1
|
Sritharan K, Akhiat H, Cahill D, Choi S, Choudhury A, Chung P, Diaz J, Dysager L, Hall W, Huddart R, Kerkmeijer LGW, Lawton C, Mohajer J, Murray J, Nyborg CJ, Pos FJ, Rigo M, Schytte T, Sidhom M, Sohaib A, Tan A, van der Voort van Zyp J, Vesprini D, Zelefsky MJ, Tree AC. Development of Prostate Bed Delineation Consensus Guidelines for Magnetic Resonance Image-Guided Radiotherapy and Assessment of Its Effect on Interobserver Variability. Int J Radiat Oncol Biol Phys 2024; 118:378-389. [PMID: 37633499 DOI: 10.1016/j.ijrobp.2023.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The use of magnetic resonance imaging (MRI) in radiotherapy planning is becoming more widespread, particularly with the emergence of MRI-guided radiotherapy systems. Existing guidelines for defining the prostate bed clinical target volume (CTV) show considerable heterogeneity. This study aimed to establish baseline interobserver variability (IOV) for prostate bed CTV contouring on MRI, develop international consensus guidelines, and evaluate its effect on IOV. METHODS AND MATERIALS Participants delineated the CTV on 3 MRI scans, obtained from the Elekta Unity MR-Linac, as per their normal practice. Radiation oncologist contours were visually examined for discrepancies, and interobserver comparisons were evaluated against simultaneous truth and performance level estimation (STAPLE) contours using overlap metrics (Dice similarity coefficient and Cohen's kappa), distance metrics (mean distance to agreement and Hausdorff distance), and volume measurements. A literature review of postradical prostatectomy local recurrence patterns was performed and presented alongside IOV results to the participants. Consensus guidelines were collectively constructed, and IOV assessment was repeated using these guidelines. RESULTS Sixteen radiation oncologists' contours were included in the final analysis. Visual evaluation demonstrated significant differences in the superior, inferior, and anterior borders. Baseline IOV assessment indicated moderate agreement for the overlap metrics while volume and distance metrics demonstrated greater variability. Consensus for optimal prostate bed CTV boundaries was established during a virtual meeting. After guideline development, a decrease in IOV was observed. The maximum volume ratio decreased from 4.7 to 3.1 and volume coefficient of variation reduced from 40% to 34%. The mean Dice similarity coefficient rose from 0.72 to 0.75 and the mean distance to agreement decreased from 3.63 to 2.95 mm. CONCLUSIONS Interobserver variability in prostate bed contouring exists among international genitourinary experts, although this is lower than previously reported. Consensus guidelines for MRI-based prostate bed contouring have been developed, and this has resulted in an improvement in contouring concordance. However, IOV persists and strategies such as an education program, development of a contouring atlas, and further refinement of the guidelines may lead to additional improvements.
Collapse
Affiliation(s)
- Kobika Sritharan
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom.
| | | | - Declan Cahill
- Department of Urology, Royal Marsden Hospital NHS Trust, London, United Kingdom
| | - Seungtaek Choi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Ananya Choudhury
- Christie National Health Service Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Lars Dysager
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - William Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert Huddart
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Colleen Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Julia Murray
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| | | | - Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Italy
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mark Sidhom
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Aslam Sohaib
- Department of Radiology, Royal Marsden Hospital NHS Trust, Sutton, United Kingdom
| | - Alex Tan
- Sunshine Coast Hospital and Health Service, Queensland, Australia; James Cook University, Townsville, Queensland, Australia
| | | | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison C Tree
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| |
Collapse
|
2
|
Abstract
Magnetic resonance imaging-guided radiation therapy (MRIgRT) has improved soft tissue contrast over computed tomography (CT) based image-guided RT. Superior visualization of the target and surrounding radiosensitive structures has the potential to improve oncological outcomes partly due to safer dose-escalation and adaptive planning. In this review, we highlight the workflow of adaptive MRIgRT planning, which includes simulation imaging, daily MRI, identifying isocenter shifts, contouring, plan optimization, quality control, and delivery. Increased utilization of MRIgRT will depend on addressing technical limitations of this technology, while addressing treatment efficacy, cost-effectiveness, and workflow training.
