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*Residency Program, Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York; yResidency Program, Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; zResidency Program, Radiation Oncology, University of Chicago Medical Center, Chicago, Illinois; xRadiation Oncology Residency and Fellowship Program, M. D. Anderson Cancer Center, Houston, Texas; jjResidency Program, Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut; {Residency Program, Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; and Residency Program, Harvard Radiation Oncology Program, Boston, Massachusetts

Background: Radiology is rapidly advancing, with a global transition to digital imaging technology to improve productivity and enhance communication. The major challenge confronting radiology practices is to demonstrate cost savings and productivity gains when a picture archiving and communication system (PACS) is established.Aim: To undertake an incremental cost analysis of PACS compared with conventional radiology to determine productivity gains, if any, at two private hospitals in Durban.Method: An incremental cost analysis for chest radiographs, computed tomography and magnetic resonance imaging brain scans with and without contrast were performed. The overall incremental cost for PACS in comparison with a conventional radiology site was determined. The net present value was also determined to evaluate the capital budgeting requirements for both systems.Results: The incremental cost of both capital and the radiology information system for installing PACS shows an expected increase. The incremental PACS image cost shows a reduction.Conclusion: The study provides a benchmark for the cost incurred when implementing PACS. It also provides a decision framework for radiology departments that plan to introduce PACS and helps to determine the feasibility of its introduction.

The South African Society of Paediatric Imaging (SASPI) is honoured to guest edit this special issue of the SA Journal of Radiology (SAJR) in celebration of the International Day of Radiology (IDoR) on 08 November, which is dedicated to paediatrics this year.

This paper presents the recommendations of the American Association of Physicists in Medicine (AAPM) and the European Society for Therapeutic Radiology and Oncology (ESTRO) on the dosimetric parameters to be characterized, and dosimetric studies to be performed to obtain them, for brachytherapy sources with average energy higher than 50 keV that are intended for routine clinical use. In addition, this document makes recommendations on procedures to be used to maintain vendor source strength calibration accuracy. These recommendations reflect the guidance of the AAPM and the ESTRO for its members, and may also be used as guidance to vendors and regulatory agencies in developing good manufacturing practices for sources used in routine clinical treatments.

Aims To document and explain self-reported practices of the radiotherapeutic management of breast cancer within different European regions. Methods An original survey questionnaire was developed to assess radiation oncologists' self-reported management of breast cancer. The questionnaire was distributed to physician members of the American Society for Therapeutic Radiology and Oncology and the European Society of Therapeutic Radiation Oncology. This paper presents the results of the comparative analysis of 702 responses from North America and 435 responses from Europe. Results Several areas of variation are identified. These include the selection criteria for post-mastectomy radiation and radiation for ductal carcinoma in situ (DCIS). Variations are also seen in the management of regional lymph nodes after lumpectomy, and radiation dose and fractionation. Conclusions Radiation oncologists within Europe vary in their self-reported practices for managing women with breast cancer. These differences may be rooted in deeper cultural differences and differences in the healthcare systems of different European countries. They may also reflect differences in the relative weight radiation oncologists place upon data generated within their own countries. These results support the need for co-operative group trials to provide evidence for more uniform treatment recommendations and policies.

Technologic advances have provided the means to deliver tumoricidal doses of radiation therapy (RT) to patients with unresectable hepatocellular carcinoma (HCC) while avoiding critical normal tissues, providing the opportunity to use RT for curative intent treatment of HCC. For the current report, the expanded role of external beam RT in the setting of HCC from palliation to cure was reviewed. A systematic literature search was undertaken using the MEDLINE data base and secondary references to identify peer-reviewed, English-language articles that reported clinical outcomes after external beam RT alone or in combination with other treatments for HCC. Abstracts from the 2005 American Society of Clinical Oncology, American Society for Therapeutic Radiology and Oncology, American Gastrointestinal Association, and Society of Surgical Oncology Gastrointestinal Cancer Symposium also were included in the search. More than 60 articles reporting on clinical outcomes among patients who received RT for HCC have been published since 1990, including 20 articles that described unique sets of at least 15 patients. RT was used for palliation, to improve local control, and with curative intent in a wide spectrum of patients who most often were unsuitable for surgery and other treatments. Pain reduction following RT was noted in approximately 75% of patients with bone metastases from HCC who received RT. For patients with liver-confined disease treated with conformal RT, proton beam RT, and/or image guided RT with or without transarterial chemoembolization (TACE), local control response rates ranged from 40% to 90%, and the median survival ranges from 10 months to 25 months. For patients with HCC who had portal vein thrombus, the median survival after RT to treat the thrombus and/or the hepatic tumor with or without TACE ranged from 5.3 months to 9.7 months. Although outcomes after high-dose conformal RT for liver-confined HCC were excellent, the potential survival benefit of RT should be tested in randomized controlled trials that require international collaboration.

