International journal of radiation oncology, biology, physics
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Int. J. Radiat. Oncol. Biol. Phys. · Jan 2008
Practice GuidelineQuality assurance needs for modern image-based radiotherapy: recommendations from 2007 interorganizational symposium on "quality assurance of radiation therapy: challenges of advanced technology".
This report summarizes the consensus findings and recommendations emerging from 2007 Symposium, "Quality Assurance of Radiation Therapy: Challenges of Advanced Technology." The Symposium was held in Dallas February 20-22, 2007. The 3-day program, which was sponsored jointly by the American Society for Therapeutic Radiology and Oncology (ASTRO), American Association of Physicists in Medicine (AAPM), and National Cancer Institute (NCI), included >40 invited speakers from the radiation oncology and industrial engineering/human factor communities and attracted nearly 350 attendees, mostly medical physicists. A summary of the major findings follows. ⋯ Second, the AAPM advanced technology RT Task Groups should better balance clinical process vs. device operation aspects--encouraging greater levels of multidisciplinary participation such as industrial engineering consultants and use-risk assessment and process-flow techniques. Third, ASTRO should form a multidisciplinary subcommittee, consisting of physician, physicist, vendor, and industrial engineering representatives, to better address modern RT quality management and QA needs. Finally, government and private entities committed to improved healthcare quality and safety should support research directed toward addressing QA problems in image-guided therapies.
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Int. J. Radiat. Oncol. Biol. Phys. · Jan 2008
Siemens multileaf collimator characterization and quality assurance approaches for intensity-modulated radiotherapy.
Application of the multileaf collimator (MLC) has evolved from replacing blocks to create treatment fields to creating photon fluence modulation for intensity-modulated radiotherapy (IMRT). Multileaf collimator system performance requirements are far more stringent for such applications and will require increased performance for future applications, such as motion tracking. This article reviews Siemens MLC systems, including a technical description and dosimetric characteristics of 56-, 82-, and 160-leaf designs. ⋯ Measured values of X-ray transmission (intra-leaf, inter-leaf, and through abutting leaf pairs) and penumbra (leaf end, leaf tongue, leaf groove) are presented with an evaluation of their characterization by a treatment-planning system. The dosimetric impact of planning system model inadequacies is demonstrated for collimator scatter, dose profile values within 30 mm of the field edge, and the resultant effect demonstrated on clinical cases. Finally, a description of automated quality assurance delivery, analysis, and calibration protocols applicable for the specific vendor's system is provided.
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Int. J. Radiat. Oncol. Biol. Phys. · Jan 2008
Stereotactic radiosurgery of the postoperative resection cavity for brain metastases.
The purpose of this study was to analyze results of adjuvant stereotactic radiosurgery (SRS) targeted at resection cavities of brain metastases without whole-brain irradiation (WBI). ⋯ In this retrospective series, SRS administered to the resection cavity of brain metastases resulted in a 79% local control rate at 12 months. This value compares favorably with historic results with observation alone (54%) and postoperative WBI (80-90%). Given the improved local control seen with less conformal plans, we recommend inclusion of a 2-mm margin around the resection cavity when using this technique.
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Helical tomotherapy uses a dynamic delivery in which the gantry, treatment couch, and multileaf collimator leaves are all in motion during treatment. This results in highly conformal radiotherapy, but the complexity of the delivery is partially hidden from the end-user because of the extensive integration and automation of the tomotherapy control systems. This presents a challenge to the medical physicist who is expected to be both a system user and an expert, capable of verifying relevant aspects of treatment delivery. ⋯ The integrated treatment planning, delivery, and patient-plan quality assurance process is described. A quality assurance protocol is proposed, with an emphasis on what a clinical medical physicist could and should check. Additionally, aspects of a tomotherapy quality assurance program that could be checked automatically and remotely because of its inherent imaging system and integrated database are discussed.
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Int. J. Radiat. Oncol. Biol. Phys. · Jan 2008
Randomized Controlled Trial Multicenter Study Comparative StudyPreoperative chemoradiotherapy for rectal cancer: randomized trial comparing oral uracil and tegafur and oral leucovorin vs. intravenous 5-fluorouracil and leucovorin.
To compare, in a randomized trial, 5-fluorouracil (FU) plus leucovorin (LV) (FU+LV) vs. oral uracil and tegafur (UFT) plus LV (UFT+LV) given concomitantly with preoperative irradiation in patients with cT3-4 or N+ rectal cancer. ⋯ Although this study lacked statistical power to exclude clinically significant differences between both groups, the outcome of patients treated with UFT+LV did not differ significantly from that of patients treated with FU+LV, and hematologic toxicity was significantly lower in the experimental arm.