Radiation oncology (RO) is a dynamic and rapidly changing field. Residents are uniquely positioned to identify issues relevant to graduate medical education and the future workforce. As the elected members of the Executive Committee for the Association of Residents in Radiation Oncology (ARRO), we communicate with the larger RO community about the issues that residents identify as being the most pressing. ARRO recently sent a brief survey to registered American Society for Radiation Oncology (ASTRO) members-in-training (N Z 710) asking them to rank in order any (or all) of 14 specified issues that "concern[ed them] as radiation oncologist[s]." Responses were received from 179 individuals from April 4th through May 10th (response rate Z 25.2%). The top 3 concerning issues (Fig. 1), by rank order, were the job market (91%), the American Board of Radiology (ABR) qualifying (written) examinations (85%), and residency expansion (84%). Other issues identified by trainees included oral boards, declining reimbursement, variability in training programs, and fellowship expansion. Additional free-text concerns were submitted by 90 trainees. The top 2 themes included clinical relevance of board certification examinations (n Z 17) and trust in leadership (n Z 11). Here, we will briefly discuss the top 3 issues. Job Market The principal concern identified by residents was the job market (Fig. 1). Not only did 91% of residents rank the job market as "a concerning issue," but 72% ranked it as 1 of the

4. Laryngoscope, 128:373-377, 2018.

To describe a novel and practical volumetric modulated arc therapy (VMAT) planning approach for grid therapy. Methods and Materials: Dose is prescribed to 1.5-cm diameter spherical contours placed throughout the gross tumor volume (GTV). Placement of spheres is variable, but they must maintain at least a 3-cm (center to center) separation, and the edge of any sphere must be at least 1 cm from any organ at risk (OAR). Three concentric ring structures are used during optimization to confine the highest doses to the center of the spheres and maximize dose sparing between them. The end result is alternating regions of high and low dose throughout the GTV and minimal dose to OARs. High-intensity flattening filter-free (FFF) modes are used to efficiently deliver the plans, and entire treatments typically take only 15 to 20 minutes. Results: The approach is illustrated with 2 examples treated at our institution. Patient #1 had a 1703-cm 3 mediastinal mass and was prescribed 20 Gray (Gy) to 24 spherical regions within the GTV. Patient #2 had a 3680-cm 3 abdominal tumor and was prescribed 18 Gy to 32 spherical regions within the GTV. Both patients received additional consolidative radiation approximately 1 week after the initial VMAT grid treatment. Each patient experienced marked reduction in tumor size and symptomatic relief without treatment-related complications. Conclusions: We have described in detail a planning approach for VMAT grid therapy treatments that can typically be delivered in a clinically practical time span. The VMAT approach is especially useful for tumors that are surrounded by sensitive critical structures. As many centers offer VMAT treatments, the approach is widely accessible and can be readily implemented once appropriate patient selection and delivery processes are established.

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No abstract