Radiation Medicine Commons^™

Software Tools And Simulation Exercises For Radiation Oncology Cyber-Attack Resiliency, Yevgeniy Vinogradskiy, James Lamb

Department of Radiation Oncology Faculty Papers

This review summarizes the rationale for radiation oncology cyberattack simulation exercises, recent results from multi-institutional resiliency drills, and the landscape of software tools developed to help clinics resume radiotherapy treatments rapidly and safely during a cyberattack or other major clinical software outage. Simulation exercises using record-and-verify (R&V) downtime and File Mode treatment delivery have identified failure modes not apparent in theoretical planning alone, including risks related to treatment documentation, repeated fractions, patient setup, and missed safety checks. Available software tools emphasize insulated backup of DICOM-format planning data and clinical notes, treatment-state dashboards, File Mode treatments, redundant R&V installations, and human-readable …

Ai-Driven Segmentation And Volumetric Response Modeling Of Liver Regions To Radiotherapy, Aashish Chandra Gupta

Dissertations and Theses (Open Access)

In liver-directed radiotherapy (RT), liver regions receiving higher doses typically undergo atrophy while contralateral/adjacent lower-dose regions may exhibit compensatory hypertrophy through regeneration of healthy tissue. Optimizing the RT plan to promote regional hypertrophy while minimizing the risk of developing atrophy has the potential to enhance post-RT liver function and long-term survivorship. However, current clinical practice largely relies on global liver dose-volume metrics during RT-planning, which may obscure favorable dose-response correlation and limit actionable guidance for clinicians. Therefore, we hypothesized that post-RT regional liver response is governed by a combination of region-specific dose-volume and patient clinical features, and that these responses …

Feasibility Evaluation Of Tumor Treating Fields For Brainstem Gliomas, Anthony Chen, Ryan Shah, William Shi, Noa Urman, Nadav Shapira, Nicholas Avgeropoulos, Patrick Conlon, Neil Mookerjee, Wenyin Shi

Department of Radiation Oncology Faculty Papers

PURPOSE: Tumor treating fields (TTFields) are FDA-approved for supratentorial glioblastoma, but feasibility in infratentorial tumors remains poorly defined. This simulation study evaluated TTFields dose in brainstem gliomas using patient-specific modeling with scalp-only transducer arrays.

METHODS: MRI and CT imaging from seven patients with brainstem gliomas were used for TTFields planning with MAXPOINT® (Novocure, Switzerland). Clinical target volume (CTV) was defined as enhancing tumor on T1 post-contrast MRI (Gross tumor volume, GTV) plus a 3 mm peritumoral expansion. The platform optimized scalp-only array layouts, and finite element calculations generated maps of local minimum field intensity (LMiFI, V/cm) and local minimum power …

Long-Term Quality Of Life For Patients With Merkel Cell Carcinoma Receiving Standard-Of-Care Adjuvant Radiation Therapy, Christian Paul D. Denolan, Kelsey N. Nordlund, Aya F. Salem, Devarati Mitra

Summer Research Program Abstracts

No abstract provided.

Fractionated Stereotactic Radiotherapy (Fsrt) For Symptomatic Who Grade 1 Cavernous Sinus Meningiomas: Long-Term Local Control, Clinical Response, And Toxicity Outcomes, Ryan Shah, Shray Jain, Nilanjan Haldar, Lauren A. Holt, Robert Walker, Christopher J Farrell, Md, Debanjan Haldar, James J. Evans, Gregory S. Alexander, Wenyin Shi

Department of Radiation Oncology Faculty Papers

PURPOSE: Cavernous sinus meningiomas represent a significant clinical challenge, given the high prevalence of neurological deficits and limited surgical options. Radiation therapy is often the preferred treatment. This study evaluates the effectiveness of fractionated stereotactic radiation therapy (fSRT) in achieving local control and symptomatic relief in patients with cavernous sinus meningiomas.

