN short and long-term treatment were 63.9% and 49%, respectively.</div></div><div><h3>Conclusions</h3><div>Compared with corticosteroids, bevacizumab is an economical alternative for CRN short-term treatment from the US payers’ perspective, whereas long-term therapy draws an opposite conclusion.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e10-e20"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.06.010
Ira R. Sharp MD
{"title":"Hope in a Physician-Patient With Pancreatic Cancer","authors":"Ira R. Sharp MD","doi":"10.1016/j.prro.2024.06.010","DOIUrl":"10.1016/j.prro.2024.06.010","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e1-e2"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.04.027
Alan C. Hartford MD, PhD, FACR, FASTRO
{"title":"A Wrinkle in Time: A Lesson in Courage","authors":"Alan C. Hartford MD, PhD, FACR, FASTRO","doi":"10.1016/j.prro.2024.04.027","DOIUrl":"10.1016/j.prro.2024.04.027","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 12-13"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.07.001
Sara. E. Beltran Ponce MD , Christina J. Small MD, MPH , Talha Ahmad BS , Kishan Patel MD , Susan Tsai MD, MHS , Mandana Kamgar MD, MPH , Ben George MD , Jordan R. Kharofa MD , Hina Saeed MD , Kulwinder S. Dua MD, DSc , Callisia N. Clarke MD, MS , Mohammed Aldakkak MD , Douglas B. Evans MD , Kathleen Christians MD , Eric S. Paulson PhD , Beth Erickson MD , William A. Hall MD
Purpose
This study aimed to generate a map of local recurrences after neoadjuvant chemotherapy and radiation (total neoadjuvant therapy [TNT]) followed by surgical resection for pancreatic ductal adenocarcinoma (PDAC). Such recurrence patterns will serve to inform radiation treatment planning volumes that should be given in the neoadjuvant setting.
Methods and Materials
Locoregional recurrences after TNT followed by surgery treated between 2009 and 2022 were radiologically identified. Recurrences were individually segmented using MIM software and complied in a single base scan. All contour compilations were used to create a threshold contour encompassing 80% of recurrences among all patients, head only, and body/tail only. The distance between organs at risk and the threshold contour were measured to design an optimal clinical target volume contour for patients treated with TNT. Recurrence patterns were also compared with existing adjuvant guidelines to assess coverage.
Results
A database of 474 patients managed with TNT for PDAC was queried. While locoregional recurrences were rare in this cohort, we identified 80 patients with either isolated locoregional or simultaneous local and distant recurrences. Patients with diagnostic imaging at the time of recurrence were identified. The majority of recurrences were partially in the field of published contouring guidelines or volumetric expansions off of vessels, and volumetric coverage was low for all. Common areas of recurrence include the aorticodiaphragmatic junction, retropancreatic duodenal nodal basin, and the region to the right of the superior mesenteric artery. A novel set of proposed neoadjuvant contours was designed to cover the central-most 80% of recurrences.
Conclusions
This is the largest collection of local/regional PDAC recurrences from a cohort of patients treated exclusively with TNT. Patterns of local/regional recurrence using TNT in PDAC vary significantly from those patients with PDAC treated with a surgery-first approach. Novel contouring guidelines presented in this study can help to ensure optimal coverage of high risk regions and avoid reliance on the current adjuvant guidelines to guide treatment planning.
