Clinical implementation of intensity-modulated radiation therapy

Saw, Cheng B.; Ayyangar, Komanduri M.; Zhen, Weining; Yoe-Sein, Maung M.; Pillai, S.; Enke, Charles Arthur

doi:10.1016/s0958-3947(02)00099-7

Cited by 16 publications

(3 citation statements)

References 21 publications

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“…The planning and quality assurance (QA) processes required for IMRT are more complex and time-consuming compared with conventional conformal radiotherapy (CRT) techniques, which can have significant impact on departmental resources [12][13][14][15]. However, several commercial systems are now available that allow multiple plan measurement of IMRT plans and facilitate batching of patient QA measurements to improve efficiency.…”

mentioning

confidence: 99%

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Teoh

Clark²,

Wood³

et al. 2011

BJR

565

440

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ABSTRACT. Volumetric modulated arc therapy (VMAT) is a novel radiation technique, which can achieve highly conformal dose distributions with improved target volume coverage and sparing of normal tissues compared with conventional radiotherapy techniques. VMAT also has the potential to offer additional advantages, such as reduced treatment delivery time compared with conventional static field intensity modulated radiotherapy (IMRT). The clinical worldwide use of VMAT is increasing significantly. Currently the majority of published data on VMAT are limited to planning and feasibility studies, although there is emerging clinical outcome data in several tumour sites. This article aims to discuss the current use of VMAT techniques in practice and review the available data from planning and clinical outcome studies in various tumour sites including prostate, pelvis (lower gastrointestinal, gynaecological), head and neck, thoracic, central nervous system, breast and other tumour sites.

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mentioning

confidence: 99%

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Teoh

Clark²,

Wood³

et al. 2011

BJR

565

440

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“…For prostate radiation therapy, on-line ultrasound imaging has gained substantial interest [142][143][144] but in practice has been found susceptible to subtle sources of error and inter-user variability. On-board CBCT holds promise to become a robust integrated on-line imaging technology that can yield unambiguous soft-tissue detail at the time of treatment.…”

Section: -113mentioning

confidence: 99%

Prostate Dose Escalation by Innovative Inverse Planning-Driven IMRT

Liu¹

2005

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Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. se. TASK NUMBER 5f. WORK UNIT NUMBER REPORT DATE PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBERStanford University Stanford, CA 94305-5401 SPONSORING I MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR'S ACRONYM(S) U.S. Army Medical Research and Materiel CommandFort Detrick, Maryland 21702-5012 SPONSORIMONITOR'S REPORT NUMBER(S) DISTRIBUTION / AVAILABILITY STATEMENTApproved for Public Release; Distribution Unlimited SUPPLEMENTARY NOTES ABSTRACTWith the development of computer controlled MLC, IMRT now provides unprecedented means to deliver 3D-dose distributions with sub-centimeter resolution. Inverse planning is at the foundation of IMRT and critically determines its success. As practiced now, however, the capacity of IMRT is greatly underutilized because of the inferior performance of the inverse planning systems. Because of the tacit ignorance of intra-structural tradeoff, the IMRT plans generated by these systems for prostate treatment are, at best, sub-optimal and our endeavor of providing the best possible patient care is compromised. We have carried out a systematic study on this unexplored issue and developed innovative techniques to improve prostate IMRT. A number of important milestones have been accomplished, which include (i) established a theoretical infrastructure of spatially non-uniform penalty scheme for inverse planning; (ii) developed method for incorporating existing clinical knowledge into inverse planning; (iii) proposed an electron density mapping technique to improve the quality of conebeam CT (CBCT) images; (iv) established a robust technique for using onboard CBCT for on-treatment IMRT dose validation; (v) improved prostate IMRT beam orientation selection by integrating organ specific EUD. It is expected these tools will greatly facilitate the imaging, planning, delivery, and quality assurance of prostate IMRT. IS. SUBJECT II.RESEARCH AND ACCOMPLISHMENTSThe success of prostate Intensity modulated radiation therapy (IMRT) depends critically on the performance of inverse planning system. As it is practiced now, however, the capacity of I...

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“…Research regarding the factors that contribute to the adoption and implementation of radiation oncology innovations is lacking. Most published work describing the steps required to implement IMRT, are technical in nature and are geared towards physics personnel [ 10 - 14 ]. Furthermore, these studies do not directly consider the 'adopting system factors', which consist of the characteristics of the innovation, the adopters, the process and the organization, all of which impact on the implementation, and eventual success, of innovations [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting the implementation of complex and evolving technologies: multiple case study of intensity-modulated radiation therapy (IMRT) in Ontario, Canada

Dobrow

Hodgson

Whitton

2011

BMC Health Serv Res

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BackgroundResearch regarding the decision to adopt and implement technological innovations in radiation oncology is lacking. This is particularly problematic since these technologies are often complex and rapidly evolving, requiring ongoing revisiting of decisions regarding which technologies are the most appropriate to support. Variations in adoption and implementation decisions for new radiation technologies across cancer centres can impact patients' access to appropriate and innovative forms of radiation therapy. This study examines the key steps in the process of adopting and implementing intensity modulated radiation therapy (IMRT) in publicly funded cancer centres and identifies facilitating or impeding factors.MethodsA multiple case study design, utilizing document analysis and key informant interviews was employed. Four cancer centres in Ontario, Canada were selected and interviews were conducted with radiation oncologists, medical physicists, radiation therapists, and senior administrative leaders.ResultsEighteen key informants were interviewed. Overall, three centres made fair to excellent progress in the implementation of IMRT, while one centre achieved only limited implementation as of 2009. Key factors that influenced the extent of IMRT implementation were categorized as: 1) leadership, 2) training, expertise and standardization, 3) collaboration, 4) resources, and 5) resistance to change.ConclusionA framework for the adoption and implementation of complex and evolving technologies is presented. It identifies the key factors that should be addressed by decision-makers at specific stages of the adoption/implementation process.

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Clinical implementation of intensity-modulated radiation therapy

Cited by 16 publications

References 21 publications

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Prostate Dose Escalation by Innovative Inverse Planning-Driven IMRT

Factors affecting the implementation of complex and evolving technologies: multiple case study of intensity-modulated radiation therapy (IMRT) in Ontario, Canada

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