Robert Kienböck was the first to identify and describe Kienböck's disease. Considered one of the early fathers of radiology, he was a prolific researcher who made an immense contribution to the early development of radiology. In addition to groundbreaking work in therapeutic radiology Kienböck had a special interest in diseases of the bones and joints, especially those that involved the hand. Kienböck's contribution to medicine, particularly the diagnosis of hand disorders, continues to resonate today.

The research grant awards data for 2003 published by the National Institutes of Health (NIH) were analyzed to obtain a snapshot of the current state of diagnostic radiology research in US medical schools. By considering awards to diagnostic radiology departments only, the authors show that NIH departmental rankings that combine diagnostic and therapeutic radiology departments together are deceptive for researchers interested primarily in diagnostic radiology. For each diagnostic radiology grant analyzed, the authors examined the source of funding, the primary modality involved in the research, the activity classification of the grant, and the degree of the associated principal investigator. Furthermore, the authors followed the funding for medical school radiology departments over the past several years to see if it kept up with the overall NIH budget. The data show that radiology research has exceeded the growth in academic medical research in general and highlight some areas of underfunded research.

Purpose: To perform a systematic review of the evidence to determine the efficacy and effectiveness of three-dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer; provide a clear presentation of the key clinical outcome questions related to the use of 3D-CRT in the treatment of localized prostate cancer that may be answered by a formal literature review; and provide concise information on whether 3D-CRT improves the clinical outcomes in the treatment of localized prostate cancer compared with conventional RT. Methods and Materials: We performed a systematic review of the literature through a structured process developed by the American Society for Therapeutic Radiology and Oncology’s Outcomes Committee that involved the creation of a multidisciplinary task force, development of clinical outcome questions, a formal literature review and data abstraction, data review, and outside peer review. Results: Seven key clinical questions were identified. The results and task force conclusions of the literature review for each question are reported. Conclusion: The technological goals of reducing morbidity with 3D-CRT have been achieved. Randomized trials and follow-up of completed trials remain necessary to address these clinical outcomes specifically with regard to patient subsets and the use of hormonal therapy.

There has been great interest in Europe in treating selected patients with early-stage breast cancer with accelerated partial breast irradiation (APBI) using interstitial brachytherapy. We review the results of these studies. Five early studies had local recurrence rates of 6% to 37%, reflecting suboptimal patient selection, target definition, and quality assurance procedures. Five more recent studies performed using much more stringent approaches have had recurrence rates of 0% to 7% with 84% to 92% of patients having excellent or good cosmetic results. The 3-year results of a single-institution phase III trial suggest that partial-breast brachytherapy performed in this manner yields local control that is very similar to that of whole-breast irradiation. Recently, a phase III multicenter protocol comparing these 2 modalities has been activated in Europe by the Breast Cancer Working Group of the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology. As data from this and other trials mature, they will address and refine issues of patient selection, target volume definition, total dose, and fractionation and hopefully support the implementation of APBI into routine clinical practice.

The surgical margin status after breast-conserving surgery is considered the strongest predictor for local failure. The purpose of this study is to survey how radiation oncologists in North America (NA) and Europe define negative or close surgical margins after lumpectomy and to determine the factors that govern the decision to recommend reexcision based on the margins status.A questionnaire was sent to active members of the European Society of Therapeutic Radiation Oncology and the American Society for Therapeutic Radiology and Oncology who had completed training in radiation oncology. Respondents were asked whether they would characterize margins to be negative or close for a variety of scenarios. A second survey was sent to 500 randomly selected radiation oncologists in the United States to assess when a reexcision would be recommended based on surgical margins.A total of 702 responses were obtained from NA and 431 from Europe to the initial survey. An additional 130 responses were obtained from the United States to the second survey regarding reexcision recommendations. Nearly 46% of the North American respondents required only that there be "no tumor cells on the ink" to deem a margin negative (National Surgical Adjuvant Breast and Bowel Project definition). A total of 7.4% and 21.8% required no tumor cells seen at1 mm and2 mm, respectively. The corresponding numbers from European respondents were 27.6%, 11.2%, and 8.8%, respectively (P0.001). Europeans more frequently required a larger distance (5 mm) between tumor cells and the inked edges before considering a margin to be negative.This study revealed significant variation in the perception of negative and close margins among radiation oncologists in NA and Europe. Given these findings, a universal definition of negative margins and consistent recommendations for reexcision are needed.

