1
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Clasie BM, Letourneau D, Schwarz M, Seuntjens J, Maughan RL. Proton Therapy Equipment Installation, Upgrades, and Building Design. Pract Radiat Oncol 2024; 14:e249-e254. [PMID: 37967747 DOI: 10.1016/j.prro.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/28/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE This work aims at reviewing challenges and pitfalls in proton facility design related to equipment upgrade or replacement. Proton therapy was initially developed at research institutions in the 1950s which ushered in the use of hospital-based machines in 1990s. We are approaching an era where older commercial machines are reaching the end of their life and require replacement. The future widespread application of proton therapy depends on cost reduction; customized building design and installation are significant expenses. METHODS AND MATERIALS We take this opportunity to discuss how commercial proton machines have been installed and how buildings housing the equipment have been designed. RESULTS Data on dimensions and weights of the larger components of proton systems (cyclotron main magnet and gantries) are presented and innovative, non-gantry-based, patient positioning systems are discussed. CONCLUSIONS We argue that careful consideration of the building design to include larger elevators, hoistways from above, wide corridors and access slopes to below grade installations, generic vault and treatment room layouts to accommodate multiple vendor's equipment, and modular system design can provide specific benefits during planning, installation, maintenance, and replacement phases of the project. Room temperature magnet coils can be constructed in a more modular manner: a potential configuration is presented. There is scope for constructing gantries and magnet yokes from smaller modular sub-units. These considerations would allow a hospital to replace a commercial machine at its end of life in a manner similar to a linac.
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Affiliation(s)
- Benjamin M Clasie
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Daniel Letourneau
- Princess Margaret Cancer Centre, University Health Network & Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Marco Schwarz
- Department of Radiation Oncology, University of Washington-Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jan Seuntjens
- Princess Margaret Cancer Centre, University Health Network & Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Richard L Maughan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Moreira A, Li W, Berlin A, Carpino-Rocca C, Chung P, Conroy L, Dang J, Dawson LA, Glicksman RM, Hosni A, Keller H, Kong V, Lindsay P, Shessel A, Stanescu T, Taylor E, Winter J, Yan M, Letourneau D, Milosevic M, Velec M. Prospective evaluation of patient-reported anxiety and experiences with adaptive radiation therapy on an MR-linac. Tech Innov Patient Support Radiat Oncol 2024; 29:100240. [PMID: 38445180 PMCID: PMC10912905 DOI: 10.1016/j.tipsro.2024.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
Purpose An integrated magnetic resonance scanner and linear accelerator (MR-linac) was implemented with daily online adaptive radiation therapy (ART). This study evaluated patient-reported experiences with their overall hospital care as well as treatment in the MR-linac environment. Methods Patients pre-screened for MR eligibility and claustrophobia were referred to simulation on a 1.5 T MR-linac. Patient-reported experience measures were captured using two validated surveys. The 15-item MR-anxiety questionnaire (MR-AQ) was administered immediately after the first treatment to rate MR-related anxiety and relaxation. The 40-item satisfaction with cancer care questionnaire rating doctors, radiation therapists, the services and care organization and their outpatient experience was administered immediately after the last treatment using five-point Likert responses. Results were analyzed using descriptive statistics. Results 205 patients were included in this analysis. Multiple sites were treated across the pelvis and abdomen with a median treatment time per fraction of 46 and 66 min respectively. Patients rated MR-related anxiety as "not at all" (87%), "somewhat" (11%), "moderately" (1%) and "very much so" (1%). Positive satisfaction responses ranged from 78 to 100% (median 93%) across all items. All radiation therapist-specific items were rated positively as 96-100%. The five lowest rated items (range 78-85%) were related to general provision of information, coordination, and communication. Overall hospital care was rated positively at 99%. Conclusion In this large, single-institution prospective cohort, all patients had low MR-related anxiety and completed treatment as planned despite lengthy ART treatments with the MR-linac. Patients overall were highly satisfied with their cancer care involving ART using an MR-linac.
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Affiliation(s)
- Amanda Moreira
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Cathy Carpino-Rocca
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Leigh Conroy
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jennifer Dang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Laura A. Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Rachel M. Glicksman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Harald Keller
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Vickie Kong
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Patricia Lindsay
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Andrea Shessel
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Teo Stanescu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Edward Taylor
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jeff Winter
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Michael Yan
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Michael Velec
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
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3
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Nafees A, Khan M, Chow R, Fazelzad R, Hope A, Liu G, Letourneau D, Raman S. Evaluation of clinical decision support systems in oncology: An updated systematic review. Crit Rev Oncol Hematol 2023; 192:104143. [PMID: 37742884 DOI: 10.1016/j.critrevonc.2023.104143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
With increasing reliance on technology in oncology, the impact of digital clinical decision support (CDS) tools needs to be examined. A systematic review update was conducted and peer-reviewed literature from 2016 to 2022 were included if CDS tools were used for live decision making and comparatively assessed quantitative outcomes. 3369 studies were screened and 19 were included in this updated review. Combined with a previous review of 24 studies, a total of 43 studies were analyzed. Improvements in outcomes were observed in 42 studies, and 34 of these were of statistical significance. Computerized physician order entry and clinical practice guideline systems comprise the greatest number of evaluated CDS tools (13 and 10 respectively), followed by those that utilize patient-reported outcomes (8), clinical pathway systems (8) and prescriber alerts for best-practice advisories (4). Our review indicates that CDS can improve guideline adherence, patient-centered care, and care delivery processes in oncology.
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Affiliation(s)
- Abdulwadud Nafees
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Maha Khan
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Ronald Chow
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelzad
- Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew Hope
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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4
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Raman S, Jia F, Liu Z, Wenz J, Carter M, Dickie C, Liu FF, Letourneau D. Forecasting Institutional LINAC Utilization in Response to Varying Workload. Technol Cancer Res Treat 2022; 21:15330338221123108. [PMID: 36285543 PMCID: PMC9608060 DOI: 10.1177/15330338221123108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ObjectivesPandemics, natural disasters, and other unforeseen circumstances can cause short-term variation in radiotherapy utilization. In this study, we aim to develop a model to forecast linear accelerator (LINAC) utilization during periods of varying workloads. Methods: Using computed tomography (CT)-simulation data and the rate of new LINAC appointment bookings in the preceding week as input parameters, a multiple linear regression model to forecast LINAC utilization over a 15-working day horizon was developed and tested on institutional data. Results: Future LINAC utilization was estimated in our training dataset with a forecasting error of 3.3%, 5.9%, and 7.2% on days 5, 10, and 15, respectively. The model identified significant variations (≥5% absolute differences) in LINAC utilization with an accuracy of 69%, 62%, and 60% on days 5, 10, and 15, respectively. The results were similar in the validation dataset with forecasting errors of 3.4%, 5.3%, and 6.2% and accuracy of 67%, 60%, and 58% on days 5, 10, and 15, respectively. These results compared favorably to moving average and exponential smoothing forecasting techniques. Conclusions: The developed linear regression model was able to accurately forecast future LINAC utilization based on LINAC booking rate and CT simulation data, and has been incorporated into our institutional dashboard for broad distribution. Advances in knowledge: Our proposed linear regression model is a practical and intuitive approach to forecasting short-term LINAC utilization, which can be used for resource planning and allocation during periods with varying LINAC workloads.
