bluuebunny/crossref_metadata_2025_split huggingface dataset:
TU‐CD‐213‐03: Communication, Negotiation, and Persuasion: Approaches for Better Results
Authors: Wells M. 
Published: June 2015

As part of the AAPM's Scope of Practice, medical physicists are expected to collaborate effectively with practioners and allied health care providers. Interpersonal skills such as communication, negotiation and persuasion are vital for successful collaboration to achieve shared goals. This session will provide some theoretical background of these interpersonal skills as well as specific techniques and practical tools to influence others. Applications of these interpersonal skills for administrative and human resource management purposes vital to medical physicists will be shared. Session attendees will gain knowledge and tools to help them effectively collaborate with administrative and physician leaders in areas such as capital and human resource selection, prioritization, and implementation. Participants will hear methods of how to articulate their goals and to understand the goals of administration, helping ensure alignment of purpose.Session speakers will present one of the topics: equipment selection, budget creation, contracts, and program‐related policy development. Specifics may include designing a business case in language that administrators understand, calculating the prioritization of budget requests, and influencing policies for safe and effective care. Human resource topics may include staffing justification, recruitment for fit, employment contracts, and benefits. Speakers will provide examples in both radiation therapy and diagnostic imaging departments and will share experiences and outcomes of their approaches for better results.Learning Objectives:After this course attendees will be better able to

Understand the shared goal between administrative and physicist leadership.
Articulate the “why” of the technical or human resource need.
Utilize communication, negotiation and persuasion tools to improve collaboration.
TU‐CD‐213‐04: Panel Discussion
Authors: Johnson J. 
Published: June 2015

As part of the AAPM's Scope of Practice, medical physicists are expected to collaborate effectively with practioners and allied health care providers. Interpersonal skills such as communication, negotiation and persuasion are vital for successful collaboration to achieve shared goals. This session will provide some theoretical background of these interpersonal skills as well as specific techniques and practical tools to influence others. Applications of these interpersonal skills for administrative and human resource management purposes vital to medical physicists will be shared. Session attendees will gain knowledge and tools to help them effectively collaborate with administrative and physician leaders in areas such as capital and human resource selection, prioritization, and implementation. Participants will hear methods of how to articulate their goals and to understand the goals of administration, helping ensure alignment of purpose.Session speakers will present one of the topics: equipment selection, budget creation, contracts, and program‐related policy development. Specifics may include designing a business case in language that administrators understand, calculating the prioritization of budget requests, and influencing policies for safe and effective care. Human resource topics may include staffing justification, recruitment for fit, employment contracts, and benefits. Speakers will provide examples in both radiation therapy and diagnostic imaging departments and will share experiences and outcomes of their approaches for better results.Learning Objectives:After this course attendees will be better able to

Understand the shared goal between administrative and physicist leadership.
Articulate the “why” of the technical or human resource need.
Utilize communication, negotiation and persuasion tools to improve collaboration.
TU‐CD‐304‐07: Intensity Modulated Electron Beam Therapy Employing Small Fields in Virtual Scanning Mode
Authors: Rodrigues A , Liang B , Yin F , Wu Q 
Published: June 2015

