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Larson D.A.,University of California at San Francisco | Galvin J.M.,Thomas Jefferson University | Mehta M.P.,Northwestern University | Potters L.,North Shore LIJ Health System | And 4 more authors.
American Journal of Clinical Oncology: Cancer Clinical Trials | Year: 2013

American College of Radiology and American Society for Radiation Oncology Practice Guideline for the Performance of Stereotactic Radiosurgery (SRS). SRS is a safe and efficacious treatment option of a variety of benign and malignant disorders involving intracranial structures and selected extracranial lesions. SRS involves a high dose of ionizing radiation with a high degree of precision and spatial accuracy. A quality SRS program requires a multidisciplinary team involved in the patient management. Organization, appropriate staffing, and careful adherence to detail and to established SRS standards is important to ensure operational efficiency and to improve the likelihood of procedural success. A collaborative effort of the American College of Radiology and American Society for Therapeutic Radiation Oncology has produced a practice guideline for SRS. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, neurosurgeon, and qualified medical physicist. Quality assurance is essential for safe and accurate delivery of treatment with SRS. Quality assurance issues for the treatment unit, stereotactic accessories, medical imaging, and treatment-planning system are presented and discussed. Adherence to these practice guidelines can be part of ensuring quality and patient safety in a successful SRS program. Copyright © 2012 by Lippincott Williams & Wilkins.


Rosenthal S.A.,Radiation Oncology Centers | Bittner N.H.J.,Valley Radiation Oncology Centers | Beyer D.C.,Arizona Oncology Services | Demanes D.J.,University of California at Los Angeles | And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Transperineal permanent prostate brachytherapy is a safe and efficacious treatment option for patients with organ-confined prostate cancer. Careful adherence to established brachytherapy standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for permanent prostate brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrist. Factors with respect to patient selection and appropriate use of supplemental treatment modalities such as external beam radiation and androgen suppression therapy are discussed. Logistics with respect to the brachtherapy implant procedure, the importance of dosimetric parameters, and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful prostate brachytherapy program. Copyright © 2011 Elsevier Inc.


Erickson B.A.,Medical College of Wisconsin | Demanes D.J.,University of California at Los Angeles | Ibbott G.S.,University of Texas M. D. Anderson Cancer Center | Hayes J.K.,Gamma West Brachytherapy | And 5 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

High-Dose-Rate (HDR) brachytherapy is a safe and efficacious treatment option for patients with a variety of different malignancies. Careful adherence to established standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for HDR brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrists. Review of the leading indications for HDR brachytherapy in the management of gynecologic, thoracic, gastrointestinal, breast, urologic, head and neck, and soft tissue tumors is presented. Logistics with respect to the brachytherapy implant procedures and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful HDR brachytherapy program. Copyright © 2011 Elsevier Inc.


Michalski J.M.,University of Washington | Lawton C.,Medical College of Wisconsin | El Naqa I.,University of Washington | Ritter M.,University of Wisconsin - Madison | And 12 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: To define a prostate fossa clinical target volume (PF-CTV) for Radiation Therapy Oncology Group (RTOG) trials using postoperative radiotherapy for prostate cancer. Methods and Materials: An RTOG-sponsored meeting was held to define an appropriate PF-CTV after radical prostatectomy. Data were presented describing radiographic failure patterns after surgery. Target volumes used in previous trials were reviewed. Using contours independently submitted by 13 radiation oncologists, a statistical imputation method derived a preliminary "consensus" PF-CTV. Results: Starting from the model-derived CTV, consensus was reached for a CT image-based PF-CTV. The PF-CTV should extend superiorly from the level of the caudal vas deferens remnant to >8-12 mm inferior to vesicourethral anastomosis (VUA). Below the superior border of the pubic symphysis, the anterior border extends to the posterior aspect of the pubis and posteriorly to the rectum, where it may be concave at the level of the VUA. At this level, the lateral border extends to the levator ani. Above the pubic symphysis, the anterior border should encompass the posterior 1-2 cm of the bladder wall; posteriorly, it is bounded by the mesorectal fascia. At this level, the lateral border is the sacrorectogenitopubic fascia. Seminal vesicle remnants, if present, should be included in the CTV if there is pathologic evidence of their involvement. Conclusions: Consensus on postoperative PF-CTV for RT after prostatectomy was reached and is available as a CT image atlas on the RTOG website. This will allow uniformity in defining PF-CTV for clinical trials that include postprostatectomy RT. © 2010 Elsevier Inc. All rights reserved.


Gay H.A.,University of Washington | Barthold H.J.,Commonwealth Hematology and Oncology | Barthold H.J.,Beth Israel Deaconess Medical Center | O'Meara E.,Radiation Therapy Oncology Group | And 19 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials. Methods and Materials: One male pelvis computed tomography (CT) data set and one female pelvis CT data set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The following were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified. Results: The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, Adnexa-R, Adnexa-L, Prostate, SeminalVesc, PenileBulb, Femur-R, and Femur-L. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed. Conclusions: Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research. © 2012 Elsevier Inc. All rights reserved.


Hartford A.C.,Dartmouth College | Galvin J.M.,Thomas Jefferson University | Beyer D.C.,Arizona Oncology Services | Eichler T.J.,Thomas Johns Cancer Hospital | And 4 more authors.
American Journal of Clinical Oncology: Cancer Clinical Trials | Year: 2012

Intensity-modulated radiation therapy (IMRT) is a complex technique for the delivery of radiation therapy preferentially to target structures while minimizing doses to adjacent normal critical structures. It is widely utilized in the treatment of a variety of clinical indications in radiation oncology, including tumors of the central nervous system, head and neck, breast, prostate, gastrointestinal tract, and gynecologic organs, as well as in situations where previous radiation therapy has been delivered, and has allowed for significant therapeutic advances in many clinical areas. IMRT treatment planning and delivery is a complex process. Safe and reliable delivery of IMRT requires appropriate process design and adherence to quality assurance (QA) standards. A collaborative effort of the American College of Radiology and American Society for Therapeutic Radiation Oncology has produced a practice guideline for IMRT. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist, dosimetrist, and radiation therapist. Factors with respect to the QA of the treatment planning system, treatment-planning process, and treatment-delivery process are discussed, as are issues related to the utilization of volumetric modulated arc therapy. Patient-specific QA procedures are presented. Successful IMRT programs involve integration of many processes: patient selection, patient positioning/immobilization, target definition, treatment plan development, and accurate treatment delivery. Appropriate QA procedures, including patient-specific QA procedures, are essential to ensure quality in an IMRT program and to assure patient safety. Copyright © 2012 by Lippincott Williams & Wilkins.


News Article | December 27, 2016
Site: co.newswire.com

One of Two Radiation Oncology Centers in Pennsylvania to Achieve this Honor ​​Northeast Pennsylvanians often think that excellent cancer care is found strictly in larger cities. However, that perception was recently disproved by Scranton’s own Northeast Radiation Oncology Center (NROC). The experienced team of physicians at NROC were one of only two centers in the Commonwealth of Pennsylvania awarded a four-year accreditation for radiation oncology services from the American Society for Radiation Oncology (ASTRO) after successfully demonstrating compliance with the Accreditation Program for Excellence (APEx®). In order to gain the APEx accreditation, NROC had to meet a comprehensive set of sixteen evidence-based standards of radiation oncology practice. The sixteen standards are focused on five pillars of patient care: 1) the process of care; 2) the radiation oncology team; 3) safety; 4) quality management; and 5) patient-centered care. “The NROC team is very pleased to receive the APEx accreditation from the premier radiation oncology society in the world,” said Christopher A. Peters, MD, medical director. “We are particularly honored to be one of only two centers in the state to receive this accreditation. Evaluating our processes in relation to ASTRO’s high standards, including standards for safety and quality, validates our practices and recognizes the efforts of our radiation oncology team to deliver patient-centered, highest quality radiation oncology care.” Accreditation through APEx is a rigorous, multi-step process that can take up to one year to complete. In becoming accredited, NROC had to have its policies and procedures evaluated using objective, verifiable expectations for performance in radiation oncology. NROC also had to demonstrate its commitment to high standards of safety and quality in the practice of radiation oncology and that it practices patient-centered care by promoting effective communication, coordinating treatment, and engaging patients and their families as partners in care. “At NROC, patients always come first,” added Dr. Peters. “As your partners in cancer care, we’ll answer all your questions precisely and promptly. We’ll guide you in the right direction, doing everything humanly and scientifically possible to get you on the road to recovering. You do not need a referral to get our help.  Even if our groundbreaking radiation treatment is not right for you, we’ll connect you to the best doctors and the proper treatment – wherever that might be.” NROC patients are also given the opportunity to participate in cancer clinical research trials. NROC physicians have served as Principal Investigators for National Cancer Institute research trials for almost 30 years. The APEx program involves both a self-assessment process and a facility visit by a medical physicist, radiation oncologist, radiation therapist, nurse, dosimetrist, nurse practitioner, physician assistant or practice administrator. “ASTRO is proud to recognize Northeast Radiation Oncology Center for achieving APEx accreditation,” said ASTRO chair Bruce D. Minsky, MD, FASTRO. “NROC has demonstrated a commitment to providing their patients with safe, high quality radiation therapy services.” ASTRO is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology • Biology • Physics (www.redjournal.org), Practical Radiation Oncology (www.practicalradonc.org) and Advances in Radiation Oncology (www.advancesradonc.org); developed and maintains an extensive patient website, RT Answers (http://www.rtanswers.org); and created the Radiation Oncology Institute (www.roinstitute.org), a nonprofit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO, visit www.astro.org. For more information, to interview Dr. Peters, or for photographs of the NROC team or facilities, please call Elaine Ferri at Lavelle Strategy Group at 570-969-6000 or eferri@lavellestrategy.com


Wu C.,Radiation Oncology Centers | Hosier K.E.,Radiation Oncology Centers | Beck K.E.,Radiation Oncology Centers | Radevic M.B.,Radiation Oncology Centers | And 8 more authors.
Medical Physics | Year: 2012

Purpose: To investigate using 3D γ analysis for IMRT and VMAT QA. Methods: We explored and studied 3D γ-analysis by comparing TPS computed and EPID back-projection reconstructed doses in patient's CT images. Two 3D γ quantities, γPTV and γ10, were proposed and studied for evaluating the QA results, and compared to 2D γ (MapCheck composite: γMC). Results: It was found that when 3(global)3 mm criteria was used, all IMRT and 90 of VMAT plans passed QA with a γ pass rate 90. A significant statistical correlation was observed between 3D and 2D γ-analysis results for IMRT QA if γ10 and γMC are concerned, but no significant relation is found between γPTV and γMC. Conclusions: 3D γ analysis based on EPID dose back-projection may provide a feasible tool for IMRT and VMAT pretreatment plan QA. © 2012 American Association of Physicists in Medicine.


Rosenthal S.A.,Radiation Oncology Centers | Sandler H.M.,Cedars Sinai Medical Center
Nature Reviews Urology | Year: 2010

High-risk prostate cancer can be defined by the assessment of pretreatment prognostic factors such as clinical stage, Gleason score, and PSA level. High-risk features include PSA > 20 ng/ml, Gleason score 8-10, and stage T3 tumors. Patients with adverse prognostic factors have historically fared poorly with monotherapeutic approaches. Multimodal treatment utilizing combined androgen suppression and radiotherapy has improved survival rates for patients with high-risk prostate cancer. In addition, multiple randomized trials in patients treated with primary radical prostatectomy have demonstrated improved outcomes with the addition of adjuvant radiotherapy. Improved radiotherapy techniques that allow for dose escalation, and new systemic therapy approaches such as adjuvant chemotherapy, present promising future therapeutic alternatives for patients with high-risk prostate cancer. © 2010 Macmillan Publishers Limited. All rights reserved.


Dutton S.C.,Radiation Oncology Centers | Sze G.K.,Yale University | Lund P.L.,Vantage Radiology and Diagnostic Services | Bluth E.I.,Ochsner Clinic Foundation
Journal of the American College of Radiology | Year: 2014

Radiologists today practice in diverse environments in addition to the traditional private practice model. Practice environments are evolving at a rapid rate, and the ACR Commission on Human Resources previously detailed the distribution of radiologists in practice in its workforce survey. Here, the commission describes the key practice options available and illustrates important differences in physician autonomy, efficiency, productivity, and subspecialty versus general practice among the practice environments. These attributes can in turn be useful to radiologists in deciding what type of work environment to seek. © 2014 American College of Radiology.

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