In radiation therapy, unlike most other applications involving radiation, the intention is to deliver high doses of radiation to diseased tissue, constrained by the effects of radiation to healthy ...tissue. With regard to patient exposure, the radiation protection framework of justification, optimization, and limitation is a direct part of the prescription process of radiation therapy. Staff and public exposures are typically far below occupational maximum permissible exposures. However, a number of other issues arise in radiation therapy that fall into the category of radiation protection. After an historical review, this paper discusses several contemporary and emerging concerns within radiation therapy, including fetal dose, secondary malignancies, and dose to implantable devices, all of which involve accurate dose assessment outside the intended treatment volume. Other concerns include quality and safety, molecularly based disease assessment and treatment, and other novel treatment strategies. The paper ends with a discussion of the interplay between best practices and regulatory oversight.
While most Radiation Oncology clinics have adopted electronic charting in one form or another, no consensus document exists that provides guidelines for safe and effective use of the Radiation ...Oncology electronic medical records (RO‐EMR). Task Group 262 was formed to provide these guidelines as well as to provide recommendations to vendors for improving electronic charting functionality in future. Guidelines are provided in the following areas: Implementation and training for the RO‐EMR, acceptance testing and quality assurance (QA) of the RO‐EMR, use of the RO‐EMR as an information repository, use of the RO‐EMR as a workflow manager, electronic charting for brachytherapy and nonstandard treatments, and information technology (IT) considerations associated with the RO‐EMR. The report was based on a literature search by the task group, an extensive survey of task group members on their respective RO‐EMR practices, an AAPM membership survey on electronic charting, as well as group consensus.
Medical physics workforce in the United States Newhauser, Wayne D.; Gress, Dustin A.; Mills, Michael D. ...
Journal of applied clinical medical physics,
December 2022, Letnik:
23, Številka:
S1
Journal Article
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Incumbent within this responsibility is as follows: protection of the patient and others from potentially harmful or excessive radiation, establishment of adequate protocols to ensure accurate ...patient dosimetry, the measurement and characterization of radiation; determination of delivered dose, advancement of procedures necessary to ensure image quality; development and direction of quality assurance programs, assistance to other health-care professionals in optimizing the balance between the beneficial and deleterious effects of radiation, and compliance with applicable federal and state regulations. The typical pathway involves participation in a Commission on Accreditation of Medical Physics Education Programs (CAMPEP)-accredited education program (master of science or doctoral degrees, or a postdoctoral training certificate), followed by a 2-year medical physics residency training program. ...the AAPM and the Society of Directors of Academic Medical Physics Programs (SDAMPP) are expanding activities to promote and facilitate nonclinical career options. 7 3.1.3.1 Organizations involved in education Several professional societies play important roles in medical physics education. In light of the “complexity of interests and areas of potential overlap,” the AAPM, CAMPEP, ABR, and SDAMPP have articulated consensus guidelines to clarify their respective roles in medical physics education, with particular relevance to workforce supply. 8 3.1.3.2 Undergraduate education Currently, in the United States, medical physicists typically earn an undergraduate degree in physics, engineering, or other physical science, with several universities offering a BS in medical physics or a concentration in medical physics as an optional component of a traditional BS degree.
The American Society for Radiation Oncology (ASTRO) Physics Core Curriculum Subcommittee (PCCSC) has updated the recommended physics curriculum for radiation oncology resident education to improve ...consistency in teaching, intensity, and subject matter.
The ASTRO PCCSC is composed of physicists and physicians involved in radiation oncology residency education. The PCCSC updated existing sections within the curriculum, created new sections, and attempted to provide additional clinical context to the curricular material through creation of practical clinical experiences. Finally, we reviewed the American Board of Radiology (ABR) blueprint of examination topics for correlation with this curriculum.
