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Thawani N, Lee J, Kirsch C, Pinnaduwage D, Srivastava SP, Patel S, Sorensen SP, Jani S, Ellefson S, Vasireddy S, Riley J, Jennifer M, Diaz AZ, Gagliano R, Patel M. Implementation Science in Radiation Oncology: Case Study for Liver SBRT. Int J Radiat Oncol Biol Phys 2023; 117:e404. [PMID: 37785348 DOI: 10.1016/j.ijrobp.2023.06.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The translation of research into clinical practice is challenging and implementation science is becoming as important as the trial design and development. Implementation science methodologies have been shown to reduce research-to-practice gap in other clinical settings. This is especially true for the field of Radiation Oncology where modern hypofractionated techniques, like Stereotactic Ablative Body Radiotherapy for Liver are at a high risk of over enthusiastic implementation as well as underutilization. We present the results of a multicomponent implementation methodology utilized to develop our Liver SBRT program as a model to safely translate a complex technology into clinical practice. MATERIALS/METHODS After review of literature and market research a setup was created with focus on machine requirements, immobilization devices, motion management techniques and QA techniques. Clinical tools in the form of checklists were developed for patient selection, simulation along with image fusion, target delineation, planning (conformity indices, dose constraint criteria) and treatment delivery. All patients were treated on Truebeam® after Bodyfix® immobilization with plastic wrap. Planning was completed on Eclipse TPS with dose constraints and conformity guidelines defined per the RTOG 1112 and TG 101. Clinical outcomes including clinical and imaging follow-up for tumor control and toxicity were recorded. For this report, all patients treated were reviewed and compared to published data to assess the success of the implementation methodology. RESULTS A total of 64 consecutive Patients treated with liver SBRT at Dignity Health Cancer Institute (DHCI) were eligible for the study. 58 patients treated for primary liver malignancies were included in this analysis to assess outcomes including control of disease and toxicity to compare to the published literature. Median follow up for these patients 6.5 months (4-46mnths). Median GTV volume was 38.7cc (0.1cc-2056.1 cc), median PTV volume was 159.35 cc (21.5cc-2673.5cc). Median SBRT prescription dose was 50 Gy/5 fractions (35-50 Gy). Median Liver- GTV was 1595.8 cc(770.7cc-2983.0cc). Following toxicities were noted- Grade 1- 10.3%, Grade 2 - 1.72%, Grade 3- 3.44%. No Grade 4 toxicity was noted. 1 year LC rate was 96.6%. 8.6% showed out of field liver failure and 6.9% developed distant metastasis. These results were compared to the current published literature and are shown to be comparable. CONCLUSION Strong and well thought out Implementation methodologies can ensure reproducing results in clinical practice, comparable to the controlled environment of trials. These are crucial in translation of clinical trials utilizing advanced technologies to promote the culture of safety in clinical practice of Radiation Oncology. Regular assessment and tracking of clinical outcomes can be used as Quality markers for directing care and reimbursements for future.
