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Sievert D, D'Souza A, Zhao X, Prusator MT, Mazur T, Kim H, Hobbis D. Complex Multi-site Stereotactic Body Re-irradiation With CT-Guided Online Adaptive Radiotherapy. Cureus 2024; 16:e68559. [PMID: 39364455 PMCID: PMC11449465 DOI: 10.7759/cureus.68559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2024] [Indexed: 10/05/2024] Open
Abstract
Online adaptive radiotherapy optimizes a patient's treatment plan to their daily anatomy to account for inter-fraction motion. Daily target and organ-at-risk (OAR) delineation allows for optimized treatments and has been shown to have favorable outcomes in the abdominal region. Adaptive radiotherapy also has the potential to support fine control of dose in re-irradiation to OARs. Herein, we describe a complex multi-site re-irradiation case utilizing CT-guided adaptive radiotherapy. A 46-year-old man with metastatic hepatocellular carcinoma presented for re-irradiation of four metastatic lesions to the right acetabulum, T11, S2, and a gastrosplenic lymph node (gsLN). The right acetabulum, T11, and S2 lesions previously received 20 Gy in five fractions. For the current course, he was prescribed 35 Gy (T11, right acetabulum, and gsLN) and 30 Gy (S2) in five fractions. An equivalent dose in 2 Gy fractions (EQD2) was employed to assess cumulative doses for critical OARs and guide planning. The re-irradiated lesions were treated with stereotactic body radiation therapy (SBRT), and the gsLN was treated with adaptive radiotherapy. An isotoxic approach was utilized to create the scheduled and adapted plans for the gsLN. Adapted plans were created on the patient's daily anatomy as visualized on kilovoltage cone beam computed tomography and compared against the scheduled plan. Dose-volume histogram objectives were used to compare the plans, and the superior plan was chosen for delivery. The adapted plan was used for all five fractions and met all critical OAR constraints while maintaining target coverage. The use of the scheduled plan would have resulted in stomach and/or esophagus constraint violations on all five fractions. This resulted in reduced EQD2 doses of 6.4 and 12.3 Gy for the esophagus and stomach, respectively. We report the successful treatment of a patient undergoing tri-site SBRT re-irradiation with concurrent CT-guided adaptive radiotherapy to a gsLN. The adaptive treatment allowed us to meet critical OAR constraints while maintaining target coverage. Few studies have described the use of CT-guided adaptive radiotherapy in re-irradiation cases, and the potential benefit for these complex cases is evident.
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Affiliation(s)
- Domenic Sievert
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Alden D'Souza
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Xiaodong Zhao
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Michael T Prusator
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Tom Mazur
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Dean Hobbis
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
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Uppal JK, Farrell T, Smoke M, Doerwald-Munoz L. Patient perceptions of advanced practice radiation therapists prescribing medication in radiation therapy. J Med Imaging Radiat Sci 2024; 55:101443. [PMID: 38878617 DOI: 10.1016/j.jmir.2024.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION The purpose of this study was to determine patient perceptions of an advanced practice radiation therapist (APRT) prescribing medication for radiation therapy treatment-related side effects. By comprehending patient perceptions, it is important to implement change in order to improve patients' quality of life. METHODS A literature review was conducted on advanced practice (AP) roles in Canada and world-wide; the roles searched were: APRT, nurse practitioner and pharmacist. The search focused on evidence demonstrating improvements made to patient care due to the implementation of these roles. Based on this review and input from a team of experts a qualitative semi-structured interview survey was designed, and pilot tested. The survey consisted of five open-ended questions, which were designed to determine patient satisfaction of an APRT prescribing medication over the course of their radiation therapy treatments. Patients undergoing head and neck radiation therapy treatments at a large, academic cancer centre were invited to participate. Six patients who had a head and neck APRT involved in their treatment were interviewed. A comprehensive thematic analysis was then conducted using the transcripts created from these interviews, which was followed by two independent blinded analyses to ensure validity of the results. DISCUSSION The thematic analysis produced four salient themes which were: side effect management, care provided by the APRT in comparison to other healthcare workers, patients' access to care, and overall patient satisfaction. Common medications for head and neck radiation therapy treatment related side effects were discussed and these were: Magic Mouthwash, Xylocaine, Nystatin, Benadryl, Advil, Tylenol, Dexamethasone, Tantum, Biotene, Mucaine, Flamazine, Hydrocortisone, Ondansetron, Senokot, and narcotics. CONCLUSION This study was valuable to understand patient experiences and provide evidence to change processes in order to improve quality of patient centered care. The study revealed that although patients were happy with the process of prescribing medication, they all agreed that having an advanced practice radiation therapist prescribe would improve care. Patient responses further demonstrated the need for future research in regards to side effect management as a whole by APRTs as well as how role clarification can impact patient perceptions of APRTs.
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Affiliation(s)
- Jasleen Kaur Uppal
- McMaster University, A.N. Bourns Science Building, Room C501, 1280 Main Street West, Hamilton, Ontario, L8S 4M1, Canada.
| | - Thomas Farrell
- McMaster University, A.N. Bourns Science Building, Room C501, 1280 Main Street West, Hamilton, Ontario, L8S 4M1, Canada
| | - Marcia Smoke
- McMaster University, A.N. Bourns Science Building, Room C501, 1280 Main Street West, Hamilton, Ontario, L8S 4M1, Canada
| | - Lilian Doerwald-Munoz
- Hamilton Health Sciences, Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario, L8V 5C2, Canada
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Troschel FM, Troschel BO, Kloss M, Jost J, Pepper NB, Völk-Troschel AS, Wiewrodt RG, Stummer W, Wiewrodt D, Eich HT. Sarcopenia is associated with chemoradiotherapy discontinuation and reduced progression-free survival in glioblastoma patients. Strahlenther Onkol 2024; 200:774-784. [PMID: 38546749 PMCID: PMC11343971 DOI: 10.1007/s00066-024-02225-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/25/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Sarcopenia may complicate treatment in cancer patients. Herein, we assessed whether sarcopenia measurements derived from radiation planning computed tomography (CT) were associated with complications and tumor progression during radiochemotherapy for glioblastoma. METHODS Consecutive patients undergoing radiotherapy planning for glioblastoma between 2010 and 2021 were analyzed. Retrocervical muscle cross-sectional area (CSA) was measured via threshold-based semi-automated radiation planning CT analysis. Patients in the lowest sex-specific quartile of muscle measurements were defined as sarcopenic. We abstracted treatment characteristics and tumor progression from the medical records and performed uni- and multivariable time-to-event analyses. RESULTS We included 363 patients in our cohort (41.6% female, median age 63 years, median time to progression 7.7 months). Sarcopenic patients were less likely to receive chemotherapy (p < 0.001) and more likely to be treated with hypofractionated radiotherapy (p = 0.005). Despite abbreviated treatment, they more often discontinued radiotherapy (p = 0.023) and were more frequently prescribed corticosteroids (p = 0.014). After treatment, they were more often transferred to inpatient palliative care treatment (p = 0.035). Finally, progression-free survival was substantially shorter in sarcopenic patients in univariable (median 5.1 vs. 8.4 months, p < 0.001) and multivariable modeling (hazard ratio 0.61 [confidence interval 0.46-0.81], p = 0.001). CONCLUSION Sarcopenia is a strong risk factor for treatment discontinuation and reduced progression-free survival in glioblastoma patients. We propose that sarcopenic patients should receive intensified supportive care during radiotherapy and during follow-up as well as expedited access to palliative care.
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Affiliation(s)
- Fabian M Troschel
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Benjamin O Troschel
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Maren Kloss
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Johanna Jost
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Niklas B Pepper
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Amelie S Völk-Troschel
- Department of Medicine II, Klinikum Wolfsburg, Sauerbruchstraße 7, 38440, Wolfsburg, Germany
| | - Rainer G Wiewrodt
- Pulmonary Research Division, Münster University, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
- Department of Pulmonary Medicine, Mathias Foundation, Hospitals Rheine and Ibbenbüren, Frankenburgsstraße 31, 48431, Rheine, Germany
| | - Walter Stummer
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Dorothee Wiewrodt
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Mitchell J, McLaren DB, Burns Pollock D, Wright J, Killean A, Trainer M, Adamson S, McKernan L, Nailon WH. Clinical implementation of real time motion management for prostate SBRT: A radiation therapist's perspective. Tech Innov Patient Support Radiat Oncol 2024; 31:100267. [PMID: 39220550 PMCID: PMC11363481 DOI: 10.1016/j.tipsro.2024.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 07/10/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024] Open
Abstract
Background and purpose The adoption of hypo-fractionated stereotactic body radiotherapy (SBRT) for treating prostate cancer has led to an increase in specialised techniques for monitoring prostate motion. The aim of this study was to comprehensively review a radiation therapist (RTT) led treatment process in which two such systems were utilised, and present initial findings on their use within a SBRT prostate clinical trial. Materials and Methods 18 patients were investigated, nine were fitted with the Micropos RayPilotTM (RP) system (Micropos Medical, Gothenburg, SE) and nine were fitted with the Micropos Raypilot Hypocath TM (HC) system. 36.25 Gray (Gy) was delivered in 5 fractions over 7 days with daily pre- and post-treatment cone beam computed tomography (CBCT) images acquired. Acute toxicity was reported on completion of treatment at six- and 12-weeks post-treatment, using the Radiation Therapy Oncology Group (RTOG) grading system and vertical (Vrt), longitudinal (Lng) and lateral (Lat) transmitter displacements recorded. Results A significant difference was found in the Lat displacement between devices (P=0.003). A more consistent bladder volume was reported in the HC group (68.03 cc to 483.7 cc RP, 196.11 cc to 313.85 cc HC). No significant difference was observed in mean dose to the bladder, rectum and bladder dose maximum between the groups. Comparison of the rectal dose maximum between the groups reported a significant result (P=0.09). Comparing displacements with toxicity endpoints identified two significant correlations: Grade 2 Genitourinary (GU) at 6 weeks, P=0.029; and no toxicity, Gastrointestinal (GI) at 12 weeks P=0.013. Conclusion Both the directly implanted RP device and the urinary catheter-based HC device are capable of real time motion monitoring. Here, the HC system was advantageous in the SBRT prostate workflow.
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Affiliation(s)
- Joanne Mitchell
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- College of Medicine and Veterinary Medicine, the University of Edinburgh, UK
| | - Duncan B. McLaren
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Donna Burns Pollock
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Joella Wright
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Angus Killean
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Michael Trainer
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Susan Adamson
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Laura McKernan
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - William H. Nailon
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- School of Engineering, the University of Edinburgh, the King’s Buildings, Mayfield Road, Edinburgh EH9 3JL, UK
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Nangia S, Gaikwad U, Joshua P, Mookaiah M, Burela N, Thirumalai A, Chilukuri S, Gayen S, Karra AR, Sharma DS. Dosimetric benefits of customised mouth-bite for head neck cancer patients undergoing modern proton therapy - An audit. Tech Innov Patient Support Radiat Oncol 2024; 31:100265. [PMID: 39224831 PMCID: PMC11367092 DOI: 10.1016/j.tipsro.2024.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 07/06/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background and aims Proton therapy (PRT) for Head Neck Cancer (HNC), in view of the Bragg peak, spares critical structures like oral mucosa better than IMRT. In PRT, mouth-bites, besides immobilising and separating mucosal surfaces, may also negate the end-of-range effect. We retrospectively analysed the details and dosimetric impact of mouth-bites in PRT for HNC. Materials and methods The data of consecutive HNC patients treated with IMPT from May 2020 to August 2022 were studied retrospectively. Details of the mouth-bite used, compliance and resultant mucosal separation were noted. Further analysis, restricted to previously unirradiated patients, comprised volumetric dosimetric data pertaining to the mouth-bite and distal mucosal surfaces. High LET zones, corresponding to 6-12 keV/micron, for mouth-bite doses above 30 Gy, were recalculated from existing plans. Results A mouth-bite was used in 69 of 80 consecutively treated patients, ranging from 8 to 42 mm in thickness, and 12 to 52 mm in the resultant mucosal sparing. In 42 patients in whom the mouth-bite V 32 Gy was > 0, median Dmean, absolute V32, V39, V50 and V60 GyE (Gray Equivalent) of the mouth bite was 35.65 GyE (Range: 2.65 - 60 GyE), 10 cc (Range: 0.1 - 32 cc), 7.6 cc (Range: 0.1 - 30.8 cc), 5.7 cc (Range: 0.2 - 29.2 cc) and 1.45 cc (Range: 0.2 - 18.1 cc) respectively, all significantly more than the spared adjacent mucosal surface. In absence of a mouth-bite, the spared mucosa would have at least partially received the high dose received by the mouth-bite. High LET zones were noted in 12 of 48 mouth-bites. Conclusion In PRT for HNC, mouth-bites play a vital role in improving the sparing of mucosa outside the target.
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Affiliation(s)
- Sapna Nangia
- Dept of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, Tamil Nadu, India
| | - Utpal Gaikwad
- Dept of Radiation Oncology, Krupamai Cancer Hospital, Aurangabad, Maharashtra, India
| | - Patrick Joshua
- Dept of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, Tamil Nadu, India
| | - Minnal Mookaiah
- Dept of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, Tamil Nadu, India
| | - Nagarjuna Burela
- Dept of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, Tamil Nadu, India
| | - Anusha Thirumalai
- Dept of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, Tamil Nadu, India
| | - Srinivas Chilukuri
- Dept of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, Tamil Nadu, India
| | - Sanjib Gayen
- Dept of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, Tamil Nadu, India
| | - Ashok Reddy Karra
- Dept of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, Tamil Nadu, India
| | - Dayananda S. Sharma
- Dept of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, Tamil Nadu, India
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Ozluk AA, Williams GR, Dai C, Goldberg J, Malla M, Pywell C, Siwakoti K, Outlaw DA, Gupta G, El-Rayes B, Giri S, Akce M. Association between frailty and overall survival among older adults with hepatocellular carcinoma. J Geriatr Oncol 2024; 15:102045. [PMID: 39129113 DOI: 10.1016/j.jgo.2024.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/10/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION Older adults undergoing cancer treatment often experience more treatment-related toxicities and increased risk of mortality compared to younger patients. The role of frailty among older individuals as a predictor of outcomes has gained growing significance. We evaluated the association between frailty and overall survival (OS) in patients with hepatocellular carcinoma (HCC) ≥60 years. MATERIALS AND METHODS Older adults ≥60 years with HCC enrolled in a prospective single-institution registry underwent a patient-reported geriatric assessment (GA) covering multiple health domains related to prior to their initial medical oncology appointment. Frailty was measured using a 44-item deficit accumulation frailty index. We categorized patients as robust, pre-frail, and frail using standard cutpoints. The primary outcome was overall survival (OS). Univariable and multivariable models were built to evaluate the association between frailty and OS after adjusting for potential confounders. RESULTS Total of 116 older adults with HCC with a median age of 67 years were enrolled; 82% male, 27% Black, and 78% with stage III/IV disease. Overall, 19 (16.3%) were robust, 39 (33.6%) pre-frail, and 58 (50.1%) frail. There were 76 patients receiving liver directed therapy. Of these, 13 (17%) were robust, 26 (34%) were pre-frail, and 37 (49%) were frail. Over a median follow up of 0.9 years, 53 patients died. After adjusting for age, stage, etiology, and Child-Pugh class, being frail (vs. robust) was associated with worse OS (hazard ratio (HR) 2.6 [95% CI 1.03-6.56]; p = 0.04). DISCUSSION Half of the participants in this study were frail, which was independently associated with worse survival in adults ≥60 years of age with HCC. Identification of pre-treatment frailty may allow opportunities to guide treatment decisions and prognostication.
