Optimization of 3-D Conformal Radiation Treatment Plans

36 Background: Evidence based guidelines pertaining to the management of bony metastases have been published. However, up to 30% of oncology treatments deviate from evidence based standards and widespread variations in clinical practice continue to exist. To explore patterns of care in the treatment of vertebral metastases in a group of working age, insured patients, we assessed treatment plans submitted for preauthorization through eviti Connect. Methods: Eviti Connect is a web-based application that enables oncology providers to obtain automated precertification for patients. The platform evaluates treatment plans for consistency with EBM and compliance with payer policies and plan language. All requests for radiation treatment submitted during a two year period from 6/1/11-5/31/13 were reviewed. Peer to peer discussions were conducted in cases that deviated from EBM. Results: A total of 229 cases for the treatment of vertebral metastases were submitted. 46/229 plans (19.8%) did not meet EBM standards. Some cases displayed more than one deviation. Reasons for non-compliance included atypical treatment schedules (8.69%), SRS/SBRT (36.9%), IMRT (32.6%), and IGRT (58.7%). In 26/46 cases (56.5%) the treating physician provided a medical rationale for the deviation. In 9 cases the physician altered the plan to be compliant; in 5 cases the physician did not agree to a change. The most common dose fractionation schedules were 30 Gy/10 fractions (48.9%) and 37.5 Gy/15 fractions (20.5%). 17 cases were treated using 20 Gy/5 fractions and only 2 cases were treated using 8 Gy X 1. Conclusions: Radiation of vertebral metastases was prescribed in accordance with EBM in the majority of cases. The main reasons for deviation were patient-specific issues that justified the medical necessity of the variance. Case review and peer to peer discussion contributed to understanding the rationale for treatment deviation from guidelines and allowed providers to bring plans into compliance with EBM. Overall only 5% of plans were non-evidence based or lacked a medical justification for deviation. Consistent with patterns of care across the US, within this group of patients, single fraction and hypofractionated radiation regimens were underutilized.

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Open Source 3D Printed Lung Tumor Movement Simulator for Radiotherapy Quality Assurance

Materials ◽

10.3390/ma11081317 ◽

2018 ◽

Vol 11 (8) ◽

pp. 1317 ◽

Cited By ~ 3

Author(s):

Darío Quiñones ◽

David Soler-Egea ◽

Víctor González-Pérez ◽

Johanna Reibke ◽

Elena Simarro-Mondejar ◽

...

Keyword(s):

Lung Cancer ◽

Quality Assurance ◽

Side Effects ◽

Causes Of Death ◽

Human Lung ◽

Radiation Treatment ◽

Lung Tumor ◽

Moving Target ◽

Treatment Plans ◽

3D Printed

In OECD (Organization for Economic Co-operation and Development) countries, cancer is one of the main causes of death, lung cancer being one of the most aggressive. There are several techniques for the treatment of lung cancer, among which radiotherapy is one of the most effective and least invasive for the patient. However, it has associated difficulties due to the moving target tumor. It is possible to reduce the side effects of radiotherapy by effectively tracking a tumor and reducing target irradiation margins. This paper presents a custom electromechanical system that follows the movement of a lung tumor. For this purpose, a hysteresis loop of human lung movement during breathing was studied to obtain its characteristic movement equation. The system is controlled by an Arduino, steppers motors and a customized 3D printed mechanism to follow the characteristic human breathing, obtaining an accurate trajectory. The developed device helps the verification of individualized radiation treatment plans and permits the improvement of radiotherapy quality assurance procedures.

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eIMRT: a web platform for the verification and optimization of radiation treatment plans

Journal of Applied Clinical Medical Physics ◽

10.1120/jacmp.v10i3.2998 ◽

2009 ◽

Vol 10 (3) ◽

pp. 205-220 ◽

Cited By ~ 3

Author(s):

Javier Pena ◽

Diego M González-Castaño ◽

Faustino Gómez ◽

Araceli Gago-Arias ◽

Francisco J. González-Castaño ◽

...

Keyword(s):

Radiation Treatment ◽

Treatment Plans ◽

Web Platform

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WITHDRAWN: Impact of Staging 68Ga-PSMA-11 PET scans on radiation treatment plans in patients with prostate cancer by Thomas Hope et al.

Urology ◽

10.1016/j.urology.2018.12.011 ◽

2018 ◽

Author(s):

Axel Heidenreich

Keyword(s):

Prostate Cancer ◽

Radiation Treatment ◽

Treatment Plans ◽

Pet Scans

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A fuzzy system for evaluating radiation treatment plans of head and neck cancer

2012 9th International Conference on Fuzzy Systems and Knowledge Discovery ◽

10.1109/fskd.2012.6234043 ◽

2012 ◽

Cited By ~ 1

Author(s):

Tsair-Fwu Lee ◽

Chang-Yu Lee ◽

Pei-Ju Chao ◽

Li-Fu Wu ◽

Chin-Shiuh Shieh ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Fuzzy System ◽

Radiation Treatment ◽

Treatment Plans

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The radiation doses to the heart and the left anterior descending coronary artery for various modes of radiation treatment of the breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12092 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12092-e12092

Author(s):

Elizaveta Maslyukova ◽

Luiza Korytova ◽

Anna Bondarenko ◽

Razifa Zhabina ◽

Oleg Korytov ◽

...

Keyword(s):

Breast Cancer ◽

At Risk ◽

Cancer Patients ◽

Supine Position ◽

Radiation Treatment ◽

Organs At Risk ◽

Free Breathing ◽

Breast Cancer Patients ◽

Heart Volume ◽

Treatment Plans

e12092 Background: The comparison of the radiation load to the organs at risk for three modes of radiation treatment of the breast cancer patients. Methods: The research includes the dosimetric radiation treatment plans for the 20 breast cancer patients with the left-side localization. They all underwent a computed tomography (CT) scan in standard supine position in free-breathing (FB), supine position with Active Breathing Control (ABC) device in deep inspiratory breath hold, and prone position in free-breathing (PP). Three-dimensional treatment plans were made for all 3 CTs. The dose valuations for 3D-planning were carried out for three CT- series. For each mode of radiation, the doze-volume parameters of organs at risk were estimated. Results: For all cases the contoured heart volume varied from 477 см3 - 1056 см3, with medium volume 769 см3. The best marks such as V25heart, medium doses to the heart and LAD, were achieved with on ABC methods (V25heart 4,26%, Dmean heart 3,13Gy, DmeanLAD 13,8Gy) in comparison FB (V25heart 9,49%, Dmean heart 4,97Gy, DmeanLAD 19,55Gy) and PP (V25heart 12,8%, Dmean heart 9,06Gy, DmeanLAD 24,18 Gy) (V25heart P = 0.00153, Dmean heart: P =0,000; Dmean LAD: P = 0.00088), when both the breast and the axillary nodes were included in the volume. The advantage of the dosimetric indexes for FB and ABC did not change while axillary and supraclavicular nodes were added to the radiation volume ABC (V25heart 3,49%, Dmean heart 3,08Gy, DmeanLAD 13,88Gy) in comparison with FB methods (V25heart 7,91%, Dmean heart 4,99Gy, DmeanLAD 19,89Gy) (V25heart P = 0.00205, Dmean heart: P =0,004; Dmean LAD: P = 0.03). Conclusions: Radiation treatment in the position on the back with controlled delay of breath on inspiration height contributed to the statistically significant reduction of the heart volume exposed to more than 25 Gy (V25heart), mean dose to the heart and mean dose to LAD.

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