Technical Innovations and Patient Support in Radiation Oncology最新文献

{"title":"Deep inspiratory breath-hold radiotherapy on a Helical Tomotherapy unit: Workflow and early outcomes in patients with left-sided breast cancer","authors":"Sapna Nangia ,&nbsp;Nagarjuna Burela ,&nbsp;Mayur Sawant ,&nbsp;G. Aishwarya ,&nbsp;Patrick Joshua ,&nbsp;Vijay Thiyagarajan ,&nbsp;Utpal Gaikwad ,&nbsp;Dayananda S. Sharma","doi":"10.1016/j.tipsro.2024.100244","DOIUrl":"https://doi.org/10.1016/j.tipsro.2024.100244","url":null,"abstract":"<div><h3>Introduction</h3><p>The clinical implementation of deep inspiratory breath-hold (DIBH) radiotherapy to reduce cardiac exposure in patients with left-sided breast cancer is challenging with helical tomotherapy(HT) and has received little attention. We describe our novel approach to DIBH irradiation in HT using a specially designed frame and manual gating, and compare cardiac substructure doses with the free-breathing (FB) technique.</p></div><div><h3>Material and methods</h3><p>The workflow incorporates staggered junctions and a frame that provides tactile feedback to the patient and monitoring for manual cut-off. The treatment parameters and clinical outcome of 20 patients with left-sided breast cancer who have undergone DIBH radiotherapy as a part of an ongoing prospective registry are reported. All patients underwent CT scans in Free Breathing (FB) and DIBH using the in-house Respiframe, which incorporates a tactile feedback-based system with an indicator pencil. Plans compared target coverage, cardiac doses, synchronizing treatment with breath-hold and avoiding junction repetition. MVCT scans are used for patient alignment.</p></div><div><h3>Results</h3><p>The mean dose (Dmean) to the heart was reduced by an average of 34 % in DIBH-HT compared to FB-HT plans (3.8 Gy vs 5.7 Gy). Similarly, 32 % and 67.8 % dose reduction were noted in the maximum dose (D0.02 cc) of the left anterior descending artery, mean 12.3 Gy vs 18.1 Gy, and mean left ventricle V5Gy 13.2 % vs 41.1 %, respectively. The mean treatment duration was 451.5 sec with a median 8 breath-holds; 3 % junction locations between successive breath-holds were replicated. No locoregional or distant recurrences were observed in the 9-month median follow-up.</p></div><div><h3>Conclusion</h3><p>Our workflow for DIBH with Helical-Tomotherapy addresses patient safety, treatment precision and challenges specific to this treatment unit. The workflow prevents junction issues by varying daily breath-hold durations and avoiding junction locations, providing a practical solution for left-sided breast cancer treatment with HT.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"30 ","pages":"Article 100244"},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000118/pdfft?md5=bd6a558187b2460535fb61e659cb6622&pid=1-s2.0-S2405632424000118-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140180505","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}

{"title":"The Radiation Therapist profession through the lens of new technology: A practice development paper based on the ESTRO Radiation Therapist Workshops","authors":"Michelle Leech ,&nbsp;Alaa Abdalqader ,&nbsp;Sophie Alexander ,&nbsp;Nigel Anderson ,&nbsp;Barbara Barbosa ,&nbsp;Dylan Callens ,&nbsp;Victoria Chapman ,&nbsp;Mary Coffey ,&nbsp;Maya Cox ,&nbsp;Ilija Curic ,&nbsp;Jenna Dean ,&nbsp;Elizabeth Denney ,&nbsp;Maeve Kearney ,&nbsp;Vincent W.S. Leung ,&nbsp;Martina Mortsiefer ,&nbsp;Eleftheria Nirgianaki ,&nbsp;Justas Povilaitis ,&nbsp;Dimitra Strikou ,&nbsp;Kenton Thompson ,&nbsp;Maud van den Bosch ,&nbsp;Monica Buijs","doi":"10.1016/j.tipsro.2024.100243","DOIUrl":"https://doi.org/10.1016/j.tipsro.2024.100243","url":null,"abstract":"<div><p>Technological advances in radiation therapy impact on the role and scope of practice of the radiation therapist. The European Society of Radiotherapy and Oncology (ESTRO) recently held two workshops on this topic and this position paper reflects the outcome of this workshop, which included radiation therapists from all global regions.</p><p>Workflows, quality assurance, research, IGRT and ART as well as clinical decision making are the areas of radiation therapist practice that will be highly influenced by advancing technology in the near future. This position paper captures the opportunities that this will bring to the radiation therapist profession, to the practice of radiation therapy and ultimately to patient care.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"30 ","pages":"Article 100243"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000106/pdfft?md5=fd6947bc30845e2ef94559dfd1a93ea0&pid=1-s2.0-S2405632424000106-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140160190","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}

