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1.
Int J Radiat Oncol Biol Phys ; 106(3): 639-647, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31983560

RESUMO

PURPOSE: We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. METHODS AND MATERIALS: State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. RESULTS: Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. CONCLUSIONS: The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.


Assuntos
Institutos de Câncer/normas , Hospitais de Veteranos/normas , Desenvolvimento de Programas , Garantia da Qualidade dos Cuidados de Saúde/normas , Radioterapia (Especialidade)/normas , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Medicina Baseada em Evidências/normas , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Revisão por Pares , Avaliação de Programas e Projetos de Saúde/normas , Neoplasias da Próstata/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Carcinoma de Pequenas Células do Pulmão/radioterapia , Sociedades Médicas/normas , Estados Unidos , Veteranos
2.
Int J Radiat Oncol Biol Phys ; 106(1): 32-36, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31647968

RESUMO

PURPOSE: Radiation treatment planning (RTP) is a unique skill that requires interdisciplinary collaboration among radiation oncologists (ROs), dosimetrists, and medical physicists (MP) to train and assess residents. With the adoption of competency-based medical education (CBME) in Canada, it is essential residency program curricula focuses on developing competencies in RTP to facilitate entrustment. Our study investigates how radiation oncology team members' perspectives on RTP education align with requirements of the CBME approach, and its implications for improving residency training. METHODS AND MATERIALS: This qualitative research study took place in the Department of Oncology at a midsize academic institution. Through convenience sampling, focus groups were conducted with radiation oncologists (n = 11), dosimetrists (n = 7), medical physicists (n = 7), and residents (n = 7). Thematic design was adopted to analyze the transcripts through open coding resulting in 3 overarching themes. RESULTS: The results identified existing strengths and weaknesses of the residency program and future opportunities to redesign the curriculum and assessment process within a CBME model. Three overarching themes emerged from the analysis: (1) the strengths of RTP in the CBME environment; (2) challenges of RTP in CBME; and (3) opportunities for change. Stakeholders were optimistic CBME will help enrich resident learning with the increased frequency and quality of competency-based assessments. Participants suggested building a library of cases and developing computer-based learning resources to provide a safe environment to develop skills in contouring, dosimetry, and plan evaluation, in accordance with CBME training. CONCLUSIONS: This study identified future opportunities to redesign the RTP curriculum and assessment process within a CBME model. The need for innovative teaching and learning strategies, including case libraries, computer-based learning, and quality assessments, were highlighted in designing an innovative RTP planning curriculum.


Assuntos
Competência Clínica , Educação Baseada em Competências , Internato e Residência , Radioterapia (Especialidade)/educação , Planejamento da Radioterapia Assistida por Computador , Canadá , Competência Clínica/normas , Educação Baseada em Competências/normas , Grupos Focais , Previsões , Humanos , Internato e Residência/normas , Cultura Organizacional , Pesquisa Qualitativa , Radio-Oncologistas , Radioterapia (Especialidade)/normas , Ensino/organização & administração , Carga de Trabalho
4.
J Urol ; 202(3): 533-538, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31042111