{"title":"Patterns of Locoregional Pancreatic Cancer Recurrence After Total Neoadjuvant Therapy and Implications on Optimal Neoadjuvant Radiation Treatment Volumes","authors":"Sara. E. Beltran Ponce MD , Christina J. Small MD, MPH , Talha Ahmad BS , Kishan Patel MD , Susan Tsai MD, MHS , Mandana Kamgar MD, MPH , Ben George MD , Jordan R. Kharofa MD , Hina Saeed MD , Kulwinder S. Dua MD, DSc , Callisia N. Clarke MD, MS , Mohammed Aldakkak MD , Douglas B. Evans MD , Kathleen Christians MD , Eric S. Paulson PhD , Beth Erickson MD , William A. Hall MD","doi":"10.1016/j.prro.2024.07.001","DOIUrl":"10.1016/j.prro.2024.07.001","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to generate a map of local recurrences after neoadjuvant chemotherapy and radiation (total neoadjuvant therapy [TNT]) followed by surgical resection for pancreatic ductal adenocarcinoma (PDAC). Such recurrence patterns will serve to inform radiation treatment planning volumes that should be given in the neoadjuvant setting.</div></div><div><h3>Methods and Materials</h3><div>Locoregional recurrences after TNT followed by surgery treated between 2009 and 2022 were radiologically identified. Recurrences were individually segmented using MIM software and complied in a single base scan. All contour compilations were used to create a threshold contour encompassing 80% of recurrences among all patients, head only, and body/tail only. The distance between organs at risk and the threshold contour were measured to design an optimal clinical target volume contour for patients treated with TNT. Recurrence patterns were also compared with existing adjuvant guidelines to assess coverage.</div></div><div><h3>Results</h3><div>A database of 474 patients managed with TNT for PDAC was queried. While locoregional recurrences were rare in this cohort, we identified 80 patients with either isolated locoregional or simultaneous local and distant recurrences. Patients with diagnostic imaging at the time of recurrence were identified. The majority of recurrences were partially in the field of published contouring guidelines or volumetric expansions off of vessels, and volumetric coverage was low for all. Common areas of recurrence include the aorticodiaphragmatic junction, retropancreatic duodenal nodal basin, and the region to the right of the superior mesenteric artery. A novel set of proposed neoadjuvant contours was designed to cover the central-most 80% of recurrences.</div></div><div><h3>Conclusions</h3><div>This is the largest collection of local/regional PDAC recurrences from a cohort of patients treated exclusively with TNT. Patterns of local/regional recurrence using TNT in PDAC vary significantly from those patients with PDAC treated with a surgery-first approach. Novel contouring guidelines presented in this study can help to ensure optimal coverage of high risk regions and avoid reliance on the current adjuvant guidelines to guide treatment planning.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e47-e56"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.08.004
Khaled Aziz MD, PhD , Daniel Koffler MD , April Vassantachart MD , Abbas Rattani MD, MBE , Nii-Kwanchie Ankrah MD , Emile Gogineni DO , Therese Y. Andraos MD , Arjun Sahgal MD , Balamurugan Vellayappan MBBS , Emma M. Dunne MBBS, PhD , Shankar Siva MBBS, PhD , Fabio Y. Moraes MD, PhD , Matthias Guckenberger MD , Daniel Lubelski MD , Samuel Chao MD , Stephanie Combs MD , Eric Chang MD , Anubhav G. Amin MD , Matthew Foote MD , Iris Gibbs MD , Kristin J. Redmond MD
Purpose
Spinal stereotactic body radiation therapy (SBRT) has become the standard of care in management of patients with limited sites of metastatic disease, radioresistant histologies, painful vertebral metastases with long life expectancy and cases of reirradiation. Our case-based guidelines aim to assist radiation oncologists in the appropriate utilization of SBRT for common, yet challenging, cases of spinal metastases.
Methods and Materials
Cases were selected to include scenarios of large volume sacral disease with nerve entrapment, medically inoperable disease abutting the thecal sac, and local failure after prior SBRT. Relevant literature was reviewed, and areas requiring further investigation were discussed to offer a framework for evidence-based clinical practice.
Results
Spinal SBRT can be effectively delivered in challenging cases following multidisciplinary discussion by using a methodical approach to patient selection, appropriate dose selection, and adherence to evidence-based dose constraints.
Conclusions
The Radiosurgery Society's case-based practice review offers guidance to practicing physicians treating technically challenging SBRT candidate patients with spinal metastases.