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Affiliation(s)
- Srinivas Raman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Srinivas Raman MD, FRCPC, Department of Radiation Oncology, University of Toronto, 700 University Avenue, Room 7-610, Toronto, Ontario, Canada M5G 2M9.
| | - Fan Jia
- Department of Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Zhihui Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Julie Wenz
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Carter
- Department of Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Colleen Dickie
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Fei-Fei Liu
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Daniel Letourneau
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Daniel Letourneau PhD, DABR, Department of Radiation Oncology, University of Toronto, 700 University Avenue, Room 7-424, Toronto, Ontario, Canada M5G 2M9.
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5
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Afzal H, Raman S, Kwon C, Seo C, Waqar A, Xu Y, Waddell T, Cypel M, Giuliani M, Tadic T, Chan T, Aleman D, Letourneau D. 123: Image-Based Machine Learning Classifier to Predict Lung Metastases Treatment: A Feasibility Study. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Raman S, Jia F, Liu Z, Wenz J, Carter M, Dickie C, Liu FF, Letourneau D. 131: Forecasting Institutional Linac Utilization in Response to Varying Workload. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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7
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Seo C, Karageorgos E, Waqar A, Xu Y, Waddell T, Cypel M, Giuliani M, Tsang D, Tadic T, Chan T, Raman S, Letourneau D. Machine Learning Classifier to Reproduce Lung Metastases Tumor Board Decisions. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Elamir AM, Stanescu T, Shessel A, Tadic T, Yeung I, Letourneau D, Kim J, Lukovic J, Dawson LA, Wong R, Barry A, Brierley J, Gallinger S, Knox J, O'Kane G, Dhani N, Hosni A, Taylor E. Simulated dose painting of hypoxic sub-volumes in pancreatic cancer stereotactic body radiotherapy. Phys Med Biol 2021; 66. [PMID: 34438383 DOI: 10.1088/1361-6560/ac215c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/26/2021] [Indexed: 12/26/2022]
Abstract
Dose painting of hypoxic tumour sub-volumes using positron-emission tomography (PET) has been shown to improve tumour controlin silicoin several sites, predominantly head and neck and lung cancers. Pancreatic cancer presents a more stringent challenge, given its proximity to critical gastro-intestinal organs-at-risk (OARs), anatomic motion, and impediments to reliable PET hypoxia quantification. A radiobiological model was developed to estimate clonogen survival fraction (SF), using18F-fluoroazomycin arabinoside PET (FAZA PET) images from ten patients with unresectable pancreatic ductal adenocarcinoma to quantify oxygen enhancement effects. For each patient, four simulated five-fraction stereotactic body radiotherapy (SBRT) plans were generated: (1) a standard SBRT plan aiming to cover the planning target volume with 40 Gy, (2) dose painting plans delivering escalated doses to a maximum of three FAZA-avid hypoxic sub-volumes, (3) dose painting plans with simulated spacer separating the duodenum and pancreatic head, and (4), plans with integrated boosts to geometric contractions of the gross tumour volume (GTV). All plans saturated at least one OAR dose limit. SF was calculated for each plan and sensitivity of SF to simulated hypoxia quantification errors was evaluated. Dose painting resulted in a 55% reduction in SF as compared to standard SBRT; 78% with spacer. Integrated boosts to hypoxia-blind geometric contractions resulted in a 41% reduction in SF. The reduction in SF for dose-painting plans persisted for all hypoxia quantification parameters studied, including registration and rigid motion errors that resulted in shifts and rotations of the GTV and hypoxic sub-volumes by as much as 1 cm and 10 degrees. Although proximity to OARs ultimately limited dose escalation, with estimated SFs (∼10-5) well above levels required to completely ablate a ∼10 cm3tumour, dose painting robustly reduced clonogen survival when accounting for expected treatment and imaging uncertainties and thus, may improve local response and associated morbidity.
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Affiliation(s)
- Ahmed M Elamir
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Teodor Stanescu
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Andrea Shessel
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Tony Tadic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ivan Yeung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - John Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jelena Lukovic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Laura A Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Rebecca Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - James Brierley
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Steven Gallinger
- Ontario Institute for Cancer Research, PanCuRx Translational Research Initiative, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Jennifer Knox
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Grainne O'Kane
- Ontario Institute for Cancer Research, PanCuRx Translational Research Initiative, Toronto, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Neesha Dhani
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Edward Taylor
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
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9
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Hanley J, Dresser S, Simon W, Flynn R, Klein EE, Letourneau D, Liu C, Yin FF, Arjomandy B, Ma L, Aguirre F, Jones J, Bayouth J, Holmes T. AAPM Task Group 198 Report: An implementation guide for TG 142 quality assurance of medical accelerators. Med Phys 2021; 48:e830-e885. [PMID: 34036590 DOI: 10.1002/mp.14992] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/16/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022] Open
Abstract
The charges on this task group (TG) were as follows: (a) provide specific procedural guidelines for performing the tests recommended in TG 142; (b) provide estimate of the range of time, appropriate personnel, and qualifications necessary to complete the tests in TG 142; and (c) provide sample daily, weekly, monthly, or annual quality assurance (QA) forms. Many of the guidelines in this report are drawn from the literature and are included in the references. When literature was not available, specific test methods reflect the experiences of the TG members (e.g., a test method for door interlock is self-evident with no literature necessary). In other cases, the technology is so new that no literature for test methods was available. Given broad clinical adaptation of volumetric modulated arc therapy (VMAT), which is not a specific topic of TG 142, several tests and criteria specific to VMAT were added.
