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Presented by
Maria P. Dimopoulos, MBA, RT(T)
Program Director
Mount Sinai Center for Radiation Therapy Education at Stony Brook University
Recorded November 11, 2019
Presented by
Pamela Castillo, BS, CMD
Medical Dosimetrist
MD Anderson Cancer Center
Angela Sobremonte, BS, CMD
Medical Dosimetrist
MD Anderson Cancer Center
Presented by Daniel W Bailey, PhD, DABR
Medical Physicist
Northside Hospital Cancer Institute
Recorded August 12, 2019
Presented by: Jonathan Rogers, MS, DABR
Chief Medical Physicist
Rock Hill and Lancaster Radiation Therapy Clinics
Recorded June 1, 2019
Presented by Grace Ungchusri, BS, RT(T)(MR)
Radiation Therapist
MD Anderson Cancer Center
Recorded June 3, 2019
Presented by Krista Kelsey, DVM, DACVR (RO)
Veterinarian
Carolina Veterinary Specialists
Recorded March 28, 2019
Presented by Gregory K. Bartlett, CMD
Certified Medical Dosimetrist
Indiana University Health
Recorded November 11, 2019
From the AAMD 44th Annual Meeting
Presented by Sanjeel S. Patel, CMD, RT(T)
Certified Medical Dosimetrist
Arizona Center for Cancer Care
Recorded November 5, 2019
From the AAMD 44th Annual Meeting
Presented by Lia M. Halasz, MD
Radiation Oncologist and Associate Professor
University of Washington Medical Center and University of Washington
Recorded October 18, 2019
From the AAMD 44th Annual Meeting
Presented by Mitchell Kamrava, MD
Director of Brachytherapy Services
Cedars Sinai Medical Center
Recorded November 8, 2019
From the AAMD 44th Annual Meeting
Presented by Adam Buell, BS, CMD, RT(T)
Medical Dosimetrist
Memorial Sloan Kettering Cancer Center
Recorded October 20, 2019
From the AAMD 44th Annual Meeting
Presented by Ashley Coffey, CMD
Medical Dosimetrist
Johns Hopkins
Recorded October 24, 2019
From the AAMD 44th Annual Meeting
Presented by Ryan M. Clark, MS, CMD
Certified Medical Dosimetrist
Radiation Therapy Center of Morris Hospital in Morris
Recorded October 8, 2019
From the AAMD 44th Annual Meeting
Presented by Jeffrey Antone, CMD
Chief Dosimetrist
Center for Advanced Medicine
Recorded September 17, 2019
From the AAMD 44th Annual Meeting
Presented by Mark Gooding, DPhil
Chief Scientist
Mirada Medical Ltd
Recorded June 19, 2019
From the AAMD 43rd Annual Meeting
Presented by Douglas McDaniel, DACM, Dipl. Ac., (NCCAOM), L.Ac
Assistant Professor of Oncology and Integrative Medicine Program Manager
Roswell Park Comprehensive Cancer Center
Recorded June 25, 2019
From the AAMD Spring 2019 Regional Meeting
Authors: Yingjie Xu, M.Sc., Jingbo Wang, M.D., Zhihui Hu, M.Sc., Yuan Tian, Ph.D., Pan Ma, Ph.D., Shuai Li, M.D., Jianrong Dai, Ph.D., and Shulian Wang, M.D.
The present study aimed to compare 4 techniques in the planning of locoregional irradiation including internal mammary nodal region for left-sided breast cancer. Ten patients with left-sided breast cancer undergoing breast conservation surgery were enrolled. For each patient, 4 treatment plans were performed: a helical tomotherapy (HT) plan, a volumetric modulated arc therapy (VMAT) plan, a static intensity modulated radiation therapy (IMRT) plan, and a hybrid IMRT plan, designed to encompass the whole breast, internal mammary, and supraclavicular nodal regions. The prescribed dose of radiation was 50 Gy in 25 fractions. The dosimetric parameters of the target and organs at risk, as well as the dose delivery time, were evaluated and compared using an independent-samples t-test. The HT and VMAT plans had the best conformity and homogeneity. For the HT, VMAT, IMRT, and hybrid IMRT plans, the mean conformity index (CI) and homogeneity index (HI) were 0.83, 0.82, 0.8, and 0.77 ( p < 0.001); and 1.07, 1.11, 1.14, and 1.14 ( p < 0.001), respectively. The corresponding V 55 values were 0.3%, 11.4%, 27.02%, and 23.29% ( p < 0.001). The D mean and V 20 of the left lung obtained using the HT plan were significantly lower than those of VMAT, IMRT, and hybrid IMRT plans ( p = 0.002, p = 0.004). There were no significant differences in D max of LAD descending coronary artery, or the D mean of the heart among the 4 types of plans. The HT and VMAT plans had a lower dose to other organ at risk (OARs) compared with the IMRT and hybrid IMRT plans. The mean delivery times were 1042 ±33 seconds, 136 ±12 seconds, 450 ±65 seconds, and 451 ±70 seconds for the HT, VMAT, IMRT, and hybrid IMRT plans, respectively ( p < 0.001). For whole breast plus supraclavicular and internal mammary nodal irradiation in left-sided breast cancer, the VMAT technique is recommended considering both the dose distribution and the delivery time. Under circumstances in which dose distribution is a priority, the HT technique is a valid option.
