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Knutsson S, Björk M, Odzakovic E, Hellström A, Sandlund C, Ulander M, Lind J, Fridlund B, Pakpour A, Broström A. The ethos brief index-validation of a brief questionnaire to evaluate wellness based on a holistic perspective in patients with restless legs syndrome. Sleep Breath 2024:10.1007/s11325-024-03058-5. [PMID: 38740633 DOI: 10.1007/s11325-024-03058-5] [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: 03/13/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE The aim of this study was to validate the Ethos Brief Index (EBI) in patients with Restless Legs Syndrome (RLS). METHODS A cross-sectional design, including 788 subjects with RLS (65% women, 70.8 years, SD 11.3) from the Swedish RLS Association, was used. A postal survey was sent out to collect data regarding socio demographics, comorbidities, and RLS-related treatment data. Questionnaires included were EBI, the Restless Legs Syndrome-6 Scale (RLS-6), Restless Legs Syndrome-Quality of Life questionnaire (RLSQoL), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis (CFA) models. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age and gender groups, as well as insomnia, daytime sleepiness, RLS-related QoL and RLS severity were assessed. RESULTS The results supported the unidimensionality of the EBI in the CFA (i.e., explaining 61.5% of the variance) and the Rasch model. The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. No DIF was identified for gender, age, insomnia, daytime sleepiness, RLS severity or RLS-related QoL. CONCLUSION The EBI showed good validity and reliability and operated equivalently for male and female patients with RLS. Accordingly, healthcare professionals can use the EBI as a psychometrically sound tool to explore and identify patient-centered problems related to the whole life situation.
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Affiliation(s)
- Susanne Knutsson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95, Växjö, Sweden.
- Center of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden.
| | - Maria Björk
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Elzana Odzakovic
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Amanda Hellström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Christina Sandlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Center, Stockholm, Region Stockholm, Sweden
| | - Martin Ulander
- Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Jonas Lind
- Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden
- Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Bengt Fridlund
- Center of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | - Amir Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Vestlandet, Norway
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Rayn K, Clark R, Hoxha K, Magliari A, Neylon J, Xiang MH, O'Connell DP. An IMRT planning technique for treating whole breast or chest wall with regional lymph nodes on Halcyon and Ethos. J Appl Clin Med Phys 2024; 25:e14295. [PMID: 38335253 PMCID: PMC11087171 DOI: 10.1002/acm2.14295] [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: 10/16/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE/OBJECTIVE Field size limitations on Halcyon and Ethos treatment machines largely preclude use of the conventional monoisocentric three-field technique for breast/chest wall and regional lymph nodes. We present an alternative, IMRT-based planning approach that facilitates treatment on Halcyon and Ethos while preserving plan quality. MATERIALS/METHODS Eight breast and regional node cases (four left-sided, four right-sided) were planned for an Ethos machine using a 15-17 field IMRT technique. Institutional plan quality metrics for CTV and PTV coverage and OAR sparing were assessed. Five plans (four right-sided, one left-sided) were also planned using a hybrid 3D multisocenter technique. CTV coverage and OAR sparing were compared to the IMRT plans. Eclipse scripting tools were developed to aid in beam placement and plan evaluation through a set of dosimetric scorecards, and both are shared publicly. RESULTS On average, the IMRT plans achieved breast CTV and PTV coverage at 50 Gy of 97.9% and 95.7%, respectively. Supraclavicular CTV and PTV coverages at 45 Gy were 100% and 95.5%. Axillary lymph node CTV and PTV coverages at 45 Gy were 100% and 97.1%, and IMN CTV coverage at 45 Gy was 99.2%. Mean ipsilateral lung V20 Gy was 19.3%, and average mean heart dose was 1.6 Gy for right-sided cases and 3.0 Gy for left-sided. In comparison to the hybrid 3D plans, IMRT plans achieved higher breast and supraclavicular CTV coverage (99.9% vs. 98.6% and 99.9% vs. 93.4%), higher IMN coverage (99.6% vs. 78.2%), and lower ipsilateral lung V20 Gy (19.6% vs. 28.2%). CONCLUSION Institutional plan quality benchmarks were achieved for all eight cases using the IMRT-based planning approach. The IMRT-based planning approach offered superior conformity and OAR sparing than a competing hybrid 3D approach.
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Affiliation(s)
- Kareem Rayn
- Varian Medical AffairsPalo AltoCaliforniaUSA
| | - Ryan Clark
- Varian Medical AffairsPalo AltoCaliforniaUSA
| | - Klea Hoxha
- Department of Radiation OncologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | | | - Jack Neylon
- Department of Radiation OncologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Michael H. Xiang
- Department of Radiation OncologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Dylan P. O'Connell
- Department of Radiation OncologyUniversity of CaliforniaLos AngelesCaliforniaUSA
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Kim JY, Tawk B, Knoll M, Hoegen-Saßmannshausen P, Liermann J, Huber PE, Lifferth M, Lang C, Häring P, Gnirs R, Jäkel O, Schlemmer HP, Debus J, Hörner-Rieber J, Weykamp F. Clinical Workflow of Cone Beam Computer Tomography-Based Daily Online Adaptive Radiotherapy with Offline Magnetic Resonance Guidance: The Modular Adaptive Radiotherapy System (MARS). Cancers (Basel) 2024; 16:1210. [PMID: 38539544 PMCID: PMC10969008 DOI: 10.3390/cancers16061210] [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: 01/30/2024] [Revised: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE The Ethos (Varian Medical Systems) radiotherapy device combines semi-automated anatomy detection and plan generation for cone beam computer tomography (CBCT)-based daily online adaptive radiotherapy (oART). However, CBCT offers less soft tissue contrast than magnetic resonance imaging (MRI). This work aims to present the clinical workflow of CBCT-based oART with shuttle-based offline MR guidance. METHODS From February to November 2023, 31 patients underwent radiotherapy on the Ethos (Varian, Palo Alto, CA, USA) system with machine learning (ML)-supported daily oART. Moreover, patients received weekly MRI in treatment position, which was utilized for daily plan adaptation, via a shuttle-based system. Initial and adapted treatment plans were generated using the Ethos treatment planning system. Patient clinical data, fractional session times (MRI + shuttle transport + positioning, adaptation, QA, RT delivery) and plan selection were assessed for all fractions in all patients. RESULTS In total, 737 oART fractions were applied and 118 MRIs for offline MR guidance were acquired. Primary sites of tumors were prostate (n = 16), lung (n = 7), cervix (n = 5), bladder (n = 1) and endometrium (n = 2). The treatment was completed in all patients. The median MRI acquisition time including shuttle transport and positioning to initiation of the Ethos adaptive session was 53.6 min (IQR 46.5-63.4). The median total treatment time without MRI was 30.7 min (IQR 24.7-39.2). Separately, median adaptation, plan QA and RT times were 24.3 min (IQR 18.6-32.2), 0.4 min (IQR 0.3-1,0) and 5.3 min (IQR 4.5-6.7), respectively. The adapted plan was chosen over the scheduled plan in 97.7% of cases. CONCLUSION This study describes the first workflow to date of a CBCT-based oART combined with a shuttle-based offline approach for MR guidance. The oART duration times reported resemble the range shown by previous publications for first clinical experiences with the Ethos system.
