Carol-Anne Davis

Improving patient outcomes and radiotherapy systems: A pan‐Canadian approach to patient‐reported outcome use

Standardized collection and use of clinical patient-reported outcomes (PRO) have potential to benefit the care of individual patients and improve radiotherapy system performance. Its centralized health-care system makes Canada a prime candidate to take a leader and collaborator role in international endeavors to promote expansion of patient-reported outcome collection and use in radiotherapy. The current review discusses the development of a pan-Canadian approach to PRO use, through a quality improvement initiative led by the Canadian Partnership for Quality Radiotherapy (CPQR), a unique partnership of Canadian radiotherapy professional organizations (Canadian Association of Radiation Oncology-CARO, Canadian Organization of Medical Physicists-COMP, and the Canadian Association of Medical Radiation Technologists-CAMRT).

Sci-Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques - 07: Transitioning from extended-distance total body irradiation to optimized VMAT total marrow irradiation

Purpose: TMI targets only the bone marrow, with the intent of sparing normal tissues. The NSCC has recently implemented a TMI protocol which includes VMAT fields to treat the bone marrow from head to mid-thigh and extended SSD POP fields to treat the lower legs. This work describes the commissioning and initial clinical results of the first reported VMAT TMI treatments in Canada. Methods: Detailed CT simulation, imaging, planning and treatment procedures were developed by a multi-disciplinary team. Patients have 1 cm of bolus over the lower legs and 0.5 cm of bolus around the lower arms. The PTV includes all bone, except mandible, facial bones and hands, with the objective of V(12 Gy) > 90%. Detailed analysis of the influence of field overlap was performed to determine optimal field placement and image-guidance tolerances. Results: PTV coverage was achieved for all cases as V(12 Gy) ranged from 90.4–96.3%. The minimum dose to the PTV, D(99%), ranged from 91.4–97.87% and V(90%Rx=10.8 Gy) ranged from 99.1–100.0%. The lungs, liver and heart had an average Dmean of (7.8±0.3)Gy/(65±2)%, (7.6±0.7)Gy/(63±5)%, and (6.8±0.4)Gy/(56±4)% respectively. Conclusions: Commissioning required input and collaboration from all team members. Transitioning from TBI to TMI requires additional time for contouring, treatment planning, QA, and treatment. Patient benefit can however be seen in the quality of OAR sparing.