bluuebunny/crossref_metadata_2025_split huggingface dataset:
TU‐G‐218‐01: Lessons Learned from Misadministrations and Accidents in Radiation Therapy Part I: Teletherapy
Authors: Foster R 
Published: June 2012

The recent publicity received by the radiation oncology community regarding misadministrations, accidents and overdoses has renewed the medical physicists' focus on safety. However, many other accidents have preceded these. Are these recent incidents similar to older ones and could they have been prevented had the medical physics community applied the lessons learned from previous incidents? Certainly technology is more advanced, but adherence to established doctrines and recommendations from our professional societies could have prevented the majority of these accidents. In this presentation, recent and much older accidents and misadministrations in radiation therapy that have been reported in the media will be presented. These events serve as teaching moments for the clinical physicists and opportunities to assess our own strategies and clinical programs with the goal of providing safe and reliable treatment deliveries. The recommendations and QA that have been established in the literature will be presented in concert with events that have either been near‐misses or grave accidents. This presentation will focus on both conventional linac delivery and the more sophisticated treatments such as SRT and IMRT.Learning Objectives:1. To review and understand the causes of various external beam treatment misadministrations and accidents reported in the media.2. To review and understand corrective and preventative actions that should be in place in order to safely administer external beam RT.3. To review and understand the recommendation for safety by the ASTRO, ACR, and AAPM and the ABS.4. To review and understand the ASTRO Six Point Protection Plan.
TU‐G‐218‐02: Enhancing Our Safety Culture by Understanding Recent Mishaps (Part 2): Brachytherapy
Authors: Libby B 
Published: June 2012

The AAPM and other associated professional societies and governmental bodies (ACR, ASTRO, ABS, NCRP, IAEA, ICRP, and NRC) are fully committed to providing the highest quality brachytherapy treatments in an effective and safe manner. Although the history of our profession can demonstrate extraordinary effectiveness in our conscientious and comprehensive approach to the radiation treatment of cancer, there have been accidents and misadministrations in brachytherapy, and we must be committed to understanding and learning from the open communication of reported medical events, whether through the media or in reports issued by national and international bodies. In this presentation several medical events in brachytherapy that have occurred and been reported will be presented and coupled with corrective actions that should have been in place. The established literature on safety and quality assurance for brachytherapy is also presented.Learning Objectives:1. To review and understand the root causes of brachytherapy medical events that have been reported in the media and to governmental and associated bodies.2. To review and understand corrective actions that should be in place in order to safely administer brachytherapy treatments.3. To review and understand the various established recommendations for the safe delivery of brachytherapy from the AAPM and associated bodies in order to foster a culture of safety surrounding brachytherapy treatments.4. To discuss communication that needs to take place among users, treatment planning system makers, and seed vendors in order to foster the use of identical terminology so that a possible source of treatment error can be eliminated.
WE‐C‐BRCD‐01: Radiation Therapy Safety: Past, Present and Future
Authors: Pawlicki T , Huq M , Mutic S , Low D 
Published: June 2012

Attendees are taught an efficient organizational framework for Part II exam preparation that maximizes high‐yield active learning study activities and minimizes low‐yield study activities. This method is then combined with a productive group‐based study technique. The format and scope of the Part II ABR exam in radiotherapy physics is described, and the eligibility requirements are reviewed. High‐yield and low‐yield study activities are defined and examples are discussed in detail. A problem‐based strategy for limiting the scope of study material is described. A method for studying in groups by distributing delegable tasks among multiple group members and ensuring their completion is described.Learning Objectives1. Understand the scope of material covered on Part II of the ABR radiotherapy physics exam and which references to study for the exam.2. Be able to design and execute an efficient study plan that enables an active learning approach.3. Learn to use group study techniques to enhance efficiency.
WE‐A‐BRA‐01: The Hybrid Linac‐MR System for Real‐Time Tumour Tracking and Radiation Treatment
Authors: Fallone BG 
Published: June 2012

