Mira Shah

Radiation oncology in Africa: improving access to cancer care on the African continent.

Radiation Oncology in Africa: Improving Access to Cancer Care on the African Continent Brandon J. Fisher, DO,* Larry C. Daugherty, MD,y John P. Einck, MD,{ Gita Suneja, MD,x Mira M. Shah, MD,k Luqman K. Dad, MD,{ Robert W. Mutter, MD, J. BenWilkinson, MD,** and Arno J. Mundt, MDz *Gamma West Cancer Services, Salt Lake City, Utah; yMayo Clinic, Jacksonville, Florida; zMoores Cancer Center, University of California San Diego, San Diego, California; xAbramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; kHenry Ford Health System, Detroit, Michigan; {Anne Arundel Medical Center, Annapolis, Maryland; Mayo Clinic, Rochester, Minnesota; and **Willis-Knighton Health System/LSU Health Science Center, Shreveport, Louisiana

Training Global Oncologists: Addressing the Global Cancer Control Problem

The global incidence of cancer has increased by approximately 20% in the past decade, an increase mostly due to cases in low- and middle-income countries (LMICs) (1). By 2020, up to 70% of the 20 million annual new cancer cases are expected to occur in LMICs (2). The incidence of cancer in LMICs is increasing rapidly; however, many countries are not prepared to address this epidemic. Cancer survival rates in LMICs are often less than one-third of those in high-income countries (3). In addition to local capacity-building efforts, the involvement of the oncology community from high-income countries will be instrumental in changing the course of this impending global cancer crisis. There is a vital need to train global oncologists to work with colleagues in LMICs to develop sustainable capacity and infrastructure for clinical oncology care, research, and education. However, enumeration of specific goals and novel programs, and the path to implementing these programs, is not clear. Oncology programs in North America lack formal training or exposure to global oncology. Even without a formal curriculum, with the rise in global health (GH) oncology interest, several opportunities have developed for trainees committed to GH. We describe herein current opportunities and future directions for oncology trainees in the United States (US) who are interested in pursuing careers as global oncologists.

Corrigendum: “Training Global Oncologists: Addressing the Global Cancer Control Problem”

[This corrects the article on p. 80 in vol. 5, PMID: 25905040.].

On the improvement of CBCT image quality for soft tissue-based SRS localization

Abstract Purpose We explore the optimal cone‐beam CT (CBCT) acquisition parameters to improve CBCT image quality to enhance intracranial stereotactic radiosurgery (SRS) localization and also assess the imaging dose levels associated with each imaging protocol. Methods Twenty‐six CBCT acquisition protocols were generated on an Edge® linear accelerator (Varian Medical Systems, Palo Alto, CA) with different x‐ray tube current and potential settings, gantry rotation trajectories, and gantry rotation speeds. To assess image quality, images of the Catphan 504 phantom were analyzed to evaluate the following image quality metrics: uniformity, HU constancy, spatial resolution, low contrast detection, noise level, and contrast‐to‐noise ratio (CNR). To evaluate the imaging dose for each protocol, the cone‐beam dose index (CBDI) was measured. To validate the phantom results, further analysis was performed with an anthropomorphic head phantom as well as image data acquired for a clinical SRS patient. Results The Catphan data indicates that adjusting acquisition parameters had direct effects on the image noise level, low contrast detection, and CNR, but had minimal effects on uniformity, HU constancy, and spatial resolution. The noise level was reduced from 34.5 ± 0.3 to 18.5 ± 0.2 HU with a four‐fold reduction in gantry speed, and to 18.7 ± 0.2 HU with a four‐fold increase in tube current. Overall, the noise level was found to be proportional to inverse square root of imaging dose, and imaging dose was proportional to the product of total tube current‐time product and the cube of the x‐ray potential. Analysis of the anthropomorphic head phantom data and clinical SRS imaging data also indicates that noise is reduced with imaging dose increase. Conclusions Our results indicate that optimization of the imaging protocol, and thereby an increase in the imaging dose, is warranted for improved soft‐tissue visualization for intracranial SRS.