Downloadable Protocols

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Great news! Radiation Oncology Resources (ROR) has posted a library of common protocols as free downloads to the radiation therapy community.

Go to the “protocols” web page at the ROR website, where you can watch a quick video, navigate body sites, and download RTOG protocols as both: 1) easy-to-read PDFs with the objectives and performance levels clearly graphed, and 2) templates that can be easily imported as automated “Plan Quality Algorithms” for Quality Reports [EMR] customers or Icarus [RT] research sites.

Great job, ROR!...

Icarus Meeting (Oct. 2, 2013)

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Great stuff today, team. Thanks for tuning in. A couple of quick updates for everyone:

1] Today’s meeting was recorded and has been added to the video portfolio, which you can find here posologie viagra 100 mg.

2] I will be updating the Icarus/Quality Reports software on the secure downloads site within a day or so. When you download the updated installer (either now or for future installers), it’s a piece of cake. You will not be starting from scratch, but rather just installing new changes based on feedback from you and other users and research partners. It usually  is done in a matter of seconds.

See you next Wednesday.


New Publication: Interplay of Target Motion and Dynamic VMAT Delivery for SBRT

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Together with Moffitt Cancer Center (Tampa, FL) and the team of Vladimir Feygelman, Ph.D., we continue our ongoing scientific studies with a new publication called “Experimentally studied dynamic dose interplay does not meaningfully affect target dose in VMAT SBRT lung treatments,” just published in Medical Physics 40(9). We are proud to say this paper was selected as one of the “Editor’s Picks” for this issue (which, among other things, means anybody can download the PDF of the article for free – a really nice feature offered by the Medical Physics journal).

Prior to this work, we had been building up our knowledge and toolset for analyzed 4D doses, specifically for volume-modulated arc therapy (VMAT). We applied to clinical SBRT plans (hypo-fractionated with 10 Gy/fraction, 5 total fractions), and at first we were surprised by our results. Then, as we set about understanding the interplay phenomenon for hypo-fractionated VMAT, it started to make more and more intuitive sense why we didn’t see interplay effects. First, the high dose per fraction ultimately allows for many cycles of breathing motion during each daily delivery, which tends to average out the interplay effect. Second, the VMAT segments tend to be less complex at any given time than dynamic IMRT segments (which we know are susceptible to interplay, at least per fraction), also working to drive down interplay. And finally, a strategy of optimization of our VMAT plans was to pump up the dose at the PTV periphery, i.e. purposely induce dose heterogeneity, and the benefits of this for a moving target are evidence in this paper....

New Publication: Bio-Models to Assess Plan Robustness / Dose QA

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It has my pleasure to work with my colleagues Wolfgang Tomé and Heming Zhen on a multi-phased study on the methods and metrics of patient-specific Dose QA.

Recently, we published our third paper on this topic called “On the use of biomathematical models in patient-specific IMRT dose QA,” which was published in Medical Physics 40(7). This paper looked at how to use biological model-based DVH reduction methods to analyze dose changes observed during per-patient dose QA, but more importantly raised the idea of using bio-models to assess the “robustness” of highly conformal plans (IMRT and VMAT). That is, wouldn’t it be useful to quantify how susceptible these plans are (or would be) to TPS or delivery errors? Moreover, wouldn’t this make sense to do as part of optimizing the plan vs. after? It’s a common sense approach to quality....

Icarus Meeting Video (Sept. 18, 2013)

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Thanks to all who attended today’s first Icarus meeting. This was an overview, a “kickoff” of the project. The actual live meeting’s audio recording was not optimal, so I re-recorded the main content again afterwards. Here is a link to the portfolio of Icarus team meetings. I hope to see you next week at our weekly Icarus meeting (Wednesdays at 12:00 p.m. Central Time, i.e. -6:00 GMT).


Icarus Kick-Off Meeting

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There has been a very strong interest in (and registration for) the Icarus research team, which I am honored to say will truly be a worldwide team of clinical peers. It is great to see so many professional dosimetrists/treatment planners take an active role in moving the field forward and learning new things.