Authors: James Rijken, M.Phil, Tanya Kairn, Ph.D, Scott Crowe, Ph.D, and Jamie Trapp, Ph.D.
Due to large doses per fraction, stereotactic ablative radiotherapy of lung or spine can lead to skin tissue toxicity, the amount of which depends on a variety of factors such as target location, beam geometry, and immobilization. The effect of arc length on spreading out entrance and exit doses and the corresponding predictions of skin reactions has not yet been studied for stereotactic body radiotherapy volumetric mod- ulated arc therapy (VMAT) treatments. 58 clinically relevant VMAT stereotactic body radiotherapy spine and lung plans were created for an anthropomorphic phantom utilizing a range of target locations, beam geometries and arc lengths. Skin dose was assessed by considering the National Cancer Institute skin re- action grades adjusted for 3 fraction treatments. While the skin volumes predicted to exhibit low grade reactions decreased with arc length, high grade reactions were found to increase at smaller arcs as well as at full arcs where a superposition of entrance and exit doses would occur. It is possible for skin dose to be effectively optimized by choice of arc length (within clinically relevant boundaries) and thus mini- mize the skin reaction. High skin doses are often attributed to effects arising from the distance between the planning target volume and patient surface but this study has demonstrated that VMAT arc length is of equal importance. Understanding this relationship will assist in minimizing skin reactions through modification of plan parameters and will provide clinicians more information for patient selection.
Authors: Victoria S. Brennan, M.B., B.Ch., B.A.O. Hons., F.F.R., R.C.S.I., Brendan Curran, BSc. Horns, Christina Skourou, PhD., Emma McVeigh, BSc. Horns., Mary Dunne, MSc., Lydia O’Sullivan, BSc. Horns., Brian D.P. O’Neill, MB., F.R.C.P.I., F.F.R.R.C.S.I.
Preoperative radiotherapy or combined chemoradiotherapy for locally advanced rectal cancer (LARC) can cause acute and late gastrointestinal (GI) side-effects. There is thought to be a dose-volume relationship between small bowel irradiation and the development of these effects. A planning study was undertaken to compare small bowel sparing for a range of 3D conformal and dynamic arc planning solutions. A planning study was carried out for 20 LARC patients. Organs at risk (OAR) contoured included bowel loops and peritoneal space (PS). For each of the 20 patients, 5 plans were created: (1) standard 3D conformal plan; (2) standard dual dynamic arc plan; (3) dual dynamic arc plan with 90 °avoidance sector through the anterior portion of the patient; (4) dual dynamic arc plan with an anterior avoidance structure in the optimizer; (5) dual dynamic arc plan with both an anterior avoidance structure and an avoidance sector. The prescription was 50.4 Gy in 28 fractions to the planning target volume (PTV). Five Dose Volume Levels (DVLs; V 15 Gy, V 20 Gy, V 25 Gy, V 35 Gy, V 40 Gy, and V 50.4 Gy ) for bowel and PS were selected. The DVLs were compared between the plans using Friedman Tests and Wilcoxon Signed Rank Tests. Comparison of the 5 plans revealed that a dual dynamic arc plan containing both an anterior avoidance sector and structure significantly improved the dose to the bowel compared to a standard 3D conformal plan and to a standard dual dynamic arc plan. This improvement was achieved while maintaining PTV coverage. This novel dual dynamic arc planning technique that uses both an avoidance sector and structure reduces the dose to the bowel and PS, which may lead to a reduction in GI toxicity.