Purpose:Dynamic electron radiation therapies such as dynamic electron arc radiotherapy (DEAR) utilize small fields to provide target conformity and fluence modulation. The purpose of this study is to demonstrate the feasibility of virtual scanning mode using small fields.Methods:Monte Carlo simulations (EGSnrc/BEAMnrc/DOSXYZnrc) were performed using validated Varian TrueBeam phase space files for electron beam energies of 6, 9, 12, and 16 MeV and square/circular fields (1×1/1, 2×2/2, 3×3/3, 4×4/4, 5×5/5 cm2/cm diameter). Resulting dose distributions (kernels) were used for subsequent calculations. The following analyses were performed: (1) Comparison of composite square fields and reference 10×10 cm2 dose distributions and (2) Scanning beam deliveries for square and circular fields realized as the convolution of kernels and scanning pattern. Preliminary beam weight and pattern optimization were also performed. Two linear scans of 10 cm with/without overlap were modeled. Comparison metrics included depth and orthogonal profiles at dmax.Results:(1) Composite fields regained reference depth dose profiles for most energies and fields within 5%. Smaller kernels and higher energies increased dose in the build‐up and Bremsstrahlung region (30%, 16MeV and 1×1 cm2), while reference dmax was maintained for all energies and composite fields. Smaller kernels (<2×2 cm2) maintained penumbra and field size within 0.2 cm, and flatness within 2%. Deterioration of penumbra for larger kernels (5×5 cm2) were observed. Balancing desirable dosimetry and efficiencies suggests that smaller kernels are used at edges and larger kernels in the center of the target. (2) Beam weight optimization improved cross‐plane penumbra (0.2 cm) and increased the field size (0.4 cm) on average. In‐plane penumbra and field size remained unchanged. Overlap depended on kernel size and optimal overlap resulted in flatness ±2%.Conclusion:Dynamic electron beam therapy in virtual scanning mode is feasible by employing small fields to achieve desired dose distributions and acceptable efficiencies.
TU‐CD‐304‐08: Feasibility of a VMAT‐Based Spatially Fractionated Grid Therapy Technique
Authors: Zhao B , Jin J , Liu M , Huang Y , Kim J , Brown S , Siddiqui F , Chetty I , Wen N 
Published: June 2015

Purpose:Grid therapy (GT) uses spatially modulated radiation doses to treat large tumors without significant toxicities. Incorporating 3D conformal‐RT or IMRT improved single‐field GT by reducing dose to normal tissues spatially through the use of multiple fields. The feasibility of a MLC‐based, inverse‐planned multi‐field GT technique has been demonstrated. Volumetric modulated arc therapy (VMAT) provides conformal dose distributions with the additional potential advantage of reduced treatment times. In this study, we characterize a new VMAT‐based GT (VMAT‐GT) technique with respect to its deliverability and dosimetric accuracy.Methods:A lattice of 5mm‐diameter spheres was created as the boost volume within a large treatment target. A simultaneous boost VMAT (RapidArc) plan with 8Gy to the target and 20Gy to the boost volume was generated using the Eclipse treatment planning system (AAA‐v11). The linac utilized HD120 MLC and 6MV flattening‐filter free beam. Four non‐coplanar arcs, with couch angles at 0, 45, 90 and 317° were used. Collimator angles were at 45 and 315°. The plan was mapped to a phantom. Calibrated Gafchromic EBT3 films were used to measure the delivered dose.Results:The VMAT plan generated a highly spatially modulated dose distribution in the target. D95%, D50%, D5% for the spheres and the targets in Gy were 18.9, 20.6, 23 and 8.0, 9.6, 14.8, respectively. D50% for a 1cm ring 1cm outside the target was 3.0Gy. The peak‐to‐valley ratio of this technique is comparable to previously proposed techniques, but the MUs were reduced by almost 50%. Film dosimetry showed good agreement between calculated and delivered dose, with an overall gamma passing rate of >98% (3% and 1mm). The point dose differences at sphere centers varied from 2–8%.Conclusion:The deliverability and dose calculation accuracy of the proposed VMAT‐GT technique demonstrates that ablative radiation doses are deliverable to large tumors safely and efficiently.
TU‐CD‐304‐09: Feasibility Study for Thermoplastic Mask Set Up Monitoring Using Force Sensing Resistor (FSR) Sensor
Authors: Kim T , Kim S , Cho M , Kang S , Kim D , Kim K , Shin D , Suh T 
Published: June 2015