{"title":"“Why am I still suffering?”: Experience of long-term fatigue and neurocognitive changes in oropharyngeal cancer survivors following (chemo)radiotherapy","authors":"Zsuzsanna Iyizoba-Ebozue ,&nbsp;Emma Nicklin ,&nbsp;James Price ,&nbsp;Robin Prestwich ,&nbsp;Sarah Brown ,&nbsp;Emma Hall ,&nbsp;John Lilley ,&nbsp;Matthew Lowe ,&nbsp;David J Thomson ,&nbsp;Finbar Slevin ,&nbsp;Louise Murray ,&nbsp;Florien Boele","doi":"10.1016/j.tipsro.2024.100241","DOIUrl":"https://doi.org/10.1016/j.tipsro.2024.100241","url":null,"abstract":"<div><h3>Background</h3><p>Late effects of cancer treatment, such as neurocognitive deficits and fatigue, can be debilitating. Other than head and neck–specific functional deficits such as impairments in swallowing and speech, little is known about survivorship after oropharyngeal cancer. This study examines the lived experience of fatigue and neurocognitive deficits in survivors of oropharyngeal squamous cell cancer and impact on their daily lives.</p></div><div><h3>Methods</h3><p>This work is part of the multicentre mixed method ROC-oN study (Radiotherapy for Oropharyngeal Cancer and impact on Neurocognition), evaluating fatigue and neurocognitive function in patients following radiotherapy +/- chemotherapy for oropharyngeal cancer and impact on quality of life. Semi-structured interviews were conducted in adults treated with radiotherapy (+/-chemotherapy) for oropharyngeal squamous cell carcinoma &gt;/=24 months from completing treatment. Reflexive thematic analysis performed.</p></div><div><h3>Results</h3><p>21 interviews (11 men and 10 women; median age 58 years and median time post-treatment 5 years) were conducted and analysed, yielding six themes: (1) <em>unexpected burden of fatigue, (2) noticing changes in neurocognitive function, (3) the new normal, (4) navigating changes, (5)insufficient awareness and (6)required support.</em> Participants described fatigue that persisted beyond the acute post-treatment period and changes in neurocognitive abilities across several domains. Paid and unpaid work, emotions and mood were impacted. Participants described navigating the new normal by adopting self-management strategies and accepting external support. They reported lack of recognition of these late effects, being poorly informed and being unprepared. Follow-up services were thought to be inadequate.</p></div><div><h3>Conclusions</h3><p>Fatigue and neurocognitive impairment were frequently experienced by survivors of oropharyngeal cancer, at least two years after treatment. Patients felt ill-prepared for these late sequelae, highlighting opportunities for improvement of patient information and support services.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"30 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000088/pdfft?md5=7b7340b124b26c3e3a2990c76f56bcec&pid=1-s2.0-S2405632424000088-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140113150","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}

{"title":"The impact of an Advanced Practice Radiation Therapist contouring for a CBCT-based adaptive radiotherapy program","authors":"Robbie Beckert,&nbsp;Joshua P Schiff,&nbsp;Eric Morris,&nbsp;Pamela Samson,&nbsp;Hyun Kim,&nbsp;Eric Laugeman","doi":"10.1016/j.tipsro.2024.100242","DOIUrl":"https://doi.org/10.1016/j.tipsro.2024.100242","url":null,"abstract":"<div><p>We successfully implemented an APRT specializing in CBCT-guided online adaptive contouring. These data show statistical improvements in contouring time with APRT-led vs non-APRT led ART contouring, suggesting that an APRT specifically trained to manage the ART process may reduce physician workload and patient treatment time.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"30 ","pages":"Article 100242"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240563242400009X/pdfft?md5=fefa0f8796ae7ec8341b44982e60ce54&pid=1-s2.0-S240563242400009X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140069529","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}

