Epworth Radiation Oncology

Richmond, Australia

Epworth Radiation Oncology

Richmond, Australia
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Hamilton D.G.,Epworth Radiation Oncology Research Center | Bale R.,Epworth Radiation Oncology Research Center | Jones C.,Epworth Radiation Oncology | Fitzgerald E.,Epworth Radiation Oncology | And 4 more authors.
Breast | Year: 2016

The purpose of this systematic review was to summarise the evidence from studies investigating the integration of tumour bed boosts into whole breast irradiation for patients with Stage 0-III breast cancer, with a focus on its impact on acute and late toxicities. A comprehensive systematic electronic search through the Ovid MEDLINE, EMBASE and PubMed databases from January 2000 to January 2015 was conducted. Studies were considered eligible if they investigated the efficacy of hypo- or normofractionated whole breast irradiation with the inclusion of a daily concurrent boost. The primary outcomes of interest were the degree of observed acute and late toxicity following radiotherapy treatment. Methodological quality assessment was performed on all included studies using either the Newcastle-Ottawa Scale or a previously published investigator-derived quality instrument. The search identified 35 articles, of which 17 satisfied our eligibility criteria. Thirteen and eleven studies reported on acute and late toxicities respectively. Grade 3 acute skin toxicity ranged from 1 to 7% whilst moderate to severe fibrosis and telangiectasia were both limited to 9%. Reported toxicity profiles were comparable to historical data at similar time-points. Studies investigating the delivery of concurrent boosts with whole breast radiotherapy courses report safe short to medium-term toxicity profiles and cosmesis rates. Whilst the quality of evidence and length of follow-up supporting these findings is low, sufficient evidence has been generated to consider concurrent boost techniques as an alternative to conventional sequential techniques. © 2016 Elsevier Ltd.


Crowe S.B.,Royal Brisbane and Womens Hospital | Crowe S.B.,Queensland University of Technology | Kairn T.,Queensland University of Technology | Middlebrook N.,Genesis CancerCare Queensland | And 5 more authors.
Physics in Medicine and Biology | Year: 2015

This study aimed to provide a detailed evaluation and comparison of a range of modulated beam evaluation metrics, in terms of their correlation with QA testing results and their variation between treatment sites, for a large number of treatments. Ten metrics including the modulation index (MI), fluence map complexity, modulation complexity score (MCS), mean aperture displacement (MAD) and small aperture score (SAS) were evaluated for 546 beams from 122 intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) treatment plans targeting the anus, rectum, endometrium, brain, head and neck and prostate. The calculated sets of metrics were evaluated in terms of their relationships to each other and their correlation with the results of electronic portal imaging based quality assurance (QA) evaluations of the treatment beams. Evaluation of the MI, MAD and SAS suggested that beams used in treatments of the anus, rectum, head and neck were more complex than the prostate and brain treatment beams. Seven of the ten beam complexity metrics were found to be strongly correlated with the results from QA testing of the IMRT beams (p<0.00008). For example, values of SAS (with multileaf collimator apertures narrower than 10mm defined as 'small') less than 0.2 also identified QA passing IMRT beams with 100% specificity. However, few of the metrics are correlated with the results from QA testing of the VMAT beams, whether they were evaluated as whole 360 arcs or as 60 sub-arcs. Select evaluation of beam complexity metrics (at least MI, MCS and SAS) is therefore recommended, as an intermediate step in the IMRT QA chain. Such evaluation may also be useful as a means of periodically reviewing VMAT planning or optimiser performance. © 2015 Institute of Physics and Engineering in Medicine.


PubMed | Epworth Radiation Oncology, Monash University, Epworth Radiation Oncology Research Center and Austin Hospital
Type: | Journal: Breast (Edinburgh, Scotland) | Year: 2016