Purpose:To improve the setup accuracy of thermoplastic mask, we developed a new monitoring method based on force sensing technology and evaluated its feasibility.Methods:The thermoplastic mask setup monitoring system consists of a force sensing resistor sensor unit, a signal transport device, a control PC and an in‐house software. The system is designed to monitor pressure variation between the mask and patient in real time. It also provides a warning to the user when there is a possibility of movement. A preliminary study was performed to evaluate the reliability of the sensor unit and developed monitoring system with a head phantom. Then, a simulation study with volunteers was conducted to evaluate the feasibility of the monitoring system. Note that the sensor unit can have multiple end‐sensors and every end‐sensor was confirmed to be within 2% reliability in pressure reading through a screening test.Results:To evaluate the reproducibility of the proposed monitoring system in practice, we simulated a mask setup with the head phantom. FRS sensors were attached on the face of the head phantom and pressure was monitored. For 3 repeated mask setups on the phantom, the variation of the pressure was less than 3% (only 1% larger than 2% potential uncertainty confirmed in the screening test). In the volunteer study, we intended to verify that the system could detect patient movements within the mask. Thus, volunteers were asked to turn their head or lift their chin. The system was able to detect movements effectively, confirming the clinical feasibility of the monitoring system developed.Conclusion:Through the proposed setup monitoring method, it is possible to monitor patient motion inside a mask in real time, which has never been possible with most commonly used systems using non‐radiographic technology such as infrared camera system and surface imaging system.This work was supported by the Radiation Technology R&D program (No. 2013M2A2A7043498) and the Mid‐career Researcher Program (2014R1A2A1A10050270) through the National Research Foundation of Korea funded by the Ministry of Science, ICT&Future Planning.
TU‐CD‐304‐10: Development and Optimization of “Compton Lens” Collimator Design for Increased Dose Rate in SRS
Authors: Shepard A , Bender E 
Published: June 2015

Purpose:To provide a proof of concept for a new collimator design to increase the dose rate at isocenter for stereotactic radiosurgery (SRS) treatments by taking advantage of off axis Compton scattered photons which are attenuated in current collimators.Methods:A fundamentally new collimator design was developed and optimized by introducing a series of slits to a standard block collimator. The introduction of slits allowed for initially off axis radiation that was scattered in the direction of the target to contribute to the target dose. For optimization, the design was broken into two parts: an upper interaction plate where primary scattering occurs, and a lower “Compton slit” region which allows for scattered photons traveling toward the target to reach isocenter. To optimize the design, a series of simulations were performed using MCNP6 in which several key parameters were adjusted and the output was compared to a standard collimator. Key parameters modified included the collimator material, cone size, and interaction plate thickness. The effects of using energies different than the traditional 6 MV beam were also explored.Results:An optimized collimator design utilizing a solid interaction plate with a Cesium‐137 beam and a 4 mm cone size resulted in a dose rate increase on the order of 5% relative to standard collimators in use. Currently, designs incorporating a Cesium‐137 source are the most feasible due to necessary size and weight concerns for 6 MV beams.Conclusion:Preliminary designs provide a proof of concept and indicate a potential to improve upon the dose rate of current collimators while not largely compromising the sharp dose falloff inherent to SRS. Further optimization into the geometry and positioning of the interaction plate, as well as slit optimization, will likely lead to further dose rate increases than were observed in this study.Funding for this work was provided by the Wisconsin Alumni Research Foundation (WARF). Authors have a conflict of interest as the technology discussed is patent pending, and thus there is a financial interest in the work.
TU‐CD‐304‐11: Veritas 2.0: A Cloud‐Based Tool to Facilitate Research and Innovation
Authors: Mishra P , Lewis J , Patankar A , Etmektzoglou A , Svatos M 
Published: June 2015

