The quantitative impact of joint peer review with a specialist radiologist in head and neck cancer radiotherapy planning

2021 ◽  
Author(s):  
Kevin Chiu ◽  
Peter Hoskin ◽  
Amit Gupta ◽  
Roeum Butt ◽  
Samsara Terparia ◽  
...  
Keyword(s):  
Head And Neck ◽  
Peer Review ◽  
Major Change ◽  
Tumour Volume ◽  
Target Volume ◽  
Radiotherapy Planning ◽  
High Dose ◽  
Quantitative Indices ◽  
Gross Error ◽  
Quantitative Impact

Objectives: Radiologist input in peer review of head and neck radiotherapy has been introduced as a routine departmental approach. The aim was to evaluate this practice and to quantitatively analyse the changes made. Methods: Patients treated with radical-dose radiotherapy between August–November 2020 were reviewed. The incidence of major and minor changes, as defined by The Royal College of Radiologists guidance, was prospectively recorded. The amended radiotherapy volumes were compared with the original volumes using Jaccard Index (JI) to assess conformity; Geographical Miss Index (GMI) for under contouring; and Hausdorff Distance (HD) between the volumes. Results: In total 73 out of 87 (84%) patients were discussed. Changes were recommended in 38 (52%) patients: 30 had ≥1 major change, eight had minor changes only. There were 99 amended volumes: The overall median JI, GMI and HD was 0.91 (interquartile range [IQR]=0.80–0.97), 0.06 (IQR = 0.02–0.18) and 0.42 cm (IQR = 0.20–1.17 cm) respectively. The nodal gross-tumour-volume (GTVn) and therapeutic high-dose nodal clinical-target-volume (CTVn) had the biggest magnitude of changes: The median JI, GMI and HD of GTVn was 0.89 (IQR = 0.44–0.95), 0.11 (IQR = 0.05–0.51), 3.71 cm (IQR = 0.31–6.93 cm); high-dose CTVn was 0.78 (IQR = 0.59–0.90), 0.20 (IQR = 0.07–0.31) and 3.28 cm (IQR = 1.22–6.18 cm) respectively. There was no observed difference in the quantitative indices of the 85 ‘major’ and 14 ‘minor’ volumes (p = 0.5). Conclusions: Routine head and neck radiologist input in radiotherapy peer review is feasible and can help avoid gross error in contouring. Advances in knowledge: The major and minor classification may benefit from differentiation with quantitative indices but requires correlation from clinical outcomes.

scholarly journals ACTIVE INVOLVEMENT OF RADIOLOGIST IN RADIATION ONCOLOGY PRACTICE

2021 ◽  
Vol 10 (4) ◽  
pp. 3199-3201
Author(s):  
Anurag A. Luharia
Keyword(s):  
Radiation Oncology ◽  
Normal Tissue ◽  
Radiation Treatment ◽  
Imaging Modality ◽  
Tumour Volume ◽  
Target Volume ◽  
Ct Images ◽  
Radiotherapy Planning ◽  
Internal Target Volume ◽  
Radiotherapy Treatment

Advancements in Radiation Oncology from conventional to 3D conformal radiotherapy treatment demands expertise in many steps of radiation planning, the horizon of radiologist is now expanded by many folds and made radiologist as a integral part of the Radiation Oncology Department. A critical aspect of radiotherapy treatment planning (RTP) is determining how to deliver the required radiation dosage to cancer cells while minimising the exposure to normal tissue for which the prerequisite is identification and accurate delineation of tumour volume as well as normal structure resulted in an increase in the therapeutic ratio by reducing complication associated with normal tissue and allowing for higher target dosage and better local control. In modern radiotherapy CT images are the standard set of imaging modality required for the radiotherapy planning along with it many other modalities like MRI, PET or DSA are used by superimposing on original CT images in order to contour or delineate the structures defined by International Commission on Radiation Units and Measurements in Reports 50, 62 and 71 (ICRU) for radiotherapy planning which comprise of Gross tumour volume, clinical target volume, planning target volume, irradiated volume, Internal target volume and the normal structures as Organ at risk. It is self-evident that the contribution of a radiologist with a thorough knowledge of the development of these new modalities is critical for optimising the potential of these novel modes of radiation treatment delivery.