METHODS: This is a single-institution retrospective analysis of patients with symptomatic presumed WHO grade 1 cavernous sinus meningiomas treated with fSRT (1.8-2 Gy per fraction). Clinical data were collected by chart review. Kaplan-Meier curves were generated to assess local control. Clinical responses were evaluated for symptom improvement, stability, or …

Folr1-Targeted Actinium-225-Based Alpha-Particle Therapy Eliminates Ovarian Cancer, Neetu Singh, Esther Need, Ayden Berndt, Matthew Goff, Lydia J. Wilson, Firas Mourtada, Feng Guo, Tara Mastren, Taslim Al-Hilal, Anil K. Sood, Amit Maity, Scott C. Miller, Satoshi Minoshima, Shreya Goel, Sixiang Shi

Department of Radiation Oncology Faculty Papers

Despite the advancement in therapies, ovarian cancer treatment is challenging because of poor prognosis and high relapse associated with acquired resistance. Emerging targeted alpha particles, particularly actinium-225 (225Ac), for treating refractory cancers have opened avenues for improved therapeutic options. Here, we describe a successful example of folate receptor 1 (FOLR1)–targeted 225Ac alpha-particle therapy for treatment of ovarian cancer. Longitudinal positron emission tomography imaging demonstrated high tumor-specific uptake of αFOLR1 (anti-FOLR1 antibody) in SKOV3 xenografts. FOLR1-targeted 225Ac demonstrated high therapeutic efficacy, achieving marked tumor regression, 80% survival, and 40% complete tumor elimination. The therapy resulted in tumor-specific double-stranded DNA damage, and …

A Multimodal Artificial Intelligence Model To Guide Use Of Whole-Pelvic Radiation Therapy In Patients With Localized Prostate Cancer: Exploratory Analysis Of Rtog 9413, Mutlay Sayan, Huei-Chung Huang, Erin L. Stewart, Timothy N. Showalter, Adam P. Dicker, George Daniel Grass, Elizabeth M. Gore, Andrew Michael Mcdonald, J. Daniel Pennington, Mark A. Hallman, Igor J. Barani, I-Chow Hsu, Michael Rooney, Stephanie L. Pugh, Paul L. Nguyen, Phuoc T. Tran, Mack Roach Iii

Department of Radiation Oncology Faculty Papers

Background/Objectives: This study explored whether a multimodal artificial intelligence (MMAI) model integrating digitized histopathology and clinical features can identify prostate cancer patients who may benefit from neoadjuvant hormonal therapy (NHT) and whole-pelvic radiotherapy (WPRT). Methods: This secondary analysis of NRG/RTOG 9413 included NHT-treated patients with digitized biopsy slides and clinical data who were not part of the MMAI model optimization. A previously validated MMAI model estimated long-term risk, and Fine-Gray models evaluated interactions between MMAI-derived scores and the radiation field (WPRT vs. prostate-only RT [PORT]) for biochemical failure (BF), chosen over progression-free survival because of extended follow-up and distant metastasis …

Celiac Plexus Radiosurgery For Retroperitoneal Pain In Advanced Cancer: A Pre-Specified Secondary Analysis Of Health-Related Quality Of Life In A Phase Ii Single-Arm Trial, Aisling Barry, Ronen Fluss, Laura Dawson, David Hausner, Michael Buckstein, Talia Golin, Laurence Freedman, Marcin Miszczyk, Dayssy Diazpardo, Artur Aguiar, Dror Limon, Raphael Pfeffer, Moaz Ben-Ayun, Liat Hammer, Ziv Symon, Ofir Morag, Gali Jacobson, Adam Dicker, Jerzy Wydmanski, Camilla Zimmermann, Yaacov Lawrence

Department of Radiation Oncology Faculty Papers

BACKGROUND: Retroperitoneal pain syndrome seen in pancreatic cancer is a major clinical challenge. Celiac plexus radiosurgery, a new palliative technique for retroperitoneal pain syndrome, decreased pain levels in a phase II study. Here Health-Related Quality of Life (HRQOL) outcomes are reported.