Purpose:We introduce Veritas 2.0, a cloud‐based, non‐clinical research portal, to facilitate translation of radiotherapy research ideas to new delivery techniques. The ecosystem of research tools includes web apps for a research beam builder for TrueBeam Developer Mode, an image reader for compressed and uncompressed XIM files, and a trajectory log file based QA/beam delivery analyzer.Methods:The research beam builder can generate TrueBeam readable XML file either from scratch or from pre‐existing DICOM‐RT plans. DICOM‐RT plan is first converted to XML format and then researcher can interactively modify or add control points to them. Delivered beam can be verified via reading generated images and analyzing trajectory log files. Image reader can read both uncompressed and HND‐compressed XIM images. The trajectory log analyzer lets researchers plot expected vs. actual values and deviations among 30 mechanical axes. The analyzer gives an animated view of MLC patterns for the beam delivery. Veritas 2.0 is freely available and its advantages versus standalone software are i) No software installation or maintenance needed, ii) easy accessibility across all devices iii) seamless upgrades and iv) OS independence. Veritas is written using open‐source tools like twitter bootstrap, jQuery, flask, and Python‐based modules.Results:In the first experiment, an anonymized 7‐beam DICOM‐RT IMRT plan was converted to XML beam containing 1400 control points. kV and MV imaging points were inserted into this XML beam. In another experiment, a binary log file was analyzed to compare actual vs expected values and deviations among axes.Conclusions:Veritas 2.0 is a public cloud‐based web app that hosts a pool of research tools for facilitating research from conceptualization to verification. It is aimed at providing a platform for facilitating research and collaboration.I am full time employee at Varian Medical systems, Palo Alto.
TU‐CD‐BRD‐01: Making Incident Learning Practical and Useful: Challenges and Previous Experiences
Authors: Ezzell G. 
Published: June 2015

It has long been standard practice in radiation oncology to report internally when a patient's treatment has not gone as planned and to report events to regulatory agencies when legally required. Most potential errors are caught early and never affect the patient. Quality assurance steps routinely prevent errors from reaching the patient, and these “near misses” are much more frequent than treatment errors. A growing number of radiation oncology facilities have implemented incident learning systems to report and analyze both errors and near misses. Using the term “incident learning” instead of “event reporting” emphasizes the need to use these experiences to change the practice and make future errors less likely and promote an educational, non‐punitive environment.There are challenges in making such a system practical and effective. Speakers from institutions of different sizes and practice environments will share their experiences on how to make such a system work and what benefits their clinics have accrued. Questions that will be addressed include:

How to create a system that is easy for front line staff to access
How to motivate staff to report
How to promote the system as positive and educational and not punitive or demeaning
How to organize the team for reviewing and responding to reports
How to prioritize which reports to discuss in depth
How not to dismiss the rest
How to identify underlying causes
How to design corrective actions and implement change
How to develop useful statistics and analysis tools
How to coordinate a departmental system with a larger risk management system
How to do this without a dedicated quality manager
Some speakers’ experience is with in‐house systems and some will share experience with the AAPM/ASTRO national Radiation Oncology Incident Learning System (RO‐ILS). Reports intended to be of value nationally need to be comprehensible to outsiders; examples of useful reports will be shown.There will be ample time set aside for audience members to contribute to the discussion.Learning Objectives:

Learn how to promote the use of an incident learning system in a clinic.
Learn how to convert “event reporting” into “incident learning”.
See examples of practice changes that have come out of learning systems.
Learn how the RO‐ILS system can be used as a primary internal learning system.
Learn how to create succinct, meaningful reports useful to outside readers.
Gary Ezzell chairs the AAPM committee overseeing RO‐ILS and has received an honorarium from ASTRO for working on the committee reviewing RO‐ILS reports.Derek Brown is a director of TreatSafely.org.Brett Miller has previously received travel expenses and an honorarium from Varian.Phillip Beron has nothing to report.
TU‐CD‐BRD‐02: Henry Ford Hospital System Experience, with Focus On Motivating and Reviewing
Authors: Miller B. 
Published: June 2015

