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Purpose: This study aimed to find descriptors that correlates with normal brain dose to determine the feasibility of performing fractionated stereotactic radiosurgery (SRS) for multiple brain metastases (BMs) using five linac machines. Methods: Thirty‐two patients with 1–30 BMs were enrolled. Treatment plans were created using TrueBeam, Novalis Tx, TrueBeam Edge, Halcyon, and Tomotherapy linacs. The sum of all planning target volumes (PTVs) was defined as PTVall, and the brain region excluding PTVall was defined as normal brain. The total surface area (TSA) of the PTV was calculated from the sum of the surface areas of the equivalent spheres for each PTV. Volumes receiving more than 5, 12, and 18 Gy (V5Gy, V12Gy, and V18Gy, respectively) were used for evaluation of normal brain dose. Correlations between normal brain dose and each tumor characteristic (number, PTVall, and TSA) were investigated using the Spearman rank correlation coefficient. Results: Correlations between each characteristic and normal brain dose were statistically significant (p < 0.05) across all machines. The correlation coefficients between each characteristic and V18Gy for the five machines were as follows: tumor number, 0.39–0.60; PTVall, 0.79–0.93; TSA, 0.93–0.99. The fit equations between TSA and V18Gy exhibited high coefficients of determination, ranging from 0.92 to 0.99 across five machines. Conclusion: This study devised fractionated SRS plans using for 1–30 BMs across five linac machines to find descriptors for determining SRS feasibility based on normal brain dose. TSA proved to be a promising descriptor of SRS feasibility for treating multiple BMs. [ABSTRACT FROM AUTHOR]

Institutional imaging protocols for the verification of brachytherapy applicator placements were investigated in a survey study of domestic radiotherapy institutions. The survey form designed by a free on-line survey system was distributed via the mailing-list system of the Japanese Society for Radiation Oncology. Survey data of 75 institutions between August 2019 and October 2019 were collected. The imaging modalities used were dependent on resources available to the institutions. The displacement of a brachytherapy applicator results in significant dosimetric impact. It is essential to verify applicator placements using imaging modalities before treatment. Various imaging modalities used in institutions included a computed tomography (CT) scanner, an angiography X-ray system, a multi-purpose X-ray system and a radiotherapy simulator. The median total exposure time in overall treatment sessions was |$\le$| 75 s for gynecological and prostate cancers. Some institutions used fluoroscopy to monitor the brachytherapy source movement. Institutional countermeasures for reducing unwanted imaging dose included minimizing the image area, changing the imaging orientation, reducing the imaging frequency and optimizing the imaging conditions. It is worth noting that half of the institutions did not confirm imaging dose regularly. This study reported on the usage of imaging modalities for brachytherapy in Japan. More caution should be applied with interstitial brachytherapy with many catheters that can lead to potentially substantial increments in imaging doses for monitoring the actual brachytherapy source using fluoroscopy. It is necessary to share imaging techniques, standardize imaging protocols and quality assurance/quality control among institutions, and imaging dose guidelines for optimization of imaging doses delivered in radiotherapy should be developed. [ABSTRACT FROM AUTHOR]

In 2016, the American Association of Physicists in Medicine (AAPM) has published a report of task group (TG) 100 with a completely new concept, entitled "application of risk analysis methods to radiation therapy quality management." TG-100 proposed implementation of risk analysis in radiotherapy to prevent harmful radiotherapy accidents. In addition, it enables us to conduct efficient and effective quality management in not only advanced radiotherapy such as intensity-modulated radiotherapy and image-guided radiotherapy but also new technology in radiotherapy. It should be noted that treatment process in modern radiotherapy is absolutely more complex and it needs skillful staff and adequate resources. TG-100 methodology could identify weakness in radiotherapy procedure through assessment of failure modes that could occur in overall treatment processes. All staff in radiotherapy have to explore quality management in radiotherapy safety.

