1
|
Flynn RT, Smith BR, Adams QE, Patwardhan K, Graves SA, Hopfensperger KM. A re-activation model for 169Yb intensity modulated brachytherapy sources accounting for spatiotemporal isotopic composition. Med Phys 2024; 51:3604-3618. [PMID: 38558460 DOI: 10.1002/mp.17048] [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] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Intensity modulated brachytherapy based on partially shielded intracavitary and interstitial applicators is possible with a cost-effective 169Yb production method. 169Yb is a traditionally expensive isotope suitable for this purpose, with an average γ-ray energy of 93 keV. Re-activating a single 169Yb source multiple times in a nuclear reactor between clinical uses was shown to theoretically reduce cost by approximately 75% relative to conventional single-activation sources. With re-activation, substantial spatiotemporal variation in isotopic source composition is expected between activations via 168Yb burnup and 169Yb decay, resulting in time dependent neutron transmission, precursor usage, and reactor time needed per re-activation. PURPOSE To introduce a generalized model of radioactive source production that accounts for spatiotemporal variation in isotopic source composition to improve the efficiency estimate of the 169Yb production process, with and without re-activation. METHODS AND MATERIALS A time-dependent thermal neutron transport, isotope transmutation, and decay model was developed. Thermal neutron flux within partitioned sub-volumes of a cylindrical active source was calculated by raytracing through the spatiotemporal dependent isotopic composition throughout the source, accounting for thermal neutron attenuation along each ray. The model was benchmarked, generalized, and applied to a variety of active source dimensions with radii ranging from 0.4 to 1.0 mm, lengths from 2.5 to 10.5 mm, and volumes from 0.31 to 7.85 mm3, at thermal neutron fluxes from 1 × 1014 to 1 × 1015 n cm-2 s-1. The 168Yb-Yb2O3 density was 8.5 g cm-3 with 82% 168Yb-enrichment. As an example, a reference re-activatable 169Yb active source (RRS) constructed of 82%-enriched 168Yb-Yb2O3 precursor was modeled, with 0.6 mm diameter, 10.5 mm length, 3 mm3 volume, 8.5 g cm-3 density, and a thermal neutron activation flux of 4 × 1014 neutrons cm-2 s-1. RESULTS The average clinical 169Yb activity for a 0.99 versus 0.31 mm3 source dropped from 20.1 to 7.5 Ci for a 4 × 1014 n cm-2 s-1 activation flux and from 20.9 to 8.7 Ci for a 1 × 1015 n cm-2 s-1 activation flux. For thermal neutron fluxes ≥2 × 1014 n cm-2 s-1, total precursor and reactor time per clinic-year were maximized at a source volume of 0.99 mm3 and reached a near minimum at 3 mm3. When the spatiotemporal isotopic composition effect was accounted for, average thermal neutron transmission increased over RRS lifetime from 23.6% to 55.9%. A 28% reduction (42.5 days to 30.6 days) in the reactor time needed per clinic-year for the RRS is predicted relative to a model that does not account for spatiotemporal isotopic composition effects. CONCLUSIONS Accounting for spatiotemporal isotopic composition effects within the RRS results in a 28% reduction in the reactor time per clinic-year relative to the case in which such changes are not accounted for. Smaller volume sources had a disadvantage in that average clinical 169Yb activity decreased substantially below 20 Ci for source volumes under 1 mm3. Increasing source volume above 3 mm3 adds little value in precursor and reactor time savings and has a geometric disadvantage.
Collapse
Affiliation(s)
- Ryan T Flynn
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Blake R Smith
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Quentin E Adams
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | | | - Stephen A Graves
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | | |
Collapse
|
2
|
Budrukkar A, Murthy V, Kashid S, Swain M, Rangarajan V, Laskar SG, Kannan S, Kale S, Upreti R, Pai P, Pantvaidya G, Gupta T, Agarwal JP. Intensity-Modulated Radiation Therapy Alone Versus Intensity-Modulated Radiation Therapy and Brachytherapy for Early-Stage Oropharyngeal Cancers: Results From a Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2024; 118:1541-1551. [PMID: 37660737 DOI: 10.1016/j.ijrobp.2023.08.056] [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: 03/24/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The objective of this study was to compare clinical outcomes of intensity-modulated radiation therapy (IMRT) alone versus IMRT + brachytherapy (BT) in patients with T1-T2N0M0 oropharyngeal squamous cell cancers (OPSCC). METHODS AND MATERIALS This open-label randomized controlled trial was conducted at Tata Memorial Hospital, Mumbai, India. Patients with stage I and II OPSCC were considered for IMRT to a dose of 50 Gy/25 fractions/5 weeks in phase I followed by randomization (1:1) to further treatment with IMRT (20 Gy/10 fractions/2 weeks) or BT (192Ir high dose rate, 21 Gy/7 fractions/2 fractions per day). The primary endpoint of the trial was the reduction in xerostomia at 6 months evaluated using 99mTc salivary scintigraphy. Severe salivary toxicity (xerostomia) was defined as posttreatment salivary excretion fraction ratio <45%. Secondary endpoints were local control, disease-free survival, and overall survival. RESULTS Between November 2010 and February 2020, 90 patients were randomized to IMRT (n = 46) alone or IMRT + BT (n = 44). Eleven patients (8 residual/recurrent disease, 2 lost to follow-up, 1 second primary) in the IMRT arm and 9 patients (8 residual/recurrence, 1 lost to follow-up) in the BT arm were not evaluable at 6 months for the primary endpoint. At 6 months, xerostomia rates using salivary scintigraphy were 14% (5/35: 95% CI, 5%-30%) in the BT arm while it was seen in 44% (14/32: 95% CI, 26%-62%) in the IMRT arm (P = .008). Physician-rated Radiation Therapy Oncology Group grade ≥2 xerostomia at any time point was observed in 30% of patients (9/30) in the IMRT arm and 6.7% (2/30) in the BT arm (P = .02). At a median follow-up of 42.5 months, the 3-year local control in the IMRT arm was 56.4% (95% CI, 43%-73%) while it was 66.2% (95% CI, 53%-82%) in the BT arm (P = .24). CONCLUSIONS The addition of BT to IMRT for T1-T2N0M0 OPSCC results in a significant reduction in xerostomia. This strongly supports the addition of BT to IMRT in suitable cases.