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Affiliation(s)
- Joseph Hanley
- Princeton Radiation Oncology, Monroe, New Jersey, 08831, USA
| | - Sean Dresser
- Winship Cancer Institute, Radiation Oncology, Emory University, Atlanta, Georgia, 30322, USA
| | | | - Ryan Flynn
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, 52242, USA
| | - Eric E Klein
- Brown university, Rhode Island Hospital, Providence, Rhode Island, 02905, USA
| | | | - Chihray Liu
- University of Florida, Gainesville, Florida, 32610-0385, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Bijan Arjomandy
- Karmanos Cancer Institute at McLaren-Flint, Flint, Michigan, 48532, USA
| | - Lijun Ma
- Department of Radiation Oncology, University of California San Francisco, San Francisco, 94143-0226, USA
| | | | - Jimmy Jones
- Department of Radiation Oncology, The University of Colorado Health-Poudre Valley, Fort Collins, Colorado, 80525, USA
| | - John Bayouth
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, 53792-0600, USA
| | - Todd Holmes
- Varian Medical Systems, Palo Alto, California, 94304, USA
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10
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Glicksman RM, Bhaskaran A, Nanthakumar K, Lindsay P, Coolens C, Conroy L, Letourneau D, Lok BH, Giuliani M, Hope A. Implementation of Cardiac Stereotactic Radiotherapy: From Literature to the Linac. Cureus 2021; 13:e13606. [PMID: 33816005 PMCID: PMC8011471 DOI: 10.7759/cureus.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Stereotactic radiotherapy (SBRT) has been applied to treat cardiac arrhythmias, but our institution had not yet implemented this technique. Here, we explain how we used implementation science and knowledge translation to provide cardiac SBRT to a critically ill patient with malignancy-associated refractory ventricular tachycardia. We reviewed the critical factors that enabled the implementation of this urgent treatment, such as the context of the implementation, the characteristics of the intervention, and the stakeholders. These principles can be used by other radiation programs to implement novel treatments in urgent settings, where the gold standard process of planning and developing policies and protocols is not possible.
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Affiliation(s)
- Rachel M Glicksman
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, CAN
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, CAN
| | - Patricia Lindsay
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Catherine Coolens
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Leigh Conroy
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Daniel Letourneau
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Benjamin H Lok
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Meredith Giuliani
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Andrew Hope
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
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11
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Tadic T, Croke J, Xie J, Stanescu T, Letourneau D, Bissonnette J, Breen S, Simeonov A, Dickie C, Hill C, Li W, Ellis C, Winter J, Velec M, Fyles A, Han K, Jaffray D, Milosevic M. In-Room MRI for Adaptive Radiotherapy for Cervical Cancer Using an Integrated MR-Guided Radiation Therapy System. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Rezaee M, Letourneau D. Assessment of Image Quality and Dosimetric Performance of CT Simulators. J Med Imaging Radiat Sci 2019; 50:297-307. [PMID: 31176438 DOI: 10.1016/j.jmir.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND CT simulator for radiation therapy aims to produce high-quality images for dose calculation and delineation of target and organs at risk in the process of treatment planning. Selection of CT imaging protocols that achieve a desired image quality while minimizing patient dose depends on technical CT parameters and their relationship with image quality and radiation dose. For similar imaging protocols using comparable technical CT parameters, there are also variations in image quality metrics between different CT simulator models. Understanding the relationship and variation is important for selecting appropriate imaging protocol and standardizing QC process. Here, we proposed an automated method to determine the relationship between image quality and radiation dose for various CT technical parameters. MATERIAL AND METHOD The impact of scan parameters on various aspects of image quality and volumetric CT dose index for a Philips Brilliance Big Bore and a Toshiba Aquilion One CT scanners were determined by using commercial phantom and automated image quality analysis software and cylindrical radiation dose phantom. RESULTS AND DISCUSSION Both scanners had very similar and satisfactory performance based on the diagnostic acceptance criteria recommended by ACR, International Atomic Energy Agency, and American Association of Physicists in Medicine. However, our results showed a compromise between different image quality components such as low-contrast and spatial resolution with the change of scanning parameters and revealed variations between the two scanners on their image quality performance. Measurement using a generic phantom and analysis by automated software was unbiased and efficient. CONCLUSION This method provides information that can be used as a baseline for CT scanner image quality and dosimetric QC for different CT scanner models in a given institution or across sites.
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Affiliation(s)
- Mohammad Rezaee
- Department of Medical Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Daniel Letourneau
- Department of Medical Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada
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Bartolac S, Heaton R, Norrlinger B, Letourneau D. Seasonal variations in measurements of linear accelerator output. J Appl Clin Med Phys 2019; 20:81-88. [PMID: 30817079 PMCID: PMC6414147 DOI: 10.1002/acm2.12548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/05/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Seasonal trends in linear accelerator output have been reported by at least one institution and data have suggested that they may be present at our center as well. The purpose of this work was to characterize these trends and determine whether local environmental conditions within the treatment rooms may be impacting the linear accelerators and/or the quality control (QC) dosimeter. METHODS Runtime plots of daily output data, acquired using an in-house ion chamber-based device, over 3 yr and for 15 linear accelerators of different makes and models were reviewed and evaluated. Environmental conditions were monitored prospectively in a representative treatment room for approximately 9 months and evaluated for correlations with output trends. Independent measures of output using daily MV portal images were compared with output measurements using the ion chamber-based device. A separate controlled experiment probing the response of the in-house dosimeter to humidity changes over time was also carried out using a constant current source and a small enclosure. RESULTS Runtime plots of output revealed sinusoidal, seasonal variations that were consistent across all treatment units, irrespective of manufacturer, model, or age of machine. The amplitude of the variation was on the order of 1% and maintained a yearly period. The independent measure of output using MV portal images did not corroborate the seasonal trends observed with the daily QC dosimeter. Based on the controlled experiment, the QC dosimeter was found to have a dependence on relative humidity changes, decreasing 1% in output per 30% increase in relative humidity. CONCLUSIONS Results confirm the presence of underlying seasonal variations in measured output from the linear accelerators. The findings identify humidity impact on the measurement device as the underlying cause of the cyclical changes and not the accelerators themselves. These results could help minimize unwarranted machine servicing.
