Maria Rosa Malisan

Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures : Analysis in relation to radiation exposure parameters

Few data are available on the quantitative assessment of complexity (C), especially in relation to a patients exposure to radiation. The relationship between several clinical (CFs), anatomic (AFs), and technical factors (TFs) versus fluoroscopy time (FT) was evaluated in 402 random percutaneous transluminal coronary angioplasty (PTCA) procedures. CFs were age, sex, single or multivessel disease, ejection fraction, and previous coronary artery bypass graft. AFs were assessed based on the American Heart Association / American College of Cardiology classification. TFs were multivessel PTCA, use of the double wire or double balloon technique, stenting, ostial stenting, bifurcation stenting, and intravascular ultrasonography. No CFs significantly influenced FT, whereas all AFs and TFs (except multivessel PTCA) did significantly influence FT. A scoring system was developed, and two complexity indexes (CI) were conceived, based on which the procedures were divided into three groups: simple, medium, and complex. The mean FTs were 471 ± 289, 805 ± 532, and 1,190 ± 641 (P < 0.0001), respectively. Total cine frame recordings were 1,119 ± 572, 1,265 ± 644 (P = 0.0355), and 1,418 ± 785 (P < 0.0001 vs. simple; P = NS vs. medium). The dose/area product measurement was 65.8 ± 41.4, 93 ± 58.5 (P < 0.0001), and 116.7 ± 72.8 (P < 0.0001 vs. simple; P = 0.00159 vs. medium), respectively. In our series, CI was directly related to AF and TF, but not to CF. Comparison of PTCA procedures and definition of appropriate FT should consider CIs. Cathet. Cardiovasc. Intervent. 51:1–9, 2000.

Lung stereotactic ablative body radiotherapy: A large scale multi-institutional planning comparison for interpreting results of multi-institutional studies

PURPOSE A large-scale multi-institutional planning comparison on lung cancer SABR is presented with the aim of investigating possible criticism in carrying out retrospective multicentre data analysis from a dosimetric perspective. METHODS Five CT series were sent to the participants. The dose prescription to PTV was 54Gy in 3 fractions of 18Gy. The plans were compared in terms of PTV-gEUD2 (generalized Equivalent Uniform Dose equivalent to 2Gy), mean dose to PTV, Homogeneity Index (PTV-HI), Conformity Index (PTV-CI) and Gradient Index (PTV-GI). We calculated the maximum dose for each OAR (organ at risk) considered as well as the MLD2 (mean lung dose equivalent to 2Gy). The data were stratified according to expertise and technology. RESULTS Twenty-six centers equipped with Linacs, 3DCRT (4% - 1 center), static IMRT (8% - 2 centers), VMAT (76% - 20 centers), CyberKnife (4% - 1 center), and Tomotherapy (8% - 2 centers) collaborated. Significant PTV-gEUD2 differences were observed (range: 105-161Gy); mean-PTV dose, PTV-HI, PTV-CI, and PTV-GI were, respectively, 56.8±3.4Gy, 14.2±10.1%, 0.70±0.15, and 4.9±1.9. Significant correlations for PTV-gEUD2 versus PTV-HI, and MLD2 versus PTV-GI, were observed. CONCLUSIONS The differences in terms of PTV-gEUD2 may suggest the inclusion of PTV-gEUD2 calculation for retrospective data inter-comparison.

The role of the biomedical physicist in the education of the healthcare professions: An EFOMP project

The role of the biomedical physicist in the education of the healthcare professions has not yet been studied in a systematic manner. This article presents the first results of an EFOMP project aimed at researching and developing this important component of the role of the biomedical physicist. A background to the study expands on the reasons that led to the need for the project. This is followed by an extensive review of the published literature regarding the role. This focuses mainly on the teaching contributions within programmes for physicians, diagnostic radiographers, radiation therapists, and the postgraduate medical specializations of radiology, radiotherapy, interventional radiology and cardiology. Finally a summary list of the specific research objectives that need to be immediately addressed is presented. These are the carrying out of a Europe-wide position audit for the role, the construction of a strategic role development model and the design of a curriculum development model suitable for modern healthcare professional education.

A comprehensive SWOT audit of the role of the biomedical physicist in the education of healthcare professionals in Europe

Although biomedical physicists provide educational services to the healthcare professions in the majority of universities in Europe, their precise role with respect to the education of the healthcare professions has not been studied systematically. To address this issue we are conducting a research project to produce a strategic development model for the role using the well-established SWOT (Strengths, Weaknesses, Opportunities, Threats) methodology. SWOT based strategic planning is a two-step process: one first carries out a SWOT position audit and then uses the identified SWOT themes to construct the strategic development model. This paper reports the results of a SWOT audit for the role of the biomedical physicist in the education of the healthcare professions in Europe. Internal Strengths and Weaknesses of the role were identified through a qualitative survey of biomedical physics departments and biomedical physics curricula delivered to healthcare professionals across Europe. External environmental Opportunities and Threats were identified through a systematic survey of the healthcare, healthcare professional education and higher education literature and categorized under standard PEST (Political, Economic, Social-Psychological, Technological-Scientific) categories. The paper includes an appendix of terminology. Defined terms are marked with an asterisk in the text.