Collapse
Affiliation(s)
- Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - Vedang Murthy
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer/Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sheetal Kashid
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sadhana Kannan
- Clinical Research Secretariat, Advanced Centre for Treatment, Research and Education in Cancer/Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shrikant Kale
- Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rituraj Upreti
- Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Prathamesh Pai
- Department of Head Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Gouri Pantvaidya
- Department of Head Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer/Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
3
|
Ikushima H, Ii N, Noda SE, Masui K, Murakami N, Yoshida K, Watanabe M, Kawamura S, Kojima T, Nomoto Y, Toita T, Ohno T, Sakurai H, Onishi H. Patterns of care for brachytherapy in Japan. JOURNAL OF RADIATION RESEARCH 2024; 65:168-176. [PMID: 38151923 PMCID: PMC10959427 DOI: 10.1093/jrr/rrad099] [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: 10/04/2023] [Revised: 11/16/2023] [Indexed: 12/29/2023]
Abstract
This study aimed to assess the current state of brachytherapy (BT) resources, practices and resident education in Japan. A nationwide survey was undertaken encompassing 177 establishments facilitating BT in 2022. Questionnaires were disseminated to each BT center, and feedback through online channels or postal correspondence was obtained. The questionnaire response rate was 90% (159/177), and every prefecture had a response in at least one center. The number of centers in each prefecture ranged from 0.6 to 3.6 (median: 1.3) per million population. The annual number of patients in each center ranged from 0 to 272 (median: 31). While most prefectures provided intracavitary (IC) BT for gynecological cancers and interstitial (IS) BT for prostate cancer, only one-third of the prefectures provided IS BT for cancer sites other than the prostate. The institutional image-guided BT implementation rate was 71%. IC and IS BT was performed for 15.4% of IC BT cases of gynecological cancer. Only 47% of the BT training centers answered that they could provide adequate training in BT for residents. The most common reason for this finding was the insufficient number of patients in each center. The results show that, although BT has achieved uniformity in terms of facility penetration, new technologies are not yet widespread enough. Furthermore, IS BT, which requires advanced skills, is limited to a few BT centers, and considerable number of BT training centers do not have sufficient caseloads to provide the necessary experience for their residents.
Collapse
Affiliation(s)
- Hitoshi Ikushima
- Department of Therapeutic Radiology, Tokushima University Graduate School, Japan, 3-18-15, Kuramoto-cho, Tokushima-shi, Tokushima 770-8503, Japan
| | - Noriko Ii
- Department of Radiation Oncology, Ise Red Cross Hospital, Japan, 1-471-2, Funae, Ise-shi, Mie 516-8512, Japan
| | - Shin-ei Noda
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Japan, 1397-1, Yamane, Hidaka-shi, Saitama 350-1298, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Japan, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, Japan, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ken Yoshida
- Department of Radiology, Kansai Medical University Medical Center, Japan 2-5-1, Shin-machi, Hirakata-shi, Osaka 573-1010, Japan
| | - Miho Watanabe
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Japan, 1-8-1, Inohara, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Shinnji Kawamura
- Department of Radiological Technology, Teikyo University Graduate School of Medicine, Japan, 6-22, Misakimachi, Omuta-shi, Fukuoka 836-8505, Japan
| | - Toru Kojima
- Department of Radiation Oncology, Saitama Prefectural Cancer Center, Japan, 1696, Itai, Kumagaya-shi, Saitama 360-0197, Japan
| | - Yoshihito Nomoto
- Department of Radiology, Mie University Graduate School of Medicine, Japan, 2-174, Edobashi, Tsu-shi, Mie 5148-507, Japan
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Japan, 281, Miyasato, Uruma-shi, Okinawa 904-2293, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Japan, 3-39-22, Showa-machi, Maebashi-shi, Gunma 371-8511, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Japan, 1-1-1, Tennoudai, Tsukuba-shi, Ibaraki 305-8575, Japan
| | - Hiroshi Onishi
- Department of Radiology, Faculty of Medicine, University of Yamanashi, Japan, 4-4-37, Takeda, Kofu-shi, Yamanashi 400-8510, Japan
| |
Collapse
|
4
|
Mulherkar R, Ling DC, Tendulkar R, Kamrava MR, Beriwal S. Quality of Radiotherapy Workforce Training within the USA. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00048-7. [PMID: 38331669 DOI: 10.1016/j.clon.2024.01.019] [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: 12/01/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
The training, competency requirements and scope of practice of professionals within a radiation oncology department vary across countries. The purpose of this review is to shed light on the current status of radiotherapy training in the USA by discussing current benchmarks for medical residency, physics residency, radiation therapy and dosimetry training programmes. Although there are notable strengths, the US radiotherapy workforce training system also faces several challenges when it comes to standardising education to develop a competent workforce that meets societal needs. Continued efforts are needed at a systemic level to improve training in areas such as brachytherapy and proton therapy, promote research involvement and develop trainees who are equipped to form a competent radiation therapy workforce.
Collapse
Affiliation(s)
- R Mulherkar
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - D C Ling
- Department of Radiation Oncology, USC Keck School of Medicine, Los Angeles, CA, USA
| | - R Tendulkar
- Department of Radiation Oncology, Cleveland Clinic Cancer Center, Cleveland, OH, USA
| | - M R Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - S Beriwal
- Department of Radiation Oncology, AHN Cancer Institute, Pittsburgh, PA, USA.
| |
Collapse
|
5
|
Van Elburg D, Meyer T, Martell K, Quirk S, Banerjee R, Phan T, Fenster A, Roumeliotis M. Clinical implementation of 3D transvaginal ultrasound for intraoperative guidance of needle implant in template interstitial gynecologic high-dose-rate brachytherapy. Brachytherapy 2023; 22:790-799. [PMID: 37722991 DOI: 10.1016/j.brachy.2023.08.004] [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: 05/10/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE To demonstrate novel clinical implementation of a 3D transvaginal ultrasound (3DTVUS) system for intraoperative needle insertion guidance in perineal template interstitial gynecologic high-dose-rate brachytherapy and assess its impact on implant quality. METHODS AND MATERIALS Interstitial implants began with preimplant 3DTVUS to visualize the tumor and anatomy, with intermittent 3DTVUS to assess the implant and guide needle adjustment. Analysis includes visualization of the implant relative to anatomy, identification of cases where 3DTVUS is beneficial, dosimetry, and a survey distributed to 3DTVUS clinicians. RESULTS Seven patients treated between November 2021 and October 2022 were included in this study. Twenty needles were inserted under 3DTVUS guidance. The tumor and vaginal wall were well-differentiated in four and all seven patients, respectively. Patients with tumours below the superior aspect of the vagina are suited for 3DTVUS. Four radiation oncologists responded to the survey. There was general agreement that 3DTVUS improves implant and anatomy visualization and is preferred over standard 2D ultrasound guidance techniques. CONCLUSIONS Based on qualitative feedback from primary users and a small preliminary patient cohort, 3DTVUS imaging improves tumor and vaginal wall visualization during gynecologic perineal template interstitial needle implant and is a powerful tool for implant assessment in an intraoperative setting.
