Japanese structure survey of radiation oncology in 2013

Cancer trend and radiotherapy utilization at a tertiary academic hospital in Malaysia

AIMS

To determine the trend of cancer cases referred to the Department of Clinical Oncology in UMMC in terms of patient volumes over a period of 10 years. To define the stage at presentation of the top five cancers in males and females, respectively. To determine the overall radiotherapy utilization rates.

METHODS AND MATERIAL

This is a retrospective analysis of all new cases seen at the Department of Clinical Oncology, University of Malaya Medical Centre (UMMC), from the year 2009 to 2018 inclusive. The top five cancers in males and females were defined in terms of patient volumes and stage at presentation. The overall actual radiotherapy utilization rates were determined.

RESULTS

A total of 12,672 patients were included for analysis. A total of 62.9% of the cases were females and 37.1% were males. The median age of presentation was 59 years old. Breast cancer was the most common cancer, followed by colorectal, lung, thyroid, and prostate cancer. The most common presenting stage was stage 4. The overall actual radiotherapy utilization rate (aRTU) was 40.1%. Curative intent makes up 74.3% of radiotherapy and 66.6% of chemotherapy utilization.

CONCLUSIONS

The cancer distribution and trends among our patients are comparable with national and regional data. The overall actual radiotherapy utilization rate in the UMMC was lower than the estimated optimal rate of 53% but higher than the actual rate of 28% for Malaysia. This study provides valuable insight into current cancer trends and treatment demands to facilitate service planning.

Current status of the educational environment to acquire and maintain the professional skills of radiotherapy technology and medical physics specialists in Japan: a nationwide survey

This study aimed to investigate the educational environment of radiotherapy technology and medical physics specialists (RTMP) in Japan. We conducted a nationwide questionnaire survey in radiotherapy institutions between June and August 2022. Participants were asked questions regarding the educational system, perspectives on updating RTMP's skills and qualifications, and perspectives on higher education for RTMP at radiotherapy institutions. The results were then analyzed in detail according to three factors: whether the hospital was designed for cancer care, whether it was a Japanese Society for Radiation Oncology (JASTRO)-accredited hospital, and whether it was an intensity-modulated radiation therapy charged hospital. Responses were obtained from 579 (69%) nationwide radiation therapy institutions. For non-qualified RTMP, 10% of the institutions had their own educational systems, only 17% of institutions provided on-the-job training, and 84% of institutions encouraged participation in educational lectures and workshops in academic societies. However, for qualified RTMP, 3.0% of institutions had their own educational systems, only 8.9% of the institutions provided on-the-job training, and 83% encouraged participation in academic conferences and workshops. Less than 1% of the facilities offered salary increases for certification, whereas 8.2% offered consideration for occupational promotion. Regarding the educational environment, JASTRO-accredited hospitals were better than general hospitals. Few institutions have their own educational systems for qualified and non-qualified RTMP, but they encourage them to attend educational seminars and conferences. It is desirable to provide systematic education and training by academic and professional organizations to maintain the skills of individuals.

A national survey on the medical physics workload of external beam radiotherapy in Japan†

Several staffing models are used to determine the required medical physics staffing, including radiotherapy technologists, of radiation oncology departments. However, since Japanese facilities tend to be smaller in scale than foreign ones, those models might not apply to Japan. Therefore, in this study, we surveyed workloads in Japan to estimate the optimal medical physics staffing in external beam radiotherapy. A total of 837 facilities were surveyed to collect information regarding radiotherapy techniques and medical physics specialists (RTMPs). The survey covered facility information, staffing, patient volume, equipment volume, workload and quality assurance (QA) status. Full-time equivalent (FTE) factors were estimated from the workload and compared with several models. Responses were received from 579 facilities (69.2%). The median annual patient volume was 369 at designated cancer care hospitals (DCCHs) and 252 across all facilities. In addition, the median FTE of RTMPs was 4.6 at DCCHs and 3.0 at all sites, and the average QA implementation rate for radiotherapy equipment was 69.4%. Furthermore, advanced treatment technologies have increased workloads, particularly in computed tomography simulations and treatment planning tasks. Compared to published models, larger facilities (over 500 annual patients) had a shortage of medical physics staff. In very small facilities (about 140 annual patients), the medical physics staffing requirement was estimated to be 0.5 FTE, implying that employing a full-time medical physicist would be inefficient. However, ensuring the quality of radiotherapy is an important issue, given the limited number of RTMPs. Our study provides insights into optimizing staffing and resource allocation in radiotherapy departments.