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Affiliation(s)
- Ahmet Anil Ozluk
- Division of Tulay Aktas Medical Oncology, Department of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Grant Richard Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jonathan Goldberg
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Midhun Malla
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cameron Pywell
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Krishmita Siwakoti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Darryl Alan Outlaw
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garima Gupta
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bassel El-Rayes
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smith Giri
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mehmet Akce
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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Luximon DC, Neylon J, Ritter T, Agazaryan N, Hegde JV, Steinberg ML, Low DA, Lamb JM. Results of an Artificial Intelligence-Based Image Review System to Detect Patient Misalignment Errors in a Multi-institutional Database of Cone Beam Computed Tomography-Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 120:243-252. [PMID: 38485098 DOI: 10.1016/j.ijrobp.2024.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Present knowledge of patient setup and alignment errors in image guided radiation therapy (IGRT) relies on voluntary reporting, which is thought to underestimate error frequencies. A manual retrospective patient-setup misalignment error search is infeasible owing to the bulk of cases to be reviewed. We applied a deep learning-based misalignment error detection algorithm (EDA) to perform a fully automated retrospective error search of clinical IGRT databases and determine an absolute gross patient misalignment error rate. METHODS AND MATERIALS The EDA was developed to analyze the registration between planning scans and pretreatment cone beam computed tomography scans, outputting a misalignment score ranging from 0 (most unlikely) to 1 (most likely). The algorithm was trained using simulated translational errors on a data set obtained from 680 patients treated at 2 radiation therapy clinics between 2017 and 2022. A receiver operating characteristic analysis was performed to obtain target thresholds. DICOM Query and Retrieval software was integrated with the EDA to interact with the clinical database and fully automate data retrieval and analysis during a retrospective error search from 2016 to 2017 and from 2021 to 2022 for the 2 institutions, respectively. Registrations were flagged for human review using both a hard-thresholding method and a prediction trending analysis over each individual patient's treatment course. Flagged registrations were manually reviewed and categorized as errors (>1 cm misalignment at the target) or nonerrors. RESULTS A total of 17,612 registrations were analyzed by the EDA, resulting in 7.7% flagged events. Three previously reported errors were successfully flagged by the EDA, and 4 previously unreported vertebral body misalignment errors were discovered during case reviews. False positive cases often displayed substantial image artifacts, patient rotation, and soft tissue anatomy changes. CONCLUSIONS Our results validated the clinical utility of the EDA for bulk image reviews and highlighted the reliability and safety of IGRT, with an absolute gross patient misalignment error rate of 0.04% ± 0.02% per delivered fraction.
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Affiliation(s)
- Dishane C Luximon
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California.
| | - Jack Neylon
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Timothy Ritter
- Department of Medical Physics, Virginia Commonwealth University, Richmond, Virginia
| | - Nzhde Agazaryan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - John V Hegde
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Michael L Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Daniel A Low
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - James M Lamb
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
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Van Vliet-van den Ende KM, Hoogendoorn-Mulder PG, Schokker RI, Moerland MA, Kroon PS, Roesink JM, Fajardo RD, Van der Leij F, Jürgenliemk-Schulz IM. Adaptive brachytherapy for cervical cancer in combined 1.5 T MR/HDR suite: Impact of repeated imaging. Tech Innov Patient Support Radiat Oncol 2024; 31:100262. [PMID: 39224832 PMCID: PMC11367091 DOI: 10.1016/j.tipsro.2024.100262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction At our department we have a dedicated 1.5 Tesla MRI/HDR brachytherapy suite, which provides the possibility of repeated MRI scanning before, during and after applicator insertion and before and/or after irradiation for patients with advanced cervical cancer. In this study we analysed the effect of this adaptive workflow. We investigated the number of interventions, their impact on organ doses (OAR) and the respective dose differences between total prescribed and total delivered doses. Materials and methods Seventy patients with locally advanced cervical cancer FIGO2009 stages IB-IVA, treated from June 2016 till August 2020, were retrospectively analysed. The standard brachytherapy schedule consisted of two applicator insertions and delivery of three or four HDR fractions.OARs were recontoured on the repeated MRI scans. The D2cm3 dose difference between total prescribed and total delivered dose for bladder, rectum, sigmoid and bowel were calculated. Results In total 153 interventions were performed, 3 replacements of the applicator, 23 adaptations of needle positions, bladder filling was changed 74 times and repeated rectal degassing 53 times. The impact of the rectal interventions was on average -1.2 Gy EQD23. Dose differences between total delivered and total prescribed D2cm3 for bladder, rectum, sigmoid and bowel were -0.6, 0.3, 2.2 and -0.6 Gy EQD23, respectively. Conclusions An MRI scanner integrated into the brachytherapy suite enables multiple interventions based on the scans before treatment planning and dose delivery. This allows for customized treatment according to the changing anatomy of the individual patient and a better estimation of the delivered dose.
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Affiliation(s)
| | | | - Rogier I. Schokker
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marinus A. Moerland
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra S. Kroon
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith M. Roesink
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Raquel Dávila Fajardo
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Femke Van der Leij
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
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Kraan AC, Susini F, Moglioni M, Battistoni G, Bersani D, Carra P, Cerello P, De Gregorio A, Ferrero V, Fiorina E, Franciosini G, Morrocchi M, Muraro S, Patera V, Pennazio F, Retico A, Rosso V, Sarti A, Schiavi A, Sportelli G, Traini G, Vischioni B, Vitolo V, Bisogni MG. In-beam PET treatment monitoring of carbon therapy patients: Results of a clinical trial at CNAO. Phys Med 2024; 125:104493. [PMID: 39137617 DOI: 10.1016/j.ejmp.2024.104493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/26/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE Carbon ion therapy treatments can be monitored non-invasively with in-beam Positron Emission Tomography (PET). At CNAO the INSIDE in-beam PET scanner has been used in a clinical trial (NCT03662373) to monitor cancer treatments with proton and carbon therapy. In this work we present the analysis results of carbon therapy data, acquired during the first phase of the clinical trial, analyzing data of nine patients treated at CNAO for various malignant tumors in the head-and-neck region. MATERIALS AND METHODS The patient group contained two patients requiring replanning, and seven patients without replanning, based on established protocols. For each patient the PET images acquired along the course of treatment were compared with a reference, applying two analysis methods: the beam-eye-view (BEV) method and the γ-index analysis. Time trends in several parameters were investigated, as well as the agreement with control CTs, if available. RESULTS Regarding the BEV-method, the average sigma value σ was 3.7 mm of range difference distributions for patients without changes (sensitivity of the INSIDE detector). The 3D-information obtained from the BEV analysis was partly in agreement with what was observed in the control CT. The data quality and quantity was insufficient for a definite interpretation of the time trends. CONCLUSION We analyzed carbon therapy data acquired with the INSIDE in-beam PET detector using two analysis methods. The data allowed to evaluate sensitivity of the INSIDE detector for carbon therapy and to make several recommendations for the future.
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Affiliation(s)
- Aafke Christine Kraan
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy.
| | - Filippo Susini
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Martina Moglioni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Giuseppe Battistoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Giovanni Celoria 16, 20133 Milano, Italy
| | - Davide Bersani
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Pietro Carra
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Piergiorgio Cerello
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Angelica De Gregorio
- Sapienza università di Roma, Dipartimento di Fisica, Piazzale Aldo Moro 2, 00185 Roma, Italy; Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy
| | - Veronica Ferrero
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Elisa Fiorina
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Gaia Franciosini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy; Sapienza università di Roma, Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Via A. Scarpa 14, 00161 Roma, Italy
| | - Matteo Morrocchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Silvia Muraro
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Giovanni Celoria 16, 20133 Milano, Italy
| | - Vincenzo Patera
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy; Sapienza università di Roma, Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Via A. Scarpa 14, 00161 Roma, Italy
| | - Francesco Pennazio
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Alessandra Retico
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Valeria Rosso
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Alessio Sarti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy; Sapienza università di Roma, Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Via A. Scarpa 14, 00161 Roma, Italy
| | - Angelo Schiavi
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy; Sapienza università di Roma, Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Via A. Scarpa 14, 00161 Roma, Italy
| | - Giancarlo Sportelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Giacomo Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy
| | - Barbara Vischioni
- CNAO National Center for Oncological Hadrontherapy, Via Erminio Borloni 1, 27100 Pavia, Italy
| | - Viviana Vitolo
- CNAO National Center for Oncological Hadrontherapy, Via Erminio Borloni 1, 27100 Pavia, Italy
| | - Maria Giuseppina Bisogni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
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Claridge Mackonis E, Stensmyr R, Poldy R, White P, Moutrie Z, Gorjiara T, Seymour E, Erven T, Hardcastle N, Haworth A. Improving motion management in radiation therapy: findings from a workshop and survey in Australia and New Zealand. Phys Eng Sci Med 2024; 47:813-820. [PMID: 38805104 PMCID: PMC11408578 DOI: 10.1007/s13246-024-01405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/09/2024] [Indexed: 05/29/2024]
Abstract
Motion management has become an integral part of radiation therapy. Multiple approaches to motion management have been reported in the literature. To allow the sharing of experiences on current practice and emerging technology, the University of Sydney and the New South Wales/Australian Capital Territory branch of the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) held a two-day motion management workshop. To inform the workshop program, participants were invited to complete a survey prior to the workshop on current use of motion management techniques and their opinion on the effectiveness of each approach. A post-workshop survey was also conducted, designed to capture changes in opinion as a result of workshop participation. The online workshop was the most well attended ever hosted by the ACPSEM, with over 300 participants and a response to the pre-workshop survey was received from at least 60% of the radiation therapy centres in Australia and New Zealand. Motion management is extensively used in the region with use of deep inspiration breath-hold (DIBH) reported by 98% of centres for left-sided breast treatments and 91% for at least some right-sided breast treatments. Surface guided radiation therapy (SGRT) was the most popular session at the workshop and survey results showed that the use of SGRT is likely to increase. The workshop provided an excellent opportunity for the exchange of knowledge and experience, with most survey respondents indicating that their participation would lead to improvements in the quality of delivery of treatments at their centres.
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Affiliation(s)
| | | | - Rachel Poldy
- Canberra Region Cancer Centre, Canberra, Australia
| | - Paul White
- South Eastern Sydney LHD, Randwick, Australia
| | - Zoë Moutrie
- South Western Sydney Cancer Services, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia
| | | | | | - Tania Erven
- South Western Sydney Cancer Services, Sydney, NSW, Australia
| | - Nicholas Hardcastle
- Peter MacCallum Cancer Centres, Melbourne, Australia
- Institute of Medical Physics, University of Sydney, Camperdown, Australia
| | - Annette Haworth
- Institute of Medical Physics, University of Sydney, Camperdown, Australia
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Chen JY, Tsai HY, Hou CP, Tsao SH, Chen YT, Juang HH, Lin YH. The role of prostatic urethral angle and intravesical prostatic protrusion on surgical capsule calculi formation in the prostate: A retrospective study. Investig Clin Urol 2024; 65:459-465. [PMID: 39249918 PMCID: PMC11390268 DOI: 10.4111/icu.20240171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/10/2024] [Accepted: 07/01/2024] [Indexed: 09/10/2024] Open
Abstract
PURPOSE To investigate the relationship between prostatic urethral angle (PUA) and the development of surgical capsule calculi (SCC) within the prostate, and to examine the presence and impact of intravesical prostatic protrusion (IPP). MATERIALS AND METHODS A retrospective analysis was conducted on 90 patients who underwent radical prostatectomy, with preoperative assessments using both transrectal ultrasound of the prostate (TRUS) and magnetic resonance imaging. Patients were divided into groups with and without SCC and further categorized into type 1 and type 2 stones based on the location and severity of the calculi. Statistical analysis included chi-square and independent sample t-tests, with p<0.05 considered significant. RESULTS Of the patients, 82.2% were diagnosed with SCC. No significant difference in PUA was found between patients with and without SCC. However, a notable disparity in IPP presence was observed, suggesting an inverse correlation with SCC development. Additionally, no significant differences were identified when comparing the two types of SCC based on PUA and IPP measurements. CONCLUSIONS The presence of IPP exhibited an inverse relationship with SCC, suggesting diminished urine flow pressure over the prostatic urethra may reduce the likelihood of SCC formation. However, no direct association between PUA and the presence or severity of SCC was identified. These findings highlight the complexity of factors contributing to prostatic calculi development and the potential role of IPP in this context.
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Affiliation(s)
- Jonathan Yj Chen
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Han-Yu Tsai
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ting Chen
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Horng-Heng Juang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Anatomy, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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62
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Ristau J, Hörner-Rieber J, Körber SA. MR-linac based radiation therapy in gastrointestinal cancers: a narrative review. J Gastrointest Oncol 2024; 15:1893-1907. [PMID: 39279945 PMCID: PMC11399841 DOI: 10.21037/jgo-22-961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 08/14/2023] [Indexed: 09/18/2024] Open
Abstract
Background and Objective Magnetic resonance guided radiotherapy (MRgRT) is an emerging technological innovation with more and more institutions gaining clinical experience in this new field of radiation oncology. The ability to better visualize both tumors and healthy tissues due to excellent soft tissue contrast combined with new possibilities regarding motion management and the capability of online adaptive radiotherapy might increase tumor control rates while potentially reducing the risk of radiation-induced toxicities. As conventional computed tomography (CT)-based image guidance methods are insufficient for adaptive workflows in abdominal tumors, MRgRT appears to be an optimal method for this tumor site. The aim of this narrative review is to outline the opportunities and challenges in magnetic resonance guided radiation therapy in gastrointestinal cancers. Methods We searched for studies, reviews and conceptual articles, including the general technique of MRgRT and the specific utilization in gastrointestinal cancers, focusing on pancreatic cancer, liver metastases and primary liver cancer, rectal cancer and esophageal cancer. Key Content and Findings This review is highlighting the innovative approach of MRgRT in gastrointestinal cancer and gives an overview of the currently available literature with regard to clinical experiences and theoretical background. Conclusions MRgRT is a promising new tool in radiation oncology, which can play off several of its beneficial features in the specific field of gastrointestinal cancers. However, clinical data is still scarce. Nevertheless, the available literature points out large potential for improvements regarding dose coverage and escalation as well as the reduction of dose exposure to critical organs at risk (OAR). Further prospective studies are needed to demonstrate the role of this innovative technology in gastrointestinal cancer management, in particular trials that randomly compare MRgRT with conventional CT-based image-guided radiotherapy (IGRT) would be of high value.