Collapse
Affiliation(s)
- Devin Van Elburg
- Department of Physics & Astronomy, University of Calgary, Calgary AB, Canada; Medical Physics Department, Tom Baker Cancer Centre, Calgary AB, Canada.
| | - Tyler Meyer
- Department of Physics & Astronomy, University of Calgary, Calgary AB, Canada; Medical Physics Department, Tom Baker Cancer Centre, Calgary AB, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary AB, Canada
| | - Kevin Martell
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary AB, Canada
| | - Sarah Quirk
- Department of Radiation Oncology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Robyn Banerjee
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary AB, Canada
| | - Tien Phan
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary AB, Canada
| | - Aaron Fenster
- School of Biomedical Engineering, University of Western Ontario, London ON, Canada; Robarts Research Institute, University of Western Ontario, London ON, Canada
| | - Michael Roumeliotis
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
6
|
Swain M, Budrukkar A, Rembielak A, Kron T, Agarwal JP. Challenges in the Sustainability of Brachytherapy Service in Contemporary Radiotherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00205-4. [PMID: 37302881 DOI: 10.1016/j.clon.2023.05.013] [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: 03/14/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Brachytherapy has a long history of delivering a highly conformal radiation dose to the target volume with sparing of adjacent normal tissue and has an irreplaceable role in certain cancers, such as cervical and prostate cancers. There have been futile attempts to replace brachytherapy with other radiation techniques. Despite that there are multifaceted challenges in preserving this dying art, from establishment, to a trained workforce, to maintenance of the equipment and source replacement costs. Here we focus on the challenges to access brachytherapy, the availability and distribution of care across the globe and appropriate training leading to proper implementation of the procedure. Brachytherapy holds a significant place in the treatment armamentarium of most common cancers, such as cervical, prostate, head and neck and skin cancers. However, there is an uneven distribution of brachytherapy facilities, not only across the globe, but also at a national level, with a larger proportion of facilities concentrated in certain regions, more so in low and low-middle income countries. The regions with the highest incidence of cervical cancer have the least access to brachytherapy facilities. Attempts to bridge the gap are essential and should be focused on uniform distribution and access to care, improving training of the workforce through specialised training programmes, reducing the cost of care, planning to reduce the recurring cost, generating evidence and research guidelines, renewing interest in brachytherapy through rebranding, use of social media and building an attainable long-term roadmap.
Collapse
Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - T Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India.
| |
Collapse
|
7
|
Ong WL, Byrne A, Chelvarajah R, Chong C, Gallo J, Kain M, Khong J, O'Reilly E, Udovicich C, Weeransinghe C, Zhong Hu T, Bece A. Survey of brachytherapy training experience among radiation oncology trainees and fellows in the Royal Australian and New Zealand College of Radiologists (RANZCR). J Med Imaging Radiat Oncol 2022; 66:980-992. [PMID: 35546425 PMCID: PMC9790377 DOI: 10.1111/1754-9485.13424] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION To evaluate brachytherapy training experience among trainees and fellows trained through the Royal Australian and New Zealand College of Radiologists (RANZCR). METHODS All current trainees and fellows (who obtained fellowship from 2015 onwards) were sent an online anonymous questionnaire on various aspects of brachytherapy training, including number of cases observed/ performed, opinions on brachytherapy assessment during training, barriers to brachytherapy training and future role of brachytherapy. RESULTS The overall survey response rate was 24% (40/161 trainees, 30/126 fellows). Of the 70 respondents, 50 (71%), 38 (54%) and 43 (61%) reported to have received formal brachytherapy teaching from radiation oncologists, radiation therapists and medical physicists respectively. Most respondents had exposure to gynaecology brachytherapy - two-thirds of trainees and all fellows have performed at least one gynaecology brachytherapy procedure. Prostate brachytherapy exposure was more limited - by the end of training, 27% and 13% of fellows did not have exposure to LDR and HDR prostate brachytherapy. More than two-thirds indicated there should be a minimum number of brachytherapy case requirements during training, and half indicated that trainees should be involved in ≥6 gynaecology brachytherapy procedures. Barriers affecting training include lack of caseload (70%) and perceived decreasing role of brachytherapy (66%). Forty-three percent of respondents were concerned about the decline in brachytherapy utilisation. CONCLUSION This is the first survey on brachytherapy training experience among RANZCR trainees and fellows. It highlighted limited brachytherapy exposure during RANZCR training, and the need to revisit brachytherapy training requirement in the current training programme, along with long-term brachytherapy workforce planning.
Collapse
Affiliation(s)
- Wee Loon Ong
- Alfred Health Radiation OncologyMelbourneVictoriaAustralia,Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Adam Byrne
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | | | - Caris Chong
- Department of Radiation OncologyGenesis Cancer CarePerthWAAustralia,Department of Radiation OncologyFiona Stanley HospitalPerthWestern AustraliaAustralia
| | - James Gallo
- Royal Brisbane and Women's HospitalHerstonQueenslandAustralia,University of QueenslandSt LuciaQueenslandAustralia
| | - Mollie Kain
- Regional Cancer and Blood ServiceAuckland City HospitalAucklandNew Zealand
| | - Jeremy Khong
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Eileen O'Reilly
- Regional Cancer and Blood ServiceAuckland City HospitalAucklandNew Zealand
| | - Cristian Udovicich
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Chamitha Weeransinghe
- Chris O'Brien Life House and Royal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Ta‐chi Zhong Hu
- Liverpool Cancer Therapy CentreLiverpoolNew South WalesAustralia,St George Cancer Care CentreKogarahNew South WalesAustralia
| | - Andrej Bece
- St George Cancer Care CentreKogarahNew South WalesAustralia
| |
Collapse
|
8
|
Lichter K, Anakwenze Akinfenwa C, MacDuffie E, Bhatia R, Small C, Croke J, Small W, Chino J, Petereit D, Grover S. Treatment of cervical cancer: overcoming challenges in access to brachytherapy. Expert Rev Anticancer Ther 2022; 22:353-359. [PMID: 35227148 PMCID: PMC9997721 DOI: 10.1080/14737140.2022.2047936] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Brachytherapy is an essential component of the cervical cancer treatment paradigm as it contributes to improved clinical outcomes and overall survival. Yet brachytherapy remains globally underutilized, with disparities in access at both national and international levels. AREAS COVERED The review explores current brachytherapy utilization practices and efforts being undertaken to address barriers to implementation in low-, middle-, and high-income countries, and how these efforts are projected to impact future brachytherapy access. The content presented is based on a review of published literature and the authors' collective clinical experiences. EXPERT OPINION There exists a tremendous opportunity to expand access to essential brachytherapy services for women with cervical cancer. Many national and international brachytherapy efforts exist; yet it remains imperative that such focused efforts continue to grow and provide further access to this critical treatment modality for women in need worldwide.
