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5.
JCO Clin Cancer Inform ; 8: e2300174, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38870441

ABSTRACT

PURPOSE: The quality of radiotherapy auto-segmentation training data, primarily derived from clinician observers, is of utmost importance. However, the factors influencing the quality of clinician-derived segmentations are poorly understood; our study aims to quantify these factors. METHODS: Organ at risk (OAR) and tumor-related segmentations provided by radiation oncologists from the Contouring Collaborative for Consensus in Radiation Oncology data set were used. Segmentations were derived from five disease sites: breast, sarcoma, head and neck (H&N), gynecologic (GYN), and GI. Segmentation quality was determined on a structure-by-structure basis by comparing the observer segmentations with an expert-derived consensus, which served as a reference standard benchmark. The Dice similarity coefficient (DSC) was primarily used as a metric for the comparisons. DSC was stratified into binary groups on the basis of structure-specific expert-derived interobserver variability (IOV) cutoffs. Generalized linear mixed-effects models using Bayesian estimation were used to investigate the association between demographic variables and the binarized DSC for each disease site. Variables with a highest density interval excluding zero were considered to substantially affect the outcome measure. RESULTS: Five hundred seventy-four, 110, 452, 112, and 48 segmentations were used for the breast, sarcoma, H&N, GYN, and GI cases, respectively. The median percentage of segmentations that crossed the expert DSC IOV cutoff when stratified by structure type was 55% and 31% for OARs and tumors, respectively. Regression analysis revealed that the structure being tumor-related had a substantial negative impact on binarized DSC for the breast, sarcoma, H&N, and GI cases. There were no recurring relationships between segmentation quality and demographic variables across the cases, with most variables demonstrating large standard deviations. CONCLUSION: Our study highlights substantial uncertainty surrounding conventionally presumed factors influencing segmentation quality relative to benchmarks.


Subject(s)
Bayes Theorem , Benchmarking , Radiation Oncologists , Humans , Benchmarking/methods , Female , Radiotherapy Planning, Computer-Assisted/methods , Neoplasms/epidemiology , Neoplasms/radiotherapy , Organs at Risk , Male , Radiation Oncology/standards , Radiation Oncology/methods , Demography , Observer Variation
6.
JAMA Netw Open ; 7(6): e2416570, 2024 Jun 03.
Article in English | MEDLINE | ID: mdl-38865123

ABSTRACT

Importance: Patients of Memorial Sloan Kettering Cancer Center in New York, New York, are now offered a choice of either in-person or remote telehealth visits for radiation oncology care. However, safety and satisfaction among patients receiving treatment with fully remote physician management is unclear. Objective: To analyze patient safety and satisfaction, financial implications, and environmental consequences associated with fully remote management among a cohort of patients treated with radiotherapy. Design, Setting, and Participants: This single-institution retrospective cohort study was performed at Memorial Sloan Kettering Cancer Center, with patients treated with radiation who opted for fully remote management between October 1, 2020, and October 31, 2022. Data on patient safety events were prospectively collected with an in-house quality improvement reporting system. Patient satisfaction surveys were distributed electronically before, during, and after treatment. Patient transportation costs and environmental consequences were estimated based on differences in travel distance. Data analysis was performed from March 14 through September 19, 2023. Exposure: Radiotherapy with fully remote physician management. Main Outcomes and Measures: Satisfaction rates among patients opting for fully remote management were analyzed via surveys administered electronically after visits with clinicians. Patient safety events, defined as staff-reported actual events and near misses that had the potential to affect patient care, were reviewed. Rates and types of safety events were analyzed and compared with patients treated by onsite clinicians. Distances between patient home zip codes and treatment site locations were compared with estimated cost savings and decreased emissions. Results: This study included 2817 patients who received radiation oncology care with fully remote physician management. The median age of patients was 65 (range, 9-99) years, and more than half were men (1467 [52.1%]). Of the 764 safety events reported, 763 (99.9%) did not reach patients or caused no harm to patients. Nearly all survey respondents (451 [97.6%]) rated patient satisfaction as good to very good across all domains. For treatment with fully remote physician management, out-of-pocket cost savings totaled $612 912.71 ($466.45 per patient) and decreased carbon dioxide emissions by 174 metric tons. Conclusions and Relevance: In this study, radiation oncology care provided by fully remote clinicians was safe and feasible, with no serious patient events. High patient satisfaction, substantial cost savings, and decreased environmental consequences were observed. These findings support the continuation of a fully remote management option for select patients in the post-COVID-19 era.


