Radiation Oncology

The American Association of Physicists in Medicine (AAPM) is a nonprofit profes-sional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the qual-ity of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been sub-jected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effecti...

Prediction of radiobiological response is a major challenge in radiotherapy. Of several radiobiological models, the linear-quadratic (LQ) model has been best validated by experimental and clinical data. Clinically, the LQ model is mainly used to estimate equivalent radiotherapy schedules (e.g. calculate the equivalent dose in 2 Gy fractions, EQD), but increasingly also to predict tumour control probability (TCP) and normal tissue complication probability (NTCP) using logistic models. The selection of accurate LQ parameters α, β and α/β is pivotal for a reliable estimate of radiation response. The aim of this review is to provide an overview of published values for the LQ parameters of human tumours as a guideline for radiation oncologists and radiation researchers to select appropriate radiobiological parameter values for LQ modelling in clinical radiotherapy. We performed a systematic literature search and found sixty-four clinical studies reporting α, β and α/β for tumours. Tumour...

To evaluate outcomes in prostate cancer patients classified as high-risk (HR) or very high-risk (VHR) who were treated with conformal radiation therapy (CRT) and androgen deprivation therapy (ADT). Between 11/2001 and 3/2012, 203 patients with HR disease received CRT to the prostate (78-82 Gy) and pelvic lymph nodes (46-50 Gy) with ADT (6 m-2 years). Median follow-up was 50 months (12 m-142 m). Biochemical failure was defined according to Phoenix definition. Imaging studies were used to identify local, regional or metastatic failure. Four different VHR/HR groupings were formed using the 2014 and revised 2015 NCCN guidelines. Differences were examined using Kaplan Meier (KM) estimates with log rank test and uni- and multivariate Cox regression analysis (MVA). Failure occurred in 30/203 patients (15%). Median time to failure was 30 m (4 m-76 m). KM estimate of 4 year biochemical disease free survival (b-DFS) for the entire cohort was 87% (95%CI: 82-92%). Four year KM survival estimate...

For studying proliferation and determination of survival of cancer cells after irradiation, the multiple MTT assay, based on the reduction of a yellow water soluble tetrazolium salt to a purple water insoluble formazan dye by living cells was modified from a single-point towards a proliferation assay. This assay can be performed with a
large number of samples in short time using multi-well-plates, assays can be performed semi-automatically with a microplate reader. Survival, the calculated parameter in this assay, is determined mathematically. Exponential growth in both control and irradiated groups was proven as the underlying basis of the applicability of the multiple MTT assay. The equivalence to a clonogenic survival assay with its disadvantages such as time consumption was proven in two setups including plating of cells before and after irradiation. Three cell lines (A 549, LN 229 and F 98) were included in the experiment to study its principal and general applicability.

In many healthcare systems, treatment recommendations for cancer patients are formulated by multidisciplinary tumor boards (MTBs). Evidence suggests that interdisciplinary contributions to case reviews in the meetings are unequal and information-sharing suboptimal, with biomedical information dominating over information on patient comorbidities and psychosocial factors. This study aimed to evaluate how different elements of the decision process affect the teams' ability to reach a decision on first case review. This was an observational quantitative assessment of 1045 case reviews from 2010 to 2014 in cancer MTBs using a validated tool, the Metric for the Observation of Decision-making. This tool allows evaluation of the quality of information presentation (case history, radiological, pathological, and psychosocial information, comorbidities, and patient views), and contribution to discussion by individual core specialties (surgeons, oncologists, radiologists, pathologists, and ...

PurposeThe 20-item EORTC QLQ-BN20 is a validated quality of life (QOL) questionnaire for patients with primary brain tumours. The EORTC QLQ-C15-PAL core palliative questionnaire is a 15-item version of the core 30-item QLQ-C30, and was developed to decrease the burden on patients with advanced cancer. The combination of the QLQ-BN20 and QLQ-C30 to assess QOL may be too burdensome for

In the health system inefficiency leads to poor use of scarce expensive resources. Lengthy patient treatment waiting time can result from inefficiency in scheduling. The use of state-of-the art multi-agent and distributed computing technologies can provide a solution to address this problem. However, distributed optimisation in such a multi-agent setting poses an important challenge that requires protocols to enable agents to optimise shared objectives without necessarily revealing all of their private constraints. In this study we show that if the problem is expressed as a Dynamic Distributed Constraint Optimisation Problem a powerful algorithm such as SBDO can be deployed to solve it. As SBDO can be deployed in a grid all of the advantages of grid computing are also gained.