Collapse
Affiliation(s)
- Katie Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | | | - Emily MacDuffie
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rohini Bhatia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Christina Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer Croke
- Department of Radiation Oncology, University of Toronto, Toronto, ON, USA
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Junzo Chino
- Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA
| | - Daniel Petereit
- Department of Radiation Oncology, Cancer Care Institute at Monument Health, Rapid City, SD, USA
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
9
|
Doyle AJ, Cody D, King DM, Sullivan PFJ, Browne JE. Use of a novel anthropomorphic prostate simulator in a prostate brachytherapy transrectal ultrasound imaging workshop for medical physicists. Phys Med 2022; 95:156-166. [PMID: 35182938 DOI: 10.1016/j.ejmp.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Ultrasound imaging training is not required as part of radiation oncology training programs nor does any objective competency measure exist to independently assess performance. Physical simulation training can provide a structured approach to this training but only if suitably challenging training simulators exist. This study describes the design and preliminary evaluation of a simulation-based transrectal ultrasound (TRUS) imaging training workshop developed for medical physicists involved in low-dose-rate (LDR) prostate brachytherapy (PBT). METHODS The study incorporated novel high-fidelity anthropomorphic PBT TRUS training simulators and a TRUS imaging module with a blended-learning pedagogical approach, to address TRUS image optimisation and managing image quality. RESULTS Results demonstrated a significant improvement in knowledge, with an average increase in multiple choice question score of 61% (P < 0.0002), and that there was a 46% (P < 0.0001) average increase in the participants perceived understanding of TRUS scanner operation, and an increase of 36% (P < 0.001) in participants readiness to optimise image quality and mitigate image artefacts. Focus group data explored participants' experiences, perceptions and challenges with TRUS LDR PBT. CONCLUSIONS This study suggests a benefit in offering a simulation training workshop to medical physicists and the potential benefit to other healthcare professionals involved in prostate brachytherapy, by incorporating novel high-fidelity anthropomorphic PBT TRUS training simulators, in a simulated environment to practice ultrasound image optimisation for PBT image guidance. This approach to training would enable competency-based skill acquisition and continued proficiency or health professionals in the TRUS PBT procedure, outside of the surgical environment without direct exposure to patients.
Collapse
Affiliation(s)
- Andrea Jane Doyle
- School of Physics and Clinical and Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland; RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Ireland.
| | - Dervil Cody
- School of Physics and Clinical and Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland
| | | | - Prof Francis J Sullivan
- Prostate Cancer Institute, National University of Ireland Galway, Galway, Ireland; Department of Radiation Oncology, Galway Clinic, Ireland; School of Medicine, National University of Ireland, Galway, Ireland
| | - Jacinta E Browne
- School of Physics and Clinical and Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland; Department of Radiology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
10
|
Wang MH, Loewen SK, Giuliani M, Fairchild A, Yee D, Debenham BJ. Clinical Learning, Didactic Education, and Research Experiences of Radiation Oncology Resident Physicians in Canada. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:155-162. [PMID: 32621072 DOI: 10.1007/s13187-020-01799-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Changes in the field of radiation oncology (RO) impacts residency training. Assessing trainee experiences is essential to inform curriculum development. We aim to explore gaps and strengths in current Canadian RO training, as we move towards competency-based medical education (CBME). An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 66 open-ended, Likert-scale, matrix-style, and multiple-choice questions, and assessed clinical exposure, didactic teaching, professional relationships, and research experiences. Statistics were calculated from anonymized, aggregate responses. Out of 128 eligible residents, 53 responded (41% response rate). Of these, 57% were male, and 77% were Canadian medical graduates. Senior residents (PGY-4 to PGY-5) perceived insufficient exposure to lymphoma and ocular malignancies, brachytherapy for breast and esophagus malignancies, and stereotactic radiotherapy of the pancreas, prostate, and adrenal gland. Half (51%) had training on image-guided radiotherapy (IGRT) challenges, and 43% had a formal staff mentor. Most residents presented at least one research project at conferences (77%) and authored ≥ 1 publications (66%) during residency. Canadian RO residents are satisfied with their clinical training and educational experience in high-volume tumor sites and high-volume brachytherapy procedures. Areas identified for potential improvement are (1) low-volume tumor sites; (2) low-volume brachytherapy procedures; (3) low-volume stereotactic radiotherapy sites; (4) IGRT challenges; and (5) mentorship opportunities. These findings will inform future CBME curriculum revisions.
Collapse
Affiliation(s)
- Michael H Wang
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada.
- Division of Radiation Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada.
| | - Shaun K Loewen
- Division of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Alysa Fairchild
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - Don Yee
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - Brock J Debenham
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
11
|
Shiao JC, Santoso A, Stuhr K, Bennett SJ, Gao D, Holt DE, Robin T, Fisher CM. Gynecologic interstitial brachytherapy curriculum using a low-cost phantom with ultrasound workshop and a treatment planning workshop is effective. Brachytherapy 2021; 21:110-119. [PMID: 34876360 DOI: 10.1016/j.brachy.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE/OBJECTIVE(S) Standardized simulation training geared towards interstitial brachytherapy (IS BT) for gynecologic malignancies is lacking in radiation oncology resident education. We developed and implemented a curriculum for IS BT training with (1) lecture on equipment, workflow, and guidelines, (2) hands-on ultrasound-guided IS BT workshop, and (3) treatment planning workshop. METHODS AND MATERIAL The cost in materials of each phantom was approximately $66. After a lecture, two alternating workshops were performed. The first session consisted of a hands-on ultrasound-guided IS BT workshop with one resident imaging the phantom with a transabdominal ultrasound probe and the other resident implanting the phantom with needles. A second session consisted of a hands-on treatment planning workshop using BrachyVision and an l-Q spreadsheet with the following objectives: coverage goal, meeting D2cc constraints, and minimizing V200. The primary outcome was improvement in knowledge assessed with Likert-style questions and objective knowledge-based questions (KBQs). RESULTS Four of the seven medical residents that participated in this curriculum had prior IS BT experience. Residents reported significantly improved knowledge regarding gynecologic IS BT equipment and procedure, evaluating gynecologic anatomy using ultrasound, CT simulation, contouring, and plan review (overall median pre-session subjective score 2 (1) -(3) versus post-session score 4 (3) -(4, p < 0.01). Residents demonstrated improvement in answering KBQs correctly from 44% correct at baseline to 88% after completion of the curriculum (p < 0.01). All residents "Agree" and "Strongly Agree" the session was an effective learning experience. CONCLUSIONS Residents participating in phantom training with an ultrasound curriculum and a treatment planning session is effective for improving knowledge and skills in IS BT for radiation oncology residents.