Authors: Ugur Akbas, Med. Phys, Canan Koksal, Med. Phys, Nazmiye Donmez Kesen, Med. Phys, Kubra Ozkaya, MD, Hatice Bilge, Med. Phys, Musa Altun, MD
The aim of the study was to investigate the effect of the Hybrid technique which was created by combining of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for the treatment of nasopharyngeal cancer (NPC) patients. 7 to 9 field IMRT, triple arc VMAT, and Hybrid plans were generated for 10 advanced stage NPC patients. The homogeneity index (HI) and the conformity index (CI) of planning target volumes (PTVs) were calculated for each technique to evaluate the plan quality. The techniques were compared in terms of plan quality, sparing of organs at risk (OARs), monitor units (MUs), and delivery time. Hybrid technique significantly improved the target dose homogeneity and the conformity for PT V70 and PT V60 compared to IMRT and VMAT. Hybrid plans significantly reduced the maximum dose of the brainstem sparing compared to the VMAT plans and also improved the sparing of spinal cord compared to IMRT and VMAT. The MUs and the delivery time of Hybrid plans were found to be between values for IMRT and VMAT plans. Hybrid technique can be useful when IMRT and VMAT techniques are not adequate alone in the treatment of NPC patients.
Locally advanced breast cancer patients with expander or implant reconstructions who require comprehensive postmastectomy radiotherapy (PMRT) can pose unique treatment planning challenges. Traditional 3D conformal radiation techniques often result in large dose inhomogeneity throughout the treatment volumes, inadequate target coverage, or excessive normal tissue doses. We have developed a volumetric modulated arc therapy (VMAT) planning technique without entering through the ipsilateral arm that produced adequate target volume coverage, excellent homogeneity throughout the target volume, and acceptable doses to the normal structures. Twenty left-sided and 10 right-sided patients with either ipsilateral or bilateral permanent implants or tissue expanders who received comprehensive PMRT between October 2014 and February 2016 were included in this study. Ten left-sided cases used deep inspiration breath hold (DIBH) technique, and others used free breathing (FB). Planning target volume (PTV) included chest wall, internal mammary nodes (IMNs), supraclavicular, and axillary lymph nodes. A VMAT plan using 4 or 5 partial arcs with 6 MV photon beam avoiding entering through the ipsilateral arm was generated for each patient. Prescription dose was 50 Gy in 25 fractions. PTV coverage, maximum depth of IMNs, dose homogeneity and dose to the heart, lungs, thyroid, contralateral intact breast or implant, liver, stomach, left anterior descending artery, ipsilateral brachial plexus, esophagus, spinal cord, and total MU were evaluated. PTV D95% (Gy) was 49.6 ±0.9, 48.7 ±0.9, and 49.5 ±1.1; PTV D05% (Gy) was 55.7 ±0.6, 55.1 ±1.4, and 55.0 ±0.7; maximum depth of IMNs (cm) was 4.3 ±0.9, 4.6 ±1.1, and 4.9 ±2.3; ipsilateral lung, V20Gy (%) was 29.0 ±2.1, 28.8 ±2.5, and 27.5 ±3.4; heart mean dose (Gy) was 4.2 ±0.4, 7.5 ±1.1, and 6.6 ±0.8 for right-sided FB, left-sided FB, and left-sided DIBH cases, respectively. D95% of IMNs all received 100% prescription dose. The maximum dose (Gy) to the left anterior descending artery was 33.8 ±11.7 for left-sided FB and 31.4 ±7.3 for left-sided DIBH. VMAT technique avoiding ipsilateral arm can produce acceptable clinical plans for locally advanced breast cancer patients with expander or implant reconstructions receiving comprehensive PMRT.
We aimed to analyze risk factors for incidents occurring during the practice of external beam radiotherapy (EBRT) at a single Japanese center. Treatment data for EBRT from June 2014 to March 2017 were collected. Data from incident reports submitted during this period were reviewed. Near-miss cases were not included. Risk factors for incidents, including patient characteristics and treatment-related factors, were explored using uni- and multivariate analyses. Factors contributing to each incident were also retrospectively categorized according to the recommendations of the American Association of Physicists in Medicine (AAPM). A total of 2887 patients were treated during the study period, and 26 incidents occurred (0.90% per patient). Previous history of radiotherapy and large fraction size were identified as risk factors for incidents by univariate analysis. Only previous history of radiotherapy was detected as a risk factor in multivariate analysis. Identified categories of contributing factors were human behavior (50.0%), communication (40.6%), and technical (9.4%). The incident rate of EBRT was 0.90% per patient in our institution. Previous history of radiotherapy and large fraction size were detected as risk factors for incidents. Human behavior and communication errors were identified as contributing factors for most incidents.
