SU-GG-J-52: Inclusion of KV CBCT Dose in the Patient Treatment Plans and Evaluation of Dose to Normal Tissue and Critical Organs

Abstract Background: An estimated 25% of older adults with diabetes (DM) may have co-occurring Alzheimer’s Disease and Related Dementias (ADRD), complicated by multiple treatment plans and providers. Assessing treatment burden has been limited to patients’ perspectives; little is known about caregiver perceptions of treatment burden despite their important role in personal care and treatment adherence. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for older adults with DM-ADRD. Methods: This qualitative study was conducted in the formative phase of “Enhanced Quality in Primary care for Elders with DM-ADRD (EQUIPED-ADRD) a pragmatic randomized controlled trial in a large, diverse healthcare system. A diverse sample of caregivers (n=15) of patients enrolled in the RCT participated in interviews about their caregiver role and perceptions of treatment burden of DM-ADRD clinical management. Qualitative data were analyzed using content analysis and themes about treatment burden were compared to domains on the Treatment Burden Questionnaire (TBQ). Results: Caregivers reported high levels of burden related to treatment plans for patients with DM-ADRD. Themes related to complexity and burden of medication management, monitoring (e.g., blood pressure, glucose monitoring), dietary and physical activity regimens, navigating healthcare providers and financial burden were reported. Caregivers also described high levels of emotional burden that was associated with patient’s cognitive decline and family functioning stress. Conclusions: Interventions to reduce treatment burden for patients and caregiver should include activating social/nursing services, respite care and care coordination that may support caregivers especially as patient treatment increases in complexity over time.

Download Full-text

Evaluation of treatment plans using target and normal tissue DVHs is no longer appropriate

Medical Physics ◽

10.1118/1.4903902 ◽

2015 ◽

Vol 42 (5) ◽

pp. 2099-2102 ◽

Cited By ~ 4

Author(s):

Christopher F. Njeh ◽

Brent C. Parker ◽

Colin G. Orton

Keyword(s):

Normal Tissue ◽

Treatment Plans

Download Full-text

Assessing HIPAA Compliance of Open Source Electronic Health Record Applications

International Journal of Information Security and Privacy ◽

10.4018/ijisp.2021040109 ◽

2021 ◽

Vol 15 (2) ◽

pp. 181-195

Author(s):

Hossain Shahriar ◽

Hisham M. Haddad ◽

Maryam Farhadi

Keyword(s):

Electronic Health Record ◽

Open Source ◽

Medical Decision ◽

Patient Treatment ◽

Health Record ◽

Technical Requirements ◽

Patient Health ◽

Treatment Plans ◽

Electronic Health ◽

Quality In Healthcare

Electronic health record (EHR) applications are digital versions of paper-based patient health information. EHR applications are increasingly being adopted in many countries. They have resulted in improved quality in healthcare, convenient access to histories of patient medication and clinic visits, easier follow up of patient treatment plans, and precise medical decision-making process. The goal of this paper is to identify HIPAA technical requirements, evaluate two open source EHR applications (OpenEMR and OpenClinic) for security vulnerabilities using two open-source scanner tools (RIPS and PHP VulnHunter), and map the identified vulnerabilities to HIPAA technical requirements.

Download Full-text

Bony-based and prostate-based image guidance for lo-calized prostate cancer radiotherapy

Brazilian Journal of Radiation Sciences ◽

10.15392/bjrs.v8i1.1175 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Saulo Santos Fortes ◽

Luiz Antonio Ribeiro Da Rosa

Keyword(s):

Prostate Cancer ◽

Normal Tissue ◽

Bone Structure ◽

Absorbed Dose ◽

Target Volume ◽

Image Guided Radiotherapy ◽

Beam Modulation ◽

Significant Difference ◽

Treatment Volume ◽

Treatment Plans

An important modality for the treatment of prostate cancer is teletherapy. The use of image-guided radiotherapy (IGRT) is a valuable tool in this treatment. This study retrospectively compared how repositioning the patient based on bone structure (B-ISO) and the prostate itself (P-ISO) affected the volumetric dose in the rectum, bladder, and clinical treatment volume (CTV). Additionally, the probability of normal tissue complication (NTCP) for the rectum was computed. We evaluated 155 cone-beam computed tomography (CBCT) from 8 patients. The treatment plans used beam modulation techniques. The planning target volume (PTV) margin adopted in both scenarios was 1 cm. The organs of interest were outlined over each CBCT and then treatment plans were applied so that the absorbed dose could be computed. NTCP values were calculated for the rectum. Analyzing dose-volume metrics published by the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC), there was no significant difference between the two repositioning strategies for the rectum and bladder. There was a slight degradation in CTV coverage for the B-ISO strategy, but still with adequate coverage. Analysis of the uniform equivalent dose (EUD) and NTCP for the rectum showed little sensitivity to the strategy used. The present study showed that the use of CBCT in radiotherapy for prostate cancer treatment did not significantly improve volumetric doses for the rectum, bladder, and CTV, as well as NTCP for the rectum.

