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Hardcastle N, Vasquez Osorio E, Jackson A, Mayo C, Aarberg AE, Ayadi M, Belosi F, Ceylan C, Davey A, Dupuis P, Handley JC, Hemminger T, Hoffmann L, Kelly C, Michailidou C, Muscat S, Murrell DH, Pérez-Alija J, Palmer C, Placidi L, Popovic M, Rønde HS, Selby A, Skopidou T, Solomou N, Stroom J, Thompson C, West NS, Zaila A, Appelt AL. Multi-centre evaluation of variation in cumulative dose assessment in reirradiation scenarios. Radiother Oncol 2024; 194:110184. [PMID: 38453055 DOI: 10.1016/j.radonc.2024.110184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE Safe reirradiation relies on assessment of cumulative doses to organs at risk (OARs) across multiple treatments. Different clinical pathways can result in inconsistent estimates. Here, we quantified the consistency of cumulative dose to OARs across multi-centre clinical pathways. MATERIAL AND METHODS We provided DICOM planning CT, structures and doses for two reirradiation cases: head & neck (HN) and lung. Participants followed their standard pathway to assess the cumulative physical and EQD2 doses (with provided α/β values), and submitted DVH metrics and a description of their pathways. Participants could also submit physical dose distributions from Course 1 mapped onto the CT of Course 2 using their best available tools. To assess isolated impact of image registrations, a single observer accumulated each submitted spatially mapped physical dose for every participating centre. RESULTS Cumulative dose assessment was performed by 24 participants. Pathways included rigid (n = 15), or deformable (n = 5) image registration-based 3D dose summation, visual inspection of isodose line contours (n = 1), or summation of dose metrics extracted from each course (n = 3). Largest variations were observed in near-maximum cumulative doses (25.4 - 41.8 Gy for HN, 2.4 - 33.8 Gy for lung OARs), with lower variations in volume/dose metrics to large organs. A standardised process involving spatial mapping of the first course dose to the second course CT followed by summation improved consistency for most near-maximum dose metrics in both cases. CONCLUSION Large variations highlight the uncertainty in reporting cumulative doses in reirradiation scenarios, with implications for outcome analysis and understanding of published doses. Using a standardised workflow potentially including spatially mapped doses improves consistency in determination of accumulated dose in reirradiation scenarios.
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Affiliation(s)
- Nicholas Hardcastle
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | | | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | | | - Myriam Ayadi
- Department of Radiation Oncology, Physics Unit, Centre Léon Bérard, Lyon, France
| | - Francesca Belosi
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Cemile Ceylan
- Department of Radiation Oncology, Istanbul Oncology Hospital, Istanbul, Turkey; Department of Medical Physics, University of Yeditepe, Istanbul, Turkey
| | - Angela Davey
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Pauline Dupuis
- Department of Radiation Oncology, Physics Unit, Centre Léon Bérard, Lyon, France
| | | | | | - Lone Hoffmann
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Colin Kelly
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Sarah Muscat
- Department of Medical Physics, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Donna H Murrell
- Department of Oncology, Western University, London, Ontario, Canada; London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Jaime Pérez-Alija
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Catherine Palmer
- Department of Radiotherapy Physics, Norfolk and Norwich University Hospitals, NHS Foundation Trust, UK
| | - Lorenzo Placidi
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Marija Popovic
- Department of Medical Physics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Heidi S Rønde
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Adam Selby
- South West Wales Cancer Centre, Swansea, Wales, UK
| | | | - Natasa Solomou
- Department of Radiotherapy Physics, Norfolk and Norwich University Hospitals, NHS Foundation Trust, UK
| | - Joep Stroom
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | | | - Ali Zaila
- Biomedical Physics Department, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh, Saudi Arabia
| | - Ane L Appelt
