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Holmes J, Zhang L, Ding Y, Feng H, Liu Z, Liu T, Wong WW, Vora SA, Ashman JB, Liu W. Benchmarking a Foundation Large Language Model on its Ability to Relabel Structure Names in Accordance With the American Association of Physicists in Medicine Task Group-263 Report. Pract Radiat Oncol 2024:S1879-8500(24)00098-5. [PMID: 39243241 DOI: 10.1016/j.prro.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE To introduce the concept of using large language models (LLMs) to relabel structure names in accordance with the American Association of Physicists in Medicine Task Group-263 standard and to establish a benchmark for future studies to reference. METHODS AND MATERIALS Generative Pretrained Transformer (GPT)-4 was implemented within a Digital Imaging and Communications in Medicine server. Upon receiving a structure-set Digital Imaging and Communications in Medicine file, the server prompts GPT-4 to relabel the structure names according to the American Association of Physicists in Medicine Task Group-263 report. The results were evaluated for 3 disease sites: prostate, head and neck, and thorax. For each disease site, 150 patients were randomly selected for manually tuning the instructions prompt (in batches of 50), and 50 patients were randomly selected for evaluation. Structure names considered were those that were most likely to be relevant for studies using structure contours for many patients. RESULTS The per-patient accuracy was 97.2%, 98.3%, and 97.1% for prostate, head and neck, and thorax disease sites, respectively. On a per-structure basis, the clinical target volume was relabeled correctly in 100%, 95.3%, and 92.9% of cases, respectively. CONCLUSIONS Given the accuracy of GPT-4 in relabeling structure names as presented in this work, LLMs are poised to become an important method for standardizing structure names in radiation oncology, especially considering the rapid advancements in LLM capabilities that are likely to continue.
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Affiliation(s)
- Jason Holmes
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
| | - Lian Zhang
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Yuzhen Ding
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Hongying Feng
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Zhengliang Liu
- School of Computing, University of Georgia, Athens, Georgia
| | - Tianming Liu
- School of Computing, University of Georgia, Athens, Georgia
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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2
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Grau C, Dasu A, Troost EGC, Haustermans K, Weber DC, Langendijk JA, Gregoire V, Orlandi E, Thariat J, Journy N, Chaikh A, Isambert A, Jereczek-Fossa BA, Vaniqui A, Vitek P, Kopec R, Fijten R, Luetgendorf-Caucig C, Olko P. Towards a European prospective data registry for particle therapy. Radiother Oncol 2024; 196:110293. [PMID: 38653379 DOI: 10.1016/j.radonc.2024.110293] [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: 03/23/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
The evidence for the value of particle therapy (PT) is still sparse. While randomized trials remain a cornerstone for robust comparisons with photon-based radiotherapy, data registries collecting real-world data can play a crucial role in building evidence for new developments. This Perspective describes how the European Particle Therapy Network (EPTN) is actively working on establishing a prospective data registry encompassing all patients undergoing PT in European centers. Several obstacles and hurdles are discussed, for instance harmonization of nomenclature and structure of technical and dosimetric data and data protection issues. A preferred approach is the adoption of a federated data registry model with transparent and agile governance to meet European requirements for data protection, transfer, and processing. Funding of the registry, especially for operation after the initial setup process, remains a major challenge.
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Affiliation(s)
- Cai Grau
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
| | - Alexandru Dasu
- The Skandion Clinic, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Sweden.
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospital, KU Leuven, Leuven, Belgium.
| | - Damien C Weber
- Proton Therapy Center, Paul Scherrer Institute, ETH Domain, Switzerland; Radiation Oncology Department, University Hospital Zürich, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | | | - Ester Orlandi
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy; Clinical Department, National Center for Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.
| | - Juliette Thariat
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, F-14000, Centre François Baclesse, Caen, France
| | - Neige Journy
- National Institute of Health and Medical Research (INSERM) Unit 1018, Centre for Research in Epidemiology and Population Health, Paris Saclay University, Gustave Roussy, Villejuif, France.
| | - Abdulhamid Chaikh
- Institut de Radioprotection et de Sûreté Nucléaire IRSN/PSE-SANTE/SER/UEM, France.
| | - Aurelie Isambert
- Institut de Radioprotection et de Sûreté Nucléaire IRSN/PSE-SANTE/SER/UEM, France.
| | - Barbara Alicja 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.
| | - Ana Vaniqui
- Belgian Nuclear Research Center (SCK CEN), Mol, Belgium.
| | - Pavel Vitek
- Proton Therapy Center Czech, Prague, Czech Republic.
| | - Renata Kopec
- Institute of Nuclear Physics Polish Academy of Sciences, Kraków, Poland.
| | - Rianne Fijten
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | | | - Pawel Olko
- Institute of Nuclear Physics Polish Academy of Sciences, Kraków, Poland.
