Journal of Radiotherapy in Practice最新文献

{"title":"Measuring and improving radiotherapy delivery efficiency","authors":"A. Cooke, C. Holborn","doi":"10.1017/S146039692200005X","DOIUrl":"https://doi.org/10.1017/S146039692200005X","url":null,"abstract":"Abstract Introduction: The researcher’s centre was in a unique position of merging with another established radiotherapy centre to create a Satellite Site. It was noted that the Satellite Site delivered more fractions per linac within the same working day profile as the Main Site. Subtle differences in the workflows allowed for an appraisal of the processes within a fraction of radiotherapy and how this can be refined to improve efficiency. Methods: Retrospective fraction timings were collected using the Oncology Information System for 98 breast and prostate treatments at both sites. A literature review was also conducted to further explore factors that impact fraction timings in other departments internationally. Results: Breast and prostate treatments took 2·1 and 2·93 minutes, respectively, longer to deliver at the Main Site. Set-up to the isocentre and verification image assessment took significantly longer in all cases at the Main Site. Literature surrounding efficiency is scarce but suggests methods used for online management of verification imaging significantly impacts appointment times. Conclusion: Implementation of a paperless workflow and process improvements for image assessment such as introducing a traffic light protocol may reduce the time to deliver a fraction of radiotherapy and maximise service efficiency.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48419440","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":"Clinical audit of breast cancer patients treated with helical tomotherapy for irradiation of the internal mammary chain","authors":"G. Shrivastav, D. Datta, T. Wadasadawala, Pallavi P Rane, S. Panda, R. Pathak, L. Scaria, R. Krishnamurthy, R. Sarin","doi":"10.1017/S1460396921000625","DOIUrl":"https://doi.org/10.1017/S1460396921000625","url":null,"abstract":"Abstract Aim: To evaluate efficacy of helical tomotherapy (HT) for treatment of breast cancer with internal mammary lymph node involvement. Methods: This is a retrospective clinical audit of planning, dosimetry, toxicity and short-term survival of a cohort of 65 patients. Patients were treated between November 2014 and May 2019. The primary and nodal region was prescribed a dose of 50 Gray (Gy) in 25 fractions, while all cases of breast conserving surgery received a simultaneous integrated boost to a dose of 61 Gy in 25 fractions. Results: The 95% coverage for the primary, supraclavicular, internal mammary node and tumour bed was 93·4%, 96·8%, 90·7% and 98·3%, respectively. Mean dose to total lung, heart and contra-lateral breast was 10·6 Gy, 6·92 Gy and 4·32 Gy, respectively. None developed grade III skin or oesophageal toxicity. Twenty-one patients had progression; of which eighteen developed only distant failure while three also had loco-regional recurrence. At a median follow-up of 36 months, the 3-year loco-regional control, disease-free survival and overall survival were 93·5, 73·9 and 85·9%, respectively. Conclusion: We report encouraging clinical outcome for patients treated uniformly with HT. The predominant pattern of failure was distant metastases which suggests the need for systemic control intensification.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48575409","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 identification of abnormalities on radiotherapy CT planning scans: a retrospective audit","authors":"Josie Cameron","doi":"10.1017/S1460396922000036","DOIUrl":"https://doi.org/10.1017/S1460396922000036","url":null,"abstract":"Abstract Introduction: Therapeutic radiographers are an essential part of a cancer patient’s journey and play a vital and changing role in the delivery of radiotherapy services. This retrospective audit highlights the number of incidental abnormalities found by a Breast Advanced Practitioner on radiotherapy computed tomography (CT) planning scans and their subsequent management. Methods: This retrospective audit investigated the incidental abnormalities found by the Breast Advanced Practitioner on routine CT planning scans for breast cancer patients 2016–2021. Any breast cancer patient found to have an abnormality had their planning scan uploaded to the national picture archiving and communication systems (PACS) system for radiology review. Further formal CT imaging was requested or direct referral to an appropriate multi-disciplinary team meeting. Results: Sixty-three significant abnormalities were found over the five-year period, of these thirty seven were malignant and the majority of these were lung lesions. Seven patients went on to have surgery alone, surgery plus chemoradiation or stereotactic ablative radiotherapy for their newly diagnosed lung primaries. Five patients were found to have liver metastases that unfortunately changed their treatment plan to palliative. Conclusion: This retrospective audit has demonstrated that CT planning for radiotherapy offers an opportunity to identify malignant abnormalities at a potentially early stage, thereby improving prognosis and survival. Radiographers have a duty of care to appraise these CT scans to ensure any abnormalities can be addressed in a timely manner.