Collapse
Affiliation(s)
- Cecil M Benitez
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA
| | - Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida; Miami, FL
| | - Luise A Künzel
- National Center for Tumor Diseases (NCT), Dresden; German Cancer Research Center (DKFZ), Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden Rossendorf, Dresden, Germany
| | - Daniela Thorwarth
- Department of Radiation Oncology, Section for Biomedical Physics, University of Tübingen, Tübingen, Germany..
| |
Collapse
|
3
|
de Leon J, Twentyman T, Carr M, Jameson M, Batumalai V. Optimising the MR-Linac as a standard treatment modality. J Med Radiat Sci 2023; 70:491-497. [PMID: 37540059 PMCID: PMC10715353 DOI: 10.1002/jmrs.712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
The magnetic resonance linear accelerator (MR-Linac) offers a new treatment paradigm, providing improved visualisation of targets and organs at risk while allowing for daily adaptation of treatment plans in real time. Online MR-guided adaptive treatment has reduced treatment uncertainties; however, the additional treatment time and resource requirements may be a concern. We present our experience of integrating an MR-Linac into a busy department and provide recommendations for improved clinical and resource efficiency. Furthermore, we discuss potential future technological innovations that can further optimise clinical productivity in a busy department.
Collapse
Affiliation(s)
| | | | - Madeline Carr
- GenesisCareAlexandriaNew South WalesAustralia
- Centre for Medical Radiation PhysicsUniversity of WollongongWollongongNew South WalesAustralia
| | - Michael Jameson
- GenesisCareAlexandriaNew South WalesAustralia
- Centre for Medical Radiation PhysicsUniversity of WollongongWollongongNew South WalesAustralia
- School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneySydneyNew South WalesAustralia
| | - Vikneswary Batumalai
- GenesisCareAlexandriaNew South WalesAustralia
- School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneySydneyNew South WalesAustralia
| |
Collapse
|
4
|
Carr ME, Jelen U, Picton M, Batumalai V, Crawford D, Peng V, Twentyman T, de Leon J, Jameson MG. Towards simulation-free MR-linac treatment: utilizing male pelvis PSMA-PET/CT and population-based electron density assignments. Phys Med Biol 2023; 68:195012. [PMID: 37652043 DOI: 10.1088/1361-6560/acf5c6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/31/2023] [Indexed: 09/02/2023]
Abstract
Objective. This study aimed to investigate the dosimetric impact of using population-based relative electron density (RED) overrides in lieu of simulation computerized tomography (CT) in a magnetic resonance linear accelerator (MRL) workflow for male pelvis patients. Additionally, the feasibility of using prostate specific membrane antigen positron emission tomography/CT (PSMA-PET/CT) scans to assess patients' eligibility for this proposed workflow was examined.Approach. In this study, 74 male pelvis patients treated on an Elekta Unity 1.5 T MRL were retrospectively selected. The patients' individual RED values for 8 organs of interest were extracted from their simulation-CT images to establish population-based RED values. These values were used to generate individual (IndD) and population-based (PopD) RED dose plans, representing current and proposed MRL workflows, respectively. Lastly, this study compared RED values obtained from CT and PET-CT scanners in a phantom and a subset of patients.Results. Population-based RED values were mostly within two standard deviations of ICRU Report 46 values. PopD plans were comparable to IndD plans, with the average %difference magnitudes of 0.5%, 0.6%, and 0.6% for mean dose (all organs), D0.1cm3(non-target organs) and D95%/D98% (target organs), respectively. Both phantom and patient PET-CT derived RED values had high agreement with corresponding CT-derived values, with correlation coefficients ≥ 0.9.Significance. Population-based RED values were considered suitable in a simulation-free MRL treatment workflow. Utilizing these RED values resulted in similar dosimetric uncertainties as per the current workflow. Initial findings also suggested that PET-CT scans may be used to assess prospective patients' eligibility for the proposed workflow. Future investigations will evaluate the clinical feasibility of implementing this workflow for prospective patients in the clinical setting. This is aimed to reduce patient burden during radiotherapy and increase department efficiencies.
