A Study on the Evaluation of Image-Guided Treatment Use in Radiotherapy Centers in Türkiye

Abstract

This study presents a preliminary investigation into the use of image-guided radiation therapy (IGRT) in radiotherapy centers in Türkiye, based on survey data. Radiation therapy technologists were administered a 67-item Internet-based questionnaire. The first five items focused on demographic data, while the remaining items pertained to IGRT applications in the clinics where the technicians worked. Statistical data of the answers obtained were used in SPSS 28.0. While evaluating the study data, descriptive statistical methods (frequency, percentage) were used. A total of 314 individuals participated in the survey, with 45.9% (n=144) being female and 54.1% (n=170) being male. The study focused on patients with stomach (20.6%), rectum (18.9%), prostate (17.6%), head and neck (14.5%), lung (14.3%), and breast (13.9%) cancers. It was observed that megavoltage (MV) ports (35.7%) were used more frequently during daily checks. It has been stated that 1-25 MV ports are drawn daily. This is followed by Cone Beam Computer Tomography (CBCT) and kilovoltage (kV) port checks. In our country, it is seen that important steps have been taken in IGRT and its use is quite common. It has been observed that the technical infrastructure and manpower in the clinics are sufficient. It is predicted that the development of systems that reduce the doses received by patients and employees with IGRT and the development of wage policies will increase the use of IGRT. We hope that this result will be supported by future large-scale studies. Although we think that the use of IGRT is at an adequate level, there are differences in practices between clinics. It is thought that the establishment of national protocols for the use of IGRT will be in favour of patients and technicians.

Keywords

• Radiotherapy
• Image-Guided Radiation Therapy (IGRT)
• Questionnaire
• Radiotherapy Centers

References

1. Batumalai, V., Holloway, L. C., Kumar, S., Dundas, K., Jameson, M. G., Vinod, S. K., & Delaney, G. P. (2017). Survey of image-guided radiotherapy use in Australia. Journal of Medical Imaging and Radiation Oncology, 61(3), 394-401. https://doi.org/10.1111/1754-9485.12556
2. Beasley, M., Brown, S., Mcnair, H., Faivre-Finn, C., Franks, K., Murray, L., Van Herk, M., & Henry, A. (2019). The advanced radiotherapy network (ART-NET) UK lung stereotactic ablative radiotherapy survey: national provision and a focus on image guidance. British Journal of Radiology, 92(1098), 20180988. https://doi.org/10.1259/bjr.20180988
3. Bertholet, J., Knopf, A., Eiben, B., McClelland, J., Grimwood, A., Harris, E., Menten, M., Poulsen, P., Nguyen, D. T., Keall, P., & Oelfke, U. (2019). Real-time intrafraction motion monitoring in external beam radiotherapy. Physics in Medicine & Biology, 64(15), 15TR01. https://doi.org/10.1088/1361-6560/ab2ba8
4. Chen, G.-P., Tai, A., Keiper, T. D., Lim, S., & Li, X. A. (2020). Technical Note: Comprehensive performance tests of the first clinical real-time motion tracking and compensation system using MLC and jaws. Medical Physics, 47(7), 2814-2825. https://doi.org/10.1002/mp.14171
5. De Los Santos, J., Popple, R., Agazaryan, N., Bayouth, J. E., Bissonnette, J. P., Bucci, M. K., Dieterich, S., Dong, L., Forster, K. M., Indelicato, D., Langen, K., Lehmann, J., Mayr, N., Parsai, I., Salter, W., Tomblyn, M., Yuh, W. T. C., & Chetty, I. J. (2013). Image Guided Radiation Therapy (IGRT) Technologies for Radiation Therapy Localization and Delivery. International Journal of Radiation Oncology, Biology, Physics, 87(1), 33-45. https://doi.org/10.1016/J.IJROBP.2013.02.021
6. Fiorino, C., Guckenberger, M., Schwarz, M., van der Heide, U. A., & Heijmen, B. (2020), Technology-driven research for radiotherapy innovation. Molecular Oncology, 14(7), 1500-1513. https://doi.org/10.1002/1878-0261.12659
7. Franzone, P., Fiorentino, A., Barra, S., Cante, D., Masini, L., Cazzulo, E., Todisco, L., Gabriele, P., Garibaldi, E., Merlotti, A., Redda, M. G. R., Alongi, F., & Corvò, R. (2016). Image-guided radiation therapy (IGRT): practical recommendations of Italian Association of Radiation Oncology (AIRO). La Radiologia Medica, 121(12), 958-965. https://doi.org/10.1007/s11547-016-0674-x
8. Kilburn, J. M., Soike, M. H., Lucas, J. T., Ayala-Peacock, D., Blackstock, W., Isom, S., Kearns, W. T., Hinson, W. H., Miller, A. A., Petty, W. J., Munley, M. T., & Urbanic, J. J. (2016). Image guided radiation therapy may result in improved local control in locally advanced lung cancer patients. Practical Radiation Oncology, 6(3), e73-e80. https://doi.org/10.1016/J.PRRO.2015.10.004