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Affiliation(s)
- Ji-Young Kim
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Bouchra Tawk
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Maximilian Knoll
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center Heidelberg, 69120 Heidelberg, Germany
| | - Philipp Hoegen-Saßmannshausen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Peter E. Huber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Molecular Radiooncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Mona Lifferth
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Clemens Lang
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Peter Häring
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Regula Gnirs
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Oliver Jäkel
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Molecular Radiooncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
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Akdeniz Y, Ispir B. Whole-brain radiotherapy with hippocampus sparing and simultaneous integrated boost to metastases: A plan quality comparison study between Ethos, HyperArc, VMAT and Tomotherapy. Med Dosim 2023:S0958-3947(23)00112-7. [PMID: 38101995 DOI: 10.1016/j.meddos.2023.11.004] [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: 08/13/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023]
Abstract
This study provides a concise and structured overview of a dosimetric comparison study conducted to assess the feasibility and effectiveness of 4 advanced radiotherapy techniques in treating brain metastases with hippocampus sparing and simultaneous integrated boost (HS-WBRT+SIB). Eleven patients with brain metastases previously treated with radiotherapy were included in the study. Planning CT scans with 2 mm slice thickness and MR imaging were used for contouring and dose prescription. The bilateral hippocampus and other organs at risk (OARs) were automatically contoured, and hippocampal avoidance regions (HAR) were defined as a 7 mm 3D expansion around the hippocampus. Gross tumor volume for each metastasis (GTVmet) and planning target volume for metastases (PTVmet) were delineated. The whole-brain CTV (CTVWB) and planning target volume for whole brain (PTVWB) were defined accordingly. Treatment planning and optimization were conducted using state-of-the-art radiotherapy techniques: Ethos, HyperArc, VMAT, and Tomotherapy. Tomotherapy achieved the highest D98% for PTVmet, indicating the best metastasis coverage. HyperArc plans showed the highest D98% for PTVWB, suggesting superior whole-brain coverage. Tomotherapy demonstrated significantly lower D98%, D2%, and Dmean values for the hippocampus, indicating its superiority in sparing the hippocampus. VMAT resulted in the lowest D2% values for the eyes, optic nerves, brainstem, and hypophysis, showing the best sparing of these critical structures. Tomotherapy consistently achieved lower Dmean values for parotids, oral cavity, and lips compared to the other techniques. The dosimetric comparison revealed distinct strengths and weaknesses for each radiotherapy technique. Tomotherapy excelled in sparing the hippocampus, while VMAT showed promise in sparing OARs. HyperArc plans demonstrated the best overall whole-brain coverage. These findings should guide clinicians in selecting the most suitable technique based on patient characteristics and institutional resources.
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Affiliation(s)
- Yucel Akdeniz
- Radiation Oncology Department, Acıbadem Adana Hospital, Adana, Turkey.
| | - Burcin Ispir
- Radiation Oncology Department, Acıbadem Ataşehir Hospital, İstanbul, Turkey
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Wegener S, Schindhelm R, Tamihardja J, Sauer OA, Razinskas G. Evaluation of the Ethos synthetic computed tomography for bolus-covered surfaces. Phys Med 2023; 113:102662. [PMID: 37572393 DOI: 10.1016/j.ejmp.2023.102662] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023] Open
Abstract
PURPOSE Ethos allows online adaption of radiotherapy treatment plans. Dose is calculated on synthetic computed tomographies (sCT), CT-like images generated by deforming planning CTs (pCT) onto daily cone beam CTs (CBCT) acquired during treatment sessions. Errors in sCT density distribution may lead to dose calculation errors. sCT correctness was investigated for bolus-covered surfaces. METHODS pCTs were recorded of a slab phantom covered with bolus of different thicknesses and with air gaps introduced by spacer rings of variable diameters and heights. Treatment plans were irradiated following the adaptive workflow with different bolus configurations present in the pCT and CBCT. sCT densities were compared to those of the pCT for the same air gap size. Additionally, the neck region of an anthropomorphic phantom was imaged using a plane standard bolus versus an individual bolus adapted to the phantom's outer contour. RESULTS Varying bolus thickness by 5 mm between pCT and CBCT was reproduced in the sCT within 2 mm accuracy. Different air gaps in pCT and CBCT resulted in highly variable bolus thickness in the sCT with a typical error of 5 mm or more. In extreme cases, air gaps were filled with bolus material density in the sCT or the phantom was unrealistically deformed near changed bolus geometries. Changes in bolus thickness and deformation also occurred in the anthropomorphic phantom. CONCLUSION sCTs must be critically examined and included in plan-specific quality assurance. The use of tight-fitting air gap-free bolus should be preferred to increase the similarity between sCT and CBCT.