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3
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Lempart M, Scherman J, Nilsson MP, Jamtheim Gustafsson C. Deep learning-based classification of organs at risk and delineation guideline in pelvic cancer radiation therapy. J Appl Clin Med Phys 2023; 24:e14022. [PMID: 37177830 PMCID: PMC10476996 DOI: 10.1002/acm2.14022] [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: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Deep learning (DL) models for radiation therapy (RT) image segmentation require accurately annotated training data. Multiple organ delineation guidelines exist; however, information on the used guideline is not provided with the delineation. Extraction of training data with coherent guidelines can therefore be challenging. We present a supervised classification method for pelvis structure delineations where bowel cavity, femoral heads, bladder, and rectum data, with two guidelines, were classified. The impact on DL-based segmentation quality using mixed guideline training data was also demonstrated. Bowel cavity was manually delineated on CT images for anal cancer patients (n = 170) according to guidelines Devisetty and RTOG. The DL segmentation quality from using training data with coherent or mixed guidelines was investigated. A supervised 3D squeeze-and-excite SENet-154 model was trained to classify two bowel cavity delineation guidelines. In addition, a pelvis CT dataset with manual delineations from prostate cancer patients (n = 1854) was used where data with an alternative guideline for femoral heads, rectum, and bladder were generated using commercial software. The model was evaluated on internal (n = 200) and external test data (n = 99). By using mixed, compared to coherent, delineation guideline training data mean DICE score decreased 3% units, mean Hausdorff distance (95%) increased 5 mm and mean surface distance (MSD) increased 1 mm. The classification of bowel cavity test data achieved 99.8% unweighted classification accuracy, 99.9% macro average precision, 97.2% macro average recall, and 98.5% macro average F1. Corresponding metrics for the pelvis internal test data were all 99% or above and for the external pelvis test data they were 96.3%, 96.6%, 93.3%, and 94.6%. Impaired segmentation performance was observed for training data with mixed guidelines. The DL delineation classification models achieved excellent results on internal and external test data. This can facilitate automated guideline-specific data extraction while avoiding the need for consistent and correct structure labels.
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Affiliation(s)
- Michael Lempart
- Radiation Physics, Department of HematologyOncology, and Radiation PhysicsSkåne University HospitalLundSweden
- Department of Translational MedicineMedical Radiation PhysicsLund UniversityMalmöSweden
| | - Jonas Scherman
- Radiation Physics, Department of HematologyOncology, and Radiation PhysicsSkåne University HospitalLundSweden
| | - Martin P. Nilsson
- Department of HematologyOncology, and Radiation PhysicsSkåne University HospitalLundSweden
| | - Christian Jamtheim Gustafsson
- Radiation Physics, Department of HematologyOncology, and Radiation PhysicsSkåne University HospitalLundSweden
- Department of Translational MedicineMedical Radiation PhysicsLund UniversityMalmöSweden
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4
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Imlach F, Dunn A, Costello S, Gurney J, Sarfati D. Driving quality improvement through better data: The story of New Zealand's radiation oncology collection. J Med Imaging Radiat Oncol 2023; 67:119-127. [PMID: 36305425 DOI: 10.1111/1754-9485.13488] [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: 03/08/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022]
Abstract
Aotearoa/New Zealand is one of the first nations in the world to develop a comprehensive, high-quality collection of radiation therapy data (the Radiation Oncology Collection, ROC) that is able to report on treatment delivery by health region, patient demographics and service provider. This has been guided by radiation therapy leaders, who have been instrumental in overseeing the establishment of clear and robust data definitions, a centralised database and outputs delivered via an online tool. In this paper, we detail the development of the ROC, provide examples of variation in practice identified from the ROC and how these changed over time, then consider the ramifications of the ROC in the wider context of cancer care quality improvement. In addition to a review of relevant literature, primary data were sourced from the ROC on radiation therapy provided nationally in New Zealand between 2017 and 2020. The total intervention rate, number of fractions and doses are reported for select cancers by way of examples of national variation in practice. Results from the ROC have highlighted areas of treatment variation and have prompted increased uptake of hypofractionation for curative prostate and breast cancer treatment and for palliation of bone metastases. Future development of the ROC will increase its use for quality improvement and ultimately link to a real time cancer services database.
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Affiliation(s)
- Fiona Imlach
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
| | - Alexander Dunn
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
| | | | - Jason Gurney
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand.,Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
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5
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Vaandering A, Jansen N, Weltens C, Moretti L, Stellamans K, Vanhoutte F, Scalliet P, Remouchamps V, Lievens Y. Radiotherapy-specific quality indicators at national level: How to make it happen. Radiother Oncol 2023; 178:109433. [PMID: 36464181 DOI: 10.1016/j.radonc.2022.11.022] [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: 08/12/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE /OBJECTIVE To promote best practice and quality of care, the Belgian College of Physicians for Radiotherapy Centers established a set of radiotherapy specific quality indicators for benchmarking on a national level. This paper describes the development, the collected QIs, the observed trends and the departments' evaluation of this initiative. MATERIAL AND METHODS The Donabedian approach was used, focussing on structural, process and outcome QIs. The criteria for QI selection were availability, required for low-threshold regular collection, and applicability to guidelines and good practice. The QIs were collected yearly and individualized reports were sent out to all RT departments. In 2021, a national survey was held to evaluate the ease of data collection and submission, and the perceived importance and validity of the collected QIs. RESULTS 18 structural QI and 37 process and outcome parameters (n = 25 patients/pathology/department) were collected. The participation rate amounted to 95 % overall. The analysis gave a national overview of RT activity, resources, clinical practice and reported acute toxicities. The individualized reports allowed departments to benchmark their performance. The 2021 survey indicated that the QIs were overall easy to collect, relevant and reliable. The collection of acute recorded toxicities was deemed a weak point due to inter-observer variabilities and lack of follow-up time. CONCLUSION QI collection on a national level is a valuable process in steering quality improvement initiatives. The feasibility and relevance was demonstrated with a high level of participation. The national initiative will continue to evolve as a quality monitoring and improvement tool.
