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Castro A, Lalonde-LeBlond G, Freitas Z, Arnaert A, Bitzas V, Kildea J, Moffatt K, Phillips D, Wiseblatt L, Hall AJ, Després V, Tsimicalis A. In-Home Respite Care Services Available to Families With Palliative Care Needs in Quebec: Novel Digital Environmental Scan. JMIR Nurs 2024; 7:e53078. [PMID: 38625735 PMCID: PMC11061788 DOI: 10.2196/53078] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/12/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Caregiving dyads in palliative care are confronted with complex care needs. Respite care services can be highly beneficial in alleviating the caregiving burden, supporting survivorship and dying at home. Yet, respite care services are difficult to locate and access in the province of Quebec, Canada, particularly when navigating ubiquitous sources of online health information of varying quality. OBJECTIVE This project aimed to (1) compile a list of at-home palliative respite care services in Quebec, Canada; (2) describe key accessibility features for each respite care service; (3) identify accessibility gaps and opportunities; and (4) describe a novel method for conducting environmental scans using internet search engines, internet-based community health databases, and member checking. METHODS A novel environmental scan methodology using 2 internet-based targeted databases and 1 internet search engine was conducted. Results were screened and data were extracted, descriptively analyzed, and geographically schematized. RESULTS A total of 401 services were screened, and 52 at-home respite care services specific to palliative populations were identified, compiled, and analyzed. These respite care services were characterized by various types of assistance, providers, fees, and serviced geographical regions. Accessibility was explored through the lens of service amenability, availability, eligibility, and compatibility. The data revealed important barriers to accessing respite care services, such as a lack of readily available information on service characteristics, limited availability, and a time-consuming, technical search process for potential respite care users and clinicians to identify appropriate services. CONCLUSIONS Both methodological and contextual knowledge have been gained through this environmental scan. Few methodologies for conducting internet-based environmental scans have been clearly articulated, so we applied several learnings from other scans and devised a methodology for conducting an environmental scan using the mixed methods of internet search engines, internet-based community health databases, and member checking. We have carefully reported our methods, so that others conducting community health environmental scans may replicate our process. Furthermore, through this scan, we identified assorted respite care services and pinpointed needs in the provision of these services. The findings highlighted that more easily accessible and centralized information about respite care services is needed in Quebec. The data will enable the creation of a user-friendly tool to share with community support services across Quebec and ultimately help alleviate the added burden caregivers and clinicians face when looking for respite care services in fragmented and complex digital spaces.
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Affiliation(s)
- Aimee Castro
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | | | - Zelda Freitas
- Professional Practice Directorate of Rehabilitation and Multidisciplinary Services, CIUSSS West-Central Montreal, Montreal, QC, Canada
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Geriatrics and Palliative Care, CIUSSS West-Central Montreal, Montreal, QC, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Karyn Moffatt
- School of Information Studies, McGill University, Montreal, QC, Canada
| | - Devon Phillips
- Palliative Care McGill, McGill University, Montreal, QC, Canada
| | | | - Audrey-Jane Hall
- Palliative Home-Care Society of Greater Montreal, Montreal, QC, Canada
| | - Véronique Després
- St-Raphaël Palliative Care Home and Day Centre, Montreal, QC, Canada
| | - Argerie Tsimicalis
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, QC, Canada
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2
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O'Sullivan-Steben K, Galarneau L, Judd S, Laizner AM, Williams T, Kildea J. Design and implementation of a prototype radiotherapy menu in a patient portal. J Appl Clin Med Phys 2024; 25:e14201. [PMID: 37942985 DOI: 10.1002/acm2.14201] [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: 10/03/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Radiotherapy patients often face undue anxiety due to misconceptions about radiation and their inability to visualize their upcoming treatments. Access to their personal treatment plans is one way in which pre-treatment anxiety may be reduced. But radiotherapy data are quite complex, requiring specialized software for display and necessitating personalized explanations for patients to understand them. Therefore, our goal was to design and implement a novel radiotherapy menu in a patient portal to improve patient access to and understanding of their radiotherapy treatment plans. METHODS A prototype radiotherapy menu was developed in our institution's patient portal following a participatory stakeholder co-design methodology. Customizable page templates were designed to render key radiotherapy data in the portal's patient-facing mobile phone app. DICOM-RT data were used to provide patients with relevant treatment parameters and generate pre-treatment 3D visualizations of planned treatment beams, while the mCODE data standard was used to provide post-treatment summaries of the delivered treatments. A focus group was conducted to gather initial patient feedback on the menu. RESULTS Pre-treatment: the radiotherapy menu provides patients with a personalized treatment plan overview, including a personalized explanation of their treatment, along with an interactive 3D rendering of their body, and treatment beams for visualization. Post-treatment: a summary of the delivered radiotherapy is provided, allowing patients to retain a concise personal record of their treatment that can easily be shared with future healthcare providers. Focus group feedback was overwhelmingly positive. Patients highlighted how the intuitive presentation of their complex radiotherapy data would better prepare them for their radiation treatments. CONCLUSIONS We successfully designed and implemented a prototype radiotherapy menu in our institution's patient portal that improves patient access to and understanding of their radiotherapy data. We used the mCODE data standard to generate post-treatment summaries in a way that is easily shareable and interoperable.
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Affiliation(s)
| | - Luc Galarneau
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Susie Judd
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrea M Laizner
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Tristan Williams
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
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3
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Patrick HM, Kildea J. The use of dose surface maps as a tool to investigate spatial dose delivery accuracy for the rectum during prostate radiotherapy. J Appl Clin Med Phys 2024:e14314. [PMID: 38425148 DOI: 10.1002/acm2.14314] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE This study aims to address the lack of spatial dose comparisons of planned and delivered rectal doses during prostate radiotherapy by using dose-surface maps (DSMs) to analyze dose delivery accuracy and comparing these results to those derived using DVHs. METHODS Two independent cohorts were used in this study: twenty patients treated with 36.25 Gy in five fractions (SBRT) and 20 treated with 60 Gy in 20 fractions (IMRT). Daily delivered rectum doses for each patient were retrospectively calculated using daily CBCT images. For each cohort, planned and average-delivered DVHs were generated and compared, as were planned and accumulated DSMs. Permutation testing was used to identify DVH metrics and DSM regions where significant dose differences occurred. Changes in rectal volume and position between planning and delivery were also evaluated to determine possible correlation to dosimetric changes. RESULTS For both cohorts, DVHs and DSMs reported conflicting findings on how planned and delivered rectum doses differed from each other. DVH analysis determined average-delivered DVHs were on average 7.1% ± 7.6% (p ≤ 0.002) and 5.0 ± 7.4% (p ≤ 0.021) higher than planned for the IMRT and SBRT cohorts, respectively. Meanwhile, DSM analysis found average delivered posterior rectal wall dose was 3.8 ± 0.6 Gy (p = 0.014) lower than planned in the IMRT cohort and no significant dose differences in the SBRT cohort. Observed dose differences were moderately correlated with anterior-posterior rectal wall motion, as well as PTV superior-inferior motion in the IMRT cohort. Evidence of both these relationships were discernable in DSMs. CONCLUSION DSMs enabled spatial investigations of planned and delivered doses can uncover associations with interfraction motion that are otherwise masked in DVHs. Investigations of dose delivery accuracy in radiotherapy may benefit from using DSMs over DVHs for certain organs such as the rectum.
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Affiliation(s)
- Haley M Patrick
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
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Patrick HM, Kildea J. More than one way to skin a dose volume: the impact of dose-surface map calculation approach on study reproducibility. Phys Med Biol 2024; 69:025025. [PMID: 38168029 DOI: 10.1088/1361-6560/ad19ef] [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: 09/11/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024]
Abstract
Objective.Dose-surface maps (DSMs) provide spatial representations of the radiation dose to organ surfaces during radiotherapy and are a valuable tool for identifying dose deposition patterns that are predictive of radiation toxicities. Over the years, many different DSM calculation approaches have been introduced and used in dose-outcome studies. However, little consideration has been given to how these calculation approaches may be impacting the reproducibility of studies in the field. Therefore, we conducted an investigation to determine the level of equivalence of DSMs calculated with different approaches and their subsequent impact on study results.Approach.Rectum and bladder DSMs were calculated for 20 prostate radiotherapy patients using combinations of the most common slice orientation and spacing styles in the literature. Equivalence of differently calculated DSMs was evaluated using pixel-wise comparisons and DSM features (rectum only). Finally, mock cohort comparison studies were conducted with DSMs calculated using each approach to determine the level of dosimetric study reproducibility between calculation approaches.Main results.We found that rectum DSMs calculated using the planar and non-coplanar orientation styles were non-equivalent in the posterior rectal region and that equivalence of DSMs calculated with different slice spacing styles was conditional on the choice of inter-slice distance used. DSM features were highly sensitive to choice of slice orientation style and DSM sampling resolution. Finally, while general result trends were consistent between the comparison studies performed using different DSMs, statisitically significant subregions and features could vary greatly in position and magnitude.Significance.We have determined that DSMs calculated with different calculation approaches are frequently non-equivalent and can lead to differing conclusions between studies performed using the same dataset. We recommend that the DSM research community work to establish consensus calculation approaches to ensure reproducibility within the field.
