Journal of Radiotherapy in Practice最新文献

{"title":"Dosimetric effect of modelling non-homogeneous LINAC couch using cone-beam computed tomography on quality assurance (QA) results","authors":"A. Banaei, Mohsen Bakhshandeh, Mohammad Rasa Golrokh-Nodehi","doi":"10.1017/S1460396921000716","DOIUrl":"https://doi.org/10.1017/S1460396921000716","url":null,"abstract":"Abstract Aim: To evaluate the dosimetric effect of modelling a non-homogeneous couch on patients’ quality assurance (QA) gamma pass rates for intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques. Materials and Methods: A non-homogeneous treatment couch (TxT 550 TTM, CIVCO, USA) was imaged using the LINAC mounted cone-beam computer tomography (CBCT) system. Modelling this couch in different situations, including incomplete (homogeneous model), correct model and not defined situations in the treatment planning system (TPS), was performed based on the geometrical and material densities data extracted from the CBCT images. Calculated gamma pass rates between TPS dose calculations and the measurements in a phantom for different couch models were obtained and compared at two gamma criteria (2%-2 mm and 3%-3 mm). Results: Comparing TPS calculations for the correct modelled couch and the measurements showed high gamma pass rates for both the IMRT and VMAT techniques (96·5 ± 0·9%, 99·2 ± 0·5% for IMRT in 2%-2 mm and 3%-3 mm criteria; 97·5 ± 0·8%, 99·4 ± 0·5% for VMAT). The overall gamma pass rate of the IMRT plan QAs was reduced by about 2% and 3% on average for incomplete and no couch modelling, respectively. These reductions for VMAT techniques were 2·5% and 4·3%, respectively. Conclusions: Non-homogeneous couches have different parts with different attenuations, which can be correctly defined using LINAC CBCT. Modelling of treatment couch has a significant effect on patient QA results for VMAT and IMRT plans, especially in radiation fields/subfield transmitting from the couch. We suggest using LINAC CBCTs as an appropriate device for couch modelling in modulated radiotherapy techniques.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47507250","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}

{"title":"A dosimetric comparison of proton versus photon irradiation for paediatric glomus tumour: a case study","authors":"G. Vidal, J. Arntzen, Salahuddin Ahmad, C. Henson","doi":"10.1017/S1460396922000140","DOIUrl":"https://doi.org/10.1017/S1460396922000140","url":null,"abstract":"Abstract Background: Intensity-modulated radiation therapy (IMRT) has revolutionised the way head and neck cancers can be treated. It allows for a more conformal treatment plan when compared to 3D conformal radiation therapy. In paediatric patients, however, IMRT continues to deliver higher doses than desirable. Proton beam therapy on the other hand has the potential to further spare organs-at-risk. Methods: A 16-year-old boy with a left-sided paraganglioma of the left base of skull manifested by headaches, neck pain and tongue cramping was simulated, planned and treated with proton therapy with significant contralateral organ-at-risk sparing. Results: For this patient, dosimetric plan comparison between photon and proton plans clearly showed better sparing of contralateral organs-at-risk with protons. The contralateral parotid gland received a mean dose of 386·3 cGy with photons, whereas it received 1·3 cGy (CGE) in the proton plan. Conclusions: The dosimetric advantage of proton beam over photon beam therapy has successfully been demonstrated in this case study for a paediatric patient with a head and neck tumour. Sparing of contralateral structures is especially important in paediatric patients who are at a greater risk of secondary malignancies due to possible long life expectancy.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48469187","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}

{"title":"Comparison of different registration methods in cone-beam computed tomography for breast boost radiation therapy","authors":"A. Lastrucci, L. Fedeli, L. Marciello, E. Serventi, S. Segnini, F. Meucci, L. Bernardi, R. Ricci, S. Marzano","doi":"10.1017/S1460396922000176","DOIUrl":"https://doi.org/10.1017/S1460396922000176","url":null,"abstract":"Abstract Introduction: The aim of this study is to compare patient geometrical uncertainties in the treatment of breast boost three-dimensional conformal radiation therapy (3D-CRT) considering both manual alignment and automatic different registration methods in cone-beam computed tomography (CBCT). Methods: A total of 85 patients were chosen for this study. A total of 254 registrations of CBCT vs planning computed tomography (CT) were retrospectively performed using automatic registration algorithms from Elekta XVI system (Clipbox and Mask) to detect patient setup uncertainties. All CBCTs were also matched manually by three health professionals. Mean shift values obtained with manual registration performed by health professionals were used as reference. Absolute value of difference between automatic algorithm shifts and reference values shifts was collected for each enrolled patient considering the three different spatial directions (x, y ,z), and the magnitude was calculated (δm for Mask and δc for Clipbox). Results: Data analysis showed a significant difference in δm and δc. t-Test statistics showed a high difference between Mask and Clipbox, in particular mean δm = (1.3 ± 0.1) mm and δc = (3.3 ± 1.2) mm (p-value <0.0001). Mask algorithm was performed in a very similar way with respect to the reference alignment, and the differences between these two procedures were of the order of 1 mm. Clipbox algorithm showed larger differences with manual registration. Conclusions: These results suggest that the Mask algorithm may be the optimal choice for patient setup verification in clinical practice for breast boost treatment in 3D-CRT.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47581370","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}