Subject(s)
Patient Safety , Patient Satisfaction , Radiation Oncology , Telemedicine , Humans , Patient Satisfaction/statistics & numerical data , Retrospective Studies , Male , Middle Aged , Female , Aged , Adult , Neoplasms/radiotherapy , New York
7.
JAMA Netw Open ; 7(6): e2416359, 2024 Jun 03.
Article in English | MEDLINE | ID: mdl-38865128

ABSTRACT

Importance: Insurance barriers to cancer care can cause significant patient and clinician burden. Objective: To investigate the association of insurance denial with changes in technique, dose, and time to delivery of radiation oncology treatment. Design, Setting, and Participants: In this single-institution cohort analysis, data were collected from patients with payer-denied authorization for radiation therapy (RT) from November 1, 2021, to December 8, 2022. Data were analyzed from December 15, 2022, to December 31, 2023. Exposure: Insurance denial for RT. Main Outcomes and Measures: Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2 tests. Results: A total of 206 cases (118 women [57.3%]; median age, 58 [range, 26-91] years) were identified. Most insurers (199 [96.6%]) were commercial payers, while 7 (3.4%) were Medicare or Medicare Advantage. One hundred sixty-one patients (78.2%) were younger than 65 years. Of 206 cases, 127 (61.7%) were ultimately authorized without any change to the requested RT technique or prescription dose; 56 (27.2%) were authorized after modification to RT technique and/or prescription dose required by the payer. Of 21 cases with required prescription dose change, the median decrease in dose was 24.0 (range, 2.3-51.0) Gy. Of 202 cases (98.1%) with RT delivered, 72 (34.9%) were delayed for a mean (SD) of 7.8 (9.1) days and median of 5 (range, 1-49) days. Four cases (1.9%) ultimately did not receive any authorization, with 3 (1.5%) not undergoing RT, and 1 (0.5%) seeking treatment at another institution. Conclusions and Relevance: In this cohort study of patients with payer-denied cases, most insurance denials in radiation oncology were ultimately approved on appeal; however, RT technique and/or effectiveness may be compromised by payer-mandated changes. Further investigation and action to recognize the time and financial burdens on clinicians and clinical effects on patients caused by insurance denials of RT is needed.


Subject(s)
Radiation Oncology , Humans , Female , Middle Aged , Male , Aged , Adult , Aged, 80 and over , Radiation Oncology/economics , United States , Insurance, Health/statistics & numerical data , Neoplasms/radiotherapy , Neoplasms/economics , Academic Medical Centers , Cohort Studies
8.
Front Public Health ; 12: 1351367, 2024.
Article in English | MEDLINE | ID: mdl-38873320

ABSTRACT

Objective: This research investigates the role of human factors of all hierarchical levels in radiotherapy safety incidents and examines their interconnections. Methods: Utilizing the human factor analysis and classification system (HFACS) and Bayesian network (BN) methodologies, we created a BN-HFACS model to comprehensively analyze human factors, integrating the hierarchical structure. We examined 81 radiotherapy incidents from the radiation oncology incident learning system (RO-ILS), conducting a qualitative analysis using HFACS. Subsequently, parametric learning was applied to the derived data, and the prior probabilities of human factors were calculated at each BN-HFACS model level. Finally, a sensitivity analysis was conducted to identify the human factors with the greatest influence on unsafe acts. Results: The majority of safety incidents reported on RO-ILS were traced back to the treatment planning phase, with skill errors and habitual violations being the primary unsafe acts causing these incidents. The sensitivity analysis highlighted that the condition of the operators, personnel factors, and environmental factors significantly influenced the occurrence of incidents. Additionally, it underscored the importance of organizational climate and organizational process in triggering unsafe acts. Conclusion: Our findings suggest a strong association between upper-level human factors and unsafe acts among radiotherapy incidents in RO-ILS. To enhance radiation therapy safety and reduce incidents, interventions targeting these key factors are recommended.