Proposal for a patient database on cardiac interventional exposures for epidemiological studies

Relatively high organ doses absorbed by patients in interventional cardiology suggest the opportunity to define these patients as a cohort to be followed forward in time in an epidemiological study of the cancer risks associated with exposure to low-dose ionising radiation. In this paper, the UNSCEAR 2000 Report risk estimates for the most exposed organs/tissues in cardiac interventional procedures are reviewed, as well as the critical features of such an epidemiological study that is anticipated to have an intrinsically low statistical power because of the low levels of risk and possible confounding factors. To overcome these limitations, data collected in different institutions can be combined provided that a common design and conduct are used for dose assessment. A minimum dataset to be collected on a patient basis is proposed that can be implemented routinely in most facilities. This data should be linked to the local patient information system in order to retrieve all the exposures of a given patient.

A strategic development model for the role of the biomedical physicist in the education of healthcare professionals in Europe

This is the third of a series of articles targeted at biomedical physicists providing educational services to other healthcare professions, whether in a university faculty of medicine/health sciences or otherwise (e.g., faculty of science, hospital-based medical physics department). The first paper identified the past and present role of the biomedical physicist in the education of the healthcare professions and highlighted issues of concern. The second paper reported the results of a comprehensive SWOT (strengths, weaknesses, opportunities, threats) audit of that role. In this paper we present a strategy for the development of the role based on the outcomes of the SWOT audit. The research methods adopted focus on the importance of strategic planning at all levels in the provision of educational services. The analytical process used in the study was a pragmatic blend of the various theoretical frameworks described in the literature on strategic planning research as adapted for use in academic role development. Important results included identification of the core competences of the biomedical physicist in this context; specification of benchmarking schemes based on experiences of other biomedical disciplines; formulation of detailed mission and vision statements; gap analysis for the role. The paper concludes with a set of strategies and specific actions for gap reduction.

Comparative study of four advanced 3d-conformal radiation therapy treatment planning techniques for head and neck cancer

For the head-and-neck cancer bilateral irradiation, intensity-modulated radiation therapy (IMRT) is the most reported technique as it enables both target dose coverage and organ-at-risk (OAR) sparing. However, during the last 20 years, three-dimensional conformal radiotherapy (3DCRT) techniques have been introduced, which are tailored to improve the classic shrinking field technique, as regards both planning target volume (PTV) dose conformality and sparing of OAR’s, such as parotid glands and spinal cord. In this study, we tested experimentally in a sample of 13 patients, four of these advanced 3DCRT techniques, all using photon beams only and a unique isocentre, namely Bellinzona, Forward-Planned Multisegments (FPMS), ConPas, and field-in-field (FIF) techniques. Statistical analysis of the main dosimetric parameters of PTV and OAR’s DVH’s as well as of homogeneity and conformity indexes was carried out in order to compare the performance of each technique. The results show that the PTV dose coverage is adequate for all the techniques, with the FPMS techniques providing the highest value for D95%; on the other hand, the best sparing of parotid glands is achieved using the FIF and ConPas techniques, with a mean dose of 26 Gy to parotid glands for a PTV prescription dose of 54 Gy. After taking into account both PTV coverage and parotid sparing, the best global performance was achieved by the FIF technique with results comparable to that of IMRT plans. This technique can be proposed as a valid alternative when IMRT equipment is not available or patient is not suitable for IMRT treatment.

Implementation and validation of a commercial portal dosimetry software for intensity-modulated radiation therapy pre-treatment verification.

Electronic portal imaging devices (EPIDs) are extensively used for obtaining dosimetric information of pre-treatment field verification and in-vivo dosimetry for intensity-modulated radiotherapy (IMRT). In the present study, we have implemented the newly developed portal dosimetry software using independent dose prediction algorithm EPIDose™ and evaluated this new tool for the pre-treatment IMRT plan quality assurance of Whole Pelvis with Simultaneous Integrated Boost (WP-SIB-IMRT) of prostate cases by comparing with routine two-dimensional (2D) array detector system (MapCHECK™). We have investigated 104 split fields using γ -distributions in terms of predefined γ frequency parameters. The mean γ values are found to be 0.42 (SD: 0.06) and 0.44 (SD: 0.06) for the EPIDose and MapCHECK™, respectively. The average γ∆ for EPIDose and MapCHECK™ are found as 0.51 (SD: 0.06) and 0.53 (SD: 0.07), respectively. Furthermore, the percentage of points with γ < 1, γ < 1.5, and γ > 2 are 97.4%, 99.3%, and 0.56%, respectively for EPIDose and 96.4%, 99.0% and 0.62% for MapCHECK™. Based on our results obtained with EPIDose and strong agreement with MapCHECK™, we may conclude that the EPIDose portal dosimetry system has been successfully implemented and validated with our routine 2D array detector

