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Purpose: This updated report on stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) is part of a series of consensus-based white papers previously published addressing patient safety. Since the first white papers were published, SRS and SBRT technology and procedures have progressed significantly such that these procedures are now more commonly used. The complexity and submillimeter accuracy, and delivery of a higher dose per fraction requires an emphasis on best practices for technical, dosimetric, and quality assurance. Therefore, quality and patient safety considerations for these techniques remain an important area of focus., Method: The American Society for Radiation Oncology convened a task force to assess the original SRS/SBRT white paper and update content where appropriate. Recommendations were created using a consensus-building methodology and task force members indicated their level of agreement based on a 5-point Likert scale, from "strongly agree" to "strongly disagree." A prespecified threshold of ≥75% of raters who select "strongly agree" or "agree" indicated consensus., Summary: This white paper builds on the previous version and uses of other guidance documents to broadly address SRS and SBRT delivery, primarily focusing on processes related to quality and safety. SRS and SBRT require a team-based approach, staffed by appropriately trained and credentialed specialists as well as significant personnel resources, specialized technology, and implementation time. A thorough feasibility analysis of resources is required to achieve the clinical and technical goals and thoroughly discussed with all personnel before undertaking new disease sites. A comprehensive quality assurance program must be developed, using established treatment guidelines, to ensure SRS and SBRT are performed in a safe and effective manner. Patient safety in SRS/SBRT is everyone's responsibility and professional organizations, regulators, vendors, and end-users must demonstrate a clear commitment to working together to ensure the highest levels of safety., (Copyright © 2022 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

In its current form, the Radiation Oncology Model (RO Model) prioritizes payment cuts over true value-based payment transformation. With significant modifications to the payment methodology, the reporting requirements, and recognition of the unique challenges faced by disadvantaged populations, the RO Model can protect patient access to care, preserve the physician-patient decision-making process, and ensure the delivery of high-quality, efficient radiation therapy treatment. The American Society for Radiation Oncology has spent several years advocating for a meaningful alternative payment model for radiation oncology and continues to push The Center for Medicare and Medicaid Innovation for changes to the RO Model that will recognize these key outcomes., Competing Interests: Constantine MantzEmployment: 21st Century Oncology Najeeb MohideenOpen Payments Link: https://openpaymentsdata.cms.gov/physician/41688 Nikhil G. ThakerEmployment: Arizona OncologyConsulting or Advisory Role: US OncologyPatents, Royalties, Other Intellectual Property: Software copyright for Python Programming Code for RO-APM Analysis Vivek KavadiEmployment: US Oncology Network Dave AdlerOther Relationship: American Society for Radiation OncologyNo other potential conflicts of interest were reported.

Purpose: Twitter is an increasingly popular social media platform within the health care community. The objective of this analysis is to characterize the profile of radiation oncology-related tweets and Twitter users over the past 6 years., Methods and Materials: Using the web-based social media analytics platform Symplur Signals, we filtered tweets containing at least 1 of the following hashtags or key words: #radonc, #radiationoncology, "rad onc," or "radiation oncology." We evaluated radiation oncology-related Twitter activity between October 2014 and March 2020 for tweet frequency, tweet content, and individuals or groups posting tweets. We identified the most influential Twitter users contributing to radiation oncology-related tweets., Results: From 2014 to 2020, the quarterly volume of radiation oncology-related tweets increased from 5027 to 29,763. Physicians contributed the largest growth in tweet volume. Academic radiation oncologists comprise 60% of the most influential Twitter accounts responsible for radiation oncology-related content. The number of radiation-oncology resident physicians on Twitter increased from 25 to 328 over the past 6 years, and 20% of radiation-oncology residency programs have a Twitter account. Seventy-one percent of radiation oncology-related tweets generated direct communication via mentions, and 59% of tweets contain links to external sources, including scientific articles., Conclusions: The number of physicians contributing radiation oncology-related Twitter content has increased significantly in recent years. Academic radiation oncologists are the primary influencers of radiation oncology-related Twitter activity. Twitter is used by radiation oncologists to both professionally network and discuss findings related to the field. There remains the opportunity for radiation oncologists to broaden their audience on Twitter to encompass a more diverse community, including patients., (Copyright © 2020 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

