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Single Iso Multi Met Brain Treatment: The Love Child of Whole Brain & SRS

Course Details

MDCB Credits: 1.00

ARRT Credits: 1.00

Available Until: 10/31/2022

Non-Member Price: $35.00

Member Price: $20.00

Member PLUS Price: $20.00

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Presented by Lexie Smith-Raymond, MAdm, CMD, RT(R)(T)
Banner University Medical Center Tucson
Regional Radiation Oncology Director
Angela Locke, BS, CMD, RT(T)
Banner University Medical Center Tucson
Medical Dosimetrist

From the AAMD Virtual 46th Annual Meeting
June 6 -10, 2021

NOTE: If you earned CE Credits for this session during the AAMD Virtual 46thAnnual Meeting, you will not be eligible to earn CE Credits for it again.

Originally patients diagnosed with diffuse brain met had one option; WBRT. This was an open field, a tipped collimator and a hand block. Cerrobend blocking allowed us to shield the eye, nasal passages and oral structures.  The introduction of MLCs made Cerrobend blocks obsolete but allowed the same avoidance capabilities. This made treatments more efficient and less labor-intensive. Planning advancements allowed us to modify MLC further to reduce hot spots or minimize side effects. IMRT was available but not widely used for WBRT until clinical trials focused on hippocampal sparing in the brain. At the same time, patients with localized, single metastatic lesions to the brain had limited treatment options such as linac-based cone SRS or Gamma Knife. As MLCs got smaller it opened the option of DCA SRS. As cancer treatments have improved, patients are often returning for retreatment to the same area. Patients have the option to receive radiation to multiple lesions delivered with separate isocenters. This planning is tedious and showed large levels of heterogeneity upon summing the total of the treatments together. These treatments were time-consuming in terms of treatment machine utilization, chart/plan verification and lengthy and uncomfortable treatment times for the patient receiving them. These problems and further continued advances in treatment planning systems have allowed for the advent of single isocenter plans that can treat multiple metastatic lesions simultaneously with VMAT. This provides more normal brain sparing and conformality. Other benefits include staff/machine time utilization and providing a better experience for patients.   

Learner Outcomes:

  1. Recognize the historical advancement of whole-brain RT and SRS
  2. Identify areas of improvement with the current standard of care treatments 
  3. Identify areas of improved efficiency in planning of these difficult cases 
  4. Identify treatment planning techniques specific to Multi Met SRS

Educational Level: Intermediate

Lexie Smith-Raymond, MAdm, CMD, RT(R)(T), is the Director of Radiation Oncology Services at Banner University Medical Center in Tucson, Arizona where she manages a staff of five dosimetrists, 16 therapists and three medical physicists.  She has been a practicing dosimetrist since 1999 and was board certified in 2002 and is a JCERT certified Clinical Preceptor for dosimetry students.  Lexie collaborates with physicians frequently on research projects and has had her cooperative work published in several nationally recognized journals.  She has also been a presentation speaker at several national and/or regional AAMD conferences.

Angela Locke, BS, CMD, RT(T), is a Certified Medical Dosimetrist who has worked at Banner University Medical Center in Tucson, Arizona since 2006.  She has worked as a Therapist, a Lead Therapist and has been a part of the Dosimetry team since 2010, passing her board examination in 2012.  She also collaborates frequently with medical and physics staff on research projects and credentialing protocols.  She was the Lead Implementation Dosimetrist when RayStation was integrated into the clinic in July 2018 and continues to expand and refine workflow practices and is the departmental treatment planning subject matter expert.