2017 Radiation Conference Abstracts

SBRT Lung Symposium Part I “Clinical Considerations for SBRT”

Friday, Sept. 8
8:45– 9:45 a.m.

Simon Fung-Kee-Fung, MD
Roswell Park Cancer Institute
Buffalo, NY

What was once an exceptional special procedure has now become commonplace and is more frequently used than brachytherapy. The origins of stereotactic body radiotherapy (SBRT) come from the early days of stereotactic radiosurgery (SRS). The American experience with SBRT was pioneered at Indiana University and much of what we know about SBRT in the modern experience, from the patient selection, the disease location, and toxicity associated with that, draws from that original experience.

This talk seeks to review the patients and clinical considerations when selecting patients for SBRT. Additionally, common dose fractionation schemes will be reviewed, including Roswell Park Cancer Institute’s experience with single fraction SBRT. Overall, this procedure is very well tolerated, especially relative to the alternate surgical option(s). This is critical, as patients who are offered SBRT often are elderly and / or medically unfit. Nonetheless, there are toxicities associated with the treatment.

Finally, one radiation oncologist’s clinical perspective on harnessing the full potential of technologic advances, including image-guided (IGRT) and inverse modulation (IMRT) to deliver treatments that may not be feasible using standard SBRT techniques. 

Learning Objectives

  1. Recognize clinical factors contributing to patient selection for SBRT;
  2. Identify different possible dose fractionation schedules in the delivery of SBRT and when they might be used;
  3. Name the potential side effects and toxicities associated with SBRT.

SBRT Lung Symposium, Part II “SBRT Treatment Planning”

Friday, Sept. 8
10:15–11:15 a.m.

Rachel Hackett, RT(T), CMD
Roswell Park Cancer Institute
Buffalo, NY

We will explore treatment planning in detail for lung SBRT. We will also touch on SBRT application for other treatment sites, such as spine, liver, adrenal gland, and oligomets.

Learning Objectives

  1. Analyze the pros and cons of 3D CRT versus VMAT for lung SBRT;
  2. Describe treatment planning processes and strategies for a successful SBRT lung treatment;
  3. Recall SBRT application to additional disease sites outside of lung.

SBRT Lung Symposium, Part III “Evaluation of Patient Positioning and Procedure for SBRT Lung Simulation and Treatment”

Friday, Sept. 8
11:15–11:45 a.m.

Gina Bellreng, RT(T)
Roswell Park Cancer Institute
Buffalo, NY

Like most treatment procedures, the introduction of new technology also creates new treatment ideas and challenges when it comes to patient positioning. The treatment of lung tumors with SBRT has changed drastically over the past decade. With the introduction of IGRT, abdominal compression and respiratory gating, the treatment options for these non-surgical candidates has grown significantly. This has also allowed for better treatment response and less treatment time on the table for the patients.

In this talk, I will walk you through the simulation and treatment process of a SBRT lung patient at Roswell Park, highlighting the treatment devices we utilize, as well as the challenges we face with patient positioning. Along with the information presented by my colleagues, we hope to give you a well-rounded approach to SBRT lung with ideas to implement into your clinics.

Learning Objectives

  1. Describe the process and procedure for SBRT lung patients;
  2. Discuss and demonstrate SBRT lung patient positioning setups;
  3. Identify possible patient positioning challenges and limitations.

“Engineering Patient Safety in a Clinic”

Friday, Sept. 8 - Breakout Session (choice A)
1:15–2:15p.m.

Harish Malhotra, PhD, DABR
Roswell Park Cancer Institute
Buffalo, NY

It is extremely important to have safe and efficient systems to plan and deliver radiation therapy. Various factors (e.g., rapid technological advances, financial reorganization, aging population, evolving societal expectations, etc.) may be compromising our ability to deliver care in a highly reliable and efficient manner. While a system like RO-ILS does provide an opportunity to learn from our mistakes, the analysis is retrospective in nature. We need to develop a framework for designing Quality Management activities, based on estimates of the probability of identified failures and their clinical outcome through the radiotherapy planning and delivery process. It is possible to apply modern risk-based analysis techniques to complex radiotherapy process in order to demonstrate that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The talk will describe the proposed methodology, presents the process maps, FMEAs, fault trees, and Quality Management programs, and show how this information could be used in the clinic.

Learning Objectives

  1. Discuss the importance of safe radiation dose delivery to the patient;
  2. Explain the significance and limitation of RO-ILS in patient safety;
  3. Discuss implementation of prospective methods [process maps, FEMA, etc.] in designing a safe and efficient process to promote patient safety in a clinic.