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Affiliation(s)
- Haley M Patrick
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
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Mayo CS, Feng MU, Brock KK, Kudner R, Balter P, Buchsbaum JC, Caissie A, Covington E, Daugherty EC, Dekker AL, Fuller CD, Hallstrom AL, Hong DS, Hong JC, Kamran SC, Katsoulakis E, Kildea J, Krauze AV, Kruse JJ, McNutt T, Mierzwa M, Moreno A, Palta JR, Popple R, Purdie TG, Richardson S, Sharp GC, Satomi S, Tarbox LR, Venkatesan AM, Witztum A, Woods KE, Yao Y, Farahani K, Aneja S, Gabriel PE, Hadjiiski L, Ruan D, Siewerdsen JH, Bratt S, Casagni M, Chen S, Christodouleas JC, DiDonato A, Hayman J, Kapoor R, Kravitz S, Sebastian S, Von Siebenthal M, Bosch W, Hurkmans C, Yom SS, Xiao Y. Operational Ontology for Oncology (O3): A Professional Society-Based, Multistakeholder, Consensus-Driven Informatics Standard Supporting Clinical and Research Use of Real-World Data From Patients Treated for Cancer. Int J Radiat Oncol Biol Phys 2023; 117:533-550. [PMID: 37244628 PMCID: PMC10741247 DOI: 10.1016/j.ijrobp.2023.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The ongoing lack of data standardization severely undermines the potential for automated learning from the vast amount of information routinely archived in electronic health records (EHRs), radiation oncology information systems, treatment planning systems, and other cancer care and outcomes databases. We sought to create a standardized ontology for clinical data, social determinants of health, and other radiation oncology concepts and interrelationships. METHODS AND MATERIALS The American Association of Physicists in Medicine's Big Data Science Committee was initiated in July 2019 to explore common ground from the stakeholders' collective experience of issues that typically compromise the formation of large inter- and intra-institutional databases from EHRs. The Big Data Science Committee adopted an iterative, cyclical approach to engaging stakeholders beyond its membership to optimize the integration of diverse perspectives from the community. RESULTS We developed the Operational Ontology for Oncology (O3), which identified 42 key elements, 359 attributes, 144 value sets, and 155 relationships ranked in relative importance of clinical significance, likelihood of availability in EHRs, and the ability to modify routine clinical processes to permit aggregation. Recommendations are provided for best use and development of the O3 to 4 constituencies: device manufacturers, centers of clinical care, researchers, and professional societies. CONCLUSIONS O3 is designed to extend and interoperate with existing global infrastructure and data science standards. The implementation of these recommendations will lower the barriers for aggregation of information that could be used to create large, representative, findable, accessible, interoperable, and reusable data sets to support the scientific objectives of grant programs. The construction of comprehensive "real-world" data sets and application of advanced analytical techniques, including artificial intelligence, holds the potential to revolutionize patient management and improve outcomes by leveraging increased access to information derived from larger, more representative data sets.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dan Ruan
- University of California, Los Angeles
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sue S Yom
- University of California, San Francisco
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Manalad J, Montgomery L, Kildea J. A Monte Carlo study on the impact of indirect action on neutron relative biological effectiveness. Radiat Prot Dosimetry 2023; 199:1917-1921. [PMID: 37819307 DOI: 10.1093/rpd/ncad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/10/2023] [Accepted: 04/12/2023] [Indexed: 10/13/2023]
Abstract
Recent Monte Carlo studies have linked the energy-dependent risk of neutron-induced stochastic effects to the relative biological effectiveness (RBE) of neutrons in inflicting difficult-to-repair clusters of lesions in nuclear deoxyribonucleic acid (DNA). However, an investigation on the damaging effects of indirect radiation action is missing from such studies. In this work, we extended our group's existing simulation pipeline by incorporating and validating a model for indirect action. Our updated simulation pipeline was used to study the impact of indirect action and estimate neutron RBE for inflicting clustered lesions in DNA. In our results, although indirect action significantly increased the average yield of DNA damage clusters, our neutron RBE values are lower in magnitude than previous estimates due to model limitations and the greater relative impact of indirect action in lower-linear energy transfer (LET) radiation than in higher-LET radiation.
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Affiliation(s)
- James Manalad
- Medical Physics Unit, McGill University, Montreal, QC H4A 3J1, Canada
| | - Logan Montgomery
- Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Kingston, ON K7L 5P9, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC H4A 3J1, Canada
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7
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Mathew F, Manalad J, Yeo J, Galarneau L, Ybarra N, Wang YC, Tonin PN, Ragoussis I, Kildea J. Single-cell DNA sequencing-a potential dosimetric tool. Radiat Prot Dosimetry 2023; 199:2047-2052. [PMID: 37819315 DOI: 10.1093/rpd/ncad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 10/13/2023]
Abstract
We hypothesised that single-cell whole-genome sequencing has the potential to detect mutational differences in the genomes of the cells that are irradiated with different doses of radiation and we set out to test our hypothesis using in silico and in vitro experiments. In this manuscript, we present our findings from a Monte Carlo single-cell irradiation simulation performed in TOPAS-nBio using a custom-built geometric nuclear deoxyribonucleic acid (DNA) model, which predicts a significant dose dependence of the number of cluster damages per cell as a function of radiation dose. We also present preliminary experimental results, obtained from single-cell whole-genome DNA sequencing analysis performed on cells irradiated with different doses of radiation, showing promising agreement with the simulation results.
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Affiliation(s)
- Felix Mathew
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - James Manalad
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Jonathan Yeo
- Singapore Nuclear Research and Safety Initiative, National University of Singapore, Singapore
| | - Luc Galarneau
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Norma Ybarra
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Yu Chang Wang
- McGill Genome Centre, McGill University, Montreal, Quebec, Canada
| | - Patricia N Tonin
- Departments of Medicine and Human Genetics, McGill University, Montreal, Quebec, Canada
- Cancer Research Program, Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
| | | | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
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8
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Patrick HM, Poon E, Kildea J. Experimental validation of a novel method of dose accumulation for the rectum. Acta Oncol 2023; 62:915-922. [PMID: 37504890 DOI: 10.1080/0284186x.2023.2238556] [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: 03/23/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Dose-surface maps (DSMs) are an increasingly popular tool to evaluate spatial dose-outcome relationships for the rectum. Recently, DSM addition has been proposed as an alternative method of dose accumulation from deformable registration-based techniques. In this study, we performed the first experimental investigation of the accuracy at which DSM accumulation can capture the total dose delivered to a rectum's surface in the presence of inter-fraction motion. MATERIAL AND METHODS A custom PVC rectum phantom capable of representing typical rectum inter-fraction motion and filling variations was constructed for this project. The phantom allowed for the placement of EBT3 film sheets on the representative rectum surface to measure rectum surface dose. A multi-fraction prostate VMAT treatment was designed and delivered to the phantom in a water tank for a variety of inter-fraction motion scenarios. DSMs for each fraction were calculated in two ways using CBCT images acquired during delivery and summed to produce accumulated DSMs. Accumulated DSMs were then compared to film measurements using gamma analysis (3%/2 mm criteria). Similarity of isodose clusters between films and DSMs was also investigated. RESULTS Baseline agreement between film measurements and accumulated DSMs for a stationary rectum was 95.6%. Agreement between film and accumulated DSMs in the presence of different types of inter.-fraction motion was ≥92%, and isodose cluster mean distance to agreement was within 1.5 mm for most scenarios. Overall, DSM accumulation performed the best when using DSMs that accounted for changes in rectum path orientation. CONCLUSION Dose accumulation performed with DSMs was found to accurately replicate total delivered dose to a rectum phantom in the presence of inter-fraction motion.