RESUMO

PURPOSE: The purpose of this amendment is to incorporate newly-published literature into the original ASTRO/AUA Adjuvant and Salvage Radiotherapy after Prostatectomy Guideline and to provide an updated clinical framework for clinicians. MATERIALS AND METHODS: The original systematic review yielded 294 studies published between January 1990 and December 2012. In April 2018, the guideline underwent an amendment and incorporated 155 references that were published from January 1990 through December 2017. Two new key questions were added. One on the use of genomic classifiers and the other on the treatment of oligo-metastases with radiation post-radical prostatectomy. RESULTS: A new statement on the use of hormone therapy with salvage radiotherapy after radical prostatectomy was added and long-term data was used to update an existing statement on adjuvant radiotherapy. The balance of the guideline statements were re-affirmed and references were added to the existing literature base. A discussion on the use of genomic classifiers as a risk stratification tool was added to the future research discussion. No relevant data on oligo-metastases was found. CONCLUSIONS: Hormone therapy should be offered to patients who have had radical prostatectomy and who are candidates for salvage radiotherapy. The clinician should discuss possible short- and long-term side effects with the patient as well as the potential benefits of preventing recurrence. The decision to use hormone therapy should be made by the patient and a multi-disciplinary team of providers with full consideration of the patient's history, values, preferences, quality of life, and functional status.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Quimiorradioterapia Adjuvante/normas , Neoplasias da Próstata/terapia , Terapia de Salvação/normas , Sociedades Médicas/normas , Quimiorradioterapia Adjuvante/métodos , Tomada de Decisão Clínica/métodos , Humanos , Masculino , Recidiva Local de Neoplasia/prevenção & controle , Equipe de Assistência ao Paciente/normas , Participação do Paciente , Prostatectomia , Qualidade de Vida , Radioterapia (Especialidade)/normas , Terapia de Salvação/métodos , Urologia/normas
5.
Pract Radiat Oncol ; 9(5): 305-321, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999000

RESUMO

PURPOSE: Although the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the electrical, communications, transportation, and medical infrastructure of the island was unprecedented in scope and caused lasting harm for many months afterward. A compilation of recommendations from radiation oncologists who were in Puerto Rico during the disaster, and from a panel of American Society for Radiation Oncology (ASTRO) cancer experts was created. METHODS AND MATERIALS: Radiation oncologists throughout Puerto Rico collaborated and improvised to continue treating patients in the immediate aftermath of the storm and as routine clinical operations were restored gradually. Empirical lessons from the experience of radiation therapy administration in this profoundly altered context of limited resources, impaired communication, and inadequate transportation were organized into a recommended template, applicable to any radiation oncology practice. ASTRO disease-site experts provided evidence-guidelines for mitigating the impact of a 2- to 3-week interruption in radiation therapy. RESULTS: Practical measures to mitigate the medical impact of a disaster are summarized within the framework of "Prepare, Communicate, Operate, Compensate." Specific measures include the development of an emergency operations plan tailored to specific circumstances, prospective coordination with other radiation oncology clinics before a disaster, ongoing communications with emergency management organizations, and routine practice of alternate methods to disseminate information among providers and patients. CONCLUSIONS: These recommendations serve as a starting point to assist any radiation oncology practice in becoming more resiliently prepared for a local or regional disruption from any cause. Disease-site experts provide evidence-based guidelines on how to mitigate the impact of a 2- to 3-week interruption in radiation therapy for lung, head and neck, uterine cervix, breast, and prostate cancers through altered fractionation or dose escalation.


Assuntos
Tempestades Ciclônicas/mortalidade , Desastres Naturais/mortalidade , Radioterapia (Especialidade)/normas , Humanos , Porto Rico
6.
Int J Radiat Oncol Biol Phys ; 104(5): 1012-1016, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30981834