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Affiliation(s)
- Steven Bartolac
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada.,Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert Heaton
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Bernhard Norrlinger
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
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Roesch J, Cho JB, Fahim DK, Gerszten PC, Flickinger JC, Grills IS, Jawad M, Kersh R, Letourneau D, Mantel F, Sahgal A, Shin JH, Winey B, Guckenberger M. Risk for surgical complications after previous stereotactic body radiotherapy of the spine. Radiat Oncol 2017; 12:153. [PMID: 28893299 PMCID: PMC5594477 DOI: 10.1186/s13014-017-0887-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECT Stereotactic body radiotherapy (SBRT) for vertebral metastases has emerged as a promising technique, offering high rates of symptom relief and local control combined with low risk of toxicity. Nonetheless, local failure or vertebral instability may occur after spine SBRT, generating the need for subsequent surgery in the irradiated region. This study evaluated whether there is an increased incidence of surgical complications in patients previously treated with SBRT at the index level. METHODS Based upon a retrospective international database of 704 cases treated with SBRT for vertebral metastases, 30 patients treated at 6 different institutions were identified who underwent surgery in a region previously treated with SBRT. RESULTS Thirty patients, median age 59 years (range 27-84 years) underwent SBRT for 32 vertebral metastases followed by surgery at the same vertebra. Median follow-up time from SBRT was 17 months. In 17 cases, conventional radiotherapy had been delivered prior to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.3 Gy (range 15-65 Gy) delivered in median 1 fraction (range 1-17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage therapy was 6 months (range 1-39 months). Reasons for subsequent surgery were pain (n = 28), neurological deterioration (n = 15) or fracture of the vertebral body (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) were most frequently performed; Five patients (6 vertebrae) were treated without complications with vertebroplasty only. Increased fibrosis complicating the surgical procedure was explicitly stated in one surgical report. Two durotomies occurred which were closed during the operation, associated with a neurological deficit in one patient. Median blood loss was 500 ml, but five patients had a blood loss of more than 1 l during the procedure. Delayed wound healing was reported in two cases. One patient died within 30 days of the operation. CONCLUSION In this series of surgical interventions following spine SBRT, the overall complication rate was 19%, which appears comparable to primary surgery without previous SBRT. Prior spine SBRT does not appear to significantly increase the risk of intra- and post-surgical complications.
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Affiliation(s)
- Johannes Roesch
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - John B.C. Cho
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada
| | - Daniel K. Fahim
- Department of Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan USA
| | - Peter C. Gerszten
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA
| | - John C. Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA
| | - Inga S. Grills
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan USA
| | - Maha Jawad
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan USA
| | - Ronald Kersh
- Department of Radiation Oncology, Riverside Medical Center, Newport News, Virginia USA
| | - Daniel Letourneau
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada
| | - Frederick Mantel
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Brian Winey
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts USA
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Stanescu T, Berlin A, Dawson L, Abed J, Simeonov A, Craig T, Letourneau D, Jaffray D. EP-1761: Workflow development for the clinical implementation of an MR-guided linear accelerator. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32124-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stanescu T, Schaer N, Breen S, Letourneau D, Shet K, Dickie C, Jaffray D. Magnetic Resonance Guided Radiation Therapy: Feasibility Study of a Linear Accelerator and Magnetic Resonance-on-Rails System. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Meyers SM, Balderson MJ, Letourneau D. SU-D-201-04: Evaluation of Elekta Agility MLC Performance Using Statistical Process Control. Med Phys 2016. [DOI: 10.1118/1.4955616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Toussaint A, Richter A, Mantel F, Flickinger JC, Grills IS, Tyagi N, Sahgal A, Letourneau D, Sheehan JP, Schlesinger DJ, Gerszten PC, Guckenberger M. Variability in spine radiosurgery treatment planning - results of an international multi-institutional study. Radiat Oncol 2016; 11:57. [PMID: 27089966 PMCID: PMC4835862 DOI: 10.1186/s13014-016-0631-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/09/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of this study was to quantify the variability in spinal radiosurgery (SRS) planning practices between five international institutions, all member of the Elekta Spine Radiosurgery Research Consortium. METHODS Four institutions provided one representative patient case each consisting of the medical history, CT and MR imaging. A step-wise planning approach was used where, after each planning step a consensus was generated that formed the basis for the next planning step. This allowed independent analysis of all planning steps of CT-MR image registration, GTV definition, CTV definition, PTV definition and SRS treatment planning. In addition, each institution generated one additional SRS plan for each case based on intra-institutional image registration and contouring, independent of consensus results. RESULTS Averaged over the four cases, image registration variability ranged between translational 1.1 mm and 2.4 mm and rotational 1.1° and 2.0° in all three directions. GTV delineation variability was 1.5 mm in axial and 1.6 mm in longitudinal direction averaged for the four cases. CTV delineation variability was 0.8 mm in axial and 1.2 mm in longitudinal direction. CTV-to-PTV margins ranged between 0 mm and 2 mm according to institutional protocol. Delineation variability was 1 mm in axial directions for the spinal cord. Average PTV coverage for a single fraction18 Gy prescription was 87 ± 5 %; Dmin to the PTV was 7.5 ± 1.8 Gy averaged over all cases and institutions. Average Dmax to the PRV_SC (spinal cord + 1 mm) was 10.5 ± 1.6 Gy and the average Paddick conformity index was 0.69 ± 0.06. CONCLUSIONS Results of this study reflect the variability in current practice of spine radiosurgery in large and highly experienced academic centers. Despite close methodical agreement in the daily workflow, clinically significant variability in all steps of the treatment planning process was demonstrated. This may translate into differences in patient clinical outcome and highlights the need for consensus and established delineation and planning criteria.