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Affiliation(s)
- Sonja Wegener
- University Hospital Wurzburg, Department of Radiation Oncology, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany.
| | - Robert Schindhelm
- University Hospital Wurzburg, Department of Radiation Oncology, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
| | - Jörg Tamihardja
- University Hospital Wurzburg, Department of Radiation Oncology, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
| | - Otto A Sauer
- University Hospital Wurzburg, Department of Radiation Oncology, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
| | - Gary Razinskas
- University Hospital Wurzburg, Department of Radiation Oncology, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
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El-qmache A, McLellan J. Investigating the feasibility of using Ethos generated treatment plans for head and neck cancer patients. Tech Innov Patient Support Radiat Oncol 2023; 27:100216. [PMID: 37744525 PMCID: PMC10511846 DOI: 10.1016/j.tipsro.2023.100216] [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: 04/21/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 09/26/2023] Open
Abstract
The Varian Ethos treatment platform is designed to automatically create complex RT treatment plans, reducing both workload and operator variability in plan quality. The aim of this study is to evaluate the quality of Ethos-generated head and neck (H&N) treatment plans. Ethos plans were created for ten previous H&N patients and these were compared with the original clinical plans generated in Eclipse. Ethos automatically creates several plans with different field arrangements for each patient. All plans were compared quantitatively using: dose-volume metrics; dose conformity; dose heterogeneity and monitor units (MU). In addition, two H&N Oncologists assessed the clinical acceptability of the Ethos plans. Consultant 1 judged there to be at least three clinically acceptable Ethos plans for 9 out of 10 patients reviewed. Consultant 2 approved of at least two Ethos plans for 5 out of 5 patients reviewed. The Ethos plans' average dose metrics were comparable to the clinical plans. The average plan MU was similar for Eclipse and Ethos VMAT plans. The average plan MU for Ethos IMRT plans was larger with respect to all VMAT plans. The Ethos Treatment Planning system is capable of automatically creating good quality treatment plans for a range of H&N cancer patients.
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Affiliation(s)
- Adam El-qmache
- Radiotherapy Physics, Medical Physics, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, Scotland AB25 2ZN, United Kingdom
| | - John McLellan
- Radiotherapy Physics, Medical Physics, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, Scotland AB25 2ZN, United Kingdom
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Stanley DN, Harms J, Pogue JA, Belliveau JG, Marcrom SR, McDonald AM, Dobelbower MC, Boggs DH, Soike MH, Fiveash JA, Popple RA, Cardenas CE. A roadmap for implementation of kV-CBCT online adaptive radiation therapy and initial first year experiences. J Appl Clin Med Phys 2023:e13961. [PMID: 36920871 DOI: 10.1002/acm2.13961] [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: 09/30/2022] [Revised: 01/12/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Online Adaptive Radiation Therapy (oART) follows a different treatment paradigm than conventional radiotherapy, and because of this, the resources, implementation, and workflows needed are unique. The purpose of this report is to outline our institution's experience establishing, organizing, and implementing an oART program using the Ethos therapy system. METHODS We include resources used, operational models utilized, program creation timelines, and our institutional experiences with the implementation and operation of an oART program. Additionally, we provide a detailed summary of our first year's clinical experience where we delivered over 1000 daily adaptive fractions. For all treatments, the different stages of online adaption, primary patient set-up, initial kV-CBCT acquisition, contouring review and edit of influencer structures, target review and edits, plan evaluation and selection, Mobius3D 2nd check and adaptive QA, 2nd kV-CBCT for positional verification, treatment delivery, and patient leaving the room, were analyzed. RESULTS We retrospectively analyzed data from 97 patients treated from August 2021-August 2022. One thousand six hundred seventy seven individual fractions were treated and analyzed, 632(38%) were non-adaptive and 1045(62%) were adaptive. Seventy four of the 97 patients (76%) were treated with standard fractionation and 23 (24%) received stereotactic treatments. For the adaptive treatments, the generated adaptive plan was selected in 92% of treatments. On average(±std), adaptive sessions took 34.52 ± 11.42 min from start to finish. The entire adaptive process (from start of contour generation to verification CBCT), performed by the physicist (and physician on select days), was 19.84 ± 8.21 min. CONCLUSION We present our institution's experience commissioning an oART program using the Ethos therapy system. It took us 12 months from project inception to the treatment of our first patient and 12 months to treat 1000 adaptive fractions. Retrospective analysis of delivered fractions showed that the average overall treatment time was approximately 35 min and the average time for the adaptive component of treatment was approximately 20 min.