{"title":"The addition of adjuvant radiotherapy in the management of extracranial arterio-venous malformations: a case discussion","authors":"Miriam Vicente-Ruiz, J. Aristu, B. Hontanilla","doi":"10.1017/S1460396922000164","DOIUrl":"https://doi.org/10.1017/S1460396922000164","url":null,"abstract":"Abstract Introduction: The management of extracranial arterio-venous malformations (AVMs) is complex and often requires a multidisciplinary approach. Currently, treatment includes surgical resection and embolotherapy. Methods: We present the case of a foot AVM that was managed with adjuvant radiotherapy after previous surgery and embolotherapy had been attempted, and we discuss the role of radiotherapy in the management of extracranial AVMs. Results: The malformation was successfully eradicated with complete obliteration of the nidus and no recurrence. Conclusions: The addition of radiotherapy in the management of extracranial arterio-venous malformations offers promising results using similar doses to those used in brain AVMs.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48649668","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}

{"title":"Normal tissue complication probabilities of lung SABR patients from a UK centre and its implication on personalised radiotherapy","authors":"J. Marsden","doi":"10.1017/S1460396922000024","DOIUrl":"https://doi.org/10.1017/S1460396922000024","url":null,"abstract":"Abstract Introduction: This work reports on the normal tissue complication probabilities (NTCP) from a UK cohort of previously treated peripheral lung SABR patients (n = 198) supplementing our previous publication on tumour control probabilities (TCP). Each patient was recalculated for alternative schedules. Materials and Methods: NTCP for 3 (54 Gy), 5 (55 and 60 Gy) and 8 (50 Gy) fraction (#) schemes were calculated with the Lyman Kutcher Burman (LKB) model in the software platform ‘Biosuite’ (Version 12·01) for lung and chest wall. Patients treated with 5 # or 8 # were then recomputed for alternative fractionations and doses (3 # and 5 #, for both 55 Gy and 60 Gy). Results: The mean lung NTCP (NTCPLUNG, for the outcome of radiation pneumonitis) was 2·8% (range 0·6 – 10·6). The mean chest wall NTCP (NTCPCW, for the outcome of rib fracture) was 1·4% (range 0·0–55·9). There were no statistically significant differences observed between male and female, tumour status or fractionation groups except for the NTCPLUNG between 5 # and 3 #. When recalculating NTCP and TCP individually, for 8 # patients, no differences were observed between mean TCP, NTCPLUNG or NTCPCW compared with 3 # or 5 # indicating that fractionation reduction is possible. Parity was observed between the 60 Gy group when recalculated for 55 Gy. For the 60 Gy in 5 # group, the NTCPCW increased significantly when recalculated for 3 #. Conclusion: NTCPs achievable with current UK planning techniques have been presented indicating SABR Consortium compliant centres are likely to have low complication population risks (< 3 %). 5 # schedules could be justified for 8 # patients, thereby reducing the number of treatment visits. Where there is a large overlap of PTV and chest wall, this indicates an NTCP/TCP calculation is required to investigate if fractionation reduction is individually appropriate.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46181620","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}