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Wheeler PA, West NS, Powis R, Maggs R, Chu M, Pearson RA, Willis N, Kurec B, Reed KL, Lewis DG, Staffurth J, Spezi E, Millin AE. Multi-institutional evaluation of a Pareto navigation guided automated radiotherapy planning solution for prostate cancer. Radiat Oncol 2024; 19:45. [PMID: 38589961 PMCID: PMC11003074 DOI: 10.1186/s13014-024-02404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/15/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Current automated planning solutions are calibrated using trial and error or machine learning on historical datasets. Neither method allows for the intuitive exploration of differing trade-off options during calibration, which may aid in ensuring automated solutions align with clinical preference. Pareto navigation provides this functionality and offers a potential calibration alternative. The purpose of this study was to validate an automated radiotherapy planning solution with a novel multi-dimensional Pareto navigation calibration interface across two external institutions for prostate cancer. METHODS The implemented 'Pareto Guided Automated Planning' (PGAP) methodology was developed in RayStation using scripting and consisted of a Pareto navigation calibration interface built upon a 'Protocol Based Automatic Iterative Optimisation' planning framework. 30 previous patients were randomly selected by each institution (IA and IB), 10 for calibration and 20 for validation. Utilising the Pareto navigation interface automated protocols were calibrated to the institutions' clinical preferences. A single automated plan (VMATAuto) was generated for each validation patient with plan quality compared against the previously treated clinical plan (VMATClinical) both quantitatively, using a range of DVH metrics, and qualitatively through blind review at the external institution. RESULTS PGAP led to marked improvements across the majority of rectal dose metrics, with Dmean reduced by 3.7 Gy and 1.8 Gy for IA and IB respectively (p < 0.001). For bladder, results were mixed with low and intermediate dose metrics reduced for IB but increased for IA. Differences, whilst statistically significant (p < 0.05) were small and not considered clinically relevant. The reduction in rectum dose was not at the expense of PTV coverage (D98% was generally improved with VMATAuto), but was somewhat detrimental to PTV conformality. The prioritisation of rectum over conformality was however aligned with preferences expressed during calibration and was a key driver in both institutions demonstrating a clear preference towards VMATAuto, with 31/40 considered superior to VMATClinical upon blind review. CONCLUSIONS PGAP enabled intuitive adaptation of automated protocols to an institution's planning aims and yielded plans more congruent with the institution's clinical preference than the locally produced manual clinical plans.
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Affiliation(s)
- Philip A Wheeler
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK.
| | - Nicholas S West
- Northern Centre for Cancer Care, Cancer Services and Clinical Haematology, Newcastle upon Tyne, UK
| | - Richard Powis
- Worcester Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Rhydian Maggs
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK
| | - Michael Chu
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK
| | - Rachel A Pearson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Willis
- Northern Centre for Cancer Care, Cancer Services and Clinical Haematology, Newcastle upon Tyne, UK
| | - Bartlomiej Kurec
- Worcester Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Katie L Reed
- Worcester Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - David G Lewis
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK
| | - John Staffurth
- School of Medicine, Cardiff University, Cardiff, Wales, UK
- Velindre Cancer Centre, Medical Directorate, Cardiff, Wales, UK
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, Wales, UK
| | - Anthony E Millin
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK
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Machavariani E, Nonyane BAS, Lebina L, Mmolawa L, West NS, Dowdy DW, Martinson N, Ahmad B, Hanrahan CF. Perceived stigma among people with TB and household contacts. Int J Tuberc Lung Dis 2023; 27:675-681. [PMID: 37608483 PMCID: PMC10443789 DOI: 10.5588/ijtld.22.0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: TB-related stigma hampers access to diagnosis and treatment, making it important to understand the demographic and clinical characteristics associated with perceived TB stigma. TB stigma has not been studied in household contacts before, yet they comprise an important population for epidemic control, with high risk of infection.METHOD: A cross-sectional study was conducted among people with TB and household contacts in South Africa using a 12-item perceived TB stigma scale (score range: 0-36). Demographic and clinical characteristic data were collected using a close-ended questionnaire. A linear mixed-effects regression model was used to explore perceived TB stigma levels and its associated characteristics.RESULTS: The sample included 143 people with TB and 135 household contacts. The mean perceived TB stigma score among people with TB was 22.1 (95% CI 21.1-23.1) and 22.2 (95% CI 21.1-23.3) among household contacts. Being in the same household explained 24.3% variability in stigma perception. Residence in the urban study site (Soshanguve) and a positive HIV diagnosis were associated with higher perceived TB stigma score.CONCLUSIONS: People with TB and household contacts have similarly high prevalence of perceived TB stigma. Positive HIV status and urban location were associated with higher prevalence of perceived TB stigma.