RESUMO

PURPOSE: To evaluate the adoption of the Royal Australian and New Zealand College of Radiologists Choosing Wisely (CW) radiation oncology recommendations before and after the release of the recommendations. METHODS AND MATERIALS: The Victorian Radiotherapy Minimum Data Set captures details of radiation therapy delivered in the state of Victoria, Australia. This study included the following 3 groups of patients relevant to 3 of the 5 CW recommendations: women who received a diagnosis of early-stage breast cancer at age ≥50 years who had breast radiation therapy (excluding nodal irradiation), patients with cancer who had palliative bone radiation therapy (excluding those with primary bone malignancies), and patients with cancer who had stereotactic radiation therapy to the brain (excluding those with primary malignancies of the central nervous system). The outcomes of interest were use of hypofractionated breast radiation therapy (<25 fractions), use of long-course palliative bone radiation therapy (>10 fractions), and use of adjuvant whole brain radiation therapy within 1 month of stereotactic radiation therapy. The Cochrane-Armitage test was used to evaluate changes in practice over time. RESULTS: Among the 8204 patients who had breast radiation therapy, there was an increase in hypofractionation use from 42% in 2013 to 82% in 2017 (P < .001). The progressive increase in hypofractionation use was observed across institutions. Of the 15,634 courses of palliative bone radiation therapy delivered, only 1279 (8%) were >10 fractions, and this decreased from 10% in 2013 to 5% in 2017 (P < .001). Of the 1049 patients who received stereotactic radiation therapy for brain metastases, only 2% had adjuvant whole brain radiation therapy, and this decreased from 4% in 2013 to 0.7% in 2017 (P = .02). CONCLUSIONS: There was a significant change in radiation oncology practice in Australia between 2013 and 2017, in line with the CW recommendations. However, some of the recommendations need to be revised to reflect the rapidly evolving evidence in radiation oncology.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Encefálicas/radioterapia , Neoplasias da Mama/radioterapia , Hipofracionamento da Dose de Radiação , Radioterapia (Especialidade)/normas , Radiocirurgia/estatística & dados numéricos , Fatores Etários , Neoplasias Ósseas/secundário , Neoplasias Encefálicas/secundário , Neoplasias da Mama/patologia , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Sobremedicalização/prevenção & controle , Sobremedicalização/estatística & dados numéricos , Sobremedicalização/tendências , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Cuidados Paliativos/tendências , Guias de Prática Clínica como Assunto , Radioterapia (Especialidade)/tendências , Radiocirurgia/tendências , Radioterapia Adjuvante/normas , Radioterapia Adjuvante/estatística & dados numéricos , Radioterapia Adjuvante/tendências , Vitória
8.
Ann Palliat Med ; 8(3): 293-304, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30943740

RESUMO

Communication is an important part of high-quality care at every step. Communication skills can be learned, practiced, and improved. In this review, we outline the basic frameworks for communication skills training, describe their components, and demonstrate their utility in the context of vignettes. We discuss specific evidence-based roadmaps for approaching the various communication tasks a radiation oncologist might encounter. Each is summarized with an easy to remember mnemonic. These include responding to emotion using NURSE statements, delivering serious news using SPIKES, discussing prognosis using ADAPT, and discussing goals of care using REMAP. To tie it all together, we offer a simplified general approach to all communication tasks with the mnemonic ACE (Assess, Communicate, Empathize).


Assuntos
Comunicação , Capacitação em Serviço/organização & administração , Neoplasias/psicologia , Neoplasias/radioterapia , Planejamento de Assistência ao Paciente/organização & administração , Radioterapia (Especialidade)/organização & administração , Emoções , Humanos , Neoplasias/patologia , Planejamento de Assistência ao Paciente/normas , Relações Médico-Paciente , Prognóstico , Radioterapia (Especialidade)/normas , Revelação da Verdade
11.
Int J Radiat Oncol Biol Phys ; 104(4): 740-744, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-30677470

RESUMO

PURPOSE: Insurance payers in the United States vary in the indications for which they consider stereotactic body radiation therapy (SBRT) "medically necessary." We compared changes in policies after the last update to the American Society for Radiation Oncology's (ASTRO) SBRT model policy. METHODS AND MATERIALS: We identified 77 payers with SBRT policies in 2015 from a policy aggregator, as well as 4 national benefits managers (NBMs). Of these, 65 payers and 3 NBMs had publicly available updates since 2015. For each of the indications in ASTRO's model policy, we calculated the proportion of payers that considered SBRT medically necessary. We used Fisher's exact test to compare these proportions between 2015 and now, between policies updated in the past 12 months and those updated less often, and between national and regional payers currently. RESULTS: Payers consider SBRT medically necessary most often for primary lung cancer (97%), reirradiation to the spine (91%), prostate cancer (68%), primary liver cancer (66%), and spinal metastases with radioresistant histologies (66%). Policies have become more aligned with ASTRO's model policy over time. National payers and NBMs cover indications in higher proportions than regional payers. CONCLUSIONS: Although there have been improvements over time, more work is needed to align payer policies with ASTRO's model SBRT policy, especially at the regional level.