{"title":"Peer review quality assurance in stereotactic body radiotherapy planning: the impact of case volume","authors":"M. Huo, L. Morley, L. Dawson, J. Bissonnette, J. Helou, M. Giuliani, A. Berlin, D. Shultz, A. Hosni, A. Shessel, J. Waldron, A. Barry","doi":"10.1017/S1460396922000152","DOIUrl":"https://doi.org/10.1017/S1460396922000152","url":null,"abstract":"Abstract Purpose: Peer review is an essential quality assurance component of radiation therapy planning. A growing body of literature has demonstrated substantial rates of suggested plan changes resulting from peer review. There remains a paucity of data on the impact of peer review rounds for stereotactic body radiation therapy (SBRT). We therefore aim to evaluate the outcomes of peer review in this specific patient cohort. Methods and materials: We conducted a retrospective review of all SBRT cases that underwent peer review from July 2015 to June 2018 at a single institution. Weekly peer review rounds are grouped according to cancer subsite and attended by radiation oncologists, medical physicists and medical radiation technologists. We prospectively compiled ‘learning moments’, defined as cases with suggested changes or where an educational discussion occurred beyond routine management, and critical errors, defined as errors which could alter clinical outcomes, recorded prospectively during peer review. Plan changes implemented after peer review were documented. Results: Nine hundred thirty-four SBRT cases were included. The most common treatment sites were lung (518, 55%), liver (196, 21%) and spine (119, 13%). Learning moments were identified in 161 cases (17%) and translated into plan changes in 28 cases (3%). Two critical errors (0.2%) were identified: an inadequate planning target volume margin and an incorrect image set used for contouring. There was a statistically significantly higher rate of learning moments for lower-volume SBRT sites (defined as ≤30 cases/year) versus higher-volume SBRT sites (29% vs 16%, respectively; p = 0.001). Conclusions: Peer review for SBRT cases revealed a low rate of critical errors, but did result in implemented plan changes in 3% of cases, and either educational discussion or suggestions of plan changes in 17% of cases. All SBRT sites appear to benefit from peer review, though lower-volume sites may require particular attention.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49229841","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}

{"title":"Rural disparities in head and neck cancer from 2017 to 2021: a single institution analysis","authors":"My-Lien Nguyen, Jonathan T. Derouen, J. N. Cantrell, Andrea L. Johnston, G. Vidal, A. Schutz, W. Ogilvie, Michael Businelle, S.Airiza Ahmad, C. Henson","doi":"10.1017/S1460396922000127","DOIUrl":"https://doi.org/10.1017/S1460396922000127","url":null,"abstract":"Abstract Introduction: This study aims to look at the trends in our head and neck cancer patient population over the past 5 years with an emphasis on the past 2 years to evaluate how the coronavirus disease 2019 (COVID-19) pandemic has impacted our disparities and availability of care for patients, especially those living in rural areas. An additional aim is to identify existing disparities at our institution in the treatment of head and neck patients and determine solutions to improve patient care. Materials and Methods: A retrospective chart review was performed to identify patients who were consulted and subsequently treated with at least one fraction of radiation therapy at our institution with palliative or curative intent. Patient demographic information was collected including hometown, distance from the cancer centre based on zip-codes and insurance information and type of appointment (in-person or telehealth). Rural–urban continuum codes were used to determine rurality. Results: A total of 490 head and neck cancer patients (n = 490) were treated from 2017 to 2021. When broken down by year, there were no significant trends in patient population regarding travel distance or rurality. Roughly 20–30% of our patients live in rural areas and about 30% have a commute > 50 miles for radiation treatment. A majority of our patients rely on public insurance (68%) with a small percentage of those uninsured (4%). Telehealth visits were rare prior to 2019 and rose to 5 and 2 visits in 2020 and 2021, respectively. Conclusions: Head and neck cancer patients, despite rurality or distance from a cancer centre, may present with alarmingly enough symptoms despite limitations and difficulties with seeking medical attention even during the COVID-19 pandemic in 2020. However, providers must be aware of these potential disparities that exist in the rural population and seek to address these.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46994729","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}