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Affiliation(s)
- Dennis N Stanley
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Joseph Harms
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Joel A Pogue
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Jean-Guy Belliveau
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Samuel R Marcrom
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Andrew M McDonald
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Michael C Dobelbower
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Drexell H Boggs
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Michael H Soike
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - John A Fiveash
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Richard A Popple
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Carlos E Cardenas
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, USA
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Nelissen KJ, Versteijne E, Senan S, Rijksen B, Admiraal M, Visser J, Barink S, de la Fuente AL, Hoffmans D, Slotman BJ, Verbakel WFAR. Same-day adaptive palliative radiotherapy without prior CT simulation: Early outcomes in the FAST-METS study. Radiother Oncol 2023; 182:109538. [PMID: 36806603 DOI: 10.1016/j.radonc.2023.109538] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 11/25/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND PURPOSE Standard palliative radiotherapy workflows involve waiting times or multiple clinic visits. We developed and implemented a rapid palliative workflow using diagnostic imaging (dCT) for pre-planning, with subsequent on-couch target and plan adaptation based on a synthetic computed tomography (CT) obtained from cone-beam CT imaging (CBCT). MATERIALS AND METHODS Patients with painful bone metastases and recent diagnostic imaging were eligible for inclusion in this prospective, ethics-approved study. The workflow consisted of 1) telephone consultation with a radiation oncologist (RO); 2) pre-planning on the dCT using planning templates and mostly intensity-modulated radiotherapy; 3) RO consultation on the day of treatment; 4) CBCT scan with on-couch adaptation of the target and treatment plan; 5) delivery of either scheduled or adapted treatment plan. Primary outcomes were dosimetric data and treatment times; secondary outcome was patient satisfaction. RESULTS 47 patients were enrolled between December 2021 and October 2022. In all treatments, adapted treatment plans were chosen due to significant improvements in target coverage (PTV/CTV V95%, p-value < 0.005) compared to the original treatment plan calculated on daily anatomy. Most patients were satisfied with the workflow. The average treatment time, including consultation and on-couch adaptive treatment, was 85 minutes. On-couch adaptation took on average 30 min. but was longer in cases where the automated deformable image registration failed to correctly propagate the targets. CONCLUSION A fast treatment workflow for patients referred for painful bone metastases was implemented successfully using online adaptive radiotherapy, without a dedicated CT simulation. Patients were generally satisfied with the palliative radiotherapy workflow.
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Affiliation(s)
- Koen J Nelissen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - Eva Versteijne
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Suresh Senan
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Barbara Rijksen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands
| | - Marjan Admiraal
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands
| | - Jorrit Visser
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands
| | - Sarah Barink
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands
| | - Amy L de la Fuente
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands
| | - Daan Hoffmans
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Ben J Slotman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Wilko F A R Verbakel
- Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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9
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Pogue JA, Cardenas CE, Cao Y, Popple RA, Soike M, Boggs DH, Stanley DN, Harms J. Leveraging intelligent optimization for automated, cardiac-sparing accelerated partial breast treatment planning. Front Oncol 2023; 13:1130119. [PMID: 36845685 PMCID: PMC9950631 DOI: 10.3389/fonc.2023.1130119] [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: 12/22/2022] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
Background Accelerated partial breast irradiation (APBI) yields similar rates of recurrence and cosmetic outcomes as compared to whole breast radiation therapy (RT) when patients and treatment techniques are appropriately selected. APBI combined with stereotactic body radiation therapy (SBRT) is a promising technique for precisely delivering high levels of radiation while avoiding uninvolved breast tissue. Here we investigate the feasibility of automatically generating high quality APBI plans in the Ethos adaptive workspace with a specific emphasis on sparing the heart. Methods Nine patients (10 target volumes) were utilized to iteratively tune an Ethos APBI planning template for automatic plan generation. Twenty patients previously treated on a TrueBeam Edge accelerator were then automatically replanned using this template without manual intervention or reoptimization. The unbiased validation cohort Ethos plans were benchmarked via adherence to planning objectives, a comparison of DVH and quality indices against the clinical Edge plans, and qualitative reviews by two board-certified radiation oncologists. Results 85% (17/20) of automated validation cohort plans met all planning objectives; three plans did not achieve the contralateral lung V1.5Gy objective, but all other objectives were achieved. Compared to the Eclipse generated plans, the proposed Ethos template generated plans with greater evaluation planning target volume (PTV_Eval) V100% coverage (p = 0.01), significantly decreased heart V1.5Gy (p< 0.001), and increased contralateral breast V5Gy, skin D0.01cc, and RTOG conformity index (p = 0.03, p = 0.03, and p = 0.01, respectively). However, only the reduction in heart dose was significant after correcting for multiple testing. Physicist-selected plans were deemed clinically acceptable without modification for 75% and 90% of plans by physicians A and B, respectively. Physicians A and B scored at least one automatically generated plan as clinically acceptable for 100% and 95% of planning intents, respectively. Conclusions Standard left- and right-sided planning templates automatically generated APBI plans of comparable quality to manually generated plans treated on a stereotactic linear accelerator, with a significant reduction in heart dose compared to Eclipse generated plans. The methods presented in this work elucidate an approach for generating automated, cardiac-sparing APBI treatment plans for daily adaptive RT with high efficiency.
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Affiliation(s)
| | - Carlos E. Cardenas
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yanan Cao
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Richard A. Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Soike
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Drexell Hunter Boggs
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dennis N. Stanley
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joseph Harms
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
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Laakkonen L, Lehtomäki J, Cahill A, Constantin M, Kulmala A, Harju A. Monte Carlo modeling of Halcyon and Ethos radiotherapy beam using CAD geometry: validation and IAEA-compliant phase space. Phys Med Biol 2023; 68. [PMID: 36657172 DOI: 10.1088/1361-6560/acb4d9] [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: 08/29/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023]
Abstract
Objective.A Monte Carlo (MC) model of a Halcyon and Ethos (Varian Medical Systems, a Siemens Healthineers Company) radiotherapy beam was validated and field-independent phase space (PHSP) files were recorded above the dual-layer multileaf collimators (MLC).Approach.The treatment head geometry was modeled according to engineering drawings and the dual-layer MLC was imported from CAD (computer-aided design) files. The information for the incident electron beam was achieved from an iterative electromagnetic solver. The validation of the model was performed by comparing the dose delivered by the square MLC fields as well as complex field measurements.Main results.An electron phase space was generated from linac simulations and achieved improved MC results. The output factors for square fields were within 1% and the largest differences of 5% were found in the build-up region of PDDs and the penumbra region of profiles. With the more complicated MLC-shaped field (Fishbone), the largest differences of up to 8% were found in the MLC leaf tip region due to the uncertainty of the MLC positioning and the mechanical leaf gap value. The impact of the collimator rotation on the PHSP solution has been assessed with both small and large fields, confirming negligible effects on in-field and out-of-field dose distributions.Significance.A computational model of the Halcyon and Ethos radiotherapy beam with a high accuracy implementation of the MLC was shown to be able to reproduce the radiation beam characteristics with square fields and more complex MLC-shaped fields. The field-independent PHSP files that were produced can be used as an accurate treatment head model above the MLC, and reduce the time to simulate particle transport through treatment head components.