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Affiliation(s)
- H M Patrick
- Medical Physics Unit, McGill University, Montreal, Québec, Canada
| | - E Poon
- Department of Medical Physics, McGill University Health Centre, Montreal, Québec, Canada
| | - J Kildea
- Medical Physics Unit, McGill University, Montreal, Québec, Canada
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
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9
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Castro AR, Ould Brahim L, Chen Q, Arnaert A, Quesnel-Vallée A, Moffatt K, Kildea J, Bitzas V, Pang C, Hall AJ, Pagnotta A, Tsimicalis A. Information and Communication Technologies to Support the Provision of Respite Care Services: Scoping Review. JMIR Nurs 2023; 6:e44750. [PMID: 37252760 DOI: 10.2196/44750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 04/15/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Respite care is one of the most frequently requested support services by family caregivers. Yet, too often, respite care services are inaccessible, due in part to families' lack of knowledge regarding available services and a lack of service flexibility. Information and communication technologies (ICTs) may help to improve the flexibility of services available and families' knowledge of such services. However, an understanding of the use of ICTs and research in this area is lacking. OBJECTIVE The objective of this study was to provide a comprehensive overview of the academic literature on ICTs for supporting the provision of respite care services. METHODS A scoping review study was conducted. Six library databases were systematically searched for relevant literature. Key data were extracted into a summary chart. Text and quantitative data were coded using descriptive qualitative content analysis techniques, and the results were collated and summarized into a comprehensive narrative. RESULTS A total of 23 papers describing 15 unique ICT programs exploring the potential of ICTs to support respite care services met the inclusion criteria. ICTs supported the provision of respite care by facilitating information-sharing with families and providers, recruiting and training respite care providers, and coordinating services. Key design considerations for developing respite care ICTs were trustworthiness and participatory design methods. Implementation considerations included designing for complementarity with existing services, assessing the appropriate timing for introducing the ICT-based services, and ensuring adequate promotion strategies to raise awareness about the services. CONCLUSIONS There is limited but promising research on the potential of ICTs to support the provision of respite care services. Further research should be conducted to advance the results of this review, ultimately aiming to build ICTs that can improve the quality of, and access to, respite care services.
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Affiliation(s)
- Aimee R Castro
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | | | - Qirong Chen
- School of Nursing, Central South University, Changsha, China
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Amélie Quesnel-Vallée
- Department of Sociology, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Karyn Moffatt
- School of Information Studies, McGill University, Montreal, QC, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Geriatrics Unit, Palliative Care Unit, CIUSSS West Central Montreal, Montreal, QC, Canada
| | - Carolyn Pang
- Oracle Corporation, Redwood Shores, CA, United States
| | - Audrey-Jane Hall
- Société de Soins Palliatifs à Domicile du Grand Montréal, Montreal, QC, Canada
| | - Ariana Pagnotta
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Argerie Tsimicalis
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Nursing Research Unit, Shriners Hospitals for Children-Canada, Montreal, QC, Canada
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Manalad JA, Montgomery L, Kildea J. A study of indirect action's impact on simulated neutron-induced DNA damage. Phys Med Biol 2023; 68. [PMID: 36881931 DOI: 10.1088/1361-6560/acc237] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/07/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The risk of radiobiological stochastic effects associated with neutrons is strongly energy dependent. Recent Monte Carlo studies simulating neutron-irradiated nuclear DNA have demonstrated that this energy dependence is correlated with the relative biological effectiveness (RBE) of neutrons to inflict DNA damage clusters that contain difficult-to-repair double-strand breaks. However, these previous investigations were either limited to modeling direct radiation action or considered the effects of both direct and indirect action together without distinguishing between the two. In this study, we aimed to quantify the influence of indirect action in neutron irradiation scenarios and acquire novel estimations of the energy-dependent neutron RBE for inducing DNA damage clusters due to both direct and indirect action.

Approach: We explored the role of indirect action in neutron-induced DNA damage by integrating a validated indirect action model into our existing simulation pipeline. Using this pipeline, we performed track-structure simulations of monoenergetic neutron irradiations (1 eV to 10 MeV) in a nuclear DNA model and analyzed the resulting simple and clustered DNA lesions. We repeated the irradiation simulations for 250 keV X-rays that acted as our reference radiation.

Main results: Including indirect action significantly increased the occurrence of DNA lesions. We found that indirect action tends to amplify the damage due to direct action by inducing DNA lesions in the vicinity of directly-induced lesions, resulting in additional and larger damage clusters. Our neutron RBE results are qualitatively similar to but lower in magnitude than the established radiation protection factors and the results of previous similar investigations, due to the greater relative impact of indirect action in photon-induced damage than in neutron-induced damage.

Significance: Although our model for neutron-induced DNA damage has some important limitations, our findings suggest that the energy-dependent risk of neutron-induced stochastic effects may not be completely modeled alone by the relative potential of neutrons to inflict clustered lesions via direct and indirect action in DNA damage.
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Affiliation(s)
- James Alfred Manalad
- Medical Physics Unit, McGill University, 1001 boul Décarie, Montreal, Quebec, H4A 3J1, CANADA
| | - Logan Montgomery
- Medical Physics Unit, McGill University, Cedars Cancer Centre, DS1.7141, 1001 boul Décarie, Montreal, Quebec, H3A 3J1, CANADA
| | - John Kildea
- Medical Physics Unit, McGill University, DS1.7141, Cedars Cancer Centre, 1001 boul Décarie, Montreal, Quebec, H4A 3J1, CANADA
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Patrick HM, Kildea J. Technical note: rtdsm-An open-source software for radiotherapy dose-surface map generation and analysis. Med Phys 2022; 49:7327-7335. [PMID: 35912447 DOI: 10.1002/mp.15900] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/07/2022] [Accepted: 07/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dose-outcome studies in radiation oncology have historically excluded spatial information due to dose-volume histograms being the most dominant source of dosimetric information. In recent years, dose-surface maps (DSMs) have become increasingly popular for characterization of spatial dose distributions and identification of radiosensitive subregions for hollow organs. However, methodological variations and lack of open-source, publicly offered code-sharing between research groups have limited reproducibility and wider adoption. PURPOSE This paper presents rtdsm, an open-source software for DSM calculation with the intent to improve the reproducibility of and the access to DSM-based research in medical physics and radiation oncology. METHODS A literature review was conducted to identify essential functionalities and prevailing calculation approaches to guide development. The described software has been designed to calculate DSMs from DICOM data with a high degree of user customizability and to facilitate DSM feature analysis. Core functionalities include DSM calculation, equivalent dose conversions, common DSM feature extraction, and simple DSM accumulation. RESULTS A number of use cases were used to qualitatively and quantitatively demonstrate the use and usefulness of rtdsm. Specifically, two DSM slicing methods, planar and noncoplanar, were implemented and tested, and the effects of method choice on output DSMs were demonstrated. An example comparison of DSMs from two different treatments was used to highlight the use cases of various built-in analysis functions for equivalent dose conversion and DSM feature extraction. CONCLUSIONS We developed and implemented rtdsm as a standalone software that provides all essential functionalities required to perform a DSM-based study. It has been made freely accessible under an open-source license on Github to encourage collaboration and community use.