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Affiliation(s)
- Aude Vaandering
- UCL Cliniques Universitaires St Luc, Department of radiation oncology, Brussels, Belgium; Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Nicolas Jansen
- University Hospital of Liège, Department of radiation oncology, Liège, Belgium
| | - Caroline Weltens
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Luigi Moretti
- Institut Jules Bordet, Department of radiation oncology, Brussels, Belgium
| | - Karin Stellamans
- AZ Groeninge, Department of radiation oncology, Kortrijk, Belgium
| | - Frederik Vanhoutte
- Ghent University Hospital and Ghent University, Department of radiation oncology, Ghent, Belgium
| | - Pierre Scalliet
- Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Vincent Remouchamps
- CHU-UCL Namur - site Saint Elisabeth, Department of radiation oncology, Namur, Belgium
| | - Yolande Lievens
- Ghent University Hospital and Ghent University, Department of radiation oncology, Ghent, Belgium
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6
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Maliko N, Stam MR, Boersma LJ, Vrancken Peeters MJTFD, Wouters MWJM, KleinJan E, Mulder M, Essers M, Hurkmans CW, Bijker N. Transparency in quality of radiotherapy for breast cancer in the Netherlands: a national registration of radiotherapy-parameters. Radiat Oncol 2022; 17:73. [PMID: 35413924 PMCID: PMC9003170 DOI: 10.1186/s13014-022-02043-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Radiotherapy (RT) is part of the curative treatment of approximately 70% of breast cancer (BC) patients. Wide practice variation has been reported in RT dose, fractionation and its treatment planning for BC. To decrease this practice variation, it is essential to first gain insight into the current variation in RT treatment between institutes. This paper describes the development of the NABON Breast Cancer Audit-Radiotherapy (NBCA-R), a structural nationwide registry of BC RT data of all BC patients treated with at least surgery and RT. Methods A working group consisting of representatives of the BC Platform of the Dutch Radiotherapy Society selected a set of dose volume parameters deemed to be surrogate outcome parameters, both for tumour control and toxicity. Two pilot studies were carried out in six RT institutes. In the first pilot study, data were manually entered into a secured web-based system. In the second pilot study, an automatic Digital Imaging and Communications in Medicine (DICOM) RT upload module was created and tested. Results The NBCA-R dataset was created by selecting RT parameters describing given dose, target volumes, coverage and homogeneity, and dose to organs at risk (OAR). Entering the data was made mandatory for all Dutch RT departments. In the first pilot study (N = 1093), quite some variation was already detected. Application of partial breast irradiation varied from 0 to 17% between the 6 institutes and boost to the tumour bed from 26.5 to 70.2%. For patients treated to the left breast or chest wall only, the average mean heart dose (MHD) varied from 0.80 to 1.82 Gy; for patients treated to the breast/chest wall only, the average mean lung dose (MLD) varied from 2.06 to 3.3 Gy. In the second pilot study 6 departments implemented the DICOM-RT upload module in daily practice. Anonymised data will be available for researchers via a FAIR (Findable, Accessible, Interoperable, Reusable) framework. Conclusions We have developed a set of RT parameters and implemented registration for all Dutch BC patients. With the use of an automated upload module registration burden will be minimized. Based on the data in the NBCA-R analyses of the practice variation will be done, with the ultimate aim to improve quality of BC RT. Trial registration Retrospectively registered.
Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02043-0.
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Affiliation(s)
- Nansi Maliko
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Surgery, AmsterdamUMC, Amsterdam, the Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eline KleinJan
- Trusted Third Party, Medical Research Data Management, Deventer, The Netherlands
| | - Maurice Mulder
- Trusted Third Party, Medical Research Data Management, Deventer, The Netherlands
| | | | - Coen W Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Nina Bijker
- Department of Radiation Oncology, AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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7
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Jamtheim Gustafsson C, Lempart M, Swärd J, Persson E, Nyholm T, Thellenberg Karlsson C, Scherman J. Deep learning-based classification and structure name standardization for organ at risk and target delineations in prostate cancer radiotherapy. J Appl Clin Med Phys 2021; 22:51-63. [PMID: 34623738 PMCID: PMC8664152 DOI: 10.1002/acm2.13446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 11/12/2022] Open
Abstract
Radiotherapy (RT) datasets can suffer from variations in annotation of organ at risk (OAR) and target structures. Annotation standards exist, but their description for prostate targets is limited. This restricts the use of such data for supervised machine learning purposes as it requires properly annotated data. The aim of this work was to develop a modality independent deep learning (DL) model for automatic classification and annotation of prostate RT DICOM structures. Delineated prostate organs at risk (OAR), support- and target structures (gross tumor volume [GTV]/clinical target volume [CTV]/planning target volume [PTV]), along with or without separate vesicles and/or lymph nodes, were extracted as binary masks from 1854 patients. An image modality independent 2D InceptionResNetV2 classification network was trained with varying amounts of training data using four image input channels. Channel 1-3 consisted of orthogonal 2D projections from each individual binary structure. The fourth channel contained a summation of the other available binary structure masks. Structure classification performance was assessed in independent CT (n = 200 pat) and magnetic resonance imaging (MRI) (n = 40 pat) test datasets and an external CT (n = 99 pat) dataset from another clinic. A weighted classification accuracy of 99.4% was achieved during training. The unweighted classification accuracy and the weighted average F1 score among different structures in the CT test dataset were 98.8% and 98.4% and 98.6% and 98.5% for the MRI test dataset, respectively. The external CT dataset yielded the corresponding results 98.4% and 98.7% when analyzed for trained structures only, and results from the full dataset yielded 79.6% and 75.2%. Most misclassifications in the external CT dataset occurred due to multiple CTVs and PTVs being fused together, which was not included in the training data. Our proposed DL-based method for automated renaming and standardization of prostate radiotherapy annotations shows great potential. Clinic specific contouring standards however need to be represented in the training data for successful use. Source code is available at https://github.com/jamtheim/DicomRTStructRenamerPublic.
