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Li AE, Jhawar S, Grignol V, Agnese D, Oppong BA, Beyer S, Bazan JG, Skoracki R, Shen C, Park KU. Implementation of a Breast Intraoperative Oncoplastic Form to Aid Management of Oncoplastic Surgery. J Surg Res 2023; 290:9-15. [PMID: 37163831 DOI: 10.1016/j.jss.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Oncoplastic breast conservation surgery (BCS) uses concurrent reduction and/or mastopexy with lumpectomy to improve aesthetic outcomes. However, tissue rearrangement can shift the original tumor location site in relation to external breast landmarks, resulting in difficulties during re-excision for a positive margin and accurate radiation targeting. We developed the Breast Intraoperative Oncoplastic (BIO) form to help depict the location of the tumor and breast reduction specimen. This study seeks to assess physician perspectives of the implementation outcomes. METHODS From February 2021 to April 2021, the BIO form was used in 11 oncoplastic BCS cases at a single institution. With institutional review board approval, surgical oncologists (SOs), plastic surgeons (PSs), and radiation oncologists (ROs) were administered a 12-question validated survey on Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM), using a 5-point Likert scale during initial implementation and at 6-month reassessment. RESULTS Twelve physicians completed the survey initially (4 SOs, 4 PSs, and 4 ROs). The mean scores for Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure were high (4.44, 4.56, and 4.56, respectively). Twelve completed the second survey (5 SOs, 3 PSs, and 4 ROs). The mean scores were marginally lower (4.06, 4.21, and 4.25). There were no significant differences when stratified by number of years in practice or specialty. Free text comments showed that 75% of physicians found the form helpful in oncoplastic BCS. CONCLUSIONS The data indicate high feasibility, acceptability, and appropriateness of the BIO form. Results of this study suggest multidisciplinary benefits of implementing the BIO form in oncoplastic BCS.
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Affiliation(s)
- Amy E Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sachin Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Valarie Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Doreen Agnese
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sasha Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jose G Bazan
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Roman Skoracki
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Chengli Shen
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Ko Un Park
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Giannotti E, Jethwa K, Closs S, Sun R, Bhatti H, James J, Clarke C. Promoting simulation-based training in radiology: a homemade phantom for the practice of ultrasound-guided procedures. Br J Radiol 2022; 95:20220354. [PMID: 35856798 PMCID: PMC10996965 DOI: 10.1259/bjr.20220354] [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: 03/30/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Ultrasound-guided intervention is an essential skill for many radiologists and critical for accurate diagnosis and treatment in many radiology subspecialties. Simulation using phantoms have demonstrated statistically significant benefits for trainees within the literature. We propose a novel phantom model which the authors feel is ideal for training clinical radiology trainees in the performance of ultrasound-guided procedures. METHODS The recipe to prepare a homemade phantom is described. Results of a local survey from trainees preparing and using the phantom are also presented. RESULTS This realistic training simulation model can be adapted to suit a variety of biopsy devices and procedures including soft tissue biopsy and cyst aspiration. The phantom mimics the sonographic appearances of soft tissue and biopsy targets can be concealed within. The phantom was easily prepared by 22 trainees (Likert score 4.5) and it functioned well (Likert score of 4.7). CONCLUSION In summary, our phantom model is ideal for training clinical radiology trainees in the performance of ultrasound-guided core biopsy. The availability and low cost of the model, combined with the ease of preparation and reproducibility, make this an efficient and effective addition to the training process. ADVANCES IN KNOWLEDGE A low cost easily handmade phantom recipe is described that could be easily implemented in training schemes.
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Affiliation(s)
- Elisabetta Giannotti
- Nottingham Breast Institute, Nottingham University Hospitals
NHS Trust, Nottingham City Hospital, Hucknall Road,
Nottingham, UK
| | - Ketan Jethwa
- University Hospitals of Derby and Burton NHS Foundation Trust,
Royal Derby Hospital, Uttoxeter New Road,
Derby, UK
| | - Samantha Closs
- Nottingham Breast Institute, Nottingham University Hospitals
NHS Trust, Nottingham City Hospital, Hucknall Road,
Nottingham, UK
| | - Rachel Sun
- Nottingham Breast Institute, Nottingham University Hospitals
NHS Trust, Nottingham City Hospital, Hucknall Road,
Nottingham, UK
| | - Hamnah Bhatti
- Department of Clinical Radiology, Nottingham University
Hospitals NHS Trust, Queens Medical Centre, Derby Road,
Nottingham, UK
| | - Jonathan James
- Nottingham Breast Institute, Nottingham University Hospitals
NHS Trust, Nottingham City Hospital, Hucknall Road,
Nottingham, UK
| | - Christopher Clarke
- Department of Clinical Radiology, Nottingham University
Hospitals NHS Trust, Queens Medical Centre, Derby Road,
Nottingham, UK
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Aldosary G, Belec J, Foottit C, Vandervoort E. Dosimetric considerations for moldable silicone composites used in radiotherapy applications. J Appl Clin Med Phys 2022; 23:e13605. [PMID: 35436377 PMCID: PMC9195024 DOI: 10.1002/acm2.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/18/2021] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
Due to their many favorable characteristics, moldable silicone (MS) composites have gained popularity in medicine and recently, in radiotherapy applications. We investigate the dosimetric properties of silicones in radiotherapy beams and determine their suitability as water substitutes for constructing boluses and phantoms. Two types of silicones were assessed (ρ= 1.04 g/cm3 and ρ= 1.07 g/cm3). Various dosimetric properties were characterized, including the relative electron density, the relative mean mass energy‐absorption coefficient, and the relative mean mass restricted stopping power. Silicone slabs with thickness of 1.5 cm and 5.0 cm were molded to mimic a bolus setup and a phantom setup, respectively. Measurements were conducted for Co‐60 and 6 MV photon beams, and 6 MeV electron beams. The doses at 1.5 cm and 5.0 cm depths in MS were measured with solid water (SW) backscatter material (DMS–SW), and with a full MS setup (DMS–MS), then compared with doses at the same depths in a full SW setup (DSW–SW). Relative doses were reported as DMS–SW/DMS–SW and DMS–MS/DSW–SW. Experimental results were verified using Monaco treatment planning system dose calculations and Monte Carlo EGSnrc simulations. Film measurements showed varying dose ratios according to MS and beam types. For photon beams, the bolus setup DMS–SW/DSW–SW exhibited a 5% relative dose reduction. The dose for 6 MV beams was reduced by nearly 2% in a full MS setup. Up to 2% dose increase in both scenarios was observed for electron beams. Compared with dose in SW, an interface of MS–SW can cause relatively high differences. We conclude that it is important to characterize a particular silicone's properties in a given beam quality prior to clinical use. Because silicone compositions vary between manufacturers and differ from water/SW, accurate dosimetry using these materials requires consideration of the reported differences.