Collapse
Affiliation(s)
- Madeline E Carr
- GenesisCare, New South Wales, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | | | - Vikneswary Batumalai
- GenesisCare, New South Wales, Australia
- School of Clinical Medicine, Medicine and Health, University of New South Wales, Australia
| | | | | | | | | | - Michael G Jameson
- GenesisCare, New South Wales, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
- School of Clinical Medicine, Medicine and Health, University of New South Wales, Australia
| |
Collapse
|
5
|
Grimbergen G, Eijkelenkamp H, van Vulpen JK, van de Ven S, Raaymakers BW, Intven MP, Meijer GJ. Feasibility of online radial magnetic resonance imaging for adaptive radiotherapy of pancreatic tumors. Phys Imaging Radiat Oncol 2023; 26:100434. [PMID: 37034029 PMCID: PMC10074242 DOI: 10.1016/j.phro.2023.100434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Background and purpose Online adaptive magnetic resonance (MR)-guided treatment planning for pancreatic tumors on 1.5T systems typically employs Cartesian 3D T 2w magnetic resonance imaging (MRI). The main disadvantage of this sequence is that respiratory motion results in substantial blurring in the abdomen, which can hamper delineation accuracy. This study investigated the use of two motion-robust radial MRI sequences as main delineation scan for pancreatic MR-guided radiotherapy. Materials and methods Twelve patients with pancreatic tumors were imaged with a 3D T 2w scan, a Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction (PROPELLER) scan (partially overlapping strips), and a 3D Vane scan (stack-of-stars), on a 1.5T MR-Linac under abdominal compression. The scans were assessed by three radiation oncologists for their suitability for online adaptive delineation. A quantitative comparison was made for gradient entropy and the effect of motion on apparent target position. Results The PROPELLER scans were selected as first preference in 56% of the cases, the 3D T 2w in 42% and the 3D Vane in 3%. PROPELLER scans sometimes contained a large interslice variation which would have compromised delineation. Gradient entropy was significantly higher in 3D T 2w patient scans. The apparent target position was more sensitive to motion amplitude in the PROPELLER scans, but substantial offsets did not occur under 10 mm peak-to-peak. Conclusion PROPELLER MRI may be a superior imaging sequence for pancreatic MRgRT compared to standard Cartesian sequences. The large interslice variation should be mitigated through further sequence optimization before PROPELLER can be adopted for online treatment adaptation.
Collapse
|
6
|
Picton M, Crawford D, Jameson M, Alvares S, Hogan L, Loo C, Moutrie Z, Jelen U, Pagulayan C, Dunkerley N, Twentyman T, de Leon J, Batumalai V. Introduction of radiation therapist‐led adaptive treatments on a 1.5 T
MR
‐Linac. J Med Radiat Sci 2022; 70 Suppl 2:94-98. [PMID: 36572532 PMCID: PMC10122921 DOI: 10.1002/jmrs.643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
The introduction of magnetic resonance (MR) linear accelerators (MR-Linac) marks the beginning of a new era in radiotherapy. MR-Linac systems are currently being operated by teams of radiation therapists (RTs), radiation oncology medical physicists (ROMPs) and radiation oncologists (ROs) due to the diverse and complex tasks required to deliver treatment. This is resource-intensive and logistically challenging. RT-led service delivery at the treatment console is paramount to simplify the process and make the best use of this technology for suitable patients with commonly treated anatomical sites. This article will discuss the experiences of our department in developing and implementing an RT-led workflow on the 1.5 T MR-Linac.