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44267646","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":"Becoming virtually real: using the Virtual Environment for Radiotherapy Training (VERT™) platform for the summative assessment of performance in a palliative radiotherapy treatment technique","authors":"A. Williams, Shelley Blane","doi":"10.1017/S1460396922000073","DOIUrl":"https://doi.org/10.1017/S1460396922000073","url":null,"abstract":"Abstract Introduction: Direct observation in the radiotherapy clinic remains the primary method for the assessment of procedural skills. But with increasing automation and reductions in clinical placement time during the recent pandemic, the role of summative, simulation-based assessment is being revisited. The aim of this article is to share early experiences of using Virtual Environment for Radiotherapy Training (VERT) in the assessment of a palliative, parallel pair, external beam treatment delivery technique in a new pre-registration undergraduate programme. Methods: Eight first-year students completed a campus-based individual virtual assessment using virtual patient plans representing metastatic disease in the brain and pelvis and late-stage primary lung tumours. Performance was logged on a 25-item checklist for pre and post-procedure checks and treatment delivery tasks. Results: All eight students participated in the assessment with seven students (87·5%) achieving a pass grade at first attempt. The course team observed that participants demonstrated a range of skills and abilities and were able to compare and contrast individual approaches to patient positioning. Specific feed-forward action points were also highlighted as areas for students’ to focus on during their second placement. The project also identified logistical benefits for assessment teams. Conclusions: While these experiences are a single snapshot, a VERT simulation-based summative assessment is feasible and identified benefits included controlled observation and structured feedback on individual performance and scheduling pressure reductions for clinical teams. However, more work is needed to determine the psychometric qualities and predictability of performance in more complex techniques.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":"22 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41418212","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":"COVID-19 testing trends: pre-radiation and throughout cancer care","authors":"I. Messing, Miriam Felps, S. Goyal, Y. Rao, Katherine Schreiner, D. Scully, M. Ojong-Ntui, M. Huynh-Le","doi":"10.1017/S1460396922000012","DOIUrl":"https://doi.org/10.1017/S1460396922000012","url":null,"abstract":"Abstract Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution’s radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24–94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1–18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45657192","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 novel technique for peripheral dose measurements in external beam radiation therapy","authors":"Gowri Balan, V. Ramasubramanian","doi":"10.1017/S1460396922000085","DOIUrl":"https://doi.org/10.1017/S1460396922000085","url":null,"abstract":"Abstract Introduction: In radiotherapy, the dose delivered outside the field is known as peripheral dose (PD). In this study, we have attempted to develop a dataset using the PD values measured with a two-dimensional array, IMatrixx. Methods: The IMatrixx was used to measure the PD up to a distance of 45 cm from the field edge, in a Varian Clinac 2100-C machine. Solid water slabs and water phantom were used to get the required geometry for the PD measurements. The measurements were done for different field sizes, collimator angles, source to surface distance (SSD) and depths. The influence of gantry angles and photon energies on the PD was studied. The surface dose measurements were carried out using thermoluminescent detectors (TLD). Results: The dataset shows that the PD increased significantly with field size and depth and its increase was insignificant for collimator rotation and SSD. The influence of gantry angle was less pronounced at dmax than at the surface. The TLD measurements at the surface of patients were in agreement with the IMatrixx measurements. Conclusions: The IMatrixx can be used for the generation of PD values and it is less time-consuming, accurate, and commonly available in all radiotherapy departments.