Improved planning efficiency in multiple brain lesion SRS VMAT cases using Eclipse scripting.

Though dosimetry has a multitude of treatment modalities, software, and workflows to aid in the treatment planning process, treatment planners are still responsible for several tedious and monotonous tasks that could decrease their planning efficiency. The purpose of this study was to determine if scripting could improve treatment planning efficiency for multiple brain lesion stereotactic radiosurgery (SRS) volumetric arc therapy cases by reducing planning time commitment. A script was developed for multiple brain lesion SRS cases using Eclipse scripting application programming interface with the intention of improving treatment planning efficiency by creating optimization structures and importing prescription and suggested OS dose metrics to the optimizer. Nine treatment planners were each provided with 3 different multiple brain lesion, single-isocenter SRS cases. Each planner created 2 plans for each case. One of these 2 plans used the SRS script, and the other did not. There were 54 treatment plans developed, totaling 27 plan comparisons. Each of the 54 treatment plans were considered clinically acceptable based on the participating institution's plan quality guidelines. Statistical analyses of planning time commitment with and without the SRS script were performed using RStudio. The mean and median planning times with and without the SRS script were compared using a paired T-test and Wilcoxon Signed Rank test, respectively, and effect size was evaluated using Cohen's classification. Using the SRS script resulted in statistically significant reduction in total contouring time (11.3 vs 2.8 minutes, p < 0.001), optimizer preparation time (7.7 vs 2.1 minutes, p < 0.001), and overall planning time (105.1 vs 77.9 minutes, p < 0.001). This study concluded that scripts developed using Eclipse scripting application programming interface offer an opportunity to improve treatment planning efficiency by reducing the planning time commitment for treatment planners.

A case study of radiotherapy treatment for Dupuytren's contracture and Ledderhose disease.

Dupuytren's contracture (DC) and Ledderhose disease (LD) are benign conditions of the fascia in the hands and feet respectively, which result in contracture of the digits. Radiation therapy has been proven effective in treating early-stage DC and LD; however, the problem is that there is a paucity of literature regarding radiation therapy treatment set-up for Dupuytren's and Ledderhose patients. The purpose of this case study was to demonstrate treatment set-up considerations of 6 and 9 MeV for DC and LD cases in radiotherapy (RT). Two patients were selected from the same cancer center, each diagnosed with DC and LD. Treatment plans were established utilizing a clinical set-up, electron dose tables, bolus, and target volumes delineated by the radiation oncologist. For each patient, the radiation oncologist prescribed 2 treatment courses of 300 cGy in 5 fractions per treatment site. The radiation oncologist determined the desired depth of treatment, through the palpation of the nodules, and used electron depth dose tables to determine the energy, isodose lines, and bolus thickness necessary to treat the lesions to the appropriate depth. Doses delivered were verified with metal oxide semiconductor field effect transistors (MOS-FET) in vivo on the first day of treatment for each course. In this case study, researchers demonstrated clinical set-up for 2 patients treated for both DC and LD. The clinical set-up considerations resulted in successful treatment delivery with minor, but acceptable, variations during treatment.

Perceptions of burnout in medical dosimetry within a postpandemic work environment.

According to the World Health Organization, burnout is described as having a negative attitude regarding one's work and being exhausted. Previous studies have shown that occupational burnout exists amongst medical dosimetrists, however, the incidence of medical dosimetrist burnout before and after a pandemic warrant continued research. Medical dosimetrists could be experiencing increased burnout in the workplace postpandemic due to staffing shortages and increased remote planning, which may reduce work performance. The researchers utilized a survey to answer research questions regarding whether staffing shortages or remote planning influenced perceived occupational burnout among medical dosimetrists in a post COVID-19 pandemic environment. The survey was intended to assess levels of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). It was distributed electronically to 2591 certified medical dosimetrists in the United States through the American Association of Medical Dosimetrists (AAMD) membership database. A total of 160 responses were recorded, resulting in a response rate of 6% (160/2591). The results of this study indicated that increased staffing shortages have a direct relationship with increased burnout incidence. Increased remote work appears to be inversely related to the incidence of burnout among medical dosimetrists.

Analyzing changes in radiotherapy treatment planning error reporting during the COVID-19 pandemic.

The 2019 coronavirus (COVID-19) pandemic has affected medical physics and radiation oncology departments and the delivery of radiation therapy. Among the changes implemented in response to the onset of the pandemic was a shift to remote treatment planning by health care institutions. The purpose of this study was to determine whether the overall frequency of errors changed after the implementation of remote radiation therapy treatment planning during the COVID-19 pandemic. Reported incidents were obtained from an incident reporting database operated by a multisite cancer care facility in the Northeast. Researchers compared the frequency of reported events in a period prior to the start of the pandemic (March 2019 to February 2020) with a period after the onset of the pandemic (March 2020 to February 2021). No significant increase in reported incidents was detected suggesting the efficiency and safety of remote radiotherapy treatment planning.

Practical Implementation of Emergent After-Hours Radiation Treatment Process Using Remote Treatment Planning on Optimized Diagnostic CT Scans.