This study investigates the quality indicators (QIs) of medical care that are expected to be introduced to radiotherapy departments in Japan and evaluates whether the QIs reflect the characteristics of the treatment facilities. For this purpose, a questionnaire survey was administered to radiotherapy treatment facilities in Japan. A consensus of early QI candidates was obtained from the panel members. The characteristics identified in the candidate QIs were subdivided into 140 items covering 27 domains of medical-care contents in radiotherapy departments. These 140 items were compiled into a questionnaire, which was administered to 15 treatment facilities in Japan. The primary results indicated that 36 items in five domains are useful QI contents. The secondary findings indicated that the provision of advanced radiotherapy to several patients, the waiting time, and the radiotherapy initiated depend on the manpower of the departmental staff.

Objective: To compare dosimetric parameters and acute toxicity rates between whole-pelvic (WP) and prostate-only (PO) volumetric-modulated arc therapy (VMAT) in patients with localized prostate cancer., Methods: A total of 224 consecutive patients treated with definitive VMAT to 78 Gy in 39 fractions were enrolled. Of these, 119 patients received initial WP VMAT at 46.8 Gy in 26 fractions using a simultaneous integrated boost technique, and 105 patients received PO VMAT. Image-guided radiotherapy was practised with daily cone beam CT., Results: The mean rectal dose, the rectal volume receiving ≥30 Gy (V30Gy), rectal V50Gy, the mean bladder dose, bladder V30Gy and bladder V50Gy were significantly increased in the WP group (p < 0.05 each); however, the rectal V70Gy did not differ between groups (p = 0.101), and the bladder V70Gy was significantly lower in the WP group (p = 0.029). The WP group experienced a significantly increased frequency of acute grade 2 diarrhoea relative to the PO group (5.9% vs 0%; p = 0.015). No differences were seen between the WP and PO groups in terms of acute grade 2 proctitis (10.1% vs 6.7%; p = 0.360) and genitourinary (GU) toxicity (12.6% vs 10.5%; p = 0.620)., Conclusion: Despite larger rectum and bladder volumes at low- and medium-dose levels, WP VMAT resulted in no significant increase in acute proctitis or GU toxicity when compared with PO VMAT., Advances in Knowledge: This study demonstrates that whole-pelvic radiotherapy has comparable acute toxicity to those observed with prostate-only radiotherapy when VMAT with daily image guidance is used.

Until recently, conservative radiation therapy of breast cancer using a wedge-filter combined with rectangular tangential irradiation was widely carried out. This method of irradiation creates uniform dose distribution in the target, minimizing the radiation dose to the lung. However, this method of irradiation results in many cases in which the amount of dose in the irradiated area differs as a result of the shape and size of the breast. It is necessary to prevent excessive doses from reaching the lung. IMRT ensures a uniform dose to the target. Therefore, IMRT was examined because of the possibility that the normal tissue dose can be effectively utilized in cases of conservative radiation therapy of breast cancer by providing a minimum dose. To compare the irradiation of each method of rectangular tangential irradiation, an electronic compensator (ELC), and IMRT, which uses Dynamic MLC, we evaluated target dose uniformity, standard deviation, and target differential DVH in 13 examples. We evaluated the lung dose of the irradiated side (V(30), 30 Gy volume) of the lung to the volume of the lung on the irradiated side based on the report of Hernando.(6)) With this method of irradiation, irrespective of the difference in the shape and size of the target, dose uniformity with ELC was very good. IMRT can reduce the lung dose in comparison with the other irradiation methods. However, it is apt to cause a high-dose area in the irradiation field. In addition, it affects the target and the skin-extracting contour, and the dose to the skin surface declines. Although ELC cannot offer lung doses that are as low as those of IMRT, most of the 13 examples planned for cure with ELC showed rates of 22% of V(30) and below. In conservative radiation therapy of breast cancer, ELC is more effective than the rectangular tangential irradiation method and IMRT.

Since the year 2000, our hospital has been equipped with an intensity modulated radiation therapy (IMRT) facility. Before IMRT is administered, the absorbed dose is measured by the ionization chamber to provide verification for the IMRT procedure. In utilizing the current point dose evaluation, large discrepancies have been experienced when the measured dose is compared with the calculated dose. This discrepancy is due to the lack of uniformity in IMRT irradiation in comparison with that of the present method of dose distribution. In order to reduce the margin of error, the average dose of the ionization chamber calculated on a dose-volume histogram was compared with the measured dose. As a result, the margin of error was minimized to <2% in uniform areas and <4% in non-uniform areas.