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Affiliation(s)
- Haley M Patrick
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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12
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Lessard D, Engler K, Ma Y, Rodriguez Cruz A, Vicente S, Kronfli N, Barkati S, Brouillette MJ, Cox J, Kildea J, Hijal T, Pomey MP, Bartlett SJ, Asselah J, Lebouché B. Remote Follow-up of Self-isolating Patients With COVID-19 Using a Patient Portal: Protocol for a Mixed Methods Pilot Study (Opal-COVID Study). JMIR Res Protoc 2022; 11:e35760. [PMID: 35820054 PMCID: PMC9390833 DOI: 10.2196/35760] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background People with COVID-19 are instructed to self-isolate at home. During self-isolation, they may experience anxiety and insufficient care. Patient portals can allow patients to self-monitor and remotely share their health status with health care professionals, but little data are available on their feasibility. Objective This paper presents the protocol of the Opal-COVID Study. Its objectives are to assess the implementation of the Opal patient portal for distance monitoring of self-isolating patients with COVID-19, identify influences on the intervention’s implementation, and describe service and patient outcomes of this intervention. Methods This mixed methods pilot study aims to recruit 50 patient participants with COVID-19 tested at the McGill University Health Centre (Montreal, Canada) for 14 days of follow-up. With access to an existing patient portal through a smartphone app, patients will complete a daily self-assessment of symptoms, vital signs, and mental health monitored by a nurse, and receive teleconsultations as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden), and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, on recruitment, retention, and fidelity, as well as on the frequency and nature of contacts with health care professionals. The statistical analyses for objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As for the qualitative analyses, for objective 2 (influences on implementation), semistructured qualitative interviews will be conducted with 4 groups of stakeholders (ie, patient participants, health care professionals, technology developers, and study administrators) and submitted for content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers to and facilitators of implementation. For objective 3 (service outcomes), reasons for contacting health care professionals through Opal will also be submitted for content analysis. Results Between December 2020 and March 2021, a total of 51 patient participants were recruited. Qualitative interviews were conducted with 39 stakeholders from April to September 2021. Delays were experienced owing to measures taken at the McGill University Health Centre to address COVID-19. The quantitative and qualitative analyses began in May 2022. As of June 2022, a total of 2 manuscripts (on the implementation and the patient outcomes) were being prepared, and 3 conference presentations had been given on the study’s methods. Conclusions This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal–based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. Trial Registration ClinicalTrials.gov NCT04978233; https://clinicaltrials.gov/ct2/show/NCT04978233 International Registered Report Identifier (IRRID) DERR1-10.2196/35760
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Affiliation(s)
- David Lessard
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments, .,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Kim Engler
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments,
| | - Yuanchao Ma
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments, .,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Mechanical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada
| | - Adriana Rodriguez Cruz
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments, .,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Serge Vicente
- See Acknowledgments, .,Department of Mathematics and Statistics, Université de Montréal, Montreal, QC, Canada
| | | | - Nadine Kronfli
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Sapha Barkati
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Josée Brouillette
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Psychiatry Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Tarek Hijal
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Susan J Bartlett
- Department of Medicine, Divisions of Experimental Medicine, Clinical Epidemiology, Respiratory Medicine, and Rheumatology, McGill University, Montreal, QC, Canada
| | - Jamil Asselah
- Department of Medicine, Division of Medical Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments, .,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
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13
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Naseri H, Skamene S, Tolba M, Faye MD, Ramia P, Khriguian J, Patrick H, Andrade Hernandez AX, David M, Kildea J. Radiomics-based machine learning models to distinguish between metastatic and healthy bone using lesion-center-based geometric regions of interest. Sci Rep 2022; 12:9866. [PMID: 35701461 PMCID: PMC9198102 DOI: 10.1038/s41598-022-13379-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/24/2022] [Indexed: 12/17/2022] Open
Abstract
Radiomics-based machine learning classifiers have shown potential for detecting bone metastases (BM) and for evaluating BM response to radiotherapy (RT). However, current radiomics models require large datasets of images with expert-segmented 3D regions of interest (ROIs). Full ROI segmentation is time consuming and oncologists often outline just RT treatment fields in clinical practice. This presents a challenge for real-world radiomics research. As such, a method that simplifies BM identification but does not compromise the power of radiomics is needed. The objective of this study was to investigate the feasibility of radiomics models for BM detection using lesion-center-based geometric ROIs. The planning-CT images of 170 patients with non-metastatic lung cancer and 189 patients with spinal BM were used. The point locations of 631 BM and 674 healthy bone (HB) regions were identified by experts. ROIs with various geometric shapes were centered and automatically delineated on the identified locations, and 107 radiomics features were extracted. Various feature selection methods and machine learning classifiers were evaluated. Our point-based radiomics pipeline was successful in differentiating BM from HB. Lesion-center-based segmentation approach greatly simplifies the process of preparing images for use in radiomics studies and avoids the bottleneck of full ROI segmentation.
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Affiliation(s)
- Hossein Naseri
- Medical Physics Unit, McGill University, Montreal, QC, Canada.
| | - Sonia Skamene
- Department of Radiation Oncology, McGill University Health Center (MUHC), Montreal, QC, Canada
| | - Marwan Tolba
- Department of Radiation Oncology, McGill University Health Center (MUHC), Montreal, QC, Canada
| | - Mame Daro Faye
- Department of Radiation Oncology, McGill University Health Center (MUHC), Montreal, QC, Canada
| | - Paul Ramia
- Department of Radiation Oncology, McGill University Health Center (MUHC), Montreal, QC, Canada
| | - Julia Khriguian
- Department of Radiation Oncology, McGill University Health Center (MUHC), Montreal, QC, Canada
| | - Haley Patrick
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | | | - Marc David
- Department of Radiation Oncology, McGill University Health Center (MUHC), Montreal, QC, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, Canada
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14
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Castro AR, Arnaert A, Moffatt K, Kildea J, Bitzas V, Tsimicalis A. Developing an mHealth Application to Coordinate Nurse-Provided Respite Care Services for Families Coping With Palliative-Stage Cancer: Protocol for a User-Centered Design Study. JMIR Res Protoc 2021; 10:e34652. [PMID: 34898464 PMCID: PMC8713105 DOI: 10.2196/34652] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patients living with palliative-stage cancer frequently require intensive care from their family caregivers. Without adequate community support services, patients are at risk of receiving inadequate care, and family caregivers are at risk for depression and poor health. For such families, in-home respite care can be invaluable, particularly when the services are flexible and staffed by trusted care providers, such as nurses. Other industries are using mobile apps to make services more flexible. However, few apps have been developed to coordinate nurse-provided respite care services, and to our knowledge, none have been designed in conjunction with families affected by cancer. Objective The aim of this study is to develop a mobile health (mHealth) app prototype for coordinating flexible and trusted in-home respite care services provided by nurses to families coping with palliative-stage cancer in Québec, Canada. Methods This user-centered design research comprises the core component of the iRespite Services iRépit research program. For this study, we are recruiting 20 nurses, 15 adults with palliative-stage cancer, and 20 of their family caregivers, from two palliative oncology hospital departments and one palliative home-care community partner. Overseen by an Expert Council, remote data collection will occur over three research phases guided by the iterative Information Systems Research Framework: Phase 1, brainstorming potential app solutions to challenging respite care scenarios, for better supporting the respite needs of both family caregivers and care recipients; Phase 2, evaluating low-fidelity proofs of concept for potential app designs; and Phase 3, usability testing of a high-fidelity interactive proof of concept that will then be programmed into an app prototype. Qualitative and quantitative data will be descriptively analyzed within each phase and triangulated to refine the app features. Results We anticipate that preliminary results will be available by Spring 2022. Conclusions An app prototype will be developed that has sufficient complimentary evidence to support future pilot testing in the community. Such an app could improve the delivery of community respite care services provided to families with palliative-stage cancer in Québec, supporting death at home, which is where most patients and their families wish to be. International Registered Report Identifier (IRRID) PRR1-10.2196/34652
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Affiliation(s)
- Aimee R Castro
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Karyn Moffatt
- School of Information Studies, McGill University, Montreal, QC, Canada
| | - John Kildea
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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15
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Di Lalla V, Patrick H, Siriani-Ayoub N, Kildea J, Hijal T, Alfieri J. Delivering Cancer Care During a Pandemic: Patient and Healthcare Staff Experience in a High-Volume Radiation Oncology Department. Int J Radiat Oncol Biol Phys 2021. [PMCID: PMC8536252 DOI: 10.1016/j.ijrobp.2021.07.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Purpose/Objective(s) Materials/Methods Results Conclusion
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16
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Mathew F, Wang H, Montgomery L, Kildea J. Natural language processing and machine learning to assist radiation oncology incident learning. J Appl Clin Med Phys 2021; 22:172-184. [PMID: 34610206 PMCID: PMC8598135 DOI: 10.1002/acm2.13437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/02/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To develop a Natural Language Processing (NLP) and Machine Learning (ML) pipeline that can be integrated into an Incident Learning System (ILS) to assist radiation oncology incident learning by semi-automating incident classification. Our goal was to develop ML models that can generate label recommendations, arranged according to their likelihoods, for three data elements in Canadian NSIR-RT taxonomy. METHODS Over 6000 incident reports were gathered from the Canadian national ILS as well as our local ILS database. Incident descriptions from these reports were processed using various NLP techniques. The processed data with the expert-generated labels were used to train and evaluate over 500 multi-output ML algorithms. The top three models were identified and tuned for each of three different taxonomy data elements, namely: (1) process step where the incident occurred, (2) problem type of the incident and (3) the contributing factors of the incident. The best-performing model after tuning was identified for each data element and tested on unseen data. RESULTS The MultiOutputRegressor extended Linear SVR models performed best on the three data elements. On testing, our models ranked the most appropriate label 1.48 ± 0.03, 1.73 ± 0.05 and 2.66 ± 0.08 for process-step, problem-type and contributing factors respectively. CONCLUSIONS We developed NLP-ML models that can perform incident classification. These models will be integrated into our ILS to generate a drop-down menu. This semi-automated feature has the potential to improve the usability, accuracy and efficiency of our radiation oncology ILS.