The new curriculum represents 56 hours of resident physics didactic education, including a 4-hour initial orientation. The committee recommends completion of this curriculum at least twice to assure both timely presentation of material and re-emphasis after clinical experience. In addition, practical clinical physics and treatment planning modules were created as a supplement to the didactic training. Major changes to the curriculum include addition of Fundamental Physics, Stereotactic Radiosurgery/Stereotactic Body Radiation Therapy, and Safety and Incidents sections, and elimination of the Radiopharmaceutical Physics and Dosimetry and Hyperthermia sections. Simulation and Treatment Verification and optional Research and Development in Radiation Oncology sections were also added. A feedback loop was established with the ABR to help assure that the physics component of the ABR radiation oncology initial certification examination remains consistent with this curriculum.
The ASTRO physics core curriculum for radiation oncology residents has been updated in an effort to identify the most important physics topics for preparing residents for careers in radiation oncology, to reflect changes in technology and practice since the publication of previous recommended curricula, and to provide practical training modules in clinical radiation oncology physics and treatment planning. The PCCSC is committed to keeping the curriculum current and consistent with the ABR examination blueprint.
The team members were drawn from those professions that are chiefly responsible for the radiation protection of workers, patients, and the public: health physics, medical physics, medicine (including ...diagnostic radiology, interventional radiology, nuclear medicine, and radiation oncology), nuclear engineering, radiation biology, and radiochemistry and nuclear chemistry. Due to practical considerations, this selection was limited; nonetheless, the authors emphasize the importance of other worker cohorts, including technologists who work in medical radiation therapy and imaging, and radiation epidemiologists and ecologists, who draw on the basic sciences of physics, chemistry, mathematics, and biology and play a significant role in radiation protection. The factors underlying the observed workforce trends include shrinkage due to worker retirements without adequate replacements, a decline in the capacity of higher-education pipelines, the closure of many training programs, and an overall decline in employment opportunities in some fields, limiting the attractiveness of those fields as a prospective career choice for incoming workers.
Purpose:
To develop the first 4D robust optimization (RO) method accounting for respiratory motion and evaluate its potential to improve plan robustness and optimality compared to 3D RO and PTV‐based ...optimization.
Methods:
A set of 4D CT images are used to track respiratory motion and deformation of tumors and organs. For each of 10 respiration phases, dose distributions for nine different uncertainty scenarios including the nominal one, those incorporating ±5mm setup uncertainties long x, y and z directions and ±3.5% range uncertainties are calculated. All 90 dose distributions are simultaneously optimized to achieve full dose coverage of 10 CTVs and sparing of normal structures. ITV‐based 3D RO and PTV‐based optimization based on the average CT are also carried for the same patient using same dose volume constrains. After optimization, 4D robustness evaluation was performed for all resulting plans. The CTV coverage and the sparing of normal tissue in 10 phases are evaluated and compared among the three methods. The widths of DVH bands represent the robustness of dose distributions in the structures.
Results:
For one patient studied so far, the worst case CTV coverage by the prescription dose among all 90 scenarios is: 99% for 4D RO; 88.9% for 3D RO, and 85.2% for PTV based optimization. 4D RO also results in best robustness with the narrowest DVH’ bandwidths for the CTV. 4D and 3D RO have similar organ sparing while PTV based optimization results in worst organ sparing.
Conclusion:
4D robust optimization which accounts for anatomy motion and deformation in the optimization process, significantly improves plan robustness and achieves higher quality treatment plans for lung cancer patients. The method is being evaluated for multiple patients with different tumor and motion characteristics.
Summary and conclusions, and abbreviations and acronyms Newhauser, Wayne D.; Williams, Jacqueline P.; Noska, Michael A. ...