METHODS: Evaluable patients, who were enrolled between January 2018 and December 2021, in an international single-arm Phase II ethics-approved study (NCT03323489), were included. The pre-specified secondary endpoint-change in HRQOL from baseline to 3- and 6-weeks post-treatment, was measured by the Functional Assessment of Cancer Therapy - Hepatobiliary (FACT-Hep) version 4 questionnaire. Mean change was deemed clinically significant (CS) if …

Influence Of Background Music On Proton Dose Monitors, Julia Colangeli, Rachel Felder, Nicole Geer, Favour Ihenwe, Shermineh Roodi, Sandra John Baptiste

Research Methods Poster Session 2026

This study examines the effects of background music, particularly varying bass frequencies, on dose monitor accuracy in proton therapy using the Hitachi PROBEAT-FR proton accelerator.

Predicting Ventilation From Single Breathing Phase Non-Contrast Ct Using Swin Transformers, Yi-Kuan Liu, Hsu-Ting Kuo, Alaa Melek, Richard Castillo, Yevgeniy Vinogradskiy, Lili Zhao, Girish Nair, Edward Castillo

Department of Radiation Oncology Faculty Papers

BACKGROUND: Pulmonary ventilation imaging enables functional avoidance radiotherapy treatment plans by quantifying regional lung function. However, current clinical standards, such as 99𝑚Tc-based single-photon emission computed tomography (SPECT), rely on radioactive tracers, which can introduce imaging deposition artifacts. CT ventilation imaging (CTVI) methods based on both physical models and deep learning approaches currently require multiple CT images as input, such as the inhale/exhale phases of a 4DCT. While the theoretical foundation of physics-based CTVI is built on multi-phase information, the feasibility of single-phase deep learning CTV models has not been determined.

PURPOSE: While deep learning methods have predicted SPECT ventilation from …

Computed Tomography For Four-Dimensional Dose Calculation: Effect Of Detector Array Length, Inhwan Yeo, Qianyi Xu

Department of Radiation Oncology Faculty Papers

PURPOSE: Four-dimensional computed tomography (4DCT) is susceptible to a geometrical error when respiration changes upon patient shift. 4DCT using 16-cm detector arrays, not needing the shift, has been shown to improve geometrical accuracy, compared with a conventional 4DCT (4-cm array), albeit with some Hounsfield unit discrepancies. The 4DCTs were validated for 4D planning.

MATERIALS AND METHODS: A lung-mimicking phantom containing a spherical target with ten respiratory traces and three tumor-shaped targets with their traces was respectively imaged when, to each of the ten-positions/phases, the lung was moved (1) step-wisely by helical scan at each movement (ground truth; 4DCT_GT), …

Prescription Tradeoff Decision Support For Pancreas Stereotactic Body Radiation Therapy: From Templates To Artificial Intelligence Models, Yibo Xie, Manisha Palta, Ruilin Li, Wentao Wang, Qiuwen Wu, Yaorong Ge, Q. Jackie Wu, Yang Sheng

Department of Radiation Oncology Faculty Papers

Objective: To develop an artificial intelligence (AI) driven plan tradeoff decision making assistant for radiation oncologists. Methods: A user interface (UI) was developed to integrate the assistant with the treatment planning system to facilitate prescription decision process. The assistant is powered by a machine learning core which was trained to learn the balance between planning target volume (PTV) coverage and organs-at-risk (OAR) sparing. A group of 98 pancreatic stereotactic body radiation therapy (SBRT) cases were retrospectively included for this study. The clinical plan's PTV coverage was compared against the model predicted value. A 10-fold cross validation was performed for all …

A Mitochondrial Plasma Proteomic Signature Identifies Metastatic Chromophobe Renal Cell Carcinoma, Clara Steiner, Tiegang Han, Steven Safi, Wafaa Bzeih, Hadi Mansour, Eddy Saad, Jessica F. Williams, Vinay K. Giri, Liliana Ascione, Yehonatan Elon, Adam P. Dicker, Yan Tang, Toni K. Choueiri, Elizabeth P. Henske, Wenxin Xu

Department of Radiation Oncology Faculty Papers

BACKGROUND: Chromophobe renal cell carcinoma (ChRCC) is characterized by the accumulation of abnormal mitochondria, a high rate of mitochondrial DNA (mtDNA) mutations, and altered oxidative metabolism. There are no existing circulating biomarkers to distinguish metastatic ChRCC from clear cell renal cell carcinoma (ccRCC).