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Affiliation(s)
- N Thawani
- Dignity Health Cancer Institute/ CUSOM/ UACC, Phoenix, AZ
| | - J Lee
- Dignity Health Cancer Institute/ CUSOM/ UACC, Phoenix, AZ
| | - C Kirsch
- Creighton School of Medicine- Phoenix, Phoenix, AZ
| | - D Pinnaduwage
- St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | | | - S Patel
- University of Arizona Cancer Center / Dignity Health Saint Joseph Hospital, Phoenix, AZ
| | - S P Sorensen
- University of Arizona Cancer Center / Dignity Health Saint Joseph Hospital, Phoenix, AZ
| | - S Jani
- University of Arizona Cancer Center / Dignity Health Saint Joseph Hospital, Phoenix, AZ
| | - S Ellefson
- Dignity Health Cancer Institute, Phoenix, AZ
| | - S Vasireddy
- University of Arizona Cancer Center, Phoenix, AZ, United States
| | - J Riley
- St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - M Jennifer
- Dignity Health cancer Institute, Phoenix, AZ
| | - A Z Diaz
- Dignity Health Cancer Institute, Phoenix, AZ
| | - R Gagliano
- Dignity Health Cancer Institute, Phoenix, AZ
| | - M Patel
- Dignity Health Cancer Institute, Phoenix, AZ
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Pulliam T, Jani S, Jing L, Zhang J, Kulikauskas R, Church C, Garnett-Benson C, Paulson K, Pardoll D, Koelle D, Topalian S, Nghiem P. LB1029 Correlation of merkel virus-specific CD8 T cells with response to immunotherapy in merkel cell carcinoma. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.1067] [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: 10/17/2022]
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Srivastava S, Jani S, Pinnaduwage D, Xiangsheng Y, Castaneda D, Patel S, Thawani N, Das I, Sorensen S. Understanding Parameters Affecting Surface Dose to Reduce Skin Toxicity in Patients Treated with SBRT. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.724] [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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Sorensen S, Srivastava S, Pinnaduwage D, Jani S, Yan X, Debbins J, Bodduluri M, Barani I. Verification of Treatment Plan Delivery for New Self-Shielded Stereotactic Radiosurgery (SRS) System. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.921] [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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Thawani N, Srivastava S, Jani S, Mutyala S, Patel S, Pinnaduwage D, Sorensen S, Huang J, Bremner R, Savvides P. Acute Skin Toxicity in Patients Treated with SBRT. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1157] [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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Yan X, Jani S, Sorensen S, Pinnaduwage D, Srivastava S, Metuge P, Mutyala S, Patel S, Thawani N. Liver SBRT Planning Template: A Simple, Novel Tool to Improve Planning Efficiency. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1473] [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: 10/28/2022]
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Hancock S, Clements C, Hyer D, Nixon E, Martin E, Wang B, Jani S, Gossman M. SU-G-TeP2-04: Comprehensive Machine Isocenter Evaluation with Separation of Gantry, Collimator, and Table Variables. Med Phys 2016. [DOI: 10.1118/1.4957039] [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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Jani S, Low D, Lamb J. SU-E-T-261: Development of An Automated System to Detect Patient Identification and Positioning Errors Prior to Radiotherapy Treatment. Med Phys 2015. [DOI: 10.1118/1.4924623] [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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Kishan A, King C, Jani S, Steinberg M, Lamb J. Pelvic Nodal Dosing With Registration to the Prostate: Implications for High-Risk Prostate Cancer Patients Receiving SBRT. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1304] [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: 10/24/2022]
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Thomas D, Tan J, Neylon J, Dou T, Jani S, Lamb J, Low D. TH-C-18A-11: Investigating the Minimum Scan Parameters Required to Generate Free-Breathing Fast-Helical CT Scans Without Motion-Artifacts. Med Phys 2014. [DOI: 10.1118/1.4889635] [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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Jani S. SU-E-J-254: Utility of Pinnacle Dynamic Planning Module Utilizing Deformable Image Registration in Adaptive Radiotherapy. Med Phys 2014. [DOI: 10.1118/1.4888308] [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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O' Connell D, Chow P, Agazaryan N, Jani S, Low D, Lamb J. SU-F-BRD-11: Prediction of Dosimetric Endpoints From Patient Geometry Using Neural Nets. Med Phys 2014. [DOI: 10.1118/1.4889065] [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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Jani S, O' Connell D, Chow P, Agazaryan N, Low D, Lamb J. SU-C-BRD-04: Automatic Detection of Patient Identification and Patient Positioning Errors Using 3D Setup Images. Med Phys 2014. [DOI: 10.1118/1.4889717] [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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Jani S. SU-E-I-63: Quantitative Evaluation of the Effects of Orthopedic Metal Artifact Reduction (OMAR) Software On CT Images for Radiotherapy Simulation. Med Phys 2014. [DOI: 10.1118/1.4888013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Jani S, Kishan A, O' Connell D, King C, Steinberg M, Low D, Lamb J. SU-E-J-179: Prediction of Pelvic Nodal Coverage Using Mutual Information Between Cone-Beam and Planning CTs. Med Phys 2014. [DOI: 10.1118/1.4888232] [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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Low D, Thomas D, Lamb J, Lee P, Gaudio S, Jani S, Dou T, White B, Wu X. OC-0501: Comparison between existing and proposed 4DCT protocols. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30606-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: 11/16/2022]