EP-1471: Lung SABR: radiobiological multi planning comparison in a perspective of a multi-institutional study

estimated for the stomach and stomach wall with endpoints of ulceration and gastric bleeding respectively (6) & (7). Results: The stomach wall model showed larger values of NTCP than the whole stomach. There was a mean increase of 5.93% (-0.42, 18.71%) in NTCP from the 50Gy3D to the 60GyRA plans and a mean increase of 8.15% (-0.42, 19.79%) in NTCP from the 50GyRA to the 60GyRA plans. When the NTCP modelling is restricted to that outside PTV2, there was a mean decrease of 0.92% (-4.70, 1.00%) in NTCP from the 50Gy3D to the 60GyRA plans, and a mean increase of 2.25% (0.42, 6.91%) in NTCP from the 50GyRA to the 60GyRA plans. There was a strong correlation between the NTCP value and the Stomach Wall/PTV1 overlap volume for all treatment plans (Pearson’s R=0.80, 0.77 and 0.77 for the 60GyRA, 50GyRA and 50Gy3D plans respectively). There was also a strong correlation between the NTCP value and the Stomach Wall/PTV2 overlap volume for the 60GyRA plan (R= 0.82). Conclusions: Radiobiological modelling suggests that increasing the prescribed dose to 60Gy may be associated with a significantly increased risk of toxicity to the stomach. The results of this study also suggest that the maximum prescribed dose safely achievable for each patient in the future may be dependent on the volume of the stomach within the treatment volume. It is recommended that stomach toxicity be closely monitored prospectively when treating patients with lower oesophageal tumours in the forthcoming SCOPE 2 trial. 1. A A Botterweck LJS, A Volovics, E Dorant, P A Van Den Brandt. Trends in incidence of adenocarcinoma of the oesophagys and gastric cardia in ten European countries. Int J Epidemiol. 2000;29(4):645-54. 2. D Buergy FL, T Baack, K Siebenlist, S Haneder, H Michaely, F Wenz, J B Heggeman. Radiotherapy for tumours of the stomach and gastroesophageal junction a review of its role in multimodal therapy. Radiat Oncol. 2012;7:192. 3. S Gwynne SF, S Gollins, L Wills, A Bateman, S Cummins, H Grabsch, M A Hawkins, R Maggs, S Mukherjee, G Radhakrishna, R Roy, R A Sharma, E Spezi, T Crosby. Oesophageal Chemoradiotherapy in the UK A Current Practive and Future Directions. Clin Oncol. 2013;25:368-77. 4. B D Kavanagh CCP, L A Dawson, S K Das, X Allen, R K T Haken, M Miften. Radiation Dose-Volume Effectes in the Stomach and Small Bowel. Int J Radiat Oncol Biol Phys. 2010;76(3):S101-S7. 5. J I Geh SJB, S M Bentzen, R G Jones. Systematic overview of preoperative (neoadjuvant) chemoradiotherapy trials in oesophageal cancer: Evidence of a radiation and chemotherapy dose response. Radiother Oncol. 2006;78:23644. 6. C Burman GJK, B Emami, M Goitein. Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys. 1991;21(1):123-5. 7. M Feng DN, C C Pan, L A Dawson, S Amarnath, W D Ensminger, T S Lawrence, R K T Haken. Dosimetric Analysis of Radiation-Induced Gastric Bleeding. Int J Radiat Oncol Biol Phys. 2012;84(1):e1.

EFOMP project on the role of biomedical physics in the education of healthcare professionals

EFOMP project on the role of biomedical physics in the education of healthcare professionals The policy statements describing the role of the medical physicist (and engineer) published by organizations representing medical physics (and engineering) in Europe include the responsibility of providing a contribution to the education of healthcare professionals (physicians and paramedical professions). As a consequence, medical physicists and engineers provide educational services in most Faculties of Medicine / Health Science in Europe. In 2005, the EFOMP council took the decision to set up a Special Interest Group to develop the role of the medical physics educator in such faculties and to work with other healthcare professional groups to produce updated European curricula for them. The effort of the group would provide a base for the progress of the role, its relevance to contemporary healthcare professional education and provide input for future EFOMP policy documents regarding this important aspect of the role of the medical physicist. The present communication will present the group, summarise its latest research and indicate future research directions.