Serial 4DCT/4DPET imaging to predict and monitor response for locally-advanced non-small cell lung cancer chemo-radiotherapy.

Background And Purpose: A FDG-PET/CT image feature with optimal prognostic potential for locally-advanced non-small cell lung cancer (LA-NSCLC) patients has yet to be identified, and neither has the optimal time for FDG-PET/CT response assessment; furthermore, nodal features have been largely ignored in the literature. We propose to identify image features or imaging time point with maximal prognostic power.

Materials And Methods: Consecutive consenting patients with LA-NSCLC receiving curative intent CRT were enrolled.

Predicting Radiation Esophagitis Using 18F-FDG PET During Chemoradiotherapy for Locally Advanced Non-Small Cell Lung Cancer.

Introduction: Treatment of locally advanced non-small cell lung cancer with chemoradiotherapy (CRT) is limited by development of toxicity in normal tissue, including radiation esophagitis (RE). Increasingly, (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is being used for adaptive planning. Our aim was to assess changes in esophageal FDG uptake during CRT and relate the changes to the onset and severity of RE.

Contouring variations and the role of atlas in non-small cell lung cancer radiation therapy: Analysis of a multi-institutional preclinical trial planning study.

Purpose: To quantify variations in target and normal structure contouring and evaluate dosimetric impact of these variations in non-small cell lung cancer (NSCLC) cases. To study whether providing an atlas can reduce potential variation.

Methods And Materials: Three NSCLC cases were distributed sequentially to multiple institutions for contouring and radiation therapy planning.

Capturing acute toxicity data during lung radiotherapy by using a patient-reported assessment tool.

Background: Comprehensive and accurate assessment of symptoms experienced by patients undergoing lung radiotherapy (RT) is challenging. This study aims to evaluate the feasibility and utility of collecting acute toxicity information by using a patient-reported instrument, the Thoracic Symptom Self-Assessment Tool (TSSAT).

Methods: The TSSAT is based on the CTCAE v3.

Volumetric image guidance using carina vs spine as registration landmarks for conventionally fractionated lung radiotherapy.

Purpose: To compare the relative accuracy of 2 image guided radiation therapy methods using carina vs spine as landmarks and then to identify which landmark is superior relative to tumor coverage.

Methods And Materials: For 98 lung patients, 2596 daily image-guidance cone-beam computed tomography scans were analyzed. Tattoos were used for initial patient alignment; then, spine and carina registrations were performed independently.

10 Years Of Exposure to a Radiation Therapist Research Culture: Where Are We Now?

Introduction: Over the past 10 years, various programmatic changes have been implemented in our radiotherapy department to increase radiation therapist (RT) research activities. The aim of this qualitative study was to investigate the attitudes of RTs who have been working in a research-rich environment concerning current research activities and the presence of enablers and inhibiters.

Materials And Methods: After obtaining research ethics approval, 5 focus groups and 6 interviews were conducted with a group of 30 RTs with varying levels of clinical experience, who were currently employed in our department.

Tumor regression and positional changes in non-small cell lung cancer during radical radiotherapy.

Introduction: We have used respiratory-correlated cone beam computed tomography (rcCBCT) imaging to study the volumetric and positional changes that occur throughout the course of radical radiotherapy in non-small cell lung cancer (NSCLC).

Methods: Tumor volumes and centers of mass were recorded and analyzed on weekly serial rcCBCT images of NSCLC patients treated with radical radiotherapy to a dose ≥45 Gy with concurrent chemotherapy.

Results: Sixty patients with locally advanced NSCLC were included; in 31 patients, the primary tumor was peripheral and thus suitable for contouring.

Investigating Patient Wait Times for Daily Outpatient Radiotherapy Appointments (A Single-Centre Study).

Introduction: Patient satisfaction is an important indicator of quality in health care. Radiotherapy (RT) requires patients to attend daily treatment through outpatient appointments (OPA). Therefore, wait times (WT) for daily RT OPAs can have a significant impact on patient satisfaction.

Effect of image-guidance frequency on geometric accuracy and setup margins in radiotherapy for locally advanced lung cancer.

Purpose: To assess the relative effectiveness of five image-guidance (IG) frequencies on reducing patient positioning inaccuracies and setup margins for locally advanced lung cancer patients.

Methods And Materials: Daily cone-beam computed tomography data for 100 patients (4,237 scans) were analyzed. Subsequently, four less-than-daily IG protocols were simulated using these data (no IG, first 5-day IG, weekly IG, and alternate-day IG).

Investigating User Perspective on Training and Clinical Implementation of Volumetric Imaging.

Purpose: Volumetric imaging (VI) is gaining momentum as a clinical tool for image guidance. The purpose of this study was to explore radiation therapists' (RTs) perception of VI training and clinical implementation. The results provide an evaluation of current training for continuous improvement, identify educational needs for the future, and chart a path for higher level evaluation of the learning activities.

The Influence of Programmatic Change on Radiation Therapist Research Capacity-A Single-center Case Study.

Purpose: To identify various programmatic changes implemented in a Canadian radiotherapy department to build therapist research capacity, and to determine their combined impact on quantitative metrics of therapist research output.

Methods And Materials: This was a single-center case study design. Programmatic changes were retrospectively identified from various departmental documentary sources.

Cone-beam computed tomographic image guidance for lung cancer radiation therapy.

Purpose: To determine the geometric accuracy of lung cancer radiotherapy using daily volumetric, cone-beam CT (CBCT) image guidance and online couch position adjustment.

Methods And Materials: Initial setup accuracy using localization CBCT was analyzed in three lung cancer patient cohorts. The first (n = 19) involved patients with early-stage non-small-cell lung cancer (NSCLC) treated using stereotactic body radiotherapy (SBRT).

Practical considerations arising from the implementation of lung stereotactic body radiation therapy (SBRT) at a comprehensive cancer center.

Introduction: With the anticipation of improved outcomes, especially for patients with early-stage non-small cell lung cancer, stereotactic body radiation therapy (SBRT) has been rapidly introduced into the thoracic radiation oncology community. Although at first glance lung SBRT might seem methodologically similar to conventional radiotherapy, there are important differences in its execution that require particular consideration. The objective of this paper is to highlight these and other issues to contribute to the safe and effective diffusion of lung SBRT.

Comparison of spine, carina, and tumor as registration landmarks for volumetric image-guided lung radiotherapy.

Purpose: To assess the feasibility, reproducibility, and accuracy of volumetric lung image guidance using different thoracic landmarks for image registration.

Methods And Materials: In 30 lung patients, four independent observers conducted automated and manual image registrations on Day 1 cone-beam computed tomography data sets using the spine, carina, and tumor (720 image registrations). The image registration was timed, and the couch displacements were recorded.