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Affiliation(s)
- André Toussaint
- />Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Anne Richter
- />Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Frederick Mantel
- />Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - John C. Flickinger
- />Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | | | - Arjun Sahgal
- />Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON Canada
| | | | - Jason P. Sheehan
- />University of Virginia School of Medicine, Charlottesville, VA USA
| | | | - Peter Carlos Gerszten
- />Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Matthias Guckenberger
- />Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
- />Division of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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Stanescu T, Breen S, Dickie C, Letourneau D, Jaffray D. OC-0543: Technical development and clinical implementation of an MR-guided radiation therapy environment. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31793-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Roesch J, Cho J, Fahim D, Flickinger J, Gerszten P, Grills I, Jawad M, Kersh R, Letourneau D, Mantel F, Sahgal A, Shin J, Winey B, Guckenberger M. PO-0653: Surgical interventions after previous SBRT of the spine - increased risk for complications? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chan MW, Thibault I, Atenafu EG, Yu E, John Cho BC, Letourneau D, Lee Y, Yee A, Fehlings MG, Sahgal A. Patterns of epidural progression following postoperative spine stereotactic body radiotherapy: implications for clinical target volume delineation. J Neurosurg Spine 2015; 24:652-9. [PMID: 26682603 DOI: 10.3171/2015.6.spine15294] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors performed a pattern-of-failure analysis, with a focus on epidural disease progression, in patients treated with postoperative spine stereotactic body radiotherapy (SBRT). METHODS Of the 70 patients with 75 spinal metastases (cases) treated with postoperative spine SBRT, there were 26 cases of local disease recurrence and 25 cases with a component of epidural disease progression. Twenty-four of the 25 cases had preoperative epidural disease with subsequent epidural disease progression, and this cohort was the focus of this epidural-specific pattern-of-failure investigation. Preoperative, postoperative, and follow-up MRI scans were reviewed, and epidural disease was characterized based on location according to a system in which the vertebral anatomy is divided into 6 sectors, with the anterior compartment comprising Sectors 1, 2, and 6, and the posterior compartment comprising Sectors 3, 4, and 5. RESULTS Patterns of epidural progression are reported specifically for the 24 cases with preoperative epidural disease and subsequent epidural progression. Epidural disease progression within the posterior compartment was observed to be significantly lower in those with preoperative epidural disease confined to the anterior compartment than in those with preoperative epidural disease involving both anterior and posterior compartments (56% vs. 93%, respectively; p = 0.047). In a high proportion of patients with epidural disease progression, treatment failure was found in the anterior compartment, including both those with preoperative epidural disease confined to the anterior compartment and those with preoperative epidural disease involving both anterior and posterior compartments (100% vs. 73%, respectively). When epidural disease was confined to the anterior compartment on the preoperative and postoperative MRIs, no epidural disease progression was observed in Sector 4, which is the most posterior sector. Postoperative epidural disease characteristics alone were not predictive of the pattern of epidural treatment failure. CONCLUSIONS Reviewing the extent of epidural disease on preoperative MRI is imperative when planning postoperative SBRT. When epidural disease is confined to the anterior epidural sectors pre- and postoperatively, covering the entire epidural space circumferentially with a prophylactic "donut" distribution may not be needed.
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Affiliation(s)
| | | | | | - Eugene Yu
- Radiology, University Health Network, University of Toronto
| | - B C John Cho
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto; and
| | - Daniel Letourneau
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto; and
| | - Young Lee
- Department of Radiation Oncology, Odette Cancer Centre, and
| | - Albert Yee
- Division of Orthopaedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto;
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, and.,Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto; and
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Sahgal A, Chan M, Thibault I, Atenafu E, Letourneau D, Cho J, Lee Y, Yu E, Yee A, Fehlings M. Patterns of Epidural Progression Following Postoperative Spine Stereotactic Body Radiation Therapy (SBRT): Implications for Clinical Target Volume Delineation. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tseng CL, Sussman MS, Atenafu EG, Letourneau D, Ma L, Soliman H, Thibault I, Cho BCJ, Simeonov A, Yu E, Fehlings MG, Sahgal A. Magnetic resonance imaging assessment of spinal cord and cauda equina motion in supine patients with spinal metastases planned for spine stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 2015; 91:995-1002. [PMID: 25832691 DOI: 10.1016/j.ijrobp.2014.12.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/14/2014] [Accepted: 12/17/2014] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess motion of the spinal cord and cauda equina, which are critical neural tissues (CNT), which is important when evaluating the planning organ-at-risk margin required for stereotactic body radiation therapy. METHODS AND MATERIALS We analyzed CNT motion in 65 patients with spinal metastases (11 cervical, 39 thoracic, and 24 lumbar spinal segments) in the supine position using dynamic axial and sagittal magnetic resonance imaging (dMRI, 3T Verio, Siemens) over a 137-second interval. Motion was segregated according to physiologic cardiorespiratory oscillatory motion (characterized by the average root mean square deviation) and random bulk shifts associated with gross patient motion (characterized by the range). Displacement was evaluated in the anteroposterior (AP), lateral (LR), and superior-inferior (SI) directions by use of a correlation coefficient template matching algorithm, with quantification of random motion measure error over 3 separate trials. Statistical significance was defined according to P<.05. RESULTS In the AP, LR, and SI directions, significant oscillatory motion was observed in 39.2%, 35.1%, and 10.8% of spinal segments, respectively, and significant bulk motions in all cases. The median oscillatory CNT motions in the AP, LR, and SI directions were 0.16 mm, 0.17 mm, and 0.44 mm, respectively, and the maximal statistically significant oscillatory motions were 0.39 mm, 0.41 mm, and 0.77 mm, respectively. The median bulk displacements in the AP, LR, and SI directions were 0.51 mm, 0.59 mm, and 0.66 mm, and the maximal statistically significant displacements were 2.21 mm, 2.87 mm, and 3.90 mm, respectively. In the AP, LR, and SI directions, bulk displacements were greater than 1.5 mm in 5.4%, 9.0%, and 14.9% of spinal segments, respectively. No significant differences in axial motion were observed according to cord level or cauda equina. CONCLUSIONS Oscillatory CNT motion was observed to be relatively minor. Our results support the importance of controlling bulk patient motion and the practice of applying a planning organ-at-risk margin.
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Affiliation(s)
- Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marshall S Sussman
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Letourneau
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lijun Ma
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Thibault
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - B C John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anna Simeonov
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yu
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Department of Neurosurgery and Spine Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
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McNiven A, Jaffray D, Letourneau D. SU-C-BRD-01: Multi-Centre Collaborative Quality Assurance Program for IMRT Planning and Delivery: Year 3 Results. Med Phys 2015. [DOI: 10.1118/1.4923796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Malcolm J, Mein S, McNiven A, Letourneau D, Oldham M. SU-D-213-05: Design, Evaluation and First Applications of a Off-Site State-Of-The-Art 3D Dosimetry System. Med Phys 2015. [DOI: 10.1118/1.4923857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Letourneau D, Amin N, Wang K, Norrlinger B, Jaffray D, McNiven A. SU-E-T-160: Characterization and Monitoring of Linear Accelerator Gantry Radiation Isocenter Motion. Med Phys 2015. [DOI: 10.1118/1.4924522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Husain ZA, Thibault I, Letourneau D, Ma L, Keller H, Suh J, Chiang V, Chang EL, Rampersaud RK, Perry J, Larson DA, Sahgal A. Stereotactic body radiotherapy: a new paradigm in the management of spinal metastases. CNS Oncol 2015; 2:259-70. [PMID: 25054466 DOI: 10.2217/cns.13.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Spine stereotactic body radiotherapy is based on delivering high biologically effective doses to spinal metastases, with the intent to maximize both tumor and pain control. The purpose of this review is to outline the technical details of spine stereotactic body radiotherapy, contrast clinical outcomes to low biologically effective dose conventional palliative radiotherapy, discuss the role of surgery in the era of spine stereotactic body radiotherapy, and summarize the major serious adverse events that patients would otherwise not be at risk of with conventional radiotherapy.