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Affiliation(s)
- Linda Laakkonen
- Varian Medical Systems, a Siemens Healthineers Company, Helsinki, Finland.,Department of Physics, University of Helsinki, Finland
| | - Jouko Lehtomäki
- Varian Medical Systems, a Siemens Healthineers Company, Helsinki, Finland
| | - Alexander Cahill
- Varian Medical Systems, a Siemens Healthineers Company, Helsinki, Finland
| | | | - Antti Kulmala
- Clinical Research Institute HUCH Ltd., Helsinki, Finland
| | - Ari Harju
- Varian Medical Systems, a Siemens Healthineers Company, Helsinki, Finland
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11
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Wegener S, Exner F, Weick S, Stark S, Hutzel H, Lutyj P, Tamihardja J, Razinskas G. Prospective risk analysis of the online-adaptive artificial intelligence-driven workflow using the Ethos treatment system. Z Med Phys 2022:S0939-3889(22)00121-0. [PMID: 36504142 DOI: 10.1016/j.zemedi.2022.11.004] [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: 07/08/2022] [Revised: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The recently introduced Varian Ethos system allows adjusting radiotherapy treatment plans to anatomical changes on a daily basis. The system uses artificial intelligence to speed up the process of creating adapted plans, comes with its own software solutions and requires a substantially different workflow. A detailed analysis of possible risks of the associated workflow is presented. METHODS A prospective risk analysis of the adaptive workflow with the Ethos system was performed using Failure Modes and Effects Analysis (FMEA). An interprofessional team collected possible adverse events and evaluated their severity as well as their chance of occurrence and detectability. Measures to reduce the risks were discussed. RESULTS A total of 122 events were identified, and scored. Within the 20 events with the highest-ranked risks, the following were identified: Challenges due to the stand-alone software solution with very limited connectivity to the existing record and verify software and digital patient file, unfamiliarity with the new software and its limitations and the adaption process relying on results obtained by artificial intelligence. The risk analysis led to the implementation of additional quality assurance measures in the workflow. CONCLUSIONS The thorough analysis of the risks associated with the new treatment technique was the basis for designing details of the workflow. The analysis also revealed challenges to be addressed by both, the vendor and customers. On the vendor side, this includes improving communication between their different software solutions. On the customer side, this especially includes establishing validation strategies to monitor the results of the black box adaption process making use of artificial intelligence.
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Affiliation(s)
- Sonja Wegener
- University of Wuerzburg, Department of Radiation Oncology, Wuerzburg, Germany.
| | - Florian Exner
- University of Wuerzburg, Department of Radiation Oncology, Wuerzburg, Germany.
| | - Stefan Weick
- University of Wuerzburg, Department of Radiation Oncology, Wuerzburg, Germany.
| | - Silke Stark
- University of Wuerzburg, Department of Radiation Oncology, Wuerzburg, Germany.
| | - Heike Hutzel
- University of Wuerzburg, Department of Radiation Oncology, Wuerzburg, Germany.
| | - Paul Lutyj
- University of Wuerzburg, Department of Radiation Oncology, Wuerzburg, Germany.
| | - Jörg Tamihardja
- University of Wuerzburg, Department of Radiation Oncology, Wuerzburg, Germany.
| | - Gary Razinskas
- University of Wuerzburg, Department of Radiation Oncology, Wuerzburg, Germany.
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12
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Byrne M, Archibald-Heeren B, Hu Y, Greer P, Luo S, Aland T. Assessment of semi-automated stereotactic treatment planning for online adaptive radiotherapy in ethos. Med Dosim 2022; 47:342-347. [PMID: 36127189 DOI: 10.1016/j.meddos.2022.08.001] [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: 05/26/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The Ethos treatment planning system allows for the rapid generation of online adaptive treatment plans while the patient is on the treatment couch. One promising application of online adaptive radiotherapy is its use in stereotactic radiotherapy. The purpose of this study was to ensure the Ethos treatment planning system (TPS) can produce clinically acceptable stereotactic plans, that are non-inferior to those from the Eclipse TPS. METHOD Forty patients that received previous stereotactic radiotherapy treatment on a Halcyon, 20 of which were lung cases, and 20 that were brain cases, were replanned using the Ethos TPS. The generated IMRT and VMAT plans were compared to the clinical Eclipse VMAT plan. RESULTS This study found that the Ethos TPS can produce VMAT plans of equivalent quality (target coverage, conformity and OAR doses) to those from the Eclipse TPS for lung SBRT and brain SRT. The IMRT plans produced by the Ethos planning system were marginally inferior to Eclipse VMAT plans, with the differences likely primarily due to beam geometry rather than the optimization system. Ethos plans were generally more modulated than Eclipse plans. With careful selection of optimization structures and reduction in the body contour, VMAT plan generation time could be reduced by 87%. CONCLUSION Ethos can generate stereotactic VMAT plans that are equivalent to those from Eclipse in the timeframe required for online adaptive radiotherapy.