The development of a successful hybrid linac‐MR system is described that allows for both perpendicular and parallel radiation‐configurations to minimize perturbations in radiation dosimetry and to improve dosimetry due to magnetic‐field effects. Successful automatic contouring of tumours of MR images obtained during treatment at four frames a sec (as recommended for lung tracking) for various low magnetic‐field strengths is described, in addition to, our successful predictive tumour‐position algorithm based on patient‐specific (with and without initial weight (IW) for each patient and treatment fraction) feed‐forward 4 layered artificial neural networks (ANN) to compensate for delays in MLC leaf‐motions. The respective tracking and predictive performances of our algorithms are tested with a database of a large number of images for 29 patients obtained independently at very high frames, as well as, with in‐house motion MR phantoms that emulate the motion of any patient on the database. The automatic algorithm successfully contoured moving tumour from dynamic MR images obtained at 4 fps with Dice coefficients of >0.96 and >0.93, and tracked the tumour position with root‐mean‐squared‐errors (RMSE) of < 0.55 mm and <0.92 mm, for 0.5 and 0.2 T images, respectively. Mean RMSE values of 0.5 – 0.9 mm are achieved by our ANN predictor for MLC systems delays ranging from 120 – 520 ms for all the patients in the database. The advantage of using our patient‐specific ANN is shown by a 30 – 60 % decrease in mean RMSE values in motion prediction as compared to results achieved with a single ANN structure and randomly chosen IW. Our results successfully demonstrate the feasibility of using auto‐contouring in low field images and of using the intrafractional tumour‐motion auto‐tracking with our laboratory linac‐MR systemLearning Objectives:1. Understand the solutions to the mutual interferences associated with a linac and an MRI2. Understand the development of MR autocontouring algorithms for low‐field MR images obtained at 4 fps3. Understand the development of algorithm that predict the tumour positions from MR images obtained at 4 fps and thus compensate for the delay in MLC leaf motions to the tumour.
WE‐A‐BRA‐04: Real‐Time Telerobotic 3D Ultrasound for Soft‐Tissue Guidance Concurrent with Beam Delivery
Authors: Hristov D , Schlosser J , Kirmizibayrak C , Shamdasani V , Salisbury K , Chang D , Metz S 
Published: June 2012

Managing internal anatomy motion due to physiological random or quasi‐ periodical processes is a critical challenge in external beam radiation therapy especially in the context of single‐ or few‐fraction ablative regiments for abdominal targets. Existing and emerging technologies for localizing abdominal targets during beam delivery employ tracking of implanted fiducial markers, tracking of external surrogates, or guidance via magnetic resonance images. However, these technologies cannot meet the challenge of providing real‐time, volumetric, non‐invasive, markerless soft‐tissue image guidance to existing radiation delivery platforms. Diagnostic ultrasound is a safe, non‐ionizing, non‐invasive modality widely used in image‐guided cancer interventions that has significant potential to address this challenge. Modern matrix array transducers can generate real‐time soft‐ tissue single plane (2D), cross‐plane, and volumetric (3D) data thus allowing optimization of frame rate, field‐of‐view and image quality for the purposes of motion monitoring and tracking. Furthermore, digital navigation links that stream live data to other devices enable the development of real‐time image‐guidance applications on dedicated interventional workstations with no interference to the imaging process. Based on these capabilities we have been developing and evaluating a novel approach that combines robotics with diagnostic ultrasound imaging. It uses a customized add‐on human‐safe robotic manipulator to control the pressure and pitch of an abdominal probe while avoiding gantry collisions. The manipulator can maintain probe pressure and pose autonomously or interactively via a haptic device that is integrated to remotely control the robotic manipulator outside the therapy room. The transducer is optically tracked to localize the ultrasound images in the coordinate system of the delivery device. Image processing techniques are implemented to monitor anatomy displacements in real time. The approach is being evaluated with regard to imaging robustness, interference with delivery devices, impact on treatment plans, localization accuracy, and temporal lag.Learning Objectives:1. Understand how tele‐robotic 2D/3D ultrasound imaging and appropriately designed workflow can enable real‐time soft‐tissue image guidance concurrent with radiation delivery.2. Recognize different imaging (2D/cross‐plane/3D) and image‐ processing approaches to real‐time anatomy motion monitoring and appreciate their performance for localization and tracking.3. Recognize interferences between the radiation delivery system and the tele‐robotic imaging system and appreciate their magnitude and mutual impact.
WE‐B‐213CD‐03: Fluoroscopy Training and Compliance ‐ Experience of a Large Academic Institution
Authors: Mahesh M 
Published: June 2012