9. Lievens, Y., Borras, J. M., & Grau, C. (2020). Provision and use of radiotherapy in Europe. Molecular Oncology, 14(7), 1461-1469. https://doi.org/10.1002/1878-0261.12690
10. Luh, J. Y., Albuquerque, K. V., Cheng, C., Ermoian, R. P., Nabavizadeh, N., Parsai, H., Roeske, J. C., Weiss, S. E., Wynn, R. B. Yu, Y., Rosenthal, S. A., & Hartford, A. (2020). ACR–ASTRO Practice Parameter for Image-guided Radiation Therapy (IGRT). American Journal of Clinical Oncology, 43(7), 459-468. https://doi.org/10.1097/COC.0000000000000697
11. Nabavizadeh, N., Elliott, D. A., Chen, Y., Kusano, A. S., Mitin, T., Thomas, C. R., & Holland, J. M. (2016). Image Guided Radiation Therapy (IGRT) practice patterns and IGRT’s impact on workflow and treatment planning: Results from a national survey of american society for radiation oncology members. International Journal of Radiation Oncology, Biology, Physics, 94(4), 850-857. https://doi.org/10.1016/j.ijrobp.2015.09.035
12. NDK, Nükleer Düzenleme Kurulu (2022). Türkiye’de Radyasyon Kaynakları 2022.
13. Pan, H., Simpson, D. R., Mell, L. K., Mundt, A. J., & Lawson, J. D. (2011). A survey of stereotactic body radiotherapy use in the United States. Cancer, 117(19), 4566-4572. https://doi.org/10.1002/cncr.26067
14. Pinitpatcharalert, A., Happersett, L., Kollmeier, M., McBride, S., Gorovets, D., Tyagi, N., Varghese, M., & Zelefsky, M. J. (2019). Early Tolerance Outcomes of Stereotactic Hypofractionated Accelerated Radiation Therapy Concomitant with Pelvic Node Irradiation in High-risk Prostate Cancer. Advances in Radiation Oncology, 4(2), 337-344. https://doi.org/10.1016/J.ADRO.2018.12.001
15. Podgorsak, E. B. (2005). Radiation Oncology Physics: A Handbook for Teachers and Students. International Atomic Energy Agency, Austria.
16. Şenışık, A. M., Tunçman, D., Mutlu, E., & Erge, E. (2022). 50 Soruda Kanser ve Radyoterapi. Altınbaş Üniversitesi Yayınları.
17. Simpson, D. R., Lawson, J. D., Nath, S. K., Rose, B. S., Mundt, A. J., & Mell, L. K. (2010). A survey of image-guided radiation therapy use in the United States. Cancer, 116(16), 3953-3960. https://doi.org/10.1002/cncr.25129
18. Sun, B., Chang, J., & Rong, Y. (2017). The more IGRT systems, the merrier? Journal of Applied Clinical Medical Physics, 18(4), 7-11. https://doi.org/10.1002/acm2.12126
19. Vaandering, A., Jansen, N., Weltens, C., Moretti, L., Stellamans, K., Vanhoutte, F., Scalliet, P., Remouchamps, V., & Lievens, Y. (2023). Radiotherapy-specific quality indicators at national level: How to make it happen. Radiotherapy and Oncology, 178, 109433. https://doi.org/10.1016/j.radonc.2022.11.022
20. WHO, World Health Organization (2020). WHO report on cancer: setting priorities, investing wisely and providing care for all. (2020). https://www.who.int/publications/i/item/9789240001299
21. Zelefsky, M. J., Kollmeier, M., Cox, B., Fidaleo, A., Sperling, D., Pei, X., Carver, B., Coleman, J., Lovelock, M., & Hunt, M. (2012). Improved Clinical Outcomes With High-Dose Image Guided Radiotherapy Compared With Non-IGRT for the Treatment of Clinically Localized Prostate Cancer. International Journal of Radiation Oncology, Biology, Physics, 84(1), 125-129. https://doi.org/10.1016/J.IJROBP.2011.11.047