Assuntos
Reembolso de Seguro de Saúde/normas , Neoplasias/radioterapia , Política Organizacional , Radioterapia (Especialidade)/normas , Radiocirurgia/economia , Sociedades Médicas/normas , Benchmarking , Humanos , Revisão da Utilização de Seguros/normas , Cobertura do Seguro/normas , Reembolso de Seguro de Saúde/estatística & dados numéricos , Radioterapia (Especialidade)/estatística & dados numéricos , Estados Unidos
12.
Int J Radiat Oncol Biol Phys ; 104(5): 979-986, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30684662

RESUMO

PURPOSE: Understanding the pathways and gateways to leadership and challenges faced by individuals in such roles can inform efforts to promote diversity and equity. We sought to describe the professional experiences and personal characteristics of academic radiation oncology (RO) chairs and to evaluate whether differences exist by gender. METHODS AND MATERIALS: Anonymous surveys were distributed to 95 chairs of RO departments during the 2016 annual meeting of the Society of Chairs of Academic Radiation Oncology Programs. The surveys included 28 closed-ended questions and the Leadership Practices Inventory. Results were analyzed by gender using χ2 tests, rank-sum, and t tests (significance P < .05). RESULTS: A total of 72 chairs responded (61 male, 10 female, 1 declined to identify gender) for a response rate of 76%. There were no significant gender differences in age, academic rank, publications, or prior leadership positions held at the time of the first chair appointment, but female respondents held significantly greater total direct funding from extramural grants than their male counterparts (median, $1.89 million [interquartile range, $0.5-$5 million] vs $0.25 million [interquartile range, $0-$1.0 million]; P = .006). Women were more likely to have spouses employed outside the home at time of their first chair appointment than men were, with a trend toward women experiencing greater difficulty relocating. Men and women identified budgeting and resource allocation as their greatest professional challenges. There were no gender differences in the Leadership Practices Inventory-identified leadership domains or professional goals. CONCLUSIONS: Female RO chairs are as equally qualified as men in terms of productivity or leadership skills, but they face distinct challenges in the context of a gender-structured society. The observation of higher grant funding among women at the time of chair appointment suggests a possible need for interventions such as unconscious bias training to ensure that selection processes do not unnecessarily hold women to a higher standard.


Assuntos
Centros Médicos Acadêmicos/normas , Pessoal Administrativo/normas , Radioterapia (Especialidade)/normas , Fatores Sexuais , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/estatística & dados numéricos , Pessoal Administrativo/economia , Pessoal Administrativo/estatística & dados numéricos , Fatores Etários , Idoso , Orçamentos , Distribuição de Qui-Quadrado , Eficiência , Emprego/estatística & dados numéricos , Docentes de Medicina , Feminino , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Radioterapia (Especialidade)/economia , Radioterapia (Especialidade)/estatística & dados numéricos , Alocação de Recursos , Cônjuges/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
13.
Int Braz J Urol ; 45(2): 273-287, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676300

RESUMO

INTRODUCTION: Several recent randomized clinical trials have evaluated hypofractionated regimens against conventionally fractionated EBRT and shown similar effectiveness with conflicting toxicity results. The current view regarding hypofractionation compared to conventional EBRT among North American genitourinary experts for management of prostate cancer has not been investigated. MATERIALS AND METHODS: A survey was distributed to 88 practicing North American GU physicians serving on decision - making committees of cooperative group research organizations. Questions pertained to opinions regarding the default EBRT dose and fractionation for a hypothetical example of a favorable intermediate - risk prostate cancer (Gleason 3 + 4). Treatment recommendations were correlated with practice patterns using Fisher's exact test. RESULTS: Forty - two respondents (48%) completed the survey. We excluded from analysis two respondents who selected radical hypofractionation with 5 - 12 fractions as a preferred treatment modality. Among the 40 analyzed respondents, 23 (57.5%) recommend conventional fractionation and 17 (42.5%) recommended moderate hypofractionation. No demographic factors were found to be associated with preference for a fractionation regimen. Support for brachytherapy as a first choice treatment modality for low - risk prostate cancer was borderline significantly associated with support for moderate hypofractionated EBRT treatment modality (p = 0.089). CONCLUSIONS: There is an almost equal split among North American GU expert radiation oncologists regarding the appropriateness to consider moderately hypofractionated EBRT as a new standard of care in management of patients with prostate cancer. Physicians who embrace brachytherapy may be more inclined to support moderate hypofractionated regimen for EBRT. It is unclear whether reports with longer followups will impact this balance, or whether national care and reimbursement policies will drive the clinical decisions. In the day and age of patient - centered care delivery, patients should receive an objective recommendation based on available clinical evidence. The stark division among GU experts may influence the design of future clinical trials utilizing EBRT for patients with prostate cancer.