Radiotherapy planning: PET/CT scanner performances in the definition of gross tumour volume and clinical target volume

2005 ◽  
Vol 32 (12) ◽  
pp. 1392-1399 ◽  
Author(s):  
Ernesto Brianzoni ◽  
Gloria Rossi ◽  
Sergio Ancidei ◽  
Alfonso Berbellini ◽  
Francesca Capoccetti ◽  
...  
Keyword(s):  
Clinical Target Volume ◽  
Tumour Volume ◽  
Target Volume ◽  
Radiotherapy Planning ◽  
Gross Tumour Volume ◽  
Ct Scanner ◽  
Pet Ct ◽  
Definition Of

Impact of interobserver variability in delineating clinical target volumes (CTV) for head and neck intensity modulated radiation therapy (IMRT): Potential for a geographical miss

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17013-e17013
Author(s):  
S. Chilukuri ◽  
S. Surana ◽  
P. P. Mohanty ◽  
R. Kuppuswamy
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Imaging Techniques ◽  
Target Volume ◽  
High Dose ◽  
Observer Variability ◽  
Median Dose ◽  
Median Percentage ◽  
Inter Observer Variability

e17013 Background: Despite modern day imaging techniques and guidelines for delineation of the clinical target volume, there remains significant inter-observer variability in delineating the CTV. With the use of IMRT, the target volume receives a significant tumoricidal dose while the regions just outside the target receive unpredictable doses. In this report, the dose to the region just outside the planning target volume (PTV) (defined as volume of uncertainty [VOU]), presumed to represent the regions subject to maximum inter-observer variability, was studied. Methods: The IMRT plans of 12 patients with head and neck cancer were used to determine the dose just outside the high-risk CTV by growing volumes around CTV with 3 mm, 5 mm, and 7 mm margins. These volumes were edited at regions close to skin/air and bone. PTVs were subsequently grown using the same margins as used in the original plans. With the Boolean operations, each of these volumes was subtracted from the existing PTV to generate the volumes of uncertainty (VOU) in 3 dimensions. The dose to these VOUs was analyzed. D95, D90 and median dose which are the doses received by 95%, 90%, and 50% of the target volume respectively were studied. Results: The median prescribed dose was 68 Gy (60 Gy-72 Gy). The median percentage D95 for 3mm, 5mm and 7mm VOU was 82.5% ± 4.95, 77.25% ± 5.53, and 69% ± 6.93, respectively. The median percentage D90 for these VOU's was 87.7% ± 3.53, 83.2% ± 4.61, and 79% ± 4.5, respectively. The median dose to each of these VOU”s was 96% ± 1.6, 94.5% ± 1.95, and 92.5% ± 1.85 respectively. Conclusions: This study documents that the volumes of uncertainty surrounding the PTV, which could contain subclinical disease, in fact receive a significant amount of RT dose. Hence, despite a large amount of evidence for inter-observer variability in target delineation for head and neck cancer,the majority of locoregional recurrences are within the high dose region and not marginal failures. No significant financial relationships to disclose.

scholarly journals Radiotherapy planning: PET/CT scanner performances in the definition of gross tumour volume and clinical target volume

2005 ◽  
Vol 32 (12) ◽  
pp. 1491-1491
Author(s):  
Ernesto Brianzoni ◽  
Gloria Rossi ◽  
Sergio Ancidei ◽  
Alfonso Berbellini ◽  
Francesca Capoccetti ◽  
...  
Keyword(s):  
Clinical Target Volume ◽  
Tumour Volume ◽  
Target Volume ◽  
Radiotherapy Planning ◽  
Gross Tumour Volume ◽  
Ct Scanner ◽  
Pet Ct ◽  
Definition Of

An introduction to proton beam therapy

2019 ◽  
Vol 80 (10) ◽  
pp. 574-578
Author(s):  
Claire Barker ◽  
Matthew Lowe ◽  
Ganesh Radhakrishna
Keyword(s):  
Proton Beam ◽  
Proton Beam Therapy ◽  
Paediatric Population ◽  
Tumour Volume ◽  
Target Volume ◽  
Evidence Base ◽  
High Energy ◽  
High Dose ◽  
Conventional Radiotherapy ◽  
Normal Tissues

Radiotherapy is a highly effective anti-cancer treatment commonly used alongside systemic therapies and surgery to achieve long-term cancer-free survival. Conventional radiotherapy uses photon beams to deliver a high dose of radiation to the tumour volume to eradicate cancer cells. This has to be offset against the irradiation of surrounding normal tissues, as increasing this dose causes more treatment-related toxicity. In August 2018, the NHS's first high energy proton beam therapy centre opened at The Christie NHS Foundation Trust in Manchester. A second NHS centre is scheduled to open in 2020 at the University College London Hospitals NHS Trust. Proton beam therapy may offer dosimetric advantages compared to conventional radiotherapy as a result of its characteristic dose deposition – proton beams deliver a comparatively higher proportion of their dose to the target volume relative to normal tissues, without significant exit doses when compared to conventional photon therapy. Therefore proton beam therapy may be indicated for certain tumours situated next to critical organs or in the paediatric population where quality of life and the reduction of secondary effects from radiation are particularly significant. The indications for proton beam therapy and patient outcomes after treatment will be carefully monitored and evaluated in order to provide a robust evidence base for its use.