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Affiliation(s)
- Christian Jamtheim Gustafsson
- Department of Hematology Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Translational Sciences, Medical Radiation Physics, Lund University, Malmö, Sweden
| | - Michael Lempart
- Department of Hematology Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Translational Sciences, Medical Radiation Physics, Lund University, Malmö, Sweden
| | - Johan Swärd
- Centre for Mathematical Sciences, Mathematical Statistics, Lund University, Lund, Sweden
| | - Emilia Persson
- Department of Hematology Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Translational Sciences, Medical Radiation Physics, Lund University, Malmö, Sweden
| | - Tufve Nyholm
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | | | - Jonas Scherman
- Department of Hematology Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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8
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Nilbert M, Thomsen LA, Winther Jensen J, Møller H, Borre M, Widenlou Nordmark A, Lambe M, Brändström H, Kørner H, Møller B, Ursin G. The power of empirical data; lessons from the clinical registry initiatives in Scandinavian cancer care. Acta Oncol 2020; 59:1343-1356. [PMID: 32981417 DOI: 10.1080/0284186x.2020.1820573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Scandinavia, there is a strong tradition for research and quality monitoring based on registry data. In Denmark, Norway and Sweden, 63 clinical registries collect data on disease characteristics, treatment and outcome of various cancer diagnoses and groups based on process-related and outcome-related variables. AIM We describe the cancer-related clinical registries, compare organizational structures and quality indicators and provide examples of how these registries have been used to monitor clinical performance, develop prediction models, assess outcome and provide quality benchmarks. Further, we define unmet needs such as inclusion of patient-reported outcome variables, harmonization of variables and barriers for data sharing. RESULTS AND CONCLUSIONS The clinical registry framework provides an empirical basis for evidence-based development of high-quality and equitable cancer care. The registries can be used to follow implementation of new treatment principles and monitor patterns of care across geographical areas and patient groups. At the same time, the lessons learnt suggest that further developments and coordination are needed to utilize the full potential of the registry initiative in cancer care.
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Affiliation(s)
- Mef Nilbert
- Department of Oncology, Lund University, Lund, Sweden
- The Danish Cancer Society Research Center, Copenhagen, Denmark
- Clinical Research Department, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | | | - Jens Winther Jensen
- The Danish Clinical Quality Program and Clinical Registries, Aarhus, Denmark
| | - Henrik Møller
- The Danish Clinical Quality Program and Clinical Registries, Aarhus, Denmark
| | - Michael Borre
- The Association of Danish Multidisciplinary Cancer Groups, Aarhus, Denmark
| | | | - Mats Lambe
- The Federation of Regional Cancer Centers, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Hartwig Kørner
- Institute of Surgical Sciences, University of Bergen, Bergen, Norway
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9
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Olsson CE, Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Johansson KA. Radiation Therapy in Sweden: Past, Present, and Future Perspectives. Int J Radiat Oncol Biol Phys 2020; 107:6-11. [PMID: 32277922 DOI: 10.1016/j.ijrobp.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/19/2019] [Accepted: 10/01/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Caroline E Olsson
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden; Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Jesper Lindberg
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden; Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paul Holmström
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden; Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Stefan Hallberg
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Karl-Axel Johansson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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10
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Beckmann K, Garmo H, Nilsson P, Franck Lissbrant I, Widmark A, Stattin P. Radical radiotherapy for prostate cancer: patterns of care in Sweden 1998-2016. Acta Oncol 2020; 59:549-557. [PMID: 32122185 DOI: 10.1080/0284186x.2020.1730003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Radiotherapy is an established treatment option for prostate cancer (PCa), both as primary treatment and secondary treatment after radical prostatectomy (RP). Since 1998, detailed data on radiotherapy delivered to Swedish men with PCa (e.g. treatment modalities, absorbed doses, fractionation) have been collated within PCa data Base Sweden (PCBaSe). This study reports patterns of radical radiotherapy for PCa in Sweden over the past two decades.Materials and methods: All men with non-metastatic PCa (1998-2016) who received external beam radiotherapy (EBRT) or high or low dose-rate brachytherapy (HDR-BT/LDR-BT) were identified in PCBaSe. Analyses included: trends in radiation techniques, fractionation patterns and total doses over time; PCa-specific survival comparing treatment in 2007-2017 with 1998-2006; and regional variation in type of primary radiotherapy.Results: About 20,876 men underwent primary radiotherapy. The main treatment modalities include conventionally fractionated (2.0 Gy/fraction) EBRT (51%), EBRT with HDR-BT boost (27%) and hypofractionated (>2.4 Gy/fraction) EBRT (11%). EBRT with photon or proton boost and HDR-BT and LDR-BT monotherapies were each used minimally. Use of dose-escalated EBRT (>74 Gy) and moderate hypofractionation increased over time, while use of HDR-BT declined. Considerable regional variation in treatment modalities was apparent. Risk of PCa death following primary radiotherapy had declined for intermediate-risk (HR: 0.60; 95%CI 0.47-0.87) and high-risk PCa (HR: 0.72; 95%CI 0.61-0.86).Discussion: Increased use of dose escalation and hypofractionated EBRT has occurred in Sweden over the past two decades, reflecting current evidence and practice guidelines. Disease-specific outcomes have also improved. Data collected in PCBaSe provide an excellent resource for further research into RT use in PCa management.