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Affiliation(s)
- Jonas Ristau
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
| | - Stefan A Körber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
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Huynh BN, Groendahl AR, Tomic O, Liland KH, Knudtsen IS, Hoebers F, van Elmpt W, Dale E, Malinen E, Futsaether CM. Deep learning with uncertainty estimation for automatic tumor segmentation in PET/CT of head and neck cancers: impact of model complexity, image processing and augmentation. Biomed Phys Eng Express 2024; 10:055038. [PMID: 39127060 DOI: 10.1088/2057-1976/ad6dcd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/09/2024] [Indexed: 08/12/2024]
Abstract
Objective.Target volumes for radiotherapy are usually contoured manually, which can be time-consuming and prone to inter- and intra-observer variability. Automatic contouring by convolutional neural networks (CNN) can be fast and consistent but may produce unrealistic contours or miss relevant structures. We evaluate approaches for increasing the quality and assessing the uncertainty of CNN-generated contours of head and neck cancers with PET/CT as input.Approach.Two patient cohorts with head and neck squamous cell carcinoma and baseline18F-fluorodeoxyglucose positron emission tomography and computed tomography images (FDG-PET/CT) were collected retrospectively from two centers. The union of manual contours of the gross primary tumor and involved nodes was used to train CNN models for generating automatic contours. The impact of image preprocessing, image augmentation, transfer learning and CNN complexity, architecture, and dimension (2D or 3D) on model performance and generalizability across centers was evaluated. A Monte Carlo dropout technique was used to quantify and visualize the uncertainty of the automatic contours.Main results. CNN models provided contours with good overlap with the manually contoured ground truth (median Dice Similarity Coefficient: 0.75-0.77), consistent with reported inter-observer variations and previous auto-contouring studies. Image augmentation and model dimension, rather than model complexity, architecture, or advanced image preprocessing, had the largest impact on model performance and cross-center generalizability. Transfer learning on a limited number of patients from a separate center increased model generalizability without decreasing model performance on the original training cohort. High model uncertainty was associated with false positive and false negative voxels as well as low Dice coefficients.Significance.High quality automatic contours can be obtained using deep learning architectures that are not overly complex. Uncertainty estimation of the predicted contours shows potential for highlighting regions of the contour requiring manual revision or flagging segmentations requiring manual inspection and intervention.
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Affiliation(s)
- Bao Ngoc Huynh
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Aurora Rosvoll Groendahl
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
- Section of Oncology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Oliver Tomic
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Kristian Hovde Liland
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Ingerid Skjei Knudtsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht, Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht, Netherlands
| | - Einar Dale
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
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64
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Hassan M, Kushniruk A, Borycki E. Barriers to and Facilitators of Artificial Intelligence Adoption in Health Care: Scoping Review. JMIR Hum Factors 2024; 11:e48633. [PMID: 39207831 PMCID: PMC11393514 DOI: 10.2196/48633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 02/28/2024] [Accepted: 06/12/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) use cases in health care are on the rise, with the potential to improve operational efficiency and care outcomes. However, the translation of AI into practical, everyday use has been limited, as its effectiveness relies on successful implementation and adoption by clinicians, patients, and other health care stakeholders. OBJECTIVE As adoption is a key factor in the successful proliferation of an innovation, this scoping review aimed at presenting an overview of the barriers to and facilitators of AI adoption in health care. METHODS A scoping review was conducted using the guidance provided by the Joanna Briggs Institute and the framework proposed by Arksey and O'Malley. MEDLINE, IEEE Xplore, and ScienceDirect databases were searched to identify publications in English that reported on the barriers to or facilitators of AI adoption in health care. This review focused on articles published between January 2011 and December 2023. The review did not have any limitations regarding the health care setting (hospital or community) or the population (patients, clinicians, physicians, or health care administrators). A thematic analysis was conducted on the selected articles to map factors associated with the barriers to and facilitators of AI adoption in health care. RESULTS A total of 2514 articles were identified in the initial search. After title and abstract reviews, 50 (1.99%) articles were included in the final analysis. These articles were reviewed for the barriers to and facilitators of AI adoption in health care. Most articles were empirical studies, literature reviews, reports, and thought articles. Approximately 18 categories of barriers and facilitators were identified. These were organized sequentially to provide considerations for AI development, implementation, and the overall structure needed to facilitate adoption. CONCLUSIONS The literature review revealed that trust is a significant catalyst of adoption, and it was found to be impacted by several barriers identified in this review. A governance structure can be a key facilitator, among others, in ensuring all the elements identified as barriers are addressed appropriately. The findings demonstrate that the implementation of AI in health care is still, in many ways, dependent on the establishment of regulatory and legal frameworks. Further research into a combination of governance and implementation frameworks, models, or theories to enhance trust that would specifically enable adoption is needed to provide the necessary guidance to those translating AI research into practice. Future research could also be expanded to include attempts at understanding patients' perspectives on complex, high-risk AI use cases and how the use of AI applications affects clinical practice and patient care, including sociotechnical considerations, as more algorithms are implemented in actual clinical environments.
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Affiliation(s)
- Masooma Hassan
- Department of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Andre Kushniruk
- Department of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Elizabeth Borycki
- Department of Health Information Science, University of Victoria, Victoria, BC, Canada
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Magnuson A, Loh KP, Stauffer F, Dale W, Gilmore N, Kadambi S, Klepin HD, Kyi K, Lowenstein LM, Phillips T, Ramsdale E, Schiaffino MK, Simmons JF, Williams GR, Zittel J, Mohile S. Geriatric assessment for the practicing clinician: The why, what, and how. CA Cancer J Clin 2024. [PMID: 39207229 DOI: 10.3322/caac.21864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.g., implementing physical therapy for impaired physical function). Multiple phase 3 clinical trials in older adults with solid tumors and hematologic malignancies have demonstrated that GAM improves treatment completion, quality of life, communication, and advance care planning while reducing treatment-related toxicity, falls, and polypharmacy. Nonetheless, implementation and uptake of GAM remain challenging. Various strategies have been proposed, including the use of GA screening tools, to identify patients most likely to benefit from GAM, the systematic engagement of the oncology workforce in the delivery of GAM, and the integration of technologies like telemedicine and mobile health to enhance the availability of GA and GAM interventions. Health inequities in minoritized groups persist, and systematic GA implementation has the potential to capture social determinants of health that are relevant to equitable care. Caregivers play an important role in cancer care and experience burden themselves. GA can guide dyadic supportive care interventions, ultimately helping both patients and caregivers achieve optimal health.
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Affiliation(s)
- Allison Magnuson
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Fiona Stauffer
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - William Dale
- Department of Supportive Care, City of Hope, Antelope Valley, Duarte, California, USA
| | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Sindhuja Kadambi
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Heidi D Klepin
- Section on Hematology and Oncology, Department of Medicine, Wake Forest School of Medicine, Wake Forest, North Carolina, USA
| | - Kaitlin Kyi
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Lisa M Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics, City of Hope, Antelope Valley, Duarte, California, USA
| | - Erika Ramsdale
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Melody K Schiaffino
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
| | - John F Simmons
- Cancer and Aging Research Group SCOREboard, City of Hope, Duarte, California, USA
| | - Grant R Williams
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason Zittel
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Supriya Mohile
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Lai J, Luo Z, Liu J, Hu H, Jiang H, Liu P, He L, Cheng W, Ren W, Wu Y, Piao JG, Wu Z. Charged Gold Nanoparticles for Target Identification-Alignment and Automatic Segmentation of CT Image-Guided Adaptive Radiotherapy in Small Hepatocellular Carcinoma. NANO LETTERS 2024; 24:10614-10623. [PMID: 39046153 PMCID: PMC11363118 DOI: 10.1021/acs.nanolett.4c02823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 07/25/2024]
Abstract
Because of the challenges posed by anatomical uncertainties and the low resolution of plain computed tomography (CT) scans, implementing adaptive radiotherapy (ART) for small hepatocellular carcinoma (sHCC) using artificial intelligence (AI) faces obstacles in tumor identification-alignment and automatic segmentation. The current study aims to improve sHCC imaging for ART using a gold nanoparticle (Au NP)-based CT contrast agent to enhance AI-driven automated image processing. The synthesized charged Au NPs demonstrated notable in vitro aggregation, low cytotoxicity, and minimal organ toxicity. Over time, an in situ sHCC mouse model was established for in vivo CT imaging at multiple time points. The enhanced CT images processed using 3D U-Net and 3D Trans U-Net AI models demonstrated high geometric and dosimetric accuracy. Therefore, charged Au NPs enable accurate and automatic sHCC segmentation in CT images using classical AI models, potentially addressing the technical challenges related to tumor identification, alignment, and automatic segmentation in CT-guided online ART.
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Affiliation(s)
- Jianjun Lai
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
- Instiute
of Intelligent Control and Robotics, Hangzhou
Dianzi University, Hangzhou 310018, China
| | - Zhizeng Luo
- Instiute
of Intelligent Control and Robotics, Hangzhou
Dianzi University, Hangzhou 310018, China
| | - Jiping Liu
- Department
of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Haili Hu
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
| | - Hao Jiang
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
| | - Pengyuan Liu
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
| | - Li He
- School
of Pharmaceutical Sciences, Zhejiang Chinese
Medical University, Hangzhou 310053, China
| | - Weiyi Cheng
- School
of Pharmaceutical Sciences, Zhejiang Chinese
Medical University, Hangzhou 310053, China
| | - Weiye Ren
- School
of Pharmaceutical Sciences, Zhejiang Chinese
Medical University, Hangzhou 310053, China
| | - Yajun Wu
- Department
of Pharmacy, Zhejiang Hospital, Hangzhou 310013, China
| | - Ji-Gang Piao
- School
of Pharmaceutical Sciences, Zhejiang Chinese
Medical University, Hangzhou 310053, China
| | - Zhibing Wu
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
- Department
of Radiation Oncology, Affiliated Zhejiang
Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
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Zenda S, Kashihara T, Saito T, Okamoto H, Kadoya N, Chiba T, Noda SE, Kawaguchi T, Jingu K, Shibuya K, Uno T, Igaki H. Two-fractionated stereotactic magnetic resonance-guided adaptive radiation therapy for patients with prostate cancer (SMART PRO trial): protocol for a confirmatory clinical trial. BMJ Open 2024; 14:e082899. [PMID: 39182931 PMCID: PMC11404251 DOI: 10.1136/bmjopen-2023-082899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION In an MRI-guided linear accelerator (MR-LINAC) system, the planned doses for organs at risk and for tumours are assessed by MR imaging and re-contouring at every treatment. This allows treatment to be safer and more precise by ensuring that it is suitable for the state of the patient's organs on that day, as well as by allowing images to be acquired during radiation therapy to prevent radiation while organs are in motion.Here, we will conduct a confirmatory study of two-fractionated stereotactic magnetic resonance-guided adaptive radiation therapy for patients with localised prostate cancer. METHODS AND ANALYSIS This will be a single-arm study to demonstrate the safety and efficacy of ultra-hypofractionated radiation (26 Gy/2 Fr) using an MR-LINAC system in patients with very low-intermediate risk prostate cancer.The primary endpoint will be the incidence of grade ≥2 acute urinary tract adverse events occurring within 90 days of the start of radiation therapy.The sample size has been determined to be 58. ETHICS AND DISSEMINATION This study is performed in accordance with Ethical Guidelines for Medical and Health Research Involving Human Subjects, published by Japan's Ministry of Education, Science and Technology and the Ministry of Health, Labour and Welfare and the modified act on the Protection of Personal Information as well as the Declaration of Helsinki. This study was approved by the institutional ethics committee of the National Cancer Center on 20 November 2021.The findings of this trial will be submitted to an international peer-reviewed journal and the key findings will be presented at an international scientific conference.Authorship will be ascribed in accordance with the International Committee of Medical Journal Editors guidance. TRIAL REGISTRATION NUMBER UMIN000049746.
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Affiliation(s)
- Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Supportive and Palliative Care Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Japan
| | - Tetsuo Saito
- Division of Integrative Medical Oncology, Saiseikai Kumamoto Hospital, Kumamoto-Shi, Kumamoto, Japan
| | - Hiroyuki Okamoto
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Chiba
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University, Iruma-gun, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiko Shibuya
- Department of Radiation Oncology, Osaka Metropolitan University Graduate School of Medicine School of Medicine, Osaka, Japan
| | - Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Japan
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Clough A, Pitt E, Nelder C, Benson R, McDaid L, Whiteside L, Davies L, Bridge J, Freear L, Chuter R, Berresford J, McPartlin A, Crockett C, Cobben D, Salem A, Faivre-Finn C, Huddart R, Eccles CL. Simultaneous implementation of unrelated tumour sites on the MR Linac: A review of the commissioning process from a radiographer perspective and lessons learned. J Med Imaging Radiat Sci 2024; 55:101728. [PMID: 39153404 DOI: 10.1016/j.jmir.2024.101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/29/2024] [Accepted: 07/10/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION This work reports on a systematic approach to select MRI sequences, quantify inter-observer image registration variation and determine patient positioning for the clinical implementation of MR-guided adaptive radiotherapy (MRgRT) in patients with oropharyngeal (H&N) and lung cancer. METHODS A total of 30 participants (N=10 H&N and N=10 lung cancer patients and N=10 healthy participants) were scanned on the Elekta Unity Magnetic Resonance Linear Accelerator (MRL). Participant experience questionnaires were used to determine the most appropriate positioning device for lung treatments and tolerability of H&N immobilization devices within the confined MR Linac environment. Visual guided assessments (VGAs) completed by three observers (one oncologist and two radiographers) were used to determine the most suitable tissue weighting (using vendor-provided 3D T1w and T2w sequences) for online image registration. Offline MRI to CT and MRI to MRI rigid registrations were undertaken by nine radiographers using bony and soft tissue matching. Single-factor ANOVA and paired t-tests were utilized to determine the interobserver variation. RESULTS Based on oncologist and patient feedback, lung cancer patients would be treated in a vac-bag with their arms by their sides, while H&N cancer patients would be immobilized using a 5-point fixation device and 5-point personalized thermoplastic shell. There was no clear preference for T1w or T2w images in the H&N cohort. However, observers preferred T2w sequences for tumour and organ at risk (OAR) visualization in the lung images. When a bony match was conducted, single-factor ANOVA tests showed no statistically significant differences between all H&N image registration types (p=0.09). For the soft-tissue registrations, T1w-CT and T1w-T1w registrations showed a statistically significant (p=0.01) reduction in inter-observer variability over T2w-CT registrations. Paired t-tests showed no statistically significant differences for bony or soft tissue matches using T1w or T2w sequences to the planning CT in the lung cohorts (p=0.63 and p=0.52, respectively). CONCLUSION We describe the systematic approach to the selection of strategies for imaging, immobilization, and online image registration we used for H&N and lung cancer treatments on the MRL. This has facilitated the selection of the most appropriate adaptive MRgRT strategies for treating these sites at our institution.