Collapse
Affiliation(s)
- Jay C Shiao
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO
| | - Andrew Santoso
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO
| | - Kelly Stuhr
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO
| | | | - Dexiang Gao
- Department of Statistics, University of Colorado Cancer Center, Aurora, CO
| | - Douglas E Holt
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO
| | - Tyler Robin
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO.
| |
Collapse
|
12
|
Taggar AS, Martell K, Leung E, Banerjee R, Fortin I, Doll CM. Changing Landscape of Radiation Therapy for Advanced Cervical Cancer With a Focus on Interstitial Brachytherapy: A Canadian Practice Patterns Survey. Pract Radiat Oncol 2021; 12:145-154. [PMID: 34678519 DOI: 10.1016/j.prro.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To document the evolution of radical radiation therapy and interstitial brachytherapy (ISBT) utilization practice patterns across Canada, including use of imaging, technical details, and usage of anesthesia/analgesia, and to compare advanced (AC) versus nonadvanced (nAC) brachytherapy (BT) center practices. METHODS AND MATERIALS All Canadian centers with BT services were identified. One gynecology radiation oncologist per center was sent a 64-item questionnaire regarding the center's practice for patients with cervical cancer. Centers were categorized based on availability of advanced BT expertise (AC) versus those referring patients to other centers for advanced BT techniques (nAC). Aggregate responses are reported and compared with practice patterns identified in our previous survey. Descriptive statistics were used to summarize data, and the Fisher exact test, Fisher-Freeman-Halton, or Mann-Whitney-Wilcox test was used for comparisons. RESULTS Thirty-seven of 38 respondents completed the survey (response rate: 97.4%). Compared with 2015, there has been an increase in utilization of magnetic resonance imaging as the sole imaging modality for BT planning: 3 of 26 (11%) versus 12 of 37 (32%; P = .03). The number of centers with the ability to perform ISBT increased in 2020 compared with 2015 (26/37 [70%] vs 13/26 [50%], P = .710); this trend is likely due to an increase in use of hybrid (Vienna, Utrecht, Venezia) applicators (36% [2015] vs 84% [2020]; P = .175). Fifteen (40%) centers had the ability to perform perineal-ISBT (P-ISBT). Sixteen and 21 centers were identified as AC and nAC, respectively. All 16 AC centers had the ability to perform ISBT, compared with only 10 nAC centers (P < .001). A higher proportion of AC centers had fellowship-trained radiation oncologists performing brachytherapy, compared with nAC centers (94% vs 14%, P < .001). In terms of anesthesia, conscious sedation was the only available choice at low-patient-volume centers (8/37, 21%) performing intracavitary BT only. Those performing ISBT had choice of general, spinal, and epidural anesthesia. CONCLUSIONS In Canada, high-quality, modern management radiation therapy practices are consistently offered to patients with cervical cancer. There is a trend toward increased utilization of ISBT. Accumulation of evidence toward the use of ISBT, increased utilization of high-quality imaging modalities such as magnetic resonance imaging, and availability of hybrid applicators are potential contributors for this upward trend.
Collapse
Affiliation(s)
- Amandeep S Taggar
- Department of Radiation Oncology, University of Toronto, Toronto, Canada.
| | - Kevin Martell
- Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Canada
| | - Eric Leung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Robyn Banerjee
- Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Canada
| | - Israel Fortin
- Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Centre affilié à l'Université de Montréal, Montréal, Canada
| | - Corinne M Doll
- Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Canada
| |
Collapse
|
13
|
Multipurpose ultrasound-based prostate phantom for use in interstitial brachytherapy. Brachytherapy 2021; 20:1139-1145. [PMID: 34420861 DOI: 10.1016/j.brachy.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE While brachytherapy is an effective treatment for localized prostate cancer, there has been a noticeable decline in its use. Training opportunity for prostate brachytherapy has been in steady decline, with some residents receiving little to no hands-on training. This work was developed to design a training environment that uses a phantom-based simulator to teach the process of TRUS-based prostate brachytherapy METHODS AND MATERIALS: A prostate phantom was fabricated from a representative prostate patient TRUS scan. Three materials were used: gelatin powder, graphite powder, and water. The prostate was developed using 9% gelatin and 0.3% graphite per 100 ml water. Five radiation oncologists were asked to qualitatively score the phantom according to image quality, haptic feedback, needle insertion quality, and its compatibility with operative tools. The contrast-to-noise ratio (CNR) was estimated using different concentrations of graphite. The elasticity of the phantom was evaluated based on ultrasound elastography measurements RESULTS: The prostate phantom had an average CNR of 3.94 ± 1.09 compared to real prostate images with a CNR of 2 ± 1.8. The average Young's modulus was computed to be 58.03 ± 6.24 kPa compared to real prostate tissue (58.8 ± 8.2 kPa). Oncologists ranked the phantom as "very good" for overall quality of the phantom. They reported that needle insertion quality was "very good" during a simulated brachytherapy procedure. CONCLUSION We have developed a 3D printing prostate phantom to be used for training purposes during prostate brachytherapy. The phantom has been evaluated for image quality and elasticity. The reconstructed phantom could be used as an anthropomorphic surrogate to train residents on prostate brachytherapy procedures.
Collapse
|
14
|
Williams VM, Kahn JM, Thaker NG, Beriwal S, Nguyen PL, Arthur D, Petereit D, Dyer BA. The Case for Brachytherapy: Why It Deserves a Renaissance. Adv Radiat Oncol 2021; 6:100605. [PMID: 33723523 PMCID: PMC7940781 DOI: 10.1016/j.adro.2020.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 01/22/2023] Open
Abstract
The recent global events related to the coronavirus disease of 2019 pandemic have significantly changed the medical landscape and led to a shift in oncologic treatment perspectives. There is a renewed focus on preserving treatment outcomes while maintaining medical accessibility and decreasing medical resource utilization. Brachytherapy, which is a vital part of the treatment course of many cancers (particularly prostate and gynecologic cancers), has the ability to deliver hypofractionated radiation and thus shorten treatment time. Studies in the early 2000s demonstrated a decline in brachytherapy usage despite data showing equivalent or even superior treatment outcomes for brachytherapy in disease sites, such as the prostate and cervix. However, newer data suggest that this trend may be reversing. The renewed call for shorter radiation courses based on data showing equivalent outcomes will likely establish hypofractionated radiation as the standard of care across multiple disease sites. With shifting reimbursement, brachytherapy represents the pinnacle in hypofractionated, conformal radiation therapy, and with extensive long-term data in support of the treatment modality brachytherapy is primed for a renaissance.
Collapse
Affiliation(s)
- Vonetta M. Williams
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Jenna M. Kahn
- Department of Radiation Oncology, Oregon Health & Science University, Portland, Oregon
| | - Nikhil G. Thaker
- Department of Radiation Oncology, Arizona Oncology, Tucson, Arizona
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Douglas Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel Petereit
- Department of Radiation Oncology, Monument Health Cancer Care Institute, Rapid City, South Dakota
| | - Brandon A. Dyer
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| |
Collapse
|
15
|
Singer L, McLaughlin PY, Alban G, Joyner M, King M, Lee L. Simulation-based graduate medical education in MR-guided brachytherapy for cervical cancer. Brachytherapy 2020; 19:725-731. [PMID: 33183971 DOI: 10.1016/j.brachy.2020.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Brachytherapy is critical for the curative treatment of locally advanced cervical cancer. Although brachytherapy use is declining in the United States (U.S.), novel interstitial or intracavitary applicators and advances in image guidance for applicator placement and treatment planning have allowed for tumor dose escalation while reducing normal tissue toxicity. Recent survey data have suggested insufficient brachytherapy training for radiation oncology trainees in the United States. This study aimed to address these gaps by developing and piloting a simulation-based education (SBE) workshop for MR-guided cervical cancer brachytherapy. METHODS AND MATERIALS An SBE workshop was developed for graduate medical education (GME) trainees focusing on MR-guided brachytherapy for cervical cancer. Four hands-on stations, simulating aspects of the procedure, were led by a team of gynecological brachytherapy experts. The learners were radiation oncology residents and fellows in a U.S. GME training program. The primary outcome was feasibility, assessed by completion of the workshop within the time constraints of the curriculum. Learners completed preworkshop and postworkshop surveys to provide information on efficacy. RESULTS The workshop was successfully completed in a 1-h block of GME didactic time. Ten trainees completed all four stations, and all completed preworkshop and postworkshop surveys, which showed improvements in knowledge and technical proficiency. Feedback was positive, and trainees requested additional learning opportunities. CONCLUSIONS This study showed that GME-focused SBE in MR-guided cervical cancer brachytherapy was feasible. SBE provided a nonclinical environment in which to practice aspects of MR-guided brachytherapy. Ongoing work includes collaboration with other U.S. institutions. Future studies should focus on international adaptation.