{"title":"Prospective evaluation of patient-reported anxiety and experiences with adaptive radiation therapy on an MR-linac","authors":"Amanda Moreira ,&nbsp;Winnie Li ,&nbsp;Alejandro Berlin ,&nbsp;Cathy Carpino-Rocca ,&nbsp;Peter Chung ,&nbsp;Leigh Conroy ,&nbsp;Jennifer Dang ,&nbsp;Laura A. Dawson ,&nbsp;Rachel M. Glicksman ,&nbsp;Ali Hosni ,&nbsp;Harald Keller ,&nbsp;Vickie Kong ,&nbsp;Patricia Lindsay ,&nbsp;Andrea Shessel ,&nbsp;Teo Stanescu ,&nbsp;Edward Taylor ,&nbsp;Jeff Winter ,&nbsp;Michael Yan ,&nbsp;Daniel Letourneau ,&nbsp;Michael Milosevic ,&nbsp;Michael Velec","doi":"10.1016/j.tipsro.2024.100240","DOIUrl":"https://doi.org/10.1016/j.tipsro.2024.100240","url":null,"abstract":"<div><h3>Purpose</h3><p>An integrated magnetic resonance scanner and linear accelerator (MR-linac) was implemented with daily online adaptive radiation therapy (ART). This study evaluated patient-reported experiences with their overall hospital care as well as treatment in the MR-linac environment.</p></div><div><h3>Methods</h3><p>Patients pre-screened for MR eligibility and claustrophobia were referred to simulation on a 1.5 T MR-linac. Patient-reported experience measures were captured using two validated surveys. The 15-item MR-anxiety questionnaire (MR-AQ) was administered immediately after the first treatment to rate MR-related anxiety and relaxation. The 40-item satisfaction with cancer care questionnaire rating doctors, radiation therapists, the services and care organization and their outpatient experience was administered immediately after the last treatment using five-point Likert responses. Results were analyzed using descriptive statistics.</p></div><div><h3>Results</h3><p>205 patients were included in this analysis. Multiple sites were treated across the pelvis and abdomen with a median treatment time per fraction of 46 and 66 min respectively. Patients rated MR-related anxiety as “not at all” (87%), “somewhat” (11%), “moderately” (1%) and “very much so” (1%). Positive satisfaction responses ranged from 78 to 100% (median 93%) across all items. All radiation therapist-specific items were rated positively as 96–100%. The five lowest rated items (range 78–85%) were related to general provision of information, coordination, and communication. Overall hospital care was rated positively at 99%.</p></div><div><h3>Conclusion</h3><p>In this large, single-institution prospective cohort, all patients had low MR-related anxiety and completed treatment as planned despite lengthy ART treatments with the MR-linac. Patients overall were highly satisfied with their cancer care involving ART using an MR-linac.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"29 ","pages":"Article 100240"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000076/pdfft?md5=1efb64100727ab207b0664f1ebdc0113&pid=1-s2.0-S2405632424000076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139999303","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}

{"title":"Evaluation of clinical parallel workflow in online adaptive MR-guided Radiotherapy: A detailed assessment of treatment session times","authors":"Claudio Votta ,&nbsp;Sara Iacovone ,&nbsp;Gabriele Turco ,&nbsp;Valerio Carrozzo ,&nbsp;Marica Vagni ,&nbsp;Aurora Scalia ,&nbsp;Giuditta Chiloiro ,&nbsp;Guenda Meffe ,&nbsp;Matteo Nardini ,&nbsp;Giulia Panza ,&nbsp;Lorenzo Placidi ,&nbsp;Angela Romano ,&nbsp;Patrizia Cornacchione ,&nbsp;Maria Antonietta Gambacorta ,&nbsp;Luca Boldrini","doi":"10.1016/j.tipsro.2024.100239","DOIUrl":"https://doi.org/10.1016/j.tipsro.2024.100239","url":null,"abstract":"<div><h3>Introduction</h3><p>Advancements in MRI-guided radiotherapy (MRgRT) enable clinical parallel workflows (CPW) for online adaptive planning (oART), allowing medical physicists (MPs), physicians (MDs), and radiation therapists (RTTs) to perform their tasks simultaneously. This study evaluates the impact of this upgrade on the total treatment time by analyzing each step of the current 0.35T-MRgRT workflow.