METHODS: High-throughput plasma proteomic profiling using the SomaScan platform was performed in 18 ChRCC (including 16 metastatic ChRCC) and 197 metastatic ccRCC patients. Data were harmonized to generate a unified 7K-protein matrix.

RESULTS: Differential expression analysis was performed using limma (version 3.62.2). Of 7272 quantified human plasma proteins, 209 were differentially expressed between ChRCC and ccRCC. Upregulated …

S6k1 Modulates Stat3 Activation To Promote Resistance To Radiotherapy In Lung Cancer, Ali Calderon-Aparicio, Noelle Francois, Tyler Grenda, Shan Xu, Olugbenga Okusanya, Jun He, Nicole L Simone

Department of Radiation Oncology Faculty Papers

Radiotherapy is a mainstay in the management of locally advanced lung cancer; however, intrinsic and acquired radioresistance contribute to poor prognosis. S6K1, a serine/threonine kinase, regulates cell growth, protein synthesis, and survival, and is increased in tumors, which is linked to enhanced survival under therapeutic stress, including radiation. The mechanisms, however, are not fully understood. This study investigates the role of S6K1 in lung cancer radioresistance and the mechanisms involved. Intrinsic radioresistance in lung cancer cells was associated with increased S6K1 activation. Pharmacologic inhibition or genetic deletion of S6K1 enhanced radiosensitivity both in vitro and in vivo, highlighting the therapeutic …

Evaluation Of The Intempo Path Set For Cyberknife Prostate And Lung Sbrt: A Single-Institution Experience, Yingcui Jia, Lei Fu, Shari Rudoler, Eric Gressen, Yevgeniy Vinogradskiy, Qianyi Xu

Department of Radiation Oncology Faculty Papers

PURPOSE: The InTempo adaptive imaging system is an important component of the Accuray CyberKnife System, designed to enhance the system's ability to track and correct tumor motion during treatment. However, a limitation of this feature is the reduction of available nodes for treatment planning. The impact of a reduced number of nodes on the quality of InTempo-based treatment plans has not previously been evaluated. This retrospective study aims to compare the dosimetry of CyberKnife plans with and without The InTempo path set for both prostate and lung stereotactic body radiotherapy (SBRT).

METHODS: This study included twelve consecutive prostate SBRT patients …

Comparing Educational Pathways For Denturists To Become Maxillofacial Prosthetic Specialists In The Us And The Uk, Minseok Kim

Oral Health

Abstract

In the absence of formal training, licensure, and professionalism, this scientific literature review will seek to include denturists in the American maxillofacial prosthetics industry. Denturists are oral health professionals who perform oral examination, design, manufacture, and place removable oral prostheses. In other regions of the world, they are also known as clinical dental technologists and dental prosthetists. This practice is not widespread in the US. The review can also be assessed on the model mediated by PRISMA, which is concentrated on the experiences of international education in the United Kingdom, Canada, and Australia, where the concentration further revolves around …

Intralabyrinthine Mri Flair As A Predictive Marker For Hearing Loss In Vestibular Schwannomas In Neurofibromatosis Type 2, Robert L. Walker, Maxwell T. Laws, H. Jeffrey Kim, Christopher Zalewski, Ashok Asthagiri, Sruthi Ranganathan, Christina Hayes, John D. Heiss, John A. Butman, Prashant Chittiboina

Department of Radiation Oncology Faculty Papers

BACKGROUND AND OBJECTIVES: The onset of hearing loss due to vestibular schwannomas (VS) is inevitable but does not correlate with the size of the tumor. In patients with Neurofibromatosis Type 2 (NF2) and VS, we previously found an association between pre-contrast fluid-attenuated inversion recovery magnetic resonance imaging (FLAIR MRI) signal in the labyrinth and hearing loss. Here, we asked whether FLAIR hyper-intensity could serve as a predictive biomarker for hearing loss in NF2 patients with VS.

