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
Recorded by Michael Rambaud, CMD
MD Anderson Proton Therapy Center
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
Presented by Lee Culp, MS, CMD, RT(T)
Dosimetrist
The Ohio State University Stephanie Spielman Comprehensive Breast Center
From the AAMD 43rd Annual Meeting
Presented by Margaret Straub, MS, PAC
Physician Assistant in Radiation Oncology
University of Wisconsin Hospital and Clinics
From the AAMD 43rd Annual Meeting
Presented by Christopher J. Moore, BS, CMD
Chief of Medical Dosimetry
MD Anderson at Cooper Cancer Center
From the AAMD 43rd Annual Meeting
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.
The purpose of this study was to characterize the effects of the normal tissue objective (NTO) on lung stereotactic body radiation therapy (SBRT) dose distributions. The NTO is a spatially varying constraint used in Eclipse to limit dose to normal tissues by steepening the dose gradient. However, the multitude of potential NTO setting combinations challenges optimal NTO tuning. In the present study, a broad range of NTO settings are investigated for lung SBRT treatment planning with volumetric modulated arc therapy(VMAT). Ten prior lung SBRT cases were replanned using NTO priorities of 1, 50, 100, 200, 500, and 999 in combination with fall-off values of 0.01, 0.05, 0.10, 0.15, 0.20, 0.30, 0.50, 1.00, and 5.00 mm−1 and the automatic NTO. NTO distances to planning target volume (PTV), start dose, and end dose were 1 mm, 100%, and 10%, respectively, for all 600 plans. Prescription dose covered 95% of the PTV. The following metrics were recorded: conformity index (CI), ratio of the 50% prescription isodose volume to PTV (R50%), maximum dose 2 cm away from PTV (D2cm), lung volume of ≥20 Gy (V20Gy), maximum PTV dose (PTVmax), and monitor units (MUs). Differences between prior plans and NTO plans were evaluated using the Wilcoxon signed-rank test. Different combinations of NTO settings resulted in wide-ranging plan quality metrics: CI (1.00 to 1.54), R50% (3.95 to 7.57), D2cm (33.4% to 67.9%), V20Gy (1.66% to 2.75%), MU (1.81 cGy−1 to 4.69 cGy−1), and PTVmax (118% to 175%). Although no settings were optimal for all metrics, a fall-off of 0.15mm−1 and a priority of 500 best satisfied institutional criteria. Compared with prior plans, NTO plans resulted in significantly lower R50% (4.00 vs 4.35, p = 0.002), lower V20Gy (1.22% vs 1.32%, p = 0.006), and higher PTVmax (138% vs 122%, p = 0.002). All of the prior and well-tuned NTO plans met Radiation Therapy Oncology Group (RTOG) 0813 guidelines. Lung SBRT dose distributions were characterized across a range of NTO settings. NTO plans with well-tuned settings compared favorably with prior plans.
Radiation therapy for limb-extremity soft tissue sarcoma (STS) requires accurate, reproducible dose delivery. However, patient positioning is challenging and there is a lack of existing guidelines to assist institutional standardization. Therefore, we conducted a multi-institutional international survey of STS immobilization, image guidance methods, and treatment protocols to investigate current practice. Seventy-three UK radiotherapy centers and 15 hospitals in 7 other countries completed a questionnaire on STS immobilization and image-guidance procedures. Specifically, the survey collated information on the current usage of immobilization equipment, including custom devices, patient setup tolerances, the use of written protocols, the modality and frequency of image guidance, the method of treatment, allocated treatment times, and the application of surgical clips. Multiple combinations of immobilization devices were reported. In the UK, 12%, 40%, 30%, 12%, and 5% use 1, 2, 3, 4, and 5 types of device for lower limb STS. Vacuum bag plus either foot or ankle support was most common (66%). Of 15 international centers, 27%, 60%, 7%, 0%, 7% use 1, 2, 3, 4, 5 devices, with vacuum bags (73%) and thermoplastic (47%) predominant, similar to UK values of 77% and 52%. For image guidance, in the UK, 37% use kV planar, 34% use MV planar, and 16% use cone-beam CT for the first 3 fractions and then weekly. Internationally, daily imaging was more prevalent with 33% using kV planar, 7% MV planar, and 40% cone-beam CT daily. Custom devices plus combinations of devices, along with 5- and 10-mm set-up tolerances, were most commonly reported. Less than half of centers have written treatment protocols. Conventional treatment is most common in the UK, with only 42% using conformal techniques. Treatment is allocated between 10 and 30 minutes. Twenty-six percent of UK centers and 53% of international centers use surgical clips. Across treatment centers, there is no consistent approach to STS immobilization, image-guidance methods, or treatment protocols assessed by this survey. A wide variety of immobilization devices and configurations are utilized, and the frequency and modality of imaging are similarly diverse. In the absence of guidelines, the creation of an online repository of example immobilization techniques could enable centers to compare a diversity of cases. The availability of a forum for viewing and discussing a range of cases could potentially lead to improved patient setup and reduce the time taken to devise an individual immobilization strategy.
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.
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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:
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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.
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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.
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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).
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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).
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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 Hypothalamus (Pediatric).
AAMD Member Prices:
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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 Hippocampus (Pediatric).
AAMD Member Prices:
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Yearly subscription price $360 (13 structures)
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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
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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 Duodenum
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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 Len.
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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 Larynx
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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 Gland.
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It may be free to add this activity to your library 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 Hippocampus.
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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 Eye.
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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.
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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 Lacrimal Gland.
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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 Large Bowel.
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While it may be free to add this activity to your library 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 Sigmoid.
AAMD Member Prices:
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While it may be free to add this activity to your library 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 Rectum.
AAMD Member Prices:
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While it may be free to add this activity to your library 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 Optic Nerve.
AAMD Member Prices:
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While it may be free to add this activity to your library 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 Optic Chiasm.
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It may be free to add this activity to your library 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 Submandibular Gland.
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It may be free to add this activity to your library 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 Right Parotid.
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It may be free to add this activity to your library 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 Brainstem.
AAMD Member Prices:
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Yearly Memberships price $360 (13 structures)
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While it may be free to add this activity to your library 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 Brachial Plexus.
AAMD Member Prices:
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