Audit of radiation oncology practice: Lessons from a new private hospital in Delhi, India.

Aims: The objective of this audit was to analyze the radiotherapy (RT) practice in a newly established tertiary private hospital. With increasing radiation oncology (RO) facilities in private sector, this report is the first audit from a private health organization in India. Subjects and Methods: The audit of all consecutively registered patients in RO has focused to extract data from the time of RT simulation planning till the completion of RT course. The patient and disease characteristics,RT-related treatment factors and compliance were analyzed in-depth. Results: In this newly established RO department, the vendor-supplied equipment, e.g., RT planning system, treatment delivery (linear accelerator and brachytherapy), and RO information system (ROIS), are integrated with enterprise-wide hospital information system into unified paperless workflow management for the patient care records in a prospective manner. This analysis comprised consecutive 328 patients who consented for RT simulation and planning from April 20, 2018, to December 31, 2019. RT course compliance was 94.8% (311/328 patients), and treatment intent-wise: curative plus adjuvant in 60.2% and palliative RT in 36%. RT technique was conformal in all 100%, with volumetric arc radiotherapy (VMAT) delivered to 66.6% of patients. With overall median RT course duration of 29 days (range 1-81 days), the patients were delivered a median of 20 fractions. Conclusions: Compared to the previously published audit from an academic RO department in Delhi, this audit from a private hospital has shown (i) lesser waiting time, (ii) improved treatment compliance, (iii) utilization of higher techniques, and (iv) a lower duration of RT course.

Impact of different breathing conditions on the dose to surrounding normal structures in tangential field breast radiotherapy.

Cardiac toxicity is an important concern in tangential field breast radiotherapy. In this study, the impact of three different breathing conditions on the dose to surrounding normal structures such as heart, ipsilateral lung, liver and contralateral breast has been assessed. Thirteen patients with early breast cancer who underwent conservative surgery (nine left-sided and four right-sided breast cancer patients) were selected in this study. Spiral CT scans were performed for all the three breathing conditions, viz., deep inspiration breath-hold (DIBH), normal breathing phase (NB) and deep expiration breath-hold (DEBH). Conventional tangential fields were placed on the 3D-CT dataset, and the parameters such as V30 (volume covered by dose >30 Gy) for heart, V20 (volume covered by dose >20 Gy) for ipsilateral lung and V(50) (volume receiving >50% of the prescription dose) for heart and liver were studied. The average reduction in cardiac dose due to DIBH was 64% (range: 26.5-100%) and 74% (range: 37-100%) as compared to NB and DEBH respectively. For right breast cancer, DIBH resulted in excellent liver sparing. Our results indicate that in patients with breast cancer, delivering radiation in deep inspiration breath-hold condition can considerably reduce the dose to the surrounding normal structures, particularly heart and liver.