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Affiliation(s)
- Kerri Beckmann
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Studies, King’s College London, London, UK
- University of South Australia Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Hans Garmo
- Regional Cancer Centre Uppsala, Uppsala University Hospital, Uppsala, Sweden
| | - Per Nilsson
- Department of Oncology and Radiation Physics, Skane University Hospital and Lund University, Lund, Sweden
| | | | - Anders Widmark
- Department of Radiation Sciences, Umea University, Umea, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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11
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Olsson C, Nyholm T, Wieslander E, Onjukka E, Gunnlaugsson A, Reizenstein J, Johnsson S, Kristensen I, Skönevik J, Karlsson M, Isacsson U, Flejmer A, Abel E, Nordström F, Nyström L, Bergfeldt K, Zackrisson B, Valdman A. Initial experience with introducing national guidelines for CT- and MRI-based delineation of organs at risk in radiotherapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 11:88-91. [PMID: 33458285 PMCID: PMC7807599 DOI: 10.1016/j.phro.2019.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 12/25/2022]
Abstract
A fundamental problem in radiotherapy is the variation of organ at risk (OAR) volumes. Here we present our initial experience in engaging a large Radiation Oncology (RO) community to agree on national guidelines for OAR delineations. Our project builds on associated standardization initiatives and invites professionals from all radiotherapy departments nationwide. Presently, one guideline (rectum) has successfully been agreed on by a majority vote. Reaching out to all relevant parties in a timely manner and motivating funding agencies to support the work represented early challenges. Population-based data and a scalable methodological approach are major strengths of the proposed strategy.
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Affiliation(s)
- Caroline Olsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden.,Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
| | - Tufve Nyholm
- Department of Radiation Sciences, Umeå University, Sweden
| | - Elinore Wieslander
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Eva Onjukka
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Johan Reizenstein
- Department of Oncology, Örebro University Hospital and Örebro University, Sweden
| | - Stefan Johnsson
- Department of Radiation Physics, Kalmar County Hospital, Sweden
| | - Ingrid Kristensen
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Johan Skönevik
- Department of Radiation Sciences, Umeå University, Sweden
| | | | - Ulf Isacsson
- Medical Radiation Physics, Dept. of Biomedical Engineering, Medical Physics and IT, Uppsala University Hospital, Uppsala, Sweden
| | - Anna Flejmer
- Department of Oncology, Linköping University Hospital, Sweden
| | - Edvard Abel
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fredrik Nordström
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Leif Nyström
- Department of Radiation Sciences, Umeå University, Sweden
| | | | | | - Alexander Valdman
- Department of Radiation Therapy, Karolinska University Hospital, Stockholm, Sweden
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12
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Kairn T, Crowe SB. Retrospective analysis of breast radiotherapy treatment plans: Curating the 'non-curated'. J Med Imaging Radiat Oncol 2019; 63:517-529. [PMID: 31081603 DOI: 10.1111/1754-9485.12892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/24/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This paper provides a demonstration of how non-curated data can be retrospectively cleaned, so that existing repositories of radiotherapy treatment planning data can be used to complete bulk retrospective analyses of dosimetric trends and other plan characteristics. METHODS A non curated archive of 1137 radiotherapy treatment plans accumulated over a 12-month period, from five radiotherapy centres operated by one institution, was used to investigate and demonstrate a process of clinical data cleansing, by: identifying and translating inconsistent structure names; correcting inconsistent lung contouring; excluding plans for treatments other than breast tangents and plans without identifiable PTV, lung and heart structures; and identifying but not excluding plans that deviated from the local planning protocol. PTV, heart and lung dose-volume metrics were evaluated, in addition to a sample of personnel and linac load indicators. RESULTS Data cleansing reduced the number of treatment plans in the sample by 35.7%. Inconsistent structure names were successfully identified and translated (e.g. 35 different names for lung). Automatically separating whole lung structures into left and right lung structures allowed the effect of contralateral and ipsilateral lung dose to be evaluated, while introducing some small uncertainties, compared to manual contouring. PTV doses were indicative of prescription doses. Breast treatment work was unevenly distributed between oncologists and between metropolitan and regional centres. CONCLUSION This paper exemplifies the data cleansing and data analysis steps that may be completed using existing treatment planning data, to provide individual radiation oncology departments with access to information on their own patient populations. Clearly, the well-planned and systematic recording of new, high quality data is the preferred solution, but the retrospective curation of non-curated data may be a useful interim solution, for radiation oncology departments where the systems for recording of new data have yet to be designed and agreed.