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Affiliation(s)
- Felix Mathew
- Medical Physics UnitMcGill UniversityMontrealQuebecH4A3J1Canada
| | - Hui Wang
- UnaffiliatedMontrealQuebecCanada
| | | | - John Kildea
- Medical Physics UnitMcGill UniversityMontrealQuebecH4A3J1Canada
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17
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Montgomery L, Lund CM, Landry A, Kildea J. Towards the characterization of neutron carcinogenesis through direct action simulations of clustered DNA damage. Phys Med Biol 2021; 66. [PMID: 34555818 DOI: 10.1088/1361-6560/ac2998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/23/2021] [Indexed: 11/11/2022]
Abstract
Neutron exposure poses a unique radiation protection concern because neutrons have a large, energy-dependent relative biological effectiveness (RBE) for stochastic effects. Recent computational studies on the microdosimetric properties of neutron dose deposition have implicated clustered DNA damage as a likely contributor to this marked energy dependence. So far, publications have focused solely on neutron RBE for inducing clusters of DNA damage containing two or more DNA double strand breaks (DSBs). In this study, we have conducted a novel assessment of neutron RBE for inducing all types of clustered DNA damage that contain two or more lesions, stratified by whether the clusters contain DSBs (complex DSB clusters) or not (non-DSB clusters). This assessment was conducted for eighteen initial neutron energies between 1 eV and 10 MeV as well as a reference radiation of 250 keV x-rays. We also examined the energy dependence of cluster length and cluster complexity because these factors are believed to impact the DNA repair process. To carry out our investigation, we developed a user-friendly TOPAS-nBio application that includes a custom nuclear DNA model and a novel algorithm for recording clustered DNA damage. We found that neutron RBE for inducing complex DSB clusters exhibited similar energy dependence to the canonical neutron RBE for stochastic radiobiological effects, at multiple depths in human tissue. Qualitatively similar results were obtained for non-DSB clusters, although the quantitative agreement was lower. Additionally we identified a significant neutron energy dependence in the average length and complexity of clustered lesions. These results support the idea that many types of clustered DNA damage contribute to the energy dependence of neutron RBE for stochastic radiobiological effects and imply that the size and constituent lesions of individual clusters should be taken into account when modeling DNA repair. Our results were qualitatively consistent for (i) multiple radiation doses (including a low-dose 0.1 Gy irradiation), (ii) variations in the maximal lesion separation distance used to define a cluster, and (iii) two distinct collections of physics models used to govern particle transport. Our complete TOPAS-nBio application has been released under an open-source license to enable others to independently validate our work and to expand upon it.
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Affiliation(s)
- Logan Montgomery
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
| | | | - Anthony Landry
- Prince Edward Island Cancer Treatment Centre, Charlottetown, PE, C1A8T5, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, NS, B3H4RZ, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
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18
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Mathew F, Yeo J, Galarneau L, Ybarra N, Tonin P, Wang YC, Ragoussis I, Kildea J. Abstract PO-021: Single-cell DNA sequencing as a means to directly examine the size and frequency of radiation-induced mutations - An exploratory study. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.radsci21-po-021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This study examines if single-cell DNA sequencing may be used to study the mutational effects of ionizing radiation. As the action of ionizing radiation is a stochastic process, each cell in an irradiated sample experiences its own unique radiation-induced DNA damage. As a result, conventional sequencing methods such as bulk cell sequencing cannot be used to identify individual mutations. In this work, Epstein-Barr virus (EBV) transformed B-lymphoblastoid cells were irradiated with 6 MV X-ray radiation using a medical linear accelerator. Four samples of cells from the same population (400,000 cells/ml) were exposed to sham irradiation (0 Gray [Gy]; control), 0.5 Gy, 1.5 Gy and 3.0 Gy respectively at a common dose rate of about 600 cGy/min. Irradiated samples were incubated for 24 hrs and subsequently underwent single-cell whole-genome DNA sequencing to characterize the radiation impact. Mutational profiles of approximately 500 cells, randomly selected from each sample, were individually analyzed and compared to identify the variation of several mutational parameters as a function of dose. We quantified the copy number variations (CNV) for each cell in our samples. Additionally, we segregated insertion CNVs and deletion CNVs and independently analyzed their dose dependences. We found that the total number of CNVs (insertion and deletion combined) increased with dose, and the number of deletion CNVs consistently increased most. We have repeated the experiment and a new round of single-cell DNA sequencing is underway. If confirmed, our results will demonstrate that the mutational effects of ionizing radiation may be examined directly using single-cell sequencing.
Citation Format: Felix Mathew, Jonathan Yeo, Luc Galarneau, Norma Ybarra, Patricia Tonin, Yu Chang Wang, Ioannis Ragoussis, John Kildea. Single-cell DNA sequencing as a means to directly examine the size and frequency of radiation-induced mutations - An exploratory study [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-021.
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Chu D, Schuster T, Lessard D, Mate K, Engler K, Ma Y, Abulkhir A, Arora A, Long S, de Pokomandy A, Lacombe K, Rougier H, Cox J, Kronfli N, Hijal T, Kildea J, Routy JP, Asselah J, Lebouché B. Acceptability of a Patient Portal (Opal) in HIV Clinical Care: A Feasibility Study. J Pers Med 2021; 11:jpm11020134. [PMID: 33669439 PMCID: PMC7920437 DOI: 10.3390/jpm11020134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/30/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Opal (opalmedapps.com), a patient portal in use at the Cedars Cancer Centre of the McGill University Health Centre (MUHC) (Montreal, Canada), gives cancer patients access to their medical records, collects information on patient-reported outcome measures (PROMs), and has demonstrated patient satisfaction with care. This feasibility study aims to evaluate Opal's potential acceptability in the context of HIV care. People living with HIV (PLWH) and their healthcare providers (HCPs) completed cross-sectional surveys from August 2019 to February 2020 at large HIV centers, including the Chronic Viral Illness Service of the MUHC, and other HIV clinical sites in Montreal and Paris, France. This study comprised 114 PLWH (mean age 48 years old, SD = 12.4), including 74% men, 24% women, and 2% transgender or other; and 31 HCPs (mean age 46.5 years old, SD = 11.4), including 32% men, 65% women, and 3% other. Ownership of smartphones and tablets was high (93% PLWH, 96% HCPs), and participants were willing to use Opal (74% PLWH, 68% HCPs). Participants were interested in most Opal functions and PROMs, particularly PROMs capturing quality of life (89% PLWH, 77% HCPs), experience of healthcare (86% PLWH, 97% HCPs), and HIV self-management (92% PLWH, 97% HCPs). This study suggests Opal has high acceptability and potential usefulness as perceived by PLWH and HCPs.
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Affiliation(s)
- Dominic Chu
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
| | - David Lessard
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Kedar Mate
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
| | - Kim Engler
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Yuanchao Ma
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Ayoub Abulkhir
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Anish Arora
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Stephanie Long
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Karine Lacombe
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, 75012 Paris, France; (K.L.); (H.R.)
| | - Hayette Rougier
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, 75012 Paris, France; (K.L.); (H.R.)
- IMEA, Institut de Médecine et d’Epidémiologie Appliquée, F75018 Paris, France
| | - Joseph Cox
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Nadine Kronfli
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Tarek Hijal
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (T.H.); (J.A.)
| | - John Kildea
- Medical Physics Unit, Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada;
| | - Jean-Pierre Routy
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Jamil Asselah
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (T.H.); (J.A.)
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Correspondence: ; Tel.: +1-514-843-2090
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20
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Patrick HM, Souhami L, Kildea J. Reduction of inter-observer contouring variability in daily clinical practice through a retrospective, evidence-based intervention. Acta Oncol 2021; 60:229-236. [PMID: 32988249 DOI: 10.1080/0284186x.2020.1825801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Inter-observer variations (IOVs) arising during contouring can potentially impact plan quality and patient outcomes. Regular assessment of contouring IOV is not commonly performed in clinical practice due to the large time commitment required of clinicians from conventional methods. This work uses retrospective information from past treatment plans to facilitate a time-efficient, evidence-based intervention to reduce contouring IOV. METHODS The contours of 492 prostate cancer treatment plans created by four radiation oncologists were analyzed in this study. Structure volumes, lengths, and DVHs were extracted from the treatment planning system and stratified based on primary oncologist and inclusion of a pelvic lymph node (PLN) target. Inter-observer variations and their dosimetric consequences were assessed using Student's t-tests. Results of this analysis were presented at an intervention meeting, where new consensus contour definitions were agreed upon. The impact of the intervention was assessed one-year later by repeating the analysis on 152 new plans. RESULTS Significant IOV in prostate and PLN target delineation existed pre-intervention between oncologists, impacting dose to nearby OARs. IOV was also present for rectum and penile-bulb structures. Post-intervention, IOV decreased for all previously discordant structures. Dosimetric variations were also reduced. Although target contouring concordance increased significantly, some variations still persisted for PLN structures, highlighting remaining areas for improvement. CONCLUSION We detected significant contouring IOV in routine practice using easily accessible retrospective data and successfully decreased IOV in our clinic through a reflective intervention. Continued application of this approach may aid improvements in practice standardization and enhance quality of care.