Standardization of knowledge-based volumetric modulated arc therapy planning with a multi-institution model (broad model) to improve prostate cancer treatment quality

PURPOSE

To evaluate whether knowledge-based volumetric modulated arc therapy plans for prostate cancer with a multi-institution model (broad model) are clinically useful and effective as a standardization method.

METHODS

A knowledge-based planning (KBP) model was trained with 561 prostate VMAT plans from five institutions with different contouring and planning policies. Five clinical plans at each institution were reoptimized with the broad and single institution model, and the dosimetric parameters and relationship between Dmean and the overlapping volume (rectum or bladder and target) were compared.

RESULTS

The differences between the broad and single institution models in the dosimetric parameters for V50, V80, V90, and Dmean were: rectum; 9.5% ± 10.3%, 3.3% ± 1.5%, 1.7% ± 1.6%, and 3.6% ± 3.6%, (p < 0.001), bladder; 8.7% ± 12.8%, 1.5% ± 2.6%, 0.7% ± 2.4%, and 2.7% ± 4.6% (p < 0.02), respectively. The differences between the broad model and clinical plans were: rectum; 2.4% ± 4.6%, 1.7% ± 1.7%, 0.7% ± 2.4%, and 1.5% ± 2.0%, (p = 0.004, 0.015, 0.112, and 0.009) bladder; 2.9% ± 5.8%, 1.6% ± 1.9%, 0.9% ± 1.7%, and 1.1% ± 4.8%, (p < 0.018), respectively. Positive values indicate that the broad model has a lower value. Strong correlations were observed (p < 0.001) in the relationship between Dmean and the rectal and bladder volume overlapping with the target in the broad model (R = 0.815 and 0.891, respectively). The broad model had the smallest R2 of the three plans.

CONCLUSIONS

KBP with the broad model is clinically effective and applicable as a standardization method at multiple institutions.

Japanese structure survey of radiation oncology in 2015

This article describes the ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution to identify and overcome any existing limitations. From May 2016 to August 2018, the Japanese Society for Radiation Oncology conducted a questionnaire based on the Japanese national structure survey of radiation oncology in 2015. Data were analyzed based on the institutional stratification by the annual number of new patients treated with radiotherapy per institution. The estimated annual numbers of new and total (new plus repeat) patients treated with radiation were 225 000 and 271 000, respectively. Additionally, the estimated cancer incidence was 891 445 cases with approximately 25.2% of all newly diagnosed patients being treated with radiation. The types and numbers of treatment devices actually used included linear accelerator (linac; n = 936), Gamma Knife (n = 43), 60Co remote afterloading system (RALS; n = 21), and 192Ir RALS (n = 129). The linac system used dual-energy functions in 754 units, 3D conformal radiotherapy functions in 867, and intensity-modulated radiotherapy (IMRT) functions in 628. There were 899 Japan Radiological Society/Japanese Society for Radiation Oncology-certified radiation oncologists (RO), 1213.9 full-time equivalent (FTE) ROs, 2394.2 FTE radiotherapy technologists (RTT), 295.7 FTE medical physicists, 210.2 FTE radiotherapy quality managers, and 906.1 FTE nurses. The frequency of IMRT use significantly increased during this time. In conclusion, the Japanese structure of radiation oncology has clearly improved in terms of equipment and utility although there was a shortage of personnel in 2015.