{"title":"Radiosurgery Society Case-Based Guide to Stereotactic Body Radiation Therapy for Challenging Cases of Spinal Metastases","authors":"Khaled Aziz MD, PhD , Daniel Koffler MD , April Vassantachart MD , Abbas Rattani MD, MBE , Nii-Kwanchie Ankrah MD , Emile Gogineni DO , Therese Y. Andraos MD , Arjun Sahgal MD , Balamurugan Vellayappan MBBS , Emma M. Dunne MBBS, PhD , Shankar Siva MBBS, PhD , Fabio Y. Moraes MD, PhD , Matthias Guckenberger MD , Daniel Lubelski MD , Samuel Chao MD , Stephanie Combs MD , Eric Chang MD , Anubhav G. Amin MD , Matthew Foote MD , Iris Gibbs MD , Kristin J. Redmond MD","doi":"10.1016/j.prro.2024.08.004","DOIUrl":"10.1016/j.prro.2024.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Spinal stereotactic body radiation therapy (SBRT) has become the standard of care in management of patients with limited sites of metastatic disease, radioresistant histologies, painful vertebral metastases with long life expectancy and cases of reirradiation. Our case-based guidelines aim to assist radiation oncologists in the appropriate utilization of SBRT for common, yet challenging, cases of spinal metastases.</div></div><div><h3>Methods and Materials</h3><div>Cases were selected to include scenarios of large volume sacral disease with nerve entrapment, medically inoperable disease abutting the thecal sac, and local failure after prior SBRT. Relevant literature was reviewed, and areas requiring further investigation were discussed to offer a framework for evidence-based clinical practice.</div></div><div><h3>Results</h3><div>Spinal SBRT can be effectively delivered in challenging cases following multidisciplinary discussion by using a methodical approach to patient selection, appropriate dose selection, and adherence to evidence-based dose constraints.</div></div><div><h3>Conclusions</h3><div>The Radiosurgery Society's case-based practice review offers guidance to practicing physicians treating technically challenging SBRT candidate patients with spinal metastases.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 54-68"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.08.007
Natalie N. Viscariello PhD , Kristen McConnell PhD, MBA , Joseph Harms PhD , Joel A. Pogue PhD , Xenia Ray PhD , Eric Laugeman PhD , Richard A. Popple PhD , Dennis N. Stanley PhD , Carlos E. Cardenas PhD
Purpose
With recent clinical adoption of online adaptive radiation therapy (oART) and the increased workload associated with adaptive radiation therapy (RT), proper staffing for medical physicists is paramount to safe clinical operation. However, there is currently no consensus on the full-time equivalent (FTE) requirements for safe administration of cone beam computed tomography (CBCT)-guided oART. This study aimed to quantitatively assess medical physics workload and staffing needs of a CBCT-guided oART program.
Methods and Materials
We conducted a detailed analysis of the CBCT-guided adaptive planning and treatment workflows, encompassing tasks such as patient consultation, treatment planning, plan review, training, quality assurance, and treatment delivery. Using data from machine logs, clinical database queries, and staff surveys, we present a framework for estimating FTE values for different staffing scenarios, considering medical physicists’ roles as planners, adaptors, or both.
Results
FTE calculations, based on an example workload of 100 adaptive and 200 nonadaptive patients per year, for 3 staffing scenarios were provided: medical physicists as planners and adaptors (2.9 FTE), medical physicists as planners but not adaptors (2.6 FTE), and medical physicists as adaptors but not planners (1.4 FTE). These findings offer calculation guidance and benchmarks for staffing requirements in CBCT-guided oART programs, emphasizing the need for specific staffing models to accommodate the complexities of adaptive RT.
Conclusions
This study outlines a framework for calculating FTE requirements for medical physicists in a CBCT-guided oART program. By analyzing the processes for 3 common adaptive RT workflows, this work can provide effective workforce planning and resource allocation estimates. This analysis can be used either before the implementation of an oART program, for program development, or as a review of current practices to ensure operational efficiency and proper staffing levels are maintained.