scholarly journals Impact of Peer Review in the Radiation Treatment Planning Process: Experience of a Tertiary Care University Hospital in Pakistan

2019 ◽  
pp. 1-7
Author(s):  
Bilal Mazhar Qureshi ◽  
Muhammad Atif Mansha ◽  
Muneeb Uddin Karim ◽  
Asim Hafiz ◽  
Nasir Ali ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Peer Review ◽  
Clinical Target Volume ◽  
Planning Process ◽  
Radiation Treatment ◽  
Tertiary Care ◽  
Major Change ◽  
Target Volume ◽  
University Hospital ◽  
Treatment Plans

PURPOSE To evaluate and report the frequency of changes in radiation therapy treatment plans after peer review in a simulation review meeting once a week. MATERIALS AND METHODS Between July 1 and August 31, 2016, the radiation plans of 116 patients were discussed in departmental simulation review meetings. All plans were finalized by the primary radiation oncologist before presenting them in the meeting. A team of radiation oncologists reviewed each plan, and their suggestions were documented as no change, major change, minor change, or missing contour. Changes were further classified as changes in clinical target volume, treatment field, or dose. All recommendations were stratified on the basis of treatment intent, site, and technique. Data were analyzed by Statistical Package for the Social Sciences and are presented descriptively. RESULTS Out of 116 plans, 26 (22.4%) were recommended for changes. Minor changes were suggested in 15 treatment plans (12.9%) and a major change in 10 (8.6%), and only one plan was suggested for missing contour. The frequency of change recommendations was greater in radical radiation plans than in palliative plans (92.3% v 7.7%). The head and neck was the most common treatment site recommended for any changes (42.3%). Most of the changes were recommended in the technique planned with three-dimensional conformal radiation therapy (50%). Clinical target volume (73.1%) was identified as the most frequent parameter suggested for any change, followed by treatment field (19.2%) and dose (0.08%). CONCLUSION Peer review is an important tool that can be used to overcome deficiencies in radiation treatment plans, with a goal of improved and individualized patient care. Our study reports changes in up to a quarter of radiotherapy plans.

scholarly journals Image guided high-dose-rate brachytherapy versus volumetric modulated arc therapy for head and neck cancer: A comparative analysis of dosimetry for target volume and organs at risk

2018 ◽  
Vol 52 (4) ◽  
pp. 461-467
Author(s):  
Hironori Akiyama ◽  
Csilla Pesznyák ◽  
Dalma Béla ◽  
Örs Ferenczi ◽  
Tibor Major ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Dose Rate ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Target Volume ◽  
High Dose Rate ◽  
High Dose ◽  
Image Guided ◽  
Arc Therapy

Abstract Background The aim of the study was to present dosimetric comparison of image guided high-dose-rate brachytherapy (IGBT) with volumetric modulated arc therapy (VMAT) for head and neck cancer regarding conformity of dose distribution to planning target volume (PTV) and doses to organs at risk (OARs). Patients and methods Thirty-eight consecutive patients with T1-4 mobile tongue, floor of mouth and base of tongue cancer treated with IGBT were selected. For these patients additional VMAT treatment plans were also prepared using identical computed tomography data. OARs and PTV related parameters (e.g. V98, D0.1cm3, Dmean, etc.) were compared. Results Mean V98 of the PTV was 90.2% vs. 90.4% (p > 0.05) for IGBT and VMAT, respectively. Mean D0.1cm3 to the mandible was 77.0% vs. 85.4% (p < 0.05). Dmean to ipsilateral and contralateral parotid glands was 4.6% vs. 4.6% and 3.0% vs. 3.9% (p > 0.05). Dmean to ipsilateral and contralateral submandibular glands was 16.4% vs. 21.9% (p > 0.05) and 8.2% vs. 16.9% (p < 0.05), respectively. Conclusions Both techniques showed excellent target coverage. With IGBT dose to normal tissues was lower than with VMAT. The results prove the superiority of IGBT in the protection of OARs and the important role of this invasive method in the era of new external beam techniques.

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