</p></div><div><h3>Methods</h3><p>The time process of the workflow steps for 254 treatment fractions in 0.35 MRgRT was examined. Patients have been grouped based on disease site, breathing modality (BM) (BHI or FB), and fractionation (stereotactic body RT [SBRT] or standard fractionated long course [LC]). The time spent for the following workflow steps in Adaptive Treatment (ADP) was analyzed: Patient Setup Time (PSt), MRI Acquisition and Matching (MRt), MR Re-contouring Time (RCt), Re-Planning Time (RPt), Treatment Delivery Time (TDt). Also analyzed was the timing of treatments that followed a Simple workflow (SMP), without the online re-planning (PSt + MRt + TDt.).</p></div><div><h3>Results</h3><p>The time analysis revealed that the ADP workflow (median: 34 min) is significantly (p &lt; 0.05) longer than the SMP workflow (19 min). The time required for ADP treatments is significantly influenced by TDt, constituting 40 % of the total time. The oART steps (RCt + RPt) took 11 min (median), representing 27 % of the entire procedure. Overall, 79.2 % of oART fractions were completed in less than 45 min, and 30.6 % were completed in less than 30 min.</p></div><div><h3>Conclusion</h3><p>This preliminary analysis, along with the comparative assessment against existing literature, underscores the potential of CPW to diminish the overall treatment duration in MRgRT-oART. Additionally, it suggests the potential for CPW to promote a more integrated multidisciplinary approach in the execution of oART.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"29 ","pages":"Article 100239"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000064/pdfft?md5=0c2b643d3bd934625d7fb6a271b2d272&pid=1-s2.0-S2405632424000064-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139748503","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}

{"title":"The value of PROMs for predicting erectile dysfunction in prostate cancer patients with Bayesian network","authors":"","doi":"10.1016/j.tipsro.2024.100234","DOIUrl":"10.1016/j.tipsro.2024.100234","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aims to develop and externally validate a clinically plausible Bayesian network structure to predict one-year erectile dysfunction in prostate cancer patients by combining expert knowledge with evidence from data using clinical and Patient-reported outcome measures (PROMs) data. In addition, compare and contrast structures that stem from PROM information and routine clinical data.</p></div><div><h3>Summary of background</h3><p>For men with localized prostate cancer, choosing the optimal treatment can be challenging since each option comes with different side effects, such as erectile dysfunction, which negatively impacts their quality of life. Our previous findings demonstrate that logistic regression models are able to identify patients at high risk of erectile dysfunction. However, methods such as Bayesian networks may be more successful, as they intricately represent the causal relations between the variables.</p></div><div><h3>Patients and methods</h3><p>946 prostate cancer patients from 65 Dutch hospitals were considered to develop the Bayesian network structure. Continuous variables were discretized before analysis based on expert opinions and literature. Patients with missing information and variables with more than 25% of missing information were excluded. Prostate cancer treating physicians first determined the relationships (arcs) between the available variables. The structures were then modified based on algorithmically derived structures using the hill-climbing algorithm. Structural Performance was evaluated based on the area under the curve (AUC) values and calibration plots on the training and test data.</p></div><div><h3>Results</h3><p>BMI and prostate volume via MRI were excluded from this analysis due to their high percentage of missingness (<em>&gt;</em>45 %). The final cohort was reduced to 505 and 216 after excluding 157 and 68 patients with missing information, respectively. The AUC of the PROM structure was better than the clinical structure in both the train and test data. The structure that combined both sources of information had an AUC value of 0.94 (0.92 – 0.96) and 0.84171 (0.77 91) in the train and test data, respectively.</p></div><div><h3>Conclusion</h3><p>Bayesian network structures derived from PROM information by complimenting expert knowledge with evidence from the data produce a clinically plausible structure that is more performant than structures from clinical data. Our study supports the growing global recognition of incorporating the patient’s perspective in outcomes research for better decision-making and optimal outcomes. However, a structure that combines both sources of information gives a more holistic view of the patient with actionable insights and improved discriminative power.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"31 ","pages":"Article 100234"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000015/pdfft?md5=ed1c7bec71a7939a8365bb03d3dfe0a9&pid=1-s2.0-S2405632424000015-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139811701","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}