Download Full-text

Dosimetric and biological comparison of treatment plans between EDGE and CyberKnife systems in stereotactic body radiation therapy for localized prostate cancer

10.21203/rs.3.rs-42811/v1 ◽

2020 ◽

Author(s):

Zhitao Dai ◽

Lian Zhu ◽

Tingting Cao ◽

Aihua Wang ◽

Xueling Guo ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Normal Tissue ◽

Stereotactic Body Radiation Therapy ◽

Localized Prostate Cancer ◽

Conformity Index ◽

Delivery Time ◽

Plan Quality ◽

Dose Volume ◽

Treatment Plans

Abstract Aims: The aim of this study was to make a quantitative comparison of plan quality between MLC-based EDGE system and the cone-based CyberKnife system in stereotactic body radiation therapy (SBRT) for patients with localized prostate cancer.Materials and methods: Ten patients with prostate volumes ranging from 34.65 to 82.16 cc were used for prostate SBRT. Treatment plans were created for both EDGE and CyberKnife G4 systems using the same dose-volume constraints. Dosimetric indices including Planning Tumor Volume (PTV) coverage, conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI) were applied for target, while the sparing of critical organs, including bladder, rectum, femoral heads, urethra, penile bulk and normal tissue outside PTV), were evaluated interms of various dose-volume metrics and integral dose (ID). Meanwhile, the required delivery time and number of monitor units (MUs) during irradiation were measured to estimate the treatment efficiency. The radiobiological indices such as equivalent uniform dose (EUD), tumor control probability (TCP) and the normal tissue complication probability (NTCP) were also analyzed. Results: All dose constraints were achieved by both systems. It showed that the DEGE plans results were closest to the CK plans results in terms of PTV coverage, HI and GI. For EDGE, more conformal dose distribution in the target as well as reduced exposure of critical organs were obtained together with reduction of 91% delivery time and 72% monitor units. EDGE plans also got lower EUD for bladder, rectum, urethra and penile bulk, which associated with reduction of NTCPs. However, higher values of EUD and TCP for tumor were obtained with CK plans. Conclusions: Our study indicated that both systems were capable of producing almost equivalent plan quality and can meet clinical requirements. CyberKnife G4 system has higher target dose while EDGE system has more advantages based on the considerations of normal tissue sparing and delivery efficiency. With abundant clinical experience, CK provides accurate SBRT treatment with high quality. EDGE system also can be considered to be an option for SBRT treatment for localized prostate cancer treatment.

Download Full-text

An analysis on medical expenses of multidisciplinary cancer care under health insurance

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.10.711 ◽

2021 ◽

Vol 64 (10) ◽

pp. 711-716

Author(s):

Myungjin Jung ◽

Byungyul Jun

Keyword(s):

Health Insurance ◽

Cancer Patients ◽

Cancer Care ◽

Treatment Plan ◽

Multidisciplinary Care ◽

Therapeutic Modality ◽

Patient Treatment ◽

Medical Expenses ◽

Hospitalization Costs ◽

Treatment Plans

Background: Cancer has been the leading cause of death in Korea for more than 40 years. As the aging population in the country increases, this trend is expected to continue. Cancer care is also being subdivided into specialties according to the development of medical technology. This division of care has made it difficult for a single physician to set up a complete cancer treatment plan. As a result, the call for multidisciplinary care has risen. Multidisciplinary cancer care allows physicians to share opinions and choose optimal patient treatment plans across multiple specialties. In August 2014, the Ministry of Health and Welfare designated a set number of approved multidisciplinary treatments and has included them under its health insurance coverage. As a result, multidisciplinary care is rapidly increasing.Current Concepts: An analysis on cancer care was conducted from 2014 to 2018, which examined the average medical expenses, hospitalization costs, and surgery costs per person according to therapeutic modality. Findings showed that multidisciplinary care decreased the overall cost of medical care in cancer patients compared to segmented care provided by single specialty physicians.Discussion and Conclusion: This study predicted that multidisciplinary care would be effective in reducing medical expenses. Cancer patients do not need to be treated by individual subspecialty physicians when personalized care treatment plans through a multidisciplinary approach is possible. The results of this study show that the Korean government should expand health insurance premium support and coverage for multidisciplinary cancer care.

Download Full-text

TH-E-BRCD-02: Automated Treatment Planning Using a Database of Prior Patient Treatment Plans

Medical Physics ◽

10.1118/1.4736348 ◽

2012 ◽

Vol 39 (6Part30) ◽

pp. 4008-4008 ◽

Cited By ~ 1

Author(s):

T McNutt ◽

B Wu ◽

J Moore ◽

S. Petit ◽

M. Kazhdan ◽

...