Rapid Progress in Intelligent Radiotherapy and Future Implementation

Radiotherapy is one of the major approaches to cancer treatment. Artificial intelligence in radiotherapy (shortly, Intelligent radiotherapy) mainly involves big data, deep learning, extended reality, digital twin, radiomics, Internet plus and Internet of Things (IoT), which establish an automatic and intelligent network platform consisting of radiotherapy preparation, target volume delineation, treatment planning, radiation delivery, quality assurance (QA) and quality control (QC), prognosis judgment and post-treatment follow-up. Intelligent radiotherapy is an interdisciplinary frontier discipline in infancy. The review aims to summary the important implements of intelligent radiotherapy in various areas and put forward the future of unmanned radiotherapy center.

Nationwide survey of the follow-up practices for patients with esophageal carcinoma after radical treatment: historical changes and future perspectives in Japan

BACKGROUND

No post-treatment follow-up methods have been established yet for patients with esophageal carcinoma who undergo radical esophagectomy (Surg) or who show complete response to definitive chemoradiotherapy (dCRT-CR). The purpose of this study was to investigate the current status of follow-up of the Surg and dCRT-CR patients in Japan, and understand the current reality and problems to establish an optimal follow-up method.

METHODS

A questionnaire on the follow-up method adopted was sent by e-mail to 124 institutions approved by the Japan Esophageal Society as training institutions for board-certified esophageal surgeons; responses were received from 89 institutions. The data were compared with those obtained by a similar survey conducted in 2014.

RESULTS

Follow-up methods markedly varied among institutions. Almost all institutions scheduled computed tomography and upper gastrointestinal endoscopy at least once a year up to postoperative year 5 for both the Surg and dCRT-CR groups. At least 70% of the institutions continued follow-up up to postoperative year 10, and this proportion had increased as compared to that reported from the 2014 survey. Only 25-30% of the institutions scheduled follow-up screening for metachronous head and neck cancer for both groups, and the health-related quality of life (HR-QOL) after the treatment were seldom assessed. These trends remained unchanged as compared to those reported from the 2014 survey.

CONCLUSIONS

The results suggest that the consensus of follow-up protocol could not be established. More attention is required for detection of metachronous cancers and assessment of the HR-QOL. Establishment of a consensus-based follow-up system and verification of its effectiveness are required.

Questionnaire survey on treatment planning techniques for lung stereotactic body radiotherapy in Japan

This study aimed to obtain details regarding treatment planning techniques for lung stereotactic body radiation therapy (SBRT) employed at each institution in Japan by using a questionnaire survey. An Internet questionnaire survey on SBRT procedures performed in 2016 was conducted by the QA/QC committee of the Japan Society of Medical Physics from April to June 2017. The questionnaire assessed two aspects: the environment for SBRT at each institution and the treatment planning techniques with and without respiratory motion management techniques (RMMT). Of the 309 evaluated responses, 218 institutions had performed SBRT. A total of 186 institutions performed SBRT without RMMT and 139 institutions performed SBRT with RMMT. When respiratory motion was ≥10 mm, 69 institutions applied RMMT. The leading RMMT were breath holding (77 institutions), respiratory gating (49 institutions) and real-time tumor tracking (11 institutions). The most frequently used irradiation technique was 3D conformal radiotherapy, which was used in 145 institutions without RMMT and 119 institutions with RMMT. Computed tomography (CT) images acquired under free breathing were mostly used for dose calculation for patients treated without RMMT. The usage ratio of IMRT/VMAT to SBRT is low in Japan, compared to elsewhere in the world (<20% vs ≥70%). Among the available dose calculation algorithms, superposition convolution was the most frequently used regardless of RMMT; however, 2% of institutions have not yet made heterogeneity corrections. In the prescription setting, about half of the institutions applied point prescriptions. The survey results revealed the most frequently used conditions, which may facilitate standardization of treatment techniques in lung SBRT.