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Affiliation(s)
- Zain A Husain
- Department of Radiation Oncology, Yale School of Medicine, New Haven, CT, USA
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Thibault I, Campbell M, Tseng C, Al-Omair A, Lochray F, Letourneau D, Yu E, Lee Y, Fehlings M, Sahgal A. Salvage Spine Stereotactic Body Radiation Therapy (SBRT) for Spinal Metastases That Failed Initial SBRT: A First Report. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wong P, Dickie C, Lee D, Chung P, O’Sullivan B, Letourneau D, Xu W, Swallow C, Gladdy R, Catton C. Spatial and volumetric changes of retroperitoneal sarcomas during pre-operative radiotherapy. Radiother Oncol 2014; 112:308-13. [DOI: 10.1016/j.radonc.2014.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/08/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
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Al-Omair A, Masucci L, Masson-Cote L, Campbell M, Atenafu EG, Parent A, Letourneau D, Yu E, Rampersaud R, Massicotte E, Lewis S, Yee A, Thibault I, Fehlings MG, Sahgal A. Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy. Neuro Oncol 2014; 15:1413-9. [PMID: 24057886 DOI: 10.1093/neuonc/not101] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spine stereotactic body radiotherapy (SBRT) is increasingly being applied to the postoperative spine metastases patient. Our aim was to identify clinical and dosimetric predictors of local control (LC) and survival. METHODS Eighty patients treated between October 2008 and February 2012 with postoperative SBRT were identified from our prospective database and retrospectively reviewed. RESULTS The median follow-up was 8.3 months. Thirty-five patients (44%) were treated with 18-26 Gy in 1 or 2 fractions, and 45 patients (56%) with 18-40 Gy in 3-5 fractions. Twenty-one local failures (26%) were observed, and the 1-year LC and overall survival (OS) rates were 84% and 64%, respectively. The most common site of failure was within the epidural space (15/21, 71%). Multivariate proportional hazards analysis identified systemic therapy post-SBRT as the only significant predictor of OS (P = .02) and treatment with 18-26 Gy/1 or 2 fractions (P = .02) and a postoperative epidural disease grade of 0 or 1 (0, no epidural disease; 1, epidural disease that compresses dura only, P = .003) as significant predictors of LC. Subset analysis for only those patients (n = 48/80) with high-grade preoperative epidural disease (cord deformed) indicated significantly greater LC rates when surgically downgraded to 0/1 vs 2 (P = .0009). CONCLUSIONS Postoperative SBRT with high total doses ranging from 18 to 26 Gy delivered in 1-2 fractions predicted superior LC, as did postoperative epidural grade.
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Affiliation(s)
- Ameen Al-Omair
- Corresponding Author: Dr Arjun Sahgal, MD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre and Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
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Masucci GL, Yu E, Ma L, Chang EL, Letourneau D, Lo S, Leung E, Chao S, Hyde D, Gorgulho A, Muacevic A, Larson DA, Fehlings MG, Sahgal A. Stereotactic body radiotherapy is an effective treatment in reirradiating spinal metastases: current status and practical considerations for safe practice. Expert Rev Anticancer Ther 2014; 11:1923-33. [DOI: 10.1586/era.11.169] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Anwar M, Lupo J, Molinaro A, Clarke J, Butowski N, Prados M, Chang S, HaasKogan D, Nelson S, Ashman J, Drazkowski J, Zimmerman R, Lidner T, Giannini C, Porter A, Patel N, Atean I, Shin N, Toltz A, Laude C, Freeman C, Seuntjens J, Roberge D, Back M, Kastelan M, Guo L, Wheeler H, Beauchesne P, Faure G, Noel G, Schmitt T, Martin L, Jadaud E, Carnin C, Bowers J, Bennion N, Lomas H, Spencer K, Richardson M, McAllister W, Sheehan J, Schlesinger D, Kersh R, Brower J, Gans S, Hartsell W, Goldman S, Chang JHC, Mohammed N, Siddiqui M, Gondi V, Christensen E, Klawikowski S, Garg A, McAleer M, Rhines L, Yang J, Brown P, Chang E, Settle S, Ghia A, Edson M, Fuller GN, Allen P, Li J, Garsa A, Badiyan S, Simpson J, Dowling J, Rich K, Chicoine M, Leuthardt E, Kim A, Robinson C, Gill B, Peskorski D, Lalonde R, Huq MS, Flickinger J, Graff A, Clerkin P, Smith H, Isaak R, Dinh J, Grosshans D, Allen P, de Groot J, McGovern S, McAleer M, Gilbert M, Brown P, Mahajan A, Gupta T, Mohanty S, Kannan S, Jalali R, Hardie J, Laack N, Kizilbash S, Buckner J, Giannini C, Uhm J, Parney I, Jenkins R, Decker P, Voss J, Hiramatsu R, Kawabata S, Furuse M, Niyatake SI, Kuroiwa T, Suzuki M, Ono K, Hobbs C, Vallow L, Peterson J, Jaeckle K, Heckman M, Bhupendra R, Horowitz D, Wuu CS, Feng W, Drassinower D, Lasala A, Lassman A, Wang T, Indelicato D, Rotondo R, Bradley J, Sandler E, Aldana P, Mendenhall N, Marcus R, Kabarriti R, Mourad WF, Mejia DM, Glanzman J, Patel S, Young R, Bernstein M, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Khatua S, Hou P, Wolff J, Hamilton J, Zaky W, Mahajan A, Ketonen L, Kim SH, Lee SR, Ji, Oh Y, Krishna U, Shah N, Pathak R, Gupta T, Lila A, Menon P, Goel A, Jalali R, Lall