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Farris MK, Razavian NB, Hughes RT, Ververs JD, Snavely AC, Leyrer CM, Tye KE, Allen LF, Pacholke HD, Weaver KE, Bunch PM, Chan MD, Clark H, Puthoff G, Farris JC, Steber CR, Wentworth S, Levine BJ, Nightingale CL, Ponnatapura J. Bridging the Communication Gaps: A Prospective Single-Arm Pilot Study Testing the Feasibility of Interdisciplinary Radiotherapy Planning in Locally Advanced Lung Cancer. Acad Radiol 2023; 30:2566-2573. [PMID: 36759296 PMCID: PMC10404636 DOI: 10.1016/j.acra.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/05/2023] [Accepted: 01/15/2023] [Indexed: 02/09/2023]
Abstract
RATIONALE AND OBJECTIVES The treatment of locally advanced lung cancer (LALC) with radiotherapy (RT) can be challenging. Multidisciplinary collaboration between radiologists and radiation oncologists (ROs) may optimize RT planning, reduce uncertainty in follow-up imaging interpretation, and improve outcomes. MATERIALS AND METHODS In this prospective clinical treatment trial (clinicaltrials.gov NCT04844736), 37 patients receiving definitive RT for LALC, six attending ROs, and three thoracic radiologists were consented and enrolled across four treatment centers. Prior to RT plan finalization, representative computed tomography (CT) slices with overlaid outlines of preliminary irradiation targets were shared with the team of radiologists. The primary endpoint was to assess feasibility of receiving feedback no later than 4 business days of RT simulation on at least 50% of plans. RESULTS Thirty-seven patients with lung cancer were enrolled, and 35 of 37 RT plans were reviewed. Of the 35 patients reviewed, mean age was 69 years. For 27 of 37 plans (73%), feedback was received within 4 or fewer days (interquartile range 3-4 days). Thirteen of 35 cases (37%) received feedback that the delineated target potentially did not include all sites suspicious for tumor involvement. In total, changes to the RT plan were recommended for over- or undercoverage in 16 of 35 cases (46%) and implemented in all cases. Radiology review resulted in no treatment delays and substantial changes to irradiated volumes: gross tumor volume, -1.9 to +96.1%; planning target volume, -37.5 to +116.5%. CONCLUSION Interdisciplinary collaborative RT planning using a simplified workflow was feasible, produced no treatment delays, and prompted substantial changes in RT targets.
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Affiliation(s)
- Michael K Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.
| | - Niema B Razavian
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - James D Ververs
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Charles M Leyrer
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Karen E Tye
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Laura F Allen
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Heather D Pacholke
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Paul M Bunch
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Hollins Clark
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gregory Puthoff
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Joshua C Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Cole R Steber
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Stacy Wentworth
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Beverly J Levine
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Feasibility and clinical utility of a workflow interfacing radiation oncology lung stereotactic body radiotherapy treatment planning and diagnostic radiology. Pract Radiat Oncol 2022; 12:e512-e516. [PMID: 35752410 DOI: 10.1016/j.prro.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022]
Abstract
Stereotactic body radiotherapy (SBRT) is commonly used to treat early stage non-small cell lung cancer (NSCLC). SBRT beam arrangements include multiple entry/exit pathways resulting in irregular low dose distributions within normal lung parenchyma. An improved understanding of post-treatment radiographic changes may improve the ability to predict clinical complications including radiation pneumonitis as well as assist in early detection of local failures. Radiation treatment planning is conducted using software systems separate from diagnostic radiology, often not accessible to the diagnostic radiologist. We developed a workflow for interfacing radiation dose information from lung SBRT treatments with diagnostic radiology picture archiving and communication system (PACS). In an anonymized PACS study folder, SBRT dose maps depicting high dose, low dose, and non-irradiated lung volumes were viewable side-by-side with pretreatment and follow up diagnostic CT scans. Clinical utility was evaluated by two thoracic diagnostic radiologists reviewing post-treatment diagnostic follow up scans in PACS both with and without radiation dose maps available. The addition of the biologically effective dose (BED) map did not significantly change identification rates of radiation induced lung injury (RILI) (92% vs. 95%, p=0.32) but did significantly decrease radiologic suspicion for LR (22% vs. 8%, p=0.003). The addition of BED maps significantly increased confidence in calling RILI (7.75 vs. 8.82, p=0.004) and LR (5.5 vs 6.6, p=0.005). Recommendation for additional workup was not significantly different (10% vs 7%, p=0.41). We demonstrated the feasibility and clinical utility of a workflow generating simplified radiation dose maps that are viewable within PACS for diagnostic radiology review.
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Vengaloor Thomas T, Reddy KK, Albert A, Ridgway M, Robinson W, Vijayakumar S. Educating the Colleagues: Radiation Basics for Obstetrics and Gynecology Residents. Adv Radiat Oncol 2022; 7:100843. [PMID: 35387425 PMCID: PMC8977845 DOI: 10.1016/j.adro.2021.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Exposure to radiation oncology (RO) is limited among medical students, excluding those who wish to pursue a radiation oncology career. Consequently, RO knowledge in gynecological malignancies may differ among obstetricians and gynecologists (OB&G), depending on their experience and training level. Establishing a program to educate OB&G residents about basic radiation oncology principles may improve patients' coordination and treatment with gynecological malignancies. At our institution, radiation oncology residents conducted a 2-part training session for OB&G colleagues, which included a lecture and hands-on training. Educational sessions targeting OB&G residents are needed to enhance knowledge about radiation treatments and improve patient care.
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Affiliation(s)
| | - Kati K. Reddy
- University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Mildred Ridgway
- University of Mississippi Medical Center, Jackson, Mississippi
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