To document and explain the current radiotherapeutic management of invasive breast cancer in North America and Europe. We also identified a number of areas of agreement, as well as controversy, toward which additional clinical research should be directed.An original survey questionnaire was developed to assess radiation oncologists' self-reported management of breast cancer. The questionnaire was administered to physician members of the American Society for Therapeutic Radiology and Oncology and the European Society for Therapeutic Radiology and Oncology. We present the results of the comparative analysis of 702 responses from North America and 435 responses from Europe.Several areas of national and international controversy were identified, including the selection of appropriate candidates for postmastectomy radiation therapy (RT) and the appropriate management of the regional lymph nodes after mastectomy, as well as after lumpectomy. Only 40.7% and 36.1% of respondents would use postmastectomy RT in patients with 1-3 positive lymph nodes in North America and Europe, respectively. Sentinel lymph node biopsy was offered more frequently by North American than European respondents (p0.0001) and more frequently by academic than nonacademic respondents in North America (p0.05). The average radiation fraction size was larger in Europe than in North America (p0.01). European respondents offered RT to the internal mammary chain more often than did the North American respondents (p0.001). North American respondents were more likely to offer RT to the supraclavicular fossa (p0.001) and axilla (p0.01).Marked differences were found in physician opinions regarding the management of breast cancer, with statistically significant international differences in patterns of care. This survey highlighted areas of controversy, providing support for international randomized trials to optimize the RT management of invasive breast cancer.

To examine the self-reported practice patterns of radiation oncologists in North America and Europe regarding radiotherapy to the internal mammary lymph node chain (IMC) in breast cancer patients.A survey questionnaire was sent in 2001 to physician members of the American Society for Therapeutic Radiology and Oncology and European Society for Therapeutic Radiology and Oncology regarding their management of breast cancer. Respondents were asked whether they would treat the IMC in several clinical scenarios.A total of 435 responses were obtained from European and 702 responses from North American radiation oncologists. Respondents were increasingly likely to report IMC irradiation in scenarios with greater axillary involvement. Responses varied widely among different European regions, the United States, and Canada (p0.01). European respondents were more likely to treat the IMC (p0.01) than their North American counterparts. Academic physicians were more likely to treat the IMC than those in nonacademic positions (p0.01).The results of this study revealed significant international variation in attitudes regarding treatment of the IMC. The international patterns of variation mirror the divergent conclusions of studies conducted in the different regions, indicating that physicians may rely preferentially on evidence from local studies when making difficult treatment decisions. These variations in self-reported practice patterns indicate the need for greater data in this area, particularly from international cooperative trials. The cultural predispositions documented in this study are important to recognize, because they may continue to affect physician attitudes and practices, even as greater evidence accumulates.

Background and purpose: The European Society for Therapeutic Radiology and Oncology was funded by the EU for a project on recording providing education, and ameliorating the consequences of treatment (REACT). An European audit was carried out as part of which to assess the usefulness of current follow-up practices. Patients and methods: Over a 4-month period in 15 cancer centres in 10 countries, patients attending for routine follow-up completed a questionnaire covering their expectations of and satisfaction with the visit. This was matched with a questionnaire completed by the physician about the content and usefulness of the consultation. The feasibility of a short toxicity scale developed by Dische and Saunders was also investigated. Results: In total, 2303 matched questionnaires were analysed. Forty percent of the patients had symptoms or medical problems related to their disease. In 18% there was a positive finding on clinical examination. In 28% investigations were undertaken part of departmental routine practice. Ten percent of the investigations showed an abnormal result. Ninety nine percent of physicians and 85% of the patients expressed satisfaction. Using the short toxicity scale rates of recording toxicity could be increased from 28 to 93%. Conclusions: There is wide variation in follow-up practices among European centres. There was a low incidence of positive findings clinically or with routine investigations. A simple scale for recording morbidity has proved easy to use by departments, which have not routinely used one of the standard measures. Further work will attempt to produce an European guideline for effective routine follow-up after radiotherapy. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