{"title":"Quantitative Assessment of Full-Time Equivalent Effort for Kilovoltage-Cone Beam Computed Tomography Guided Online Adaptive Radiation Therapy for Medical Physicists","authors":"Natalie N. Viscariello PhD , Kristen McConnell PhD, MBA , Joseph Harms PhD , Joel A. Pogue PhD , Xenia Ray PhD , Eric Laugeman PhD , Richard A. Popple PhD , Dennis N. Stanley PhD , Carlos E. Cardenas PhD","doi":"10.1016/j.prro.2024.08.007","DOIUrl":"10.1016/j.prro.2024.08.007","url":null,"abstract":"<div><h3>Purpose</h3><div>With recent clinical adoption of online adaptive radiation therapy (oART) and the increased workload associated with adaptive radiation therapy (RT), proper staffing for medical physicists is paramount to safe clinical operation. However, there is currently no consensus on the full-time equivalent (FTE) requirements for safe administration of cone beam computed tomography (CBCT)-guided oART. This study aimed to quantitatively assess medical physics workload and staffing needs of a CBCT-guided oART program.</div></div><div><h3>Methods and Materials</h3><div>We conducted a detailed analysis of the CBCT-guided adaptive planning and treatment workflows, encompassing tasks such as patient consultation, treatment planning, plan review, training, quality assurance, and treatment delivery. Using data from machine logs, clinical database queries, and staff surveys, we present a framework for estimating FTE values for different staffing scenarios, considering medical physicists’ roles as planners, adaptors, or both.</div></div><div><h3>Results</h3><div>FTE calculations, based on an example workload of 100 adaptive and 200 nonadaptive patients per year, for 3 staffing scenarios were provided: medical physicists as planners and adaptors (2.9 FTE), medical physicists as planners but not adaptors (2.6 FTE), and medical physicists as adaptors but not planners (1.4 FTE). These findings offer calculation guidance and benchmarks for staffing requirements in CBCT-guided oART programs, emphasizing the need for specific staffing models to accommodate the complexities of adaptive RT.</div></div><div><h3>Conclusions</h3><div>This study outlines a framework for calculating FTE requirements for medical physicists in a CBCT-guided oART program. By analyzing the processes for 3 common adaptive RT workflows, this work can provide effective workforce planning and resource allocation estimates. This analysis can be used either before the implementation of an oART program, for program development, or as a review of current practices to ensure operational efficiency and proper staffing levels are maintained.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e72-e81"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11710968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.07.007
Ying Zhang PhD, DABR , Asma Amjad PhD , Jie Ding PhD , Christina Sarosiek PhD , Mohammad Zarenia PhD , Renae Conlin PhD , William A. Hall MD , Beth Erickson MD , Eric Paulson PhD, DABR
Purpose
The current commonly used metrics for evaluating the quality of auto-segmented contours have limitations and do not always reflect the clinical usefulness of the contours. This work aims to develop a novel contour quality classification (CQC) method by combining multiple quantitative metrics for clinical usability-oriented contour quality evaluation for deep learning-based auto-segmentation (DLAS).
Methods and Materials
The CQC was designed to categorize contours on slices as acceptable, minor edit, or major edit based on the expected editing effort/time with supervised ensemble tree classification models using 7 quantitative metrics. Organ-specific models were trained for 5 abdominal organs (pancreas, duodenum, stomach, small, and large bowels) using 50 magnetic resonance imaging (MRI) data sets. Twenty additional MRI and 9 computed tomography (CT) data sets were employed for testing. Interobserver variation (IOV) was assessed among 6 observers and consensus labels were established through majority vote for evaluation. The CQC was also compared with a threshold-based baseline approach.
Results
For the 5 organs, the average area under the curve was 0.982 ± 0.01 and 0.979 ± 0.01, the mean accuracy was 95.8% ± 1.7% and 94.3% ± 2.1%, and the mean risk rate was 0.8% ± 0.4% and 0.7% ± 0.5% for MRI and CT testing data set, respectively. The CQC results closely matched the IOV results (mean accuracy of 94.2% ± 0.8% and 94.8% ± 1.7%) and were significantly higher than those obtained using the threshold-based method (mean accuracy of 80.0% ± 4.7%, 83.8% ± 5.2%, and 77.3% ± 6.6% using 1, 2, and 3 metrics).
Conclusions
The CQC models demonstrated high performance in classifying the quality of contour slices. This method can address the limitations of existing metrics and offers an intuitive and comprehensive solution for clinically oriented evaluation and comparison of DLAS systems.