Collapse
Affiliation(s)
| | | | - Michael Jameson
- GenesisCare Alexandria New South Wales Australia
- School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Kensington New South Wales Australia
| | | | - Louise Hogan
- GenesisCare Alexandria New South Wales Australia
| | - Conrad Loo
- GenesisCare Alexandria New South Wales Australia
| | - Zoe Moutrie
- GenesisCare Alexandria New South Wales Australia
- Department of Radiation Oncology South West Sydney Local Health District Sydney New South Wales Australia
| | | | | | | | | | | | - Vikneswary Batumalai
- GenesisCare Alexandria New South Wales Australia
- School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Kensington New South Wales Australia
| |
Collapse
|
7
|
Turkkan G, Bilici N, Sertel H, Keskus Y, Alkaya S, Tavli B, Ozkirim M, Fayda M. Clinical utility of a 1.5 T magnetic resonance imaging-guided linear accelerator during conventionally fractionated and hypofractionated prostate cancer radiotherapy. Front Oncol 2022; 12:909402. [PMID: 36052268 PMCID: PMC9424496 DOI: 10.3389/fonc.2022.909402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/27/2022] [Indexed: 12/21/2022] Open
Abstract
Purpose To report our initial experience with 1.5 T magnetic resonance imaging (MRI) linear accelerator (LINAC) in prostate cancer radiotherapy in terms of its use in a radiation oncology clinic. Methods The medical records of 14 prostate cancer patients treated with MRI-guided radiotherapy were retrospectively evaluated. The fraction time, adapt-to-position (ATP):adapt-to-shape (ATS) usage rate, machine-associated treatment interruption rate, median gamma pass rate, the percentage of planning target volume receiving at least 95% of the prescription dose coverage value of each ATS fraction, the effect of the learning curve on the fraction time and radiation-related acute gastrointestinal and genitourinary toxicities were evaluated. Results Fourteen patients have completed their treatment receiving a total of 375 fractions. Six patients (42%) were treated with the moderately hypofractionated regimen, five patients (36%) with conventionally fractionated, and three patients (22%) with the ultra-hypofractionated radiotherapy regimens. The ATP : ATS usage ratio was 3:372. The median fraction time was 46 min (range, 24-81 min). For the 3%/3 mm criterion, median gamma pass rate was 99.4% (range, 94.6–100%). Machine-related treatment interruptions were observed in 11 (2.9%) of 375 fractions, but this interruption rate decreased from 4.1% to 0.8%, after an upgrade. Three patients (22%) had gastrointestinal and five patients (36%) had genitourinary toxicity. No ≥grade 3 toxicity was observed. Conclusion 1.5 T MRI-LINAC device could be used as a conventional LINAC device, when the conditions of the radiotherapy center are appropriate. MRI-guided prostate radiotherapy is safe and feasible, and high-quality studies with a larger number of patients and long-term results are needed to better evaluate this new technology.
Collapse
Affiliation(s)
- Gorkem Turkkan
- Department of Radiation Oncology, Istinye University Faculty of Medicine, Istanbul, Turkey
- Department of Radiation Oncology, Liv Hospital Ulus, Istanbul, Turkey
- *Correspondence: Gorkem Turkkan, ;
| | - Nazli Bilici
- Department of Radiation Oncology, Liv Hospital Ulus, Istanbul, Turkey
| | - Huseyin Sertel
- Department of Radiation Oncology, Liv Hospital Ulus, Istanbul, Turkey
| | - Yavuz Keskus
- Department of Radiation Oncology, Liv Hospital Ulus, Istanbul, Turkey
| | - Sercan Alkaya
- Department of Radiation Oncology, Liv Hospital Ulus, Istanbul, Turkey
| | - Busra Tavli
- Department of Radiation Oncology, Liv Hospital Ulus, Istanbul, Turkey
| | - Muge Ozkirim
- Department of Radiation Oncology, Liv Hospital Ulus, Istanbul, Turkey
| | - Merdan Fayda
- Department of Radiation Oncology, Istinye University Faculty of Medicine, Istanbul, Turkey
- Department of Radiation Oncology, Liv Hospital Ulus, Istanbul, Turkey
| |
Collapse
|
8
|