Keyword(s):

Treatment Planning ◽

Patient Treatment ◽

Treatment Plans

Download Full-text

Significance of different conformity indices for evaluation of radiosurgery treatment plans for vestibular schwannomas

Journal of Neurosurgery ◽

10.3171/jns.2004.101.supplement_3.0334 ◽

2004 ◽

pp. 334-340

Author(s):

Gunnar Surber ◽

Klaus Hamm ◽

Gabriele Kleinert

Keyword(s):

Normal Tissue ◽

Treatment Plan ◽

Target Volume ◽

Vestibular Schwannomas ◽

Content Type ◽

Target Volumes ◽

Treatment Plans ◽

Surgery Center ◽

Prescription Isodose ◽

Fine Print

Object. There are various kinds of conformity parameters currently in use, although several of them are limited and reflect only target volume coverage or normal tissue overdosage. Indices are reviewed with the goal of determining those that are most significant for the evaluation of radiosurgery treatment plans for patients with vestibular schwannoma, based on the authors' experience at the Novalis Shaped Beam Surgery Center. Methods. Fifty-five radiosurgery plans for patients with vestibular schwannomas (VSs) have been evaluated. In this paper the conformation number (CN) and dose-related CN (dCN) are evaluated, and a penalty for underdosed target volumes and overdosed normal tissue is incorporated. A strategy is discussed to apply these indices (CN and dCN) to define the optimal prescription isodose (PI). For a given radiosurgery treatment plan, permitting partial target underdosage may offer an improvement of the CN. Variations of different conformation indices have been calculated for varying prescription levels—for example, an isodose plan. The resulting graph for the CN is discussed in detail to illustrate its use in defining the optimal PI level. For the 55 cases of VSs reported on, the median CNmax result was 0.78. Conclusions. It is possible to achieve highly conformal dose distributions with Novalis radiosurgical system. The CN is the parameter of choice when evaluating radiosurgery treatment plans and scoring possible treatment plans. It takes into account both target underdosage and normal tissue overdosage and offers a valuable scoring parameter while avoiding false-perfect scores.

Download Full-text

Dosimetric Comparison of CyberKnife with Other Radiosurgical Modalities for an Ellipsoidal Target

Neurosurgery ◽

10.1227/01.neu.0000088805.01793.5a ◽

2003 ◽

Vol 53 (5) ◽

pp. 1155-1163 ◽

Cited By ~ 44

Author(s):

Cheng Yu ◽

Gabor Jozsef ◽

Michael L.J. Apuzzo ◽

Zbigniew Petrovich

Keyword(s):

Radiation Dose ◽

Linear Accelerator ◽

Normal Tissue ◽

Intensity Modulated Radiotherapy ◽

Treatment Modalities ◽

Conformity Index ◽

Target Coverage ◽

Homogeneity Index ◽

Three Dimensional Model ◽

Treatment Plans

Abstract OBJECTIVE To compare treatment plans obtained with the CyberKnife (CK) (Accuray, Inc., Sunnyvale, CA) with those of other commonly used radiosurgical modalities, such as the gamma knife (GK), linear accelerator multiple arcs, conformally shaped static fields, and intensity-modulated radiotherapy (IMRT). METHODS An ellipsoidal simulated target was chosen centrally located in a three-dimensional model of a patient's head acquired with magnetic resonance or computed tomographic imaging. It was 25 mm in diameter and 35 mm long. The aims of treatment plans were 100% target volume coverage with an appropriate isodose line, minimum radiation dose to normal tissue, and clinically acceptable delivery. These plans were evaluated by use of a dose-volume histogram and other commonly used radiosurgical parameters such as target coverage, homogeneity index, and conformity index. RESULTS All selected treatment modalities were equivalent in providing full target coverage. For dose homogeneity, all modalities except for multiple isocenter plans for GK (homogeneity index, 2.0) were similar (homogeneity index, ≅1.25). Dose conformity was essentially equivalent for all treatment plans except for IMRT, which had a slightly higher value (conformity index, ≅1.27). There was a substantial variation in the radiation dose to normal tissue between the studied modalities, particularly at the lower dose levels. CONCLUSION CK plans seemed to be more flexible for a given target size and shape. For a target of limited volume and essentially of any shape, one could obtain similarly good conformal dosimetry with CK and GK. For a regular-shaped but other than spherical target, homogeneous dose distribution could be obtained with all selected modalities except for multiple isocenters, linear accelerator multiple arcs, or GK. Both IMRT and conformally shaped static fields offered good alternative treatment modalities to CK, GK, or linear accelerator multiple arc radiosurgery, with slightly inferior dosimetry in conformity (IMRT).

Download Full-text