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Affiliation(s)
- Tanya Kairn
- Genesis Cancer Care, Auchenflower, Queensland, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Scott B Crowe
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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13
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Olsson CE, Jackson A, Deasy JO, Thor M. A Systematic Post-QUANTEC Review of Tolerance Doses for Late Toxicity After Prostate Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:1514-1532. [PMID: 30125635 PMCID: PMC6652194 DOI: 10.1016/j.ijrobp.2018.08.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/27/2018] [Accepted: 08/04/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE The aims of this study were to systematically review tolerance doses for late distinct gastrointestinal (GI), genitourinary (GU), and sexual dysfunction (SD) symptoms after external beam radiation therapy (EBRT) alone and treatments involving brachytherapy (BT) for prostate cancer after Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) and ultimately to perform quantitative syntheses of identified dose/volume tolerances represented by dose-volume histogram (DVH) thresholds, that is, statistically significant (P ≤ .05) cutoff points between symptomatic and asymptomatic patients in a certain study. METHODS AND MATERIALS PubMed was scrutinized for full-text articles in English after QUANTEC (January 1, 2010). The inclusion criteria were randomized controlled trials, case-control studies, or cohort studies with tolerance doses for late distinct symptoms ≥3 months after primary radiation therapy for prostate cancer (N > 30). All DVH thresholds were converted into equivalent doses in 2-Gy fractions (EQD2α/β) and were fitted with a linear or linear-quadratic function (goodness of fit, R2). The review was registered on PROSPERO (CRD42016042464). RESULTS From 33 identified studies, which included 36 to 746 patients per symptom domain, the majority of dose/volume tolerances were derived for GI toxicity after EBRT alone (GI, 97 thresholds; GU, 8 thresholds; SD, 1 threshold). For 5 symptoms (defecation urgency, diarrhea, fecal incontinence, proctitis, and rectal bleeding), relationships between dose/volume tolerances across studies (R2 = 0.93 [0.82-1.00]), and across symptoms, leading to a curve for overall GI toxicity (R2 = 0.98), could be determined. For these symptoms, mainly rectal thresholds were found throughout low and high doses (10 Gy ≤ equivalent dose in 2-Gy fractions using α/β = 3Gy (EQD23) ≤ 50 Gy and 55 Gy ≤ EQD23 ≤ 78 Gy, respectively). For BT with or without EBRT, dose/volume tolerances were also mainly identified for GI toxicity (GI, 14 thresholds; GU, 4 thresholds; SD, 2 thresholds) with the largest number of DVH thresholds concerning rectal bleeding (5 thresholds). CONCLUSIONS Updated dose/volume tolerances after QUANTEC were found for 17 GI, GU, or SD symptoms. A DVH curve described the relationship between dose/volume tolerances across 5 GI symptoms after EBRT alone. Restricting treatments for EBRT alone using the lower boundaries of this curve is likely to limit overall GI toxicity, but this should be explored prospectively. Dose/volume tolerances for GU and SD toxicity after EBRT alone and after BT with or without EBRT were scarce and support further research including data-sharing initiatives to untangle the dose/volume relationships for these symptoms.
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Affiliation(s)
- Caroline E Olsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Regional Cancer Center West, Western Sweden Healthcare Region, Gothenburg, Sweden
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
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14
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Mayo CS, Phillips M, McNutt TR, Palta J, Dekker A, Miller RC, Xiao Y, Moran JM, Matuszak MM, Gabriel P, Ayan AS, Prisciandaro J, Thor M, Dixit N, Popple R, Killoran J, Kaleba E, Kantor M, Ruan D, Kapoor R, Kessler ML, Lawrence TS. Treatment data and technical process challenges for practical big data efforts in radiation oncology. Med Phys 2018; 45:e793-e810. [PMID: 30226286 DOI: 10.1002/mp.13114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022] Open
Abstract
The term Big Data has come to encompass a number of concepts and uses within medicine. This paper lays out the relevance and application of large collections of data in the radiation oncology community. We describe the potential importance and uses in clinical practice. The important concepts are then described and how they have been or could be implemented are discussed. Impediments to progress in the collection and use of sufficient quantities of data are also described. Finally, recommendations for how the community can move forward to achieve the potential of big data in radiation oncology are provided.
