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2010 AAMD Online Continuing Education Modules Descriptions
Image-Guided Radiation Therapy: Benefits and Limitations
Faiz Khan, PhD
University of Minnesota Medical School
Abstract:
Image-guided radiation therapy (IGRT) uses image guidance at various stages of its process: patient data acquisition, treatment planning, treatment simulation, patient setup, and target localization before and during treatment. These procedures use imaging technology to identify and correct problems arising from inter- and intrafractional variations in patient setup and anatomy, including shapes and volumes of treatment target, organs at risk and surrounding normal tissues. In that context, we will describe a number of technologies and methods that are available to implement IGRT, along with their benefits and limitations.
Targeted Radionuclide Therapy: Today and Tomorrow
Tod Speer, MD
University of Wisconsin School of Medicine
Abstract:
Targeted radionuclide therapy (TRT) is a form of systemic radiation therapy that utilizes various radionuclides, conjugated to antibodies or antibody fragments, to specifically target malignancies. The radiation is delivered in a continually, exponentially decreasing low dose and low dose-rate fashion. Standard LQ modeling predicts that this form of radiotherapy should be rather ineffective. In contrast, however, TRT appears to be very effective clinically. There is a plethora of solid tumor data that appears to be very promising. Radiolabeled ant-CD20 antibodies (Zevalin/ Bexxar) are beginning to move into the adjuvant, front-line setting for treating lymphoma. Surely, utilization of these agents will significantly increase over the next several years. Further, dosimetric evaluation of malignant and normal tissues is becoming increasingly important. The new era of radiation oncology will need to embrace this form of systemic radiotherapy in order to maintain a "forefront" position in oncology. TRT will allow radiation oncologists to begin to think like medical oncologist and will provide the necessary tool so that we can reach out and grip the elusive "Holy Grail", a cure for stage IV epithelial carcinoma. This session will be designed to review where oncology stands "today" with regards to TRT and the bright "tomorrow" that awaits our field.
Peer Review in Radiation Therapy
Robert D. Adams, EdD, CMD
University of North Carolina
Abstract:
Peer review is emerging as a critical issue in radiation therapy clinical practice. The purpose of this presentation is to review the role of peer review, determine its role in radiation therapy clinical practice, and discuss methods to enhance peer review in radiation therapy. ASTRO has recently developed a sub-committee looking at ways to enhance peer review and quality assurance in clinical practice.
Regulatory and Legislative Influences Impacting Medical Physicists and Medical Dosimetrists
Lynne A. Fairobent
American Association of Physicists in Medicine
Abstract:
There are many regulatory and legislative initiatives that have implications for medical physicists and medical dosimetrists. Recent articles in the NY Times have resulted in AAPM testifying before the U.S. House of Representatives, Subcommittee on Health. Several bills are pending in Congress that have implications on the practice of medicine and the credentials for medical physicists and medical dosimetrists that when passed will have regulatory implications. Safety Culture, Increased Controls, Patient Safety, Accreditation, Registration, Credentials – what do these mean to medical physics and medical dosimetrists?
The Rationale for Dose-Escalation Techniques in Prostate Cancer: IMRT, IGRT, Immobilization
Andrew Lee, MD
M.D. Anderson Cancer Center
Abstract:
Higher doses of external beam radiation therapy have improved clinical outcomes in prostate cancer in at least three randomized studies. However, each of these studies has shown an increase in toxicity with higher radiation doses. Subsequent analyses have shown a correlation between dose and volume of tissue irradiated and established the importance of dose-volume constraints. Newer radiation techniques (e.g. IMRT) and improved daily image-guidance may improve cancer control outcomes and also decrease toxicity. This presentation will review the studies that provide the foundation for dose-escalation radiation therapy in prostate cancer. This will include not only the trial design but also an interpretation of the clinical outcomes and side effect profiles. The clinical rationale of managing inter- and intra-fractional target variation will also be addressed with a discussion of image-guidance as well as immobilization techniques.