Training of physicians performing fluoroscopy is key to patient and staff safety. In the absence of uniform regulations regarding credentialing of physicians performing fluoroscopy, various states have adopted/implemented regulations. State of Maryland requires a 4‐hour initial training in fluoroscopy operations and safety and a one‐hour refresher course on the same subject once every 2 years. This applies to all physicians performing fluoroscopy with exception to board certified radiologists. The implementation of a program to comply with such regulatory requirements in a large academic center (Johns Hopkins) and the challenges to ensure compliance of all physicians performing fluoroscopy is the focus of this presentation. Along with that, the process on how to prepare and comply for the Joint Commission's sentinel event policy pertaining to prolonged fluoroscopy will be discussed. In addition, the presentation will also discuss process set in place to comply with regulatory requirements of monitoring personal radiation monitors, other training issues and radiation dose reduction strategies in fluoroscopy.Learning Objectives:1. To understand the credentialing and other requirements for physicians performing fluoroscopy.2. To become familiar with the process set to comply with regulations at a large academic medical center.3. To be able to utilize the information to implement similar process at other institutions.
WE‐C‐213AB‐01: How to Prepare for the ABR Therapy Oral Exam
Authors: Becker SJ 
Published: June 2012

Preparing for Part III (Oral Exam) of the ABR Therapy Physics boards is more than just studying as much material as possible. There will always be material that is missed and gaps in one's knowledge. Therefore, in order to fill those gaps, it is crucial to understand how the parts of the material relate to each other and to the clinical experience. Part III presents its own challenges compared to the written exams. It requires not only knowledge of and experience with clinical procedures, but also the ability to explain orally how they are performed and what they mean. One must be able to easily and confidently respond to oral questions about all aspects of working in the clinic and clearly explain why those clinical methods and procedures are performed that way. This talk is not a comprehensive review of all required study material. Instead, it focuses on the required experiences, skill sets, and study methods that are needed to pass Part III of the board exam.Learning Objectives:1. Generate a list of clinical experiences needed for the exam2. Understand how the study material and clinical experiences relate to each other3. Learn how to effectively prepare for an oral style exam
WE‐G‐218‐01: Management of RT Patients with Implanted Cardiac Devices: Updated Recommendations?
Authors: Mihailidis D 
Published: June 2012