METHODS: A prospective longitudinal study (NCT00598351) of NF2 enrolled 168 subjects between 2008 and 2013. This study included 34 patients with small VS (total …

Designing Theranostic Radiopharmaceutical Trials For Uterine Cervix Cancer, Denise Fabian, Molly E. Buffington, Brianna S. Cagle, Steve M. Keefe, Michael K. Schultz, Charles A. Kunos

Radiation Medicine Faculty Publications

Designing and interpreting early phase trials of theranostic radiopharmaceuticals remains challenging because it is difficult to isolate effective levels of activity in enriched patient populations that would be worth following up in later-phase development. This study explores the known challenges and emerging opportunities for clinical research on patients with uterine cervical cancer. We identified eight randomized combination trials for advanced-stage uterine cervix cancer that were activated between 2011 and 2022 and tabulated their results to determine whether combinations were better than individual constituents and which suitable study population is best situated for the study of a new theranostic agent. In …

Simulation Training In Radiation Oncology, Michael C. Schell, Andrew W. Beavis, Derek W. Brown, Michael Milano, Michael O'Neill, Yan Yu, Daniel C. Pavord, Peter Dunscombe

Department of Radiation Oncology Faculty Papers

Simulation training can be used in the design of new processes or, more commonly, to train and re-train healthcare personnel in standard processes. Simulation training is one avenue to making radiation oncology a high reliability health care intervention. In this paper, we explore the relevance of simulation training to the provision of high-quality and safe radiation oncology practice against the background of simulation training conducted in high reliability industries. The use of simulation training in healthcare, as well as specific examples in radiation oncology, is reviewed. An outline of the steps for developing a simulation training program is provided. Simulation …

Clinical Test Cases For Commissioning, Qa, And Benchmarking Of Model-Based Dose Calculation Algorithms In 1⁹2ir Hdr Gynecologic Tandem And Ring Brachytherapy, Vasiliki Peppa, Maude Robitaille, Fatemeh Akbari, Shirin Enger, Rowan Thomson, Firas Mourtada, Gabriel Fonseca

Department of Radiation Oncology Faculty Papers

PURPOSE: To develop clinically relevant test cases for commissioning Model-Based Dose Calculation Algorithms (MBDCAs) for ¹⁹²Ir High Dose Rate (HDR) gynecologic brachytherapy following the workflow proposed by the TG-186 report and the WGDCAB report 372.

ACQUISITION AND VALIDATION METHODS: Two cervical cancer intracavitary HDR brachytherapy models were developed based on a real patient, using either uniformly structured regions or realistic segmentation. The patient's computed tomography (CT) images were processed, converted to a series of digital imaging and communications in medicine (DICOM) CT images, and imported into two treatment planning systems (TPSs), the Oncentra Brachy and BrachyVision. The original segmentation …

Implementation Of Tg-351 Reference Dosimetry For A 6 Mv Photon Beam In An Mr-Guided Radiotherapy System, Nicholas A. Castellano Jr.

Theses and Dissertations

Magnetic resonance guided radiation therapy (MRgRT) combines magnetic resonance imaging (MRI) and radiation therapy to enable the visualization of anatomy in real time during treatment. The presence of a magnetic field in MRgRT affects charged particle radiation and detector responses, necessitating changes to traditional reference dosimetry procedures. The American Association of Physicists in Medicine (AAPM) Task Group 351 (TG-351) provides a formalism for reference dosimetry in MRgRT. In this study, the TG 351 formalism is used to perform reference dosimetry for a 6 MV flattening filter-free (FFF) photon beam from a Viewray MRIdian MR-Linac radiation therapy system. Beam quality determination, …

Improving Prostate Cancer Patients’ Experience And Understanding With A Pre-Ct Simulation Checklist In Genitourinary Radiation Oncology, Christopher Le

Doctor of Nursing Practice Final Project Abstract

Improving Prostate Cancer Patients’ Experience and Understanding With a Pre-CT Simulation Checklist in Genitourinary Radiation Oncology

Purpose

The purpose of this quality improvement (QI) project was to implement a Pre-CT Simulation checklist for Prostate cancer patients in the outpatient Radiation Oncology Genitourinary clinic to improve patients’ experience and comprehension on their Simulation Day.