Subject(s)
Bayes Theorem , Radiotherapy , Humans , Radiotherapy/adverse effects , Radiotherapy/statistics & numerical data , Patient Safety/statistics & numerical data , Medical Errors/statistics & numerical data , Safety Management , Radiation Oncology , Factor Analysis, Statistical
10.
Semin Radiat Oncol ; 34(3): 351-364, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38880544

ABSTRACT

The "FLASH effect" is an increased therapeutic index, that is, reduced normal tissue toxicity for a given degree of anti-cancer efficacy, produced by ultra-rapid irradiation delivered on time scales orders of magnitude shorter than currently conventional in the clinic for the same doses. This phenomenon has been observed in numerous preclinical in vivo tumor and normal tissue models. While the underlying biological mechanism(s) remain to be elucidated, a path to clinical implementation of FLASH can be paved by addressing several critical translational questions. Technological questions pertinent to each beam type (eg, electron, proton, photon) also dictate the logical progression of experimentation required to move forward in safe and decisive clinical trials. Here we review the available preclinical data pertaining to these questions and how they may inform strategies for FLASH cancer therapy clinical trials.


Subject(s)
Neoplasms , Translational Research, Biomedical , Humans , Neoplasms/radiotherapy , Animals , Radiation Oncology/methods , Clinical Trials as Topic
11.
Semin Radiat Oncol ; 34(3): 302-309, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38880539

ABSTRACT

Spatially fractionated radiation therapy (SFRT), also known as the GRID and LATTICE radiotherapy (GRT, LRT), the concept of treating tumors by delivering a spatially modulated dose with highly non-uniform dose distributions, is a treatment modality of growing interest in radiation oncology, physics, and radiation biology. Clinical experience in SFRT has suggested that GRID and LATTICE therapy can achieve a high response and low toxicity in the treatment of refractory and bulky tumors. Limited initially to GRID therapy using block collimators, advanced, and versatile multi-leaf collimators, volumetric modulated arc technologies and particle therapy have since increased the capabilities and individualization of SFRT and expanded the clinical investigation of SFRT to various dosing regimens, multiple malignancies, tumor types and sites. As a 3D modulation approach outgrown from traditional 2D GRID, LATTICE therapy aims to reconfigure the traditional SFRT as spatial modulation of the radiation is confined solely to the tumor volume. The distinctively different beam geometries used in LATTICE therapy have led to appreciable variations in dose-volume distributions, compared to GRID therapy. The clinical relevance of the variations in dose-volume distribution between LATTICE and traditional GRID therapies is a crucial factor in determining their adoption in clinical practice. In this Point-Counterpoint contribution, the authors debate the pros and cons of GRID and LATTICE therapy. Both modalities have been used in clinics and their applicability and optimal use have been discussed in this article.


Subject(s)
Dose Fractionation, Radiation , Neoplasms , Radiotherapy, Intensity-Modulated , Humans , Neoplasms/radiotherapy , Radiotherapy, Intensity-Modulated/methods , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy Dosage , Radiation Oncology/methods
12.
Lancet Oncol ; 25(6): e270-e280, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38821101

ABSTRACT

Although radiotherapy continues to evolve as a mainstay of the oncological armamentarium, research and innovation in radiotherapy in low-income and middle-income countries (LMICs) faces challenges. This third Series paper examines the current state of LMIC radiotherapy research and provides new data from a 2022 survey undertaken by the International Atomic Energy Agency and new data on funding. In the context of LMIC-related challenges and impediments, we explore several developments and advances-such as deep phenotyping, real-time targeting, and artificial intelligence-to flag specific opportunities with applicability and relevance for resource-constrained settings. Given the pressing nature of cancer in LMICs, we also highlight some best practices and address the broader need to develop the research workforce of the future. This Series paper thereby serves as a resource for radiation professionals.