JAMES M. GALVIN D.SC.,* GARY EZZELL, PH.D., AVRAHAM EISBRAUCH, M.D.,* CEDRIC YU, D.SC., BRIAN BUTLER, M.D.,* YING XIAO, PH.D., ISAAC ROSEN, PH.D., JULIAN ROSENMAN, M.D.,* MICHAEL SHARPE, PH.D., LEI XING, PH.D., PING XIA, PH.D., TONY LOMAX, PH.D., DANIEL A. LOW, PH.D., AND JATINDER PALTA, PH.D. *American Society for Therapeutic Radiology and Oncology IMRT Scope Committee; American Association of Physicists in Medicine IMRT Subcommittee of the Radiation Therapy Committee

This is the first report of the toxicity outcomes using dose level IV (74 Gy) on Radiation Therapy Oncology Group (RTOG) study 9406 for Stage T1-T2 prostate adenocarcinoma.A total of 262 patients were entered in this cooperative group, Phase I-II, dose-escalation trial of three-dimensional conformal radiotherapy for localized prostate carcinoma treated to a dose of 74 Gy (Level IV); 256 patients were analyzable for toxicity. A minimal dose of 2 Gy/fraction was prescribed to the planning target volume (PTV). Patients were stratified according to the risk of seminal vesicle invasion on the basis of the Gleason score and presenting prostate-specific antigen level. Group 1 patients had clinical Stage T1-T2 tumors with a seminal vesicle invasion risk of15%. Group 2 patients had clinical Stage T1-T2 tumors with a seminal vesicle invasion risk of/=15%. Patients in Group 1 were prescribed 74 Gy to a prostate PTV. Patients in Group 2 were prescribed 54 Gy to the prostate and seminal vesicles (PTV1) followed by a boost to the prostate only (PTV2) to 74 Gy. PTV margins between 5 and 10 mm were required. Elective pelvic radiotherapy was not used. The frequency of late effects of Grade 3 or greater was compared with that for a similar group of patients treated in RTOG studies 7506 and 7706, with length of follow-up adjustments made for the interval from therapy completion. A second comparison was made with 206 patients treated to dose level II (73.8 Gy in 1.8-Gy fractions) to see whether the fraction size affected toxicity.The average months at risk for late Grade 3+ toxicity after therapy completion were 28.9 and 23.9 months for Group 1 and 2, respectively. Acute toxicity at dose level IV (74 Gy) was remarkably low, with Grade 3 acute effects reported in only 1% of Group 1 and 3% of Group 2 patients. No Grade 4 or 5 acute toxicities were reported. Late toxicity continued to be low compared with RTOG historical controls. One patient in Group 1 and 4 patients in Group 2 experienced Grade 3 bladder toxicity. Two patients in Group 2 experienced Grade 3 bowel toxicity. No Grade 4 or 5 late effects were reported. The rate of late Grade 2 toxicity (any type) was 23% and 16% in Group 1 and 2, respectively. The observed rate of Grade 3 or greater late effects for Group 1 (1 case) was significantly lower (p0.0001) than the 18.5 cases that would have been expected from the historical control data. The observed rate for Group 2 (6 cases) was also significantly lower (p = 0.0009) than the 21.3 cases expected. No statistically significant difference was noted in the rate of acute or late toxicity in patients who were treated to 73.8 Gy at 1.8 Gy/fraction or 74 Gy at 2.0 Gy/fraction. Patients treated with the larger 2.0-Gy fractions tended to have more Grade 3 or greater toxicity than patients treated with 1.8-Gy fractions (2% vs. 1%, p = 0.09). The results after the longer follow-up with dose level II suggest these differences may increase with additional follow-up.Tolerance to three-dimensional conformal radiotherapy with 74 Gy in 2-Gy fractions remains better than expected compared with historical controls. The magnitude of any effect from fraction size requires additional follow-up.