Background

The CT simulation is a critical step in treatment planning. Lack of clear, concise, consistent instruction and education preparation prior to simulation day can delay planning and treatment. Currently, there is no standardized checklist to ensure patients are educated and prepared for their CT simulation day. …

Urgent Radiotherapy For Superior Vena Cava Syndrome In Metastatic Non-Small Cell Lung Cancer: A Case Report, Arpeet Patel, Nilanjan Haldar, Ida Micaily, Michael Greenberg, Evan Nardone, John A. Lippert, Christopher Fundakowski, Adam C. Mueller

Department of Radiation Oncology Faculty Papers

Superior vena cava (SVC) syndrome is a life-threatening complication of thoracic malignancies, requiring rapid management in the setting of airway compromise or hemodynamic instability. We present a 59-year-old male with metastatic non-small cell lung cancer (NSCLC) who developed superior vena cava syndrome (SVCS) due to compression from a large mediastinal mass identified as metastatic lung adenocarcinoma. His declining respiratory status progressed rapidly, necessitating intensive care. After extensive multidisciplinary collaboration, the patient was determined fit for inpatient radiation therapy and 10 fractions of 300 cGy external beam radiotherapy to the obstructing lesion was planned. However, the patient was unable to lay …

Detection Of Phase-Binning And Interpolation Artifacts In 4-Dimensional Computed Tomography Imaging Using Deep Learning And Rule-Based Approaches, Jorge Cisneros, Nathan H. Feldt, Yevgeniy Vinogradskiy, Richard Castillo, Edward Castillo

Department of Radiation Oncology Faculty Papers

BACKGROUND: Four-dimensional computed tomography (4DCT) imaging is a crucial component to lung cancer radiotherapy planning and enables CT-ventilation-based functional avoidance planning to mitigate radiation toxicity. However, 4DCT scans are frequently impaired by acquisition artifacts that corrupt downstream analyses that depend on lung segmentation and deformable image registration, such as CT-ventilation and dose accumulation.

PURPOSE: This study develops 3D deep learning models to identify phase-binning artifacts at the voxel level and a heuristic, rule-based method to identify interpolation slices within 4DCT images.

METHODS: We introduce a generator that systematically inserts synthetic phase-binning and interpolation artifacts into any artifact-free breathing phase obtained …

Integrating Spot-Scanning Proton Arc Therapy With Functional Avoidance Strategies To Reduce Pulmonary Toxicity, Yingxuan Chen, Peilin Liu, Xiaoda Cong, Edward Castillo, Richard Castillo, Inga Grills, Craig Stevens, Xiangkun Xu, Xiaoqiang Li, Yevgeniy Vinogradskiy, Xuanfeng Ding

Department of Radiation Oncology Faculty Papers

Background and purpose: Functional avoidance radiotherapy has emerged as a promising technique using functional imaging to minimize pulmonary toxicity by reducing doses to functional lung. This study aims to investigate the potential dose-volume advantages of a novel spot-scanning proton arc (SPArc) therapy for functional avoidance radiotherapy with four-dimensional computed tomography (4DCT)-based ventilation imaging.

Material and methods: Twenty-five patients from a prospective functional avoidance clinical trial treated with intensity-modulated photon radiotherapy were included. Robustly optimized intensity modulated proton therapy (IMPT) and SPArc plans were generated in RayStation. Functional lung contour was derived from the 4DCT-based ventilation imaging and utilized as an …

A Feasibility Study Of Sexual Organ-Dose Sparing Volumetric Modulated Arc Therapy In Female Low Rectal Cancer Patients Treated With Three-Dimensional Conformal Radiation Therapy, Margaret Downes, Victoria Olsen, Andre Williams, Rendi Sheu, Maria Thor, Lucy Greenwald, Vishruta Dumane, Kristin Hsieh, Ayesha Ali, Orly Morgan, Michael Buckstein, Deborah Marshall

Department of Radiation Oncology Faculty Papers

BACKGROUND: Sexual dysfunction is a significant toxicity of pelvic radiation therapy (RT) for female rectal cancer patients and may be more common with intensity-modulated techniques compared to three-dimensional conformal radiation therapy (3D-CRT). However, limited research has evaluated dose sparing of female sexual organs at risk (OARs), particularly erectile tissues that are critical for sexual function.