Assuntos
Braquiterapia/métodos , Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação/normas , Radioterapia (Especialidade)/normas , Braquiterapia/normas , Humanos , Masculino , Gradação de Tumores , Neoplasias da Próstata/patologia , Radioterapia (Especialidade)/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Estados Unidos
14.
Clin Transl Oncol ; 21(4): 519-533, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30311145

RESUMO

PURPOSE: Current cancer treatment options include surgical intervention, radiotherapy, and chemotherapy. The quality of the provision of each of them and their effective coordination determines the results in terms of benefit/risk. Regarding the radiation oncology treatments, there are not stabilised quality indicators to be used to perform control and continuous improvement processes for healthcare services. Therefore, the Spanish Society of Radiation Oncology has undertaken a comprehensive project to establish quality indicators for use with the information systems available in most Spanish healthcare services. METHODS: A two-round Delphi study examines consensus of several possible quality indicators (n = 28) in daily practice. These indicators were defined after a bibliographic search and the assessment by radiation oncology specialists (n = 8). They included aspects regarding treatment equipment, patient preparation, treatment, and follow-up processes and were divided in structure, process, and outcome indicators. RESULTS: After the evaluation of the defined quality indicators (n = 28) by an expert panel (38 radiation oncologist), 26 indicators achieved consensus in terms of agreement with the statement. Two quality indicators did not achieve consensus. CONCLUSIONS: There is a high degree of consensus in Spanish Radiation Oncology specialists on which indicators in routine clinical practice can best measure quality. These indicators can be used to classify services based on several parameters (patients, equipments, complexity of the techniques used, and scientific research). Furthermore, these indicators allow assess our current situation and set improvements' objectives.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Radioterapia (Especialidade)/normas , Consenso , Técnica Delfos , Humanos , Neoplasias/radioterapia , Radioterapia (Especialidade)/organização & administração , Espanha
15.
Clin Transl Oncol ; 21(4): 420-432, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30293231

RESUMO

BACKGROUND: The knowledge in the field of castration-resistant prostate cancer (CRPC) is developing rapidly, with emerging new therapies and advances in imaging. Nonetheless, in multiple areas there is still a lack of or very limited evidence, and clear guidance from clinicians regarding optimal strategy is required. METHODS: A modified Delphi method, with 116 relevant questions divided into 7 different CRPC management topics, was used to develop a consensus statement by the URONCOR group. RESULTS: A strong consensus or unanimity was reached on 93% of the proposed questions. The seven topics addressed were: CRPC definition, symptomatic patients, diagnosis of metastasis, CRPC progression, M0 management, M1 management and sequencing therapy, and treatment monitoring. CONCLUSIONS: The recommendations based on the radiation oncology experts' opinions are intended to provide cancer specialists with expert guidance and to standardise CRPC patient management in Spain, facilitating decision-making in different clinically relevant issues regarding CRPC patients.