It has long been standard practice in radiation oncology to report internally when a patient's treatment has not gone as planned and to report events to regulatory agencies when legally required. Most potential errors are caught early and never affect the patient. Quality assurance steps routinely prevent errors from reaching the patient, and these “near misses” are much more frequent than treatment errors. A growing number of radiation oncology facilities have implemented incident learning systems to report and analyze both errors and near misses. Using the term “incident learning” instead of “event reporting” emphasizes the need to use these experiences to change the practice and make future errors less likely and promote an educational, non‐punitive environment.There are challenges in making such a system practical and effective. Speakers from institutions of different sizes and practice environments will share their experiences on how to make such a system work and what benefits their clinics have accrued. Questions that will be addressed include:

How to create a system that is easy for front line staff to access
How to motivate staff to report
How to promote the system as positive and educational and not punitive or demeaning
How to organize the team for reviewing and responding to reports
How to prioritize which reports to discuss in depth
How not to dismiss the rest
How to identify underlying causes
How to design corrective actions and implement change
How to develop useful statistics and analysis tools
How to coordinate a departmental system with a larger risk management system
How to do this without a dedicated quality manager
Some speakers’ experience is with in‐house systems and some will share experience with the AAPM/ASTRO national Radiation Oncology Incident Learning System (RO‐ILS). Reports intended to be of value nationally need to be comprehensible to outsiders; examples of useful reports will be shown.There will be ample time set aside for audience members to contribute to the discussion.Learning Objectives:

Learn how to promote the use of an incident learning system in a clinic.
Learn how to convert “event reporting” into “incident learning”.
See examples of practice changes that have come out of learning systems.
Learn how the RO‐ILS system can be used as a primary internal learning system.
Learn how to create succinct, meaningful reports useful to outside readers.
Gary Ezzell chairs the AAPM committee overseeing RO‐ILS and has received an honorarium from ASTRO for working on the committee reviewing RO‐ILS reports.Derek Brown is a director of TreatSafely.org.Brett Miller has previously received travel expenses and an honorarium from Varian.Phillip Beron has nothing to report.
TU‐CD‐BRB‐05: Radiation Damage Signature of White Matter Fiber Bundles Using Diffusion Tensor Imaging (DTI)
Authors: Zhu T , Chapman C , Tsien C , Lawrence T , Cao Y 
Published: June 2015

Purpose:To develop an automated and scalable approach and identify temporal, spatial and dosimetric patterns of radiation damage of white matter (WM) fibers following partial brain irradiation.Methods:An automated and scalable approach was developed to extract DTI features of 22 major WM fibers from 33 patients with low‐grade/benign tumors treated by radiation therapy (RT). DTI scans of the patients were performed pre‐RT, 3‐ and 6‐week during RT, and 1, 6 and 18 months after RT. The automated tractography analysis was applied to 198 datasets as: (1) intra‐subject registration of longitudinal DTI, (2) spatial normalization of individual‐patient DTI to the Johns Hopkins WM Atlas, (3) automatic fiber tracking regulated by the WM Atlas, and (4) segmentation of WM into 22 major tract profiles. Longitudinal percentage changes in fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD) of each tract from pre‐RT were quantified and correlated to 95%, 90% and 80% percentiles of doses and mean doses received by the tract. Heatmaps were used to identify clusters of significant correlation and reveal temporal, spatial and dosimetric signatures of WM damage. A multivariate linear regression was further carried out to determine influence of clinical factors.Results:Of 22 tracts, AD/MD changes in 12 tracts had significant correlation with doses, especially at 6 and 18 months post‐RT, indicating progressive radiation damage after RT. Most interestingly, the DTI‐index changes in the elongated tracts were associated with received maximum doses, suggesting a serial‐structure behavior; while short association fibers were affected by mean doses, indicating a parallel‐structure response.Conclusion:Using an automated DTI‐tractography analysis of whole brain WM fibers, we reveal complex radiation damage patterns of WM fibers. Damage in WM fibers that play an important role in the neural network could be associated with late neurocognitive function declines after brain irradiation.NIH NS064973