{"title":"Use of rectal balloon spacer in patients with localized prostate cancer receiving external beam radiotherapy","authors":"Paulo Costa ,&nbsp;Joana Vale ,&nbsp;Graça Fonseca ,&nbsp;Adelina Costa ,&nbsp;Michael Kos","doi":"10.1016/j.tipsro.2024.100237","DOIUrl":"10.1016/j.tipsro.2024.100237","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the efficacy of the balloon spacer when used to reduce the radiation dose delivered to the rectum in prostate cancer patients undergoing external beam radiotherapy.</p></div><div><h3>Method</h3><p>A single center retrospective analysis including 75 PC patients with localized T1-T3a disease who received balloon spacer followed by EBRT. Pre- and post-implantation computed tomography (CT) scans were utilized for treatment planning for standard EBRT (78–81 Gy in 1.8–2 Gy fractions). Rectal dosimetry was assessed using DVHs, and toxicities were graded with CTCAE v.4.</p></div><div><h3>Results</h3><p>A median (IQR) prostate-rectum separation resulted in 1.6 cm (1.4–2.0) post balloon spacer implantation. Overall, 90.6 % (68/75) of patients had a clinically significant 25 % relative reduction in the rectal with a median relative reduction of 91.8 % (71.2–98.6 %) at rV70. Three (4.0 %) patients reported mild procedural adverse events, anal discomfort and dysuria. Within 90 days post-implantation, five patients (6.67 %) and 1 patient (1.33 %) reported grade 1 and grade 2 rectal toxicities (anal pain, constipation, diarrhea and hemorrhoids). Genitourinary (GU) grade 1 toxicity was reported in 37 patients (49.33 %), with only one patient (1.33 %) experiencing grade 2 GU toxicity. No grade ≥ 3 toxicity was reported.</p></div><div><h3>Conclusion</h3><p>Balloon spacer implantation effectively increased prostate-rectum separation and associated with dosimetric gains EBRT for PC stage T1-T3a. Further controlled studies are required to ascertain whether this spacer allows for radiotherapy dose escalation and minimizes gastrointestinal (GI) toxicity.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"29 ","pages":"Article 100237"},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000040/pdfft?md5=ad795fd805e8d44977f75047133e6feb&pid=1-s2.0-S2405632424000040-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635828","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}

{"title":"Framework Development: Standardizing Definition of Advanced Practice Radiation Therapy Activities for Clinical Workload Quantification","authors":"Kitty Chan ,&nbsp;Biu Chan ,&nbsp;Kelly Linden ,&nbsp;Darby Erler ,&nbsp;Laura D'Alimonte ,&nbsp;Vickie Kong ,&nbsp;Julie Kraus ,&nbsp;Nicole Harnett","doi":"10.1016/j.tipsro.2024.100238","DOIUrl":"10.1016/j.tipsro.2024.100238","url":null,"abstract":"<div><h3>Purpose</h3><p>Advanced practice (AP) in radiation therapy (RT) is being implemented around the globe. In an effort to advance the understanding of the similarities and differences in APRT roles in Ontario, Canada, a community of practice (CoP) sought ways to provide quantitative data on the nature of APRT clinical activities and the frequency with which these activities were being executed.</p></div><div><h3>Methods</h3><p>In 2017, a consensus building project involving 20 APRTs and 14 radiation therapy (RT) department managers in Ontario was completed to establish a mechanism to quantify APRTs’ clinical impact. In Round 1 &amp; 2, expert feedback was gathered to generate an Advanced Practice (AP) Activity List. In Round 3: 20 APRTs completed an online survey to assess the importance and applicability of each AP Activity to their role using Likert scale (0–5). A final AP Activity List &amp; Definitions was generated.