Assuntos
Neoplasias de Próstata Resistentes à Castração/diagnóstico , Neoplasias de Próstata Resistentes à Castração/terapia , Radioterapia (Especialidade)/normas , Tomada de Decisão Clínica , Consenso , Técnica Delfos , Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/patologia , Radioterapia (Especialidade)/organização & administração , Espanha
16.
Oral Maxillofac Surg Clin North Am ; 31(1): 31-38, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454789

RESUMO

Treatment of head and neck cancer with curative intent consists of surgery and/or radiotherapy (RT) sometimes combined with adjuvant chemotherapy depending on the tumor site, extent, and histology. Herein, the authors review the role of RT in the management of head and neck mucosal squamous cell carcinoma (SCC). The authors focus on the outcomes of definitive RT and, depending on the primary site, postoperative RT. Unless otherwise specified, outcomes data cited are from the University of Florida.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia (Especialidade)/normas , Radioterapia (Especialidade)/tendências , Quimioterapia Adjuvante , Terapia Combinada , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Prognóstico , Terapia com Prótons , Procedimentos Cirúrgicos Robóticos
17.
Pract Radiat Oncol ; 9(2): 65-72, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30576843

RESUMO

PURPOSE: The comprehensive identification and delineation of organs at risk (OARs) are vital to the quality of radiation therapy treatment planning and the safety of treatment delivery. This guidance aims to improve the consistency of ontouring OARs in external beam radiation therapy treatment planning by providing a single standardized resource for information regarding specific OARs to be contoured for each disease site. The guidance is organized in table format as a quality assurance tool for practices and a training resource for residents and other radiation oncology students (see supplementary materials). METHODS AND MATERIALS: The Task Force formulated recommendations based on clinical practice and consensus. The draft manuscript was peer reviewed by 16 reviewers, the American Society for Radiation Oncology (ASTRO) legal counsel, and ASTRO's Multidisciplinary Quality Assurance Subcommittee and revised accordingly. The recommendations were posted on the ASTRO website for public comment in June 2018 for a 6-week period. The final document was approved by the ASTRO Board of Directors in August 2018. RESULTS: Standardization improves patient safety, efficiency, and accuracy in radiation oncology treatment. This consensus guidance represents an ASTRO quality initiative to provide recommendations for the standardization of normal tissue contouring that is performed during external beam treatment planning for each anatomic treatment site. Table 1 defines 2 sets of structures for anatomic sites: Those that are recommended in all adult definitive cases and may assist with organ selection for palliative cases, and those that should be considered on a case-by-case basis depending on the specific clinical scenario. Table 2 outlines some of the resources available to define the parameters of general OAR tissue delineation. CONCLUSIONS: Using this paper in conjunction with resources that define tissue parameters and published dose constraints will enable practices to develop a consistent approach to normal tissue evaluation and dose documentation.


Assuntos
Consenso , Neoplasias/radioterapia , Órgãos em Risco/efeitos da radiação , Garantia da Qualidade dos Cuidados de Saúde , Planejamento da Radioterapia Assistida por Computador/normas , Humanos , Neoplasias/diagnóstico por imagem , Órgãos em Risco/diagnóstico por imagem , Segurança do Paciente , Guias de Prática Clínica como Assunto , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Radioterapia (Especialidade)/métodos , Radioterapia (Especialidade)/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Estados Unidos
18.
Oral Oncol ; 87: 131-137, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527228

RESUMO

Target volume selection and delineation for both the primary tumor and the lymph nodes are critical steps in the treatment of head and neck tumors with Intensity Modulated Radiation therapy (IMRT). These steps should be based on a probabilistic approach, which is that selection and delineation will be considered as optimal when reaching the best compromise between a too tight volume that could be associated to an unacceptable rate of local recurrence, and a too large volume, which could be associated to an unacceptable rate of treatment morbidity. Failure to do so have been reported to be associated to a higher risk of loco-regional recurrences and/or morbidity after treatment. In this framework, groups of experts proposed sets of guidelines for the radiation oncology community, aiming at standardizing radiotherapy practices of head and neck cancer patients. Although in constant improvement, such guidelines have been shown to translate into more consistent treatment approaches. This review article summarizes the knowledge accumulated over the years on target volume selection and delineation and tries to reconcile the various schools of thoughts on the topic.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Recidiva Local de Neoplasia/prevenção & controle , Radioterapia (Especialidade)/normas , Radioterapia de Intensidade Modulada/normas , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Consenso , Relação Dose-Resposta à Radiação , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Laringe/diagnóstico por imagem , Laringe/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Metástase Linfática/radioterapia , Boca/diagnóstico por imagem , Boca/patologia , Faringe/diagnóstico por imagem , Faringe/patologia , Guias de Prática Clínica como Assunto , Radioterapia (Especialidade)/métodos , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Tomografia Computadorizada por Raios X , Carga Tumoral/efeitos da radiação
19.
Radiat Oncol ; 13(1): 239, 2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30509283

