2019
DOI: 10.1016/j.adro.2019.06.002
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Unforeseen Computed Tomography Resimulation for Initial Radiation Planning: Associated Factors and Clinical Impact

Abstract: PurposeRepeat computed tomography (CT) simulation is problematic because of additional expense of clinic resources, patient inconvenience, additional radiation exposure, and treatment delay. We investigated the factors and clinical impact of unplanned CT resimulations in our network.Methods and MaterialsWe used the billing records of 18,170 patients treated at 5 clinics. A total of 213 patients were resimulated before their first treatment. The disease site, location, use of 4-dimensional CT (4DCT), contrast, … Show more

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Cited by 6 publications
(5 citation statements)
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“…Head and neck sites are commonplace for repeat CT simulations, largely due to changes in anatomy from the aggressive nature of such tumors. 7 The necessity for repeat planning is paramount with more conformal therapies such as intensitymodulated radiotherapy (IMRT) becoming available, where it is deemed essential in ensuring adequate target doses and safe normal tissue exposure. 9,13 In this study that included non-metastatic, locally advanced head and neck cancers, as well as primary cancers metastatic to this location, the median time to radiotherapy initiation was 37 days, with a range from zero to as much as 278 days.…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…Head and neck sites are commonplace for repeat CT simulations, largely due to changes in anatomy from the aggressive nature of such tumors. 7 The necessity for repeat planning is paramount with more conformal therapies such as intensitymodulated radiotherapy (IMRT) becoming available, where it is deemed essential in ensuring adequate target doses and safe normal tissue exposure. 9,13 In this study that included non-metastatic, locally advanced head and neck cancers, as well as primary cancers metastatic to this location, the median time to radiotherapy initiation was 37 days, with a range from zero to as much as 278 days.…”
Section: Discussionmentioning
confidence: 99%
“…A study by Metzger evaluating frequencies for all cancer histologies found that the repeat simulation rate in 683 patients with head and neck cancer was relatively high at 3.07%, attributed primarily to changes in anatomy from the delay of treatment initiation. 7 The possible causes for repeat simulation include set up changes, immobilization devices, and changes in RT plan. Changes in the set up that typically lead to repeat simulation include radiotherapy field adjustments and the need for patient repositioning.…”
Section: Introductionmentioning
confidence: 99%
“…After the simulation scan is performed, radiotherapy planning is done over several days, following which quality checks are done. In some cases, changes that occur in between simulation and the start of treatment, or during the course of radiotherapy treatment, may necessitate a repeat simulation and replanning process, such issues include weight loss, development of seromas, or difficulty reproducing the treatment position due to injury [61]. Thus, for patients who prefer to complete their treatment over a shorter period of time and avoid the more lengthy process of radiotherapy simulation, planning, and multiple visits for treatment, cryoablation may be the preferred option.…”
Section: Factors Favouring the Use Of Cryoablationmentioning
confidence: 99%
“…Globally, computed tomography simulation (CT sim) operations are susceptible to inevitable delays due to limited resources and the simulator's typical 9-h shift without a break (3)(4)(5). In addition, multiple doctors are competing for patients' sim time slots.…”
Section: Introductionmentioning
confidence: 99%