The future of medical physics in the US health‐care system

Mills, Michael D.

doi:10.1120/jacmp.v14i5.4622

Cited by 11 publications

(10 citation statements)

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“…Krayenbuehi et al also reported a similar study in six MPM patients with significant postoperative intrathoracic air cavities. They concluded that VMAT allowed a lower lung dose and was less affected by air cavity variation than IMRT [ 20 ]. Helical tomotherapy is a rotational delivery method.…”

Section: Discussionmentioning

confidence: 99%

“…However, the higher percentages of the contralateral lung volume receiving ≥5 Gy (V5), or the mean lung dose (MLD), have been associated with severe pulmonary toxicity [ 15 – 18 ]. Volumetric modulated arc therapy (VMAT), a form of intensity-modulated arc therapy, is a promising new method using the regular linear accelerator and, compared with conventional static IMRT, it has the potential to improve target coverage and dose sparing to the organs at risk (OARs) [ 19 , 20 ]. However, there are limited reports of VMAT.…”

Section: Introductionmentioning

confidence: 99%

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Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy

Kimura¹,

Doi²,

Nakashima³

et al. 2015

Journal of Radiation Research

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The purpose of this study was to evaluate the efficacy and safety of volumetric modulated arc therapy (VMAT) after extrapleural pneumonectomy (EPP) in patients with malignant pleural mesothelioma (MPM). A total of 15 patients who received VMAT after EPP were enrolled. All patients were males, and the median age was 67 years (Stage IB in two, II in six, and III in seven patients). The clinical target volume (CTV) included the entire preoperative ipsilateral hemithorax and involved nodal stations. The CTV was generally expanded by 10–15 mm beyond the planning target volume (PTV). The dose prescription was designed to cover 95% of the PTV with 54 Gy in 30 fractions. The median follow-up period was 11 months. Treatment-related toxicities were evaluated by Common Terminology Criteria for Adverse Events (CTCAE) ver. 4. One-year local control, disease-free survival, and overall survival rates were 55.7% [95% confidence interval (CI): 25.6–85.8%], 29.3% (95% CI: 5.3–53.3%), and 43.1% (95% CI: 17.1–69.0%), respectively. According to the histological analysis, the one-year LC rate was significantly worse in patients with non-epithelial type (biphasic and sarcomatoid types) than in patients with epithelial type [epithelial type: 83.3% (95% CI, 53.5–100%), non-epithelial type: 0% (95% CI, 0%), P = 0.0011]. Grade 3 pneumonitis after VMAT was observed in three patients (20.0%); however, no patients died of pulmonary toxicity. VMAT appears to be relatively safe for patients with MPM after EPP because of the low pulmonary dose.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy

Kimura¹,

Doi²,

Nakashima³

et al. 2015

Journal of Radiation Research

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“…Indeed, only 1 study has addressed this issue reporting a rate of acute Grade 3 pneumonitis in 20% of patients, a figure that favorably matches with previously reported data on IMRT. 54 , 55 …”

Section: Resultsmentioning

confidence: 99%

Volumetric modulated arc therapy for treatment of solid tumors: current insights

Macchia¹,

Deodato²,

Cilla³

et al. 2017

OTT

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AimThis article discusses the current use of volumetric modulated arc therapy (VMAT) techniques in clinical practice and reviews the available data from clinical outcome studies in different clinical settings. An overview of available literature about clinical outcomes with VMAT stereotactic/radiosurgical treatment is also reported.Materials and methodsAll published manuscripts reporting the use of VMAT in a clinical setting from 2009 to November 2016 were identified. The search was carried out in December 2016 using the National Library of Medicine (PubMed/Medline). The following words were searched: “volumetric arc therapy”[All Fields] OR “vmat”[All Fields] OR “rapidarc”[All Fields], AND “radiotherapy”[All Fields] AND “Clinical Trial”[All Fields].ResultsOverall, 37 studies (21 prospective and 16 retrospective) fulfilling inclusion criteria and thus included in the review evaluated 2,029 patients treated with VMAT; of these patients, ~30.8% had genitourinary (GU) tumors (81% prostate, 19% endometrial), 26.2% head-and-neck cancer (H&NC), 13.9% oligometastases, 11.2% had anorectal cancer, 10.6% thoracic neoplasms (81% breast, 19% lung), and 7.0% brain metastases (BMs). Six different clinical scenarios for VMAT use were identified: 1) BMs, 2) H&NC, 3) thoracic neoplasms, 4) GU cancer, 5) anorectal tumor, and 6) stereotactic body radiation therapy (SBRT) performed by VMAT technique in the oligometastatic patient setting.ConclusionThe literature addressing the clinical appropriateness of VMAT is scarce. Current literature suggests that VMAT, especially when used as simultaneous integrated boost or SBRT strategy, is an effective safe modality for all cancer types.

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“…Thompson [ 19 ] also report difficulties in the identification of a magnetic valve in a CT image. The manual identification is not a practical procedure to be employed in the routine of a radiotherapy service, and another possible procedure could be minimizing artifacts using post-reconstruction algorithms [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Radiotherapy Treatment Planning in the Presence of a Magnetic Valve Tissue Expander

et al. 2015

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The combination of radiotherapy treatments and breast reconstruction, using temporary tissue expanders, generates several concerns due to the presence of a magnetic valve inside the radiation field. The objective of this work is to evaluate a radiotherapy treatment planning for a patient using a tissue expander. Isodose curve maps, obtained using radiochromic films, were compared to the ones calculated with two different dose calculation algorithms of the Eclipse radiotherapy Treatment Planning System (TPS), considering the presence or absence of the heterogeneity. The TPS calculation considering the presence of the heterogeneity shows changes around 5% in the isodose curves when they were compared with the calculation without heterogeneity correction. This calculation did not take in account the real density value of the heterogeneity. This limitation was quantified to be around 10% in comparison with the TPS calculation and experimental measurements using the radiochromic film. These results show that the magnetic valve should be taken in account in dose calculations of the TPS. With respect to the AAA and Pencil Beam Convolution algorithms, when the calculation is compared with the real distribution, AAA presents a distribution more similar to experimental dose distribution.

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The future of medical physics in the US health‐care system

Cited by 11 publications

References 0 publications

Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy

Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy

Volumetric modulated arc therapy for treatment of solid tumors: current insights

Evaluation of the Radiotherapy Treatment Planning in the Presence of a Magnetic Valve Tissue Expander

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