RESUMO

BACKGROUND: Peer review systems within radiation oncology are important to ensure quality radiation care. Several individualized methods for radiation oncology peer review have been described. However, despite the importance of peer review in radiation oncology barriers may exist to its effective implementation in practice. The purpose of this study was to quantify the rate of plan changes based on our group peer review process as well as the quantify amount of time and resources needed for this process. METHODS: Data on cases presented in our institutional group consensus peer review conference were prospectively collected. Cases were then retrospectively analyzed to determine the rate of major change (plan rejection) and any change in plans after presentation as well as the median time of presentation. Univariable logistic regression was used to determine factors associated with major change and any change. RESULTS: There were 73 cases reviewed over a period of 11 weeks. The rate of major change was 8.2% and the rate of any change was 23.3%. The majority of plans (53.4%) were presented in 6-10 min. Overall, the mean time of presentation was 8 min. On univariable logistic regression, volumetric modulated arc therapy plans were less likely to undergo a plan change but otherwise there were no factors significantly associated with major plan change or any type of change. CONCLUSION: Group consensus peer review allows for a large amount of informative clinical and technical data to be presented per case prior to the initiation of radiation treatment in a thorough yet efficient manner to ensure plan quality and patient safety.


Assuntos
Neoplasias/radioterapia , Revisão por Pares/métodos , Garantia da Qualidade dos Cuidados de Saúde/normas , Radioterapia (Especialidade)/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos de Viabilidade , Seguimentos , Humanos , Segurança do Paciente , Prognóstico , Estudos Prospectivos , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos
20.
J Med Imaging Radiat Sci ; 49(1): 18-22, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30479282

RESUMO

Magnetic resonance imaging (MRI) uses a strong magnetic field to generate diagnostic images. This magnetic field has the potential to cause serious and even fatal injuries to patients undergoing scans and to personnel in the area. Ensuring awareness of MRI hazards and safety procedures through a formalized education and training program is integral in creating an MRI safety culture that protects patients and staff from harm. The aim of our project was to develop an accessible and interprofessional electronic e-module learning series to instill an MRI safety culture throughout the entire hospital. This is the first such program in Canada. A simplified e-search was conducted using key search terms "mri: safety, education, safety training." Very few articles were found that fulfilled our needs in helping us build an MRI safety program. In concert with an e-search we reached out to similar institutions and, through informal discussions, we confirmed the lack of a formalized, transferable safety program within Canada. This led to the creation of an interprofessional working team at our institution composed of key stakeholders: educators, clinical and technical experts from radiation therapy, medical imaging, the research institute, medical radiation physics, nursing, and radiation oncology. This team collaborated on the development of three education modules tailored for specific audiences based on classification as Non-MR Personnel, Level 1 MR Personnel, or Level 2 MR Personnel as defined by the American College of Radiology guidelines. All modules were 10 to 20 minutes in length with interactive engagement activities throughout as well as a final summative evaluation to test for comprehension. Knowledge of the existence of the MRI unit is only one facet of creating an MRI safety culture. By increasing the awareness of the hazards of MRI to all personnel throughout the hospital, the risk of harm to patients and staff may be decreased.


Assuntos
Educação Continuada/métodos , Imagem por Ressonância Magnética/efeitos adversos , Radioterapia (Especialidade)/educação , Radiologia/educação , Gestão da Segurança/organização & administração , Canadá , Instrução por Computador/métodos , Humanos , Capacitação em Serviço/métodos , Imagem por Ressonância Magnética/normas , Segurança do Paciente , Radioterapia (Especialidade)/normas , Radiologia/normas , Gestão da Segurança/normas
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