Tetar SU, Bruynzeel AM, Verweij L, Bohoudi O, Slotman BJ, Rosario T, Palacios MA, Lagerwaard FJ. Magnetic resonance imaging-guided radiotherapy for intermediate- and high-risk prostate cancer: Trade-off between planning target volume margin and online plan adaption. Phys Imaging Radiat Oncol 2022; 23:92-96. [PMID: 35844255 PMCID: PMC9283928 DOI: 10.1016/j.phro.2022.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance-guided radiotherapy with daily plan adaptation for intermediate- and high-risk prostate cancer is time and labor intensive. Fifty adapted plans with 3 mm planning target volume (PTV)-margin were compared with non-adapted plans using 3 or 5 mm margins. Adequate (V95% ≥ 95%) prostate coverage was achieved in 49 fractions with 5 mm PTV without plan adaptation, however, coverage of the seminal vesicles (SV) was insufficient in 15 of 50 fractions. There was no insufficient coverage for prostate and SV using plan adaptation with 3 mm. Hence, daily adaptation is recommended to obtain adequate SV-coverage when using 3 mm PTV.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Frank J. Lagerwaard
- Corresponding author at: Amsterdam UMC, location VUmc, Postbox 7057, 1007 MB Amsterdam, The Netherlands.
| |
Collapse
|
9
|
Powers M, Baines J, Crane R, Fisher C, Gibson S, Marsh L, Oar B, Shoobridge A, Simpson-Page E, Van der Walt M, de Vine G. Commissioning measurements on an Elekta Unity MR-Linac. Phys Eng Sci Med 2022; 45:457-473. [PMID: 35235188 PMCID: PMC9239956 DOI: 10.1007/s13246-022-01113-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/18/2022] [Indexed: 11/03/2022]
Abstract
Magnetic resonance-guided radiotherapy technology is relatively new and commissioning publications, quality assurance (QA) protocols and commercial products are limited. This work provides guidance for implementation measurements that may be performed on the Elekta Unity MR-Linac (Elekta, Stockholm, Sweden). Adaptations of vendor supplied phantoms facilitated determination of gantry angle accuracy and linac isocentre, whereas in-house developed phantoms were used for end-to-end testing and anterior coil attenuation measurements. Third-party devices were used for measuring beam quality, reference dosimetry and during treatment plan commissioning; however, due to several challenges, variations on standard techniques were required. Gantry angle accuracy was within 0.1°, confirmed with pixel intensity profiles, and MV isocentre diameter was < 0.5 mm. Anterior coil attenuation was approximately 0.6%. Beam quality as determined by TPR20,10 was 0.705 ± 0.001, in agreement with treatment planning system (TPS) calculations, and gamma comparison against the TPS for a 22.0 × 22.0 cm2 field was above 95.0% (2.0%, 2.0 mm). Machine output was 1.000 ± 0.002 Gy per 100 MU, depth 5.0 cm. During treatment plan commissioning, sub-standard results indicated issues with machine behaviour. Once rectified, gamma comparisons were above 95.0% (2.0%, 2.0 mm). Centres which may not have access to specialized equipment can use in-house developed phantoms, or adapt those supplied by the vendor, to perform commissioning work and confirm operation of the MRL within published tolerances. The plan QA techniques used in this work can highlight issues with machine behaviour when appropriate gamma criteria are set.
Collapse
Affiliation(s)
- Marcus Powers
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia. .,College of Science and Engineering, James Cook University, Townsville, QLD, Australia.
| | - John Baines
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia.
| | - Robert Crane
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Chantelle Fisher
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Stephen Gibson
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Linda Marsh
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Bronwyn Oar
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Ariadne Shoobridge
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia.,College of Science and Engineering, James Cook University, Townsville, QLD, Australia
| | - Emily Simpson-Page
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Marchant Van der Walt
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Glenn de Vine
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
| |
Collapse
|