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46533069","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":"Monte Carlo evaluation of target dose coverage in lung stereotactic body radiation therapy with flattening filter-free beams.","authors":"Oleg N Vassiliev, Christine B Peterson, Joe Y Chang, Radhe Mohan","doi":"10.1017/s1460396920000886","DOIUrl":"10.1017/s1460396920000886","url":null,"abstract":"<p><strong>Aim: </strong>Previous studies showed that replacing conventional flattened beams (FF) with flattening filter-free (FFF) beams improves the therapeutic ratio in lung stereotactic body radiation therapy (SBRT), but these findings could have been impacted by dose calculation uncertainties caused by the heterogeneity of the thoracic anatomy and by respiratory motion, which were particularly high for target coverage. In this study, we minimized such uncertainties by calculating doses using high-spatial-resolution Monte Carlo and four-dimensional computed tomography (4DCT) images. We aimed to evaluate more reliably the benefits of using FFF beams for lung SBRT.</p><p><strong>Materials and methods: </strong>For a cohort of 15 patients with early stage lung cancer that we investigated in a previous treatment planning study, we recalculated dose distributions with Monte Carlo using 4DCT images. This included fifteen FF and fifteen FFF treatment plans.</p><p><strong>Results: </strong>Compared to Monte Carlo, the treatment planning system (TPS) over-predicted doses in low-dose regions of the planning target volume. For most patients, replacing FF beams with FFF beams improved target coverage, tumor control, and uncomplicated tumor control probabilities.</p><p><strong>Conclusions: </strong>Monte Carlo tends to reveal deficiencies in target coverage compared to coverage predicted by the TPS. Our data support previously reported benefits of using FFF beams for lung SBRT.</p>","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":"21 1","pages":"81-87"},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8992779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43255634","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 use of emoji to establish student wellbeing: does the image reflect the reality?","authors":"J. Callender, P. Bridge, F. Al-Samarraie, Daniel Blair","doi":"10.1017/S1460396921000704","DOIUrl":"https://doi.org/10.1017/S1460396921000704","url":null,"abstract":"Abstract Introduction: The impact of COVID-19 social restrictions on mental wellbeing of health professional students during placement is largely unknown. Conventional survey methods do not capture emotional fluctuations. Increasing use of smartphones suggests short message service (SMS) functionality could provide easy, rapid data. This project tested the feasibility and validity of gathering data on Therapeutic Radiography student mental wellbeing during clinical placement via emoji and SMS. Methods: Participants provided anonymous daily emoji responses via WhatsApp to a dedicated mobile phone. Additional weekly prompts sought textual responses indicating factors impacting on wellbeing. A short anonymous online survey validated responses and provided feedback on the method. Results: Participants (n = 15) provided 254 daily responses using 108 different emoji; these triangulated with weekly textual responses. Feedback concerning the method was positive. ‘Happy’ emoji were used most frequently; social interaction and fatigue were important wellbeing factors. Anonymity and opportunity to feedback via SMS were received positively; ease and rapidity of response engendered engagement throughout the 3-week study. Conclusions: The use of emoji for rapid assessment of cohort mental wellbeing is valid and potentially useful alongside more formal evaluation and support strategies. Capturing simple wellbeing responses from a cohort may facilitate the organisation of timely support interventions.