Subject(s)
Developing Countries , Neoplasms , Radiation Oncology , Humans , Developing Countries/economics , Neoplasms/radiotherapy , Radiation Oncology/economics , Biomedical Research/economics , Radiotherapy/economics , Poverty
13.
Strahlenther Onkol ; 200(Suppl 1): 1-204, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38801449
14.
Med Phys ; 51(6): 4447-4457, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38709978

ABSTRACT

BACKGROUND: The use of Computed Tomography (CT) imaging data to create 3D printable patient-specific devices for radiation oncology purposes is already well established in the literature and has shown to have superior conformity than conventional methods. Using non-ionizing radiation imaging techniques such as photogrammetry or laser scanners in-lieu of a CT scanner presents many desirable benefits including reduced imaging dose and fabrication of the device can be completed prior to simulation. With recent advancements in smartphone-based technology, photographic and LiDAR-based technologies are more readily available than ever before and to a high level of quality. As a result, these non-ionizing radiation imaging methods are now able to generate patient-specific devices that can be acceptable for clinical use. PURPOSE: In this work, we aim to determine if smartphones can be used by radiation oncologists or other radiation oncology staff to generate bolus or brachytherapy surface moulds instead of conventional CT with equivalent or comparable accuracy. METHODS: This work involved two separate studies: a phantom and participant study. For the phantom study, a RANDO anthropomorphic phantom (limited to the nose region) was used to generate 3D models based on three different imaging techniques: conventional CT, photogrammetry & LiDAR which were both acquired on a smartphone. Virtual boli were designed in Blender and 3D printed from PLA plastic material. The conformity of each printed boli was assessed by measuring the air gap volume and approximate thickness between the phantom & bolus acquired together on a CT. For the participant study, photographs, and a LiDAR scan of four volunteers were captured using an iPhone 13 Pro™ to assess their feasibility for generating human models. Each virtual 3D model was visually assessed to identify any issues in their reconstruction. The LiDAR models were registered to the photogrammetry models where a distance to agreement analysis was performed to assess their level of similarity. Additionally, a 3D virtual bolus was designed and printed using ABS material from all models to assess their conformity onto the participants skin surface using a verbal feedback method. RESULTS: The photogrammetry derived bolus showed comparable conformity to the CT derived bolus while the LiDAR derived bolus showed poorer conformity as shown by their respective air gap volume and thickness measurements. The reconstruction quality of both the photogrammetry and LiDAR models of the volunteers was inadequate in regions of facial hair and occlusion, which may lead to clinically unacceptable patient-specific device that are created from these areas. All participants found the photogrammetry 3D printed bolus to conform to their nose region with minimal room to move while three of the four participants found the LiDAR was acceptable and could be positioned comfortably over their entire nose. CONCLUSIONS: Smartphone-based photogrammetry and LiDAR software show great potential for future use in generating 3D reference models for radiation oncology purposes. Further investigations into whether they can be used to fabricate clinically acceptable patient-specific devices on a larger and more diverse cohort of participants and anatomical locations is required for a thorough validation of their clinical usefulness.


Subject(s)
Radiation Oncology , Smartphone , Radiation Oncology/instrumentation , Humans , Phantoms, Imaging , Printing, Three-Dimensional , Brachytherapy/instrumentation , Tomography, X-Ray Computed/instrumentation
15.
J Appl Clin Med Phys ; 25(6): e14359, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38689502

ABSTRACT

PURPOSE: AAPM Task Group No. 263U1 (Update to Report No. 263 - Standardizing Nomenclatures in Radiation Oncology) disseminated a survey to receive feedback on utilization, gaps, and means to facilitate further adoption. METHODS: The survey was created by TG-263U1 members to solicit feedback from physicists, dosimetrists, and physicians working in radiation oncology. Questions on the adoption of the TG-263 standard were coupled with demographic information, such as clinical role, place of primary employment (e.g., private hospital, academic center), and size of institution. The survey was emailed to all AAPM, AAMD, and ASTRO members. RESULTS: The survey received 463 responses with 310 completed survey responses used for analysis, of whom most had the clinical role of medical physicist (73%) and the majority were from the United States (83%). There were 83% of respondents who indicated that they believe that having a nomenclature standard is important or very important and 61% had adopted all or portions of TG-263 in their clinics. For those yet to adopt TG-263, the staffing and implementation efforts were the main cause for delaying adoption. Fewer respondents had trouble adopting TG-263 for organs at risk (29%) versus target (44%) nomenclature. Common themes in written feedback were lack of physician support and available resources, especially in vendor systems, to facilitate adoption. CONCLUSIONS: While there is strong support and belief in the benefit of standardized nomenclature, the widespread adoption of TG-263 has been hindered by the effort needed by staff for implementation.  Feedback from the survey is being utilized to drive the focus of the update efforts and create tools to facilitate easier adoption of TG-263.