“Documentation and Coding, Part 1”

Friday, Sept. 8 - Breakout Session (Choice B)
1:15–2:15 p.m.

Adam Brown, BSRT(T), CMD
Revenue Cycle, Inc.
Austin, TX

This session is designed to provide the oncology staff with references and resources to assist in their day-to-day responsibilities in the realm of documentation, reimbursement and compliance. The course will provide a detail of the importance of these, as well as a review of the current Medicare guidelines, to assist in compliant documentation and code capture for procedures performed within the Radiation Oncology Department. The session will also inform the clinician on new updates and proposed rules for the 2018 calendar year, and allow for an interactive discussion for questions and advice.

Learning Objectives

  1. Conduct an overview of Billing and Coding;
  2. Review Authoritative Guidance and Legislative Updates;
  3. Conduct an overview of the Medicare Program;
  4. Discuss Hot Topics.

“Prostate Cancer – One Man’s Journey”

Friday, Sept. 8 - Breakout Session (choice A)
2:15–3:15 p.m.

Lori Kasuske, RT(R) (T), CMD
Prairie Lakes Healthcare System – Cancer Center
Watertown, SD

Other than skin cancer, prostate cancer is the most common cancer in American men. Men are living longer with prostate cancer even after metastasis. There are many treatment options available for metastatic prostate cancer including radiation, chemotherapy, hormone therapy, and immunotherapy. In this presentation, I will discuss the journey of a gentleman who was diagnosed at age 50 with prostate cancer and how he continues his battle today with metastatic prostate cancer.

Learning Objectives

  1. Describe radiation treatments to prostate BED and metastatic sites in bone;
  2. Discuss the use of hormone therapy in prostate cancer;
  3. Explain immunotherapy for prostate cancer;
  4. Recognize Xofigo (Ra 223 dichloride) injections.

“ Documentation & Coding, Part 2”

Friday, Sept. 8 - Breakout Session (choice B)
2:15–3:15 p.m.

Adam Brown, BSRT(T), CMD
Revenue Cycle, Inc.
Austin, TX

This session will be an in-depth continuation of the 1:15 p.m. “Documentation & Coding” session.


“The Quest for Hakuna Matata – My Journey into Global Radiation Therapy Outreach”

Friday, Sept. 8 - Breakout Session (choice A)
3:45–4:45 p.m.

Regina Anne Ley, RT(T)
Memorial Sloan-Kettering Cancer Center
New York, NY

Can you imagine if your chances of surviving cancer were determined on winning a health care “lottery”? This is the reality for people in under-developed countries every day. Hakuna Matata may mean “no worries” in Swahili but you won’t hear that “wonderful phrase” from any of the 1,200 Kenyan people on the waitlist for radiation treatments. Our professional community has the skills, compassion and resources it takes to change that. Join me as I share my experience as an outreach fellow in Nairobi, Kenya with the unique viewpoint of a veteran radiation therapist and two-time cancer survivor.

Learning Objectives

  1. Assess our role in improving health care globally;
  2. Illustrate our differences in treatment standards and practices;
  3. Locate outreach organizations and ways to volunteer/donate;
  4. Identify benefits and potential disadvantages of volunteering;
  5. Recognize areas to focus where our expertise is most needed.

“Multi-Criteria Optimization Volumetric-Modulated Arc Therapy (MCO-VMAT) for Hippocampus Avoidance – Whole Brain Radiation Therapy (HA-WBRT)”

Friday, Sept. 8 - Breakout Session (choice B)
3:45–4:45 p.m.

Stephen Zieminski, BS, RT(T), CMD
Massachusetts General Hospital
Boston, MA

Purpose

To compare hippocampus avoidance whole brain radiation therapy (HA-WBRT) treatment planning methods utilizing multi-criteria optimization intensity modulated radiation therapy (MCO-IMRT), standard optimization volumetric-modulated arc therapy (STD-VMAT) and multi-criteria optimization volumetric-modulated arc therapy (MCO-VMAT). To evaluate the difference of multi-criteria optimization within the VMAT environment for complex targets with a variety of conditions (multiple metastatic targets, variable lesion sizes and hippocampus proximity to simultaneous integrated boost targets).

Learning Objectives

  1. Review the utility and dosimetric benefits of multi-criteria optimization (MCO) along with challenges in HA-WBRT;
  2. Compare HA-WBRT planning metrics for the following modalities: STD-VMAT, MCO-IMRT, MCO-VMAT;
  3. Discuss the influence of head positioning on the treatment planning process;
  4. Examine select case studies utilizing the benefits of both MCO and standard optimization for challenging HA-WBRT scenarios (previous RT and high number of SIB targets).