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Affiliation(s)
- A Clough
- The Christie NHSFT, Manchester, United Kingdom
| | - E Pitt
- The Christie NHSFT, Manchester, United Kingdom
| | - C Nelder
- The Christie NHSFT, Manchester, United Kingdom
| | - R Benson
- The Christie NHSFT, Manchester, United Kingdom
| | - L McDaid
- The Christie NHSFT, Manchester, United Kingdom
| | - L Whiteside
- The Christie NHSFT, Manchester, United Kingdom
| | - L Davies
- The Christie NHSFT, Manchester, United Kingdom
| | - J Bridge
- The Christie NHSFT, Manchester, United Kingdom
| | - L Freear
- The Christie NHSFT, Manchester, United Kingdom
| | - R Chuter
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | | | - A McPartlin
- The Christie NHSFT, Manchester, United Kingdom
| | - C Crockett
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - D Cobben
- Clatterbridge Cancer Centre, Department of Clinical Oncology; Department of Health Data Science, Institute of Population Health, University of Liverpool
| | - A Salem
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - C Faivre-Finn
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - R Huddart
- The Royal Marsden NHSFT, London, United Kingdom; The Institute for Cancer Research
| | - C L Eccles
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
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Kadhim M, Haraldsson A, Kügele M, Enocson H, Bäck S, Ceberg S. Surface guided ring gantry radiotherapy in deep inspiration breath hold for breast cancer patients. J Appl Clin Med Phys 2024:e14463. [PMID: 39138877 DOI: 10.1002/acm2.14463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/22/2024] [Accepted: 06/24/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE This study investigated the use of surface guided radiotherapy (SGRT) in combination with a tomotherapy treatment mode using discrete delivery angles for deep inspiration breath hold (DIBH) treatments of breast cancer (bc). We aimed to assess the feasibility and dosimetric advantages of this approach. MATERIALS AND METHODS We evaluated camera occlusion in the Radixact treatment system bore and the stability of DIBH signals during couch movement. The SGRT system's ability to maintain signal and surface image accuracy was analyzed at different depths within the bore. Dosimetric parameters were compared and measured for 20 left-sided bc patients receiving TomoDirect (TD) tangential radiotherapy in both DIBH and free breathing (FB). RESULTS The SGRT system maintained surface coverage and precise DIBH-signal at depths up to 40 cm beyond the treatment center. Camera occlusion occurred in the clavicular and neck regions due to the patient's morphology and gantry geometry. Nonetheless, the system accurately detected respiratory motion for all measurements. The DIBH plans significantly (p < 0.001) reduced mean heart and left anterior descending artery (LAD) radiation doses by up to 40%, with a 50% reduction in near-maximum heart and LAD doses, respectively. No significant dosimetric differences between DIBH and FB were observed in other investigated parameters and volumes. CONCLUSIONS Camera occlusion and couch movement minimally impacted the real-time surface image accuracy needed for DIBH treatments of bc. DIBH reduced heart and LAD radiation doses significantly compared to FB, indicating the feasibility and dosimetric benefits of combining these modalities.
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Affiliation(s)
- Mustafa Kadhim
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - André Haraldsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Malin Kügele
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Hedda Enocson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Bäck
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sofie Ceberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
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Hay L, McLoone P, Campbell F, Reid H, James A, Lamb C, Schipani S, Grose D, Wilson C, Paterson C. How did the COVID-19 pandemic change patient experience during radiation therapy for head and neck cancer: A single centre survey. J Med Imaging Radiat Sci 2024; 55:101712. [PMID: 39128320 DOI: 10.1016/j.jmir.2024.101712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/07/2024] [Accepted: 06/18/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION/BACKGROUND Patients receiving treatment for head and neck cancer (HNC) with curative intent, will potentially undergo primary or adjuvant radiation therapy (RT). These patients require supportive management from an extended multi-disciplinary team, to manage the severe toxicities and distress that a course of treatment can bring. A survey was designed to determine if there were changes in the experience of HNC patients attending for radical RT, from the beginning to the end of their treatment course. During the conduct of the survey the COVID-19 pandemic began. As a result cancer services were adapted to keep patients receiving treatment protected from the virus, while continuing to treat their malignant disease. This enabled a comparison of HNC patient experiences pre-pandemic (PP) and during the pandemic (DP). The study aimed to assess the impact of changes in treatment logistics, implemented as a result of the COVID-19 pandemic, on the patient experience, analysing and comparing how well patients understood the information provided to them, their level of distress and anxiety during treatment, and their overall satisfaction with the experience. METHODS Eligible patients were receiving radical RT for HNC of any sub-site or histological type. Identical, anonymous surveys were distributed to patients at week 1 and the final week of RT. The initial PP questionnaire (distributed December 2019 to 11th March 2020) contained 22 questions with space for free text. The questionnaire was amended DP to include 6 additional COVID-19 related questions (distributed June to November 2020). RESULTS One hundred and eighty two surveys were returned; 95 (52%) PP and 87 (48%) DP. Patients were moderately distressed from wearing the immobilisation mask towards the end of treatment DP with a statistically significant difference in the final week, median (IQR) values of 1 (0-4) PP and 2 (1-6) DP, p=0.024. Patients reported increased distress by attending daily for treatment by the final week of RT DP, with a PP and DP median of 1 (0-3) and 2 (1-4) respectively, p=0.039. Patients reporting increased levels of distress about attending for RT also reported high levels of anxiety about COVID-19 (r=0.40, p=0.005). COVID-19 anxiety score displayed a weak inverse association with overall treatment satisfaction score (r=-0.28, p=0.008). CONCLUSION Despite the adapted COVID-19 working practices implemented and the challenges a course of head and neck RT entails, patients reported a positive experience attending for treatment, both PP and DP.
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Affiliation(s)
- Lisa Hay
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland.
| | - Philip McLoone
- School of Health & Wellbeing, Clarice Pears Building, University of Glasgow, G12 8TB Scotland
| | - Frances Campbell
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Heather Reid
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Allan James
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Carolynn Lamb
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Stefano Schipani
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Derek Grose
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Christina Wilson
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Claire Paterson
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
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Otten M, Djamei V, Augustin M. Development, Feasibility, and Acceptability of the Electronic Patient Benefit Index for Psoriasis in Clinical Practice: Mixed Methods Study. JMIR DERMATOLOGY 2024; 7:e54762. [PMID: 39121470 PMCID: PMC11344180 DOI: 10.2196/54762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Patient-reported outcomes are relevant in clinical practice showing patient benefits, supporting clinicians' decision-making, and contributing to the delivery of high standards of care. Digital monitoring of patient-reported outcomes is still rare. The Patient Benefit Index (PBI) measures benefits and goals from patients' views and may be relevant for regular documentation and shared decision-making. OBJECTIVE This study aimed to develop electronic versions of the PBI to examine their feasibility and acceptability in clinical practice for patients with psoriasis. METHODS We developed an app and a web version of the existing, valid PBI using focus groups and cognitive debriefings with patients before conducting a quantitative survey on its feasibility and acceptability. Conduction took part in an outpatient dermatology care unit in Germany. Descriptive and subgroup analyses were conducted. RESULTS A total of 139 patients completed the electronic PBIs (ePBIs) and took part in the survey. The ePBI was understandable (n=129-137, 92.8%-98.6%) and feasible, for example, easy to read (n=135, 97.1%) and simple to handle (n=137, 98.5%). Acceptability was also high, for example, patients can imagine using and discussing the ePBI data in practice (n=91, 65.5%) and documenting it regularly (n=88, 63.3%). They believe it could support treatment decisions (n=118, 84.9%) and improve communication with their physician (n=112, 81.3%). They can imagine filling in electronic questionnaires regularly (n=118, 84.9%), even preferring electronic over paper versions (n=113, 81.2%). Older and less educated people show less feasibility, but the latter expected the relationship with their physician to improve and would be more willing to invest time or effort. CONCLUSIONS The app and web version of the PBI are usable and acceptable for patients offering comprehensive documentation and patient participation in practice. An implementation strategy should consider patients' needs, barriers, and facilitators but also physicians' attitudes and requirements from the health care system.
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Affiliation(s)
- Marina Otten
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vahid Djamei
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Stankiewicz M, Maletta A, Tan C, Howard DAF, Olson DR. BC cancer radiation therapists' perspective on the impact of COVID-19 precautions in clinical practice. J Med Imaging Radiat Sci 2024; 55:101734. [PMID: 39116834 DOI: 10.1016/j.jmir.2024.101734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION There were many policy and procedure (P&P) changes implemented in health care facilities to combat the spread of the coronavirus disease 2019 (COVID-19). Common changes included an increase in personal protective equipment usage, room occupancy limits, limitations in visitors/family members and the absence of volunteers. This study evaluated the current views and opinions of Radiation Therapists (RTs) in British Columbia relating to how COVID-19 P&P changes have impacted their clinical practice. The goal was to identify gaps in the areas of RT practice, allow for self-reflection among RTs and potentially guide future P&Ps with patient-centred care at the forefront. METHODS A 24-item cross-sectional questionnaire was created and sent via e-mail to all RTs working across the province. Key sections explored in the questionnaire were: 1) patient care delivery, 2) staff-work environment, and 3) work satisfaction. Descriptive analysis was performed on the questionnaire responses. RESULTS Of the approximate 300 invited participants, 107 responses were received from all areas of Radiation Therapy (Treatment units, CT simulation, Dosimetry, etc.) and from all cancer centres in the province. RT staff indicated that COVID-19 P&P negatively impacted patient care, including the ability to verbally and non-verbally communicate with patients (82 %), assess for side effects (85 %), and build rapport (62 %). A majority (79 %) of RT staff felt that communication with co-workers had been negatively impacted as well. When queried regarding the impact on staff environment, 51 % of RT staff agreed that the absence of volunteers increased their workload and the responses were polarized (46 % disagree, 35 % agree) when asked if RT staff have enough time for cleaning their clinical areas with new COVID-19 P&Ps in place. 78 % of RTs were aware of where to go with COVID-19 safety concerns and thought they received adequate education concerning COVID P&Ps. When asked to rank the factors that most impacted RT practice, RTs identified increased PPE usage (83 %), absence of volunteers (74 %), and room occupancy limits (70 %) as the leading P&P changes that negatively impacted their practice; while plexiglass barriers (39 %), re-arranged workspaces (37 %) and working remotely (12 %) were the least negatively impactful. CONCLUSION The majority of RTs across BC Cancer responding to the questionnaire indicated that their ability to provide patient care and their staff-work environment were negatively impacted by implemented COVID-19 P&Ps. Views regarding COVID-19 P&P training/education was positive, yet there was no consensus regarding whether the changes were implemented smoothly. This study can facilitate reflection among both clinical leadership and RTs on how P&Ps can be implemented in the future and can encourage further retrospective analyses in aiding the development of P&Ps regarding future public health outbreaks.
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Affiliation(s)
- Michal Stankiewicz
- BC Cancer Centre for the North, Radiation Therapy, Prince George, BC, Canada.
| | - Anthony Maletta
- BC Cancer Centre for the North, Radiation Therapy, Prince George, BC, Canada
| | - Christopher Tan
- BC Cancer Centre for the North, Radiation Therapy, Prince George, BC, Canada
| | - Dr A Fuchsia Howard
- The University of British Columbia, Faculty of Applied Sciences, School of Nursing, Vancouver, BC, Canada
| | - Dr Robert Olson
- BC Cancer Centre for the North, Radiation Oncology, Prince George, BC, Canada
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Fereidooni M, Toni E, Toni E, Ayatollahi H. Application of virtual reality for supportive care in cancer patients: a systematic review. Support Care Cancer 2024; 32:570. [PMID: 39103681 DOI: 10.1007/s00520-024-08763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND In recent years, virtual reality (VR) technology has been widely used to support cancer patients with physical, emotional, and functional needs. This systematic review aimed to investigate the application of VR in the supportive care of cancer patients. METHOD This systematic review was conducted in 2024. In this study, various databases including PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, IEEE Xplore, and ProQuest were searched, and quantitative, qualitative, and mixed-method studies which were in English and published up to 20th May 2024 were included. The keywords consisted of "virtual reality," "supportive care," and "cancer". Studies were assessed in terms of quality and risk of bias using standard tools, and results were analyzed and reported narratively. RESULTS A total of 33 articles were reviewed. VR interventions, primarily using fully immersive head-mounted displays, were associated with significant reductions in anxiety, pain, and fatigue. VR also improved mood, relaxation, and overall quality of life, and some studies noted enhanced vital signs such as heart rate and blood pressure. This technology could be used along with other medical interventions. Both patients and healthcare providers reported high level of satisfaction with VR, and appreciated its ease of use and therapeutic benefits. However, some technical barriers, like inadequate visual performance and realism, were reported. CONCLUSION VR demonstrates substantial potential benefits as a supportive care tool for cancer patients, effectively addressing their psychological, physiological, psychosocial needs. Despite technical challenges, high level of user satisfaction and benefits underscore the need for further research to optimize VR interventions in cancer care.
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Affiliation(s)
- Mahsa Fereidooni
- Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran
| | - Esmaeel Toni
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
| | - Elham Toni
- Department of Health Information Management and Technology, Faculty of Management and Health Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
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Kornek D, Lotter M, Szkitsak J, Dürrbeck C, Karius A, Ott OJ, Brandl C, Bert C. Improving the safety of radiotherapy treatment processes via incident-driven FMEA feedback loops. J Appl Clin Med Phys 2024:e14455. [PMID: 39101683 DOI: 10.1002/acm2.14455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/22/2024] [Accepted: 06/26/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Failure mode and effects analysis (FMEA) is a valuable tool for radiotherapy risk assessment, yet its outputs might be unreliable due to failures not being identified or due to a lack of accurate error rates. PURPOSE A novel incident reporting system (IRS) linked to an FMEA database was tested and evaluated. The study investigated whether the system was suitable for validating a previously performed analysis and whether it could provide accurate error rates to support the expert occurrence ratings of previously identified failure modes. METHODS Twenty-three pre-identified failure modes of our external beam radiotherapy process, covering the process steps from patient admission to treatment delivery, were proffered on dedicated FMEA feedback and incident reporting terminals generated by the IRS. The clinical setting involved a computed tomography scanner, dosimetry, and five linacs. Incoming reports were used as basis to identify additional failure modes or confirm initial ones. The Kruskal-Wallis H test was applied to compare the risk priorities of the retrospective and prospective failure modes. Wald's sequential probability ratio test was used to investigate the correctness of the experts' occurrence ratings by means of the number of incoming reports. RESULTS Over a 15-month period, 304 reports were submitted. There were 0.005 (confidence interval [CI], 0.0014-0.0082) reported incidents per imaging study and 0.0006 (CI, 0.0003-0.0009) reported incidents per treatment fraction. Sixteen additional failure modes could be identified, and their risk priorities did not differ from those of the initial failure modes (p = 0.954). One failure mode occurrence rating could be increased, whereas the other 22 occurrence ratings could not be disproved. CONCLUSIONS Our approach is suitable for validating FMEAs and deducing additional failure modes on a continual basis. Accurate error rates can only be provided if a sufficient number of reports is available.
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Affiliation(s)
- Dominik Kornek
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Juliane Szkitsak
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christopher Dürrbeck
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Oliver J Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Carolin Brandl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Salama V, Godinich B, Geng Y, Humbert-Vidan L, Maule L, Wahid KA, Naser MA, He R, Mohamed ASR, Fuller CD, Moreno AC. Artificial Intelligence and Machine Learning in Cancer Pain: A Systematic Review. J Pain Symptom Manage 2024:S0885-3924(24)00908-4. [PMID: 39097246 DOI: 10.1016/j.jpainsymman.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND/OBJECTIVES Pain is a challenging multifaceted symptom reported by most cancer patients. This systematic review aims to explore applications of artificial intelligence/machine learning (AI/ML) in predicting pain-related outcomes and pain management in cancer. METHODS A comprehensive search of Ovid MEDLINE, EMBASE and Web of Science databases was conducted using terms: "Cancer," "Pain," "Pain Management," "Analgesics," "Artificial Intelligence," "Machine Learning," and "Neural Networks" published up to September 7, 2023. AI/ML models, their validation and performance were summarized. Quality assessment was conducted using PROBAST risk-of-bias andadherence to TRIPOD guidelines. RESULTS Forty four studies from 2006 to 2023 were included. Nineteen studies used AI/ML for classifying pain after cancer therapy [median AUC 0.80 (range 0.76-0.94)]. Eighteen studies focused on cancer pain research [median AUC 0.86 (range 0.50-0.99)], and 7 focused on applying AI/ML for cancer pain management, [median AUC 0.71 (range 0.47-0.89)]. Median AUC (0.77) of models across all studies. Random forest models demonstrated the highest performance (median AUC 0.81), lasso models had the highest median sensitivity (1), while Support Vector Machine had the highest median specificity (0.74). Overall adherence to TRIPOD guidelines was 70.7%. Overall, high risk-of-bias (77.3%), lack of external validation (14%) and clinical application (23%) was detected. Reporting of model calibration was also missing (5%). CONCLUSION Implementation of AI/ML tools promises significant advances in the classification, risk stratification, and management decisions for cancer pain. Further research focusing on quality improvement, model calibration, rigorous external clinical validation in real healthcare settings is imperative for ensuring its practical and reliable application in clinical practice.
