Hurkmans C.W.,Catharina Hospital Eindhoven |
Knegjens J.L.,Netherlands Cancer Institute |
Oei B.S.,Verbeeten Instituut |
Maas A.J.J.,Robert Bosch GmbH |
And 4 more authors.
Radiation Oncology | Year: 2012
Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient's perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients' perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well. © 2012 Hurkmans et al.; licensee BioMed Central Ltd.
Slotman B.J.,VU University Amsterdam |
Vos P.H.,Verbeeten Instituut
Radiotherapy and Oncology | Year: 2013
Background and purpose: In the late 1990s a period of shortage of radiotherapy capacity caused long waiting times in The Netherlands. Investments in treatment vaults, equipment and training capacity were made. The developments since then are described and the actual situation is compared with the predictions throughout the years. Method and materials: Data are based on annual surveys on production, personnel and equipment of all 21 Dutch radiotherapy centers. Results: An annual increase in patients, radiotherapy treatments and a corresponding increase in equipment and personnel was seen, on average 3.5-4% per year. After an initial shift to more 3D conformal treatments, a subsequent change from 3D conformal to intensity modulated and image guided techniques was observed. There has been no increase in the number of radiotherapy centers and the average size of a Dutch department in 2010 was 5.7 linacs, 10.4 fte radiation oncologists, 4.8 fte physicists and 45.8 fte technologists. Conclusions: The number of linacs increased as anticipated. The increase in staffing was in balance with the need, resulting in only a limited number of vacancies. In 2010 there were virtually no waiting lists, and no overcapacity. The predicted need and the actual number of radiotherapy treatment series per year correspond very well. A national program for a planned increase of radiotherapy capacity is feasible. Expansion of existing departments instead of increasing the number allows for a more rapid introduction of new technologies and sufficient subspecialization of the staff. © 2012 Elsevier Ireland Ltd. All rights reserved.