R, Lall R, Smith T, Schumacher A, McCaslin A, Kalapurakal J, Chandler J, Magnuson W, Robins HI, Mohindra P, Howard S, Mahajan A, Manfredi D, Rogers CL, Palmer M, Hillebrandt E, Bilton S, Robinson G, Velasco K, Mehta M, McGregor J, Grecula J, Ammirati M, Pelloski C, Lu L, Gupta N, Bell S, Moller S, Law I, Rosenschold PMA, Costa J, Poulsen HS, Engelholm SA, Morrison A, Cuglievan B, Khatib Z, Mourad WF, Kabarriti R, Young R, Santiago T, Blakaj DM, Welch M, Graber J, Patel S, Hong LX, Patel A, Tandon A, Bernstein MB, Shourbaji RA, Glanzman J, Kinon MD, Fox JL, Lasala P, Kalnicki S, Garg MK, Nicholas S, Salvatori R, Lim M, Redmond K, Quinones A, Gallia G, Rigamonti D, Kleinberg L, Patel S, Mourad W, Young R, Kabarriti R, Santiago T, Glanzman J, Bernstein M, Patel A, Yaparpalvi R, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Redmond K, Mian O, Degaonkar M, Sair H, Terezakis S, Kleinberg L, McNutt T, Wharam M, Mahone M, Horska A, Rezvi U, Melian E, Surucu M, Mescioglu I, Prabhu V, Clark J, Anderson D, Robbins J, Yechieli R, Ryu S, Ruge MI, Suchorska B, Hamisch C, Mahnkopf K, Lehrke R, Treuer H, Sturm V, Voges J, Sahgal A, Al-Omair A, Masucci L, Masson-Cote L, Atenafu E, Letourneau D, Yu E, Rampersaud R, Lewis S, Yee A, Thibault I, Fehlings M, Shi W, Palmer J, Li J, Kenyon L, Glass J, Kim L, Werner-wasik M, Andrews D, Susheela S, Revannasiddaiah S, Muzumder S, Mallarajapatna G, Basavalingaiah A, Gupta M, Kallur K, Hassan M, Bilimagga R, Tamura K, Aoyagi M, Ando N, Ogishima T, Yamamoto M, Ohno K, Maehara T, Xu Z, Vance ML, Schlesinger D, Sheehan J, Young R, Blakaj D, Kinon MD, Mourad W, LaSala PA, Hong L, Kalnicki S, Garg M, Young R, Mourad W, Patel S, Fox J, LaSala PA, Hong L, Graber JJ, Santiago T, Kalnicki S, Garg M, Zimmerman AL, Vogelbaum MA, Barnett GH, Murphy ES, Suh JH, Angelov L, Reddy CA, Chao ST. RADIATION THERAPY. Neuro Oncol 2013; 15:iii178-iii188. [PMCID: PMC3823902 DOI: 10.1093/neuonc/not187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
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Letourneau D, Wang K, Amin N, Lee P, Pearce J, McNiven A, Keller H, Norrlinger B, Jaffray D. Linear Accelerator Performance Monitoring and Improvement Using Semiautomated Testing and Statistical Process Control. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Guckenberger M, Mantel F, Kersh R, Sheehan J, Sahgal A, Letourneau D, Inga G, Jawad M, Flickinger J, Gerszten P. Radiosurgery as Primary Treatment for Vertebral Metastases: Results From an International Multicenter Database. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Al-Omair A, Masucci L, Masson L, Campbell M, Atenafu E, Parent A, Letourneau D, Yu E, Fehlings M, Sahgal A. Postoperative Stereotactic Body Radiation Therapy (SBRT) for Patients With Spinal Metastasis: Predictive and Prognostic Factors Analysis. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ren J, McNiven A, Letourneau D. SU-E-T-161: Assessment of Phantom Positioning Accuracy in IMRT Quality Assurance: Insert Design and Implementation. Med Phys 2013. [DOI: 10.1118/1.4814596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Marchand EL, Sahgal A, Zhang TJ, Millar BA, Sharpe M, Moseley D, Letourneau D. Treatment Planning and Delivery Evaluation of Volumetric Modulated Arc Therapy for Stereotactic Body Radiotherapy of Spinal Tumours: Impact of Arc Discretization in Planning System. Technol Cancer Res Treat 2012; 11:599-606. [DOI: 10.7785/tcrt.2012.500268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to compare single arc volumetric modulated arc therapy (VMAT) to intensity modulated radiotherapy (IMRT) for spine SBRT in terms of target coverage, organ at risk (OAR) sparing and delivery performance. VMAT plans with 91 control points (VMAT-91CP) were generated for 15 spine metastases patients previously treated with a nine-field IMRT technique. VMAT and IMRT plans were compared based on target coverage, maximum spinal cord dose, maximum plan dose and volume of normal tissue receiving 20% to 80% of the prescribed dose. Treatment delivery time and monitor units (MU) were measured to determine delivery efficiency. To assess the impact of arc discretization in the treatment planning system (TPS), the VMAT-91CP plans were modified by almost doubling the number of CPs (VMAT-181CP). Planned-to-delivered dose agreement for both techniques was assessed using two types of 3D detector arrays. VMAT-91CP target coverage was equivalent to IMRT while maintaining or improving spinal cord sparing. This was achieved without increasing the volume of normal tissue receiving low or intermediate dose levels. Planned-to-delivered dose agreement equivalent to IMRT was achieved with VMAT, but required decreasing the CP angular spacing from 4° to 2° (VMAT-181CP plans). On average, VMAT-181CP plans reduced delivery time by 53% compared to IMRT. Single-arc VMAT for spine SBRT improved delivery efficiency while maintaining target coverage and OAR sparing compared to IMRT. VMAT plans generated with a CP gantry angular spacing of 2° is recommended to avoid a discretization effect in the TPS and ensure acceptable planned-to-delivered dose agreement.
