Medical Physics Community Surveys

The Surveys section hosted on our website is a repository of over 275 medical physics and dosimetry community surveys circulated through email distribution lists (MedPhys ListServ, MEDDOS, etc.) with rich data on clinically-relevant topics.

Easy access to responses from clinical physicists from community hospitals to academic centers can be helpful when starting a new technique, validating current methodologies, or simply observing trends in the field. We know it was helpful to us when we were in the clinic. To save others from digging through old emails (like we were doing), we individually categorized and tagged each survey so that the information you need is easy to locate.

In addition to hosting the surveys, we’re adding new category-based analysis cards, grouping relevant surveys to provide new graphical insights from the data. We’re also combining duplicate responses for a more complete and thorough understanding of community practices. We’ll be adding new surveys on a periodic basis—several times over the course of the year—to ensure the database remains up-to-date.

 

Simulation, Setup, and Treatment Verification

As little as 30 years ago, treatment planning in radiation oncology was performed using hand calculations of open fields to a point at depth. Plans did not consider internal structures or density changes, which allowed for little sparing of the surrounding tissue. Fast forward a few decades and hand calculations have been relegated to textbooks as a conceptual tool while computed tomography (CT) simulation has become the standard of care for treatment planning in external beam radiation therapy (EBRT). CT simulation forms the backbone of modern EBRT and allows for complex patient-specific plans to be created with high precision. This category addresses surveys related to the first segments of the radiation oncology workflow, encompassing patient simulation, setup, and treatment verification. Read now >

Treatment Planning

The first episodes of radiation therapy can be traced as far back as 1895—immediately following the discovery of x-rays—to the treatment of advanced breast cancer in Chicago resident Emil Grubbe. Treatment plans were based on empirical data, as very little was understood about the clinical application of x-rays. Developed over decades of clinical and scientific research, modern treatment planning techniques involve more sophisticated methods for achieving higher rates of tumor control via dose conformality and normal tissue sparing. Today, treatment planning encompasses the workflow occur ring between simulation and treatment. This survey card provides new contextual insights for surveys related to this rich topic. Read now >

Electrons, Brachy, VMAT and IMRT

Volumetric modulated arc therapy (VMAT), intensity-modulated arc therapy (IMRT), brachytherapy, and electrons are workhorses of radiation therapy. VMAT and IMRT use inverse planning methods to carefully shape incoming dose to maximize tumor control probability while minimizing the dose to adjacent healthy tissue. Brachytherapy uses radioactive sources to effectively target tissues, and electrons are ideal for superficial cancers due to their shallow depth of penetration. Together, these modalities provide a complement of tools for tackling the broad challenges encountered in radiation oncology. These surveys offer insights into the techniques, QA, calculations, and preferences from hundreds of clinicians on these topics. Read Now >

SRS/SBRT

SRS and SBRT are forms of highly precise, hypofractionated treatments that offer a number of advantages over conventional methods for small lesions: shorter overall treatment time, proven tumor control, and cost effectiveness. The extremely tight spatial margins are typically achieved through steep dose gradients, stereotactic target localization, and rigorous motion management through immobilization and/or IGRT. Ensuring highly accurate delivery is critical in reducing acute toxicity in the surrounding radiosensitive volumes and maintaining tumor control. In this card, insights on current techniques, QA procedures, and methods for starting a new program are gathered from the community to assist those looking to learn more. Read Now >

Breast Treatment

EBRT is used commonly in breast treatment cancer to reduce recurrence risk in post-operative procedures such as mastectomies and lumpectomies. Post-surgery, narrow tissue margins exist that increase risk for recurrence. EBRT offers the ability to target the tissues surrounding the surgical site, chest wall, lymph nodes, and tumors that cannot be surgically removed. Anatomically, treating the breast presents a problem due to its proximity of the heart to target tissues. In order to improve dose homogeneity and simultaneously avoid these radiosensitive organs, techniques such as parallel opposed tangents, 4D simulation, deep-inspiration breath-holds (DIBH), and immobilization devices are used. Here is a list of clinically relevant insights on the topic. Read more >

Prostate treatment

Prostate external beam treatment is routinely used in low to intermediate-risk prostate cancer due to its high tumor control. Recent studies have shown hypofractionation, including stereotactic body radiation therapy (SBRT), has improved tumor control, decreased treatment time, and improved efficiency and cost-effectiveness. Due to the escalation in fraction dose, localization of the target volume and intra-treatment motion management is critical to successful treatment. This is further confounded with motion concerns caused by rectal and bladder filling, which displaces surrounding tissue. Here is a compilation of surveys discussing techniques, standards, and methods for prostate treatment. Read more >

Commissioning and QA

Radiation therapy departments aim to deliver accurate, safe, high-quality treatment to their patients. In support of those efforts, professional guidelines have been created to provide a framework of standards for commissioning and QA, a process that establishes a baseline data set for clinical use. The accuracy of any treatment model is limited by the quality of the data used to create it and improper modeling can disrupt every workflow step downstream that utilizes these models.

For this reason, a comprehensive set of ongoing quality assurance (QA) tests ensure the functionality of these systems. QA is multi-faceted and is involved in many steps in the patient planning workflow from initial consultation to discharge. A list of relevant surveys detailing pertinent practicies in our field, from beam modeling to in vivo dosimetry, are posted here.

Clinical Workflow

Workflow is the lynchpin in any successful operation of any clinic. More generally, workflow takes a series of fragmented repeatable processes and consolidates them into one efficient system. In a clinical setting, that process begins at a patient’s initial consultation and ends with patient discharge and follow-up. When designing a workflow, an efficient clinic must consider everything from administrative objectives and employee responsibilities to risk reduction and regulatory nuances while enhancing patient experience.. For this reason, the clinical workflow survey topic represents the largest of the categories, touching on ideas about roles, responsibilities, and optimization through automation. Read more >

Have an idea for something else we should do with all these surveys? Let us know your thoughts. Drop a comment below with any feedback on the surveys or analysis.