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Affiliation(s)
- Vivian Salama
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Brandon Godinich
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Medical Education (B.G.), Paul L. Foster School of Medicine, Texas Tech Health Sciences Center, El Paso, TX, USA
| | - Yimin Geng
- Research Medical Library (Y.G.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laia Humbert-Vidan
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Maule
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kareem A Wahid
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed A Naser
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renjie He
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Moreno
- Department of Radiation Oncology (V.S., B.G., L.H.V., L.M., K.A.W., M.A.N., R.H., A.S.R.M., C.D.F., A.C.M), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Salahuddin S, Buzdar SA, Iqbal K, Azam MA, Aslam M, Altaf S, Ikhlaq A, Mustafa MU, Strigari L. Quality assurance for cancer patient safety: Clinical assessment for precise angles in linac during radiation therapy. TUMORI JOURNAL 2024:3008916241261450. [PMID: 39096026 DOI: 10.1177/03008916241261450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
PURPOSE Quality assurance for stereotactic body radiation treatment requires that isocentric verification be ensured during gantry rotation at various angles. This study examined statistical parameters on Winston-Lutz tests to distinguish the deviation of angles from isocenter during gantry rotation using machine learning. METHOD The Varian TrueBeam linac was aligned with the marked lines on the Ruby phantom. Eight images were captured while the gantry was rotating at a 45° shift. The statistical features were derived from IsoCheck EPID software. The decision tree model was applied to these Winston-Lutz tests to cluster data into two groups: precise and error angles. RESULTS At 90° and 270° angles, the gantry exhibits isocentric stability compared to other angles. In these angles, the most statistical features were inside the range. Most variations were observed at 0° and 180° angles. In most tests, the angles 45°, 135°, 225°, and 315° showed reasonable performance and with less variation. CONCLUSION The comprehensive statistical analyses for gantry rotation of angles assists expert radiotherapists in determining the contribution of each feature that highly affects gantry movement at specific angles. Misalignment between radiation isocenter and imaging isocenter, tuning of the beam at each angle, or a slight change in the position of the Ruby phantom can further improve the inaccuracy that causes the most variations. Better precision can effectively increase patient safety and quality during cancer treatment.
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Affiliation(s)
- Sana Salahuddin
- Institute of Physics, The Islamia University of Bahawalpur, Pakistan
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | - Khalid Iqbal
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Muhammad Adeel Azam
- Department of Advanced Robotics, Italian Institute of Technology (IIT), Genova, Italy
| | - Mamona Aslam
- Institute of Physics, The Islamia University of Bahawalpur, Pakistan
| | - Saima Altaf
- Institute of Physics, The Islamia University of Bahawalpur, Pakistan
| | - Ayesha Ikhlaq
- Institute of Physics, The Islamia University of Bahawalpur, Pakistan
| | | | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
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Magon H, Smith J, Besson J, Hau E, Taylor S, Ruben J, Jones D, Mabb K, Feldman J, Gholam Rezaei L, Lee YY. Adapting to change: exploring perceptions and demands of the coronavirus (COVID-19) workforce changes - an Australian multi-institutional radiation oncology survey. AUST HEALTH REV 2024; 48:388-395. [PMID: 38467124 DOI: 10.1071/ah23183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Objective To evaluate the perceptions of the coronavirus disease 2019 (COVID-19) initiated workplace strategies implemented in radiation oncology departments across Australia. Methods A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies on areas such as patient care, staff education, well-being, flexible working arrangements, and research. The survey was conducted from November 2020 to April 2021. Results Out of 210 respondents from seven institutions, 45% reported burnout and 57% experienced work work-related stress. A significant majority of respondents were in favour of continued remote work (86%, 131/153). Radiation oncologists identified administrative or non-clinical work (92%, 34/37), telehealth clinics (32%, 12/37), or radiation therapy planning (22%, 8/37) as suitable for remote work. Additionally, 54% (21/39) of the radiation oncologists plan to use telehealth more frequently, with 67% (26/39) feeling more confident with the technology. The majority (81%, 171/210) of participants favoured continuation of hybrid in-person and virtual meetings. Virtual solutions were adopted for quality assurance activities (72%, 118/165) and 52% (60/116) indicated preference for ongoing utility of virtual platforms. However, 38% (79/210) of the respondents expressed concerns about the negative impact on junior staff training. Conclusion These findings reveal a strong inclination towards technological advancements and remote work arrangements to enable flexible working conditions. Our study suggests the need for ongoing reforms, focusing on improving clinical service delivery efficiencies and enhancing job satisfaction among clinicians.
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Affiliation(s)
- Honor Magon
- Digital Health and Informatics, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld 4102, Australia
| | - Justin Smith
- Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld, Australia; and Faculty of Medicine, University of QLD, Brisbane, Qld, Australia; and College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia
| | - Jacqueline Besson
- Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld, Australia
| | - Eric Hau
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia; and Blacktown Haematology and Oncology Cancer Cente, Blacktown Hospital, Sydney, NSW, Australia; and Westmead Institute of Medical Research, Sydney, NSW, Australia; and Westmead Medical School, University of Sydney, Sydney, NSW, Australia
| | - Suzanne Taylor
- Faculty of Medicine, University of QLD, Brisbane, Qld, Australia; and Department of Radiation Oncology, Princess Alexandra Hospital Raymond Terrace Campus, Brisbane, Qld, Australia
| | | | - Diana Jones
- Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld, Australia
| | - Kira Mabb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital Ipswich Road Campus, Brisbane, Qld, Australia
| | - Jamie Feldman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital Ipswich Road Campus, Brisbane, Qld, Australia
| | - Leily Gholam Rezaei
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Yoo Young Lee
- Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld, Australia; and Faculty of Medicine, University of QLD, Brisbane, Qld, Australia
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Alfishawy MM, Kany AI, Elshahat KM. Impact of flattening filter-free beams on remaining volume at risk in lung cancer treatment. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024; 63:455-464. [PMID: 38762614 DOI: 10.1007/s00411-024-01073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
Modern radiotherapy machines offer a new modality, like flattening filter-free beam (FFF), which is used especially in stereotactic body radiation therapy (SBRT) to reduce treatment time. The remaining volume at risk (RVR) is known as undefined normal tissue, and assists in evaluating late effects such as carcinogenesis. This study aimed to compare the effects of flattening and un-flattened beams on RVR in lung cancer treated by conventional doses using volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT). Twenty-three lung cancer patients with a prescribed dose of 60 Gy delivered in 30 fractions were selected retrospectively. Four treatment plans were generated for each case (VMAT FF, VMAT FFF, IMRT FF and IMRT FFF). Mean doses to RVR and volumes that received low doses (V15Gy, V10Gy and V5Gy) were introduced as RVR evaluation parameters. Variance percentage comparison between flattening filter (FF) and FFF for the RVR evaluation parameters gave 2.38, 1.10, 1.80 and 2.22 for VMAT, and 1.73, 1.18, 1.62 and 1.81 for IMRT. In contrast, VMAT and IMRT RVR evaluation parameters resulted in variance percentage differences of 10.29, 5.02, - 8.84 and - 4.82 for FF, and 11.18, 4.96, - 8.59 and - 4.48for FFF. It is concluded that in terms of RVR evaluation parameters, FFF is clinically beneficial compared to FF for RVR, due to the decrease in mean RVR dose and low-dose irradiated RVR volume. Furthermore, VMAT is preferred in the mean RVR dose and V15Gy, while IMRT is better in V10Gy and V5Gy for RVR.
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Affiliation(s)
| | - Amr Ismail Kany
- Radiation Physics, Faculty of Science, Al -Azhar University, Cairo, Egypt
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Hurkmans C, Bibault JE, Brock KK, van Elmpt W, Feng M, David Fuller C, Jereczek-Fossa BA, Korreman S, Landry G, Madesta F, Mayo C, McWilliam A, Moura F, Muren LP, El Naqa I, Seuntjens J, Valentini V, Velec M. A joint ESTRO and AAPM guideline for development, clinical validation and reporting of artificial intelligence models in radiation therapy. Radiother Oncol 2024; 197:110345. [PMID: 38838989 DOI: 10.1016/j.radonc.2024.110345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND PURPOSE Artificial Intelligence (AI) models in radiation therapy are being developed with increasing pace. Despite this, the radiation therapy community has not widely adopted these models in clinical practice. A cohesive guideline on how to develop, report and clinically validate AI algorithms might help bridge this gap. METHODS AND MATERIALS A Delphi process with all co-authors was followed to determine which topics should be addressed in this comprehensive guideline. Separate sections of the guideline, including Statements, were written by subgroups of the authors and discussed with the whole group at several meetings. Statements were formulated and scored as highly recommended or recommended. RESULTS The following topics were found most relevant: Decision making, image analysis, volume segmentation, treatment planning, patient specific quality assurance of treatment delivery, adaptive treatment, outcome prediction, training, validation and testing of AI model parameters, model availability for others to verify, model quality assurance/updates and upgrades, ethics. Key references were given together with an outlook on current hurdles and possibilities to overcome these. 19 Statements were formulated. CONCLUSION A cohesive guideline has been written which addresses main topics regarding AI in radiation therapy. It will help to guide development, as well as transparent and consistent reporting and validation of new AI tools and facilitate adoption.
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Affiliation(s)
- Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands; Department of Electrical Engineering, Technical University Eindhoven, Eindhoven, the Netherlands.
| | | | - Kristy K Brock
- Departments of Imaging Physics and Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Mary Feng
- University of California San Francisco, San Francisco, CA, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, TX
| | - Barbara A Jereczek-Fossa
- Dept. of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Dept. of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stine Korreman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, a Partnership between DKFZ and LMU University Hospital Munich, Germany; Bavarian Cancer Research Center (BZKF), Partner Site Munich, Munich, Germany
| | - Frederic Madesta
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chuck Mayo
- Institute for Healthcare Policy and Innovation, University of Michigan, USA
| | - Alan McWilliam
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Filipe Moura
- CrossI&D Lisbon Research Center, Portuguese Red Cross Higher Health School Lisbon, Portugal
| | - Ludvig P Muren
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jan Seuntjens
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network & Departments of Radiation Oncology and Medical Biophysics, University of Toronto, Toronto, Canada
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michael Velec
- Radiation Medicine Program, Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, Canada
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Moore LC, Nematollahi F, Li L, Meyers SM, Kisling K. Improving 3D dose prediction for breast radiotherapy using novel glowing masks and gradient-weighted loss functions. Med Phys 2024. [PMID: 39088756 DOI: 10.1002/mp.17326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/17/2024] [Accepted: 07/08/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND The quality of treatment plans for breast cancer can vary greatly. This variation could be reduced by using dose prediction to automate treatment planning. Our work investigates novel methods for training deep-learning models that are capable of producing high-quality dose predictions for breast cancer treatment planning. PURPOSE The goal of this work was to compare the performance impact of two novel techniques for deep learning dose prediction models for tangent field treatments for breast cancer. The first technique, a "glowing" mask algorithm, encodes the distance from a contour into each voxel in a mask. The second, a gradient-weighted mean squared error (MSE) loss function, emphasizes the error in high-dose gradient regions in the predicted image. METHODS Four 3D U-Net deep learning models were trained using the planning CT and contours of the heart, lung, and tumor bed as inputs. The dataset consisted of 305 treatment plans split into 213/46/46 training/validation/test sets using a 70/15/15% split. We compared the impact of novel "glowing" anatomical mask inputs and a novel gradient-weighted MSE loss function to their standard counterparts, binary anatomical masks, and MSE loss, using an ablation study methodology. To assess performance, we examined the mean error and mean absolute error (ME/MAE) in dose across all within-body voxels, the error in mean dose to heart, ipsilateral lung, and tumor bed, dice similarity coefficient (DSC) across isodose volumes defined by 0%-100% prescribed dose thresholds, and gamma analysis (3%/3 mm). RESULTS The combination of novel glowing masks and gradient weighted loss function yielded the best-performing model in this study. This model resulted in a mean ME of 0.40%, MAE of 2.70%, an error in mean dose to heart and lung of -0.10 and 0.01 Gy, and an error in mean dose to the tumor bed of -0.01%. The median DSC at 50/95/100% isodose levels were 0.91/0.87/0.82. The mean 3D gamma pass rate (3%/3 mm) was 93%. CONCLUSIONS This study found the combination of novel anatomical mask inputs and loss function for dose prediction resulted in superior performance to their standard counterparts. These results have important implications for the field of radiotherapy dose prediction, as the methods used here can be easily incorporated into many other dose prediction models for other treatment sites. Additionally, this dose prediction model for breast radiotherapy has sufficient performance to be used in an automated planning pipeline for tangent field radiotherapy and has the major benefit of not requiring a PTV for accurate dose prediction.
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Affiliation(s)
- Lance C Moore
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
| | - Fatemeh Nematollahi
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
| | - Lingyi Li
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
| | - Sandra M Meyers
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
| | - Kelly Kisling
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
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Saito M, Ueda K, Nemoto H, Onishi Y, Suzuki H, Suzuki T, Sano N, Komiyama T, Marino K, Onishi H. Development of a phantom for assessing the precision of setup in skin mark-less surface-guided radiotherapy. J Appl Clin Med Phys 2024; 25:e14381. [PMID: 38696715 PMCID: PMC11302819 DOI: 10.1002/acm2.14381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/19/2024] [Accepted: 04/10/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Surface-guided radiotherapy (SGRT) is adopted by several institutions; however, reports on the phantoms used to assess the precision of the SGRT setup are limited. PURPOSE The purpose of this study was to develop a phantom to verify the accuracy of the irradiation position during skin mark-less SGRT. METHODS An acrylonitrile butadiene styrene (ABS) plastic cube phantom with a diameter of 150 mm on each side containing a dummy target of 15 mm and two types of body surface-shaped phantoms (breast/face shape) that could be attached to the cube phantom were fabricated. Films can be inserted on four sides of the cubic phantom (left, right, anterior and posterior), and the center of radiation can be calculated by irradiating the dummy target with orthogonal MV beams. Three types of SGRT using a VOXELAN-HEV600M (Electronics Research&Development Corporation, Okayama, Japan) were evaluated using this phantom: (i) SGRTCT-a SGRT set-up based solely on a computed tomography (CT)-reference image. (ii) SGRTCT + CBCT-a method where cone beam computed tomography (CBCT) matching was performed after SGRTCT. (iii) SGRTScan-a resetup technique using a scan reference image obtained after completing the (ii) step. RESULTS Both the breast and face phantoms were recognized in the SGRT system without problems. SGRTScan ensure precision within 1 mm/1° for breast and face verification, respectively. All SGRT methods showed comparable rotational accuracies with no significant disparities. CONCLUSIONS The developed phantom was useful for verifying the accuracy of skin mark-less SGRT position matching. The SGRTScan demonstrated the feasibility of achieving skin-mark less SGRT with high accuracy, with deviations of less than 1 mm. Additional research is necessary to evaluate the suitability of the developed phantoms for use in various facilities and systems. This phantom could be used for postal surveys in the future.