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Affiliation(s)
- Mikel Byrne
- Strategic Investment & Clinical Care, Icon Group, South Brisbane, QLD, Australia; University of Newcastle, Newcastle, NSW, Australia.
| | - Ben Archibald-Heeren
- Strategic Investment & Clinical Care, Icon Group, South Brisbane, QLD, Australia
| | - Yunfei Hu
- Strategic Investment & Clinical Care, Icon Group, South Brisbane, QLD, Australia
| | - Peter Greer
- University of Newcastle, Newcastle, NSW, Australia; Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
| | - Suhuai Luo
- University of Newcastle, Newcastle, NSW, Australia
| | - Trent Aland
- Strategic Investment & Clinical Care, Icon Group, South Brisbane, QLD, Australia
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Chapman JW, Lam D, Cai B, Hugo GD. Robustness and reproducibility of an artificial intelligence-assisted online segmentation and adaptive planning process for online adaptive radiation therapy. J Appl Clin Med Phys 2022; 23:e13702. [PMID: 35801266 PMCID: PMC9359017 DOI: 10.1002/acm2.13702] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/23/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Clinical implementation of online adaptive radiation therapy requires initial and ongoing performance assessment of the underlying auto‐segmentation and adaptive planning algorithms, although a straightforward and efficient process for this in phantom is lacking. The purpose of this work was to investigate robustness and repeatability of the artificial intelligence‐assisted online segmentation and adaptive planning process on the Varian Ethos adaptive platform, and to develop an end‐to‐end test strategy for online adaptive radiation therapy. Five synthetic deformations were generated and applied to a computed tomography image of an anthropomorphic pelvis phantom, and reference treatment plans were generated from each of the resulting deformed images. The undeformed phantom was repeatedly imaged, and the online adaptive process was performed including auto‐segmentation, review and manual correction of contours, and adaptive plan creation. One adaptive fractions in five different deformation scenarios were performed. The manually corrected contours had a high degree of consistency (> 93% Dice similarity coefficient and < 1.0 mm mean surface distance) across repeated fractions, with no significant variation across the synthetic deformation instance except for bowel (p = 0.026, one‐way ANOVA). Adaptive treatment plans also resulted in highly consistent dose–volume values for targets and organs at risk. A straightforward and efficient process was developed and used to quantify a set of organ specific contouring and dosimetric action levels to help establish uncertainty bounds for an end‐to‐end test on the Varian Ethos system.
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Affiliation(s)
- John W Chapman
- Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dao Lam
- Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bin Cai
- Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geoffrey D Hugo
- Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
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14
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Kim T, Ji Z, Lewis B, Laugeman E, Price A, Hao Y, Hugo G, Knutson N, Cai B, Kim H, Henke L. Visually guided respiratory motion management for Ethos adaptive radiotherapy. J Appl Clin Med Phys 2021; 23:e13441. [PMID: 34697865 PMCID: PMC8803298 DOI: 10.1002/acm2.13441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/22/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Ethos adaptive radiotherapy (ART) is emerging with AI‐enhanced adaptive planning and high‐quality cone‐beam computed tomography (CBCT). Although a respiratory motion management solution is critical for reducing motion artifacts on abdominothoracic CBCT and improving tumor motion control during beam delivery, our institutional Ethos system has not incorporated a commercial solution. Here we developed an institutional visually guided respiratory motion management system to coach patients in regular breathing or breath hold during intrafractional CBCT scans and beam delivery with Ethos ART. Methods The institutional visual‐guidance respiratory motion management system has three components: (1) a respiratory motion detection system, (2) an in‐room display system, and (3) a respiratory motion trace management software. Each component has been developed and implemented in the clinical Ethos ART workflow. The applicability of the solution was demonstrated in installation, routine QA, and clinical workflow. Results An air pressure sensor has been utilized to detect patient respiratory motion in real time. Either a commercial or in‐house software handled respiratory motion trace display, collection and visualization for operators, and visual guidance for patients. An extended screen and a projector on an adjustable stand were installed as the in‐room visual guidance solution for the closed‐bore ring gantry medical linear accelerator utilized by Ethos. Consistent respiratory motion traces and organ positions on intrafractional CBCTs demonstrated the clinical suitability of the proposed solution in Ethos ART. Conclusion The study demonstrated the utilization of an institutional visually guided respiratory motion management system for Ethos ART. The proposed solution can be easily applied for Ethos ART and adapted for use with any closed bore‐type system, such as computed tomography and magnetic resonance imaging, through incorporation with appropriate respiratory motion sensors.
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Affiliation(s)
- Taeho Kim
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Zhen Ji
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Benjamin Lewis
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Geoffrey Hugo
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Nels Knutson
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Bin Cai
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA.,Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Lauren Henke
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
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15
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Descamps Y. Global Sign, Shared Meaning? Kobe Bryant's Life and Its Representation from the USA to France. J Afr Am Stud (New Brunsw) 2021; 25:179-207. [PMID: 34248443 PMCID: PMC8254057 DOI: 10.1007/s12111-021-09539-1] [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] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 06/13/2023]
Abstract
This article examines the media representation of Kobe Bryant's life in the media and his meaning as a global sign, both in France and the USA. It analyzes the representation of Bryant in French magazine 5 Majeur to highlight the specificities of the French media coverage of the NBA. In doing so, this article reconsiders Kobe Bryant's story, its meaning to people in the USA and France, but also what it shows about evolving societal communications.