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Affiliation(s)
- E. L. Marchand
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - A. Sahgal
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - T. J. Zhang
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - B. A. Millar
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - M. Sharpe
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - D. Moseley
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - D. Letourneau
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Letourneau D, McNiven A, Jaffray D. Multicenter Collaborative Quality Assurance Program for the Province of Ontario, Canada: First Year Results. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cunha MV, Al-Omair A, Atenafu EG, Masucci GL, Letourneau D, Korol R, Yu E, Howard P, Lochray F, da Costa LB, Fehlings MG, Sahgal A. Vertebral Compression Fracture (VCF) After Spine Stereotactic Body Radiation Therapy (SBRT): Analysis of Predictive Factors. Int J Radiat Oncol Biol Phys 2012; 84:e343-9. [DOI: 10.1016/j.ijrobp.2012.04.034] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 10/27/2022]
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Al-Omair A, da Cunha M, Atenafu E, Letourneau D, Korol R, Yu E, Masucci L, Da Costa L, Fehlings M, Sahgal A. The Risk of Vertebral Compression Fracture (VCF) Postspine Stereotactic Body Radiation Therapy (SBRT) and Evaluation of the Spinal Instability Neoplastic Score (SINS). Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tseng C, Sussman M, Simeonov A, Letourneau D, Yu E, Sahgal A. Spinal Cord Motion Considerations for Spine Stereotactic Body Radiation Therapy (SBRT): Does the Cord Move? Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cunha M, Al-Omair A, Atenafu E, Letourneau D, Korol R, Yu E, Masucci L, Da Costa LB, Fehlings MG, Sahgal A. 183 The Risk of Vertebral Compression Fracture (VCF) Post-spine Stereotactic Body Radiotherapy (SBRT) and Evaluation of the Spinal Instability Neoplastic Score (SINS). Neurosurgery 2012. [DOI: 10.1227/01.neu.0000417772.78805.4b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Letourneau D, Wang K, Norrlinger B, Nurul A, Homer P, Lee P, Jaffray D. SU-E-T-94: Multileaf Collimator Performance and Validation of Quality Control Tolerances. Med Phys 2012; 39:3724. [PMID: 28517165 DOI: 10.1118/1.4735151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The automated quality assurance system (AQUA) is a centralized quality control (QC) software designed to automate QC tests. Statistical analysis of AQUA results was performed to assess the geometric accuracy and long-term reproducibility of a commercially available multileaf collimator (MLC) and examine the applicability of the American Association of Physicists in Medicine (AAPM) tolerances for MLC QC. METHODS The MLC was first calibrated with AQUA by minimizing leaf-positioning errors on megavoltage images for 5 different leaf-bank positions (-60 to 100 mm from radiation isocenter). Leaf-positioning accuracy and reproducibility was assessed by repeating the AQUA test 5 times/week. The range of leaf-positioning error over leaf-bank positions and time was reported. Measured leaf-positioning errors were then separated into systematic and random error components. The systematic error corresponds to the variation (standard deviation) in mean positioning errors between leaves over leaf-bank positions and time. The random error quantifies the leaf position variations around its mean and is calculated as the root-mean-square of the individual leaf position standard deviations. RESULTS To date, 2 different MLCs have been calibrated using AQUA and 9-18 datasets have been acquired to assess performance. For the unit with the longest follow up, the range of leaf-positioning errors was -0.62 to 0.85 mm and 98% of the measured leaf positions (n=7200) were within ±0.5 mm of the nominal position. The systematic error was the main error component (±0.15 to ±0.2 mm) and was attributed to the residual errors after calibration. The random error was ±0.07 mm for both units and demonstrated good leaf-positioning reproducibility and limited uncertainty of the AQUA measurements. CONCLUSIONS Preliminary results show that after MLC calibration with AQUA, leaf-positioning errors on two different units are well within the AAPM-recommended ±1 mm tolerances. Additional MLC performance improvement is possible if residual errors after calibration can be reduced further as the MLC demonstrated high reproducibility. Funded in part by Elekta Inc.
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Affiliation(s)
| | - K Wang
- Princess Margaret Hospital, Toronto, ON
| | | | - A Nurul
- Princess Margaret Hospital, Toronto, ON
| | - P Homer
- Princess Margaret Hospital, Toronto, ON
| | - P Lee
- Princess Margaret Hospital, Toronto, ON
| | - D Jaffray
- Princess Margaret Hospital, Toronto, ON
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Sahgal A, Roberge D, Schellenberg D, Purdie TG, Swaminath A, Pantarotto J, Filion E, Gabos Z, Butler J, Letourneau D, Masucci GL, Mulroy L, Bezjak A, Dawson LA, Parliament M. The Canadian Association of Radiation Oncology scope of practice guidelines for lung, liver and spine stereotactic body radiotherapy. Clin Oncol (R Coll Radiol) 2012; 24:629-39. [PMID: 22633542 DOI: 10.1016/j.clon.2012.04.006] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 03/29/2012] [Accepted: 04/25/2012] [Indexed: 12/12/2022]
Abstract
AIMS The Canadian Association of Radiation Oncology-Stereotactic Body Radiotherapy (CARO-SBRT) Task Force was established in 2010. The aim was to define the scope of practice guidelines for the profession to ensure safe practice specific for the most common sites of lung, liver and spine SBRT. MATERIALS AND METHODS A group of Canadian SBRT experts were charged by our national radiation oncology organisation (CARO) to define the basic principles and technologies for SBRT practice, to propose the minimum technological requirements for safe practice with a focus on simulation and image guidance and to outline procedural considerations for radiation oncology departments to consider when establishing an SBRT programme. RESULTS We recognised that SBRT should be considered as a specific programme within a radiation department, and we provide a definition of SBRT according to a Canadian consensus. We outlined the basic requirements for safe simulation as they pertain to spine, lung and liver tumours, and the fundamentals of image guidance. The roles of the radiation oncologist, medical physicist and dosimetrist have been detailed such that we strongly recommend the development of SBRT-specific teams. Quality assurance is a key programmatic aspect for safe SBRT practice, and we outline the basic principles of appropriate quality assurance specific to SBRT. CONCLUSION This CARO scope of practice guideline for SBRT is specific to liver, lung and spine tumours. The task force recommendations are designed to assist departments in establishing safe and robust SBRT programmes.
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Affiliation(s)
- A Sahgal
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada.
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Masucci GL, Masson-Cote L, Letourneau D, Sahgal A. Case Report: Grade 4 Radiation-Induced Colitis following Conventional Reirradiation to a Hip Metastasis. J Palliat Med 2012; 15:370-3. [DOI: 10.1089/jpm.2011.0121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giuseppina Laura Masucci
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laurence Masson-Cote
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Letourneau
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Jaffray D, Letourneau D, Sharpe M. 357 AUTOMATION IN BEAM MODELING AND QUALITY CONTROL. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Masucci G, Masson-Cote L, Letourneau D, Atenafu E, Massicotte E, Lewis S, Rampersaud R, Laperriere N, Fehlings M, Sahgal A. Local Control With Stereotactic Body Radiation Therapy (SBRT) For Spinal Metastasis: Is It Dose Or Biology That Matters? Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Conrad T, Coolens C, Guibord B, San Miguel J, Gospodarowicz M, Tsang R, Sun A, Purdie T, Letourneau D, Hodgson D. Active Breath Control to Reduce Normal Tissue Dose in Patients Receiving Mediastinal Radiotherapy for Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Letourneau D, Wang A, Homer P, Nurul A, Norrlinger B, Jaffray D. SU-C-224-12: Automated Quality Assurance System for Linear Accelerators. Med Phys 2011. [DOI: 10.1118/1.3611460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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