Subject(s)
Radiation Oncology , Terminology as Topic , Humans , Radiation Oncology/standards , Surveys and Questionnaires , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy Planning, Computer-Assisted/standards , Neoplasms/radiotherapy , Organs at Risk/radiation effects , Practice Guidelines as Topic , Perception
16.
JCO Glob Oncol ; 10: e2300462, 2024 May.
Article in English | MEDLINE | ID: mdl-38723217

ABSTRACT

PURPOSE: Radiation oncology in the Philippines, a large lower- and middle-income country in Southeast Asia, is facing a critical shortage in manpower, with only 113 radiation oncologists (ROs) over 55 radiotherapy (RT) centers serving 100 million population. Paramount to workforce expansion is ensuring that training programs can produce adequately trained specialists. In this study, we describe the current state of radiation oncology training programs in the Philippines. METHODS: This is a cross-sectional observational analysis of the nine radiation oncology residency training programs in the Philippines. Data were collected from a survey of the program directors, the Philippine Radiation Oncology Society database, and a PubMed literature search. RESULTS: Eight of the nine programs are in the National Capital Region. Since program standardization in 2005, there have been 82 four-year residency graduates, with up to 18 new graduates annually. Faculty-to-trainee ratio ranges from 0.5 to 2.67. In terms of technology, all programs have intensity-modulated RT and high-dose-rate brachytherapy, but only six are equipped with computed tomography-based image guidance and stereotactic capabilities. Clinical education schemes vary per institution regarding curriculum implementation, resident activities, and methods of evaluation. Required resident case logs are not met for lung, GI, genitourinary, bone and soft tissue, and hematologic malignancies. In total, there are only 22 resident-led publications from 10 unique individuals in two training programs. CONCLUSION: Program expansions are warranted to meet the projected demand for ROs in the Philippines, but training programs must first improve key aspects of staffing, technology, clinical education, and research. Addressing training challenges related to resource limitations necessitates local and international collaborations with higher-capacity centers to bridge gaps for continued quality improvement with the aim of ultimately delivering better overall cancer care.


Subject(s)
Developing Countries , Radiation Oncology , Philippines , Humans , Radiation Oncology/education , Cross-Sectional Studies , Neoplasms/radiotherapy , Internship and Residency/statistics & numerical data
17.
Radiat Oncol ; 19(1): 60, 2024 May 21.
Article in English | MEDLINE | ID: mdl-38773605

ABSTRACT

BACKGROUND: The brachytherapy is an indispensable treatment for gynecological tumors, but the quality and efficiency of brachytherapy training for residents is still unclear. METHODS: An anonymous questionnaire was designed to collect information on gynecological brachytherapy (GBT) training for radiation oncology residents from 28 training bases in China. The questionnaire content was designed based on the principle of competency based medical education (CBME). The Likert scale was employed to evaluate self-reported competence and comprehension regarding GBT. A total of 132 senior residents were included in the final analysis. RESULTS: 53.79% (71/132) of senior residents had experience in performing image-guided GBT, whereas 76.52% (101/132) had observed the procedure during their standardized residency training. The proportion of senior residents who reported having the self-reported competence to independently complete the GBT was 78.03% for intracavity GBT, 75.00% for vaginal stump GBT, and 50.03% for interstitial GBT, respectively. The number of successful completion of Interstitial, intracavity and vaginal GBT was correlated with the self- confidence of trainees after standardized training. In particular, the independent completion of interstitial GBT for more than 20 cases was an independent factor for the self-reported competence of senior residents. During the training period, 50.76% and 56.82% of the residents had not participated in the specialized examinations and professional GBT courses. CONCLUSIONS: The study revealed that the self-confidence of residents to independently complete brachytherapy was relatively high, and the specialized curriculum setting and training process assessment for brachytherapy training still need to be strengthened in the future.