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Low D, Lamb J, White B, Thomas D, Gaudio S, Jani S, Wu X, Lee P. A New 4DCT Technique. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1781] [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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Lamb J, Jani S, White B, Thomas D, Gaudio S, Robinson C, Low D. SU-E-J-82: Ground-Truth Tests of Deformable Image Registration Using Matched PET-CT Image Pairs. Med Phys 2013. [DOI: 10.1118/1.4814294] [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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Wu X, Jani S, Dahlbom M, Low D, Lamb J. SU-E-I-84: Comparing the Accuracy of the Bilateral Filter and Gaussian Filter for PET Image Post-Processing Through a Phantom Study. Med Phys 2013. [DOI: 10.1118/1.4814195] [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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Thomas D, White B, Gaudio S, Jani S, Lee P, Lamb J, Low D. MO-F-WAB-07: A Novel 4D CT Acquisition and Analysis Technique to Account for the Effect of Cardiac Induced Lung Tissue Motion During Free Breathing. Med Phys 2013. [DOI: 10.1118/1.4815296] [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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White B, Thomas D, Lamb J, Jani S, Gaudio S, Min Y, Srinivasan S, Ennis D, Santhanam A, Low D. WE-A-134-08: Modeling Cardiac Induced Lung Tissue Motion for a Quantitative Breathing Motion Model. Med Phys 2013. [DOI: 10.1118/1.4815514] [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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Jani S, Dahlbom M, White B, Thomas D, Gaudio S, Low D, Lamb J. SU-D-500-05: Comparison of Gating Algorithms in 4D-PET for Mobile Tumor Segmentation. Med Phys 2013. [DOI: 10.1118/1.4814022] [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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Gaudio S, Thomas D, White B, Jani S, Lee P, Lamb J, Low D. SU-E-J-138: Breathing Motion Model Comparison Inside and Outside the Lung. Med Phys 2013. [DOI: 10.1118/1.4814350] [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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Aliotta E, Thomas D, Gaudio S, White B, Jani S, Lee P, Lamb J, Low D. TU-C-141-06: Improving Image Quality in 4D-CT Scans Using Deformable Registration and Selective Averaging. Med Phys 2013. [DOI: 10.1118/1.4815383] [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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Low D, Thomas D, White B, Gaudio S, Jani S, Lee P, Lamb J. SU-E-J-126: Development of a Prospective Gating Algorithm for a Novel 4DCT Technique: Retrospective Data Analysis. Med Phys 2013. [DOI: 10.1118/1.4814338] [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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Thomas D, White B, Gaudio S, Jani S, Lee P, Lamb J, Low D. TU-G-141-01: BEST IN PHYSICS (JOINT IMAGING-THERAPY)-A Novel 4D CT Acquisition and Analysis Technique to Generate Low Noise Artifact-Free Images at User Selected Breathing Phases. Med Phys 2013. [DOI: 10.1118/1.4815461] [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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Jergova S, Pathak N, Jani S, Gajavelli S, Sagen J. Targeting glutamate and opioid signaling by gene therapy in spinal cord injury-induced pain in rats. The Journal of Pain 2013. [DOI: 10.1016/j.jpain.2013.01.613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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White B, Santhanam A, Wang Z, Jani S, Lamb J, Ennis D, Ruan D, Low D. Addition of Cardiac Motion in a Breathing Motion Model. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1996] [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: 10/27/2022]
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Jani S, Lamb J, Dahlbom M, Robinson C, White B, Low D. WE-G-213CD-02: 4D-PET Maximum Intensity Projections Improve Accuracy of Mobile Tumor Volume Delineation. Med Phys 2012; 39:3970-3971. [DOI: 10.1118/1.4736203] [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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Lamb J, Lee P, Jani S, Dahlbom M, White B, Low D. SU-E-J-169: 4D-PET for Abdominal Tumor Target Volume Generation. Med Phys 2012; 39:3691. [PMID: 28518934 DOI: 10.1118/1.4735008] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To examine the impact of 4D-PET on target volume delineation of upper-abdominal tumors, versus conventional un-gated PET. METHODS Four patients with upper-abdominal tumors underwent respiratory-correlated FDG PET/CT scanning (4D-PET) as part of a continuing IRB-approved research protocol. Internal target volumes of FDG-avid tumors were contoured on the 4D-PET and conventional un-gated PET by a radiation oncologist who is a specialist in gastro-intestinal tumors. To create the 4D-PET ITV, the end-inhale and end-exhale 4D-PET phases were used. The relative volumes and volumetric overlaps of the 4D and un-gated target volumes were examined. Additionally, 4D-PET was used to measure the motion of the tumors. RESULTS Of the four patients who were imaged, one