Advances in dose-volume/outcome (or normal tissue complication probability, NTCP) modeling since the seminal Emami paper from 1991 are reviewed. There has been some progress with an increasing number of studies on large patient samples with three-dimensional dosimetry. Nevertheless, NTCP models are not ideal. Issues related to the grading of side effects, selection of appropriate statistical methods, testing of internal and external model validity, and quantification of predictive power and statistical uncertainty, all limit the usefulness of much of the published literature. Synthesis (meta-analysis) of data from multiple studies is often impossible because of suboptimal primary analysis, insufficient reporting and variations in the models and predictors analyzed. Clinical limitations to the current knowledge base include the need for more data on the effect of patient-related cofactors, interactions between dose distribution and cytotoxic or molecular targeted agents, and the effe...

Background: Melatonin is a natural body product that has shown potent antioxidant property against various toxic agents. For more than two decades, the abilities of melatonin as a potent radioprotector against toxic effects of ionizing radiation (IR) has been proved. However, in recent years, several studies have been conducted to illustrate how melatonin protects normal cells against IR. Studies proposed that melatonin is able to directly neutralize free radicals produced by IR, leading to the production of some low toxic products. Moreover, melatonin affects several signaling pathways, such as inflammatory responses, antioxidant defense, DNA repair response enzymes, pro-oxidant enzymes etc. Animal studies has confirmed that melatonin is able to alleviate radiation-induced cell death via inhibiting pro-apoptosis and upregulation of anti-apoptosis genes. These properties are very interesting for clinical radiotherapy applications, as well as mitigation of radiation injury in a possible radiation disaster. An interesting property of melatonin is mitochondrial ROS targeting that has been proposed as a strategy for mitigating effects in radiosensitive organs such as bone marrow, gastrointestinal system and lungs. However, there is a need to prove the mitigatory effects of melatonin in experimental studies. Conclusion: In this review, we aim to clarify the molecular mechanisms of radioprotective effects of melatonin, as well as possible applications as a radiation countermeasure in accidental exposure or nuclear/radiological disasters.

Egypt is a young nation with a growing oncology health sector. It is faced with many challenges, such as the endemicity of HCV and schistosomiasis causing the high prevalence rates of hepatocellular carcinoma and bladder cancer respectively. In recognition of their tremendous health and economic burden, the Egyptian government established the “100 Million Healthy Lives” campaign in September 2018 for the screening of HBV, HCV, hypertension, and diabetes mellitus patients. MoH also founded the National Committee for Control of Viral Hepatitis to implement an integrated national strategy to contain the situation. More oncology-specialized hospitals and units are built every year to cope with the increased demand, such as the New National Cancer Institute, Shefaa El-Orman hospital, and Baheya hospital. Non-Communicable Diseases (NCDs), especially neoplasms, are the twenty-first century’s biggest challenge after significant control of communicable ones with the advancement of antimicrobial and progression of community health and epidemiology knowledge. Hence, we believe more light should be shed on their burden in society to increase public awareness and encourage investment in the health care sector.

At this stage the patient first meet their radiation technologists, too (called " Therapists Radiation or Radiotherapy and radiology technicians "). The technician is trained to administer radiation dose prescribed by the doctor. It is also responsible for helping you achieve a comfortable position that will be the best to allow photons or electrons X-rays pass through the body part being treated. He or she will provide special accessories or foam supports for the patient to stay in the same position for each treatment. The patients also know his medical physicist. A medical physicist made the remarks on the physical aspects of the treatment plan.

Introduction Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether oncologist traits were associated with empathic opportunities and empathic responses. Patients and Methods We audio-recorded 398 clinic conversations between 51 oncologists and 270 patients with advanced cancer; oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and oncologist responses. Analyses examined the relationship with oncologists' demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of car...

The term ''patient experience'' is currently ubiquitous in health care. Many facilities are striving to improve care by examining how patients interact with and view their organization and the health care professionals who work within it. Although there is a great deal of literature on patient centered care, patient engagement and patient experience in health care generally, there is little focused literature on how this is related to patient experience in medical imaging and radiation therapy. This review article examines the underpinning concepts of patient experience and the factors that contribute to a positive patient experience. These include good communication, care for the patient as an individual, and emotional support. Patients experiencing care in medical imaging and radiation therapy departments have broadly similar expectations, although this can be challenging to provide in a technologically focused, time-limited environment. R ESUM E L'expression « exp erience du patient » est actuellement utilis ee partout dans les soins de sant e. Plusieurs etablissements s'efforcent d'am eliorer les soins en examinant comment les patients interagissent avec leur organisation et les professionnels de la sant e qui y travaillent, et comment ils les perçoivent. Bien qu'un grand nombre d'articles aient et e publi es a propos des soins centr es sur le patient, de l'engagement du patient et de l'exp erience du patient, peu de ces articles portent sur l'exp erience du patient en imagerie m edicale ou en radioth erapie. Dans cet article de synth ese, les auteurs se penchent sur les notions sous-jacentes a l'exp erience du patient et les facteurs qui contribuent a une exp erience positive pour le patient. Ces facteurs comprennent la bonne communication, les soins pour le patient en tant que personne et le soutien emotionnel. Les patients qui reçoivent des soins dans les services d'imagerie m edicale et de radioth erapie ont des attentes largement similaires bien que cela soit difficile a assurer dans un environnement o u l'accent est mis sur la technologie et o u le temps est limit e.

