Practical radiation oncology
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To quantify, and compare, workload for several common physician-based treatment planning tasks using objective and subjective measures of workload. To assess the relationship between workload and performance to define workload levels where performance could be expected to decline. ⋯ The NASA-TLX may provide a reasonable method to quantify subjective workload for broad activities, and objective physiologic eye-based measures may be useful to monitor workload for more granular tasks within activities. The subjective and objective measures, as herein quantified, do not necessarily track each other, and more work is needed to assess their utilities. From a series of controlled experiments, we found that performance appears to decline at subjective workload levels ≥55 (as measured via NASA-TLX), which is consistent with findings from other industries.
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The traditional Fletcher-Williamson tandem and ovoid brachytherapy applicators for treatment of cervical cancer have ovoid shields that reduce the dose to the bladder and rectum. However, these shields produce artifact on computed tomography (CT) that prevents acquisition of high-quality images. To address this limitation, we designed and tested a novel CT-compatible applicator with movable shields, called MDA(3). ⋯ This novel applicator provides a clinically feasible solution to overcome the limitation of lack of ovoid shields on currently available CT-compatible applicators.
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With increased use of stereotactic body radiotherapy (SBRT) for early-stage lung cancer, quantification of intrafraction variation (IFV) is required to develop adequate target margins. ⋯ IFV is dependent on several factors: immobilization device, treatment time, pulmonary function, and bodyweight. These factors are responsible for a significant portion of target margins with a mean IFV vector of 3 mm. Target margins of 6 mm or greater are required to encompass IFV in all dimensions when using four-dimensional CT with CBCT without respiratory gating or compression.
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Clinical evaluation of a "virtual" methodology for providing 6 degrees of freedom (6DOF) patient set-up corrections and comparison to corrections facilitated by a 6DOF robotic couch. ⋯ Results showed that the virtual corrections yielded dosimetric distributions that were essentially equivalent to those obtained when 6DOF robotic corrections were used, and that always outperformed the most commonly employed clinical approach of 3 translations only. This suggests that for the patient datasets studied here, highly effective image-guidance corrections can be made without the use of a robotic couch.
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Beginning in the 1990s, and emphasized in 2000 with the release of an Institute of Medicine report, health care providers and institutions have dedicated time and resources to reducing errors that impact the safety and well-being of patients. However, in January 2010, the first of a series of articles appeared in The New York Times that described errors in radiation oncology that grievously impacted patients. ⋯ The meeting was co-hosted by 14 organizations in the United States and Canada. The meeting yielded 20 recommendations that provided a pathway to reducing errors and improving patient safety in radiation therapy facilities everywhere.