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Radiation therapy is an established form of therapy for breast cancer, often applied in an adjuvant setting delivered in a post-operative environment to volumes including the breast, surgical cavity, and regional lymph nodes when appropriate. Historically, radiation therapy has not been considered an option for care when the patient recurs with the disease despite being treated with radiation therapy in the adjuvant setting. However, there can be clinical circumstances that require a different approach to the care including comprehensive re-treatment with radiation therapy in highly selected situations. This paper reviewed two patients with clinical circumstances requiring consideration for re-treatment with radiation therapy and were successfully re-treated with an acceptable outcome.

Proton therapy is increasing in utilization worldwide at a rapid rate. With process improvements in costs, footprints, and continued advances in the delivery of care, including intensity modulation and image guidance, proton therapy may evolve into standard treatment with photon radiation therapy. This chapter reviews process improvements in proton therapy and the application in modern care.

The use of proton therapy in oncology is not a new idea. The unique physical properties of protons and potential advantages in radiation therapy were initially recognized in the 1940s. Since the first patients were treated in the 1950s, technology and clinical applications have evolved as evidenced by the increasing number of proton therapy centers and patients being treated throughout the world. This chapter will review the history of proton therapy providing a detailed overview of the cyclotron and synchrotron techniques used and how they have advanced with time.

Radiation therapy remains important in the modern management of both Hodgkin and non-Hodgkin lymphoma. Radiation is applied as both consolidation therapy post chemotherapy and primary therapy for selected limited volume clinically favorable histology. Application of modern therapy techniques permits more sparing of normal tissue in all anatomical locations. Modern image guidance permits both security in daily patient treatment set up and permits strategic titration of the planning target volume to further spare normal tissue. Four-dimensional planning makes certain targets are fully treated in all phases of the breathing cycle. Dose painting with altered fractionation permits identification of low, intermediate, and high-risk areas of concern and treat each in a single plan with multiple fractionation schemes saving both time of treatment and cost of therapy. In this paper we present multiple examples of the application of modern therapy techniques in lymphoma management and demonstrate advantages of modern radiation in several anatomical regions.

Radiation therapy has undergone an extraordinary transformation in treatment technology. Daily patient care is vastly different today than the past with less normal tissue in the treatment field and fewer acute sequelae during and immediately post therapy. It is anticipated that modern therapy will decrease acute effects during treatment. Modern primary care physicians and internal medicine/emergency physicians will encounter more patients in their practice who are survivors of therapy. In this paper we review current expectations for clinical sequelae of management and strategies to both identify and manage treatment effects moving forward including what is needed in the medical record for evaluation of late effects.

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.

Purpose: Nomograms once had a vital role in prostate brachytherapy practice. Although some of their functions have been assumed by computerized dosimetry, many programs still find them useful to determine the number and strength of seeds to be ordered in advance of the implant. As it has been demonstrated that brachytherapists differ in their implant practices and preferences (in regard to seed distribution and total implanted activity), we propose a simple technique for generating institution-specific nomograms. Material and methods: Using the data generated by previous implants, we demonstrate a simple technique, utilizing ubiquitous software, for generating nomograms to predict seed number, strength, and total implant activity. Results: Despite wide variations in the degree of post-implant swelling (+12% to +56%), nine of the first ten implants using the generated nomogram have met all target dose parameters. Conclusions: It is appropriate for each institution to develop nomograms specific to their prostate brachytherapy technique and constraints. Nomograms can estimate the number and strength of seeds to be ordered, and may partially compensate for the effects of implant-induced swelling. J Contemp Brachytherapy 2014; 6, 3: 293–296 DOI: 10.5114/jcb.2014.45582

The ever‐increasing data demands in a radiation oncology (RO) clinic require medical physicists to have a clearer understanding of information technology (IT) resource management issues. Clear lines of collaboration and communication among administrators, medical physicists, IT staff, equipment service engineers, and vendors need to be established. In order to develop a better understanding of the clinical needs and responsibilities of these various groups, an overview of the role of IT in RO is provided. This is followed by a list of IT‐related tasks and a resource map. The skill set and knowledge required to implement these tasks are described for the various RO professionals. Finally, various models for assessing one's IT resource needs are described. The exposition of ideas in this white paper is intended to be broad, in order to raise the level of awareness of the RO community; the details behind these concepts will not be given here and are best left to future task group reports. PACS number: 87.52.Tr, 87.53.St, 87.53.Xd, 87.90.+y

OBJECTIVE. The purpose of this article is to review the history of permanently implanted brachytherapy sources and to establish methods of identifying radon sources and discussing appropriate management.CONCLUSION. There are likely thousands of people bearing radon seeds that continue to emit radiation decades after implantation. They can be identified by clinical history and emission of characteristic x-rays. Surgical removal of these sources is rarely warranted.