The purpose of this report is to present the implementation of a process for after-hours radiation treatment (RT) utilizing remote treatment planning based on optimized diagnostic computed tomography (CT) scans for the urgent palliative treatment of inpatients. A standardized operating procedure was developed by an interprofessional panel to improve the quality of after-hours RT and minimize the risk of treatment errors. A new diagnostic CT protocol was created that could be performed after-hours on hospital scanners and would ensure a reproducible patient position and adequate field of view. An on-call structure for dosimetry staff was created utilizing remote treatment planning. The optimized CT protocol was developed in collaboration with the radiology department, and a novel order set was created in the electronic health system. The clinical workflow begins with the radiation oncologist notifying the on-call team (therapist, dosimetrist, and physicist) and obtaining an optimized diagnostic CT scan on a hospital-based scanner. The dosimetrist remotely creates a plan; the physicist checks the plan; and the patient is treated. Plans are intentionally simple (parallel opposed fields, symmetric jaws) to expedite care and reduce the risk of error. Education on the new process was provided for all relevant staff. Our process was successfully implemented with the use of an optimized CT protocol and remote treatment planning. This approach has the potential to improve the quality and safety of emergent after-hours RT by better approximating the normal process of care.

Incidence of work related musculoskeletal disorders in medical dosimetry.

Musculoskeletal disorders (MSDs) account for almost 70 million physician office visits per year in the United States and are the most common workplace injuries. These are conditions involving the nerves, tendons, muscles, and supporting structures of the body. Previous studies have concluded that computer users are at high risk of developing work-related musculoskeletal disorders (WRMSDs). As computer users, medical dosimetrists are at risk of developing WRMSDs, yet there is a lack of information regarding the incidence of WRMSDs among medical dosimetrists. The purpose of this study was to determine the incidence of WRMSDs and variables of workstation ergonomics that contribute to the increased risk of WRMSDs in medical dosimetrists. A Qualtrics survey was created to support the 3 research questions guiding this study. The survey was distributed to 2,646 full members of the American Association of Medical Dosimetrists (AAMD), which included only certified medical dosimetrists (CMDs), via email. The distribution of email surveys sent through the AAMD email distribution list resulted in 988 emails opened, for a contact rate of 37% (988/2646). One hundred sixty-four responses were recorded yielding a completion rate of 17% (164/988). Fifty-five percent (90/163) of participants responded that they have experienced WRMSDs. Forty-four percent (289/652) of responses indicated WRMSDs have a slight or moderate interference on work. Sixty-two percent (94/152) of participants felt that their workstations were not ergonomically designed; even greater 68% (104/153) did not feel their workstations were designed for their individually needs. Of those respondents 64% (98/152) would like to see further adaptations made to their workspaces.

Minimizing clearance issues with prone breast patients on Varian linear accelerators through isocenter placement.

The prone position is frequently used for breast irradiation in an effort to minimize dose to normal tissue and reduce skin toxicities. Immobilization required for prone breast irradiation can cause collision issues with the linear accelerator, disrupting treatment and negatively affecting the patient experience. The purpose of this retrospective study was to determine if an isocenter location guideline could be developed to prevent collisions with the prone breast immobilization device and gantry head, while still creating a clinically acceptable treatment plan. Clearance isocenter guidelines were established by measuring clearance between the Civco Horizon breast board and Varian linear accelerator. Fourteen patients with known clearance issues at a single institution were selected for this study and re-planned using clearance isocenter guidelines. Collision plans were compared to clearance plans created within the established clearance threshold through the institutions breast treatment guidelines based on arm II of the Radiation Therapy Oncology Group (RTOG) 1005 recommendations. Researchers in this study demonstrated clinical relevance by establishing that a clearance isocenter location guideline can be developed to prevent collisions with the prone breast immobilization and gantry head, while still creating a clinically acceptable treatment plan.

A case study of evaluating bilateral lung dose for VMAT treatment planning using a partial sagittal arc.

Radiation pneumonitis (RP) is a potential toxic side effect of thoracic radiotherapy. Optimal planning techniques must maintain tumor coverage while limiting dose to normal lung tissue to reduce the risk of patients developing RP. The addition of a noncoplanar arc may be beneficial by increasing treatment angles and providing an ideal dose distribution for tumor coverage while decreasing dose to organs at risk (OAR). The purpose of this research was to compare the effects on the normal bilateral lung tissue receiving 20 Gy, 10 Gy and 5 Gy (V20, V10, V5) and the mean lung dose (MLD) values when medial lung tumors are treated with 3 partial coplanar arcs vs 2 partial coplanar arcs combined with a partial sagittal arc. Researchers hypothesized that a beam arrangement of 2 partial coplanar arcs and 1 partial sagittal arc would reduce V20, V10, V5, and MLD values when compared to a 3 partial coplanar arc plan. In a retrospective study of 5 patients with bulky, medial right lung lesions without nodal involvement, cases were planned with both a noncoplanar and a coplanar arc geometry. Results were evaluated using a two-tailed t-test to determine the statistical significance (p < 0.05) of changes to total lung volume analyzation metrics when a noncoplanar sagittal arc was incorporated compared to the standard lung treatment using only coplanar arcs. Although some patient cases showed minor improvement in the V20, V10, V5, and MLD metrics, the study results were not statistically significant and showed no advantage with the introduction of an anterior sagittal arc over a coplanar beam arrangement.