Subject(s)
Brachytherapy , Clinical Competence , Genital Neoplasms, Female , Internship and Residency , Radiation Oncology , Humans , Brachytherapy/methods , Female , China , Surveys and Questionnaires , Genital Neoplasms, Female/radiotherapy , Radiation Oncology/education , Adult , Male
18.
Radiat Oncol ; 19(1): 61, 2024 May 21.
Article in English | MEDLINE | ID: mdl-38773620

ABSTRACT

PURPOSE: Accurate deformable registration of magnetic resonance imaging (MRI) scans containing pathologies is challenging due to changes in tissue appearance. In this paper, we developed a novel automated three-dimensional (3D) convolutional U-Net based deformable image registration (ConvUNet-DIR) method using unsupervised learning to establish correspondence between baseline pre-operative and follow-up MRI scans of patients with brain glioma. METHODS: This study involved multi-parametric brain MRI scans (T1, T1-contrast enhanced, T2, FLAIR) acquired at pre-operative and follow-up time for 160 patients diagnosed with glioma, representing the BraTS-Reg 2022 challenge dataset. ConvUNet-DIR, a deep learning-based deformable registration workflow using 3D U-Net style architecture as a core, was developed to establish correspondence between the MRI scans. The workflow consists of three components: (1) the U-Net learns features from pairs of MRI scans and estimates a mapping between them, (2) the grid generator computes the sampling grid based on the derived transformation parameters, and (3) the spatial transformation layer generates a warped image by applying the sampling operation using interpolation. A similarity measure was used as a loss function for the network with a regularization parameter limiting the deformation. The model was trained via unsupervised learning using pairs of MRI scans on a training data set (n = 102) and validated on a validation data set (n = 26) to assess its generalizability. Its performance was evaluated on a test set (n = 32) by computing the Dice score and structural similarity index (SSIM) quantitative metrics. The model's performance also was compared with the baseline state-of-the-art VoxelMorph (VM1 and VM2) learning-based algorithms. RESULTS: The ConvUNet-DIR model showed promising competency in performing accurate 3D deformable registration. It achieved a mean Dice score of 0.975 ± 0.003 and SSIM of 0.908 ± 0.011 on the test set (n = 32). Experimental results also demonstrated that ConvUNet-DIR outperformed the VoxelMorph algorithms concerning Dice (VM1: 0.969 ± 0.006 and VM2: 0.957 ± 0.008) and SSIM (VM1: 0.893 ± 0.012 and VM2: 0.857 ± 0.017) metrics. The time required to perform a registration for a pair of MRI scans is about 1 s on the CPU. CONCLUSIONS: The developed deep learning-based model can perform an end-to-end deformable registration of a pair of 3D MRI scans for glioma patients without human intervention. The model could provide accurate, efficient, and robust deformable registration without needing pre-alignment and labeling. It outperformed the state-of-the-art VoxelMorph learning-based deformable registration algorithms and other supervised/unsupervised deep learning-based methods reported in the literature.


Subject(s)
Brain Neoplasms , Deep Learning , Glioma , Magnetic Resonance Imaging , Unsupervised Machine Learning , Humans , Magnetic Resonance Imaging/methods , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/radiotherapy , Glioma/diagnostic imaging , Glioma/radiotherapy , Glioma/pathology , Radiation Oncology/methods , Image Processing, Computer-Assisted/methods , Imaging, Three-Dimensional/methods
19.
Rev Med Liege ; 79(S1): 4-8, 2024 May.
Article in French | MEDLINE | ID: mdl-38778642

ABSTRACT

Clinical research is summarizing scientific trials performed in human aiming to improve biological and medical knowledges. The management of such an activity has to be conducted in a secured environment in terms of expertise, competency and professionalism of involved actors. In the field of cancer, multidisciplinarity is key in the treatment of malignant disease and plays a major role sequentially or concomitantly. In the 90s, clinical research in radiation oncology obtained historical successes, which remain validated guidelines for national societies in a significant number of clinical situations. They concern not only technological improvements but also combined modality treatments with chemotherapy, hormonal therapy and potentially new targeted agents. Radiotherapy, in a palliative or in a curative setting, benefited from dramatic technological improvements aiming to address patient quality of life after radiation therapy. Actually, the emergence of artificial intelligence is willing to modify our current practice historically based on old concepts of clinical evaluation.


