Radiation Oncology Report
February 2010
The field of Radiation Oncology continues to be in a state of flux with new technologies continuously being brought into clinical practice in effort to improve patient outcomes. With implementation of new technology into the clinic comes both excitement and uncertainty in treating cancer patients. Many years ago, cancer was treated with simple two-field or four-field techniques and maximal treatment dosages were limited by the radiation tolerance of large volumes of surrounding normal tissue. In this modern era patients can expect to have choices of treatment modalities. For example, whereas prostate cancer used to be treated by rotational or four-field box techniques, now we have at our disposal 3-D conformal radiation, Intensity Modulated Radiation Therapy (IMRT), prostate brachytherapy, proton therapy, and, more recently, Image-Guided Radiation Therapy (IGRT). These technologies facilitate tumor radiation dose escalation while still respecting tissue tolerance of adjacent normal organs. Whereas breast cancer was treated by simple tangential fields, one may now opt to treat by 3-D conformal, breast IMRT, as well as accelerated Partial Breast Irradiation delivered via either external beam therapy or temporary placement of an internal high-dose-rate brachytherapy applicator. The internet has allowed patients to be much more informed, and they often consult with a physician armed with extensive information on their particular disease.
It is crucial that Radiation Oncologists and Medical Physicists maintain a high standard to provide patients with the best possible care. I would encourage all radiation facilities to become accredited through the American College of Radiology (ACR) to ensure that high level of performance. It is especially important to regulate the quality of new facilities in our state, and the Massachusetts Radiological Society is committed to this. An article in the Boston Globe in September 2006 stated that, due to the rise in the number of cancer patients, there will be a need for additional radiation facilities statewide. The efficacy of radiation therapy in the treatment of cancer patients has been highlighted in subsequent Boston Globe articles. In counterpoint, a January 2010 New York Times article on a New York City hospital patient’s catastrophic injuries from repeated radiation misadministration in the first days of treatment underscores the need for radiation oncology clinicians and physicists to understand the need for appropriate, rigorous quality assurance practices to be in place whenever new technology is brought into the clinic.
In addition, the MRS continues to work closely with the Carrier Advisory Committee both statewide and nationally, and with CARROS, the ASTRO (American Society for Radiation Oncology) liaison to the ACR, to keep Radiation Oncologists and Medical Physicists well informed on new government regulations, reimbursement issues, and state-of-the-art treatment modalities in our field.
I would encourage all Radiation Oncologists and Medical Physicists in Massachusetts to become active in our state chapter, the MRS, or nationally with the ACR or ASTRO, so that we can keep abreast of new developments, and have a voice in the future of our profession. I would be glad to assist anyone in that regard. Please feel free to contact me with any questions or concerns that might arise.
Addendum: March 2011
In response to continued reports over the last year of patient misadministration in clinical radiation oncology practice, ASTRO and AAPM (American Association of Physicists in Medicine) convened a working meeting in mid-2010 entitled “Safety in Radiation Therapy: A Call to Action”. This meeting was co-hosted by 14 radiation therapy organizations in Canada and the United States and had over 400 individuals in attendance. The meeting yielded 20 recommendations to reduce errors in clinical practice and improve patient safety during radiation therapeutic procedures. The conclusions and recommendations made by this working meeting were published simultaneously by ASTRO (Practical Radiation Oncology, 1(1):16-21, 2011) and AAPM (Medical Physics, 38(1):78-82, 2011). ASTRO has provided (free to its members) CME/SAM credits for the successful completion of an educational module on policies and procedures in Quality Assurance for Advanced Technology in Radiation Therapy. ASTRO and ACR, along with the ABS (American Brachytherapy Society), have jointly published (International Journal of Radiation Oncology, Biology, and Physics, 79(3):641-9, 2011) practice guidelines specific to high-dose-rate brachytherapy. Currently ASTRO is in the process of producing a “white paper” to address quality assurance processes specific to Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy. Lastly, at this year’s ACR annual meeting an entire afternoon session is dedicated to patient safety in radiation oncology. It behooves every practicing Radiation Oncologist and Medical Physicist to keep abreast of the latest quality improvement guidelines so as to assure the highest quality care for each patient. Toward this end, the professional staffs of all radiation oncology facilities are strongly encouraged to seek accreditation by the ACR or American College of Radiation Oncology (ACRO).
Respectfully submitted,
John E. Mignano, MD, PhD
Tufts Medical Center