Our study aimed to correlate the overall 3-dimensional (3-D) shape of the breast to the compensation depth to produce a homogeneous dose distribution using the electronic tissue compensation (ECOMP) treatment technique. The study involved creating a number of semioval water phantoms with the diameter of the larger axis representing the breast separation and the shorter axis representing the distance from the chest wall to the apex of the breast. Multiple plans with 2 tangential fields were created for each phantom using different transmission penetration depths (TPDs) to determine the optimum TPD value based on the evaluation of dose uniformity and maximum hot spot. Optimum TPD values from the semioval water phantom plans were plotted on a graph as a function of separation and radius and were used as guidelines to choose the optimum TPD for the breast patient’s cases. A total of 10 patients who had been treated with radiation therapy using ECOMP tangential fields were randomly selected. The separation and the radius of the breast were measured for 3 regions (superior, middle, and inferior) to retrospectively determine the optimum TPD from the graph for each region. These TPD values were then used to plan the breast cases. For all the patients studied, the optimized TPD technique produced a lower average homogeneity index (HI) value of 0.658 than the standard ECOMP technique of 0.856. These results showed that optimized TPD technique produced a more homogeneous dose distribution than the standard ECOMP technique. By measuring the breast size based on breast separation and the chest wall- to-apex distance at different locations along the superior-inferior axis of the breast, the optimum TPD can be determined at each location to provide a homogeneous dose distribution. A module can be created within the planning system to automatically assign the optimum TPD for both tangential fields so uniform fluence maps can be achieved throughout the whole breast volume. This method can serve as a guideline in ECOMP during the treatment planning to obtain a homogeneous dose distribution.
It is free to add this activity to your AAMD library, however, there are Member and Non-Member prices and payment will need to be made on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Rectum - Male Pelvis Series.
AAMD Member Prices:
Yearly Memberships price $306 (13 structures)
Monthly Memberships price $25.50 (Access to 1 structure token per month)
Non-Member Prices:
Yearly Memberships price $360 (13 structures)
Monthly Memberships price $30.00 (Access to 1 structure token per month)
It is free to add this activity to your AAMD library, however, there are Member and Non-Member prices and payment will need to be made on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Penile Bulb - Male Pelvis Series.
AAMD Member Prices:
Yearly Memberships price $306 (13 structures)
Monthly Memberships price $25.50 (Access to 1 structure token per month)
Non-Member Prices:
Yearly Memberships price $360 (13 structures)
Monthly Memberships price $30.00 (Access to 1 structure token per month)
It is free to add this activity to your AAMD library, however, there are Member and Non-Member prices and payment that have to be paid on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Seminal Vesicles - Male Pelvis Series.
AAMD Member Prices:
Yearly Memberships price $306 (13 structures)
Monthly Memberships price $25.50 (Access to 1 structure token per month)
Non-Member Prices:
Yearly Memberships price $360 (13 structures)
Monthly Memberships price $30.00 (Access to 1 structure token per month)
It is free to add this activity to your AAMD library, however, there are Member and Non-Member prices and payment that have to be paid on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Prostate - Male Pelvis Series.
AAMD Member Prices:
Yearly Memberships price $306 (13 structures)
Monthly Memberships price $25.50 (Access to 1 structure token per month)
Non-Member Prices:
Yearly Memberships price $360 (13 structures)
Monthly Memberships price $30.00 (Access to 1 structure token per month)
It is free to add this activity to your AAMD library, however, there are Member and Non-Member prices and payment that have to be paid on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Pituitary (Pediatric).
AAMD Member Prices:
Yearly Memberships price $306 (13 structures)
Monthly Memberships price $25.50 (Access to 1 structure token per month)
Non-Member Prices:
Yearly Memberships price $360 (13 structures)
Monthly Memberships price $30.00 (Access to 1 structure token per month)
It is free to add this activity to your AAMD library, however, there are Member and Non-Member prices and payment that have to be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Cochlea (Pediatric).
AAMD Member Prices:
Yearly Memberships price $306 (13 structures)
Monthly Memberships price $25.50 (Access to 1 structure token per month)
Non-Member Prices:
Yearly Memberships price $360 (13 structures)
Monthly Memberships price $30.00 (Access to 1 structure token per month)
It is free to add this activity to your library, however there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Small Bowel
AAMD Member Prices:
Yearly Memberships price $306 (13 structures)
Monthly Memberships price $25.50 (Access to 1 structure token per month)
Non-Member Prices:
Yearly Memberships price $360 (13 structures)
Monthly Memberships price $30.00 (Access to 1 structure token per month)