The purpose of this systematic review was to summarise the evidence from studies investigating the integration of tumour bed boosts into whole breast irradiation for patients with Stage 0-III breast cancer, with a focus on its impact on acute and late toxicities. A comprehensive systematic electronic search through the Ovid MEDLINE, EMBASE and PubMed databases from January 2000 to January 2015 was conducted. Studies were considered eligible if they investigated the efficacy of hypo- or normofractionated whole breast irradiation with the inclusion of a daily concurrent boost. The primary outcomes of interest were the degree of observed acute and late toxicity following radiotherapy treatment. Methodological quality assessment was performed on all included studies using either the Newcastle-Ottawa Scale or a previously published investigator-derived quality instrument. The search identified 35 articles, of which 17 satisfied our eligibility criteria. Thirteen and eleven studies reported on acute and late toxicities respectively. Grade 3 acute skin toxicity ranged from 1 to 7% whilst moderate to severe fibrosis and telangiectasia were both limited to 9%. Reported toxicity profiles were comparable to historical data at similar time-points. Studies investigating the delivery of concurrent boosts with whole breast radiotherapy courses report safe short to medium-term toxicity profiles and cosmesis rates. Whilst the quality of evidence and length of follow-up supporting these findings is low, sufficient evidence has been generated to consider concurrent boost techniques as an alternative to conventional sequential techniques.


Charles P.H.,Princess Alexandra Hospital | Charles P.H.,Queensland University of Technology | Cranmer-Sargison G.,Saskatchewan Cancer Agency | Cranmer-Sargison G.,University of Saskatchewan | And 9 more authors.
Medical Physics | Year: 2014

Results: 1.0 mm of air was required to make the PTWe diode correction-free. This modified diode (PTWeair) produced output factors equivalent to those in water at all field sizes (5-50 mm). The optimal air thickness required for the EDGEe diode was found to be 0.6 mm. The modified diode (EDGEeair) produced output factors equivalent to those in water, except at field sizes of 8 and 10 mmwhere it measured pproximately 2% greater than the relative dose to water. The experimentally calculated k fclin, f msr Qclin,Qmsrfor both the PTWe and the EDGEe diodes (without air) matched Monte Carlo simulated results, thus proving that it is feasible to transfer k fclin, f msr Qclin,Qmsrfrom one commercially available detector to another using experimental methods and the recommended experimental setup.Conclusions: It is possible to create a diode which does not require corrections for small field output factor measurements. This has been performed and verified experimentally. The ability of a detector to be correction-free depends strongly on its design and composition. A nonwater-equivalent detector can only be correction-free if competing perturbations of the beam cancel out at all field sizes. This should not be confused with true water equivalency of a detector.Purpose: Two diodes which do not require correction factors for small field relative output measurements are designed and validated using experimental methodology. This was achieved by adding an air layer above the active volume of the diode detectors, which canceled out the increase in response of the diodes in small fields relative to standard field sizes.Methods: Due to the increased density of silicon and other components within a diode, additional electrons are created. In very small fields, a very small air gap acts as an effective filter of electrons with a high angle of incidence. The aim was to design a diode that balanced these perturbations to give a response similar to a water-only geometry. Three thicknesses of air were placed at the proximal end of a PTW 60017 electron diode (PTWe) using an adjustable air cap. A set of output ratios (ORfclin Det) for square field sizes of side length down to 5 mm was measured using each air thickness and compared to ORfclin Detmeasured using an IBA stereotactic field diode (SFD). kfclin, f msr Qclin,Qmsrwas transferred from the SFD to the PTWe diode and plotted as a function of air gap thickness for each field size. This enabled the optimal air gap thickness to be obtained by observing which thickness of air was required such that k fclin, f msr Qclin,Qmsrwas equal to 1.00 at all field sizes. A similar procedure was used to find the optimal air thickness required to make a modified Sun Nuclear EDGE detector (EDGEe) which is correction-free in small field relative dosimetry. In addition, the feasibility of experimentally transferring k fclin, f msr Qclin,Qmsrvalues from the SFD to unknown diodes was tested by comparing the experimentally transferred k fclin, f msr Qclin,Qmsrvalues for unmodified PTWe and EDGEe diodes to Monte Carlo simulated values. © 2014 Am. Assoc. Phys. Med.


Crowe S.B.,Queensland University of Technology | Kairn T.,Queensland University of Technology | Kenny J.,Epworth Radiation Oncology | Knight R.T.,Genesis Cancer Care Queensland | And 3 more authors.
Australasian Physical and Engineering Sciences in Medicine | Year: 2014

The planning of IMRT treatments requires a compromise between dose conformity (complexity) and deliverability. This study investigates established and novel treatment complexity metrics for 122 IMRT beams from prostate treatment plans. The Treatment and Dose Assessor software was used to extract the necessary data from exported treatment plan files and calculate the metrics. For most of the metrics, there was strong overlap between the calculated values for plans that passed and failed their quality assurance (QA) tests. However, statistically significant variation between plans that passed and failed QA measurements was found for the established modulation index and for a novel metric describing the proportion of small apertures in each beam. The ‘small aperture score’ provided threshold values which successfully distinguished deliverable treatment plans from plans that did not pass QA, with a low false negative rate. © 2014, Australasian College of Physical Scientists and Engineers in Medicine.