</p></div><div><h3>Results &amp; discussion</h3><p>Round 1: Forty-seven AP activities were identified. Round 2: 3/14 RT managers provided 145 feedback statements on Round 1 AP Activity List. The working group used RT managers’ feedback to clarify AP activities and definitions, specifically merging 33 unique AP activities to create 11 inclusive AP activities and eliminating 8 activities identified from Round 1. The most inclusive AP activity created was #1 New Patient Consultation, this AP Activity is merged from 7 unique AP activities. Incorporating RT managers’ feedback with the internal AP clinical workload lists from 2 Ontario cancer centres resulted in a revised AP Activity List with 20 AP inclusive activities. Round 3: 14/20 APRTs provided Likert scores on this revised list. The most applicable AP activities (mean score) were #16 Technical Consultation (4.0), #15 Contouring Target Volume (3.8) and #2 Planning Consultation (3.8); the least applicable was #18 MR Applicator Assessment (0.9).</p></div><div><h3>Conclusions</h3><p>This is the first systematic attempt to build consensus on AP clinical activities. Non-clinical APRT activities related to research, education, innovation, and program development were not in the scope of this project.<!--> <!-->The Final AP Activity List &amp; Definitions serves as a framework that allows standardized and continuous monitoring of AP clinical activities and impact.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"29 ","pages":"Article 100238"},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000052/pdfft?md5=4df7790d7d0d03f6c077bc3a2b682faa&pid=1-s2.0-S2405632424000052-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139634046","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}

{"title":"Are offline ART decisions for NSCLC impacted by the type of dose calculation algorithm?","authors":"Dylan Callens ,&nbsp;Karel Aerts ,&nbsp;Patrick Berkovic ,&nbsp;Liesbeth Vandewinckele ,&nbsp;Maarten Lambrecht ,&nbsp;Wouter Crijns","doi":"10.1016/j.tipsro.2024.100236","DOIUrl":"10.1016/j.tipsro.2024.100236","url":null,"abstract":"<div><h3>Introduction</h3><p>Decisions for plan-adaptations may be impacted by a transitioning from one dose-calculation algorithm to another. This study examines the impact on dosimetric-triggered offline adaptation in LA-NSCLC in the context of a transition from superposition/convolution dose calculation algorithm (Type-B) to linear Boltzmann equation solver dose calculation algorithms (Type-C).</p></div><div><h3>Materials &amp; Methods</h3><p>Two dosimetric-triggered offline adaptive treatment workflows are compared in a retrospective planning study on 30 LA-NSCLC patients. One workflow uses a Type-B dose calculation algorithm and the other uses Type-C. Treatment plans were re-calculated on the anatomy of a mid-treatment synthetic-CT utilizing the same algorithm utilized for pre-treatment planning. Assessment for plan-adaptation was evaluated through a decision model based on target coverage and OAR constraint violation. The impact of algorithm during treatment planning was controlled for by recalculating the Type-B plan with Type-C.</p></div><div><h3>Results</h3><p>In the Type-B approach, 13 patients required adaptation due to OAR-constraint violations, while 15 patients required adaptation in the Type-C approach. For 8 out of 30 cases, the decision to adapt was opposite in both approaches. None of the patients in our dataset encountered CTV-target underdosage that necessitated plan-adaptation. Upon recalculating the Type-B approach with the Type-C algorithm, it was shown that 10 of the original Type-B plans revealed clinically relevant dose reductions (≥3%) on the CTV in their original plans. This re-calculation identified 21 plans in total that required ART.</p></div><div><h3>Discussion</h3><p>In our study, nearly one-third of the cases would have a different decision for plan-adaption when utilizing Type-C instead of Type-B. There was no substantial increase in the total number of plan-adaptations for LA-NSCLC. However, Type-C is more sensitive to altered anatomy during treatment compared to Type-B. Recalculating Type-B plans with the Type-C algorithm revealed an increase from 13 to 21 cases triggering ART.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"29 ","pages":"Article 100236"},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000039/pdfft?md5=a4ff12837ebd840b53860064f67ac04c&pid=1-s2.0-S2405632424000039-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540771","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}