showed minimal motion (〈 3 mm in any direction) and one showed minimal FDG avidity; these were removed from further analysis. Of the two tumors which showed significant motion and FDG uptake, 4D-PET volumes were 28% and 21% larger than un-gated PET volumes. The un-gated PET volumes were almost entirely contained within the 4D-PET volumes (95% and 93% for the two tumors). Tumors appeared to deform as well as translate with breathing, although this could be due to varying intra-gate motion rather than actual physiological deformation. The superior-inferior borders of the tumors exhibited the most motion, with displacements of 5.6 mm and 6.4 mm. CONCLUSIONS 4D-PET can be used to estimate the motion of FDG-avid upper-abdominal tumors. Use of 4D-PET increases the size of target volumes compared to un-gated PET in a subset of upper-abdominal cancer patients. Direct measurement of tumor motion and deformation by 4D-PET imaging could allow the use of patient-specific margins rather than population-based margins, potentially leading to increased target coverage and reduced normal tissue irradiation.
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Affiliation(s)
- J Lamb
- UCLA School of Medicine, Los Angeles, CA
| | - P Lee
- UCLA School of Medicine, Los Angeles, CA
| | - S Jani
- UCLA School of Medicine, Los Angeles, CA
| | - M Dahlbom
- UCLA School of Medicine, Los Angeles, CA
| | - B White
- UCLA School of Medicine, Los Angeles, CA
| | - D Low
- UCLA School of Medicine, Los Angeles, CA
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Lamb J, Robinson C, Jani S, Laforest R, Bradley J, Dehdashti F, White B, Dahlbom M, Lee P, Low D. Comparison of 4D-PET Gating Methods with Regards to Determining Internal Target Volumes of Mobile Lung Tumors. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1436] [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: 11/16/2022]
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White B, Lamb J, Zhao T, Jani S, Low D. Distribution of Tissue Divergence in the Apex of the Lung. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1201] [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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Jani S. TU-C-301-01: Going Paperless in a Radiation Oncology Clinic. Med Phys 2011. [DOI: 10.1118/1.3613160] [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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White B, Zhao T, Jani S, Lamb J, Bradley J, Low D. SU-E-T-511: Distribution of Hysteresis Magnitude during Free Breathing. Med Phys 2011. [DOI: 10.1118/1.3612464] [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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Jani S, Lamb J, Robinson C, Laforest R, Dehdashti F, Bradley J, White B, Low D. SU-C-110-03: Utility of Maximum Intensity Projections of Gated PET Images in Determining Internal Target Volumes of Moving Lung Tumors: A Phantom Study. Med Phys 2011. [DOI: 10.1118/1.3611487] [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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Shah N, Sinha U, Jani S. SU-GG-T-321: Effect of Uneven Surface of Incidence on Dose Distribution for Electron Beams during Radiotherapy. Med Phys 2010. [DOI: 10.1118/1.3468717] [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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Jani S, Glazebrook S, Volpp B, Weinstein G. SU-GG-J-17: Technical Aspects of a Simple and Effective Method to Perform Stereotactic Body Radiation Therapy (SBRT) in Lung Cancer Patients without 4D-Ct and Gating. Med Phys 2010. [DOI: 10.1118/1.3468240] [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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Jani S, Shah N. SU-GG-T-361: Feasibility of Making In-Vivo Peripheral Dose Measurements Using a Portable Dosimeter System - Beta Testing of a Novel Device. Med Phys 2010. [DOI: 10.1118/1.3468758] [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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Abstract
This study was undertaken to investigate the effect of crosslinking ultra-high molecular weight polyethylene (UHMWPE) in a sequential manner to the final desired dose and to compare the results to single-dose crosslinking. To verify these results, an explanted, commercially available, sequentially crosslinked component was characterized. Finally, additional tensile testing was conducted to determine if tensile-sample thickness has a significant effect on the mechanical properties of UHMWPE. Based upon this well-controlled study with the same starting material, there is no apparent benefit of sequential crosslinking over crosslinking by single dose in any of the mechanical, thermophysical, physical, or oxidative properties evaluated in this study. In contrast, the soak temperature of the postirradiation heat treatment was more influential and exhibited statistically significant effects on the stability, structure, and properties of the resultant material. Compared to virgin material, crosslinking always resulted in decreases in tensile strength, elongation, and impact strength. These results were confirmed by characterization of a retrieved, sequentially crosslinked (X3) cup. All of the metrics derived for the retrieved cup were virtually identical to the sequential- and single-dose-crosslinked materials produced in this study. Examination of the effect of tensile-sample thickness demonstrated that there are significant effects on the resultant properties. In particular, the ultimate tensile strength of UHMWPE can be elevated by conducting tensile tests with thin specimens.