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Affiliation(s)
- C S Mayo
- University of Michigan, Ann Arbor, MI, USA
| | - M Phillips
- University of Washington, Seattle, WA, USA
| | - T R McNutt
- Johns Hopkins University, Baltimore, MD, USA
| | - J Palta
- Virginia Commonwealth University, Richmond, VA, USA
| | - A Dekker
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Y Xiao
- University of Pennsylvania, Philadelphia, PA, USA
| | - J M Moran
- University of Michigan, Ann Arbor, MI, USA
| | | | - P Gabriel
- University of Pennsylvania, Philadelphia, PA, USA
| | - A S Ayan
- Ohio State University, Columbus, OH, USA
| | | | - M Thor
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N Dixit
- University of California at San Francisco, San Francisco, CA, USA
| | - R Popple
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - E Kaleba
- University of Michigan, Ann Arbor, MI, USA
| | - M Kantor
- MD Anderson Cancer Center, Houston, TX, USA
| | - D Ruan
- University of California at Los Angeles, Los Angeles, CA, USA
| | - R Kapoor
- Johns Hopkins University, Baltimore, MD, USA
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15
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Jin F, Luo HL, Zhou J, He YN, Liu XF, Zhong MS, Yang H, Li C, Li QC, Huang X, Tian XM, Qiu D, He GL, Yin L, Wang Y. Cancer risk assessment in modern radiotherapy workflow with medical big data. Cancer Manag Res 2018; 10:1665-1675. [PMID: 29970965 PMCID: PMC6021004 DOI: 10.2147/cmar.s164980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Modern radiotherapy (RT) is being enriched by big digital data and intensive technology. Multimodality image registration, intelligence-guided planning, real-time tracking, image-guided RT (IGRT), and automatic follow-up surveys are the products of the digital era. Enormous digital data are created in the process of treatment, including benefits and risks. Generally, decision making in RT tries to balance these two aspects, which is based on the archival and retrieving of data from various platforms. However, modern risk-based analysis shows that many errors that occur in radiation oncology are due to failures in workflow. These errors can lead to imbalance between benefits and risks. In addition, the exact mechanism and dose-response relationship for radiation-induced malignancy are not well understood. The cancer risk in modern RT workflow continues to be a problem. Therefore, in this review, we develop risk assessments based on our current knowledge of IGRT and provide strategies for cancer risk reduction. Artificial intelligence (AI) such as machine learning is also discussed because big data are transforming RT via AI.
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Affiliation(s)
- Fu Jin
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Huan-Li Luo
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Juan Zhou
- Forensic Identification Center, College of Criminal Investigation, Southwest University of Political Science and Law, Chongqing, People’s Republic of China
| | - Ya-Nan He
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xian-Feng Liu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Ming-Song Zhong
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Han Yang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Chao Li
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Qi-Cheng Li
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xia Huang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xiu-Mei Tian
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Da Qiu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Guang-Lei He
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Li Yin
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Ying Wang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
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16
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Glimelius B, Melin B, Enblad G, Alafuzoff I, Beskow A, Ahlström H, Bill-Axelson A, Birgisson H, Björ O, Edqvist PH, Hansson T, Helleday T, Hellman P, Henriksson K, Hesselager G, Hultdin M, Häggman M, Höglund M, Jonsson H, Larsson C, Lindman H, Ljuslinder I, Mindus S, Nygren P, Pontén F, Riklund K, Rosenquist R, Sandin F, Schwenk JM, Stenling R, Stålberg K, Stålberg P, Sundström C, Thellenberg Karlsson C, Westermark B, Bergh A, Claesson-Welsh L, Palmqvist R, Sjöblom T. U-CAN: a prospective longitudinal collection of biomaterials and clinical information from adult cancer patients in Sweden. Acta Oncol 2018. [PMID: 28631533 DOI: 10.1080/0284186x.2017.1337926] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Progress in cancer biomarker discovery is dependent on access to high-quality biological materials and high-resolution clinical data from the same cases. To overcome current limitations, a systematic prospective longitudinal sampling of multidisciplinary clinical data, blood and tissue from cancer patients was therefore initiated in 2010 by Uppsala and Umeå Universities and involving their corresponding University Hospitals, which are referral centers for one third of the Swedish population. MATERIAL AND METHODS Patients with cancer of selected types who are treated at one of the participating hospitals are eligible for inclusion. The healthcare-integrated sampling scheme encompasses clinical data, questionnaires, blood, fresh frozen and formalin-fixed paraffin-embedded tissue specimens, diagnostic slides and radiology bioimaging data. RESULTS In this ongoing effort, 12,265 patients with brain tumors, breast cancers, colorectal cancers, gynecological cancers, hematological malignancies, lung cancers, neuroendocrine tumors or prostate cancers have been included until the end of 2016. From the 6914 patients included during the first five years, 98% were sampled for blood at diagnosis, 83% had paraffin-embedded and 58% had fresh frozen tissues collected. For Uppsala County, 55% of all cancer patients were included in the cohort. CONCLUSIONS Close collaboration between participating hospitals and universities enabled prospective, longitudinal biobanking of blood and tissues and collection of multidisciplinary clinical data from cancer patients in the U-CAN cohort. Here, we summarize the first five years of operations, present U-CAN as a highly valuable cohort that will contribute to enhanced cancer research and describe the procedures to access samples and data.