I will kick off the Icarus research with a meeting on Wednesday, September 18th at 12:00 p.m. (Central Time). Icarus researchers who have registered have been sent an email with the GoToMeeting link. This first meeting will give an overview discussion and demonstration. At the end, I will explain how the research team members can get started by downloading and installing the software, and getting it licensed. After the first meeting, I will host weekly “Brownbag Meetings” for progressive training and Q&A, to occur every Wednesday at 12:00 p.m. Central Time. These meetings will be recorded and posted for those who cannot join the live meetings.

If you’re an Icarus research registrant, check your inbox for details, and if you did not receive the meeting info, please let me know.

Thanks, -bn...

Icarus: Team Member Registration

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There is great excitement building around the Icarus project. I’ve been working on and previewing the software prototype, and needless to say the interest level is high, and unanimous. Encouraging to me is that all vested roles are interested: dosimetrists, physicists, physicians, and even department administrators. Everybody has their “ah ha” moment about how Icarus can make their work life better in terms of efficiency, communication, and quality.

It’s time to get started and distribute software to the Icarus research team, give some training, and open the door to let the future in.

Before that, I must collect information about the research team members. So without further ado, please fill out this survey to officially register as an Icarus research team member....

Canis Lupus LLC Awards $100,000 Technology Grant to SIU Dosimetry Program

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In the past few years, I’ve developed closer collaborations with the dosimetry community, giving annual talks at the national AAMD meeting and working with Radiation Oncology Resources, Inc. to develop much-needed Quality Systems and training programs for radiation therapy. In the process, I have met more and more dosimetrists and dosimetry students, and am always impressed by their hunger to learn, improve, and share techniques and best practices. Dosimetrists are a highly collaborative population of colleagues as opposed to a competitive population of rivals. This is healthy.

As part of my commitment and appreciation for the dosimetry community, I proudly announce that I will be working with Dr. Scott Collins and his Dosimetry Master program at Southern Illinois University (Carbondale). I will be giving guest lectures, working with ROR to run plan quality projects (i.e. Plan Challenges devoted to the students), and most importantly I will be arming the students with “Quality Reports [EMR]” licenses throughout their education. Read more about it here or here (ROR website, longer press release) or here (Reuters).

We just finished a pilot project with the outgoing class of 2013, and in just a few weeks we were already seeing how the software can help on so many fronts – from interactive education on core principles of radiation therapy, to clinical protocols and continual improvement initiatives. We now look forward to the 2014 class, and beyond.

– Ben Nelms...

Project Icarus: Survey Results & Next Steps

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Two weeks ago, I posted a survey to help gather some information that will help me plan for Project Icarus. I sent 70 email notifications and 40 people filled out the survey, which is a pretty good response rate (thanks for that). The survey results are summarized here along with the “next steps” for Project Icarus.

Survey Summary

95% of all respondents heard about Project Icarus from the AAMD talk, either because they were there (85%) or heard from somebody who was (10%). As far as demographics of workforce, 42.5% of dosimetrists worked with three or more other planners and just 12.5% worked as the sole planner at their site. In terms of number of radiation oncologists, 42.5% work with five or more rad oncs and 40% working with just one or two.

Regarding how or why people want to be involved, a menu of possible responses was provided where people could enter multiple answers as applicable. There were four standout responses: 1) I want to use it to generate objective data regarding dose or DVH objectives that might be impossible to achieve, per patient (90%); 2) I want to be part of something new and useful in my industry (82.5%); 3) I want to connect with a network of like-minded planners with mutual interests (70%); and 4) I want to use it to help communication with my physicians (60%).

Fewer respondents (15%) were interested in publishing results or presenting at a future AAMD meeting. I believe this reflects that clinical workloads do not allow dosimetrists much time for dedicated “research” projects, though I will note that 95% of people graded their boss as either “somewhat supportive” or “very supportive” of clinically relevant research projects. So listen, I think you should remain open-minded about the topic of research, because even though publishing is certainly a lot of work and the review process requires thick skin, it is still a very effective way to contribute to the knowledge base in your industry. Here is how I see it: if you figure out something important, useful, or just cool, then get the word out....