Journal of applied clinical medical physics,
December 2022, Letnik:
23, Številka:
S1
Journal Article
Recenzirano
Odprti dostop
Health physics: A shortage of health physicists would lead to a detrimental impact on multiple services, including the nation's ability to provide radiation environmental monitoring and remediation, ...engage in emergency responses, maintain radiation safety standards within military and radionuclide production facilities, as well as overseeing selected safety aspects of the diagnostic and therapeutic uses of radiation in medicine. ...shortages in the health physics workforce will have a direct impact on regulatory compliance, the nation's defense capabilities, and worker and general population safety. Medical physics: A shortage of medical physicists would affect those areas of health practice where their expertise is a requirement for patient throughput, likely leading to an increase in the time intervals between diagnosis and the initiation of radiation treatment (most commonly for cancer), reduced quality and safety of clinical procedures, delayed implementation of new technologies, increased labor costs, and so forth. ...a decline in the medical physics workforce would have a direct impact on medical practice and the nation's health. The educational needs of residents in some fields are already affected by the loss of trained radiobiology teachers. ...a shortage of radiobiologists would negatively affect the nation's defense capabilities, medical training, and practice. Shortages of workers within the radio- and nuclear chemistry workforces would affect multiple areas of national importance, including nuclear power generation, nuclear forensics, homeland defense, and medical applications. ...a shortage in the radio- and nuclear chemistry workforce will have a direct impact on the nation's defense capabilities, energy network, and medical practice. 8.3 PROFESSION-SPECIFIC CONCERNS REGARDING ADEQUACY OF THE WORKFORCE IN THE FUTURE The teams identified several profession-specific concerns regarding the future workforces, which are summarized here and detailed in Chapters 2 through 7.
There is a lack of prescriptive, practical information for those doing the work of commissioning high-dose-rate (HDR) gynecologic (GYN) treatment equipment. The purpose of this work is to develop a ...vendor-neutral, consensus-based, commissioning template to improve standardization of the commissioning process.
A series of commissioning procedures and tests specific to HDR GYN treatments were compiled within one institution. The list of procedures and tests was then sent to five external reviewers at clinics engaged in HDR GYN treatments. External reviewers were asked to (1) suggest deletions, additions, and improvements/modifications to descriptions, (2) link the procedures and tests to common, severe failure modes based on their effectiveness at mitigating those failure modes, and (3) rank the procedures and tests based on perceived level of importance.
External reviewers suggested the addition of 14 procedures and tests. The final template consists of 67 procedures and tests. "Treatment process" and "staff training" sections were identified as mitigating the highest number of commonly reported failure modes. The mean perceived importance for all procedures and tests was 4.4 of 5, and the mean for each section ranged from 3.6 to 4.8. Sections of the template that were identified as mitigating the highest number of commonly reported failure modes were not assigned the highest perceived importance.
The commissioning template developed here provides a standardized approach to process and equipment commissioning. The discord between perceived importance and mitigation of the highest number of failure modes suggests that increased focus should be placed on procedures and tests in "treatment process" and "staff training" sections.
Sexual function was evaluated in 34 patients with low‐risk prostate cancer (PSA ≤ 10, Gleason score ≤ 6, clinical stage T1/T2) undergoing brachytherapy in a phase III prospective randomized trial ...comparing iodine‐125 (125I) to palladium‐103 (103Pd). The mean and median International Index of Erectile Function (IIEF) scores for the entire group were 14.2 and 16.5, respectively, and there was no difference between these scores when stratified by isotope. IIEF scores < 6, 6 to 11, and ≥ 12 were recorded in 35% (12/34), 6% (2/34), and 59% (20/34) of patients, respectively. Hematospermia, orgasmalgia (pain at the time of orgasm), and alteration in intensity of orgasm were documented in 26% (9/34), 15% (5/34), and 38% (13/34) of patients, respectively, but these side effects were of limited duration for most patients. There was no relationship between radiation dose to the neurovascular bundles (NVB), which averaged 209% of the prescribed prostate dose, and the development of postbrachytherapy impotence. All four impotent patients who used sildenafil responded favorably. With a median follow‐up of 13 months, 65% of patients undergoing prostate brachytherapy maintained sexual function without pharmacologic support. Including sildenafil responses, 76.5% of patients sustained erections sufficient for sexual intercourse. 2001 Wiley‐Liss, Inc.
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