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Affiliation(s)
| | - B A S Nonyane
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Lebina
- Perinatal HIV Research Unit, Johannesburg, South Africa
| | - L Mmolawa
- Perinatal HIV Research Unit, Johannesburg, South Africa
| | - N S West
- University of California, San Francisco, CA, USA
| | - D W Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Martinson
- Perinatal HIV Research Unit, Johannesburg, South Africa
| | - B Ahmad
- Yale School of Medicine, New Haven, CT
| | - C F Hanrahan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mott JHL, West NS. Essentials of Depth Dose Calculations for Clinical Oncologists. Clin Oncol (R Coll Radiol) 2020; 33:5-11. [PMID: 32718763 DOI: 10.1016/j.clon.2020.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/12/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Affiliation(s)
- J H L Mott
- Radiotherapy Physics, Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - N S West
- Radiotherapy Physics, Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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West NS, Parkes MJ, Snowden C, Prentis J, McKenna J, Iqbal MS, Cashmore J, Walker C. Mitigating Respiratory Motion in Radiation Therapy: Rapid, Shallow, Non-invasive Mechanical Ventilation for Internal Thoracic Targets. Int J Radiat Oncol Biol Phys 2018; 103:1004-1010. [PMID: 30496883 DOI: 10.1016/j.ijrobp.2018.11.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Reducing respiratory motion during the delivery of radiation therapy reduces the volume of healthy tissues irradiated and may decrease radiation-induced toxicity. The purpose of this study was to assess the potential for rapid shallow non-invasive mechanical ventilation to reduce internal anatomy motion for radiation therapy purposes. METHODS AND MATERIALS Ten healthy volunteers (mean age, 38 years; range, 22-54 years; 6 female and 4 male) were scanned using magnetic resonance imaging during normal breathing and at 2 ventilator-induced frequencies: 20 and 25 breaths per minute for 3 minutes. Sagittal and coronal cinematic data sets, centered over the right diaphragm, were used to measure internal motions across the lung-diaphragm interface. Repeated scans assessed reproducibility. Physiologic parameters and participant experiences were recorded to quantify tolerability and comfort. RESULTS Physiologic observations and experience questionnaires demonstrated that rapid shallow non-invasive ventilation technique was tolerable and comfortable. Motion analysis of the lung-diaphragm interface demonstrated respiratory amplitudes and variations reduced in all subjects using rapid shallow non-invasive ventilation compared with spontaneous breathing: mean amplitude reductions of 56% and 62% for 20 and 25 breaths per minute, respectively. The largest mean amplitude reductions were found in the posterior of the right lung; 40.0 mm during normal breathing to 15.5 mm (P < .005) and 15.2 mm (P < .005) when ventilated with 20 and 25 breaths per minute, respectively. Motion variations also reduced with ventilation; standard deviations in the posterior lung reduced from 14.8 mm during normal respiration to 4.6 mm and 3.5 mm at 20 and 25 breaths per minute, respectively. CONCLUSIONS To our knowledge, this study is the first to measure internal anatomic motion using rapid shallow mechanical ventilation to regularize and minimize respiratory motion over a period long enough to image and to deliver radiation therapy. Rapid frequency and shallow, non-invasive ventilation both generate large reductions in internal thoracic and abdominal motions, the clinical application of which could be profound-enabling dose escalation (increasing treatment efficacy) or high-dose ablative radiation therapy.
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Affiliation(s)
- Nicholas S West
- Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Michael J Parkes
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christopher Snowden
- Departments of Perioperative and Critical Care Medicine, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James Prentis
- Departments of Perioperative and Critical Care Medicine, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jill McKenna
- Department of Therapeutic Radiography, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jason Cashmore
- Hall Edwards Radiotherapy Group, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Christopher Walker
- Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Affiliation(s)
- N S West
- Division of Fruit Products, University of California, Berkeley, California
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Abstract
AIM To identify causes of fever, treatable diseases, and the most helpful investigations in febrile children, who had travelled to the tropics or subtropics in the preceding year. METHODS Prospective observational study of all admissions to children's wards in a district general hospital in Birmingham between January 1997 and July 1999. Children with fever >37.5 degrees C and a history of travel to the tropics or subtropics in the preceding 12 months were included. Data were available on 153/162 children; median age was 5 years (range 0.1-15). A total of 133 (85%) children had visited South Asia; only 18/135 had received malarial prophylaxis. Median time to presentation after travel was four weeks. Children were investigated with full blood count, blood film, and stool culture. Other investigations were performed at the discretion of the admitting paediatrician. RESULTS Diarrhoeal illness (n = 41) and malaria (n = 22) were the most common diagnoses. A treatable cause for the febrile illness was identified in 70 (46%) children. One or more investigations were positive in 60% of children. Stool culture (17% positive) and blood film (14% positive) were the most helpful investigations. Platelet counts greater than 190 x 10(9)/l had a negative predictive value of 97% for malaria in this population. CONCLUSIONS Children who present with fever and have travelled to the tropics or subtropics in the preceding year, often have a treatable infection. They should have a full blood count, blood film for malarial parasites, stool culture, blood culture, and chest x ray.
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Affiliation(s)
- N S West
- Dept of Child Health, Birmingham Heartlands Hospital, Birmingham, UK
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