{"title":"Comprehensive Clinical Usability-Oriented Contour Quality Evaluation for Deep Learning Auto-segmentation: Combining Multiple Quantitative Metrics Through Machine Learning","authors":"Ying Zhang PhD, DABR , Asma Amjad PhD , Jie Ding PhD , Christina Sarosiek PhD , Mohammad Zarenia PhD , Renae Conlin PhD , William A. Hall MD , Beth Erickson MD , Eric Paulson PhD, DABR","doi":"10.1016/j.prro.2024.07.007","DOIUrl":"10.1016/j.prro.2024.07.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The current commonly used metrics for evaluating the quality of auto-segmented contours have limitations and do not always reflect the clinical usefulness of the contours. This work aims to develop a novel contour quality classification (CQC) method by combining multiple quantitative metrics for clinical usability-oriented contour quality evaluation for deep learning-based auto-segmentation (DLAS).</div></div><div><h3>Methods and Materials</h3><div>The CQC was designed to categorize contours on slices as acceptable, minor edit, or major edit based on the expected editing effort/time with supervised ensemble tree classification models using 7 quantitative metrics. Organ-specific models were trained for 5 abdominal organs (pancreas, duodenum, stomach, small, and large bowels) using 50 magnetic resonance imaging (MRI) data sets. Twenty additional MRI and 9 computed tomography (CT) data sets were employed for testing. Interobserver variation (IOV) was assessed among 6 observers and consensus labels were established through majority vote for evaluation. The CQC was also compared with a threshold-based baseline approach.</div></div><div><h3>Results</h3><div>For the 5 organs, the average area under the curve was 0.982 ± 0.01 and 0.979 ± 0.01, the mean accuracy was 95.8% ± 1.7% and 94.3% ± 2.1%, and the mean risk rate was 0.8% ± 0.4% and 0.7% ± 0.5% for MRI and CT testing data set, respectively. The CQC results closely matched the IOV results (mean accuracy of 94.2% ± 0.8% and 94.8% ± 1.7%) and were significantly higher than those obtained using the threshold-based method (mean accuracy of 80.0% ± 4.7%, 83.8% ± 5.2%, and 77.3% ± 6.6% using 1, 2, and 3 metrics).</div></div><div><h3>Conclusions</h3><div>The CQC models demonstrated high performance in classifying the quality of contour slices. This method can address the limitations of existing metrics and offers an intuitive and comprehensive solution for clinically oriented evaluation and comparison of DLAS systems.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 93-102"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.prro.2024.10.014
Abigail Pepin MD , Ana Kiess MD, PhD , J. Nicholas Lukens MD , Philipose Mulugeta MD , Neil K. Taunk MD, MSCTS
Treatment options for patients with metastatic castration-resistant prostate cancer include the use of radioligand therapy with 177Lu-PSMA-617. Although 177Lu-PSMA-617 can selectively target prostate cancer cells, salivary glands express PSMA on the apical lumen of the acinar epithelium. Xerostomia resulting from the use of radioligand therapy is common. Herein, we report on a case of a Common Terminology Criteria for Adverse Events version 5 grade 2 dry mouth event after administration of 177Lu-PSMA-617. The patient was managed with oral hygiene and xerostomia mitigation strategies using oral rinses.
{"title":"Management of Dry Mouth Toxicity Following 177Lu-PSMA-617 Radioligand Therapy","authors":"Abigail Pepin MD , Ana Kiess MD, PhD , J. Nicholas Lukens MD , Philipose Mulugeta MD , Neil K. Taunk MD, MSCTS","doi":"10.1016/j.prro.2024.10.014","DOIUrl":"10.1016/j.prro.2024.10.014","url":null,"abstract":"<div><div>Treatment options for patients with metastatic castration-resistant prostate cancer include the use of radioligand therapy with <sup>177</sup>Lu-PSMA-617. Although <sup>177</sup>Lu-PSMA-617 can selectively target prostate cancer cells, salivary glands express PSMA on the apical lumen of the acinar epithelium. Xerostomia resulting from the use of radioligand therapy is common. Herein, we report on a case of a Common Terminology Criteria for Adverse Events version 5 grade 2 dry mouth event after administration of <sup>177</sup>Lu-PSMA-617. The patient was managed with oral hygiene and xerostomia mitigation strategies using oral rinses.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 14-18"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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