“Tackling Treatment Time & Tobacco: Twin Terrors of Head & Neck Radiation”

Friday, Sept. 8
4:45–5:45 p.m.

Anurag Singh, MD
Roswell Park Cancer Institute
Buffalo, NY

Discuss the deleterious effects of prolonged treatment time and smoking during head and neck radiation. How to solve these issues is also to be discussed.

Learning Objectives

  1. Quantify the loss of local with each missed day of radiation;
  2. Identify two simple methods to reduce the impact of missed days from radiation;
  3. Quantify the loss in survival with smoking during radiation compared to having quit for at least 30 days.

“The Road Ahead”

Saturday, Sept. 9 - Breakout Session (Choice A)
8–9 a.m.

Tami Canterbury, BS, CPC, CTS
Pinnacle Staffing Solutions
Clearwater, FL

Don't forget the most important plan - your own! How did I get here? Where are you on the Road of Life? From first job to Empty Nesters. Tools of the Trade - Resume vs CV; Content tips; who should I have as my references? Top 10 Interviewing Mistakes. Three reasons everyone should work with a Recruiter.

Learning Objectives

  1. Identify the potential of your next career move;
  2. Develop a better resume;
  3. Interview with Confidence.

“When Cancer Attacked Me: A Personal Look at Role Reversal”

Saturday, Sept. 9 - Breakout Session (Choice B)
8–9 a.m.

Lexie Smith-Raymond, MAdm, BS, RT(R )(T), CMD
Banner-University Medical Center
Tucson, AZ

For a radiation therapist or dosimetrist, the task of fighting cancer is part of a daily routine; striving to defeat the tumor that looms on the computer screen. Dealing with time constraints, concurrent chemotherapy, machine schedules and rush cases are tasks that become intertwined with the everyday workflow. Calling our patients by their site of disease, like prostate or brain turns habitual during the long, crazy hours in the clinic. But what happens when cancer comes home? How do these dynamics change when the disease strikes a family member? And, what if we can do nothing to change the course of their loved one’s path? These questions are not easy to answer when the tables are turned on the Radiation Oncology professional who plays an intricate role in bettering the lives of so many others. This course will examine what happens when our expertise and emotions are brought face to face with faults in our own system, HIPPA compliance, treating a family member and resisting the urge to do the “perfect” plan. Additionally, thoughts on how this type of experience may change future relationships with not only patients, but co-workers and physician staff will also be shared.

Learning Objectives 

  1. Describe the effects of radiation dose to heart and lung.
  2. Examine difficulties in dealing with expertise and emotion during a specific situation;
  3. Discuss HIPPA compliance issues;
  4. Discuss interpersonal issues between physicians, family members and involved staff;
  5. Explain how situations like this affect future professional relationships;/em>
  6. Examine lasting effects on future job performance.

“Improving Radiation Therapy Safety & Quality Through Real-Time Surface-Guided Radiation Therapy (SGRT)”

Saturday, Sept. 9
9:05–10:05 a.m.

Daniel Bailey, PhD, DABR
Northside Hospital Cancer Institute
Atlanta, GA

The last five years have seen a dramatic increase in the availability and clinical use of video-based systems for patient setup and intrafraction monitoring. This technique, increasingly known as Surface-Guided Radiation Therapy (SGRT), utilizes camera systems boasting capabilities such as positional monitoring accuracy to the millimeter or submillimeter level, integration with treatment units to automatically interrupt the beam upon detection of patient motion, and very fast (near real-time) response - all without producing any additional radiation exposure to the patient. At the same time, all commercially-available systems have limitations, either inherent to the implementation of SGRT technology or to the nature of optical surface imaging itself. In this discussion, we will objectively examine the advantages and limitations of SGRT and the currently available SGRT systems, and introduce the requisite steps to implement an SGRT program in the modern radiotherapy clinic.

Learning Objectives

  1. Review the progress of SGRT technology and its clinical use in the years since the AAPM Task Group 147 report;
  2. Discuss the capabilities and limitations of current SGRT systems;
  3. Gain conceptual understanding of the commissioning and continued quality assurance of an SGRT system;
  4. Explain the multidisciplinary planning and processes required to implement an SGRT program in the modern radiotherapy clinic.

“Radiation Therapy for Locally Advanced Breast Cancer”

Saturday, Sept. 9
10:35–11:35 a.m.

Killian Salemo, MD
Roswell Park Cancer Institute
Buffalo, NY

Review of breast cancer, staging, and definition of locally advanced breast cancer, incidence, prognosis, and overall treatment paradigms. Present rationale for radiation for loco-regional control. Discuss simulation, treatment, planning and therapy considerations. Review contouring and dose constraints, recent trials, and treatment guidelines.