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Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anna Beskow
- Uppsala Biobank, Uppsala Clinical Research Center, Uppsala, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Helgi Birgisson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ove Björ
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Per-Henrik Edqvist
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tony Hansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Thomas Helleday
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hellman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kerstin Henriksson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Magnus Hultdin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Michael Häggman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Höglund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Håkan Jonsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Chatarina Larsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | | | - Peter Nygren
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Fredrik Sandin
- RCC Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden
| | - Jochen M. Schwenk
- Affinity Proteomics, SciLifeLab, School of Biotechnology, KTH Royal Institute of Technology, Solna, Sweden
| | - Roger Stenling
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Peter Stålberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Christer Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Bengt Westermark
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Lena Claesson-Welsh
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Richard Palmqvist
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Tobias Sjöblom
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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17
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Romanchikova M, Harrison K, Burnet NG, Hoole ACF, Sutcliffe MPF, Parker MA, Jena R, Thomas SJ. Automated customized retrieval of radiotherapy data for clinical trials, audit and research. Br J Radiol 2018; 91:20170651. [PMID: 29125328 PMCID: PMC5965461 DOI: 10.1259/bjr.20170651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To enable fast and customizable automated collection of radiotherapy (RT) data from tomotherapy storage. METHODS Human-readable data maps (TagMaps) were created to generate DICOM-RT (Digital Imaging and Communications in Medicine standard for Radiation Therapy) data from tomotherapy archives, and provided access to "hidden" information comprising delivery sinograms, positional corrections and adaptive-RT doses. RESULTS 797 data sets totalling 25,000 scans were batch-exported in 31.5 h. All archived information was restored, including the data not available via commercial software. The exported data were DICOM-compliant and compatible with major commercial tools including RayStation, Pinnacle and ProSoma. The export ran without operator interventions. CONCLUSION The TagMap method for DICOM-RT data modelling produced software that was many times faster than the vendor's solution, required minimal operator input and delivered high volumes of vendor-identical DICOM data. The approach is applicable to many clinical and research data processing scenarios and can be adapted to recover DICOM-RT data from other proprietary storage types such as Elekta, Pinnacle or ProSoma. Advances in knowledge: A novel method to translate data from proprietary storage to DICOM-RT is presented. It provides access to the data hidden in electronic archives, offers a working solution to the issues of data migration and vendor lock-in and paves the way for large-scale imaging and radiomics studies.
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Affiliation(s)
- Marina Romanchikova
- Department of Medical Physics & Clinical Engineering, Cambridge University Hospitals, Cambridge, UK
| | - Karl Harrison
- Department of Physics, University of Cambridge, Cambridge, UK
| | - Neil G Burnet
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Andrew CF Hoole
- Department of Medical Physics & Clinical Engineering, Cambridge University Hospitals, Cambridge, UK
| | | | | | - Rajesh Jena
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Simon James Thomas
- Department of Medical Physics & Clinical Engineering, Cambridge University Hospitals, Cambridge, UK
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18
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Brink C, Lorenzen EL, Krogh SL, Westberg J, Berg M, Jensen I, Thomsen MS, Yates ES, Offersen BV. DBCG hypo trial validation of radiotherapy parameters from a national data bank versus manual reporting. Acta Oncol 2018; 57:107-112. [PMID: 29202666 DOI: 10.1080/0284186x.2017.1406140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The current study evaluates the data quality achievable using a national data bank for reporting radiotherapy parameters relative to the classical manual reporting method of selected parameters. METHODS The data comparison is based on 1522 Danish patients of the DBCG hypo trial with data stored in the Danish national radiotherapy data bank. In line with standard DBCG trial practice selected parameters were also reported manually to the DBCG database. Categorical variables are compared using contingency tables, and comparison of continuous parameters is presented in scatter plots. RESULTS For categorical variables 25 differences between the data bank and manual values were located. Of these 23 were related to mistakes in the manual reported value whilst the remaining two were a wrong classification in the data bank. The wrong classification in the data bank was related to lack of dose information, since the two patients had been treated with an electron boost based on a manual calculation, thus data was not exported to the data bank, and this was not detected prior to comparison with the manual data. For a few database fields in the manual data an ambiguity of the parameter definition of the specific field is seen in the data. This was not the case for the data bank, which extract all data consistently. CONCLUSIONS In terms of data quality the data bank is superior to manually reported values. However, there is a need to allocate resources for checking the validity of the available data as well as ensuring that all relevant data is present. The data bank contains more detailed information, and thus facilitates research related to the actual dose distribution in the patients.
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Affiliation(s)
- Carsten Brink
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Ebbe L. Lorenzen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Simon Long Krogh
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Jonas Westberg
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Martin Berg
- Department of Medical Physics, Vejle Hospital, Vejle, Denmark
| | - Ingelise Jensen
- Department of Medical Physics, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Birgitte Vrou Offersen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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19
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Medical physics in radiation Oncology: New challenges, needs and roles. Radiother Oncol 2017; 125:375-378. [PMID: 29150160 DOI: 10.1016/j.radonc.2017.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
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Mayo CS, Kessler ML, Eisbruch A, Weyburne G, Feng M, Hayman JA, Jolly S, El Naqa I, Moran JM, Matuszak MM, Anderson CJ, Holevinski LP, McShan DL, Merkel SM, Machnak SL, Lawrence TS, Ten Haken RK. The big data effort in radiation oncology: Data mining or data farming? Adv Radiat Oncol 2016; 1:260-271. [PMID: 28740896 PMCID: PMC5514231 DOI: 10.1016/j.adro.2016.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 09/23/2016] [Accepted: 10/05/2016] [Indexed: 12/01/2022] Open
Abstract
Although large volumes of information are entered into our electronic health care records, radiation oncology information systems and treatment planning systems on a daily basis, the goal of extracting and using this big data has been slow to emerge. Development of strategies to meet this goal is aided by examining issues with a data farming instead of a data mining conceptualization. Using this model, a vision of key data elements, clinical process changes, technology issues and solutions, and role for professional societies is presented. With a better view of technology, process and standardization factors, definition and prioritization of efforts can be more effectively directed.
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Affiliation(s)
- Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Marc L Kessler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Grant Weyburne
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Mary Feng
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, California
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Carlos J Anderson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Lynn P Holevinski
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Daniel L McShan
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Sue M Merkel
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Sherry L Machnak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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