PURPOSE: This feasibility study aimed to demonstrate the practicality of contouring and sparing female sexual OARs in rectal cancer RT by generating sexual organ-sparing volumetric modulated arc therapy (SO-VMAT) plans from a small 3D-CRT cohort and comparing dose distributions to guide future planning.

METHODS: Nine …

From Standard To Stratified: Modeling Ntcp And Ear To Personalize Daily Mv-Cbct In Radiotherapy., Duong Thanh Tai, Luong Tien Phat, Tran Trung Kien, Duong Tuan Linh, Nguyen Ngoc Anh, Nguyen Quang Hung, Peter Sandwall, Parham Alaei, David Bradley, James C L Chow

Oncology Articles

PURPOSE: To evaluate the cumulative radiobiological impact of daily megavoltage cone-beam computed tomography (MV-CBCT) imaging dose based on normal tissue complication probability (NTCP) and excess absolute risk (EAR) of secondary malignancies among radiotherapy patients treated for breast, pelvic, and head & neck cancers. This study investigated whether MV-CBCT imaging dose warrants protocol personalization according to patient age, anatomical treatment site, and organ-specific radiosensitivity.

METHODS: This retrospective study included cohorts of breast (n = 30), pelvic (n = 17), and head & neck (n = 20) cancer patients undergoing radiotherapy with daily MV-CBCT. Imaging dose distributions employing two common MV-CBCT protocols …

Streamlining Nuclear Theranostic Clinic Workflow, Charisma Desai, Anne Fisher

Advances in Cancer Education and Quality Improvement

Nuclear medicine clinic needs have drastically changed with the emergence of theranostics, exciting new agents in the fight against cancer. However, administering these agents is a resource-intensive task, increasing demand for physician consultation time with patients, clinic office space, and scanner time. We examined our institution’s nuclear medicine clinic workflow and interviewed the clinic’s front desk staff, technologists, nurses, managers, physicians, and patients to find sources of delays, dissatisfaction, and decreased efficiency. An Ishikawa diagram and decision matrix helped us determine the most impactful intervention with our available resources. For this cycle, we focused on the consent process. Theranostic patients …

Enhancing Cyberattack Resiliency Through The Radiotherapy Backup And Recovery Dashboard Tool, Justin Pijanowski, Eric Nguyen, Yasin Abdulkadir, Justin Hink, Yevgeniy Vinogradskiy, James Lamb

Department of Radiation Oncology Faculty Papers

PURPOSE: Radiation Oncology departments impacted by recent cyberattacks were unable to access data backups or their Record and Verify (R&V) system and therefore faced challenges to resume patient treatments in a timely manner. We present a novel software tool that backs-up critical radiotherapy treatment information and displays essential information for on-treatment patients in an intuitive and accessible dashboard allowing clinics to continue radiotherapy treatments. The purpose of this report is to describe implementation details, challenges, and share open-source code to facilitate radiation oncology clinics' efforts to develop tools to improve cyberattack resiliency.

METHODS: The Radiotherapy Backup and Recovery Dashboard Tool …

Evaluation Of Image Quality In Mobile Cone-Beam Ct With Dose Modulation Using Automatic Exposure Control: A Phantom Study, Keita Okazaki, Wenchao Cao, Reza Taleei, Firas Mourtada, Jun Li, Karen Mooney, Pramila Rani Anne, Yingxuan Chen

Department of Radiation Oncology Faculty Papers

BACKGROUND: The integration of mobile cone-beam computed tomography (CBCT) into brachytherapy workflows offers clinical advantages such as immediate verification of applicator placement and adaptive treatment planning. These benefits require sufficient image quality to delineate applicators, target volumes, and organs at risk. A systematic evaluation of automatic exposure control (AEC) settings, radiation dose, and image quality is essential to ensure clinically acceptable imaging while minimizing patient exposure.

PURPOSE: This study evaluates the characteristics of AEC and its impact on image quality and radiation dose in a mobile CBCT system used for brachytherapy.

METHODS: The Elekta ImagingRing CBCT system was used to …