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Affiliation(s)
- H. M. Patrick
- Medical Physics Unit, McGill University, Montreal, Canada
| | - L. Souhami
- Department of Oncology, McGill University Health Centre, Montreal, Canada
| | - J. Kildea
- Medical Physics Unit, McGill University, Montreal, Canada
- Department of Oncology, McGill University Health Centre, Montreal, Canada
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21
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Mohsen K, Kildea J, Lambert SD, Laizner AM. Exploring Cancer Patients' Perceptions of Accessing and Experience with Using the Educational Material in the Opal Patient Portal. Support Care Cancer 2021; 29:4365-4374. [PMID: 33415366 DOI: 10.1007/s00520-020-05900-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/19/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Opal is a new patient-centered mobile application that gives cancer patients access to their real time medical data in conjunction with disease- and treatment-specific patient education material. Few studies have focused on patients' experiences with such mobile applications. This study's objectives were to (1) explore cancer patients' perceptions of accessing the educational materials through Opal and (2) explore their experiences using these educational materials. METHODS A qualitative descriptive design was used. Patients were invited to participate in the study via Opal itself. Semi-structured individual interviews were done in person or over the phone, transcribed verbatim and analyzed using qualitative content analysis. RESULTS Nine women were interviewed. Three themes were identified as participants spoke about their perceptions of and experiences with Opal. First, Opal makes me feel like I have more control, conveying how learning more about their diagnosis and treatments allowed patients to advocate for themselves and plan their care. Second, Opal tends to reassure me, illustrating that having access to information was reassuring. Lastly, Opal is just starting to have information which could help meet my needs, reflecting patients' belief Opal is on the right track but could provide more of their medical record, treating team contact information and education material. CONCLUSION Patients can feel more empowered when using patient-centered mobile applications, and mobile applications have potential for improving collaboration with healthcare professionals and care coordination. Healthcare professionals, including oncologists and nurses, should support patients' use of mobile applications and integrate them in their patient interactions.
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Affiliation(s)
- Katherine Mohsen
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - John Kildea
- Medical Physics Unit - Gerald Bronfman, Department of Oncology, McGill University, Montréal, Québec, Canada
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Sylvie D Lambert
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
- St. Mary's Research Centre, Montréal, Québec, Canada
| | - Andréa M Laizner
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada.
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
- Nursing Directorate, McGill University Health Centre, Montréal, Québec, Canada.
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22
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Sepulveda E, Patrick H, Freeman CR, Kildea J. Implementation of a DVH Registry to provide constraints and continuous quality monitoring for pediatric CSI treatment planning. J Appl Clin Med Phys 2020; 22:191-202. [PMID: 33315306 PMCID: PMC7856485 DOI: 10.1002/acm2.13131] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/13/2020] [Accepted: 11/22/2020] [Indexed: 11/08/2022] Open
Abstract
Craniospinal irradiation (CSI) is a complex radiation therapy technique that is used for patients, often children and teenagers/young adults, with tumors that have a propensity to spread throughout the central nervous system such as medulloblastoma. CSI is associated with important long‐term side effects, the risk of which may be affected by numerous factors including radiation modality and technique. Lack of standardization for a technique that is used even in larger radiation oncology departments only a few times each year may be one such factor and the current ad hoc manner of planning new CSI patients may be greatly improved by implementing a dose–volume histogram registry (DVHR) to use previous patient data to facilitate prospective constraint guidance for organs at risk. In this work, we implemented a DVHR and used it to provide standardized constraints for CSI planning. Mann–Whitney U tests and mean differences at 95% confidence intervals were used to compare two cohorts (pre‐ and post‐DVHR intervention) at specific dosimetric points to determine if observed improvements in standardization were statistically significant. Through this approach, we have shown that the implementation of dosimetric constraints based on DVHR‐derived data helped improve the standardization of pediatric CSI planning at our center. The DVHR also provided guidance for a change in CSI technique, helping to achieve practice standardization across TomoTherapy and IMRT.
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Affiliation(s)
- Esteban Sepulveda
- Medical Physics Unit, Department of Physics, McGill University, Montréal, Canada
| | - Haley Patrick
- Medical Physics Unit, Department of Physics, McGill University, Montréal, Canada
| | - Carolyn R Freeman
- Division of Radiation Oncology, Department of Oncology, McGill University, Montréal, Canada
| | - John Kildea
- Medical Physics Unit, Department of Physics, McGill University, Montréal, Canada
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23
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Mathew F, Makdessi GA, Montgomery L, Evans M, Kildea J. The impact of treatment parameter variation on secondary neutron spectra in high-energy electron beam radiotherapy. Phys Med 2020; 80:125-133. [DOI: 10.1016/j.ejmp.2020.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 12/28/2022] Open
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24
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Patrick HM, Hijal T, Souhami L, Freeman C, Parker W, Joly L, Kildea J. A Canadian Response to the Coronavirus Disease 2019 (COVID-19) Pandemic: Is There a Silver Lining for Radiation Oncology Patients? Adv Radiat Oncol 2020; 5:774-776. [PMID: 32775791 PMCID: PMC7323646 DOI: 10.1016/j.adro.2020.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Haley M Patrick
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Luis Souhami
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Carolyn Freeman
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - William Parker
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Lise Joly
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
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25
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Lund CM, Famulari G, Montgomery L, Kildea J. A microdosimetric analysis of the interactions of mono-energetic neutrons with human tissue. Phys Med 2020; 73:29-42. [PMID: 32283505 DOI: 10.1016/j.ejmp.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/05/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022] Open
Abstract
Nuclear reactions induced during high-energy radiotherapy produce secondary neutrons that, due to their carcinogenic potential, constitute an important risk for the development of iatrogenic cancer. Experimental and epidemiological findings indicate a marked energy dependence of neutron relative biological effectiveness (RBE) for carcinogenesis, but little is reported on its physical basis. While the exact mechanism of radiation carcinogenesis is yet to be fully elucidated, numerical microdosimetry can be used to predict the biological consequences of a given irradiation based on its microscopic pattern of energy depositions. Building on recent studies, this work investigated the physics underlying neutron RBE by using the microdosimetric quantity dose-mean lineal energy (y‾D) as a proxy. A simulation pipeline was constructed to explicitly calculate the y‾D of radiation fields that consisted of (i) the open source Monte Carlo toolkit Geant4, (ii) its radiobiological extension Geant4-DNA, and (iii) a weighted track-sampling algorithm. This approach was used to study mono-energetic neutrons with initial kinetic energies between 1 eV and 10 MeV at multiple depths in a tissue-equivalent phantom. Spherical sampling volumes with diameters between 2 nm and 1 μm were considered. To obtain a measure of RBE, the neutron y‾D values were divided by those of 250 keV X-rays that were calculated in the same way. Qualitative agreement was found with published radiation protection factors and simulation data, allowing for the dependencies of neutron RBE on depth and energy to be discussed in the context of the neutron interaction cross sections and secondary particle distributions in human tissue.
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Affiliation(s)
- C M Lund
- Medical Physics Unit, McGill University, Montreal, QC H4A3J1, Canada.
| | - G Famulari
- Medical Physics Unit, McGill University, Montreal, QC H4A3J1, Canada
| | - L Montgomery
- Medical Physics Unit, McGill University, Montreal, QC H4A3J1, Canada
| | - J Kildea
- Medical Physics Unit, McGill University, Montreal, QC H4A3J1, Canada
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26
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Brown E, O’Donnell J, Barbera L, Bird L, Caissie A, Davis CA, Kildea J, Milosevic M, Olson R, Brundage M. 212 Patient Reported Outcomes Used in Radiation Programs Across Canada. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33274-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Patrick H, Souhami L, Kildea J. 30 Retrospective Evaluation of the Effects of Interobserver Contouring Practices in Clinical Practice. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Gluszko J, Lambert C, Yu O, Davis SD, Kildea J, Serban M. Development and Implementation of an Online Educational Module for the Deep Inspiration Breath-Hold Technique. J Med Imaging Radiat Sci 2019. [DOI: 10.1016/j.jmir.2019.03.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Kildea J, Battista J, Cabral B, Hendren L, Herrera D, Hijal T, Joseph A. Design and Development of a Person-Centered Patient Portal Using Participatory Stakeholder Co-Design. J Med Internet Res 2019; 21:e11371. [PMID: 30741643 PMCID: PMC6388099 DOI: 10.2196/11371] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/31/2018] [Accepted: 11/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background Patient portals are increasingly accepted as part of standard medical care. However, to date, most patient portals provide just passive access to medical data. The use of modern technology such as smartphones and data personalization algorithms offers the potential to make patient portals more person-centered and enabling. Objective The aim of this study is to share our experience in designing and developing a person-centered patient portal following a participatory stakeholder co-design approach. Methods Our stakeholder co-design approach comprised 6 core elements: (1) equal coleadership, including a cancer patient on treatment; (2) patient preference determination; (3) security, governance, and legal input; (4) continuous user evaluation and feedback; (5) continuous staff input; and (6) end-user testing. We incorporated person-centeredness by recognizing that patients should decide for themselves their level of medical data access, all medical data should be contextualized with explanatory content, and patient educational material should be personalized and timely. Results Using stakeholder co-design, we built, and are currently pilot-testing, a person-centered patient portal smartphone app called Opal. Conclusions Inclusion of all stakeholders in the design and development of patient-facing software can help ensure that the necessary elements of person-centeredness, clinician acceptability, and informatics feasibility are achieved.