{"title":"Impact of split X-jaw technique on target volume coverage and organ at risk sparing in prostate cancer: a comparative dosimetric study","authors":"G. Sarma, J. Nath, Shrayanti Goswami, Pranjal Goswami, S. Sharma, A. Kalita","doi":"10.1017/S1460396922000103","DOIUrl":"https://doi.org/10.1017/S1460396922000103","url":null,"abstract":"Abstract Introduction: The Varian Trilogy linear accelerator’s multi-leaf collimator moves on a carriage with a maximum leaf span of 15 cm. The traditional open and limited X-jaw technique of volumetric-modulated arc radiotherapy (VMAT) yields a relatively compromised dose distribution within the planning target volume (PTV) region. This study aimed to determine whether the split X-jaw planning technique for VMAT improves plan quality regarding target dose coverage and organs at risk (OAR) sparing for PTVs that require a field size of more than 15 cm in the X-jaw direction in prostate cancer patients. Method: Computed tomography data sets from 15 patients with prostate cancer were enrolled in the study. Only the PTVs requiring a field size larger than 18 cm in the X-jaw position were considered, and a dose of 4500 cGy in 25 fractions was prescribed. For each case, three separate treatment plans were generated: open, limited and split X-jaw planning techniques with similar planning objectives Results: The split X-jaw technique resulted in statistically significant superior coverage of PTV when compared with the open (P < 0·0001) and limited methods (P < 0·001). The split technique delivered a lower dose to the OARs, although statistical significance could not be achieved. D2% (cGy) was lowest for the PTV in the split technique (4684·8 ± 18·16) and highest for the open technique (4710 ± 18·75), P < 0·001. Conclusion: The x-split jaw technique can replace the traditional open X-jaw practice of VMAT for PTVs requiring an X-jaw width of more than 15 cm in the Varian linear accelerator.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44252331","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}

{"title":"The psychosocial responses of patients in cancer clinical trials: are they a barrier to participation?","authors":"L. Davies, H. Drury-Smith","doi":"10.1017/S1460396922000139","DOIUrl":"https://doi.org/10.1017/S1460396922000139","url":null,"abstract":"Abstract Introduction: This paper aims to discuss the psychosocial concomitants with involvement in oncology clinical trials, focusing on barriers that can impact upon participation. It will conclude with some recommendations for strategies to address potential psychosocial barriers with the aim of increasing trial participation rates. Materials and methods: A literature search was carried out using CINAHL, PubMed and EMCare databases with the following keywords for filtering: psychological distress, clinical trials, participation and oncology. The final selection of papers that met the inclusion criteria for this review was manually subjected to Critical Appraisal Skills Programme tool for relevance. Results: Thirteen papers were included in the review. The dominant theme within the literature is psychosocial obstacles to oncology clinical trial participation. Five key barriers were identified: anxiety and fear; ethnicity and social background; tensions between scientific objectives and personal motivations to participation; tensions between personal benefits versus altruism; carer perspectives. Conclusions: The key barriers discussed led to the identification of a set of strategies to help mediate conflicting tensions and motivations of trial enrolment with a view to increasing participation rates. Further prospective research garnering primary data investigating both the psychological and psychosocial factors influencing cancer clinical trial participation for patients needs to be undertaken.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45123879","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}

{"title":"Rotational effect and dosimetric impact: HDMLC vs 5-mm MLC leaf width in single isocenter multiple metastases radiosurgery with Brainlab Elements™","authors":"C. Venencia, J. A. Rojas-López, Rogelio Manuel Diaz Moreno, S. Zunino","doi":"10.1017/S1460396922000048","DOIUrl":"https://doi.org/10.1017/S1460396922000048","url":null,"abstract":"Abstract Purpose: To analyse the impact of multileaf collimator (MLC) leaf width in multiple metastases radiosurgery (SRS) considering the target distance to isocenter and rotational displacements. Methods: Ten plans were optimised. The plans were created with Elements Multiple Mets SRS v2·0 (Brainlab AG, Munchen, Germany). The mean number of metastases per plan was 5 ± 2 [min 3, max 9], and the mean volume of gross tumour volume (GTV) was 1·1 ± 1·3 cc [min 0·02, max 5·1]. Planning target volume margin criterion was based on GTV-isocenter distance and target dimensions. Plans were performed using 6 MV with high-definition MLC (HDMLC) and reoptimised using 5-mm MLC (MLC-5). Plans were compared using Paddick conformity index (PCI), gradient index, monitor units , volume receiving half of prescription isodose (PIV50), maximum dose to brainstem, optic chiasm and optic nerves, and V12Gy, V10Gy and V5Gy for healthy brain were analysed. The maximum displacement due to rotational combinations was optimised by a genetic algorithm for both plans. Plans were reoptimised and compared using optimised margin. Results: HDMLC plans had better conformity and higher dose falloff than MLC-5 plans. Dosimetric differences were statistically significant (p < 0·05). The smaller the lesion volume, the higher the dosimetric differences between both plans. The effect of rotational displacements produced for each target in SRS was not dependent on the MLC (p > 0·05). Conclusions: The finer HDMLC offers dosimetric advantages compared with the MLC-5 in terms of target conformity and dose to the surrounding organs at risk. However, only dose falloff differences due to rotations depend on MLC.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43395044","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}