Maryann Bishop-Jodoin, MEd, is an instructor and scientific writer in the Department of Radiation Oncology, UMass Chan Medical School, USA. She has worked with her co-editor Dr. FitzGerald at the Quality Assurance Review Center for more than twenty-five years. She writes and edits manuscripts, books, grants, and other publications.
The discovery of radiation has enabled great healthcare advances as well as catastrophic injury. This paper reviews major historical incidents of public radiation exposure and the evolution of standards affecting today’s public and health care workers. Current patient care and response assessment to radiation exposure are reviewed. The strengths of modern radiation therapy and the need for continuous process improvements to ensure optimal patient care and secure safe environments are identified. The discovery of radiation has brought significant scientific achievements as well as catastrophic injury.
Part of the book: Essentials of Accident and Emergency Medicine
The discovery of radiation has led to many advances. Guidelines have been created to minimize radiation exposure and treatment management following both unintentional and intentional exposure. The effects of radiation exposure on specific tissues varies. Tragic consequences can result, ranging from severe, acute injury to long- lasting effects that present years after the initial exposure. In this chapter we provide observations that demonstrate the importance of understanding guidelines to minimize radioactive exposure and the expectations and treatment management following exposure. For the safety and well-being of patients, health care professionals need to remain well-informed to minimize the risks of this tool.
Part of the book: Trauma and Emergency Surgery
Technology and computational analytics are moving forward at an extraordinary rate with changes in patient care and department workflows. This rapid pace of change often requires initiating and maintaining the educational support at multiple levels to introduce technology to radiation oncology staff members. Modern physics quality assurance and dosimetry treatment planning now require expertise beyond traditional skill based in computational algorithms and image management including quality assurance of the process of image acquisition and fusion of image datasets. Expertise in volumetric anatomy and normal tissue contouring are skills now performed by physics/dosimetry in collaboration with physicians and these skills are required in modern physics dosimetry training programs. In this chapter, challenges of modern radiation planning are reviewed for each disease site. Skills including future applications of image integration into planning objects and the future utility of artificial intelligence in modern radiation therapy treatment planning are reviewed as these issues will need to be added to modern training programs.
Part of the book: Dosimetry
Clinical trials in radiation oncology are the best vehicle to optimize our strengths in therapeutic technology, define progress in our field, and improve patient outcome. Trials advance our knowledge in each disease site and provide us information to improve the radiation dose-volume for both tumor control and therapeutic sequelae to normal tissue. An increasing number of systemic and targeted therapies have been developed and are currently in early phase clinical trial design. Ultimately, these new therapies will need to be tested with standard-of-care therapy including radiation oncology. Therefore, during a study, it is essential that radiation therapy is delivered in a uniform and consistent manner for the credibility of the study. If the radiation therapy component of the study does not have a structure or management for maintaining therapeutic compliance, including a real-time data management strategy, it becomes difficult to trust the study outcome and apply the outcome to daily clinical practice. In this chapter, we review the strategy and process involved in the management of dosimetry in radiation oncology clinical trials and how this can impact clinical trial management, primary study endpoints, and the overall success of the study.
Part of the book: Advances in Dosimetry and New Trends in Radiopharmaceuticals
Radiation therapy remains a cornerstone in the clinical care of patients with medulloblastoma. Nevertheless, while treatment with radiation improves disease control, it is also associated with potential late effects impacting neurologic and neurocognitive function, pituitary function as well as hearing. The development of secondary, treatment-related malignancies is an uncommon but possible late outcome. In this chapter, we review the role of radiation therapy in medulloblastoma, as well as changes in management that have resulted both from technological therapeutic advancements and enterprising cooperative group clinical trials for this disease. Moreover, with increasing utilization of molecular diagnostics both for prognosis and stratification of treatment, we also endeavor to explore opportunities to further improve the delivery of radiation therapy to patients with varied risk of disease recurrence.
Part of the book: Medulloblastoma - Therapeutic Outcomes and Future Clinical Trials [Working title]
Medulloblastoma is the most common malignant brain tumor in children. Prognosis remains guarded in patients who at diagnosis are very young, have craniospinal metastatic disease, or after resection, have residual disease. Treatment incorporates chemotherapy and radiation therapy. Cancer survivors often have life-altering treatment effects. This chapter reviews clinical trials over the years and the efforts to improve survival and minimize sequelae along with challenges in performing clinical trials. Quality assurance of the radiation therapy provided worldwide monitors compliance. Advances in the risk stratification and targeted treatment based on the genomics and biology of medulloblastoma are highlighted in recent clinical trials. Through chemotherapy aligned with specific biomarkers, sophisticated radiation therapy strategies, and continued quality assurance, the future vision of managing medulloblastoma is presented.
Part of the book: Medulloblastoma - Therapeutic Outcomes and Future Clinical Trials [Working title]