Radiation Dose-Volume Effects in the Esophagus

Publications relating esophageal radiation toxicity to clinical variables and to quantitative dose and dose–volume measures derived from three-dimensional conformal radiotherapy for non–small-cell lung cancer are reviewed. A variety of clinical and dosimetric parameters have been associated with acute and late toxicity. Suggestions for future studies are presented

Radiation Dose–Volume Effects of the Urinary Bladder

An in-depth overview of the normal-tissue radiation tolerance of the urinary bladder is presented. The most informative studies consider whole-organ irradiation. The data on partial-organ/nonuniform irradiation are suspect because the bladder motion is not accounted for, and many studies lack long enough follow-up data. Future studies are needed

Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiotherapy (SBRT) of the thorax

The Lessons of QUANTEC: Recommendations for Reporting and Gathering Data on Dose–Volume Dependencies of Treatment Outcome

The 16 clinical articles in this issue review the dose volume dependence of toxicities of external beam radiotherapy. They are limited by the difficulty of synthesizing results from different publications. The major problems stem from incomplete reporting of results and use of incompatible or ambiguous endpoints. Here we specify these problems, give recommendations to authors, editors, and reviewers on standards of reporting, and, provide methods of defining endpoints suitable for the dose-volume analysis of toxicity. Adopting these recommendations will facilitate meta-analysis and increase the utility of individual studies of the dependence of complications on dose distributions

Improving Normal Tissue Complication Probability Models: The Need to Adopt a “Data-Pooling” Culture

Clinical studies of the dependence of normal tissue response on dose-volume factors are often confusingly inconsistent, as the QUANTEC reviews demonstrate. A key opportunity to accelerate progress is to begin storing high-quality datasets in repositories. Using available technology, multiple repositories could be conveniently queried, without divulging protected health information, to identify relevant sources of data for further analysis. After obtaining institutional approvals, data could then be pooled, greatly enhancing the capability to construct predictive models that are more widely applicable and better powered to accurately identify key predictive factors (whether dosimetric, image-based, clinical, socioeconomic, or biological). Data pooling has already been carried out effectively in a few normal tissue complication probability studies and should become a common strategy

The Use of Normal Tissue Complication Probability (NTCP) Models in the Clinic

The QUANTEC (quantitative analysis of normal tissue effects in the clinic) review summarizes the currently-available three dimensional dose/volume/outcome data to update and refine the normal tissue dose/volume tolerance guidelines provided by the classic “Emami” paper (IJROBP 21:109, 1991). A “clinician’s view” on using the QUANTEC information in a responsible manner is presented along with a description of the most commonly-used normal tissue complication probability (NTCP) models. A summary of organ-specific dose/volume/outcome data, based on the QUANTEC reviews, is included

Flattening filter-free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group.

This report describes the current state of flattening filter-free (FFF) radiotherapy beams implemented on conventional linear accelerators, and is aimed primarily at practicing medical physicists. The Therapy Emerging Technology Assessment Work Group of the American Association of Physicists in Medicine (AAPM) formed a writing group to assess FFF technology. The published literature on FFF technology was reviewed, along with technical specifications provided by vendors. Based on this information, supplemented by the clinical experience of the group members, consensus guidelines and recommendations for implementation of FFF technology were developed. Areas in need of further investigation were identified. Removing the flattening filter increases beam intensity, especially near the central axis. Increased intensity reduces treatment time, especially for high-dose stereotactic radiotherapy/radiosurgery (SRT/SRS). Furthermore, removing the flattening filter reduces out-of-field dose and improves beam modeling accuracy. FFF beams are advantageous for small field (e.g., SRS) treatments and are appropriate for intensity-modulated radiotherapy (IMRT). For conventional 3D radiotherapy of large targets, FFF beams may be disadvantageous compared to flattened beams because of the heterogeneity of FFF beam across the target (unless modulation is employed). For any application, the nonflat beam characteristics and substantially higher dose rates require consideration during the commissioning and quality assurance processes relative to flattened beams, and the appropriate clinical use of the technology needs to be identified. Consideration also needs to be given to these unique characteristics when undertaking facility planning. Several areas still warrant further research and development. Recommendations pertinent to FFF technology, including acceptance testing, commissioning, quality assurance, radiation safety, and facility planning, are presented. Examples of clinical applications are provided. Several of the areas in which future research and development are needed are also indicated

Re-evaluating the Quoit Brooch Style: Economic and Cultural Transformations in the 5th Century ad, with an Updated Catalogue of Known Quoit Brooch Style Artefacts

Quoit Brooch Style material, produced from the early 5th century onwards, has previously been considered mostly from a stylistic point of view, leaving much scope for further investigation. In addition, the known corpus of material has been much expanded through newly excavated and metal-detected finds. In this article, I bring together the known extant material for the first time, and document important evidence relating to contextual dating, gender associations, manufacture (including new compositional analysis of c 75 objects), repair, and reuse. The article questions previous interpretations of Quoit Brooch Style material relating to Germanic mercenaries and/or post-Romano-British political entities. It interprets the earliest material as part of wider trends elsewhere, in Britain and in Continental northwestern Europe, for the production of material imitating late Roman symbols of power. It presents new evidence for connectivity with Continental Europe via the western Channel route in the 5th century. A detailed investigation of individual artefacts shows that many Quoit Brooch Style objects were reused, sometimes being subjected to extensive repair and modification. This provides new insights into the 5th century metal economy, for instance, acute problems in the availability of new metal objects in southeastern Britain in the middle years of the 5th century. Compositional analysis contributes further to our understanding of metal supply in the 5th century and relationships with the post-Roman West. Insights are provided into wider cultural transformations in the 5th century and the gradual loss of value that occurred for Roman-style objects

Interfractional anatomic variation in patients treated with respiration-gated radiotherapy," Journal of applied clinical medical physics [electronic resource

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