Standardizing dose prescriptions: An ASTRO white paper

Abstract

This white paper recommends the standardization (content and presentation order) of several "key components" of the radiation therapy prescription to facilitate accurate communication between radiation therapy care providers. The rationale, other similar efforts, and detailed considerations are described. In brief, the Task Force recommends that the prescription's "elements" include: treatment site, method of delivery, dose per fraction, total number of fractions, total dose (eg, right breast, tangent photons, 267 cGy * 16 = 4272 cGy). A similar formalism is recommended for brachytherapy (eg, cervix, Ir-192 brachytherapy, 600cGy * 5 = 3000 cGy) and other modalities. The white paper also considers future directions for other items such as the simulation order, treatment planning objectives, prescription point or volume, treatment schedule, localization imaging, laboratory monitoring, concurrent chemotherapy, patient instructions for treatment, etc. The intent of this white paper is to facilitate accurate communication among providers to support safe practice as well as to guide vendors in product development that is consistent with this standard prescription.

American Association of Physicists in Medicine Task Group 263: Standardizing Nomenclatures in Radiation Oncology

“…Standardizations are important for supporting a wide range of data use goals for clinical practice, research, and safety (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The primary objective in defining the nomenclature was to reduce variability in naming.…”

“…The prescription of doses in units of cGy is common in the United States, is the current recommendation of the ASTRO working group on prescriptions, and is supported by analysis of Radiation Oncology Incident Learning System (RO-ILS) data ( 9 , 10 ). Prescription in units of Gy is more common in European countries and is also used in some large institutions in the United States.…”

Characterization of a Bayesian network‐based radiotherapy plan verification model

“…Finally, it is important to continue working on the radiation oncology ontology to inform the construction, modification, and growth of our network. We feel that a robust ontology, along with associated software and adoption of data standards, can greatly reduce the work needed to update our BN while at the same time ensuring that the resulting models match our understanding of the fundamental processes of cancer and radiation therapy.…”

Three discipline collaborative radiation therapy (3DCRT) special debate: Peer review in radiation oncology is more effective today than 20 years ago

“…Peer review should not be viewed as one-size-fits-all, but rather tailored to case complexity. Strategies to reduce the cognitive load of peer review, such as standardization in nomenclature, 31 organization, 32 and display of as many parameters as possible can and should be implemented. Institutional and interinstitutional guidelines should be developed and converted into treatment site-specific care plans to maximize standardization of simulation-to-treatment processes (simulation, prescription, planning technique/goals, etc.)…”