It has been long time since AAPM published TG‐34 on cardiac pacemakers of older technology, which has been the standard document for clinical use, even today, for pacemakers (ICPs) and for defibrillators (ICDs), alike. Management of RT patients with recent technology cardiac devices has been widely published in literature without the provision of a new comprehensive and concise set of recommendations. The various effects of interaction of non‐ionizing and ionizing radiations with those devices are crucial to be studied and accounted for during RT treatment deliveries. Thus, AAPM has formed the new TG‐203 to work on this issue and provide recommendations to the clinical user for management of patients with cardiac devices when receiving RT. It has been numerous postings that we see in medical physics list server groups inquiring advices on dealing with these devices during patient imaging and radiation treatments. As treatment delivery technologies (IMRT, SBRT, dose escalations, proton beams, etc) and ICP/ICD technology advance, the need to address the management of patients with such devices receiving radiation treatment becomes increasingly important. ICDs offer the same functionality as ICPs, but they are also able to deliver a high‐voltage shock to the heart, if needed. Finally, major discrepancies exist among manufacturer recommendations and wide variations exist among radiation therapy facilities regarding patient management precautions.Learning Objectives:1. Provide a review on sources of potential malfunctions of modern ICPs and ICDs, including malfunction mechanisms from high‐LET radiations and transient effects attributed to medical imaging procedures for radiotherapy.2. Provide a review on management of radiotherapy patients with cardiac implanted devices.3. Utilize recently available data and computation methods of out‐of‐field/peripheral dose by scattered photons and secondary neutrons in order to assess cumulative doses on the ICPs and ICDs, during current treatment deliveries (IMRT, SBRT, proton beam therapy, etc). Risk of failure associated with these doses will be discussed.4. Provide recommendations for management of radiotherapy patients with implanted cardiac devices including the initial patient evaluation stage, dosimetric evaluation to the ICP/ICD during treatment simulation, treatment planning and treatment delivery. Recommendations for the final evaluation of the integrity and functionality of the device after treatment completion will be assessed.
WE‐G‐218‐03: Management of RT Patients with Implanted Cardiac Devices: From Recommendation to Practical Implementation
Authors: Hurkmans CW 
Published: June 2012

Guidelines for the management of patients with an internal cardiac pacemaker (ICP) or internal cardiac defibrillator (ICD) referred for radiotherapy exist but are outdated, as both ICP and ICD technology and radiation therapy techniques have evolved. (ICPs and ICDs are both CIEDs). Furthermore, the clinical practice of patient management varies widely and the number of patient with a ICP or ICD referred for radiation therapy is increasing. There is thus a clear need for updated guidelines, which are currently developed by the new AAPM TG 203.An overview of the literature, existing recommendations and dose measurement methods has been given the previous speakers of this session. In this presentation, the focus will be more on the management aspects. Which questions need to be answered to decide if a patient can receive radiation therapy? How can this be weighted against e.g. CIED relocation or replacement? It is clear that good communication between the patient, the treating cardiologist and radiation therapy department is of importance to come to the best multidisciplinary treatment approach. When radiotherapy is given, the practical measures that need to be taken should preferably be categorised based on the chance on CIED failure combined with the consequence for the patient in case of such failure. Thus, an important distinction may be made between pacing dependent and pacing independent patients. Examples of such risk classifications with corresponding practical implications will be presented, including the new Dutch national guideline recently authorised by the national cardiology, pacemaker technologists, medical physics and radiation oncology societies.Learning Objectives:1. Understand and list the questions that need to be answered to tailor the treatment to the individual patient and whom should be involved in this process.2. Appreciate the reasons why only a crude categorisation of risks can be given.3. Know how to interpret new CIED guidelines, their strengths and weaknesses and have sufficient knowledge to translate and incorporate these guidelines into your own institution.
TH‐A‐BRB‐02: Mechanistic Linear‐Quadratic‐Linear (LQL) Model for Large Doses Per Fraction
Authors: Guerrero M , Carlone M 
Published: June 2012