Perfromance management in healthcare organisations’ has been hampered by the enduring chasm between clinical performance measurement and business financial, operational and customer service performance measurement. This has led to poor management of stakeholder needs and negative audits for most public and many private healthcare organisations, including healthcare funders such as medical aid schemes. This study examined the opportunity to address private healthcare organisational performance measurement, management and control system (PMMCS) needs through a logically aggregated but adaptable dashboard. The resulting model combined the strategic offerings of the Balanced Scorecard (BSC) by Kaplan and Norton (1996), and the Theory of Constraints (TOC), by Dr Eliyahu Goldratt (2004), into a Performance Optimisation Triangle (POT), as formulated by Mahesh Gupta (2012).
A qualitative design strategy was employed in the from of a depth case study that allowed both inductive and deductive reasoning principles to be applied in analysing multiple forms of data selected to demonstrate how the theory behind the POT could be inculcated into a sample organisation’s nascent PMMCS dashboard. The study aimed to address organisational diagnosis, “What needs to change”, the so-called “current reality tree” of TOC thinking process; “what it needs to change to”, the “future reality tree”, and finally “how it needs to change” (Ferduko, 2013)
The project revealed that an operational and industrial engineering theory, (TOC), and a business strategic concept, (BSC), could be harnessed to simplify a healthcare organisation’s PMMCS. There is an opportunity to provide a simple dashboard (POT), for healthcare business decision-makers to rule on decisions such as mergers and acquisitions, outsourcing, product choice, through to the recruitment of new staff.

Radionuclides are naturally present throughout all environments, in varying amounts in air, water, plants, soil, rocks and etc. Naturally – occurring radionuclide’s are mainly derived from three separate decay chains (238U, 235U, and 232Th), and singly occurring 40K. These radionuclides may enter the human body from eating, drinking, external exposure or by inhaling. Then they penetrate into tissue and its cells, which causes ionization effects to its basic matter "cytoplasm".
222Rn is a colorless, odorless, tasteless, radioactive noble gas, which arises from the radioactive decay of 226Ra (itself a decay product of 238U). It is present in almost all rock, soil, and water, and typically moves up through the ground to the air above and into buildings through cracks and other holes in the underlying foundation. 222Rn is one of the most significant of the avoidable hazards in the environment, typically accounting for more than 50% of the dose to an average population.
Measurements of natural radioactivity and radon levels in water samples from Qena governorate, Egypt, and their human impact are outlined in this thesis. This was performed by collecting two hundred twenty water samples (ground, drinking tap and mineral water) from different sites in Qena, and employing Alpha GUARD monitoring system to determine the activity concentrations of 222Rn, also gamma spectrometry "NaI(Tl)" was used to determine the activity concentrations of 222Rn, 226Ra, 232Th and 40K in ground water.
In ground water samples 222Rn activity concentrations were fluctuated between 0.04±0.025 and 10.07±0.219 Bq/l, with an average value of 3.57±0.077 Bq/l.
In order to check the obtained results, two radon measuring techniques (Alpha GUARD and gamma spectrometry) were applied for measure some ground water samples from all sites, and the obtained results show that the two radon measuring techniques results are in a good agreement.
In the measuring ground water samples, the obtained measuring results for 226Ra, 232Th and 40K activity concentrations were fluctuated between (0.126±0.007 and 1.93±0.117), (0.037±0.003 and 0.899±0.077) and (3.18±0.273 and 7±0.602), with averages values of 0.54±0.029, 0.4±0.027 and 5.10±0.44 Bq/l, for 226Ra, 232Th and 40K, respectively.
In the investigated drinking tap water samples, the obtained results for 222Rn activity concentrations show that, the activity concentrations were ranged between 0.006±0.0005 and 0.117±0.0027 Bq/l, with an average value of 0.049±0.003 Bq/l.
The obtained results for 222Rn activity concentrations in the investigated mineral water samples show that, the activity concentrations were fluctuated between 0.014±0.003 and 0.237±0.005 Bq/l, with an average value of 0.077±0.002 Bq/l.
The impacts of geochemical parameters of water such as PH, conductivity and TDS on the natural radionuclides activity concentration were studied, a reasonable correlation between pH and the 222Rn, 226Ra and 232Th activity concentrations were found, in which the activity concentrations decreased with increasing PH, whereas no general trend was observed that related the radionuclides activity concentrations with conductivity and TDS.
Health aspects are discussed, based on calculation of the annual effective doses for different age groups, which found in values lower than the reference level.