Collapse
|
16
|
Simulation-based learning for enhanced gynecologic brachytherapy training among radiation oncology residents. Brachytherapy 2020; 20:128-135. [PMID: 33158776 DOI: 10.1016/j.brachy.2020.08.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Brachytherapy is an irreplaceable component of gynecologic cancer treatment. Resident training has declined, and procedural exposure is variable. We evaluated whether simulation-based gynecologic brachytherapy training among radiation oncology residents could improve knowledge, confidence, and interest. METHODS AND MATERIALS Before a brachytherapy workshop, radiation oncology residents without prior gynecologic brachytherapy experience completed a survey on brachytherapy knowledge, procedural confidence, plan evaluation, and quality/safety. Residents then participated in a gynecologic brachytherapy workshop. Lectures covered brachytherapy imaging and physics principles/quality assurance, followed by hands-on and individualized feedback regarding applicator selection and placement, target segmentation, and physics quality assurance. Afterward, preworkshop questions were recollected. Descriptive statistics and Fisher's exact tests were used for data analysis. RESULTS After the workshop, resident responses regarding the learning environment and baseline knowledge questions improved overall. There was a 30% improvement in favorable responses to the learning environment statement "My residency has a formal process/curriculum to teach brachytherapy" and for baseline knowledge the greatest improvement was seen for "I am familiar with the anatomy and placement of the applicators in relation to the anatomy". "Lack of didactic or procedural training exposure" was identified as the main reason for declining brachytherapy use. Initially, 1/8 residents correctly completed the knowledge questions, and after the workshop, 6/7 (p < 0.001) residents correctly completed the questions. CONCLUSIONS Domain-specific knowledge, procedural confidence, and brachytherapy interest improved after a gynecologic brachytherapy workshop. Integrated didactic and simulation-based brachytherapy training may serve as a valuable learning tool to augment resident knowledge, introduce practical skills, and spark resident interest in brachytherapy.
Collapse
|
17
|
Brachytherapy education and certification—A Canadian approach. Brachytherapy 2020; 19:857-860. [DOI: 10.1016/j.brachy.2020.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/13/2020] [Accepted: 05/12/2020] [Indexed: 11/22/2022]
|
18
|
More than learning technical skills: The importance of mentorship and coaching during a brachytherapy fellowship. Brachytherapy 2020; 19:758-761. [PMID: 32798179 DOI: 10.1016/j.brachy.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/02/2020] [Accepted: 07/07/2020] [Indexed: 11/24/2022]
Abstract
Brachytherapy exposure during residency varies between residency training programs. As a result, many graduating radiation oncology residents do not feel competent or confident in performing brachytherapy procedures. A brachytherapy fellowship encompasses hands-on procedural skills in addition to clinical decision-making, radiotherapy treatment planning, as well as post-treatment care. During this time, a fellow develops interpersonal relationships with their faculty supervisors in the form of mentorship, sponsorship, and coaching in addition to clinical teaching. The objective of this article is to review these important relationships focusing on brachytherapy fellowship training as an example.
Collapse
|
19
|
Kahn JM, Campbell SR, Albert AA, Knoll MA, Shah C. #ThisIsBrachytherapy: Increasing awareness of brachytherapy. Brachytherapy 2020; 20:232-236. [PMID: 32811760 DOI: 10.1016/j.brachy.2020.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/08/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The use of brachytherapy continues to be a vital application of radiation oncology for various cancers. Despite this, there has been a decrease in the utilization of brachytherapy in many cancers. Social media in medicine facilitates engagement and advocacy. We launched a social media campaign to bring awareness of brachytherapy throughout the world with #ThisIsBrachytherapy hashtag on July 17, 2019. METHODS AND MATERIALS #ThisIsBrachytherapy hashtag was registered with Symplur Healthcare Hashtag Project. We collected total tweet counts, retweet counts, impression counts, geolocation, top 10 influencers, associated hashtags, associated words, and word sentiment score. RESULTS The campaign launched on July 17, 2019, had a total of 145 tweets on that day with 213,416 impressions. Twenty-seven accounts (45%) were identified as physicians. Top countries which tweeted, among those with information available, included the United States, United Kingdom, and Australia. Since July 17, 2019, there has been an increase in tweets using #ThisIsBrachytherapy, with 1990 total tweets with 1,999,248 impressions. Fifty-four percent (1030) of the tweets contained photos and 319 contained links. This was from 462 unique users. Word sentiment was overwhelmingly positive. Associated hashtags with #ThisIsBrachytherapy included most commonly #radonc, #brachytherapy, #brachy, #prostatecancer, and #pcsm. CONCLUSIONS The #ThisIsBrachytherapy inaugural campaign was successful and has continued to grow throughout the months after the initiation. By continuing to advocate for brachytherapy through the social media campaign #ThisIsBrachytherapy, we can empower radiation oncologists, especially trainees, and patients to address underutilization.
Collapse
Affiliation(s)
- Jenna M Kahn
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR.