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Affiliation(s)
- M L Morrison
- Smith and Nephew Orthopaedics, Memphis, Tennessee 38116, USA.
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Malinowski KT, Noel C, Roy M, Willoughby T, Djemi T, Jani S, Solberg T, Liu D, Levine L, Parikh PJ. Efficient use of continuous, real-time prostate localization. Phys Med Biol 2008; 53:4959-70. [DOI: 10.1088/0031-9155/53/18/007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Malinowski K, Parikh P, Noel C, Roy M, Willoughby T, Djemil T, Jani S, Solberg T, Liu D, Levine L. Efficient use of a Real-time Wireless Electromagnetic Tracking System in the Prostate During External Beam Radiation Therapy. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1393] [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: 10/22/2022]
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Litzenberg D, Willoughby T, Kupelian P, Djemil T, Mahadevan A, Jani S, Weinstein G, Solberg T, Enke C, Levine L. Prostate Margins for Real-Time Monitoring and Correction Strategies. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.2037] [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: 10/22/2022]
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Weinstein G, Jani S, Li K, Jani S, Pothilat J, Glazebrook S, Lee S. In Vivo Comparison of Marker-Based Localization of Prostate With Conventional Anatomical Match Using Stereoscopic kVp X-rays During External Beam Radiotherapy. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1451] [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: 10/22/2022]
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Kupelian P, Willoughby T, Mahadevan A, Djemil T, Weinstein G, Jani S, Enke C, Solberg T, Flores N, Liu D, Beyer D, Levine L. Multi-institutional clinical experience with the Calypso System in localization and continuous, real-time monitoring of the prostate gland during external radiotherapy. Int J Radiat Oncol Biol Phys 2007; 67:1088-98. [PMID: 17187940 DOI: 10.1016/j.ijrobp.2006.10.026] [Citation(s) in RCA: 344] [Impact Index Per Article: 20.2] [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: 09/15/2006] [Accepted: 10/15/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the clinical experience with an electromagnetic treatment target positioning and continuous monitoring system in patients with localized prostate cancer receiving external beam radiotherapy. METHODS AND MATERIALS The Calypso System is a target positioning device that continuously monitors the location of three implanted electromagnetic transponders at a rate of 10 Hz. The system was used at five centers to position 41 patients over a full course of therapy. Electromagnetic positioning was compared to setup using skin marks and to stereoscopic X-ray localization of the transponders. Continuous monitoring was performed in 35 patients. RESULTS The difference between skin mark vs. the Calypso System alignment was found to be >5 mm in vector length in more than 75% of fractions. Comparisons between the Calypso System and X-ray localization showed good agreement. Qualitatively, the continuous motion was unpredictable and varied from persistent drift to transient rapid movements. Displacements > or =3 and > or =5 mm for cumulative durations of at least 30 s were observed during 41% and 15% of sessions. In individual patients, the number of fractions with displacements > or =3 mm ranged from 3% to 87%; whereas the number of fractions with displacements > or =5 mm ranged from 0% to 56%. CONCLUSION The Calypso System is a clinically efficient and objective localization method for positioning prostate patients undergoing radiotherapy. Initial treatment setup can be performed rapidly, accurately, and objectively before radiation delivery. The extent and frequency of prostate motion during radiotherapy delivery can be easily monitored and used for motion management.