Purpose: To provide a guideline curriculum covering theoretical and practical aspects of education and training for medical physicists in radiotherapy within Europe. Material and methods: Guidelines have been developed for the specialist theoretical knowledge and practical experience required to practice as a medical physicist in radiotherapy. It is assumed that the typical entrant into training will have a good initial degree in the physical sciences, therefore these guidelines also require that and are additional to it. National training programmes of medical physics, radiation physics and radiotherapy physics from a range of European countries and from North America were reviewed by an expert panel set up by the European Society of Therapeutic Radiology and Oncology (ESTRO) and the European Federation of Organisations for Medical Physics (EFOMP). A draft document prepared by this group was circulated, via the EFOMP infrastructure, among national professional medical physics societies in Europe for review and comment and was also discussed in an education session in the May 2003 EFOMP scientific meeting in Eindhoven. Results: The resulting guideline curriculum for education and training of medical physicists in radiotherapy within Europe discusses the EFOMP terms, qualified medical physicist (QMP) and specialist medical physicist (SMP), and the group's view of the links to the EU (Directive 97/43) term, medical physics expert (MPE). The minimum level expected in each topic in the theoretical knowledge and practical experience sections is intended to bring trainees up to the requirements of a QMP. The responses from the circulation of the document to national societies and its discussion were either to agree its content, with no changes required, or to suggest changes, which were taken into account after consideration by the expert group. Following this the guidelines have been endorsed by the parent organisations. Conclusions: This new joint ESTRO/EFOMP European guideline curriculum is a first step to harmonise specialist training of medical physicists in radiotherapy within Europe. It provides a common framework for national medical physics societies to develop or benchmark their own curricula, but is also flexible enough to suit different situations of initial physics qualifications, medical physics training programmes, accreditation structures, etc. The responsibility for the implementation of these standards and guidelines will lie with the national training bodies and authorities. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Purpose: We report the long-term prostate specific antigen relapse-free survival rates and predictors of biochemical outcome for patients 60 years or younger with prostate cancer treated with high dose conformal external beam radiotherapy.Materials and Methods: We retrospectively reviewed the records of 740 patients with prostate cancer treated with 3-dimensional conformal radiotherapy or intensity modulated external beam radiotherapy. Patients who also received androgen deprivation therapy were excluded from this analysis. Median radiation dose was 75.6 Gy and median followup was 88 months with a minimum followup of 24 months. Median followup for patients 60 years or younger in this report was 54 months (range 24 to 132). Biochemical failure was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology Consensus Panel.Results: Biochemical failure developed in 20 (21%) of the 96 men 60 years or younger, which was similar to the 22% failure rate ob...

Cataloged from PDF version of article. The purpose of this study was to demonstrate the use of a transrectal system that enables precise magnetic resonance (MR) image guidance and monitoring of prostate interventions. The system used a closed-bore 1.5-T MR imaging unit and enables one to take advantage of the higher signal-to-noise ratio achieved with traditional magnet designs, which is crucial for accurate targeting and monitoring of prostate interventions. In the first of the four canine studies, reliable needle placement, with all needles placed within 2 mm of the desired target site, was achieved. In two other studies, MR imaging was used to monitor distribution of injected contrast agent solution (gadopentetate dimeglumine mixed with trypan blue dye) in and around the prostate, thereby confirming that solution had been delivered to the desired tissue and also detecting faulty injections. In the final study, accurate placement and MR imaging of brachytherapy seeds in the prostate were demonstrated. The described system provides a flexible platform for a variety of minimally invasive MR image-guided therapeutic and diagnostic prostate interventions.

Among the areas defined by the National Cancer Institute as "Extraordinary Opportunities for Research Investment" that are highly relevant to the technology-oriented disciplines within the broad field of radiology are cancer imaging, defining the signatures (ie, underlying molecular features) of cancer cells, and molecular targets of prevention and treatment. In molecular target credentialing, a specific molecular target is imaged, the molecular signature is defined, a treatment is given, and the effect of the intervention on the image findings and the signature is then evaluated. Such an approach is used to validate the proposed target as a legitimate one for cancer therapy or prevention and to provide the opportunity to ultimately individualize therapy on the basis of both the initial characteristics of the tumor and the tumor's response to an intervention. Therapeutic radiation is focused biology (ie, radiation produces molecular events in the irradiated tissue). Radiation can (a) kill cancer cells by itself, (b) be combined with cytotoxic or cytostatic drugs, and (c) serve to initiate radiation-inducible molecular targets that are amenable to treatment with drugs and/or biologic therapies. Focused biology can be anatomically confined with various types of external beams and with brachytherapy, and it can be used systemically with targeted radioisotopes. These new paradigms link diagnostic imaging, radiation therapy, and nuclear medicine in unique ways by way of basic biology. It is timely to develop new collaborative research, training, and education agendas by building on one another's expertise and adopting new fields of microtechnology, nanotechnology, and mathematical analysis and optimization.