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Affiliation(s)
- Ghada Aldosary
- Department of Physics, Carleton University, Ottawa, Ontario, Canada.,Radiation Oncology Section, Department of Oncology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Jason Belec
- Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.,Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Claire Foottit
- Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.,Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Eric Vandervoort
- Department of Physics, Carleton University, Ottawa, Ontario, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.,Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
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Low-Cost and Easily Fabricated Ultrasound-Guided Breast Phantom for Breast Biopsy Training. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11167728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to develop an inexpensive and easy-to-fabricate gelatin-based training phantom for improving the breast biopsy skill and confidence level of residents. Young’s modulus and acoustic properties of the gelatin tissue phantom and simulated tumors were investigated. Six residents were requested to evaluate the effectiveness of the breast phantom. The results showed that 83% (n = 5) of the participants agreed that the ultrasound image quality produced by the breast phantom was excellent or good. Only 17% (n = 1) of the participants claimed that there was room for improvement for the haptic feedback they received during the placement of the core needle into the breast phantom. The mean pre-instructional score was 17% (SD 17%) for all participants. The mean post-instructional score was 83% (SD 17%), giving an overall improvement of 67%. In conclusion, the mean needle biopsy skill and confidence levels of the participants substantially increased through simulation training on our breast phantom. The participants’ feedback showed the phantom is sufficiently realistic in terms of ultrasound imaging and haptic feedback during needle insertion; thus, the training outcome can be linked to the performance of residents when they perform a live biopsy.
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Aldosary G, Caudrelier JM, Arnaout A, Chang L, Tse T, Foottit C, Song J, Belec J, Vandervoort E. Can we rely on surgical clips placed during oncoplastic breast surgery to accurately delineate the tumor bed for targeted breast radiotherapy? Breast Cancer Res Treat 2021; 186:343-352. [PMID: 33484375 DOI: 10.1007/s10549-020-06086-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Oncoplastic breast surgery (OBS) is gaining popularity among surgeons for breast-conserving surgery treatments. OBS relies on complex relocation and deformation of breast tissue involving the tumor bed (TB). In this study, we investigate the validity of using surgical clips with OBS for accurate TB delineation in adjuvant, targeted breast radiotherapy. METHODS Different OBS techniques were simulated on realistic breast phantoms. Surgical clips were used to demarcate the TB. Following tumor resection and closure, the true TB (TBTrue) was extracted. Each phantom was CT imaged at several phases of surgery in order to record pre- and post-OBS closure surgical clip displacements. Two senior radiation oncologists (ROs) were asked to delineate TBs on CTs by relying on surgical clips placed as per standard protocol, and by referring to operative notes. Their original contours, as well as those expanded using 5-15 mm margins, were compared with the accurate TBTrue using the dice similarity coefficient (DSC), Hausdorff Distance (HD), and over- and under-contoured volumes. Inter- and intra-RO contour agreements were also evaluated. RESULTS Post-OBS surgical clips were significantly displaced outside the original breast quadrant. Inter- and Intra-RO TB contours were consistent, yet systematically differed from TBTrue (DSC values range = 0.38 to 0.69, and maximum HD range = 17.8 mm to 38.0 mm). Using expansion margins did not improve contour congruence and caused significant over-contoured volumes. CONCLUSION Following OBS, surgical clips alone are not reliable radiographic surrogates of TB locations and accurate TB delineation is challenging. For complex OBS cases, indication of any type of partial breast irradiation is very questionable.
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Affiliation(s)
- Ghada Aldosary
- Department of Physics, Carleton University, Ottawa, ON, Canada. .,Radiation Oncology Section, Department of Oncology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Jean-Michel Caudrelier
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Angel Arnaout
- Department of Surgery, The University of Ottawa, Ottawa, ON, Canada.,Department of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Lynn Chang
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tabitha Tse
- Department of Surgery, The University of Ottawa, Ottawa, ON, Canada
| | - Claire Foottit
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Jiheon Song
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Jason Belec
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Eric Vandervoort
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
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