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Willoughby T, Meeks S, Vertatschitsch E, Dimmer S, Riley J, Flynn J, Solberg T, Liu N, Djemil T, Jani S. MO-D-ValB-05: Commissioning An AC Electromagnetic Localization System for Radiation Therapy. Med Phys 2006. [DOI: 10.1118/1.2241419] [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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Price MJ, Moses JW, Leon MB, Mehran R, Negoita M, Lansky A, Collins M, Giap H, Lin R, Jani S, Steuterman S, Balter S, Dalton J, Lipsztein R, Tripuraneni P, Teirstein PS. A multicenter, randomized, dose-finding study of gamma intracoronary radiation therapy to inhibit recurrent restenosis after stenting. J Invasive Cardiol 2006; 18:169-73. [PMID: 16732060] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES The objective of this double-blind, randomized study was to determine the safety and efficacy of intracoronary radiation therapy (ICRT) with a dose of 17 Gray (Gy) compared to the currently recommended dose prescription of 14 Gy for the treatment of in-stent restenosis within bare metal stents. BACKGROUND While gamma ICRT for in-stent restenosis has been proven efficacious, the optimal dose is unknown, and radiation failure due to recurrent neointimal hyperplasia remains a significant clinical problem for some patients. A higher radiation dose may improve outcomes, but may potentially increase adverse events. METHODS Following coronary intervention, 336 patients with in-stent restenosis were randomly assigned to receive ICRT with either 14 Gy or 17 Gy at 2 mm from an 192-iridium source. RESULTS At 8-month follow up, fewer patients in the 17 Gy group underwent target lesion revascularization (TLR = 15.2% versus 27.2%; p = 0.01), target vessel revascularization (21.3% versus 33.1%; p = 0.02), or reached the composite endpoint of death, myocardial infarction, thrombosis, or TLR (17.1% versus 28.4%; p = 0.02). There were no differences in late thrombosis or mortality between treatment groups. There was a strong trend toward reduced in-lesion late loss (0.36 +/- 0.63 mm vs. 0.51 +/- 0.64 mm; p = 0.09) and a significantly lower rate of binary restenosis (23.9% versus 38.1%; p = 0.031) in the high dose group. CONCLUSIONS Gamma ICRT with 17 Gy is safe and, compared to 14 Gy, reduces recurrent stenosis and clinical events at 8-month follow up. An increase in the currently recommended gamma radiation dose prescription from 14 Gy to 17 Gy should be strongly considered.
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Affiliation(s)
- Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA
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Abstract
Three types of ultrahigh molecular weight polyethylene (UHMWPE) acetabular liners were tested against cobalt-chrome (CoCr) femoral heads on a hip simulator to approximately 20 million cycles. The materials included (1) conventional, nonirradiated liners (C-PE); (2) 5 Mrad gamma-irradiated, remelted, and artificially aged liners (5-XPE); and (3) 10 Mrad gamma-irradiated, remelted, and artificially aged liners (10-XPE). Wear was quantified by gravimetric analysis and wear particle characterization. Particle number and morphology were quantified by scanning electron microscopy (SEM) and compared between groups. Atomic force microscopy (AFM) was used to measure particle height in an effort to improve the total wear volume estimation. The wear debris, as characterized by SEM, was predominantly submicron and round, with occasional fibrils documented in the C-PE material. AFM analysis showed that particle height was approximately one-third of the particle equivalent circular diameter for all three materials. This correlation was used to improve the estimation of volumetric wear rate through SEM particle analysis. This technique is particularly useful for high-dose crosslinked UHMWPE, such as 10-XPE, which show weight gain due to fluid absorption during wear testing. This study has shown that particle analysis provides additional particle morphology and quantity information that cannot be obtained through gravimetric analysis.
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Affiliation(s)
- M Scott
- Smith and Nephew, Inc., 1450 Brooks Rd., Memphis, Tennessee 38116, USA.
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Teirstein PS, Moses J, Leon M, Collins M, Mehran R, Aymong E, Neogota M, Giap H, Jani S, Balter S, Dalton J, Lipsztein R, Sawhney N, Tripuraneni P. 1121-58 A double-blind randomized dose finding study of gamma radiation for in-stent restenosis. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90329-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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