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Affiliation(s)
- Masahide Saito
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Koji Ueda
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Hikaru Nemoto
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Yoshiko Onishi
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Hidekazu Suzuki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Naoki Sano
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Kan Marino
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiYamanashiJapan
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Sterpin E, Widesott L, Poels K, Hoogeman M, Korevaar EW, Lowe M, Molinelli S, Fracchiolla F. Robustness evaluation of pencil beam scanning proton therapy treatment planning: A systematic review. Radiother Oncol 2024; 197:110365. [PMID: 38830538 DOI: 10.1016/j.radonc.2024.110365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 04/30/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024]
Abstract
Compared to conventional radiotherapy using X-rays, proton therapy, in principle, allows better conformity of the dose distribution to target volumes, at the cost of greater sensitivity to physical, anatomical, and positioning uncertainties. Robust planning, both in terms of plan optimization and evaluation, has gained high visibility in publications on the subject and is part of clinical practice in many centers. However, there is currently no consensus on the methods and parameters to be used for robust optimization or robustness evaluation. We propose to overcome this deficiency by following the modified Delphi consensus method. This method first requires a systematic review of the literature. We performed this review using the PubMed and Web Of Science databases, via two different experts. Potential conflicts were resolved by a third expert. We then explored the different methods before focusing on clinical studies that evaluate robustness on a significant number of patients. Many robustness assessment methods are proposed in the literature. Some are more successful than others and their implementation varies between centers. Moreover, they are not all statistically or mathematically equivalent. The most sophisticated and rigorous methods have seen more limited application due to the difficulty of their implementation and their lack of widespread availability.
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Affiliation(s)
- E Sterpin
- KU Leuven - Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium; UCLouvain - Institution de Recherche Expérimentale et Clinique, Center of Molecular Imaging Radiotherapy and Oncology (MIRO), Brussels, Belgium; Particle Therapy Interuniversity Center Leuven - PARTICLE, Leuven, Belgium.
| | - L Widesott
- Proton Therapy Center - UO Fisica Sanitaria, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - K Poels
- Particle Therapy Interuniversity Center Leuven - PARTICLE, Leuven, Belgium; UZ Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - M Hoogeman
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, the Netherlands; HollandPTC, Delft, the Netherlands
| | - E W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - M Lowe
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - S Molinelli
- Fondazione CNAO - Medical Physics Unit, Pavia, Italy
| | - F Fracchiolla
- Proton Therapy Center - UO Fisica Sanitaria, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Cucchiaro B, Davies NA, Weekes CE, O'Reilly M, Roddie C, Slee A. Malnutrition and cachexia are associated with poor CAR T-cell therapy outcomes including survival. Clin Nutr ESPEN 2024; 62:206-215. [PMID: 38901943 DOI: 10.1016/j.clnesp.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND & AIMS Chimeric Antigen Receptor (CAR) T-cell therapy has emerged as a revolutionary treatment for patients with refractory or relapsed B-cell malignancies. However, a significant proportion of patients experience negative outcomes, including severe inflammatory toxicities and relapse. Cachexia and malnutrition are known secondary syndromes in many cancer patients, attributed to the effects of active malignancy, systemic inflammation, and cumulative treatment burden; however, further research is required to accurately characterise these issues in CAR T-cell patients. The aims of this service evaluation were to explore the changes in nutritional status (malnutrition and cachexia) in CAR T-cell therapy patients and the potential impact on patient outcomes including survival. Additionally, we describe the utilisation of dietetic resources in this specific patient population in a London tertiary referral centre. METHODS Adult haematology patients receiving licensed CD19-targeting CAR T-cell therapy at University College London Hospital between 01/04/19 and 01/09/21 were included. Data were collected from the time of treatment consent, and throughout admission to day of discharge: body weight (BW), C-reactive protein, albumin, lactate dehydrogenase, nutrition-risk screening scores (hospital-specific) and dietetic input. Clinical outcomes such as 12-month all-cause mortality, intensive care unit (ICU) admission, high-grade toxicities, and length of hospital stay (LoS) were also recorded. Cachexia and malnutrition were defined using the modified Glasgow Prognostic Score (mGPS) and Global Leadership Initiative on Malnutrition (GLIM) consensus, respectively. RESULTS 114 patients (55.6 ± 15.1 years; 57% males) with B-cell non-Hodgkin's lymphoma (n = 109) and B-cell acute lymphoblastic leukaemia (n = 5), receiving axicabtagene ciloleucel (n = 89) and tisagenlecleucel (n = 25) were included. Median LoS for treatment was 34 (27-38) days. Prior to treatment, 31.5% of patients developed malnutrition, with pre-cachexia/refractory cachexia (mGPS) identified in 43.6% of patients. This altered nutritional status pre-treatment was significantly associated with adverse patient outcomes post-infusion; mGPS was independently associated with inferior overall survival (HR = 3.158, CI = 1.36-7.323, p = 0.007), with malnutrition and mGPS associated with increased LoS (p = 0.037), sepsis (p = 0.022) and ICU admission (p = 0.039). During admission, patients experienced significant BW loss (-5.6% (-8.8 to -2.4); p=<0.001), with 68.4% developing malnutrition. Malnutrition screening during admission identified 57% patients at-risk, with 66.6% of patients referred to dietetics; however, there was a lack of malnutrition screening and dietetic referrals prior to treatment. CONCLUSION Pre-treatment malnutrition and cachexia was significantly associated with adverse CAR T patient outcomes, including mGPS cachexia status independently associated with inferior overall survival. Further research in this novel space is essential to confirm the extent and impact of nutritional issues, to assist with implementing dietetic pathways, and to identify potential interventions with a view to optimising outcomes.
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Affiliation(s)
- B Cucchiaro
- University College London, Division of Medicine, Rayne Institute, 5 University Street, London, WC1E 6BT, UK; University College London Hospital, Nutrition and Dietetics Department, 250 Euston Road, NW1 2PG, UK
| | - N A Davies
- University College London, Division of Medicine, Rayne Institute, 5 University Street, London, WC1E 6BT, UK
| | - C E Weekes
- University College London, Division of Medicine, Rayne Institute, 5 University Street, London, WC1E 6BT, UK
| | - M O'Reilly
- University College London Hospital, 250 Euston Road, NW1 2PG, UK
| | - C Roddie
- University College London, Cancer Institute, 72 Huntley Street, WC1E 6DD, UK
| | - A Slee
- University College London, Division of Medicine, Rayne Institute, 5 University Street, London, WC1E 6BT, UK.
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Simões FV, da Silva e Silva T, Pires AA, França CRM, Velasco NS, Santos VO, Moreira K, da Silva MM, Brandão MAG, de Oliveira BGRB, da Silva RC. Spray skin protectant versus standard moisturiser in the prevention of radiodermatitis in patients with anal canal and rectal cancer: A randomised clinical trial. Int Wound J 2024; 21:e70030. [PMID: 39171868 PMCID: PMC11339855 DOI: 10.1111/iwj.70030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024] Open
Abstract
The evidence on products for the prevention of radiodermatitis is limited. The primary objective was to analyse the effectiveness of the spray skin protectant 'non-burning barrier film' in the prevention of radiodermatitis with moist desquamation in patients with the anal canal and rectal cancer followed in nursing consultations compared to a standardised moisturiser based on Calendula officinalis and Aloe barbadensis. Single-blind randomised clinical trial. The study was performed in a hospital in Rio de Janeiro, Brazil, with 63 patients undergoing anal canal and rectal cancer treatment, randomised into one of the following two groups: an experimental group, which used a spray skin protectant and a control group, which used a moisturiser. Data were collected using an initial and subsequent evaluation form and were assessed using descriptive and inferential analyses. Participants who used the spray skin protectant had a lower chance of presenting radiodermatitis with moist desquamation and a longer time without this outcome when compared to the control group. The overall incidence of radiodermatitis was 100%, with 36.5% being severe. Furthermore, 17.5% of participants discontinued radiotherapy due to radiodermatitis. There were no differences between the groups regarding the severity of radiodermatitis and the number of patients who discontinued radiotherapy. The skin protectant was effective in preventing radiodermatitis with moist desquamation amongst patients with anal canal and rectal cancer.
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Affiliation(s)
| | | | - Aline Aniceto Pires
- Anna Nery School of NursingFederal University of Rio de JaneiroRio de JaneiroBrazil
| | | | | | | | - Katia Moreira
- José Alencar Gomes da Silva National Cancer InstituteRio de JaneiroBrazil
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Zhang L, Jin S, Wang Y, Zhang Z, Jia H, Li D, Lu Q. Predict nutrition-related adverse outcomes in head and neck cancer patients undergoing radiotherapy: A systematic review. Radiother Oncol 2024; 197:110339. [PMID: 38795812 DOI: 10.1016/j.radonc.2024.110339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Acute nutrition-related adverse outcomes are common in head and neck cancer patients undergoing radiotherapy. Predictive models can assist in identifying high-risk patients to enable targeted intervention. We aimed to systematically evaluate predictive models for predicting severe acute nutritional symptoms, insufficient intake, tube feeding, sarcopenia, and weight loss. METHODS We searched PubMed, Web of Science, EBSCO, Embase, WanFang, CNKI, and SinoMed. We selected studies developing predictive models for the aforementioned outcomes. Data were extracted using a predefined checklist. Risk of bias and applicability assessment were assessed using the Prediction model Risk of Bias Assessment Tool. A narrative synthesis was conducted to summarize the model characteristics, risk of bias, and performance. RESULTS A total of 2941 studies were retrieved and 19 were included. Study outcome measure were different symptoms (n = 11), weight loss (n = 5), tube feeding (n = 3), and symptom or tube feeding (n = 1). Predictive factors mainly encompassed sociodemographic data, disease-related data, and treatment-related data. Seventeen studies reported area under the curve or C-index values ranging from 0.610 to 0.96, indicating moderate to good predictive performance. However, candidate predictors were incomplete, outcome measures were diverse, and the risk of bias was high. Most of them used traditional model development methods, and only two used machine learning. CONCLUSIONS Most current models showed moderate to good predictive performance. However, predictors are incomplete, outcome are inconsistent, and the risk of bias is high. Clinicians could carefully select the models with better model performance from the available models according to their actual conditions. Future research should include comprehensive and modifiable indicators and prioritize well-designed and reported studies for model development.
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Affiliation(s)
- Lichuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, 100191, China
| | - Shuai Jin
- Department of Adult Care, School of Nursing, Capital Medical University, Beijing, 100069, China
| | - Yujie Wang
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, 450003, China
| | - Zijuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, 100191, China
| | - Huilin Jia
- School of Nursing, Hebei University, Baoding, 071000, China
| | - Decheng Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, 100191, China.
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Mulla Z, Hashem R, Joseph V, Maumenah H, Weber A, Khasim A, Altoukhi H. Treatment Reproducibility in Brain Stereotactic Radiotherapy Using a Shim Mask Versus a Standard Mask. Cureus 2024; 16:e66108. [PMID: 39229440 PMCID: PMC11369750 DOI: 10.7759/cureus.66108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction This study aimed to evaluate the setup accuracy of the new shim mask with mouth bite compared to the standard full brain mask in stereotactic radiosurgery (SRS) and radiotherapy (SRT) treatments for brain metastases or tumors. Method A combined retrospective and prospective design was employed, involving 40 patients treated at our center. Patients previously treated using standard head masks formed the retrospective cohort, while those treated with the Shim mask and mouth bite formed the prospective cohort. Daily cone-beam computed tomography (CBCT) scans were obtained before each treatment session to ensure patient setup accuracy. Key metrics included absolute shifts in translational and rotational directions, the number of repeat CBCTs, and the time interval between CBCTs. Results The Shim mask significantly reduced the mean setup errors in the lateral translation (p=0.022) from 0.17 cm (SD=0.10) to 0.10 cm (SD=0.10), and in X-axis rotation (p=0.030) from 0.79° (SD=0.43) to 0.47° (SD=0.47). By considering cutoff points of 1 mm in translational and 1° in rotational directions, the Shim mask was significantly more accurate in the lateral direction (p=0.004). Moreover, while 70% of patients in the standard group required repeat CBCT scans, none in the Shim group did, resulting in an average time saving of 10.4 minutes per patient. Conclusion The Shim mask with mouth bite offers enhanced immobilization accuracy in SRT/SRS treatments, leading to time and potential cost savings by reducing the need for repeat CBCT scans. This underscores the importance of adopting innovative immobilization techniques to optimize patient outcomes.
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Affiliation(s)
- Zaheeda Mulla
- Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Rania Hashem
- Radiology, King Abdul-Aziz University, Jeddah, SAU
| | - Victor Joseph
- Radiology, King Abdul-Aziz University Hospital, Jeddah, SAU
| | - Hani Maumenah
- Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Amina Weber
- Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
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Bertholet J, Carlson DJ, Aznar MC. Membership Data From Scientific and Professional Societies: An Ally in the Quest to Improve the Retention of Women in Medical Physics and Radiation Oncology Societies. Int J Radiat Oncol Biol Phys 2024; 119:1344-1346. [PMID: 39038908 DOI: 10.1016/j.ijrobp.2024.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
| | - David J Carlson
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut
| | - Marianne C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Stoffel E, Hwang SY, Qian X, Geller B, Morelli G, Zhang W. Sarcopenia is an independent risk factor for short-term mortality in patients undergoing transjugular intrahepatic portosystemic shunt. Eur J Gastroenterol Hepatol 2024; 36:1010-1015. [PMID: 38808872 DOI: 10.1097/meg.0000000000002790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Sarcopenia is common in patients with cirrhosis and is a risk factor for increased mortality. Transjugular intrahepatic portosystemic shunt (TIPS) placement has been utilized in cirrhosis patients with decompensation . We investigated the role of sarcopenia in predicting mortality in patients undergoing TIPS. METHODS We conducted a single-center retrospective study of 232 patients with cirrhosis who underwent TIPS between January 2010 and December 2015. Sarcopenia was defined by the psoas muscle index (PMI) cutoff value, calculated based on dynamic time-dependent outcomes using X-tile software. Kaplan-Meier analysis demonstrated the difference in survival in the sarcopenia group versus the non-sarcopenia group. . Univariate and multivariate analyses were used to identify the relationship between sarcopenia and post-TIPS mortality during a follow-up period of 1 year. RESULTS For TIPS indications, 111 (47.84%) patients had refractory ascites, 69 (29.74%) patients had variceal bleeding, 12 (5.17%) patients had ascites, and 40 (17.24%) for other indications. The mean PMI was 4.40 ± 1.55. Sarcopenia was defined as a PMI value of <4.36 in males, and <3.23 in females. Sarcopenia was present in 96 (41.38%) of patients. . Kaplan-Meier analysis showed thatsarcopenia is associated with worse survival (log-rank P < 0.01). Multivariate Cox regression analysis showed that sarcopenia is independently associated with worse survival during the 1-year follow-up period with an hazard ratio of 2.435 (95% CI 1.346-4.403) ( P < 0.01), after adjusting for age, BMI, indications for TIPS, etiology for cirrhosis, and MELD score and stratified by sex. CONCLUSION Sarcopenia is an independent risk factor for 1-year mortality in patients undergoing TIPS and should be considered when patients are evaluated as a candidate for TIPS.