The Clinical Rationale for Proton Therapy
Andrew Lee, MD
M.D. Anderson Cancer Center
Abstract:
Proton therapy has been available in the U.S. for several decades, but only recently has it started gaining more wide-spread use. The first hospital-based proton center began treating patients in the early 1990's and since then over six large-scale proton centers have begun operation in this country alone. This presentation will describe the unique physical properties of protons in comparison to photons and how they can be used in clinical radiation oncology. The basics of proton physics, dosimetry, and treatment planning considerations for various disease sites will be addressed including elements surrounding the Bragg peak, range uncertainty, and tumor motion. A review of historical experiences with proton therapy in various disease sites such as cancers of the prostate, lung, and liver will be discussed along with the development for future applications. The clinical rationale of proton therapy for various malignancies with a particular emphasis on prostate cancer, lung cancer, and pediatric cancers will be addressed along with the unique aspects of treatment planning for these sites. The development of advanced proton therapy techniques such as gating and pencil-beam scanning will be presented. The clinical experiences from a large-scale, high-volume proton therapy center also will be discussed.
SBRT: Treatment Planning and Immobilization
Rachel Hackett, CMD, RT(T)
Roswell Park Cancer Institute
Abstract:
SBRT is quickly becoming the treatment of choice for many patients who either do not qualify for invasive surgery, or who are afflicted with a cancer that responds well to high doses of hypofractionated radiation. However, radiation doses have been historically below such high, powerful doses. Therefore, what dangers to normal tissue should medical dosimetrists be aware of when planning an SBRT case? What kind of immobilization should be employed to minimize damage to areas outside the target area? What is the role of IGRT? What kind of treatment planning methods can be used to achieve a seamless conformality index? Are there future indications of SBRT for other cancers?
Planning and Delivery of Bolus Electron Conformal Therapy
Kenneth Hogstrom, PhD
LSU/Mary Bird Perkins Cancer Ctr.
Abstract:
Bolus electron conformal therapy (ECT) can be thought of as the electron beam equivalent to intensity modulated x-ray therapy (IMXT), applicable to PTVs lying within 6 cm of the patient surface. Bolus ECT is planned using a single electron beam with the appropriate direction, energy, and field size, after which a variable thickness wax bolus that lies on the patient's surface is designed for the 90% (of given dose) dose contour to contain and closely conform to the distal PTV surface. The bolus design algorithm implemented into .decimal's p.d software is based on the forward planning process of Low et al (1994). The software can be used with any treatment planning system capable of DICOMRT exchange. Following bolus design, .decimal fabricates and ships the bolus to the customer, who is responsible for performing a quality assurance check that consists of a repeat CT scan and dose calculation with the bolus on the patient. Bolus ECT is useful in sites historically treated with electrons and where there can be considerable variation in PTV depth across the treatment field. Post mastectomy chest wall cases will exemplify its utilization for patients with deep excisions, abnormal anatomy, and recurrences where fields normally abut. Head and neck cases will illustrate how bolus ECT can be used for nose, parotid, and ear cancers. Examples of mixing IMXT with bolus ECT and of abutting IMXT with bolus ECT will illustrate how such mixed beam therapy can be advantageous. The recent availability of bolus ECT adds another significant technology for improved ability to optimize individual patient treatment.
Remote Radiation Treatment Planning: A Paradigm Shift
Dawn Henrich, CMD, RT(R)(T),BS; Jennifer Buskerud, CMD, RT(T)
Abstract:
An informational session will take place surrounding remote treatment planning capabilities. Historically, the telemedicine concept has been documented since the 1900's, although this care over a distance was indeed very primitive. Over the years, the concept has evolved into markets such as teleradiology and more recently radiation therapy. Shortages of qualified medical dosimetrists in the United States are identified as a problem, and a complete absence is standard in many countries. One factor during the remote treatment planning process that will be addressed is communication. Communication is vital in radiation oncology to provide accurate care to our patients. This increases dramatically when the radiation oncologist and medical dosimetrist are in a remote setting. Remote treatment planning appears to have evolved from concept to reality and presents significant potential to address numerous challenges in Radiation Oncology.
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