Current status and developments of German curriculum-based residency training programmes in radiation oncology.

PURPOSE: The current status of German residency training in the field of radiation oncology is provided and compared to programmes in other countries. In particular, we present the DEGRO-Academy within the international context. METHODS: Certified courses from 2018 and 2019 were systematically assigned to the DEGRO-Curriculum, retrospectively for 2018 and prospectively for 2019. In addition, questionnaires of course evaluations were provided, answered by course participants and collected centrally. RESULTS: Our data reveal a clear increase in curriculum coverage by certified courses from 57.6% in 2018 to 77.5% in 2019. The analyses enable potential improvements in German curriculum-based education. Specific topics of the DEGRO-Curriculum are still underrepresented, while others decreased in representation between 2018 and 2019. It was found that several topics in the DEGRO-Curriculum require more attention because of a low DEGRO-curriculum coverage. Evaluation results of certified courses improved significantly with a median grade of 1.62 in 2018 to 1.47 in 2019 (p = 0.0319). CONCLUSION: The increase of curriculum coverage and the simultaneous improvement of course evaluations are promising with respect to educational standards in Germany. Additionally, the early integration of radiation oncology into medical education is a prerequisite for resident training because of rising demands on quality control and increasing patient numbers. This intensified focus is a requirement for continued high standards and quality of curriculum-based education in radiation oncology both in Germany and other countries.

Quantification of MRI visibility and artifacts at 3T of liquid fiducial marker in a pancreas tissue-mimicking phantom.

PURPOSE: X-ray-based position verification of the target volume in image-guided radiation therapy (IGRT) of patients with pancreatic ductal adenocarcinoma (PDAC) is currently performed on solid fiducial markers that are implanted under endoscopic ultrasonography. A new biodegradable liquid fiducial marker has recently been introduced. To assess its potential use for magnetic resonance imaging (MRI)-guided photon or proton radiotherapy of PDAC, the MRI visibility and artifacts of this marker were quantified and compared against solid gold markers. MATERIAL AND METHODS: Different spherical volumes (10 µL, 25 µL, 50 µL, and 100 µL) of a biodegradable liquid fiducial marker as well as seven differently sized and oriented solid gold (0.35 mm diameter; 5 mm and 10 mm length) and iron-gold alloy fiducial markers (0.28 mm diameter; 1 cm and 2 cm length) were implanted in a spherical gel phantom, mimicking the proton spin relaxation properties of healthy pancreatic tissue at 3 Tesla. MR relaxometry was performed to quantify the size and magnitude of the decrease in the effective transversal relaxation time T2∗ and relative proton density ρ(H) as a measure of potential visibility and to quantify the size and magnitude of the increase in magnetic field inhomogeneity ΔB0 as a measure of potential signal artifacts. The phantom was scanned in a 3.0 T PET/MR scanner with an eight-channel head coil. RESULTS: The solid fiducial markers showed a direct linear relationship between the potentially visible size and artifact size. The liquid fiducial marker showed a tendency toward a potentially visible size at smaller artifacts. Liquid markers from 25 to 100 µL generated visible volumes comparable to the size of the solid markers. The magnitude of visibility was the highest for the liquid fiducial marker with volumes of 25-100 µL showing no correlation with the magnitude of artifact. The solid markers showed a strong nonlinear correlation between magnitude of visibility and artifact, whereas the solid marker consisting of a gold-iron alloy induced the strongest artifacts. CONCLUSION: The liquid fiducial marker causes signal voids on MRI due to its absence of water hydrogen atoms without strongly affecting the magnetic field in the surrounding tissue. The alteration of the static magnetic field was found to be the main effect leading to the visibility of the solid fiducial markers. Hence, especially when a low level of image distortion is required, MRI characteristics of the liquid marker surpass those of solid gold markers currently being used for IGRT of PDAC.