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Purpose: Prior research suggests that patient education materials on radiation therapy from various professional groups are written at reading levels above national recommendations of sixth to eighth grade. Since publication of these initial findings, many materials from these sources have been updated or newly created. However, the extent to which readability was considered in the design of these new documents remains unknown. Therefore, the goal of this investigation was to evaluate readability of online education materials for radiation therapy, comparing readability of updated materials with those included in the previous study., Methods and Materials: Patient education materials related to radiation oncology were identified from websites of the 3 professional societies used in the original investigation (the American College of Radiology, the American Cancer Society, and the American Society for Radiation Oncology). The documents included in the first analysis were used as a comparator. To allow for accurate evaluation across groups, materials were matched by content; when necessary, documents were combined from the original cohort to create topically equivalent materials to reflect those currently available on society websites. Identified materials were analyzed using 7 validated readability indices, and results are reported in grade-level equivalents. Original materials were also reanalyzed with the same method., Results: American Cancer Society materials had the lowest average baseline levels (9.4-11.3 grade level) and showed improved readability in the more recent materials (8.0-10.5 grade level). By contrast, the American Society for Radiation Oncology materials had high average baseline readability levels (11.1-13.9 grade level) that actually worsened in the more recent materials (11.7-16.2 grade level). The number of documents meeting national recommendations did not improve in the updated cohort., Conclusion: Despite evidence that readability levels of patient education materials in radiation oncology are unacceptably high, the readability of newly created materials is not consistently improving across professional societies. Although certain groups may incorporate readability in the design of educational documents, more consistent consideration across all organizations is needed., (Copyright © 2019 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

Purpose: Precise patient positioning is critical due to the large fractional doses and small treatment margins employed for thoracic stereotactic body radiation therapy (SBRT). The goals of this study were to evaluate the following: (1) the accuracy of kilovoltage x-ray (kV x-ray) matching to bony anatomy for pretreatment positioning; (2) the magnitude of intrafraction tumor motion; and (3) whether treatment or patient characteristics correlate with intrafraction motion., Methods and Materials: Eighty-seven patients with lung cancer were treated with SBRT. Patients were positioned with orthogonal kV x-rays matched to bony anatomy followed by cone-beam computed tomography (CBCT), with matching of the CBCT-visualized tumor to the internal gross target volume obtained from a 4-dimensional CT simulation data set. Patients underwent a posttreatment CBCT to assess the magnitude of intrafraction motion., Results: The mean CBCT-based shifts after initial patient positioning using kV x-rays were 2.2 mm in the vertical axis, 1.8 mm in the longitudinal axis, and 1.6 mm in the lateral axis (n = 335). The percentage of shifts greater than 3 mm and 5 mm represented 39% and 17%, respectively, of all fractions delivered. The mean CBCT-based shifts after treatment were 1.6 mm vertically, 1.5 mm longitudinally, and 1.1 mm laterally (n = 343). Twenty-seven percent and 10% of shifts were greater than 3 mm and 5 mm, respectively. Univariate and multivariable analysis demonstrated a significant association between intrafraction motion with weight and pulmonary function., Conclusions: Kilovoltage x-ray matching to bony anatomy is inadequate for accurate positioning when a conventional 3-5 mm margin is employed prior to lung SBRT. Given the treatment techniques used in this study, CBCT image guidance with a 5-mm planning target volume margin is recommended. Further work is required to find determinants of interfraction and intrafraction motion that may help guide the individualized application of planning target volume margins., (Copyright © 2013 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)