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Similar to that in the Chernobyl nuclear accident, the occurrence of thyroid cancer in children was also feared following the Fukushima nuclear in Japan. Thyroid examination of children residing in the Fukushima Prefecture was performed quickly and nearly 200 cases or suspected cases of thyroid cancer have been reported. However, the thyroid glands of children evacuated from Fukushima and the hotspot area of Kanto have not been screened. Therefore, in response to requests from mothers outside Fukushima Prefecture, we started ultrasound examinations of the thyroid glands of children in October 2013. Since then, examinations have been performed annually until now. This report describes the results of these examinations performed through December 2017. The judgment standards for ultrasound examination of the thyroid gland were as indicated by Fukushima Prefectural University. Briefly, A1 judgment: without nodules or cysts, A2 judgment: with nodules measuring 5.0 mm or less or cysts measuring 20.0 mm or less, B judgment: nodules measuring 5.1 mm or more or cysts measuring 20.1 mm or more, and C judgment: requiring immediate secondary examination. Ultrasound examinations of the thyroid gland were conducted in the presence of family members and parents; in order to correctly convey the findings to the family, the findings were explained while viewing the images on the spot. Thyroid screening was conducted for residents of the Kanto hotspot for four years and a total of 8,171 people were examined. A1, A2, B, and C judgments were observed in 2,089 （25.6%）, 5,969 （73.1%）, 106 （1.3%）, and 7 persons （0.1%）, respectively. Nodules were noted in 226 patients （2.77%）. At the time of the nuclear accident, pediatric thyroid ultrasonography was performed in a total of 7,693 children under 18 years of age. A1, A2, B, and C judgments were observed in 1,922 （25%）, 5,735 （74.5%）, B 34 （0.4%）, and C two people （0.29%）, respectively, and nodules were observed in 125 people （1.62%）. The thyroid examinations were conducted annually by traveling through the hotspot. The number of A2 judgments increased each year, while the number of B judgments did not increase. There was also no increase in the number of C judgments. The results of screening in the Kanto hotspot area revealed that, contrary to the expectation based on reports after the Chernobyl nuclear accident, the frequent occurrence of childhood thyroid cancer was not observed.

BACKGROUND: The structure of radiation oncology in designated cancer care hospitals in Japan was surveyed in terms of equipment, personnel, patient load, and geographic distribution, and compared with the structure in other radiotherapy facilities and the previous survey. METHODS: The Japanese Society for Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2009. The structures of 365 designated cancer care hospitals and 335 other radiotherapy facilities were compared. RESULTS: Designated cancer care hospitals accounted for 50.0 % of all the radiotherapy facilities in Japan. The patterns of equipment and personnel in designated cancer care hospitals and the other radiotherapy facilities were, respectively, as follows: linear accelerators per facility: 1.4 and 1.0; dual-energy function: 78.6 and 61.3 %; three-dimensional conformal radiotherapy function: 88.5 and 70.0 %; intensity-modulated radiotherapy function: 51.6 and 25.3 %; annual number of patients per linear accelerator: 301.3 and 185.2; Ir-192 remote-controlled after-loading systems: 31.8 and 4.2 %; and average number of full-time equivalent radiation oncologists per facility: 1.8 and 0.8. Compared with the previous survey, the ownership ratio of equipment and personnel improved in both designated cancer care hospitals and the other radiotherapy facilities. Annual patient loads per full-time equivalent radiation oncologist in the designated cancer care hospitals and the other radiotherapy facilities were 225.5 and 247.6, respectively. These values exceeded the standard guidelines level of 200. CONCLUSIONS: The structure of radiation oncology in designated Japanese cancer care hospitals was more mature than that in the other radiotherapy facilities. There is still a shortage of personnel. The serious understaffing problem in radiation oncology should be corrected in the future.

The ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution was evaluated in order to radiation identify and improve any deficiencies. A questionnaire-based national structure survey was conducted from March 2010 to January 2011 by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). These data were analyzed in terms of the institutional stratification of the Patterns of Care Study (PCS). The total numbers of new cancer patients and total of cancer patients (new and repeat) treated with radiation in 2009 were estimated at 201,000 and 240,000, respectively. The type and numbers of systems in actual use consisted of Linac (816), telecobalt (9), Gamma Knife (46), (60)Co remote afterloading system (RALS) (29) and (192)Ir RALS systems (130). The Linac systems used dual energy function for 586 (71.8%), 3DCRT for 663 (81.3%) and IMRT for 337 units (41.3%). There were 529 JASTRO-certified radiation oncologists (ROs), 939.4 full-time equivalent (FTE) ROs, 113.1 FTE medical physicists and 1836 FTE radiation therapists. The frequency of interstitial radiation therapy use for prostate and of intensity-modulated radiotherapy increased significantly. PCS stratification can clearly identify the maturity of structures based on their academic nature and caseload. Geographically, the more JASTRO-certified physicians there were in a given area, the more radiation therapy tended to be used for cancer patients. In conclusion, the Japanese structure has clearly improved during the past 19 years in terms of equipment and its use, although a shortage of manpower and variations in maturity disclosed by PCS stratification remained problematic in 2009.

PURPOSE: To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. METHODS AND MATERIALS: In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). RESULTS: The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). CONCLUSIONS: ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.

The nonsurgical gold standard treatment for esophageal cancer is radiotherapy, but chemoradiation therapy using anticancer agents concurrently is becoming standard management. With chemoradiation adverse responses in the acute stage may be enhanced in comparison with conventional radiation therapy alone, but improved treatment outcomes are reported. A consensus has nearly been reached on the standard radiation technique and dose, and a guideline changes, but drug type, timing, and optimum dosage in chemoradiation are unclear. Further future study is thus necessary. In this report, recent trends in radiotherapy and chemoradiation are outlined and future problems described.