PubMed | Epworth Radiation Oncology, University of Saskatchewan, University of New South Wales, Genesis Centre and Queensland University of Technology
Type: Journal Article | Journal: Medical physics | Year: 2014

Two diodes which do not require correction factors for small field relative output measurements are designed and validated using experimental methodology. This was achieved by adding an air layer above the active volume of the diode detectors, which canceled out the increase in response of the diodes in small fields relative to standard field sizes.Due to the increased density of silicon and other components within a diode, additional electrons are created. In very small fields, a very small air gap acts as an effective filter of electrons with a high angle of incidence. The aim was to design a diode that balanced these perturbations to give a response similar to a water-only geometry. Three thicknesses of air were placed at the proximal end of a PTW 60017 electron diode (PTWe) using an adjustable air cap. A set of output ratios (ORDet (fclin) ) for square field sizes of side length down to 5 mm was measured using each air thickness and compared to ORDet (fclin) measured using an IBA stereotactic field diode (SFD). kQclin,Qmsr (fclin,fmsr) was transferred from the SFD to the PTWe diode and plotted as a function of air gap thickness for each field size. This enabled the optimal air gap thickness to be obtained by observing which thickness of air was required such that kQclin,Qmsr (fclin,fmsr) was equal to 1.00 at all field sizes. A similar procedure was used to find the optimal air thickness required to make a modified Sun Nuclear EDGE detector (EDGEe) which is correction-free in small field relative dosimetry. In addition, the feasibility of experimentally transferring kQclin,Qmsr (fclin,fmsr) values from the SFD to unknown diodes was tested by comparing the experimentally transferred kQclin,Qmsr (fclin,fmsr) values for unmodified PTWe and EDGEe diodes to Monte Carlo simulated values.1.0 mm of air was required to make the PTWe diode correction-free. This modified diode (PTWeair) produced output factors equivalent to those in water at all field sizes (5-50 mm). The optimal air thickness required for the EDGEe diode was found to be 0.6 mm. The modified diode (EDGEeair) produced output factors equivalent to those in water, except at field sizes of 8 and 10 mm where it measured approximately 2% greater than the relative dose to water. The experimentally calculated kQclin,Qmsr (fclin,fmsr) for both the PTWe and the EDGEe diodes (without air) matched Monte Carlo simulated results, thus proving that it is feasible to transfer kQclin,Qmsr (fclin,fmsr) from one commercially available detector to another using experimental methods and the recommended experimental setup.It is possible to create a diode which does not require corrections for small field output factor measurements. This has been performed and verified experimentally. The ability of a detector to be correction-free depends strongly on its design and composition. A nonwater-equivalent detector can only be correction-free if competing perturbations of the beam cancel out at all field sizes. This should not be confused with true water equivalency of a detector.


James C.,Epworth Radiation Oncology | Frantzis J.,Epworth Radiation Oncology | Ripps L.,Epworth HealthCare IT | Fenton P.,Epworth Radiation Oncology
Journal of Physics: Conference Series | Year: 2014

The management of patient information and treatment planning is traditionally an intra-departmental requirement of a radiation oncology service. Epworth Radiation Oncology systems must support the transient nature of Visiting Medical Officers (VMOs). This unique work practice created challenges when implementing the vision of a completely paperless solution that allows for a responsive and efficient service delivery. ARIA® and EclipseTM (Varian Medical Systems, Palo Alto, CA, USA) have been deployed across four dedicated Citrix® (Citrix Systems, Santa Clara, CA, USA) servers allowing VMOs to access these applications remotely. A range of paperless solutions were developed within ARIA® to facilitate clinical and organisational management whilst optimising efficient work practices. The IT infrastructure and paperless workflow has enabled VMOs to securely access the VarianTM (Varian Medical Systems, Palo Alto, CA, USA) oncology software and experience full functionality from any location on multiple devices. This has enhanced access to patient information and improved the responsiveness of the service. Epworth HealthCare has developed a unique solution to enable remote access to a centralised oncology management suite, while maintaining a secure and paperless working environment. © Published under licence by IOP Publishing Ltd.

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