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Affiliation(s)
- Elina Stoffel
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York City, New York
| | - Soo Young Hwang
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- University of Maryland Medical System, Baltimore, Maryland
| | - Xia Qian
- Department of Radiology, University of Florida, Gainesville, Florida
- Department of Pathology, Beth Israel Deaconess Hospital, Boston, Massachusetts
| | - Brian Geller
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Giuseppe Morelli
- Department of Radiology, University of Florida, Gainesville, Florida
| | - Wei Zhang
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Wang J, Dai X, Qu B, Yan C, Kou Y, Liu X, Wang X, Cai B. Solution for the External Contour Changes in Cone Beam Computed Tomography-Guided On-demand Online Adaptive Radiotherapy for a Patient With Very Advanced Head and Neck Cancer: A Technical Case Report. Cureus 2024; 16:e67804. [PMID: 39328634 PMCID: PMC11424223 DOI: 10.7759/cureus.67804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/28/2024] Open
Abstract
This article presents a case of a patient with advanced head and neck cancer, characterized by a large and protruding tumor. The patient was treated with an innovative on-demand online adaptive radiotherapy (ART) technology, guided by cone beam computed tomography (CBCT), on the Ethos adaptive radiotherapy platform (version 1.0, Varian Medical Systems, Palo Alto, CA). A solution was provided for this special case to address the issue where part of the target volume could not participate in the optimization due to exceeding the external contour boundary during online adaptive radiotherapy. The treatment outcome was satisfactory in terms of tumor regression, while only grade 1 radiodermatitis and grade 2 oral mucositis at the end of radiotherapy. This article discusses the clinical diagnosis, treatment process, and follow-up of this case, aiming to provide clinical references for a broader application of this technology.
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Affiliation(s)
- Jinyuan Wang
- Department of Radiotherapy, The First Medical Center of the Chinese PLA General Hospital, Beijing, CHN
| | - Xiangkun Dai
- Department of Radiotherapy, The First Medical Center of the Chinese PLA General Hospital, Beijing, CHN
| | - Baolin Qu
- Department of Radiotherapy, The First Medical Center of the Chinese PLA General Hospital, Beijing, CHN
| | - Changxin Yan
- Department of Radiotherapy, The First Medical Center of the Chinese PLA General Hospital, Beijing, CHN
| | - Yuhan Kou
- Department of Radiotherapy, The First Medical Center of the Chinese PLA General Hospital, Beijing, CHN
| | - Xiaoyu Liu
- Department of Radiotherapy, The First Medical Center of the Chinese PLA General Hospital, Beijing, CHN
| | - Xiaoshen Wang
- Clinical Application Training Department, Varian Medical System, Beijing, CHN
| | - Boning Cai
- Department of Radiotherapy, The First Medical Center of the Chinese PLA General Hospital, Beijing, CHN
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Keum H, Cevik E, Kim J, Demirlenk YM, Atar D, Saini G, Sheth RA, Deipolyi AR, Oklu R. Tissue Ablation: Applications and Perspectives. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2310856. [PMID: 38771628 PMCID: PMC11309902 DOI: 10.1002/adma.202310856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/05/2024] [Indexed: 05/22/2024]
Abstract
Tissue ablation techniques have emerged as a critical component of modern medical practice and biomedical research, offering versatile solutions for treating various diseases and disorders. Percutaneous ablation is minimally invasive and offers numerous advantages over traditional surgery, such as shorter recovery times, reduced hospital stays, and decreased healthcare costs. Intra-procedural imaging during ablation also allows precise visualization of the treated tissue while minimizing injury to the surrounding normal tissues, reducing the risk of complications. Here, the mechanisms of tissue ablation and innovative energy delivery systems are explored, highlighting recent advancements that have reshaped the landscape of clinical practice. Current clinical challenges related to tissue ablation are also discussed, underlining unmet clinical needs for more advanced material-based approaches to improve the delivery of energy and pharmacology-based therapeutics.
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Affiliation(s)
- Hyeongseop Keum
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Enes Cevik
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Jinjoo Kim
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Yusuf M Demirlenk
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Dila Atar
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Gia Saini
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Amy R Deipolyi
- Interventional Radiology, Department of Surgery, West Virginia University, Charleston Area Medical Center, Charleston, WV 25304, USA
| | - Rahmi Oklu
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
- Division of Vascular & Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, Arizona 85054, USA
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Fogliata A, Burger H, Groenewald A, Punt L, Parkes J, Cozzi L. Intensity Modulated Therapy for Patients With Breast Cancer. Practical Guidelines and Tips for an Effective Treatment Planning Strategy. Adv Radiat Oncol 2024; 9:101535. [PMID: 38993192 PMCID: PMC11233865 DOI: 10.1016/j.adro.2024.101535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 03/16/2024] [Indexed: 07/13/2024] Open
Abstract
Purpose Practical guidelines and tips for effective and robust radiation therapy treatment planning for patients with breast cancer are addressed for fixed-field intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) techniques. The concepts described here are general and valid on all treatment planning systems. However, some details shown here have been applied to the Varian platforms used at the authors' institutions. Methods and Materials The specific aspects of using C-arm- or O-ring-mounted linear accelerators are covered in the document, as well as tips for dealing with certain resource constraints, target cropping, and skin flash aiming to reduce risks of skin toxicity and to manage (residual after breath control) respiration motion or edema. Results A decision tree is presented, and practical solutions for cases where a target volume is contoured or not and where volumetric modulated arc therapy or fixed-beam intensity modulation should be applied and details about the technical implementation (tangential IMRT, butterfly IMRT or VMAT, and large partial VMAT arcs) are discussed. Target cropping and skin flash implications are discussed in detail, and links to plan robustness are outlined. Conclusions Practical guidelines for breast planning are presented and summarized with a decision tree and technical summaries.
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Affiliation(s)
- Antonella Fogliata
- Department of Radiotherapy and Radiosurgery, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
| | - Hester Burger
- Department of Radiation Medicine, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa
- Medical Affairs, Varian Medical Systems, a Siemens Healthineers Company, Palo Alto, California
| | - Annemari Groenewald
- Department of Radiation Medicine, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa
| | - Lydia Punt
- Department of Radiation Medicine, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa
| | - Jeannette Parkes
- Department of Radiation Medicine, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa
| | - Luca Cozzi
- Department of Radiotherapy and Radiosurgery, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
- Medical Affairs, Varian Medical Systems, a Siemens Healthineers Company, Palo Alto, California
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Snaith B, Clarkson M, Whitlock K, Carr R, Compton E, Bradshaw K, Mills K. Recognition of advanced level practice against multiprofessional capabilities: Experiences of the first radiography applicants. Radiography (Lond) 2024; 30:1243-1248. [PMID: 38959619 DOI: 10.1016/j.radi.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Advanced practice is well established in the health professions with multiprofessional capabilities in place in England. To recognise achievement of these capabilities an ePortfolio (supported) route was initiated in 2022. This study aimed to review the demographics and experiences of radiographers applying for recognition in the first year of operation. METHODS The multi method evaluation consisted of quantitative data analysis of information regarding the first three cohorts of radiographers (n = 40) participating in the NHS England (NHSE) scheme. Interviews with 12 participants was undertaken with thematic analysis of the transcripts. RESULTS Self-rated scores of expertise were significantly higher by therapeutic radiographers (n = 8) compared to their 32 diagnostic colleagues (t = 5.556; p < 0.01). Radiographers saw the ePortfolio as an opportunity to validate their experience and to evidence parity with other professions. Participants felt the process also enabled critical reflection and gave unseen insight into themselves and their roles. The support of experienced educational supervisors was felt to be vital in this process and for successful completion of portfolio. CONCLUSIONS Several radiographers have now achieved the necessary standards to achieve NHSE recognition. The evaluation exposed that most radiographers did not have the relevant evidence to hand and the ongoing collection of evidence around capabilities and impact is critical to evidencing advanced practice capabilities. IMPLICATIONS FOR PRACTICE Radiographers are able to achieve the capabilities expected for multiprofessional practice. Cultural change is required to normalise recording of evidence within practice including case-based discussions, clinical supervision and feedback from colleagues and patients. The support of an experienced educational supervisor aided the critical reflection on practice level.
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Affiliation(s)
- B Snaith
- University of Bradford, Bradford, BD7 1DP, UK; Mid Yorkshire Teaching NHS Trust, Wakefield, WF1 4DG, UK.
| | - M Clarkson
- Sheffield Hallam University, Sheffield, UK. https://twitter.com/mclarkson20
| | - K Whitlock
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK. https://twitter.com/kwhitlock03
| | - R Carr
- RC Sonography, Hove, UK. https://twitter.com/ryac1601
| | - E Compton
- Guy's and St Thomas' NHS Trust, London, UK. https://twitter.com/EmmaDRad
| | - K Bradshaw
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Mills
- NHS England Workforce Training & Education Directorate, Birmingham, UK. https://twitter.com/kerryannemills
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Arjmandi N, Momennezhad M, Arastouei S, Mosleh-Shirazi MA, Albawi A, Pishevar Z, Nasseri S. Deep learning-based automated liver contouring using a small sample of radiotherapy planning computed tomography images. Radiography (Lond) 2024; 30:1442-1450. [PMID: 39179459 DOI: 10.1016/j.radi.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/11/2024] [Accepted: 08/06/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION No study has yet investigated the minimum amount of data required for deep learning-based liver contouring. Therefore, this study aimed to investigate the feasibility of automated liver contouring using limited data. METHODS Radiotherapy planning Computed tomography (CT) images were subjected to various preprocessing methods, such as denoising and windowing. Segmentation was conducted using the modified Attention U-Net and Residual U-Net networks. Two different modified networks were trained separately for different training sizes. For each architecture, the model trained with the training set size that achieved the highest dice similarity coefficient (DSC) score was selected for further evaluation. Two unseen external datasets with different distributions from the training set were also used to examine the generalizability of the proposed method. RESULTS The modified Residual U-Net and Attention U-Net networks achieved average DSCs of 97.62% and 96.48%, respectively, on the test set, using 62 training cases. The average Hausdorff distances (AHDs) for the modified Residual U-Net and Attention U-Net networks were 0.57 mm and 0.71 mm, respectively. Also, the modified Residual U-Net and Attention U-Net networks were tested on two unseen external datasets, achieving DSCs of 95.35% and 95.82% for data from another center and 95.16% and 94.93% for the AbdomenCT-1K dataset, respectively. CONCLUSION This study demonstrates that deep learning models can accurately segment livers using a small training set. The method, utilizing simple preprocessing and modified network architectures, shows strong performance on unseen datasets, indicating its generalizability. IMPLICATIONS FOR PRACTICE This promising result suggests its potential for automated liver contouring in radiotherapy planning.
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Affiliation(s)
- N Arjmandi
- Department of Medical Physics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Student research committee, Mashhad University of medical sciences, Mashhad, Iran.
| | - M Momennezhad
- Department of Medical Physics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Medical Physics Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad.
| | - S Arastouei
- Department of Radiation Oncology, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - M A Mosleh-Shirazi
- Physics Unit, Department of Radio-Oncology, Shiraz University of Medical Sciences, Shiraz, Iran; Ionizing and Non-Ionizing Radiation Protection Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - A Albawi
- Radiology Techniques Department, College of Medical Technology, The Islamic University, Najaf, Iraq; Department of Computer Engineering, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Z Pishevar
- Department of Radiation Oncology, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - S Nasseri
- Department of Medical Physics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kuszaj O, Day M, Wronski M, Corbin K, Herst P, Hill R, Rades D, Wong C, Karam I, Gallant F, Lee SF, Tse SSW, Chow E, Wong H. Mepitel film for the prevention of radiation dermatitis: A comprehensive review of its efficacy, side effects, physics measurements, patient- and clinician-reported outcomes. Asia Pac J Oncol Nurs 2024; 11:100530. [PMID: 39051046 PMCID: PMC11268185 DOI: 10.1016/j.apjon.2024.100530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/29/2024] [Indexed: 07/27/2024] Open
Abstract
Objective This review aimed to summarize the benefits, side effects, physics measurements, and patient- and clinician-reported outcomes of Mepitel film (MF) in preventing radiation dermatitis (RD) for cancer patients. Methods The online database PubMed was searched from inception to April 15, 2024 with the search terms "Mepitel film" or "Mepitel." Articles of any study design evaluating MF for the prevention of RD were included. Non-human studies were excluded. Results The database search identified 119 articles and 13 of them were included in this review. Across these studies, MF was found to be beneficial in reducing RD and improved patient- and clinician-reported outcomes in breast and head and neck cancers. Side effects of MF included itchiness, acne, allergic reaction, tightness, discomfort, and poor film adherence, but patient dropouts were uncommon. MF did not cause a bolus effect or increased skin dose in physics measurements. Conclusions MF is a safe and effective intervention for preventing acute RD. It should be recommended in breast cancer patients where the data is more robust. Further research is needed to evaluate MF's efficacy on patients with different skin tones, its cost-effectiveness, and identifying patients who most benefit from MF relative to other effective interventions.
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Affiliation(s)
- Olivia Kuszaj
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marley Day
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Matt Wronski
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Patries Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | - Rosemary Hill
- Lions Gate Hospital, North Vancouver, British Columbia, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Cindy Wong
- Union Oncology Centre, Kowloon, Hong Kong S.A.R., China
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Francois Gallant
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Shirley SW. Tse
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon Central Cluster, Hospital Authority, Hong Kong S.A.R, China
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R, China
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Wang C, Liu X, Li Y, Liu D, Yang L, Wang Y. Effects of psychological support intervention on patients with nasopharyngeal carcinoma undergoing radiotherapy. Pak J Med Sci 2024; 40:1420-1424. [PMID: 39092052 PMCID: PMC11255788 DOI: 10.12669/pjms.40.7.7875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/11/2024] [Accepted: 03/27/2024] [Indexed: 08/04/2024] Open
Abstract
Objective To find out the effects of psychological support intervention on patients with nasopharyngeal carcinoma undergoing radiotherapy. Methods This was a retrospective study. Sixty six patients with nasopharyngeal carcinoma who received radiotherapy in the Affiliated Hospital of Hebei University from March 2021 to March 2022 were included and randomly divided into the observation group and the control group, with 33 cases in each group. Patients in the control group were given conventional care measures, while those in the observation group were given psychological support intervention on top of conventional care measures. The nursing effects between the two groups were compared. Results After the intervention, the psychological resilience score of the observation group was significantly higher than that of the control group, with a statistically significant difference (P<0.05). The psychological resilience scores after the intervention were significantly higher in the observation group than before the intervention, and those in the control group were higher than before the intervention, with a statistically significant difference(P<0.05). The overall health score of quality of life in the observation group was significantly higher than that in the control group after the intervention, with a statistically significant difference(P<0.05). Moreover, the skin reaction in the observation group after radiotherapy was significantly better than that of the control group (P<0.01). Conclusion Psychological support intervention is an effective means to treat patients with nasopharyngeal carcinoma, which results in various benefits such as improving patients' mental resilience and quality of life and reducing the incidence of adverse reactions after radiotherapy.
