Comparing immobilisation devices in gynaecological external beam radiotherapy: improving inter-fraction reproducibility of pelvic tilt.

Introduction: The aim was to determine which immobilisation device improved inter-fraction reproducibly of pelvic tilt and required the least pre-treatment setup and planning interventions.

Methods: Sixteen patients were retrospectively reviewed, eight immobilised using the BodyFIX system (BodyFIX®, Elekta, Stockholm, Sweden) and eight using the Butterfly Board (BB) (Bionix Radiation Therapy, Toledo, OH, USA). The daily pre-treatment images were reviewed to assess setup variations between each patient and groups for pelvic tilt, pubic symphysis, sacral promontory and the fifth lumbar spine (L5).

Comprehensive nodal breast VMAT: solving the low-dose wash dilemma using an iterative knowledge-based radiotherapy planning solution.

Introduction: Aimed to develop a simple and robust volumetric modulated arc radiotherapy (VMAT) solution for comprehensive lymph node (CLN) breast cancer without increase in low-dose wash.

Methods: Forty CLN-breast patient data sets were utilised to develop a knowledge-based planning (KBP) VMAT model, which limits low-dose wash using iterative learning and base-tangential methods as benchmark. Another twenty data sets were employed to validate the model comparing KBP-generated ipsilateral VMAT (ipsi-VMAT) plans against the benchmarked hybrid (h)-VMAT (departmental standard) and bowtie-VMAT (published best practice) methods.

Intra-fraction displacement of the prostate bed during post-prostatectomy radiotherapy.

Background: To measure intra-fraction displacement (IFD) in post-prostatectomy patients treated with anisotropic margins and daily soft tissue matching.

Methods: Pre-treatment cone beam computed tomography (CBCT) scans were acquired daily and post-treatment CBCTs for the first week then weekly on 46 patients. The displacement between the scans was calculated retrospectively to measure IFD of the prostate bed (PB).

Implementing daily soft tissue image guidance with reduced margins for post-prostatectomy radiotherapy: research-based changes to clinical practice.

Introduction: We have previously demonstrated that daily soft tissue matching with reduced anisotropic margins provides an ideal balance between prostate bed coverage and meeting organ at risk constraints. The aim of this study was to evaluate the implementation of this approach in clinical practice.

Methods: Thirty-eight radiation therapists (RTs) completed offline IGRT training involving six patients.

Initial experience with intra-fraction motion monitoring using Calypso guided volumetric modulated arc therapy for definitive prostate cancer treatment.

Introduction: Accurate delivery of radiation while reducing dose to organs at risk is essential in prostate treatment. The Calypso motion management system detects and corrects both inter- and intra-fraction motion which offers potential benefits over standard alignment to fiducial markers. The aims of this study were to implement Calypso with Dynamic Edge™ gating and to assess both the motion seen, and interventions required.

Increasing consistency and accuracy in radiation therapy via educational interventions is not just limited to radiation oncologists.

This editorial is advocating that increasing consistency and accuracy in radiation therapy via educational interventions is important for radiation therapist. Education and training with ongoing refreshers is the key to maintaining consistency throughout the radiotherapy process, which in turn will ensure all patients receive accurate treatment.

Definition and visualisation of regions of interest in post-prostatectomy image-guided intensity modulated radiotherapy.

Introduction: Standard post-prostatectomy radiotherapy (PPRT) image verification uses bony anatomy alignment. However, the prostate bed (PB) moves independently of bony anatomy. Cone beam computed tomography (CBCT) can be used to soft tissue match, so radiation therapists (RTs) must understand pelvic anatomy and PPRT clinical target volumes (CTV).

Determining optimal planning target volume and image guidance policy for post-prostatectomy intensity modulated radiotherapy.

Background: There is limited information available on the optimal Planning Target Volume (PTV) expansions and image guidance for post-prostatectomy intensity modulated radiotherapy (PP-IMRT). As the prostate bed does not move in a uniform manner, there is a rationale for anisotropic PTV margins with matching to soft tissue. The aim of this study is to find the combination of PTV expansion and image guidance policy for PP-IMRT that provides the best balance of target coverage whilst minimising dose to the organs at risk.

The descriptive epidemiology of yersiniosis: a multistate study, 2005-2011.

Objectives: Yersiniosis, a foodborne infection of zoonotic origin caused by the bacteria Yersinia enterocolitica and Yersinia pseudotuberculosis, is a reportable disease in 38 states. Both sporadic and foodborne outbreaks of yersiniosis have been reported in the U.S.

The importance of prostate bed tilt during postprostatectomy intensity-modulated radiotherapy.

Variations in rectal and bladder filling can create a tilt of the prostate bed, which generates the potential for a geographic miss during postprostatectomy radiotherapy. The aim of this study is to assess the effect that bladder and rectum filling has on planning target volume angle, to determine a method to assess prostate bed tilt leading to potential geographic miss, and to discuss possible implementation issues. The cone-beam computed tomography images (n = 377) of 40 patients who received postprostatectomy radiotherapy with intensity-modulated radiotherapy were reviewed.

The impact of rectal and bladder variability on target coverage during post-prostatectomy intensity modulated radiotherapy.

Background And Purpose: Accuracy when delivering post-prostatectomy intensity modulated radiotherapy (IMRT) is crucial. The aims of this study were to quantify prostate bed movement and determine what amount of bladder or rectum size variation creates the potential for geographic miss.

Methods And Materials: The Cone Beam CT (CBCT) images (n=377) of forty patients who received post-prostatectomy IMRT with daily on-line alignment to bony anatomy were reviewed.

Prostate bed motion may cause geographic miss in post-prostatectomy image-guided intensity-modulated radiotherapy.

Introduction: There is little data to guide radiation oncologists on appropriate margin selection in the post-prostatectomy setting. The aim of this study was to quantify interfraction variation in motion of the prostate bed to determine these margins.

Methods: The superior and inferior surgical clips in the prostate bed were tracked on pretreatment cone beam CT images (n = 377) for 40 patients who had received post-prostatectomy radiotherapy.

Human rabies exposures and postexposure prophylaxis in South Carolina, 1993-2002.

Objectives: South Carolina mandates reporting of animal bites and manages distribution of biologics for rabies postexposure prophylaxis (PEP). Incidence and epidemiologic characteristics of potential human rabies exposures and preventive treatment in South Carolina from 1993 through 2002 were examined to help assess the burden of PEP in the state and determine if the incidence of rabies exposures has changed over time.

Methods: Data on animal exposure investigations and PEP administration at the state and county level were examined, and the annual incidences of potential rabies exposures and human PEP courses were calculated.