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Affiliation(s)
- Yann Descamps
- Department of Sport Studies, Research Center C3S “Culture, Sport, Santé, Société” Université Bourgogne Franche-Comté, (E.A. 4660), Besançon, France
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16
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Broström A, Ulander M, Nilsen P, Lin CY, Pakpour AH. Development and psychometric evaluation of the Motivation to Use CPAP Scale (MUC-S) using factorial structure and Rasch analysis among patients with obstructive sleep apnea before CPAP treatment is initiated. Sleep Breath 2021; 25:627-637. [PMID: 32705529 PMCID: PMC8195890 DOI: 10.1007/s11325-020-02143-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Continuous positive airway treatment (CPAP) is first-line treatment for obstructive sleep apnea (OSA), but adherence tends to be low. A clinical tool focusing on motivation to use CPAP is missing. The purpose was to develop a brief questionnaire to assess motivation to use CPAP that is psychometrically robust and suitable for use in clinical practice. METHODS A convenience sample including 193 treatment naive patients with OSA (67% men; mean age = 59.7 years, SD 11.5) from two CPAP clinics was used. Clinical assessments and full night polygraphy were performed. Questionnaires administered before CPAP treatment included the newly developed Motivation to Use CPAP Scale (MUC-S), Minimal Insomnia Symptoms Scale (MISS), Epworth Sleepiness Scale (ESS), and Attitude towards CPAP treatment Inventory (ACTI). The validity and reliability of the MUC-S were investigated using Rasch and exploratory factor analysis models. Measurement invariance, dimensionality and differential item functioning (i.e., across gender groups, excessive daytime sleepiness (ESS), insomnia (MISS) and attitude towards CPAP (ACTI) groups) were assessed. RESULTS The results supported a two-factor solution (autonomous motivation, 6 items, factor loadings between 0.61 and 0.85 and controlled motivation, 3 items, factor loadings between 0.79 and 0.88) explaining 60% of the total variance. The internal consistency was good with Cronbach's alpha of 0.88 and 0.86 for the two factors. No differential item functioning was found. A latent class analysis yielded three profiles of patients with high (n = 111), moderate (n = 60) and low (n = 22) motivation. Patients with high motivation were older, had higher daytime sleepiness scores, more insomnia symptoms and a more positive attitude towards CPAP. CONCLUSIONS The MUC-S seems to be a valid tool with robust psychometric properties suitable for use at CPAP clinics. Future studies should focus on how motivation changes over time and if MUC-S can predict objective long-term CPAP adherence.
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Affiliation(s)
- Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
- Department of Clinical Neurophysiology, Linköping University Hospital, S-581 85, Linköping, Sweden.
| | - M Ulander
- Department of Clinical Neurophysiology, Linköping University Hospital, S-581 85, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Division of Clinical Neurophysiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - P Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - A H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahounar BLV, Qazvin, 3419759811, Iran
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17
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Hu Y, Byrne M, Archibald-Heeren B, Collett N, Liu G, Aland T. Validation of the preconfigured Varian Ethos Acuros XB Beam Model for treatment planning dose calculations: A dosimetric study. J Appl Clin Med Phys 2020; 21:27-42. [PMID: 33068070 PMCID: PMC7769396 DOI: 10.1002/acm2.13056] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 06/07/2020] [Revised: 08/26/2020] [Accepted: 09/18/2020] [Indexed: 12/29/2022] Open
Abstract
Varian (Palo Alto, California, United States) recently released an online adaptation treatment platform, Ethos, which has introduced a new Dose Preview and Automated Plan Generation module despite sharing identical beam data with the existing Halcyon linac. The module incorporates a preconfigured beam model and the Acuros XB algorithm (Ethos AXB model) to generate final dose calculations from an initial fluence optimization. In this study, we comprehensively validated the accuracy of the Ethos AXB model by comparing it against the Halcyon AXB model, the Halcyon Anisotropic Analytical Algorithm (AAA) model, and measurements acquired on an Ethos linac. Results indicated that the Ethos AXB model demonstrated a comparable if not superior dosimetric accuracy to the Halcyon AXB model in basic and complex calculations, and at the same time its dosimetric accuracy in modulated and heterogeneous plans was better than that of the Halcyon AAA model. Despite the fact that the same algorithm was utilized, the Ethos AXB model and the Halcyon AXB model still exhibited variations across a range of tests, although these variations were predominantly insignificant in the clinical environment. The accuracy of the Ethos AXB model has been successfully verified in this study and is considered appropriate for the current clinical scope. On the basis of this study, clinical physicists can perform a data validation instead of a full data commissioning when implementing the Ethos system, thereby adopting a more efficient approach for Ethos installation.
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Affiliation(s)
- Yunfei Hu
- Icon Cancer Center Gosford, Gosford, NSW, Australia
| | - Mikel Byrne
- Icon Cancer Centre Wahroonga, Wahroonga, NSW, Australia
| | | | - Nick Collett
- Icon Cancer Centre Wahroonga, Wahroonga, NSW, Australia
| | - Guilin Liu
- Icon Cancer Centre Wahroonga, Wahroonga, NSW, Australia
| | - Trent Aland
- Icon Core Office, South Brisbane, QLD, Australia
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Broström A, Pakpour AH, Nilsen P, Fridlund B, Ulander M. Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated. Sleep Breath 2019; 23:761-768. [PMID: 30523558 PMCID: PMC6700038 DOI: 10.1007/s11325-018-1762-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/07/2018] [Accepted: 11/21/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP). METHODS A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed. RESULTS The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index. CONCLUSIONS The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity.
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Affiliation(s)
- Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
- Department of Clinical Neurophysiology, Linköping University Hospital, S-581 85, Linköping, Sweden.
| | - A H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - P Nilsen
- Department of Health and Society, Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | | | - M Ulander
- Department of Clinical Neurophysiology, Linköping University Hospital, S-581 85, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Division of Clinical Neurophysiology, Faculty of Health Sciences Linköping University, Linköping, Sweden
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Lanzerath D. [European ethics committees in transition: challenges of new requirements]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:697-705. [PMID: 31069417 DOI: 10.1007/s00103-019-02952-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Guided by the example of ethics committees in medicine, the ethical review system of research projects in Europe is increasingly expanding to other disciplines such as psychology, the social sciences, and engineering, especially when human subjects are directly involved or personal data are collected. However, ethical reviews are not uniformly regulated in most European countries.With the new EU Regulation No. 536/2014, which is expected to come into force in 2020, it is intended to standardize the work of medical research ethics committees for clinical trials. Clear deadlines and the use of a central electronic EU portal are also given in order to accelerate the approval process for economic reasons. Member states are left free in terms of the scope of the ethical review, but this would run counter to unification and could lead some to choose a test model that excludes the evaluation of the methodology and risks of a study and thus contributes less to the protection of the participants.The European Research Ethics Committees have been working together since 2005 within the European Network of Research Ethics Committees (EUREC). For a discussion on the impact and implementation of the new EU Regulation and on the development of the EU portal, EUREC has provided a forum for a qualified debate.In this period of change, it is not clear yet which direction the ethics committees will develop. Professional management can have a positive impact on the quality of the ethics review. However, the marginalization inherent in the EU Regulation is counteracting the increasing evaluation of nonmedical research projects and adequate protection of subjects.