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Affiliation(s)
- Ce Wang
- Ce Wang, Department of Radiotherapy, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Xiaohui Liu
- Xiaohui Liu, Department of Radiotherapy, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Yanhong Li
- Yanhong Li, Department of Radiotherapy, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Dongxue Liu
- Dongxue Liu, Department of Radiotherapy, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Litao Yang
- Litao Yang, Department of Orthopedics, Baoding NO.1 Central Hospital, Baoding, Hebei, 071000, China
| | - Yue Wang
- Yue Wang, Department of Radiotherapy, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
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96
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Miller LJ, Halliday V, Snowden JA, Aithal GP, Lee J, Greenfield DM. Health professional attitudes and perceptions of prehabilitation and nutrition before haematopoietic cell transplantation. J Hum Nutr Diet 2024; 37:1007-1021. [PMID: 38696512 DOI: 10.1111/jhn.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/20/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Nutritional prehabilitation may improve haematopoietic cell transplantation (HCT) outcomes, although little evidence exists. The present study aimed to understand healthcare professional (HCP) perceptions of prehabilitation and nutritional care pre-HCT in UK centres. METHODS An anonymous online survey (developed and refined via content experts and piloting) was administered via email to multidisciplinary HCPs in 39 UK adult centres, between July 2021 and June 2022. Data are presented as proportions of responses. Routine provision denotes that care was provided >70% of time. RESULTS Seventy-seven percent (n = 66) of HCPs, representing 61.5% (n = 24) of UK adult HCT centres, responded. All HCPs supported prehabilitation, proposing feasible implementation between induction chemotherapy (60.4%; n = 40) and first HCT clinic (83.3%; n = 55). Only 12.5% (n = 3) of centres had a dedicated prehabilitation service. Nutrition (87.9%; n = 58), emotional wellbeing (92.4%; n = 61) and exercise (81.8%; n = 54) were considered very important constituents. HCPs within half of the HCT centres (n = 12 centres) reported routine use of nutrition screening pre-HCT with a validated tool; 66.7% of HCPs (n = 36) reported using the malnutrition universal screening tool (MUST). Sixty-two percent (n = 41) of HCPs reported those at risk, received nutritional assessments, predominantly by dietitians (91.6%; n = 22) using the dietetic care process (58.3%; n = 14). Body mass index (BMI) was the most frequently reported body composition measure used by HCPs (70.2%, n = 33). Of 59 respondents, non-dietitians most routinely provided dietary advice pre-HCT (82.4%; n = 28 vs. 68%; n = 17, p = 0.2); including high-energy/protein/fat and neutropenic diet advice. Prophylactic enteral feeding pre-HCT was rare, indicated by low BMI and significant unintentional weight loss. Just under half (n = 25 of 59, 42.4%) HCPs reported exercise advice was given routinely pre-HCT. CONCLUSIONS Nutrition and prehabilitation pre-HCT are considered important and deliverable by HCPs, but current provision in UK centres is limited and inconsistent.
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Affiliation(s)
- Laura J Miller
- Department of Dietetics and Nutrition, Nottingham University Hospitals NHS Trust, Nottingham, UK
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Vanessa Halliday
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- British Society of Blood and Marrow Transplantation & Cellular Therapy (BSBMTCT), London, UK
| | - Guruprasad P Aithal
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Julia Lee
- British Society of Blood and Marrow Transplantation & Cellular Therapy (BSBMTCT), London, UK
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Jeong I, Cho EJ, Yook JS, Choi Y, Park DH, Kang JH, Lee SH, Seo DY, Jung SJ, Kwak HB. Mitochondrial Adaptations in Aging Skeletal Muscle: Implications for Resistance Exercise Training to Treat Sarcopenia. Life (Basel) 2024; 14:962. [PMID: 39202704 PMCID: PMC11355854 DOI: 10.3390/life14080962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/13/2024] [Accepted: 07/29/2024] [Indexed: 09/03/2024] Open
Abstract
Sarcopenia, the age-related decline in muscle mass and function, poses a significant health challenge as the global population ages. Mitochondrial dysfunction is a key factor in sarcopenia, as evidenced by the role of mitochondrial reactive oxygen species (mtROS) in mitochondrial biogenesis and dynamics, as well as mitophagy. Resistance exercise training (RET) is a well-established intervention for sarcopenia; however, its effects on the mitochondria in aging skeletal muscles remain unclear. This review aims to elucidate the relationship between mitochondrial dynamics and sarcopenia, with a specific focus on the implications of RET. Although aerobic exercise training (AET) has traditionally been viewed as more effective for mitochondrial enhancement, emerging evidence suggests that RET may also confer beneficial effects. Here, we highlight the potential of RET to modulate mtROS, drive mitochondrial biogenesis, optimize mitochondrial dynamics, and promote mitophagy in aging skeletal muscles. Understanding this interplay offers insights for combating sarcopenia and preserving skeletal muscle health in aging individuals.
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Affiliation(s)
- Ilyoung Jeong
- Program in Biomedical Science & Engineering, Department of Biomedical Science, Inha University, Incheon 22212, Republic of Korea; (I.J.); (E.-J.C.); (D.-H.P.); (J.-H.K.)
| | - Eun-Jeong Cho
- Program in Biomedical Science & Engineering, Department of Biomedical Science, Inha University, Incheon 22212, Republic of Korea; (I.J.); (E.-J.C.); (D.-H.P.); (J.-H.K.)
| | - Jang-Soo Yook
- Institute of Sports and Arts Convergence, Inha University, Incheon 22212, Republic of Korea; (J.-S.Y.); (Y.C.)
| | - Youngju Choi
- Institute of Sports and Arts Convergence, Inha University, Incheon 22212, Republic of Korea; (J.-S.Y.); (Y.C.)
- Institute of Specialized Teaching and Research, Inha University, Incheon 22212, Republic of Korea
| | - Dong-Ho Park
- Program in Biomedical Science & Engineering, Department of Biomedical Science, Inha University, Incheon 22212, Republic of Korea; (I.J.); (E.-J.C.); (D.-H.P.); (J.-H.K.)
- Institute of Sports and Arts Convergence, Inha University, Incheon 22212, Republic of Korea; (J.-S.Y.); (Y.C.)
- Department of Kinesiology, Inha University, Incheon 22212, Republic of Korea
| | - Ju-Hee Kang
- Program in Biomedical Science & Engineering, Department of Biomedical Science, Inha University, Incheon 22212, Republic of Korea; (I.J.); (E.-J.C.); (D.-H.P.); (J.-H.K.)
- Institute of Sports and Arts Convergence, Inha University, Incheon 22212, Republic of Korea; (J.-S.Y.); (Y.C.)
- Department of Pharmacology, College of Medicine, Inha University, Incheon 22212, Republic of Korea
| | - Seok-Hun Lee
- Combat Institute of Australia, Leederville, WA 6007, Australia;
| | - Dae-Yun Seo
- Basic Research Laboratory, Department of Physiology, College of Medicine, Smart Marine Therapeutic Center, Cardiovascular and Metabolic Disease Core Research Support Center, Inje University, Busan 47392, Republic of Korea
| | - Su-Jeen Jung
- Department of Leisure Sports, Seoil University, Seoul 02192, Republic of Korea
| | - Hyo-Bum Kwak
- Program in Biomedical Science & Engineering, Department of Biomedical Science, Inha University, Incheon 22212, Republic of Korea; (I.J.); (E.-J.C.); (D.-H.P.); (J.-H.K.)
- Institute of Sports and Arts Convergence, Inha University, Incheon 22212, Republic of Korea; (J.-S.Y.); (Y.C.)
- Department of Kinesiology, Inha University, Incheon 22212, Republic of Korea
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Cheng SH, Lee SY, Lee HH. Harnessing the Power of Radiotherapy for Lung Cancer: A Narrative Review of the Evolving Role of Magnetic Resonance Imaging Guidance. Cancers (Basel) 2024; 16:2710. [PMID: 39123438 PMCID: PMC11311467 DOI: 10.3390/cancers16152710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Compared with computed tomography (CT), magnetic resonance imaging (MRI) traditionally plays a very limited role in lung cancer management, although there is plenty of room for improvement in the current CT-based workflow, for example, in structures such as the brachial plexus and chest wall invasion, which are difficult to visualize with CT alone. Furthermore, in the treatment of high-risk tumors such as ultracentral lung cancer, treatment-associated toxicity currently still outweighs its benefits. The advent of MR-Linac, an MRI-guided radiotherapy (RT) that combines MRI with a linear accelerator, could potentially address these limitations. Compared with CT-based technologies, MR-Linac could offer superior soft tissue visualization, daily adaptive capability, real-time target tracking, and an early assessment of treatment response. Clinically, it could be especially advantageous in the treatment of central/ultracentral lung cancer, early-stage lung cancer, and locally advanced lung cancer. Increasing demands for stereotactic body radiotherapy (SBRT) for lung cancer have led to MR-Linac adoption in some cancer centers. In this review, a broad overview of the latest research on imaging-guided radiotherapy (IGRT) with MR-Linac for lung cancer management is provided, and development pertaining to artificial intelligence is also highlighted. New avenues of research are also discussed.
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Affiliation(s)
- Sarah Hsin Cheng
- Department of Clinical Education and Training, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Shao-Yun Lee
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Hsin-Hua Lee
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung 807, Taiwan
- Department of Radiation Oncology, Faculty of Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Wieland LS, Shade S, Moffet I, Ansari A, Emadi A, Knott CL, Gorman EF, D’Adamo CR. Effects of Antioxidant Dietary Supplement Use upon Response to Cancer Treatment: A Scoping Review of Available Evidence. Nutr Cancer 2024; 76:902-913. [PMID: 39078314 PMCID: PMC11419937 DOI: 10.1080/01635581.2024.2385167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION The effects of antioxidant dietary supplements on response to biological therapies for cancer is unknown. We conducted a scoping review of the available systematic review evidence on this question. METHODS AND ANALYSIS We searched six databases from inception to August 19, 2022 for systematic reviews of randomized controlled trials of antioxidant dietary supplements used by patients receiving curative chemotherapy, radiotherapy, or other biological therapy for cancer and assessing the impact of supplements on survival, treatment response, or disease progression. We focused on results from reviews at high or moderate AMSTAR-2 quality. Records were selected, data extracted, and AMSTAR-2 ratings assessed independently by two authors. RESULTS We found 24 systematic reviews with relevant evidence. Reviews were heterogenous in cancers, treatments, and antioxidant dietary supplements assessed. Conclusions across reviews were mixed, ranging from negative to no apparent difference to positive, but always with caveats about the limited size and quality of the evidence. One review was rated 'moderate' on AMSTAR-2; it included one small trial of vitamin C and formed no firm conclusions. CONCLUSIONS We did not find reliable systematic review evidence on the effects of antioxidant dietary supplements upon therapies for cancer. More research is necessary to inform clinical recommendations.
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Affiliation(s)
- L. Susan Wieland
- Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore MD
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sydney Shade
- Geisinger Commonwealth School of Medicine, Scranton PA
- Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Ilana Moffet
- University of Michigan College of Literature, Science, and the Arts, Ann Arbor MI
| | - Amir Ansari
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore MD
| | - Ashkan Emadi
- Department of Medicine, University of Maryland School of Medicine, Baltimore MD
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore MD
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore MD
- Department of Medical Oncology, West Virginia University School of Medicine, Morgantown, WV
- West Virginia University Cancer Institute, Morgantown, WV
| | - Cheryl L. Knott
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore MD
- Department of Behavioral and Community Health, University of Maryland, College Park MD
| | - Emily F. Gorman
- Health Sciences and Human Services Library, University of Maryland, Baltimore MD
| | - Christopher R. D’Adamo
- Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore MD
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Calvo-Ortega JF, Laosa-Bello C, Moragues-Femenía S, Pozo-Massó M, Jones A. Experience with patient-specific quality assurance of dosimetrist-led online adaptive prostate SBRT. J Med Imaging Radiat Sci 2024; 55:101719. [PMID: 39084157 DOI: 10.1016/j.jmir.2024.101719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/30/2024] [Accepted: 06/27/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION The aim of this study was to assess the results of the local pre-treatment verifications of online adaptive prostate SBRT plans performed by dosimetrists METHODS AND MATERIALS: Prostate SBRT treatments are planned in our department using an online adaptive method developed and validated by our group. The adaptive plans were computed on the daily CBCT scan using the Acuros XB v. 16.1 algorithm of the Varian Eclipse treatment planning system. Adaptive plans consisted of a single VMAT with 6 MV flattening-filter-free (FFF) energy performed on a Varian TrueBeam linac. Pre-treatment verification of the adaptive "plan-of-the-day" (POD) created in each treatment session was performed using the Mobius 3D v. 3.1 secondary dose calculation program (M3D). Commissioning of M3D included the tuning of the dosimetric leaf gap correction (DLGc) parameter. Generic and specific DLGc values were then derived using a set of plans for typical sites (prostate, head and neck, brain, lung and bone palliative) and another set were determined for specific online SBRT PODs (gDLGc and sDLGc, respectively). The first 50 prostate patients treated with the PACE-B schedule (5 × 7.25 Gy) were included, i.e., 250 adaptive SBRT PODs were collected in this study. For each online adaptive POD, a global 3D gamma comparison between the Eclipse 3D dose and the M3D dose in the patient CBCT was performed. Gamma passing rates (GPRs) for the whole external patient contour (Body) and the PTV were recorded, using the 5 % global /3 mm criteria. The target mean dose and target coverage differences between the Eclipse and M3D doses were also analyzed (ΔDmean and ΔD90 %, respectively). The accuracy of M3D was assessed against PRIMO Monte Carlo software. Twenty-five online prostate SBRT PODs were randomly selected from the set of 250 adaptive plans and simulated with PRIMO. RESULTS Values of -1 mm and -0.14 mm were found as optimal gDLGc and sDLGc, respectively. Over the 250 online adaptive PODs, excellent GPR values ∼ 100 % were obtained for the Body and PTV structures, regardless the type of DLGc used. The use of the sDLGc instead of the gDLGc provided better results for ΔDmean (0.1 % ± 0.5% vs. -1.9 ± 0.7 %) and ΔD90 % (-1.0 % ± 0.5 %. vs. -3.5 % ± 0.8 %). This issue was also observed when M3D calculations were compared to PRIMO simulations. CONCLUSIONS M3D can be effectively used for independent pre-treatment verifications of online adaptive prostate SBRT plans. The use of a specific DLGc value is advised for this SBRT online adaptive technique.
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Affiliation(s)
- Juan-Francisco Calvo-Ortega
- Hospital Quirónsalud Barcelona. Servicio de Oncología Radioterápica, Plaza Alfonso Comín 5, 08023 Barcelona, Spain; Hospital Quirónsalud Málaga. Servicio de Oncología Radioterápica, Calle Pilar Lorengar 1, 29004 Málaga, Spain.
| | - Coral Laosa-Bello
- Hospital Quirónsalud Barcelona. Servicio de Oncología Radioterápica, Plaza Alfonso Comín 5, 08023 Barcelona, Spain
| | - Sandra Moragues-Femenía
- Hospital Quirónsalud Barcelona. Servicio de Oncología Radioterápica, Plaza Alfonso Comín 5, 08023 Barcelona, Spain
| | - Miguel Pozo-Massó
- Hospital Quirónsalud Barcelona. Servicio de Oncología Radioterápica, Plaza Alfonso Comín 5, 08023 Barcelona, Spain
| | - Adam Jones
- Hospital Quirónsalud Barcelona. Servicio de Oncología Radioterápica, Plaza Alfonso Comín 5, 08023 Barcelona, Spain; Hospital Quirónsalud Barcelona. Servicio de Radiofísica y Protección Radiológica. Plaza Alfonso Comín 5, 08023 Barcelona, Spain
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