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45171623","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 impact of the radiotherapy technique in sparing the heart substructures in central tumor irradiation in lung cancer","authors":"Gulhan Guler Avci, Gonca Altınısık Inan, Halis Bozkurt","doi":"10.1017/S1460396921000686","DOIUrl":"https://doi.org/10.1017/S1460396921000686","url":null,"abstract":"Abstract Introduction: In thoracic radiotherapy (RT), heart sparing is very essential, as the high cardiac dose is associated with poor survival in patients with locally advanced non-small-cell lung cancer (NSCLC). The study aims to determine the doses exposed to heart substructures and coronary arteries by different RT techniques in central tumor irradiation in lung cancer. Methods: Twenty patients with NSCLC, irradiated between January 2018 and December 2020 in our department, were included in this study. Patients whose primary tumor was centrally located in the left lung were selected. The heart substructures [left atrium, right atrium (RA), left ventricle, and right ventricle] and coronary arteries (left main, left anterior descending, circumflex, and right coronary arteries) were delineated by the same physician. The doses of 60 Gy external RT were prescribed in 30 fractions using three-dimensional conformal radiotherapy (3D-CRT), static intensity-modulated radiotherapy (s-IMRT), and dynamic intensity-modulated radiotherapy (d-IMRT) techniques in all patients. The obtaining plans using three different techniques were compared. Results: The d-IMRT plans were statistically the best optimal plan for planning target volume (PTV) [Dmean (p = 0 04), Dmax (p < 0 0001), V95 (p < 0 0001), V107 (p < 0 0001), CI (p < 0 0001) and HI (p < 0 0001)]. The s-IMRT plans were significantly superior to 3D-CRT plans for PTV. RA Dmax and V45 were not different between the three techniques [Dmax (p = 0 148) and V45 (p = 0 12)]. The d-IMRT technique was significantly better in other heart substructures and coronary arteries. Conclusions: Compared to 3D-CRT and s-IMRT techniques, the d-IMRT technique provided the best protection in all heart substructures except for a few parameters (RA Dmax and V45 doses).","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47798435","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":"Primary non-Hodgkin’s lymphoma of the orbit: treatment outcomes from India","authors":"B. Yadav, Vjai Simha","doi":"10.1017/S1460396921000698","DOIUrl":"https://doi.org/10.1017/S1460396921000698","url":null,"abstract":"Abstract Background: Primary non-Hodgkin’s lymphoma (NHL) of the orbit is rare. Orbital NHLs show good response to both radiotherapy (RT) and chemotherapy, and hence, the emphasis should be to ensure maximum cure rate with minimum morbidity. In this study, we present the clinical profile and treatment outcomes of patients with NHL who had initial presentation in the orbit. Materials and methods: In this retrospective analysis, case records of patients with a diagnosis of NHL of the orbit were analysed from January 2005 to January 2015. Patients were worked up and staged according to the Ann Arbor system. Patients with large tumours were initially given chemotherapy with CHOP regimen (cyclophosphamide, vincristine, adriamycin and prednisolone) three weekly for 4–6 cycles. Patients with residual disease were given RT 20–30 Gy at 2 Gy per fraction. RT when given as a primary treatment consisted of 36–45 Gy at 1·8–2 Gy per fraction on either Cobalt 60 machine or linear accelerator. Results: A total of 52 patients with diagnosis of orbital NHL were included in this study. Median age at presentation was 57 years (range 13–71). Left, right and bilateral orbit was involved in 21 (40%), 28(54%) and 3(6%) patients, respectively. Low- and high-grade pathology was seen in 39(75%) and 13(25%) patients, respectively. On immunohistochemistry, 23(44%) tumors were CD 20 positive. After staging, 33 (63%) patients had stage I disease. Median tumour size was 4·0 × 3·2 × 1·5 cm (1·7 × 1·7 × 1·4 cm to 5·8 × 4·0 × 4·7 cm). Primary RT was given to 7(13%) patients. Upfront chemotherapy was given in 45(86·5%) patients, out of which 24 had stage I disease. RT consolidation was done in 26 (50%) patients for residual disease after chemotherapy. Median follow-up was 88 months (range 29–183 months). Relapse occurred in 6(9·6%) patients; 2 local; 2 local + distant and in 2 distant alone. These patients were successfully salvaged with systemic chemotherapy and local RT. One patient died due to neutropenia. Overall survival in this series was 96%. Conclusions: Excellent local control was achieved with initial chemotherapy followed by RT for primary orbital NHL with minimal toxicity. We recommend a dose of 36–40 Gy for definitive RT and 30 Gy for lymphoma following chemotherapy using 2 Gy/fraction for Indian patients who present with bulky tumours. RT should be incorporated in treatment of orbital NHL whenever possible as it is safe, effective and is associated with minimal complications.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48301121","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}