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Toronto, Canada

Cashell A.,Radiation Medicine Program
Journal of Radiotherapy in Practice | Year: 2010

A recurring theme from the literature is that the definition of reflection is nebulous and/or complex. Many authors have suggested that more research needs to be conducted to better understand an individuals perception of reflection and reflective practice, and how these concepts affect their clinical practice as well as their personal growth and development. This paper offers the findings of a qualitative study of radiation therapists in Canada. The aim of the study was to explore radiation therapists understanding of the concept of reflection, and to understand how they incorporated it into their daily practice. Secondary objectives were to examine some of the perceived barriers to its use, and the possible challenges of implementing reflective writing. Two focus groups were initially conducted, and a follow-up questionnaire was developed using the themes generated from the focus groups. The questionnaire was distributed to radiation therapists at two large cancer centres in Toronto, Canada. Most participants indicated that it is an integral part of their practice and professional lives, and that they use a variety of different methods for engaging in reflection. It is not without its barriers, but many of these can be overcome by providing time, coaching and a supportive work environment. Respondents were divided as to whether they would benefit from being taught reflection; however, small group teaching would be the favoured method. Further study is suggested to determine whether there are any improvements to patient care and in particular patient outcomes. Copyright © Cambridge University Press 2010.

Van Prooijen M.,Radiation Medicine Program
Journal of applied clinical medical physics / American College of Medical Physics | Year: 2010

The impact of the treatment couch on a radiotherapy plan is rarely fully assessed during the treatment planning process. Incorporating a couch model into the treatment planning system (TPS) enables the planner to avoid or dosimetrically evaluate beam-couch intersections. In this work, we demonstrate how existing TPS tools can be used to establish this capability and assess the accuracy and effectiveness of the system through dose measurements and planning studies. Such capabilities may be particularly relevant for the planning of arc therapies.Treatment couch top models were introduced into a TPS by fusing their CT image sets with the patient CT dataset. Regions of interest characterizing couch elements were then imported and assigned appropriate densities in the TPS. Measurements in phantom agreed with TPS calculations to within 2% dose and 1 degrees gantry rotation. To clinically validate the model, a retrospective study was performed on patient plans that posed difficulties in beam-couch intersection during setup. Beam-couch intersection caused up to a 3% reduction in PTV coverage, defined by the 95% of the prescribed dose, and up to a 1% reduction in mean CTV coverage. Dose compensation strategies for IMRT treatments with beams passing through couch elements were investigated using a four-field IMRT plan with three beams passing through couch elements. In this study, ignoring couch effects resulted in point dose reductions of 8 +/- 3%.A methodology for incorporating detailed couch characteristics into a TPS has been established and explored. The method can be used to predict beam-couch intersections during planning, potentially eliminating the need for pretreatment appointments. Alternatively, if a beam-couch intersection problem arises, the impact of the couch can be assessed on a case-by-case basis and a clinical decision made based on full dosimetric information.

Montgomery L.,Radiation Medicine Program
Journal of Medical Imaging and Radiation Sciences | Year: 2015

Health literacy is one of the most important determinants of patient outcome. Literacy levels are influenced by factors such as formal education status, socioeconomic circumstances, age, language, cultural background, and employment status. Few health professionals are aware of health literacy issues, and even fewer can accurately address them. The purpose of this review article was to bring attention to the issue of health literacy, to provide information on how to identify patients at risk of limited health literacy, and to develop communication strategies designed to support cancer patients and their families. This article also aimed to develop and identify specific tools for radiation therapists and the radiation medical science community based on literature, evidence, and educational material from nursing and other allied professions. Health care organizations and professionals need to be aware of their duty to ensure that patients fully comprehend both the complex and simple information presented. Improving comprehension related to health choices leads to better decision making by the patient, improves patient outcomes, reduces hospitalization rates, and cuts health care costs. © 2015 Elsevier Inc. All rights reserved.

Clark B.G.,Radiation Medicine Program | Brown R.J.,Radiation Medicine Program | Ploquin J.,Radiation Safety and Health Physics | Dunscombe P.,Tom Baker Cancer Center
Practical Radiation Oncology | Year: 2013

Purpose: To quantify the impact of a comprehensive incident learning system in terms of safety improvements. Methods and Materials: An incident learning system tailored for radiation treatment and based on published principles has been used consistently in our large academic cancer center for more than 5 years. In the adopted system, every incident, whether or not there is a resulting direct impact on a patient treatment, is recorded and investigated to determine basic causes. The scope of the program thus includes potential, or near miss, events which have no impact on patients but which provide valuable insights into program weaknesses and hence facilitate proactive measures to minimize risk. Results: Analysis of 2506 incident reports generated over a 5-year period demonstrate a substantial decline in actual, nonminor incidents; ie, those with a dose variation from that prescribed of greater than 5%. Only 49 incidents (1.95%) had an impact on patients. The actual incident rate at the point of treatment delivery, the most vulnerable point in our process, has also decreased. The system has provided rapid feedback to monitor several initiatives including implementation of new technology and several new treatment techniques. Using the evidence provided by these incident reports, strategies were developed by a multidisciplinary team to address system weaknesses. Interventions introduced include several human error reduction strategies including forcing functions and constraints to improve system resilience. Conclusions: Our results demonstrate that effective use of an incident learning system will strongly encourage the reporting of incidents, whether or not they directly impact a patient, and serve as a proactive means of enhancing safety and quality. As a side benefit, addressing and overcoming the cultural barriers between the 3 professional groups involved in radiation treatment has resulted in an improvement in the safety culture in our center. © 2013 American Society for Radiation Oncology.

Jaffray D.A.,Radiation Medicine Program | Lindsay P.E.,Radiation Medicine Program | Brock K.K.,Radiation Medicine Program | Deasy J.O.,Washington University in St. Louis | Tome W.A.,University of Wisconsin - Madison
International Journal of Radiation Oncology Biology Physics | Year: 2010

The actual distribution of radiation dose accumulated in normal tissues over the complete course of radiation therapy is, in general, poorly quantified. Differences in the patient anatomy between planning and treatment can occur gradually (e.g., tumor regression, resolution of edema) or relatively rapidly (e.g., bladder filling, breathing motion) and these undermine the accuracy of the planned dose distribution. Current efforts to maximize the therapeutic ratio require models that relate the true accumulated dose to clinical outcome. The needed accuracy can only be achieved through the development of robust methods that track the accumulation of dose within the various tissues in the body. Specific needs include the development of segmentation methods, tissue-mapping algorithms, uncertainty estimation, optimal schedules for image-based monitoring, and the development of informatics tools to support subsequent analysis. These developments will not only improve radiation outcomes modeling but will address the technical demands of the adaptive radiotherapy paradigm. The next 5 years need to see academia and industry bring these tools into the hands of the clinician and the clinical scientist. © 2010 Elsevier Inc. All rights reserved.

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