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
20
|
Sarria GR, Sperk E, Wenz F, Schneider F, Abo-Madyan Y, Giordano FA, Ehmann M. Adjuvant electronic brachytherapy for endometrial carcinoma: A 4-year outcomes report. Brachytherapy 2020; 19:635-641. [PMID: 32651094 DOI: 10.1016/j.brachy.2020.06.002] [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: 03/31/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to report the outcomes of a single-center adjuvant electronic brachytherapy (e-BT) experience for patients with endometrial carcinoma. METHODS AND MATERIALS Patients were retrospectively assessed. Intracavitary e-BT was applied through a cylindrical applicator (diameters 2.5-3.5 cm). e-BT single doses ranged between 4 and 7 Gy (EQD2 ∼ 6-12, α/β of 10 Gy and an relative biological effectiveness of 1.3) at 5-mm depth. Adverse events are reported at first week, 1-3 months, 3-12 months, 12-24 months, and >24 months. The overall survival, disease-free survival, distant disease control rate, and local control rate were estimated using the Kaplan-Meier method. RESULTS Twenty-nine patients were assessed. The median age was 68 [48-86] years. External beam radiotherapy was added in n = 8 (27.6%) patients. Staging was 13.8% for T1a, 51.7% for T1b, 24.1% for T2, 6.9% for T3a, and 3.4% for T3b. Grading was G3 in 51.7% (n = 15), G2 in 20.7% (n = 6), and G1 in 27.6% (n = 8). Median followup was 47 months [5-88]. Overall Grade 1, 2, and 3 toxicity was 89.7% (n = 26), 17.2% (n = 5), and 6.9% (n = 2), respectively. No Grade 3 cystitis or proctitis or any Grade 4 or 5 toxicity occurred during followup. No local recurrences were detected. Estimated distant disease control rate was 92.1% (n = 2, distant metastasis at 7 and 11 months). Estimated 4-year overall survival was 84.8% (n = 4 events, two unrelated to disease) and disease-free survival was 84.6%. CONCLUSIONS Our data suggest that e-BT resembles a very-low-toxicity profile and a high local control rate in the adjuvant scenario for patients with endometrial carcinoma.
Collapse
Affiliation(s)
- Gustavo R Sarria
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- University Medical Center Freiburg, Medical Faculty Freiburg, Freiburg University, Freiburg, Germany
| | - Frank Schneider
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany.
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
21
|
Hopfensperger KM, Adams Q, Kim Y, Wu X, Xu W, Patwardhan K, Thammavong B, Caster J, Flynn RT. Needle-free cervical cancer treatment using helical multishield intracavitary rotating shield brachytherapy with the 169 Yb Isotope. Med Phys 2020; 47:2061-2071. [PMID: 32073669 PMCID: PMC7377278 DOI: 10.1002/mp.14101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess the capability of an intracavitary 169 Yb-based helical multishield rotating shield brachytherapy (RSBT) delivery system to treat cervical cancer. The proposed RSBT delivery system contains a pair of 1.25 mm thick platinum partial shields with 45° and 180° emission angles, which travel in a helical pattern within the applicator. METHODS A helically threaded tandem applicator with a 45° tandem curvature containing a helically threaded catheter was designed. A 0.6 mm diameter 169 Yb source with a length of 10.5 mm was simulated. A 37-patient treatment planning study, based on Monte Carlo dose calculations using MCNP5, was conducted with high-risk clinical target volumes (HR-CTVs) of 41.2-192.8 cm3 (average ± standard deviation of 79.9 ± 35.8 cm3 ). All patients were assumed to receive 25 fractions of 1.8 Gy of external beam radiation therapy (EBRT) before receiving 5 fractions of high-dose-rate brachytherapy (HDR-BT). For each patient, 192 Ir-based intracavitary (IC) HDR-BT, 192 Ir-based intracavitary/interstitial (IC/IS) HDR-BT using a hybrid applicator with eight IS needles, and 169 Yb-based RSBT plans were generated. RESULTS For the IC, IC/IS, and RSBT treatment plans, 38%, 84%, and 86% of the plans, respectively, met the planning goal of an HR-CTV D90 (minimum dose to hottest 90%) of 85 GyEQD2 (α/β = 10 Gy). Median (25th percentile, 75th percentile) treatment times for IC, IC/IS, and RSBT were 11.71 (6.62, 15.40) min, 68.00 (45.02, 80.02) min, and 25.30 (13.87, 35.39) min, respectively. 192 Ir activities ranging from 159.1-370 GBq (4.3-10 Ci) and 169 Yb activities ranging from 429.2-999 GBq (11.6-27 Ci) were used, which correspond to the same clinical ranges of dose rates at 1 cm off-source-axis in water. Extra needle insertion and planning time beyond that needed for intracavitary-only approaches was accounted for in the IC/IS treatment time calculations. CONCLUSION 169 Yb-based RSBT for cervical cancer met the HR-CTV D90 goal of 85 Gy in a greater percentage of the patients considered than IC/IS (86% vs 84%, respectively) and can reduce overall treatment time relative to IC/IS. 169 Yb-based RSBT could be used to replace IC/IS in instances where IC/IS treatment is not available, especially in instances when HR-CTV volumes are ≥30 cm3 .
Collapse
Affiliation(s)
- Karolyn M Hopfensperger
- Department of Biomedical Engineering, University of Iowa, 1402 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, 52242, USA
| | - Quentin Adams
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Yusung Kim
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Xiaodong Wu
- Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, 52242, USA
| | - Weiyu Xu
- Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, 52242, USA
| | - Kaustubh Patwardhan
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Joseph Caster
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Ryan T Flynn
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| |
Collapse
|
22
|
Chopra S, Mittal P, Viswanathan A, Tharavichitkul E, Zubizarreta E, Nout RA, Yap ML, Grover S, Rodin D, Rai B, Gondhowiardjo S, Shrivastava SK. Global Collaborations for Cervical Cancer: Can the East-West Alliance Facilitate Treatment for all? Clin Oncol (R Coll Radiol) 2019; 31:529-538. [PMID: 31229379 DOI: 10.1016/j.clon.2019.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/11/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022]
Abstract
Despite the advances in the primary prevention of cervical cancer, there is an absolute increase in the incidence of cervical cancer as a result of an increase in world population. A vast majority of patients in low and low-middle income countries continue to present at a locally advanced stage, necessitating treatment with chemoradiation and brachytherapy. There is a dearth of equipment and trained professionals for the treatment of cervical cancer, especially in low and low-middle income countries. There is an urgent need to improve treatment availability and develop better treatments. Worldwide trends, however, reveal a low number of therapeutic and innovative research trials in cervical cancer. The present article elucidates the existing challenges and provides solutions to improve outcomes. The proposed strategies hinge on strengthening collaborations for global advocacy.
