28 Quality Assurance of Dosimetry in Centres participating in the CHHIP Prostate Radiotherapy Trial

Naismith, O.; Clark, C.H.; Mayles, Helen; Moore, Andrea; Bidmead, A. Margaret; Dearnaley, David P.

doi:10.1016/j.clon.2007.01.317

Cited by 2 publications

(3 citation statements)

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“…intensity-modulated radiotherapy, which required time, resources and a training programme to implement [22]. Radiotherapy trials in the UK have proven to be an important mechanism to facilitate, support and accelerate the introduction of such techniques [23,24]. In introducing a novel adaptive approach, numerous challenges required time and resources to enable the safe implementation of PoD.…”

Section: Discussionmentioning

confidence: 99%

The Development of Therapeutic Radiographers in Imaging and Adaptive Radiotherapy Through Clinical Trial Quality Assurance

et al. 2021

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Aims: Adaptive radiotherapy (ART) is an emerging advanced treatment option for bladder cancer patients. Therapeutic radiographers (RTTs) are central to the successful delivery of this treatment. The purpose of this work was to evaluate the image-guided radiotherapy (IGRT) and ART experience of RTTs before participating in the RAIDER trial. A plan of the day (PoD) quality assurance programme was then implemented. Finally, the post-trial experience of RTTs was evaluated, together with the impact of trial quality assurance participation on their routine practice. Materials and methods: A pre-trial questionnaire to assess the experience of the RTT staff group in IGRT and ART in bladder cancer was sent to each centre. Responses were grouped according to experience. The PoD quality assurance programme was implemented, and the RAIDER trial commenced. During stage 1 of the trial, RTTs reported difficulties in delivering PoD and the quality assurance programme was updated accordingly. A follow-up questionnaire was sent assessing experience in IGRT and ART post-trial. Any changes in routine practice were also recorded. Results: The experience of RTTs in IGRT and ART pre-trial varied. For centres deemed to have RTTs with more experience, the initial PoD quality assurance programme was streamlined. For RTTs without ART experience, the full quality assurance programme was implemented, of which 508 RTTs completed. The quality assurance programme was updated (as the trial recruited) and it was mandated that at least one representative RTT (regardless of pre-trial experience) participated in the update in real-time. The purpose of the updated quality assurance programme was to provide further support to RTTs in delivering a complex treatment. Engagement with the updated quality assurance programme was high, with RTTs in 24/33 centres participating in the real-time online workshop. All 33 UK centres reported all RTTs reviewed the updated training offline. Post-trial, the RTTs' experience in IGRT and ART was increased. Conclusion: Overall, 508 RTTs undertook the PoD quality assurance programme. There was a high engagement of RTTs in the PoD quality assurance programme and trial. RTTs increased their experience in IGRT and ART and subsequently updated their practice for bladder cancer and other treatment sites.

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Section: Discussionmentioning

confidence: 99%

The Development of Therapeutic Radiographers in Imaging and Adaptive Radiotherapy Through Clinical Trial Quality Assurance

et al. 2021

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“…The aim was to deliver 74 Gy in 37 fractions to the prostate median isodose level with a concurrent boost of 86 Gy to the DILs. The rectum and bladder tolerances were taken from the CHHiP [10] , [15] , [16] , [17] protocol. In the CHHiP constraints, the max (1 cm 3 ) rectum dose was limited to 77 Gy and max (1 cm 3 ) bladder dose to 80 Gy as per the FLAME [6] study.…”

Section: Methodsmentioning

confidence: 99%

“…Image guidance for FLAME, PIVOTALboost and DELINEATE was achieved using fiducial markers with daily cone beam CT (CBCT). However, since prostate motion can take place following imaging [9] the performance of a trans-perineal ultrasound system for real time image guided radiotherapy (IGRT) [10] in relation to DIL margins was evaluated. In view of the high dose gradients, small size of the DILs and their proximity to OARs, measurement was used to verify that the planned dose distributions could be accurately delivered.…”

Section: Introductionmentioning

confidence: 99%

A study of the clinical, treatment planning and dosimetric feasibility of dose painting in external beam radiotherapy of prostate cancer

Blake

Stapleton

Brown

et al. 2020

Physics and Imaging in Radiation Oncology

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Background and purpose: Radiotherapy dose painting is a promising technique which enables dose escalation to areas of higher tumour cell density within the prostate which are associated with radioresistance, known as dominant intraprostatic lesions (DILs). The aim of this study was to determine factors affecting the feasibility of radiotherapy dose painting in patients with high and intermediate risk prostate cancer. Materials & Methods: Twenty patients were recruited into the study for imaging using a 3 T magnetic resonance imaging (MRI) scanner. Identified DILs were outlined and the scan registered with the planning computed tomography (CT) dataset. Intensity-modulated plans were produced and evaluated to determine the effect of the organ-at-risk constraints on the dose that could be delivered to the DILs. Measurements were made to verify that the distribution could be safely delivered. Results: MRI scans were obtained for nineteen patients. Fourteen patients had one to two DILs with ten overlapping the urethra and/or rectum. The target boost of 86 Gy was achieved in seven plans but was limited to 80 Gy for five patients whose boost volume overlapped or abutted the urethra. Dosimetric measurements gave a satisfactory gamma pass rate at 3%/3 mm. Conclusions: It was feasible to produce dose-painted plans for a boost of 86 Gy for approximately half the patients with DILs. The main limiting factor was the proximity of the urethra to the boost volumes. For a small proportion of patients, rigid registration between CT and MRI images was not adequate for planning purposes.

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28 Quality Assurance of Dosimetry in Centres participating in the CHHIP Prostate Radiotherapy Trial

Cited by 2 publications

References 0 publications

The Development of Therapeutic Radiographers in Imaging and Adaptive Radiotherapy Through Clinical Trial Quality Assurance

The Development of Therapeutic Radiographers in Imaging and Adaptive Radiotherapy Through Clinical Trial Quality Assurance

A study of the clinical, treatment planning and dosimetric feasibility of dose painting in external beam radiotherapy of prostate cancer

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