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Affiliation(s)
- John Kildea
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada.,Medical Physics Unit, McGill University, Montreal, QC, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - John Battista
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Briana Cabral
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Laurie Hendren
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,School of Computer Science, McGill University, Montreal, QC, Canada
| | - David Herrera
- School of Computer Science, McGill University, Montreal, QC, Canada
| | - Tarek Hijal
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Ackeem Joseph
- Department of Medical Physics, McGill University Health Centre, Montreal, QC, Canada
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30
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Kildea J, Hijal T, Hendren L. Development of a person-centered patient portal in oncology using stakeholder co-design. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
221 Background: Patient portals are software products that provide care recipients (patients) with access to some or all of their personal health information (PHI) within a healthcare institution’s electronic medical record (EMR). Most patient portals are just that–windows into an EMR. However, in today’s connected world, a patient portal can offer much more than just access to PHI. By exploiting modern technology and by recognizing that care recipients are people with complex needs that extend beyond just the delivery of care, patient portals can be person-centered. Such person-centered needs include: the ability to plan ahead and know one’s position in a waiting list, to feel in control of one’s own care, to understand one’s treatment options, and to share in all decision-making about one’s care. Methods: We used stakeholder co-design, involving care recipients, care providers (clinicians) and technical experts at all levels, to design and develop a person-centered patient portal from within the healthcare system. Results: Our mobile-friendly patient portal, known as Opal (opalmedapps.com), contains the following: One-stop multi-speciality and multi-institutional operation; Appointment schedule with personalized appointment preparation guidelines; Appointment check-in and waiting room management tools; Monitoring of step-by-step radiotherapy treatment planning; Access to PHI contextualized with explanatory information; Access to personalized educational materials; Patient-reported outcomes questionnaires with response visualizations; An automated rules-based system to minimize clinician workload; Triggered notifications to alert patients and clinicians to actionable events. Conclusions: Opal is currently in beta release involving a small number of oncology patients at our centre who are providing feedback about its use and usefulness. Their initial feedback is very positive and enthusiastic. A full pilot study is starting by July 2018.
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Affiliation(s)
- John Kildea
- McGill University Health Centre, 1001 Boul Décarie, Montreal, QC, CA
| | - Tarek Hijal
- McGill University Health Centre, Montreal, QC, CA
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31
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Montgomery L, Evans M, Liang L, Maglieri R, Kildea J. The effect of the flattening filter on photoneutron production at 10 MV in the Varian TrueBeam linear accelerator. Med Phys 2018; 45:4711-4719. [PMID: 30141186 DOI: 10.1002/mp.13148] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Neutrons are an unavoidable by-product of high-energy radiation therapy treatments that deliver unwanted nontarget dose to patients. Use of flattening-filter-free (FFF) photon beams has been shown to significantly reduce photoneutron production per monitor unit (MU) of dose delivered. The purpose of this investigation was to characterize the photoneutron production of the 10 MV and 10 MV FFF beams of the Varian TrueBeamTM linear accelerator. METHODS Neutron fluence spectra were measured using a Nested Neutron SpectrometerTM (NNS, Detec Inc., Gatineau, Canada). The ratios of neutron fluence and ambient dose equivalent for the 10 MV FFF beam relative to the 10 MV beam, dubbed FF-ratios (FFF/FF), were used to characterize the difference between the two beams. FF-ratios were compared under the following three conditions (a) per MU, at various locations in the treatment room, (b) per MU, with the linac jaws opened and closed, and (c) per electron striking the bremsstrahlung target, as opposed to per MU, at one location with the jaws closed. RESULTS On average, the neutron fluence for the 10 MV FFF beam was 37% lower per MU than the 10 MV beam (FF-ratio = 0.63). The FF-ratio in neutron fluence and ambient dose equivalent did not vary by much between different locations within the treatment room. However, the FF-ratio in neutron ambient dose equivalent was reduced significantly when the linac jaws were opened compared to closed, which implies that the jaws contribute more to the photoneutron spectrum of the 10 MV FFF beam than to the 10 MV beam. Finally, it was found that the 10 MV FFF beam produces more photoneutrons per electron striking the bremsstrahlung target than the 10 MV beam (FF-ratio = 2.56). CONCLUSIONS The photoneutron fluence per MU produced by the 10 MV FFF beam is 37% lower than the 10 MV beam of a Varian TrueBeam linac. Accordingly, a reduction in neutron dose received by patients is achieved through use of the unflattened beam, provided that treatment plans for each beam require approximately the same number of MU. It was found to be instructive to compare the photoneutron yield per source electron between the two beams as it helped provide an understanding of the physics underlying photoneutron production in both beams.
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Affiliation(s)
- Logan Montgomery
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
| | - Michael Evans
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
| | - Liheng Liang
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada.,Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, H3T1E2, Canada
| | - Robert Maglieri
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
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32
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Ali F, Atanackovic J, Boyer C, Festarini A, Kildea J, Paterson LC, Rogge R, Stuart M, Richardson RB. Dosimetric and microdosimetric analyses for blood exposed to reactor-derived thermal neutrons. J Radiol Prot 2018; 38:1037-1052. [PMID: 29871999 DOI: 10.1088/1361-6498/aaca9f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Thermal neutrons are found in reactor, radiotherapy, aircraft, and space environments. The purpose of this study was to characterise the dosimetry and microdosimetry of thermal neutron exposures, using three simulation codes, as a precursor to quantitative radiobiological studies using blood samples. An irradiation line was designed employing a pyrolytic graphite crystal or-alternatively-a super mirror to expose blood samples to thermal neutrons from the National Research Universal reactor to determine radiobiological parameters. The crystal was used when assessing the relative biological effectiveness for dicentric chromosome aberrations, and other biomarkers, in lymphocytes over a low absorbed dose range of 1.2-14 mGy. Higher exposures using a super mirror will allow the additional quantification of mitochondrial responses. The physical size of the thermal neutron fields and their respective wavelength distribution was determined using the McStas Monte Carlo code. Spinning the blood samples produced a spatially uniform absorbed dose as determined from Monte Carlo N-Particle version 6 simulations. The major part (71%) of the total absorbed dose to blood was determined to be from the 14N(n,p)14C reaction and the remainder from the 1H(n,γ)2H reaction. Previous radiobiological experiments at Canadian Nuclear Laboratories involving thermal neutron irradiation of blood yielded a relative biological effectiveness of 26 ± 7. Using the Particle and Heavy Ion Transport Code System, a similar value of ∼19 for the quality factor of thermal neutrons initiating the 14N(n,p)14C reaction in soft tissue was determined by microdosimetric simulations. This calculated quality factor is of similar high value to the experimentally-derived relative biological effectiveness, and indicates the potential of thermal neutrons to induce deleterious health effects in superficial organs such as cataracts of the eye lens.
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Affiliation(s)
- F Ali
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, Chalk River, ON, K0J 1J0, Canada
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33
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Pembroke C, Albers J, Kildea J, Parker W, Faria S. EP-1407: Dosimetric Variables for Chest Wall Pain following Lung Stereotactic Body Radiotherapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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Montgomery L, Fava P, Freeman CR, Hijal T, Maietta C, Parker W, Kildea J. Development and implementation of a radiation therapy incident learning system compatible with local workflow and a national taxonomy. J Appl Clin Med Phys 2018; 19:259-270. [PMID: 29165915 PMCID: PMC5767999 DOI: 10.1002/acm2.12218] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/05/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Collaborative incident learning initiatives in radiation therapy promise to improve and standardize the quality of care provided by participating institutions. However, the software interfaces provided with such initiatives must accommodate all participants and thus are not optimized for the workflows of individual radiation therapy centers. This article describes the development and implementation of a radiation therapy incident learning system that is optimized for a clinical workflow and uses the taxonomy of the Canadian National System for Incident Reporting - Radiation Treatment (NSIR-RT). METHODS The described incident learning system is a novel version of an open-source software called the Safety and Incident Learning System (SaILS). A needs assessment was conducted prior to development to ensure SaILS (a) was intuitive and efficient (b) met changing staff needs and (c) accommodated revisions to NSIR-RT. The core functionality of SaILS includes incident reporting, investigations, tracking, and data visualization. Postlaunch modifications of SaILS were informed by discussion and a survey of radiation therapy staff. RESULTS There were 240 incidents detected and reported using SaILS in 2016 and the number of incidents per month tended to increase throughout the year. An increase in incident reporting occurred after switching to fully online incident reporting from an initial hybrid paper-electronic system. Incident templating functionality and a connection with our center's oncology information system were incorporated into the investigation interface to minimize repetitive data entry. A taskable actions feature was also incorporated to document outcomes of incident reports and has since been utilized for 36% of reported incidents. CONCLUSIONS Use of SaILS and the NSIR-RT taxonomy has improved the structure of, and staff engagement with, incident learning in our center. Software and workflow modifications informed by staff feedback improved the utility of SaILS and yielded an efficient and transparent solution to categorize incidents with the NSIR-RT taxonomy.