Learning Objectives

  1. Learn the role for radiation in the treatment of locally advanced breast cancer;
  2. Recognize the natural history of disease, patterns of spread, areas at risk, and implications for radiation treatment planning;
  3. Identify references for contouring, dose constraints, and treatment planning;
  4. Recognize areas of ongoing study.

“Is Your Team Evolving at the Pace of Your Technology?”

Saturday, Sept. 9 
11:35 a.m.–12:35 p.m.

Lisbet Williams, RT(T)(CT), CMD
Ashley Benincasa, RT(T), MBA
New York Oncology Hematology
Albany, NY

Radiation Oncology is constantly evolving, with new technology and techniques being introduced at a dizzying pace. But are you keeping up with the changes? Is your team ready and able to implement new technology? Does each team member have the needed training and skills for the procedures they are being asked to perform? Do you have processes in place to identify, evaluate, and teach those skills? What are some of the important skills and traits that radiation therapists and dosimetrists should possess (or learn) to stay current? Is your team working cohesively toward a common goal and does everyone know what that goal is?

This presentation addresses all of these questions. It discusses ways to build stronger teams and how to encourage and help every team member reach their full potential. It focuses on ways for individuals to stay current on new technology and techniques, and how to maximize their learning opportunities.


Impact of Daily MRI on Planning and Treatment

Saturday, Sept. 9
1:35 - 2:35 p.m.

James "Vito" Victoria, CMD
ViewRay, Inc.
Mountain View, CA

The introduction of imaging technologies into the treatment room for patient setup and alignment has had a direct impact on the accuracy and precision of treatment delivery. Early imaging systems such as planar films, and orthogonal x-ray images, allowed the therapists to visualize and align the patient based on surrogates such as implanted markers or bony anatomy, which allowed for improvement in patient setup resulting in eventual margin reduction. Further developments over the past decade have resulted in availability of in-room MR, which enables daily volumetric visualization of soft-tissues, such that the patient can be aligned, based on the position of the target. Imaging, on a frequent and scheduled basis, has demonstrated improvement in clinical outcomes. Imaging advances will continue to improve localization of targets, planning volume definition and overall treatment quality. Daily MRI and soft tissue imaging will support the delineation and targeting of treatment delivery and account for daily positional changes and deformation. MR imaging during treatment will confirm the treatment volume prior to delivery and allow for improvements in motion management as well. This presentation will describe the advancements in in-room imaging, and effects of MRI imaging in treatment planning and during delivery.

Learning Objectives

  1. Discuss the advances in imaging technology
  2. Identify the impacts of daily imaging on treatment plan development
  3. Describe the effects of daily and real time imaging during delivery

“The Role of Radiation for Symptom Palliation”

Saturday, Sept. 9
2:50–3:50 p.m.

Gregg Hermann, MD, MPH
Roswell Park Cancer Institute
Buffalo, NY

Approximately half of all radiation treatments are delivered to palliate symptoms related to incurable cancer. The purpose of this presentation is to review the role of radiation for symptomatic management in these patients. Discussion will include topics related to the treatment of brain and bone metastases, spinal cord compression, superior vena cava syndrome, airway obstruction, dysphagia, and hemostasis. We will also cover the use of stereotactic radiosurgery and stereotactic body radiation therapy for palliation, updated guidelines for re-irradiation of bone metastases and hypofractionated techniques used for palliation including the quad-shot for head and neck cancers.

Learning Objectives

  1. Appraise the role of radiation for symptom palliation;
  2. Review the clinical outcomes following palliative radiotherapy;
  3. Discuss updated guidelines and contemporary approaches.

“High Grade Gliomas: Current Management and Future Directions”

Saturday, Sept. 9
3:50–4:50 p.m.

Charlotte Rivers, MD
Roswell Park Cancer Institute
Buffalo, NY

High grade gliomas are a class of particularly aggressive and often fatal brain tumors. Untreated disease is rapidly progressive, usually leading to death within weeks to months. However, radiation and chemotherapy can improve both survival and quality of life, with some patients living several years after diagnosis. Recent advances in both radiation technique as well as other treatment modalities have provided new options for these patients. This presentation will provide an overview of the natural history of high grade glioma, as well as current treatment options and future directions.

Learning Objectives

  1. Discuss the general classification and natural history of high grade gliomas;
  2. Review the role of radiation therapy and techniques in glioblastoma patients;
  3. Discuss alternate treatment modalities and recent literature.