Adoption of the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus definition has been critical for evaluating and comparing outcome following treatment with radiation. However, since its almost universal adoption, several points have remained controversial, notably backdating the date of failure to the point midway between the posttreatment prostate specific antigen (PSA) nadir and the first increase. We evaluated the impact of backdating on no biochemical evidence of disease (bNED) control and suggest changes in the definition.Between April 1, 1989 and November 30, 1998, 1,017 patients with nonmetastatic prostate cancer were treated with 3-dimensional conformal radiation therapy alone. bNED control was defined using the ASTRO consensus definition. bNED failure was calculated from the time midway between the posttreatment PSA nadir and the first of the 3 consecutive increases in PSA (date of failure A). Four alternate failure time points were chosen, including backdating to the date of the first increase in PSA after the nadir, the date between the first and second consecutive PSA increases, the date between the second and third consecutive PSA increases, and the date of the third increase in PSA after the nadir (dates of failure 1 to 4). Kaplan-Meier estimates were calculated for all definitions of failure as well as hazard functions with time. Subset analyses based on prognostic group and followup time were also performed.The 10-year Kaplan-Meier bNED control rates were 64%, 52%, 47%, 42% and 39% using dates of failure A and 1 to 4, respectively. These differences persisted when patients were stratified by prognostic group. These same differences in bNED control were observed for the long-term followup subset, in which 10-year bNED control rates were 48%, 47%, 44%, 41% and 39% using dates of failure A and 1 to 4, respectively.Adoption of the ASTRO consensus definition has been crucial for evaluating outcome in the radiation oncology community. However, the date of failure should be moved from the current point to one closer to the point at which failure is declared. Additional analysis with large numbers of patients from multiple institutions is necessary to determine the point.

Combination high dose rate brachytherapy (HDRB) and external beam radiation therapy is technically and clinically feasible as definitive treatment for localized prostate cancer. We report the first large Australian experience using this technique of radiation dose escalation in 82 patients with intermediate- and high-risk disease. With a median follow up of 3 years (156 weeks), complications were low and overall prostate-specific antigen progression-free survival was 91% using the American Society for Therapeutic Radiology and Oncology consensus definition. The delivery of hypofractionated radiation through the HDRB component shortens overall treatment time and is both biologically and logistically advantageous. As a radiation boost strategy, HDRB is easy to learn and could be introduced into most facilities with brachytherapy capability.

No abstract available.

This is a pilot study that aims to elucidate regional disparities in the distribution of medical resources in Japan. For this purpose, we employed the Gini coefficient (GC) in order to analyze the distribution of radiotherapy resources, which are allocated to each prefecture in Japan depending on the size of its population or physical area. Our study used data obtained from the 2005 and 2007 national surveys on the structure of radiation oncology in Japan, conducted by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). Our analysis showed that the regional disparities regarding the radiation oncologists and radiotherapy technologists were small, and concluded that such resources were almost equitably distributed. However, medical physicists are inequitably distributed. Thus, policymakers should create and implement measures to train and retain medical physicists in areas with limited radiotherapy resources. Further, almost 26% of the secondary medical service areas lacked radiotherapy institutions. We attribute this observation to the existence of tertiary medical service areas, and almost all of prefectures face a shortage of such resources. Therefore, patients' accessibility to these resources in such areas should be improved.

Apart from assessment of spinal trauma, the diagnostic yield from radiography of the spine is limited.CT and MRI are now the main modalities for diagnosis of spinal disease.In spinal trauma, thin section CT with multiplanar reformations allows comprehensive assessment of bony injury. MRI is required for assessment of associated soft tissue injury.Degenerative disc disease is common. MRI is the definitive first line investigation, demonstrating associated thecal and/or root compression.Heavy T2 weighted images may diminish detection of cord lesions.Vertebroplasty is a useful alternative to spinal fixation in patients with osteoporotic collapse.