La recherche clinique correspond aux études scientifiques réalisées sur la personne humaine en vue du développement des connaissances biologiques et médicales. Sa conduite doit désormais être assurée dans des environnements garantissant l'expertise, la compétence et le professionnalisme des acteurs impliqués. Dans le traitement du cancer, la pluridisciplinarité, garante de la meilleure prise en charge des tumeurs malignes, fait intervenir, de manière séquentielle ou concomitante, de nombreuses spécialités. La recherche clinique en oncologie-radiothérapie a permis d'obtenir des acquis historiques qui restent, dans leur grande majorité, des référentiels de la prise en charge de la maladie reconnus par les sociétés nationales. Elles portent sur la validation des acquis technologiques, mais également sur des associations avec la chimiothérapie, l'hormonothérapie et, demain, les nouveaux agents de thérapie ciblée. La radiothérapie à visée palliative ou curative a considérablement bénéficié des évolutions technologiques et informatiques pour améliorer la qualité de vie des patients après traitement. L'émergence de l'intelligence artificielle permet d'envisager d'améliorer les pratiques basées sur une appréciation du bénéfice-risque. On peut espérer que l'intelligence artificielle devienne supérieure à l'appréciation clinique établie sur les anciens critères retenus au cours de l'histoire.


Subject(s)
Biomedical Research , Radiation Oncology , Humans , Neoplasms/radiotherapy , Neoplasms/therapy
20.
Rev Med Liege ; 79(S1): 107-112, 2024 May.
Article in French | MEDLINE | ID: mdl-38778657

ABSTRACT

INTRODUCTION: The promotion of diversity, equity and inclusion (DEI) is increasingly sought after in healthcare, which is why we wanted to draw up a picture of DEI in radiation oncology and give some ideas on how to contribute to its dissemination. METHOD: This article proposes a non-exhaustive review of the international literature on DEI in radiation oncology, both among health professionals and patients. In addition, this review identifies some implicit cognitive biases and proposes strategies to address them. RESULTS: Most of the proposed publications identify a lack of DEI among radiation oncology staff and document inequities in access to high-quality radiotherapy affecting patients belonging to minority groups. CONCLUSION: Significant disparities exist between genders and ethnic groups within the radiotherapy teams, and in the radiotherapy treatment of patients. Nevertheless, DEI is gaining importance, and a range of initiatives and instruments are being developed to address these disparities.


INTRODUCTION: La promotion de l'équité, de la diversité et de l'inclusion (EDI) est de plus en plus recherchée dans les soins de santé, raison pour laquelle nous avons voulu dresser un tableau de l'EDI en radiothérapie et donner des pistes pour contribuer à sa diffusion. Méthode : Cet article propose une revue non exhaustive de la littérature internationale sur l'EDI en radiothérapie, tant chez les professionnels de la santé que chez les patients. En outre, cette revue relève des biais cognitifs implicites et propose des stratégies pour y remédier. Résultats : La majorité des publications proposées identifient un manque d'EDI parmi les professionnels en radiothérapie, et documentent également des iniquités dans l'accès à une radiothérapie de haute qualité touchant les patients issus de groupes minoritaires. CONCLUSION: D'importantes disparités existent entre genres et groupes ethniques au sein des équipes de radiothérapie ainsi que dans le traitement des patients par radiothérapie. Néanmoins, l'EDI gagne en importance et toute une série d'initiatives et d'instruments pour remédier à ces disparités se développent.


Subject(s)
Cultural Diversity , Radiation Oncology , Humans , Healthcare Disparities , Social Inclusion , Minority Groups
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