Supporting Radiation Therapy Patients with Limited Health Literacy.

Health literacy is one of the most important determinants of patient outcome. Literacy levels are influenced by factors such as formal education status, socioeconomic circumstances, age, language, cultural background, and employment status. Few health professionals are aware of health literacy issues, and even fewer can accurately address them. The purpose of this review article was to bring attention to the issue of health literacy, to provide information on how to identify patients at risk of limited health literacy, and to develop communication strategies designed to support cancer patients and their families. This article also aimed to develop and identify specific tools for radiation therapists and the radiation medical science community based on literature, evidence, and educational material from nursing and other allied professions. Health care organizations and professionals need to be aware of their duty to ensure that patients fully comprehend both the complex and simple information presented. Improving comprehension related to health choices leads to better decision making by the patient, improves patient outcomes, reduces hospitalization rates, and cuts health care costs.

Evaluation of a thermoplastic immobilization system for breast and chest wall radiation therapy.

We report on the impact of a thermoplastic immobilization system on intra- and interfraction motion for patients undergoing breast or chest wall radiation therapy. Patients for this study were treated using helical tomotherapy. All patients were immobilized using a thermoplastic shell extending from the shoulders to the ribcage. Intrafraction motion was assessed by measuring maximum displacement of the skin, heart, and chest wall on a pretreatment 4D computed tomography, while inter-fraction motion was inferred from patient shift data arising from daily image guidance procedures on tomotherapy. Using thermoplastic immobilization, the average maximum motion of the external contour was 1.3 ± 1.6 mm, whereas the chest wall was found to be 1.6 ± 1.9 mm. The day-to-day setup variation was found to be large, with random errors of 4.0, 12.0, and 4.5 mm in the left-right, superior-inferior, and anterior-posterior directions, respectively, and the standard deviations of the systematic errors were found to be 2.7, 9.8, and 4.1 mm. These errors would be expected to dominate any respiratory motion but can be mitigated by daily online image guidance. Using thermoplastic immobilization can effectively reduce respiratory motion of the chest wall and external contour, but these gains can only be realized if daily image guidance is used.

Helical tomotherapy for locoregional irradiation including the internal mammary chain in left-sided breast cancer: dosimetric evaluation.

PURPOSE: To compare a standard 3- or 4-field technique to intensity modulated radiotherapy with helical tomotherapy (IMRT-HT) in the planning of locoregional breast radiation including the internal mammary chain (IMC). METHODS AND MATERIALS: For 10 women with stage III left-sided breast cancer with a planning target volume (PTV) defined by the breast/chest wall and regional nodes, radiotherapy to a dose of 50 Gy in 25 fractions was planned using a standard 3- or 4-field technique and using IMRT-HT. Various metrics were extracted from dose-volume histograms, and were compared using the paired Student's t-test. RESULTS: The PTV receiving at least 95% of the prescribed dose did not differ between the two plans, but the VD115% was significantly lower with IMRT-HT. The dose conformality was significantly better with IMRT-HT. The cardiac V30(Gy) was reduced with IMRT-HT. The mean lungs dose was lower with IMRT-HT, as well the V20(Gy). With IMRT-HT, a greater volume of contralateral breast was irradiated to 5 Gy, but a smaller volume of soft tissue received dose above 50 Gy. CONCLUSIONS: Compared to a standard technique, IMRT-HT provides similar target coverage, improves dose conformality and dose homogeneity within the PTV, decreases mean lung dose and spares heart, lung and soft tissue from high dose exposure.

On-line rapid palliation using helical tomotherapy: a prospective feasibility study.

Rapid delivery of radiation therapy is expected to benefit patients requiring palliation. We investigated the feasibility of employing a helical tomotherapy unit to scan, plan, and deliver a radiation treatment in a single radiation therapy appointment. Eleven patients each had an MVCT scan acquired, a plan created, and delivery completed while the patient was on the treatment couch. Timelines for each step of the process were recorded for each patient, and compared with the conventional process for similar patients. Preliminary results show that patients routinely can be treated within a 1 hour appointment for the first fraction.