Collapse
Affiliation(s)
- S Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
| | - P Mittal
- Homi Bhabha National Institute, Mumbai, India; Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - A Viswanathan
- Department of Radiation Oncology, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - E Tharavichitkul
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - E Zubizarreta
- Division of Human Health, International Atomic of Energy Agency - Vienna International Centre, Vienna, Austria
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Center LUM, Leiden, the Netherlands
| | - M L Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, UNSW Sydney, Liverpool, New South Wales, Australia; Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia; School of Public Health, The University of Sydney, Camperdown, Australia
| | - S Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA; Botswana-UPENN Partnership, University of Botswana, Gaborone, Botswana
| | - D Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - B Rai
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gondhowiardjo
- Department of Radiotherapy, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - S K Shrivastava
- Department of Radiation Oncology, Apollo Hospital, Belapur, Navi Mumbai, India
| |
Collapse
|
23
|
Singer L, Braunstein S, Klopp A, Joyner M. Development and Implementation of a Simulation-Based Educational Workshop on Gynecological Brachytherapy: Pilot Study at a National Meeting. Pract Radiat Oncol 2019; 9:e465-e472. [PMID: 31128303 DOI: 10.1016/j.prro.2019.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/17/2019] [Accepted: 05/13/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite the importance of brachytherapy in the curative treatment of locally advanced cervical cancer, reviews of practice patterns in the United States have identified a decline in brachytherapy use in clinically appropriate patient populations. A survey of radiation oncologists identified lack of time and lack of guidance as barriers. To address these barriers, the purpose of this study was to develop a simulation-based educational (SBE) gynecologic brachytherapy workshop. METHODS AND MATERIALS The SBE gynecologic brachytherapy workshop was developed with expertise from 2 institutions, combining procedural simulation with a practical discussion of brachytherapy applicator insertion techniques. The primary outcome was feasibility of workshop deployment, defined as completion of all workshop components in the time allotted. Preworkshop and postworkshop surveys were also administered to assess efficacy, a secondary outcome. RESULTS The workshop took place at a national radiation oncology meeting, and all workshop components were completed in the 2 hours allotted. SBE stations focused on (1) fiducial placement, (2-3) applicator selection, (4) suturing, and (5) pelvic examination and applicator placement. Fourteen participants completed surveys. Respondents included residents and attending physicians. More than 50% of respondents were from academic practices and practiced gynecologic brachytherapy weekly or more. Curricular objectives for this workshop were for ≥20% trainees to report increased confidence in practice and ≥20% of trainees to report increased familiarity with applicators. After participation in the workshop, confidence in applicator choice improved in 9 of 13 participants (69%), confidence in complication management improved in 8 of 13 participants (62%), and familiarity with applicators improved in 7 of 13 participants (54%). These differences were statistically significant at α = .05. CONCLUSIONS This study demonstrated feasibility in using simulation for gynecologic brachytherapy education at a national meeting. Although most respondents were experienced in brachytherapy, more than half reported increased confidence and familiarity with aspects of the procedure after the workshop. Future work should address interstitial needle placement and improved time management of workshop stations.
Collapse
Affiliation(s)
- Lisa Singer
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Ann Klopp
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Melissa Joyner
- University of Texas, MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, University of Texas Medical Branch, Houston, Texas
| |
Collapse
|
24
|
Brachytherapy Training Survey of Radiation Oncology Residents. Int J Radiat Oncol Biol Phys 2019; 103:557-560. [DOI: 10.1016/j.ijrobp.2018.10.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 11/23/2022]
|
25
|
Taggar AS, Phan T, Traptow L, Banerjee R, Doll CM. Cervical cancer brachytherapy in Canada: A focus on interstitial brachytherapy utilization. Brachytherapy 2016; 16:161-166. [PMID: 27914911 DOI: 10.1016/j.brachy.2016.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/17/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Brachytherapy (BT) techniques for cervical cancer in Canada have changed over the last decade, with evolution to high-dose-rate and image-guided BT. However, there are currently no national data on the use of interstitial BT (IBT). The purpose of this study was to document IBT utilization in Canadian centers, as well as update details of cervical cancer BT practices. METHODS AND MATERIALS All Canadian centers with gynecologic BT services (n = 33) were identified, and one gynecology radiation oncologist per center was sent a 33-item e-mail questionnaire regarding their center's practice for cervical cancer BT in 2015. Responses were reported and compared with practice patterns identified in a 2012 Canadian survey. RESULTS The response rate was 85% (28/33 centers). The majority (93%) of respondents used high-dose-rate BT, similar to the 2012 survey; 96% of centers had transitioned to three-dimensional (MRI/CT)-based planning in 2015 vs. 75% in 2012 (p = 0.03); 57% centers incorporated MRI for treatment planning in 2015 compared to 38% in 2012 (p = 0.15); the majority (13/16) using a combination of MRI and CT; 50% (14/28 centers) had the capacity to perform IBT, whereas 71% of those that did not referred patients to other centers. Of centers performing IBT, the majority (11/14) used template-based techniques with a median of 6 (range 2-20) needles/catheters and an average of 4 (range 1-5) fractions. Catheters were placed using: strategy based on pre-op imaging (21%), intra-op ultrasound (50%), intra-op MRI (7%), and intra-op CT (21%). The most common dose/fractionation schedules were 6 Gy × 5 fractions (40%), 8 Gy × 3 fractions (19%), and 7 Gy × 4 fractions (15%). CONCLUSIONS In Canada, treatment of cervical cancer continues to evolve. IBT has been adopted by half of the responding centers. As more centers move to MRI-based image-guided treatment planning, IBT will become an even more integral part of cervical cancer treatment.
Collapse
Affiliation(s)
- Amandeep S Taggar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tien Phan
- Department of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada
| | - Laurel Traptow
- Department of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada
| | - Robyn Banerjee
- Department of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada
| | - Corinne M Doll
- Department of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
26
|
Attitude and practice of brachytherapy in India: a study based on the survey amongst attendees of Annual Meeting of Indian Brachytherapy Society. J Contemp Brachytherapy 2016; 7:462-8. [PMID: 26816503 PMCID: PMC4716124 DOI: 10.5114/jcb.2015.55666] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/12/2015] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We performed a survey amongst attendees of the 4(th) Annual Meeting of Indian Brachytherapy Society to study the patterns of brachytherapy practice and attitude towards brachytherapy use. MATERIAL AND METHODS A 19-point questionnaire was designed and e-mailed to the attendees immediately after the conference. Descriptive analysis of the responses were done and satisfaction index was used as a tool for evaluation of the program effectiveness. Binomial test was used to assess the difference between distributions of responses and Mann-Whitney U test was used to assess the correlation between responses. P value (2-tailed) of < 0.05 was taken significant for all statistical analysis. RESULTS Of a total of 202 attendees, 90 responded to the survey (response rate: 44.5%). Seventy-two percent belonged to an academic institute while 28% belonged to non-academic institutes. Eighty-six percent were radiation oncologists and 10% were medical physicists. Eighty-nine percent respondents used high-dose-rate, 14% - pulse-dose-rate, and 13% used low-dose-rate brachytherapy facility. Orthogonal X-rays, computed tomography, and magnetic resonance imaging was used for brachytherapy planning by 56%, 69%, and 14%, respectively. Ninety-three percent of them thought that lack of training is a hurdle in practicing brachytherapy and 92% opined that brachytherapy dedicated meetings can change their perception about brachytherapy. Seventy percent respondents admitted to make some changes in their practice patterns after attending this meeting. Ninety-seven percent of them would like to attend future meetings and 98% felt the need to include live workshops, hands on demonstrations, and video presentations in the scientific programme. CONCLUSIONS The survey highlights a positive attitude towards increasing brachytherapy use, and may serve as an important guiding tool in designing teaching and training programmes; thus overcoming the hurdles in successful and widespread use of a quality brachytherapy programme at radiotherapy centers.
Collapse
|