Purpose: Forty percent of all patients referred for radiotherapy are treated with palliative intent. The American Society for Therapeutic Radiology and Oncology (ASTRO) has recently emphasized the importance of radiation oncologists being skilled in the field of symptom control and palliative care (SCPC). The purpose of this study was to determine the number of abstracts relating to SCPC presented at the annual ASTRO meetings. Methods and Materials: The number of SCPC abstracts presented at ASTRO meetings between 1993 and 2000 was counted. Abstracts were included if they described populations with advanced or metastatic cancer for whom the goal of treatment was symptom palliation. The treatment sites and symptoms palliated were recorded. Results: Of 3511 abstracts presented at ASTRO between 1993 and 2000, an average of 47 (1.3%, range 0.9–2.2%/y) were related to SCPC. The most common treatment sites were bone, brain, and lung. Pain, bleeding, and neurologic and pulmonary symptoms were the ones most commonly palliated. Thirty-two percent of the SCPC abstracts involved randomized controlled trials, 47% had palliation of symptoms as a secondary treatment outcome, and in 21%, the symptomatic treatment outcome was not specifically stated. Conclusion: SCPC research has been poorly represented at the annual ASTRO meetings. Education and research in this field needs to be actively encouraged, because SCPC is an important component of a radiation oncologist's role in comprehensive patient care.

Purpose: We determined the biochemical failure rate in patients 60 years and younger, and older than 60 years old who were treated with external beam radiation for localized prostate cancer or locally advanced prostate cancer. We also evaluated prognostic factors in the 2 age groups.Materials and Methods: We reviewed the medical records of 964 patients who received full dose radiotherapy as the only treatment for prostate cancer. Followup prostate specific antigen was measured 3 to 6 months after the completion of radiotherapy and every 3 to 6 months thereafter. Biochemical failure was defined using the criteria established by the American Society for Therapeutic Radiology and Oncology Consensus Panel. Median followup in the whole study group was 48 months.Results: Of the 98 men 60 years or younger 46 (47%) had biochemical failure, whereas 261 (30%) of the 866 older than 60 years old had biochemical failure. The 5 and 7-year biochemical disease-free survival rates were 55% and 47% in the younger men, and ...

No abstract available.

a Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; c Division of Applied Molecular Oncology, Ontario Cancer Institute, Toronto Canada; d Gray Institute for Radiation Oncology and Biology, Oxford University, Oxford, United Kingdom; e Division of Cell Biology, National Cancer Institute, Bethesda, Maryland; and f Radiation Research Program, Division of Cancer Treatment & Diagnosis, National Cancer Institute, Bethesda, Maryland

Musculoskeletal radiology in South Africa has shown significant growth in the last decade. This was achieved through advanced educational programmes, international input and significantly improved imaging techniques and equipment - which in turn has enabled musculoskeletal (MSK) radiologists to offer an improved service to referring physicians.

Background: To study the pattern of patient load, personnel and equipment resources from 30-years experience in Southern Thailand. Materials and Methods: This retrospective study collected secondary data from the Division of Therapeutic Radiology and Oncology and the Songklanagarind Hospital Tumor Registry database, Faculty of Medicine, Prince of Songkla University, during the period of 1982-2012. Results: The number of new patients who had radiation treatment gradually increased from 121 in 1982 to 2,178 in 2011. Shortages of all kinds of personnel were demonstrated as compared to the recommendations, especially in radiotherapy technicians. In 2011, Southern Thailand, with two radiotherapy centers, had 0.44 megavoltage radiotherapy machines (cobalt or linear accelerator) per million of population. This number is suboptimal, but could be managed cost-effectively by prolonging machine operating times during personnel shortages. Conclusions: This study identified a discrepancy between workload and resources in one medical school radiotherapy center in Southern Thailand. This information is crucial for future strategic planning both regionally and nationally.

The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists,and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance thescience of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encouragecontinuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields.The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to helpadvance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters andtechnical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated.Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensusprocess in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safeand effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document.Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is notauthorized.?

