Training for tomorrow: Establishing a worldwide curriculum in online adaptive radiation therapy.

This commentary discusses the implementation of online adaptive radiation therapy (oART) in cancer treatment within the context of current challenges faced by radiation therapy professionals. oART enables modifications to treatment plans based on daily imaging, enhancing target accuracy while minimising harm to surrounding organs. Despite its potential to improve patient outcomes, the application of oART is hindered by notable barriers, particularly in human resources.

Pan-Canadian assessment of image guided adaptive radiation therapy and the role of the radiation therapist.

Purpose: Adaptive radiation therapy (ART) is a close-looped process where anatomic changes observed during treatment are identified, leading to plan modification prior to treatment delivery. The aim of this study was to explore the status of ART across Canada and review the impact of adaptive technologies on the roles and responsibilities of Radiation Therapists (RTTs).

Materials And Methods: Study information and a link to a 30-question survey was sent via email to the RTT manager of all cancer centres across Canada (n = 48).

Development of a territory-wide household-based composite index for measuring relative distribution of households by economic status in individual small areas throughout Hong Kong.

Background: Many countries have developed their country/nation-wide multidimensional area-based index on deprivation or socioeconomic status for resource allocation, service planning and research. However, whether each geographical unit proxied by a single index is sufficiently small to contain a relatively homogeneous population remains questionable. Globally, this is the first study that presents the distribution of domestic households by the territory-wide economic status index decile groups within each of the 2,252 small subunit groups (SSUGs) throughout Hong Kong, with a median study population of 1,300 and a median area of 42,400 m.

Understanding delays to parathyroidectomy: A mixed-methods approach.

Background: Patients from ethnic and racial minority groups with primary hyperparathyroidism may have greater time delays to curative parathyroidectomy. Contributing factors are unclear.

Methods: This was a sequential mixed-methods study.

Repeatability and reproducibility of prostate apparent diffusion coefficient values on a 1.5 T magnetic resonance linear accelerator.

Background And Purpose: Integrated magnetic resonance linear accelerator (MR-Linac) systems offer potential for biologically based adaptive radiation therapy using apparent diffusion coefficient (ADC). Accurate tracking of longitudinal ADC changes is key to establishing ADC-driven dose adaptation. Here, we report repeatability and reproducibility of intraprostatic ADC using deformable image registration (DIR) to correct for inter-fraction prostate changes.

Prospective evaluation of patient-reported anxiety and experiences with adaptive radiation therapy on an MR-linac.

Purpose: An integrated magnetic resonance scanner and linear accelerator (MR-linac) was implemented with daily online adaptive radiation therapy (ART). This study evaluated patient-reported experiences with their overall hospital care as well as treatment in the MR-linac environment.

Methods: Patients pre-screened for MR eligibility and claustrophobia were referred to simulation on a 1.

Impact of technological advances in treatment planning, image guidance, and treatment delivery on target margin design for prostate cancer radiotherapy: an updated review.

Recent innovations in image guidance, treatment delivery, and adaptive radiotherapy (RT) have created a new paradigm for planning target volume (PTV) margin design for patients with prostate cancer. We performed a review of the recent literature on PTV margin selection and design for intact prostate RT, excluding post-operative RT, brachytherapy, and proton therapy. Our review describes the increased focus on prostate and seminal vesicles as heterogenous deforming structures with further emergence of intra-prostatic GTV boost and concurrent pelvic lymph node treatment.

Practice-based training strategy for therapist-driven prostate MR-Linac adaptive radiotherapy.

Purpose: To develop a practice-based training strategy to transition from radiation oncologist to therapist-driven prostate MR-Linac adaptive radiotherapy.

Methods And Materials: In phase 1, 7 therapists independently contoured the prostate and organs-at-risk on T2-weighted MR images from 11 previously treated MR-Linac prostate patients. Contours were evaluated quantitatively (i.

Assessment of intra-fraction motion during frameless image guided Gamma Knife stereotactic radiosurgery.

As frameless stereotactic radiosurgery increase in use, the aim of this study was to evaluate intra-fraction motion through cone-beam CT (CBCT) and high-definition motion management (HDMM) systems. Intra-fraction motion measured between localization, repeat localization and post-treatment CBCTs were correlated to intra-faction motion indicated by the HDMM files using the Pearson coefficient (r). A total of 302 plans were reviewed from 263 patients (114 male, 149 female); 216 pairs of localization-repeat localization, and 260 localization-post-treatment CBCTs were analyzed against HDMM logs.

Impact of intrafraction changes in delivered dose of the day for prostate cancer patients treated with stereotactic body radiotherapy via MR-Linac.

Purpose: The purpose of this study is to evaluate the impact of intrafraction pelvic motion by comparing the adapted plan dose (APD) and the computed delivered dose of the day (DDOTD) for patients with prostate cancer (PCa) treated with SBRT on the MR-Linac.

Methods: Twenty patients with PCa treated with MR-guided adaptive SBRT were included. A 9-field IMRT distribution was adapted based on the anatomy of the day to deliver a total prescription dose of 3000 cGy in 5 fractions to the prostate plus a 5 mm isotropic margin.

Case Report: MR-Guided Adaptive Radiotherapy, Some Room to Maneuver.

Background: A magnetic resonance linear accelerator (MR-Linac) provides superior soft tissue contrast to evaluate inter- and intra-fraction motion and facilitate online adaptive radiation therapy (ART). We present here an unusual case of locally advanced castrate-resistant prostate cancer treated with high-dose palliative ultra-hypofractionated radiation therapy on the MR-Linac with significant inter-fraction tumor regression.

Case Presentation: The patient was a 65-year-old man diagnosed with metastatic prostate cancer to bone and pelvic lymph nodes 7 years prior.

Dosimetric comparison of MR-guided adaptive IMRT versus 3DOF-VMAT for prostate stereotactic radiotherapy.

Introduction: To compare the dosimetry of prostate stereotactic radiotherapy (SBRT) delivered by adaptive intensity modulated radiotherapy (A-IMRT) and 3 degree of freedom volumetric modulated arc therapy (3DOF-VMAT).

Methods & Materials: Twenty-five prostate patients treated with High Dose Rate (HDR) brachytherapy followed by SBRT were included (fifteen with hydrogel spacer in place for treatment). Interfraction changes in the volume of prostate, rectum and bladder were measured.

MRI-Guided Online Adaptive Stereotactic Body Radiation Therapy of Liver and Pancreas Tumors on an MR-Linac System.

Purpose: To describe a comprehensive workflow for MRI-guided online adaptive stereotactic body radiation therapy (SBRT) specific to upper gastrointestinal cancer patients with abdominal compression on a 1.5T MR-Linac system. Additionally, we discuss the workflow's clinical feasibility and early experience in the case of 16 liver and pancreas patients.

Could knowledge of patient demographics facilitate a personalized approach to radiation therapy patient education?

Introduction: Using patient demographics to tailor cancer patient education processes results in improved patient outcomes. However, there is little information on how to successfully tailor radiation therapy (RT) educational content and delivery. The aim of this quality improvement project was to describe the information preferences of a diverse group of patients undergoing RT and determine if different RT education processes were associated with certain patient demographics.

Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners.

Study Objectives: Obstructive sleep apnea (OSA) is a prevalent and debilitating condition that is significantly underdiagnosed. The majority of adults sleep with someone-a partner. Partners can play a significant role in the patient's OSA diagnosis.

Patient perspectives on frame versus mask immobilization for gamma knife stereotactic radiosurgery.

Purpose: To assess patient experiences and perspectives following Gamma Knife (GK) stereotactic radiosurgery (SRS) using frame versus mask immobilization.

Methods: Patients who received GK-SRS using both frame and mask immobilization were included in this study. One-on-one semi-structured interviews, led by a third-party expert, were used to gain insight into the patient experience.

A Multidisciplinary Approach to Implement Image-Guided Craniospinal Irradiation.

Purpose: Practical considerations dictated a change in the craniospinal irradiation (CSI) technique. We report our experience in developing and refining CSI planning and treatment parameters, using a 3-isocenter image-guided intensity-modulated radiation therapy (IG-IMRT) technique.

Methods And Materials: Two institutional values guided development: multidisciplinary decision-making and coordinated considerations throughout simulation, planning, and delivery.

The Ramanujan conjecture and its applications.

In this paper, we review the Ramanujan conjecture in classical and modern settings and explain its various applications in computer science, including the explicit constructions of the spectrally extremal combinatorial objects, called Ramanujan graphs and Ramanujan complexes, points uniformly distributed on spheres, and Golden-Gate Sets in quantum computing. The connection between Ramanujan graphs/complexes and their zeta functions satisfying the Riemann hypothesis is also discussed. This article is part of a discussion meeting issue 'Srinivasa Ramanujan: in celebration of the centenary of his election as FRS'.

The Effect of Lumpectomy Cavity Changes on Planning Dose in Breast Radiotherapy Boost.

Introduction: The addition of a postoperative tumour bed (cavity) boost after whole-breast radiotherapy (RT) is known to decrease the risk of local in-breast recurrence. The purpose of this retrospective study is to assess breast excision cavity changes and planned doses at the time of initial boost RT treatments after the completion of whole-breast RT.

Methods: Over a 4-month period, women with highly visible cavity on computed tomography (CT) and treated with whole-breast RT followed by a conformal photon boost to the tumour bed were identified.

Impact of Immobilization on Interfractional Errors for Upper Extremity Soft Tissue Sarcoma Radiation Therapy.

Introduction/background: Owing to the rare nature and presentation of upper extremity soft tissue sarcomas (STSs) and the high mobility of associated anatomy, various patient positioning strategies are used for radiation therapy. The purpose of this study is to measure the interfractional setup errors associated with upper extremity sarcomas using different immobilization methods through cone-beam computed tomography (CBCT) images.

Methods: All patients treated with daily CBCT guidance for upper extremity STSs during 2014-2015 were identified and triaged based on type of immobilization.

Impact of a pharmacy-led smoking cessation clinic in a dermatology centre.

Introduction: Cigarette smoking is a leading cause of morbidity and mortality, and has a deleterious effect on dermatological conditions, such as skin cancers, hidradenitis suppurativa and psoriasis. The study aimed to evaluate the efficacy of a pharmacist-led smoking cessation clinic in reducing cigarette smoking at a tertiary referral dermatology centre. We described the impact of this clinic to provide guidance on how such a model could be further improved and implemented more widely.

Evidence-based region of interest matching guidelines for sarcoma volumetric image-guided radiation therapy.

Purpose: Region-of-interest (ROI) guidelines for online cone-beam computed tomography (CBCT) radiotherapy may improve matching reproducibility and reduce inter-user variability of soft tissue sarcoma (STS) image guidance. The purpose of this work is to standardize ROI STS CBCT image registration guidelines using the plan-do-study-act (PDSA) cycle for the lower extremity, retroperitoneal, pelvis, and thorax.

Methods: Based on anatomic bony surrogates, initial ROI matching guidelines for STS were developed by a team of radiation therapists, physicists and oncologists (Plan).