A three-isocenter jagged-junction IMRT approach for craniospinal irradiation without beam edge matching for field junctions.

PURPOSE: Traditionally craniospinal irradiation treats the central nervous system using two or three adjacent field sets. We propose a technique using a three-isocenter intensity-modulated radiotherapy (IMRT) plan (jagged-junction IMRT) which overcomes problems associated with field junctions and beam edge matching and improves planning and treatment setup efficiencies with homogenous target dose distribution. METHODS AND MATERIALS: Treatments for 3 patients with a prescription of 36 Gy in 20 fractions were retrospectively planned with jagged-junction IMRT and compared to conventional treatment plans. Planning target volume (PTV) included the whole brain and spinal canal to the S3 vertebral level. The plan used three field sets, each with a unique isocenter. One field set with seven fields treated the cranium. Two field sets treated the spine, each set using three fields. Fields from adjacent sets were overlapped, and the optimization process smoothly integrated the dose inside the overlapped junction. RESULTS: For jagged-junction IMRT plans vs. conventional technique, the average homogeneity index equaled 0.08 ± 0.01 vs. 0.12 ± 0.02, respectively, and conformity number equaled 0.79 ± 0.01 vs. 0.47 ± 0.12, respectively. The 95% isodose surface covered (99.5 ± 0.3)% of the PTV vs. (98.1 ± 2.0)%, respectively. Both jagged-junction IMRT plans and the conventional plans had good sparing of organs at risk. CONCLUSIONS: Jagged-junction IMRT planning provided good dose homogeneity and conformity to the target while maintaining a low dose to organs at risk. Results from jagged-junction IMRT plans were better than or equivalent to those from the conventional technique. Jagged-junction IMRT optimization smoothly distributed dose in the junction between field sets. Because there was no beam matching, this treatment technique is less likely to produce hot or cold spots at the junction, in contrast to conventional techniques. The planning process is also simplified as only one IMRT plan is required for the entire target volume.

Development of Dual Language Information Cards as a Tool for Communication Between Radiation Therapists and Cantonese-Speaking Patients Undergoing Radiation Treatments for Head-and-Neck Cancer.

The establishment of an effective relationship between patient and provider is dependent upon effective communication. However, this can be difficult to achieve with patients who do not speak English as their first language. Language barriers are associated with adverse effects on quality of care, treatment outcomes, and patient and provider satisfaction. These patients are more likely to experience acute side effects and more likely to use emergency room services for problems that are treatable in primary care settings. Interpreter services and dual language providers are often used to overcome these barriers, but they are often limited by their cost and availability. The radiation therapy environment provides further challenges to overcoming these barriers by virtue of the outpatient setting and high volume of appointments. As part of their efforts to improve patient care, the British Columbia Cancer Agency (BCCA)-Vancouver Centre radiation therapy department introduced dual language cards as a tool to facilitate communication between Cantonese-speaking patients and radiation therapists. This paper outlines the method of devising and evaluating a dual language tool.

The Regulation of Health Professionals: An Overview of the British Columbia Experience.

Although regulation is intended to protect the public interest, it also confers certain advantages to the profession with respect to recognition, credibility, and political influence. As more medical radiation technologists become regulated, it is important to understand and appreciate the purposes of regulation as well as its limitations and its implications for the profession. This paper provides an overview of the regulation of health professionals within Canada, specifically focusing on developments within British Columbia (BC).