Objective: Stereotactic radiosurgery (SRS) represents an expanding approach for neurosurgeons and radiation oncologists. We evaluate educational gaps of senior residents drawn from each specialty as part of a focused SRS course. We also evaluate the strengths and limitations of SRS training in current residency programs of the course residents and faculty., Methods: The American Association of Neurological Surgeons and American Society of Radiation Oncology jointly held a senior resident course in SRS. Residents were nominated by program directors from across the United States. Thirty residents were chosen to participate in the course. The residents were surveyed before and after the course. Faculty (n = 14) were also surveyed to ascertain their perspectives on current training in SRS., Results: Most (96.7%) of the residents planned to perform SRS when finished, and 94% anticipated SRS indications to expand. Regarding SRS technique, 47% reported average/above average understanding of intracranial SRS; only 17% expressed similar understanding of spinal SRS. Before the course, 76.6% noted below average/average ability to recognize and manage SRS complications. Twenty-three percent of the faculty indicated that graduating residents from their programs were unprepared to perform radiosurgery. Residents' self-assessed understanding of brain SRS indication (P = 0.000693), SRS techniques (P = 0.000021), spinal SRS indications (P = 0.000050), spinal SRS techniques (P = 0.000019), and complication recognition and management (P = 0.00033) significantly improved following the course., Conclusions: Knowledge and training gaps in SRS appear evident to the senior residents and faculty of both specialties. We believe that other educational opportunities for SRS experience are necessary to optimize clinical competency, as well as meet future clinical staffing needs for this expanding, multidisciplinary approach. Further evaluation of gaps in SRS is necessary through a larger, nationwide survey of U.S. neurosurgeons, program directors, and residents., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Radiation therapy is an effective, personalized cancer treatment that has benefited from technological advances associated with the growing ability to identify and target tumors with accuracy and precision. Given that these advances have played a central role in the success of radiation therapy as a major component of comprehensive cancer care, the American Society for Radiation Oncology (ASTRO), the American Association of Physicists in Medicine (AAPM), and the National Cancer Institute (NCI) sponsored a workshop entitled "Technology for Innovation in Radiation Oncology," which took place at the National Institutes of Health (NIH) in Bethesda, Maryland, on June 13 and 14, 2013. The purpose of this workshop was to discuss emerging technology for the field and to recognize areas for greater research investment. Expert clinicians and scientists discussed innovative technology in radiation oncology, in particular as to how these technologies are being developed and translated to clinical practice in the face of current and future challenges and opportunities. Technologies encompassed topics in functional imaging, treatment devices, nanotechnology, and information technology. The technical, quality, and safety performance of these technologies were also considered. A major theme of the workshop was the growing importance of innovation in the domain of process automation and oncology informatics. The technologically advanced nature of radiation therapy treatments predisposes radiation oncology research teams to take on informatics research initiatives. In addition, the discussion on technology development was balanced with a parallel conversation regarding the need for evidence of efficacy and effectiveness. The linkage between the need for evidence and the efforts in informatics research was clearly identified as synergistic., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: To highlight 5 interventions that patients should question, as part of the Choosing Wisely campaign. This initiative, led by the American Board of Internal Medicine Foundation, fosters conversations between physicians and patients about treatments and tests that may be overused, unnecessary, or potentially harmful., Methods and Materials: Potential items were initially compiled using an online survey. They were then evaluated and refined by a work group representing the American Society for Radiation Oncology (ASTRO) Clinical Affairs and Quality, Health Policy, and Government Relations Councils. Literature reviews were carried out to support the recommendation and narrative, as well as to provide references for each item. A final list of 5 items was then selected by the ASTRO Board of Directors., Results: ASTRO's 5 recommendations for the Choosing Wisely campaign are the following: (1) Don't initiate whole-breast radiation therapy as a part of breast conservation therapy in women age ≥50 with early-stage invasive breast cancer without considering shorter treatment schedules; (2) don't initiate management of low-risk prostate cancer without discussing active surveillance; (3) don't routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases; (4) don't routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry; and (5) don't routinely use intensity modulated radiation therapy to deliver whole-breast radiation therapy as part of breast conservation therapy., Conclusions: The ASTRO list for the Choosing Wisely campaign highlights radiation oncology interventions that should be discussed between physicians and patients before treatment is initiated. These 5 items provide opportunities to offer higher quality and less costly care.

Intensity-modulated radiation therapy (IMRT) is a complex technique for the delivery of radiation therapy preferentially to target structures while minimizing doses to adjacent normal critical structures. It is widely utilized in the treatment of a variety of clinical indications in radiation oncology, including tumors of the central nervous system, head and neck, breast, prostate, gastrointestinal tract, and gynecologic organs, as well as in situations where previous radiation therapy has been delivered, and has allowed for significant therapeutic advances in many clinical areas. IMRT treatment planning and delivery is a complex process. Safe and reliable delivery of IMRT requires appropriate process design and adherence to quality assurance (QA) standards. A collaborative effort of the American College of Radiology and American Society for Therapeutic Radiation Oncology has produced a practice guideline for IMRT. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist, dosimetrist, and radiation therapist. Factors with respect to the QA of the treatment planning system, treatment-planning process, and treatment-delivery process are discussed, as are issues related to the utilization of volumetric modulated arc therapy. Patient-specific QA procedures are presented. Successful IMRT programs involve integration of many processes: patient selection, patient positioning/immobilization, target definition, treatment plan development, and accurate treatment delivery. Appropriate QA procedures, including patient-specific QA procedures, are essential to ensure quality in an IMRT program and to assure patient safety.