Applied Radiology
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Applied Radiation Oncology
Applied Radiation Oncology (ARO) is pleased to offer you a selection of free SA-CME accredited courses to choose from, as part of your free subscription to ARO.
SA-CME
Accreditation/Designation Statement
These credits qualify as SA-CME credits based on the criteria of the American Board of Radiology.
The Institute for Advanced Medical Education (IAME) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Institute for Advanced Medical Education (IAME) designates these Journal-based activities for a maximum of 1 AMA PRA Category 1 Credit™ each. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Actualizing Risk-Adapted Thoracic Stereotactic Body Radiation Therapy with MR Guidance
Lisa Singer, MD, PhD; Benjamin H. Kann, MD; Daniel N. Cagney, MD; Jonathan E. Leeman, MD; Sue S. Yom, MD, PhD; David Kozono, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2021   •   Expiration Date: August 31, 2023
While traditionally CT- and x-ray based, lung stereotactic body radiation therapy (SBRT) practices will likely be impacted by the emerging availability of MR guidance. This review provides an overview of the role of MR guidance in SBRT for the treatment of lung cancers. