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Yorke AA, Williams VM, Elmore S, Alleyne-Mike K, Addison E, Kyeremeh PO, Tagoe SNA, Trauernicht CJ, Lazarus GL, Ford EC. Radiation Therapy Physics Quality Assurance and Management Practices in Low- and Middle-Income Countries: An Initial Pilot Survey in Six Countries and Validation Through a Site Visit. Adv Radiat Oncol 2024; 9:101335. [PMID: 38405318 PMCID: PMC10885564 DOI: 10.1016/j.adro.2023.101335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/31/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Our purpose was to assess physics quality assurance (QA) practices in less resourced radiation therapy (RT) centers to improve quality of care. Methods and Materials A preliminary study was conducted in 2020 of 13 select RT centers in 6 countries, and in 2021, our team conducted onsite visits to all the RT centers in Ghana, one of the countries from the initial survey. The RT centers included 1 private and 2 public institutions (denoted as Public-1 and Public-2). Follow-up surveys were sent to 17 medical physicists from the site visit. Questions centered on the topics of equipment, institutional practice, physics quality assurance, management, and safety practices. Qualitative and descriptive methods were used for data analysis. Questions regarding operational challenges (machine downtime, patient-related issues, power outages, and staffing) were asked on a 5-point Likert scale. Results The preliminary survey from 2020 had a 92% response rate. One key result showed that for RT centers in lower gross national income per capita countries there was a direct correlation between QA needs and the gross national income per capita of the country. The needs identified included film/array detectors, independent dose calculation software, calibration of ion chambers, diodes, thermoluminiscence diodes (TLDs), phantoms for verification, Treatment Planning System (TPS) test phantoms, imaging test phantoms and film dosimeters, education, and training. For the post survey after the site visit in 2021, we received a 100% response rate. The private and the Public-1 institutions each have computed tomography simulators located in their RT center. The average daily patient external beam workload for each clinic on a linear accelerator was: private = 25, Public-1 = 55, Public-2 = 40. The Co-60 workload was: Public-1 = 45, Public-2 = 25 (there was no Co-60 at the private hospital). Public-1 and -2 lacked the equipment necessary to conform to best practices in Task Group reports (TG) 142 and 198. Public-2 reported significant operational challenges. Notably, Public-1 and -2 have peer review chart rounds, which are attended by clinical oncologists, medical physicists, physicians, and physics trainees. All 17 physicists who responded to the post site visit survey indicated they had a system of documenting, tracking, and trending patient-related safety incidents, but only 1 physicist reported using International Atomic Energy Agency Safety in Radiation Oncology. Conclusions The preliminary study showed a direct correlation between QA needs and the development index of a country, and the follow-up survey examines operational and physics QA practices in the RT clinics in Ghana, one of the initial countries surveyed. This will form the basis of a planned continent-wide survey in Africa intended to spotlight QA practices in low- and middle-income countries, the challenges faced, and lessons learned to help understand the gaps and needs to support local physics QA and management programs. Audits during the site visit show education and training remain the most important needs in operating successful QA programs.
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Affiliation(s)
- Afua A. Yorke
- Department of Radiation Oncology, UW Medicine, Seattle, Washington
| | | | - Shekinah Elmore
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kellie Alleyne-Mike
- Department of Radiation Oncology, Cancer Center of Trinidad and Tobago, St. James Medical Complex, St. James, Trinidad, and Tobago
| | - Eric Addison
- Komfo Anokye Teaching Hospital, Oncology Directorate, Kumasi, Ghana
| | | | - Samuel Nii Adu Tagoe
- University of Ghana and National Center for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | | | - Eric C. Ford
- Department of Radiation Oncology, UW Medicine, Seattle, Washington
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Liu S, Chapman KL, Berry SL, Bertini J, Ma R, Fu Y, Yang D, Moran JM, Della-Biancia C. Implementation of a knowledge-based decision support system for treatment plan auditing through automation. Med Phys 2023; 50:6978-6989. [PMID: 37211898 DOI: 10.1002/mp.16472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Independent auditing is a necessary component of a comprehensive quality assurance (QA) program and can also be utilized for continuous quality improvement (QI) in various radiotherapy processes. Two senior physicists at our institution have been performing a time intensive manual audit of cross-campus treatment plans annually, with the aim of further standardizing our planning procedures, updating policies and guidelines, and providing training opportunities of all staff members. PURPOSE A knowledge-based automated anomaly-detection algorithm to provide decision support and strengthen our manual retrospective plan auditing process was developed. This standardized and improved the efficiency of the assessment of our external beam radiotherapy (EBRT) treatment planning across all eight campuses of our institution. METHODS A total of 843 external beam radiotherapy plans for 721 lung patients from January 2020 to March 2021 were automatically acquired from our clinical treatment planning and management systems. From each plan, 44 parameters were automatically extracted and pre-processed. A knowledge-based anomaly detection algorithm, namely, "isolation forest" (iForest), was then applied to the plan dataset. An anomaly score was determined for each plan using recursive partitioning mechanism. Top 20 plans ranked with the highest anomaly scores for each treatment technique (2D/3D/IMRT/VMAT/SBRT) including auto-populated parameters were used to guide the manual auditing process and validated by two plan auditors. RESULTS The two auditors verified that 75.6% plans with the highest iForest anomaly scores have similar concerning qualities that may lead to actionable recommendations for our planning procedures and staff training materials. The time to audit a chart was approximately 20.8 min on average when done manually and 14.0 min when done with the iForest guidance. Approximately 6.8 min were saved per chart with the iForest method. For our typical internal audit review of 250 charts annually, the total time savings are approximately 30 hr per year. CONCLUSION iForest effectively detects anomalous plans and strengthens our cross-campus manual plan auditing procedure by adding decision support and further improve standardization. Due to the use of automation, this method was efficient and will be used to establish a standard plan auditing procedure, which could occur more frequently.
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Affiliation(s)
- Shi Liu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katherine L Chapman
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sean L Berry
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Julian Bertini
- Committee on Medical Physics, Biological Science Division, University of Chicago, Chicago, Illinois, USA
| | - Rongtao Ma
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yabo Fu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Deshan Yang
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Jean M Moran
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cesar Della-Biancia
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Rubagumya F, Mushonga M, Abdihamid O, Nyagabona S, Hopman W, Nwamaka L, Omar AA, Ndlovu N, Booth C, Aggarwal A, Brundage M, Vanderpuye V, de Moraes FY. Status of Peer Review in Radiation Oncology: A Survey of Cancer Centers in Sub-Saharan Africa. Int J Radiat Oncol Biol Phys 2023; 116:984-991. [PMID: 37453798 DOI: 10.1016/j.ijrobp.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and; Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Melinda Mushonga
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Omar Abdihamid
- Garissa Cancer Center-Garissa County Referral Hospital, Garissa, Kenya
| | - Sarah Nyagabona
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wilma Hopman
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Kingston Health Sciences Centre Research Institute, Kingston, Ontario, Canada
| | | | - Abeid Athman Omar
- Kenyatta University Teaching Research and Referral Hospital, Nairobi, Kenya
| | - Ntokozo Ndlovu
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Christopher Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and; Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and
| | | | - Fabio Ynoe de Moraes
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and
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Claridge Mackonis ER, Hardcastle N, Haworth A. A survey of compliance with stereotactic ablative body radiotherapy quality recommendations. J Med Imaging Radiat Oncol 2023. [PMID: 36996443 DOI: 10.1111/1754-9485.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/05/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Many publications have proposed quality standards for stereotactic ablative body radiotherapy (SABR). However, data on the level of compliance with these guidelines is lacking in the literature. This study aimed to understand how these guidelines are applied in the clinic and to identify barriers to implementing such recommendations. METHODS Interviews were conducted with multidisciplinary staff at radiation oncology centres across New South Wales formulated around the RANZCR Guidelines for Safe Practice of Stereotactic Body (Ablative) Radiation Therapy. The interview responses were grouped into 20 topics, assessed against the guidelines and thematically analysed. RESULTS Good compliance with the guidelines was found, with more than 80% of centres achieving satisfactory results in more than half the topics. The areas with the lowest compliance were auditing, risk assessment and reporting recommendations. Barriers to the quality of SABR treatments included limited training opportunities, low patient numbers and a lack of clear requirements on comprehensive auditing and reporting. CONCLUSION Overall, the centres surveyed reported good compliance with most of the RANZCR SABR guidelines. The tasks with the lowest compliance were those that monitor quality outcomes. Potential strategies for improvement include inclusion in clinical trials and the use of databases which link treatment parameters, dosimetry and outcomes. Further work will focus on the barriers identified in this survey and propose practical solutions to improve compliance in these areas.
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Affiliation(s)
- Elizabeth Ruth Claridge Mackonis
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Nick Hardcastle
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
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Nait-Achour O, Cucchiaro S, Nardin S, Brusadin G. [Radiation TherapisTs Radiographer (RTTs) and risk management in radiotherapy: An international survey]. Cancer Radiother 2022; 26:846-850. [PMID: 35961930 DOI: 10.1016/j.canrad.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE In order to study the role perception and the effective involvement of Radiation TherapisTs (RTTs) in risk management in radiotherapy, a survey was developed and distributed in five countries (France, Switzerland, Belgium, Ireland, the Netherlands). MATERIALS AND METHODS The article presents the results of this survey and the comparison between the different countries. RESULTS Overall, the results of the survey show a good involvement and perception of the RTTs around the risk management approach, although training in this area has yet to be systematized. CONCLUSION Although with differences in the results between the participating countries, the survey seems to highlight the deployment of preventive actions that are evaluated as not very effective by the respondents and by the international scientific literature.
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Affiliation(s)
- O Nait-Achour
- Département IMRT, Lycée Antoine-de-Saint-Exupéry, 2, rue Henri-Matisse, 94000 Créteil, France
| | - S Cucchiaro
- Service de radiothérapie, CHU Liège, 1, avenue de l'Hôpital, 4000 Liège, Belgique
| | - S Nardin
- Service de radiothérapie, Centre de Haute Énergie, 10, boulevard Pasteur, 06000 Nice, France
| | - G Brusadin
- Direction qualité et gestion des risques, France Gustave-Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif cedex, France.
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Manjali JJ, Krishnatry R, Palta JR, Agarwal J. Quality and Safety With Technological Advancements in Radiotherapy: An Overview and Journey Narrative From a Low- and Middle-Income Country Institution. JCO Glob Oncol 2022; 8:e2100367. [PMID: 35994694 PMCID: PMC9470131 DOI: 10.1200/go.21.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
To present an overview of quality and safety in radiotherapy from the context of low- and middle-income countries on the basis of a recently conducted annual meeting of our institution and our experience of implementing an error management system at our center. Quality and safety improvement with evolving technology in LMIC, a journey described.![]()
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Affiliation(s)
- Jifmi Jose Manjali
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Jatinder R. Palta
- Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - J.P. Agarwal
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
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Dunn A, Costello S, Imlach F, Jo E, Gurney J, Simpson R, Sarfati D. Using national data to model the New Zealand radiation oncology workforce. J Med Imaging Radiat Oncol 2022; 66:708-716. [PMID: 35768935 PMCID: PMC9542613 DOI: 10.1111/1754-9485.13448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
Introduction Demand for radiation therapy is expected to increase over time. In Aotearoa/New Zealand, the radiation oncology workforce experiences high numbers of clinical hours but an intervention rate that is lower than in comparable countries, suggesting unmet treatment need. Accurate models on the supply and demand for radiation oncologists (ROs) are needed to ensure adequate staffing levels. Methods We developed a demand model that predicted the future number of ROs required, using national data from the Radiation Oncology Collection (ROC) and a survey of ROs. Radiation therapy intervention and retreatment rates (IR/RTRs), and benign and non‐cancer conditions being treated, were derived from the ROC and applied to Census population projections. Survey data provided definitions of treatment by complexity, time spent in different activities and time available for work. Results were linked to radiation oncology workforce forecasts from a supply model developed by the Ministry of Health. Results The demand model showed that 85 ROs would be needed in 2031, if current IR/RTRs were maintained, an increase from 68 in 2021. The supply model predicted a decrease in ROs over time, leaving a significant shortfall. Model parameters could be modified to assess the impact of workforce or practice changes; more ROs would be needed if average working hours reduced or IR/RTRs increased. Conclusion Workforce models based on robust data collections are an important tool for workforce planning. The RO demand model presented here combines detailed information on treatment and work activities to provide credible estimates that can be used to inform actions on training, recruitment and retention.
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Affiliation(s)
- Alex Dunn
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
| | | | - Fiona Imlach
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
| | - Emmanuel Jo
- Health Workforce Directorate, Ministry of Health, Wellington, New Zealand.,Department of Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand.,Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Rose Simpson
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
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Chilkuri M, Millar J, Adams G. 'With great power comes great responsibility': An impetus for quality and safety in radiation oncology. J Med Imaging Radiat Oncol 2022; 66:242-248. [PMID: 35243779 DOI: 10.1111/1754-9485.13377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
Abstract
Strict quality control and vigilance at every step is essential to maintain rigour and ensure quality and safety in radiation oncology. The scientific knowledge and technological capabilities we possess give us enormous power to deliver specialised and complex treatments and improve health outcomes for our cancer patients. However, this requires development of whole system performance and its evaluation against established standards and benchmarks. It calls for organisational commitment and active participation of managers and clinical teams in quality improvement initiatives. In addition to medical physicists and radiation therapist, radiation oncologists, including trainees, must accept important leadership responsibilities to maintain a positive safety culture.
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Affiliation(s)
- Madhavi Chilkuri
- Radiation Oncology, Townsville University Hospital, Townsville, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Jeremy Millar
- Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gerard Adams
- Radiation Oncology, Genesis Care, Bundaberg, Queensland, Australia
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Nic Giolla Easpaig B, Tran Y, Winata T, Lamprell K, Fajardo Pulido D, Arnolda G, Delaney GP, Liauw W, Smith K, Avery S, Rigg K, Westbrook J, Olver I, Currow D, Karnon J, Ward RL, Braithwaite J. The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings. BMC Health Serv Res 2022; 22:190. [PMID: 35151314 PMCID: PMC8841048 DOI: 10.1186/s12913-022-07593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. Methods A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding ‘work as done’. Data were analysed using an adapted “Qualitative Rapid Appraisal, Rigorous Analysis” approach. Results Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients “falling through the cracks.” Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. Conclusions The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants; professional acumen; institutional knowledge; social ties and relationships between and within professional groups; and commitment to patient-centred care. An understanding of the realities of ‘work-as-done’ may help OPCs to sustain high-quality care in the face of escalating service demand.
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Pourel N, Meyrieux C, Lisbona A. Quality/risk management system in radiotherapy: Changes afoot. Cancer Radiother 2021; 26:14-19. [PMID: 34953695 DOI: 10.1016/j.canrad.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The French sanitary and regulatory context in which radiotherapy centres are comprised is evolving. Risk and quality management systems are currently adapting to these evolutions. The French nuclear safety agency (ASN) decision of July 1st 2008 on quality assurance obligations in radiotherapy has reached 10 years of age, and the French high authority of health (HAS) certification system 20 years now. Mandatory tools needed for the improvement of quality and safety in healthcare are now well known. From now on, the focus of healthcare policies is oriented towards evaluation of efficiency of these new organisations designed following ASN and HAS nationwide guidelines.
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Affiliation(s)
- N Pourel
- Pôle radiothérapie, Institut du cancer Avignon-Provence, 250, chemin de Baigne-Pieds, 84000 Avignon, France.
| | - C Meyrieux
- Département Qualité, Institut du cancer Avignon-Provence, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - A Lisbona
- Département de physique médicale, Institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
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11
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Ghalibafian M, Masoudifar M, Mohammadi E, Girinsky T, Oberlin O, Bouffet E. Establishing a pediatric radiation oncology department in a low- and middle-income country: Major challenge in implementing the Global Initiative for Childhood Cancer. Pediatr Blood Cancer 2021; 68:e29233. [PMID: 34357689 DOI: 10.1002/pbc.29233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Mithra Ghalibafian
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Maryam Masoudifar
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Ehsan Mohammadi
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | | | - Odile Oberlin
- Department of Pediatrics, Gustave Roussy, Villejuif, France
| | - Eric Bouffet
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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Lopes de Castro C, Fundowicz M, Roselló A, Jové J, Deantonio L, Aguiar A, Pisani C, Villà S, Boladeras A, Konstanty E, Kruszyna-Mochalska M, Milecki P, Jurado-Bruggeman D, Lencart J, Modolell I, Muñoz-Montplet C, Aliste L, Torras MG, Puigdemont M, Carvalho L, Krengli M, Guedea F, Malicki J. Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres. Sci Rep 2021; 11:12323. [PMID: 34112863 PMCID: PMC8192927 DOI: 10.1038/s41598-021-91723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/21/2021] [Indexed: 11/24/2022] Open
Abstract
To assess adherence to standard clinical practice for the diagnosis and treatment of patients undergoing prostate cancer (PCa) radiotherapy in four European countries using clinical audits as part of the international IROCA project. Multi-institutional, retrospective cohort study of 240 randomly-selected patients treated for PCa (n = 40/centre) in the year 2015 at six European hospitals. Clinical indicators applicable to general and PCa-specific radiotherapy processes were evaluated. All data were obtained directly from medical records. The audits were performed in the year 2017. Adherence to clinical protocols and practices was satisfactory, but with substantial inter-centre variability in numerous variables, as follows: staging MRI (range 27.5-87.5% of cases); presentation to multidisciplinary tumour board (2.5-100%); time elapsed between initial visit to the radiation oncology department and treatment initiation (42-102.5 days); number of treatment interruptions ≥ 1 day (7.5-97.5%). The most common deviation from standard clinical practice was inconsistent data registration, mainly failure to report data related to diagnosis, treatment, and/or adverse events. This clinical audit detected substantial inter-centre variability in adherence to standard clinical practice, most notably inconsistent record keeping. These findings confirm the value of performing clinical audits to detect deviations from standard clinical practices and procedures.
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Affiliation(s)
- Carla Lopes de Castro
- Instituto Português de Oncologia, Porto, Portugal.
- Department of Radiation Oncology, Instituto Português de Oncologia Francisco Gentil-Porto, Porto, Portugal.
| | | | | | - Josep Jové
- Institut Català d'Oncologia, Badalona, Spain
| | - Letizia Deantonio
- Università degli Studi del Piemonte Orientale (UNIUPO), Novara, Italy
| | - Artur Aguiar
- Instituto Português de Oncologia, Porto, Portugal
| | - Carla Pisani
- Università degli Studi del Piemonte Orientale (UNIUPO), Novara, Italy
| | | | - Anna Boladeras
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | | | - Marta Kruszyna-Mochalska
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
| | - Piotr Milecki
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
| | | | | | | | | | - Luisa Aliste
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | | | | | | | - Marco Krengli
- Università degli Studi del Piemonte Orientale (UNIUPO), Novara, Italy
| | - Ferran Guedea
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | - Julian Malicki
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
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Addressing the burden of cervical cancer through IAEA global brachytherapy initiatives. Brachytherapy 2020; 19:850-856. [PMID: 32928684 PMCID: PMC7895316 DOI: 10.1016/j.brachy.2020.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/29/2020] [Accepted: 07/29/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE: Brachytherapy (BT) is an essential component of definitive therapy for locally advanced cervical cancer. Despite the advantages of the dose distribution with BT in cervical cancer, there is paucity of specific skills required for good-quality BT applications. Furthermore, replacing BT with other modern external beam techniques as a boost can lead to suboptimal results in cervix cancer. METHODS AND MATERIALS: Review of available IAEA resources, research and cooperation programs available from the IAEA was completed. These opportunities can be used to address challenges in Brachytherapy. The International Atomic Energy Agency (IAEA) provides support for BT through various means that includes education and training, both long term, short term and continuing medical education of professionals, providing expert visits to support implementation, development of curricula for professionals, e-learning through the human health campus, contouring workshops, 2D to 3D BT training, and virtual tumor boards. In addition, the IAEA provides support for implementing quality assurance in radiotherapy to its member states and provides guidelines for comprehensive audits in radiation therapy (QUATRO), and produces safety standards and training in radiation safety. In addition, mapping BT resources, making the case for investment and support for setting up BT services and radiotherapy centers are also available. The IAEA Dosimetry Laboratory provides calibration services to Secondary Standards Dosimetry Laboratories for well chambers used to confirm the reference air kerma rate of Co60 and Ir192 high-dose-rate BT sources, as well as for Cs137 low-dose-rate sources. Furthermore, the IAEA supports research and development in radiotherapy (and BT) through coordinated research activities that include controlled randomized clinical trials, Patterns of Care studies among others. Partnerships with professional organizations and funding bodies, as well as through the United Nations Joint Global Programme on Cervical Cancer Prevention and Control support radiotherapy activities, including BT in countries worldwide. CONCLUSION: The IAEA supports brachytherapy implementation, training and research and provides resources to professionals in the area.
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Vaandering A, Lievens Y, Scalliet P. Feasibility and impact of national peer reviewed clinical audits in radiotherapy departments. Radiother Oncol 2020; 144:218-223. [PMID: 32044420 DOI: 10.1016/j.radonc.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE/OBJECTIVE A national incentive brought about the instauration of systematic clinical audits of all Belgian radiotherapy departments (n = 25) from 2011 to 2015 using the International Atomic Energy Agency QUATRO (Quality Improvement Quality Assurance Team for Radiation Oncology) methodology. The impact of these audits was evaluated and the emitted recommendations originating from the audit reports were analysed to identify areas of weakness on a national basis. METHOD The QUATRO audits performed in each radiotherapy department gave rise to reports in which each department received a list of recommendations that it is free to implement. These audit reports were analyzed to identify common areas for which improvements were recommended. Moreover, questionnaires were sent to all departments in order to evaluate the overall usefulness of the recommendations as well as the relevancy and the actual impact of each individual recommendation. RESULTS Of the 381 emitted recommendations, 34% concerned process optimization of which a quarter involved process improvement and protocol development. Twenty-seven percent of the recommendations concerned infrastructure of which one-third was related to the quality of the equipment or facility. Nineteen and 20% of recommendations addressed department organisational and staff issues respectively. When analysing the departments' feedback questionnaires, 54% of the departments evaluated the audits' recommendations as being very useful. Furthermore, 42.7% of the recommendations were found to be very relevant and 23.5% were deemed to have an important impact. CONCLUSION This first round of audits in Belgium allowed for the identification of common areas for improvements of practice in radiation oncology departments, with a focus on process optimization and infrastructure elements. Similarly, the audits' emitted recommendations were globally deemed very relevant. Encouraged, by this analysis, a second cycle of audits has started in Belgium with a modified version of the QUATRO document (B-QUATRO).
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Affiliation(s)
- Aude Vaandering
- Radiation Oncology Department, Cliniques Universitaires Saint Luc, Brussels, Belgium; Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital, Ghent, Belgium
| | - Pierre Scalliet
- Radiation Oncology Department, Cliniques Universitaires Saint Luc, Brussels, Belgium; Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
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Kazantsev P, Lechner W, Gershkevitsh E, Clark CH, Venencia D, Van Dyk J, Wesolowska P, Hernandez V, Jornet N, Tomsej M, Bokulic T, Izewska J. IAEA methodology for on-site end-to-end IMRT/VMAT audits: an international pilot study. Acta Oncol 2020; 59:141-148. [PMID: 31746249 DOI: 10.1080/0284186x.2019.1685128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The IAEA has developed and tested an on-site, end-to-end IMRT/VMAT dosimetry audit methodology for head and neck cases using an anthropomorphic phantom. The audit methodology is described, and the results of the international pilot testing are presented.Material and methods: The audit utilizes a specially designed, commercially available anthropomorphic phantom capable of accommodating a small volume ion chamber (IC) in four locations (three in planning target volumes (PTVs) and one in an organ at risk (OAR)) and a Gafchromic film in a coronal plane for the absorbed dose to water and two-dimensional dose distribution measurements, respectively. The audit consists of a pre-visit and on-site phases. The pre-visit phase is carried out remotely and includes a treatment planning task and a set of computational exercises. The on-site phase aims at comparing the treatment planning system (TPS) calculations with measurements in the anthropomorphic phantom following an end-to-end approach. Two main aspects were tested in the pilot study: feasibility of the planning constraints and the accuracy of IC and film results in comparison with TPS calculations. Treatment plan quality was scored from 0 to 100.Results: Forty-two treatment plans were submitted by 14 institutions from 10 countries, with 79% of them having a plan quality score over 90. Seventeen sets of IC measurement results were collected, and the average measured to calculated dose ratio was 0.988 ± 0.016 for PTVs and 1.020 ± 0.029 for OAR. For 13 film measurement results, the average gamma passing rate was 94.1% using criteria of 3%/3 mm, 20% threshold and global gamma.Conclusions: The audit methodology was proved to be feasible and ready to be adopted by national dosimetry audit networks for local implementation.
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Affiliation(s)
| | - Wolfgang Lechner
- Department of Radiation Oncology, Division of Medical Physics, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Vienna, Austria
| | | | - Catharine H. Clark
- Department of Medical Physics, Royal Surrey County Hospital, Guildford, UK
- Metrology for Medical Physics (MEMPHYS), National Physical Laboratory, Teddington, UK
| | | | - Jacob Van Dyk
- Department of Oncology and Medical Biophysics, Western University, London, Canada
| | | | - Victor Hernandez
- Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Tarragona, Spain
| | - Nuria Jornet
- Servei de Radiofisica i Radioproteccio, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Milan Tomsej
- CHU Charleroi, Hopital Andre Vesale, Montigny-le-Tilleul, Belgium
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Lye J, Kry S, Shaw M, Gibbons F, Keehan S, Lehmann J, Kron T, Followill D, Williams I. A comparison of IROC and ACDS on-site audits of reference and non-reference dosimetry. Med Phys 2019; 46:5878-5887. [PMID: 31494941 PMCID: PMC6916618 DOI: 10.1002/mp.13800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/19/2019] [Accepted: 08/05/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Consistency between different international quality assurance groups is important in the progress toward similar standards and expectations in radiotherapy dosimetry around the world, and in the context of consistent clinical trial data from international trial participants. This study compares the dosimetry audit methodology and results of two international quality assurance groups performing a side-by-side comparison at the same radiotherapy department, and interrogates the ability of the audits to detect deliberately introduced errors. METHODS A comparison of the core dosimetry components of reference and non-reference audits was conducted by the Imaging and Radiation Oncology Core (IROC, Houston, USA) and the Australian Clinical Dosimetry Service (ACDS, Melbourne, Australia). A set of measurements were conducted over 2 days at an Australian radiation therapy facility in Melbourne. Each group evaluated the reference dosimetry, output factors, small field output factors, percentage depth dose (PDD), wedge, and off-axis factors according to their standard protocols. IROC additionally investigated the Electron PDD and the ACDS investigated the effect of heterogeneities. In order to evaluate and compare the performance of these audits under suboptimal conditions, artificial errors in percentage depth dose (PDD), EDW, and small field output factors were introduced into the 6 MV beam model to simulate potential commissioning/modeling errors and both audits were tested for their sensitivity in detecting these errors. RESULTS With the plans from the clinical beam model, almost all results were within tolerance and at an optimal pass level. Good consistency was found between the two audits as almost all findings were consistent between them. Only two results were different between the results of IROC and the ACDS. The measurements of reference FFF photons showed a discrepancy of 0.7% between ACDS and IROC due to the inclusion of a 0.5% nonuniformity correction by the ACDS. The second difference between IROC and the ACDS was seen with the lung phantom. The asymmetric field behind lung measured by the ACDS was slightly (0.3%) above the ACDS's pass (optimal) level of 3.3%. IROC did not detect this issue because their measurements were all assessed in a homogeneous phantom. When errors were deliberately introduced neither audit was sensitive enough to pick up a 2% change to the small field output factors. The introduced PDD change was flagged by both audits. Similarly, the introduced error of using 25° wedge instead of 30° wedge was detectible in both audits as out of tolerance. CONCLUSIONS Despite different equipment, approach, and scope of measurements in on-site audits, there were clear similarities between the results from the two groups. This finding is encouraging in the context of a global harmonized approach to radiotherapy quality assurance and dosimetry audit.
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Affiliation(s)
- Jessica Lye
- Australian Clinical Dosimetry ServiceARPANSAMelbourneAustralia
| | - Stephen Kry
- Imaging and Radiation Oncology Core Houston QA CenterMD Anderson Cancer CenterHoustonTXUSA
| | - Maddison Shaw
- Australian Clinical Dosimetry ServiceARPANSAMelbourneAustralia
| | - Francis Gibbons
- Australian Clinical Dosimetry ServiceARPANSAMelbourneAustralia
- Sunshine Coast Hospital and Health ServiceBirtinyaQldAustralia
| | | | - Joerg Lehmann
- Australian Clinical Dosimetry ServiceARPANSAMelbourneAustralia
- Department of Radiation OncologyCalvary Mater NewcastleNewcastleAustralia
| | - Tomas Kron
- Peter MacCallum Cancer CentreMelbourneAustralia
| | - David Followill
- Imaging and Radiation Oncology Core Houston QA CenterMD Anderson Cancer CenterHoustonTXUSA
| | - Ivan Williams
- Australian Clinical Dosimetry ServiceARPANSAMelbourneAustralia
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Mahantshetty UM. Scale-up of radiotherapy for cervical cancer. Lancet Oncol 2019; 20:888-889. [DOI: 10.1016/s1470-2045(19)30376-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
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Kapoor R, Moghanaki D, Rexrode S, Monzon B, Ray M, Hulick PR, Albuquerque K, Rosenthal SA, Palta JR, Hagan MP. Quality Improvements of Veterans Health Administration Radiation Oncology Services Through Partnership for Accreditation With the ACR. J Am Coll Radiol 2018; 15:1732-1737. [DOI: 10.1016/j.jacr.2018.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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Coffey M, Rosenblatt E. Guest short communication: Is education of RTTs really unnecessary? Tech Innov Patient Support Radiat Oncol 2018; 8:1-2. [PMID: 32095579 PMCID: PMC7033760 DOI: 10.1016/j.tipsro.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/18/2022] Open
Abstract
Radiation TherapisTs (RTTs) are an integral part of the radiation oncology team, however the provision of high quality education for these professionals can be met with difficulties. Over many years, the RTT committee of the European Society for Radiotherapy and oncology (ESTRO), together with the International Atomic Energy Agency (IAEA) have endeavoured to improve the educational standards of RTTs. This article summarises the main difficulties experienced in this field as well as the steps that both the IAEA and ESTRO have taken to improve the education of RTTs and thereby improve the safe treatment of cancer patients internationally.
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Affiliation(s)
- Mary Coffey
- Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
| | - Eduardo Rosenblatt
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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Vaandering A, Jornet N, Scalliet P, Coffey M, Lievens Y. Doing the right thing: Quality in radiotherapy, a European perspective. Radiother Oncol 2018; 127:161-163. [PMID: 29548562 DOI: 10.1016/j.radonc.2018.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/15/2018] [Indexed: 11/18/2022]
Affiliation(s)
- A Vaandering
- Department of Radiation Oncology, Université Catholique de Louvain, St Luc University hospital, Brussels, Belgium; Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - N Jornet
- Servei de Radiofísica i Radioprotecció. Hospital Sant Pau.Barcelona, Spain
| | - P Scalliet
- Department of Radiation Oncology, Université Catholique de Louvain, St Luc University hospital, Brussels, Belgium
| | - M Coffey
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland
| | - Y Lievens
- Ghent University Hospital and Ghent University, Ghent, Belgium
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