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Cazalis R. An extended framework for science. Prog Biophys Mol Biol 2017; 131:121-130. [PMID: 28870740 DOI: 10.1016/j.pbiomolbio.2017.08.016] [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] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
We may be at the cusp of a next generation framework for science which can be facilitated by understanding current limitations in the context of a divergence of 'scientific' tradition from the Axial Age (800-200 BCE) to the present. A powerful advance may come from fusing certain elements from Western and Eastern traditions, synthesizing the framework with an apt understanding of the divergence. Key traits will include the ethopoetic nature of the scientist with attention to his/her experience of self. The framework will also 'access' knowledge through a state of mind less encumbered with paradoxes, duality, incompatibility and other aporias. Case studies in biology and physics illustrate possibilities.
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Affiliation(s)
- Roland Cazalis
- SPS/URBV, Cognivege, Faculty of Sciences, University of Namur, 61 rue de Bruxelles, 5000 Namur, Belgium.
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Salloch S. Same same but different: why we should care about the distinction between professionalism and ethics. BMC Med Ethics 2016; 17:44. [PMID: 27448658 PMCID: PMC4957338 DOI: 10.1186/s12910-016-0128-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/13/2016] [Indexed: 11/23/2022] Open
Abstract
Medical professionalism forms a belief system which is used to defend physicians’ ethos against counterforces which might threaten the integrity of medical practice. The current debates on professionalism, however, are characterized by the lack of a clear distinction between professional and ethical aspects of physicians’ conduct. This article argues that a differentiation between professionalism and ethics is not of mere academic interest. Instead, it is of great practical importance with regard to morally contentious issues in medicine. A short analysis of the discussions in history and social sciences reveals that professionalism is more than a catchphrase of modern medical debates but has a complex theoretical background which is still not conclusively understood. Whereas professionalism is clearly linked to the honorable aims of providing services to the individual and the society, it potentially entails problematic aspects, such as elitism, monopoly or the maintaining of power and privileges. With regard to morally contentious topics, the professional ethos of physicians must be differentiated from the perspective of ethics which can take a universal standpoint and has the potential to critically assess context-specific moral norms. The example of the current regulation on suicide assistance in German professional law is taken as an example to demonstrate how professional bodies tend to overstep the limits of their expertise and regulatory power with regard to issues which need an ethical evaluation. The article concludes that the narrowing of ethics and professionalism in public discussions and in medical education should be seen as problematic and that morally contentious topics in modern societies should be open to a participatory and inclusive discussion and democratic decision procedures.
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Affiliation(s)
- Sabine Salloch
- Institute for Ethics and History of Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, D-17487, Greifswald, Germany.
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Elżbieta P, Waldemar G, Barbara MC. Polish Code of Ethics of a Medical Laboratory Specialist. EJIFCC 2014; 25:199-206. [PMID: 27683468 PMCID: PMC4975296] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Along with the development of medicine, increasingly significant role has been played by the laboratory diagnostics. For over ten years the profession of the medical laboratory specialist has been regarded in Poland as the autonomous medical profession and has enjoyed a status of one of public trust. The process of education of medical laboratory specialists consists of a five-year degree in laboratory medicine, offered at Medical Universities, and of a five-year Vocational Specialization in one of the fields of laboratory medicine such as clinical biochemistry, medical microbiology, medical laboratory toxicology, medical laboratory cytomorphology and medical laboratory transfusiology. An important component of medical laboratory specialists' identity is awareness of inherited ethos obtained from bygone generations of workers in this particular profession and the need to continue its further development. An expression of this awareness is among others Polish Code of Ethics of a Medical Laboratory Specialist (CEMLS) containing a set of values and a moral standpoint characteristic of this type of professional environment. Presenting the ethos of the medical laboratory specialist is a purpose of this article. Authors focus on the role CEMLS plays in areas of professional ethics and law. Next, they reconstruct the Polish model of ethos of medical diagnostic laboratory personnel. An overall picture consists of a presentation of the general moral principles concerning execution of this profession and rules of conduct in relations with the patient, own professional environment and the rest of the society. Polish model of ethical conduct, which is rooted in Hippocratic medical tradition, harmonizes with the ethos of medical laboratory specialists of other European countries and the world.
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Affiliation(s)
- Puacz Elżbieta
- National Chamber of Medical Laboratory Specialists,National Chamber of Medical Laboratory Specialists ul. Konopacka 4 03-428, Warszawa, Poland
| | - Glusiec Waldemar
- Medical University of Lublin, Department of Ethics and Philosophical Anthropology,Medical University of Lublin Department of Ethics and Philosophical Anthropology ul. Szkolna 18 20-124 Lublin, Poland +48 514513463
| | - Madej-Czerwonka Barbara
- Medical University of Lublin, Department of Descriptive and Clinical Anatomy,Prof. associate Medical University of Lublin, Department of Descriptive and Clinical Anatomy ul.Jaczewskiego 4 20-090, Lublin, Poland
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Baker SR. The dictated report and the radiologist's ethos. An inextricable relationship: pitfalls to avoid. Eur J Radiol 2013; 83:236-8. [PMID: 24262977 DOI: 10.1016/j.ejrad.2013.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/02/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
Radiologists' reputation as expert image interpreters are in large measured defined by the content of their written reports. Habitually use of terms that reveal a lack of decisiveness will serve to diminish their esteem in the minds of their referrers. Recurrent resort expression to such as questionable, suspicious, cannot rule out, and clinical correlation requested when frequently deployed are examples of phrases that can have a negative effect on the radiologist's ethos.
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Affiliation(s)
- Stephen R Baker
- Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
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