Endovascular brachytherapy is a new, rapidly growing field of interest in radiotherapy for the prevention of neointimal hyperplasia after angioplasty in both coronary and peripheral arteries. Many physics aspects of these treatments have already been addressed in the report of the American Association of Physicists in Medicine task group on 'Intravascular brachytherapy', but up to now there are no generally accepted recommendations for recording and reporting radiation doses and volumes. The terminology to be used by all individuals involved in such treatments (radiation oncologists, physicists, and interventionalists) is not clearly defined. The Endovascular Groupe Europeen de Curietherapie/European Society for Therapeutic Radiology and Oncology Working Group in this document presents recommendations for a common language for general use in endovascular brachytherapy. This proposal addresses general terms and concepts for target and dose specification as well as detailed recommendations for dose prescription, recording and reporting in endovascular brachytherapy for both peripheral and coronary arteries. Additionally, quality assurance and radiation safety aspects are briefly addressed, as are aspects related to equipment, personnel, and training and education related to endovascular brachytherapy.

Background Recently, as the number of elderly people in Japan is growing, so is the number of new cancer cases. The number of patients treated with radiotherapy is therefore also on the increase, so that it is important to estimate the future demand for radiotherapy and to make preparations for it. Methods All the surveys were conducted for 106 facilities selected randomly out of 556 radiotherapy facilities in Japan. To obtain trends in the number of new cancer patients treated with radiotherapy in Japan, we conducted a survey with a self-administered mail questionnaire designed to obtain the number of new patients treated with radiotherapy for each year of the past decade (1990-99). The future number of new patients treated with radiotherapy was estimated from the data thus obtained. To investigate structural problems of Japanese radiotherapy, surveys about the number of treatment machines and full-time equivalent (FTE) radiation oncologists were conducted according to data from the Japanese Society for Therapeutic Radiology and Oncology (JASTRO) structure survey and the Patterns of Care Study (PCS). We also compared the structure of Japanese radiotherapy with that in the USA. Results The number of patients treated with radiotherapy has increased for every institutional stratum, with an overall increase of 1.4-fold over the past 10 years in Japan. It is estimated that the number of cancer patients treated with radiotherapy will reach 190 000 in 2015. In Japanese non-academic institutions, less than one FTE radiation oncologist has been managing many of these patients. In both equipment and manpower, academic institutions exceed nonacademic institutions. Conclusion The future demand for Japanese radiotherapy will grow substantially, so that it is of vital importance to prepare for it. Specifically, the number of FTE radiation oncologists must be increased.

The 2010 Multidisciplinary Head and Neck Cancer Symposium was held in Arizona on February 25–27, 2010 and sponsored by the American Head and Neck Society, American Society of Clinical Oncology, American Society for Therapeutic Radiology and Oncology, and Society of Nuclear Medicine. Expertise from various fields spanned topics that included diagnosis and management of skull-base malignancies; discovery and integration of biomarkers in clinical trials; organ preservation and functional outcomes; patient-centered care initiatives; functional imaging for head and neck cancer; and the treatment of recurrent disease. This meeting was informative and provocative in reporting the latest advances in the management of head and neck cancer. It provided the opportunity to gather expertise for interdisciplinary discussion and especially illustrated the challenges in managing these complex and heterogeneous diseases.

No abstract available.

Six departments of radiology and six departments of radiation oncology from areas with low, medium, or high managed care penetration were asked to complete a questionnaire designed to address the impact of managed care on research and scholarly activity. Information, when available, was taken from fiscal years 1993 and 1998. Questionnaires were followed by site visits to the 12 departments. The study showed that departments with medium to high managed care penetration reported more dissatisfaction in their ability to remain active in their education and research goals. Results indicated that for the period surveyed, the departments needed to increase clinical time to make up for decreasing patient care revenues. In turn, this has reduced the time and money devoted to scholarly activities. Information from this study will be used to develop a trends database for all U.S. radiology and radiation oncology departments. This, together with a more comprehensive study by the RSNA, will assist in measuring the current and potential long-term impact of managed care and other system changes on the practice of radiology and radiation oncology.

No abstract available.

C'est sous le soleil du Texas et dans un palais des congres refait a neuf que la ville de San Antonio a accueilli la 41e reunion de l'American Society for Therapeutic Radiology and Oncology (ASTRO). Comme chaque annee, nous nous sommes attaches a presenter les communications les plus interessantes mais les lecteurs pourront completer leurs recherches par la lecture du supplement du n∘ 3 du volume 45 de l'International Journal of Radiation and Oncology Biology and Physics.