The Linear‐Quadratic (LQ) model has been successfully used for at least two decades to quantify radiation effects at standard (1.2‐3Gy) doses. The validity of the standard LQ model for larger doses per fraction has been called into question by many authors, in part due to the continuous bending of the cell survival curve at large doses, contrary to results from in‐vitro experiments. In recent years, Stereotactic Body Radiation Therapy (SBRT) treatments with large fraction doses have become more common, making the modeling for large doses per fraction of significant clinical relevance. Many authors have proposed extensions of the LQ model to address the shape of the cell survival curve at larger doses by arbitrary adding a phenomenological parameter to the LQ model. In this work, we discuss a Linear‐Quadratic‐Linear (LQL) model with a mechanistic formulation. This LQL model has one additional parameter with respect to the standard LQ model and can be derived by mechanistic arguments. The additional parameter makes the survival curve linear at high doses and has been estimated using in‐vivo and in‐vitro data. The advantage of a mechanistic model is that it allows for modeling of radiation effects for any given dose‐ rate and fractionation scheme. As an example, we present the LQL prediction for split dose experiments and low‐dose‐rate (LDR) prostate brachytherapy. The LQL model is equivalent to other mechanistic models like the Lethal‐Potentially‐Lethal model (LPL) but it retains the well‐known parameters from the standard LQ model. As a clinical application, using estimated values of the additional parameter, we investigate the impact on the biologically effective dose (BED) for clinical SBRT treatment schedules of various cancer sites.Learning Objectives:1. Understand the limitations of the standard LQ model for large doses per fraction.2. Understand the mechanistic formulation of the proposed LQL.3. Understand how the LQL can be used to calculate the BED for SBRT radiation treatment schedules and compare them with standard fractionation.
TH‐A‐217A‐01: Image Gently and Image Wisely in Nuclear Medicine
Authors: Fahey F 
Published: June 2012

There has been recent interest in the radiation dose delivered to the public as a result of medical imaging in both children and adults. Reports in the public press as well as hearings held by our public servants have concerned themselves with the need to be judicious about the use of medial imaging that involves ionizing radiation and to consider ways to reduce the radiation dose to the public without compromising the quality of the diagnostic information provided to our clinical collaborators. For these reasons, it is imperative that health professionals understand the nature of the health risks associated with ionizing radiation, the dosimetry in the context on medical imaging and ways that may be considered for the reduction of radiation dose. This presentation will cover these topics in the context nuclear medicine imaging performed in both children and adults. The basis for radiation risk estimation will be discussed as well as estimates of risk in the dose range associated with clinical nuclear medicine. Ways to communicate this risk to our patients and their families will also be described. The dosimetric models used in nuclear medicine, factors that affect dose and methods that may be used to reduce dose will be presented. The dosimetry of computed tomography in the context of hybrid imaging will also be described. Lastly, efforts and plans of both the Image Gently (in children) and Image Wisely (in adults) campaigns with respect to nuclear medicine will be discussed including the recently published North American Consensus Guidelines for Children and Adolescents developed by the Image Gently Group.Learning Objectives:1. List 2 factors that affect radiation dose in nuclear medicine2. Discuss 3 approaches that may lead to dose reduction in nuclear medicine3. Discuss the advantages and disadvantages of 3 ways of conversing about the radiation from nuclear medicine with their patients
TH‐C‐211‐01: How to Be a Journal Referee: A Panel Discussion
Authors: Becker S , Boone J , Orton C , Starkschall G , Thomadsen B 
Published: June 2012

Being a referee for a journal article is an important yet daunting task. It is especially worrisome for someone who has little reviewing experience. It is important to remember is that it is an honor and perhaps a duty, but not a burden. Someone considers you to be an expert in the subject and it is with that mindset that you should approach the task.Each part of the review process has its own difficulties:• Grammar and Language: How much of this do you need to do? Does poor grasp of the English language warrant rejection? Is it effective or excessively verbose?• Science: Is this project novel? How do you determine that? How similar can it be to other previously published manuscripts?• References: Are the proper studies referenced? How much does this affect the review?• Methods: How do you determine if the methods are sound? How much can you suggest without trying to be a collaborator?• Results: Are graphs and tables being utilized wisely? Are there an excessive number of them?All of these issues are important part of the review process and need to be considered. But how do you weight them in your final recommendation and communicate them to the authors and editors? This panel of senor medical physics, which has extensive experience in refereeing, will help guide the audience through the entire review process. These experts will share their experiences and methods to help new referees best prepare for the opportunity of reviewing manuscripts.Learning Objectives:1. Learn the role of the referee and what is expected of them.2. Learn how to perform a review.3. Learn how to communicate a review with authors and editors.