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Affiliation(s)
- Logan Montgomery
- Medical Physics UnitDepartment of PhysicsMcGill UniversityMontréalCanada
| | - Palma Fava
- Division of Radiation OncologyDepartment of OncologyMcGill UniversityMontréalCanada
| | - Carolyn R. Freeman
- Division of Radiation OncologyDepartment of OncologyMcGill UniversityMontréalCanada
| | - Tarek Hijal
- Division of Radiation OncologyDepartment of OncologyMcGill UniversityMontréalCanada
| | - Ciro Maietta
- Division of Radiation OncologyDepartment of OncologyMcGill UniversityMontréalCanada
| | - William Parker
- Medical Physics UnitDepartment of OncologyMcGill UniversityMontréalCanada
| | - John Kildea
- Medical Physics UnitDepartment of OncologyMcGill UniversityMontréalCanada
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Liszewski B, Angers C, Kildea J. Mitigating the Barriers to a Culture of Quality and Safety in Radiation Oncology. Clin Oncol (R Coll Radiol) 2017; 29:676-679. [PMID: 28844311 DOI: 10.1016/j.clon.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Affiliation(s)
- B Liszewski
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
| | - C Angers
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd, Box 927, Ottawa, Ontario K1H 8L6, Canada
| | - J Kildea
- Cancer Research Program of the McGill University Health Centre, Cedars Cancer Centre, DS1.7141, 1001 boul Décarie, Montréal, Québec H4A 3J1, Canada
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Kildea J, Hendren L, Hererra D, Joseph A, Maglieri R, Hijal T. EP-1730: Opal - The Oncology Portal and Application. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maglieri R, Licea A, Evans M, Seuntjens J, Kildea J. Measuring neutron spectra in radiotherapy using the nested neutron spectrometer. Med Phys 2016; 42:6162-9. [PMID: 26520709 DOI: 10.1118/1.4931963] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Out-of-field neutron doses resulting from photonuclear interactions in the head of a linear accelerator pose an iatrogenic risk to patients and an occupational risk to personnel during radiotherapy. To quantify neutron production, in-room measurements have traditionally been carried out using Bonner sphere systems (BSS) with activation foils and TLDs. In this work, a recently developed active detector, the nested neutron spectrometer (NNS), was tested in radiotherapy bunkers. METHODS The NNS is designed for easy handling and is more practical than the traditional BSS. Operated in current-mode, the problem of pulse pileup due to high dose-rates is overcome by measuring current, similar to an ionization chamber. In a bunker housing a Varian Clinac 21EX, the performance of the NNS was evaluated in terms of reproducibility, linearity, and dose-rate effects. Using a custom maximum-likelihood expectation-maximization algorithm, measured neutron spectra at various locations inside the bunker were then compared to Monte Carlo simulations of an identical setup. In terms of dose, neutron ambient dose equivalents were calculated from the measured spectra and compared to bubble detector neutron dose equivalent measurements. RESULTS The NNS-measured spectra for neutrons at various locations in a treatment room were found to be consistent with expectations for both relative shape and absolute magnitude. Neutron fluence-rate decreased with distance from the source and the shape of the spectrum changed from a dominant fast neutron peak near the Linac head to a dominant thermal neutron peak in the moderating conditions of the maze. Monte Carlo data and NNS-measured spectra agreed within 30% at all locations except in the maze where the deviation was a maximum of 40%. Neutron ambient dose equivalents calculated from the authors' measured spectra were consistent (one standard deviation) with bubble detector measurements in the treatment room. CONCLUSIONS The NNS may be used to reliably measure the neutron spectrum of a radiotherapy beam in less than 1 h, including setup and data unfolding. This work thus represents a new, fast, and practical method for neutron spectral measurements in radiotherapy.
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Affiliation(s)
- Robert Maglieri
- Medical Physics Unit, McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Angel Licea
- Canadian Nuclear Safety Commission, Ottawa, Ontario K1P 5S9, Canada
| | - Michael Evans
- Medical Physics Unit, McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Jan Seuntjens
- Medical Physics Unit, McGill University, Montreal, Quebec H4A 3J1, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec H4A 3J1, Canada
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Joseph A, Herrera D, Kildea J, Hijal T, Hendren L. Sci-Thur PM - Colourful Interactions: Highlights 05: Opal-the Oncology Patient Application. Med Phys 2016. [DOI: 10.1118/1.4961765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Montgomery L, Kildea J. Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting - Radiation Treatment. Med Phys 2016. [DOI: 10.1118/1.4961842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Joseph A, Herrera D, Hijal T, Hendren L, Leung A, Wainberg J, Sawaf M, Maxim G, Maglieri R, Keshavarz M, Kildea J. Sci-Fri AM: Quality, Safety, and Professional Issues 04: Predicting waiting times in Radiation Oncology using machine learning. Med Phys 2016. [DOI: 10.1118/1.4961840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kildea J, Hijal T. Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre. Med Phys 2016. [DOI: 10.1118/1.4961800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kildea J, Enger S, Maglieri R, Mirzakhanian L, Dahlgren CV, Dubeau J, Witharana S. Poster - 25: Neutron Spectral Measurements around a Scanning Proton Beam. Med Phys 2016. [DOI: 10.1118/1.4961799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Joseph A, Herrera D, Hijal T, Hendren L, Leung A, Wainberg J, Sawaf M, Gorshkov M, Maglieri R, Keshavarz M, Kildea J. SU-F-P-20: Predicting Waiting Times in Radiation Oncology Using Machine Learning. Med Phys 2016. [DOI: 10.1118/1.4955727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Létourneau M, Kildea J, Parker W, Joseph A, Freeman C. EP-1414: Using a DVH registry standardizes IMRT-CSI planning and reduces V20 in non-target tissues. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Maglieri R, Licea A, Seuntjens J, Kildea J. Sci-Fri PM: Dosimetry-02: A Nested Neutron Spectrometer to Measure Neutron Spectra in Radiotherapy. Med Phys 2014. [DOI: 10.1118/1.4894957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Joseph A, Seuntjens J, Freeman C, Parker W, Kildea J. Poster - Thur Eve - 51: An analysis of the effectiveness of automated pre-, post- and intra-treatment auditing of electronic health records. Med Phys 2014. [DOI: 10.1118/1.4894911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kildea J, Joseph A. Poster - Thur Eve - 52: A Web-based Platform for Collaborative Document Management in Radiotherapy. Med Phys 2014. [DOI: 10.1118/1.4894912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Maglieri R, Liang L, Evans M, Licea A, Dubeau J, Witharana S, DeBlois F, Seuntjens J, Kildea J. SU-F-BRE-11: Neutron Measurements Around the Varian TrueBeam Linac. Med Phys 2014. [DOI: 10.1118/1.4889049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kildea J, Parker W. Sci-Sat AM: Brachy - 05: Comprehensive web-based QA in radiation oncology. Med Phys 2012; 39:4645. [DOI: 10.1118/1.4740212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Khatchadourian R, Davis S, Evans M, Licea A, Seuntjens J, Kildea J. Sci-Sat AM: Brachy - 04: Neutron production around a radiation therapy linac bunker - monte carlo simulations and physical measurements. Med Phys 2012; 39:4645. [PMID: 28516634 DOI: 10.1118/1.4740211] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Photoneutrons are a major component of the equivalent dose in the maze and near the door of linac bunkers. Physical measurements and Monte Carlo (MC) calculations of neutron dose are key for validating bunker design with respect to health regulations. We attempted to use bubble detectors and a 3 He neutron spectrometer to measure neutron equivalent dose and neutron spectra in the maze and near the door of one of our bunkers. We also ran MC simulations with MCNP5 to measure the neutron fluence in the same region. Using a point source of neutrons, a Clinac 1800 linac operating at 10 MV was simulated and the fluence measured at various locations of interest. We describe the challenges faced when measuring dose with bubble detectors in the maze and the complexity of photoneutron spectrometry with linacs operating in pulsed mode. Finally, we report on the development of a userfriendly GUI for shielding calculations based on the NCRP 151 formalism.
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Affiliation(s)
| | - S Davis
- McGill University Health Center, Montreal, QC
| | - M Evans
- McGill University, Montreal, QC.,McGill University Health Center, Montreal, QC
| | - A Licea
- Canadian Nuclear Safety Commission - CNSC, Ottawa, ON
| | - J Seuntjens
- McGill University, Montreal, QC.,McGill University Health Center, Montreal, QC
| | - J Kildea
- McGill University Health Center, Montreal, QC
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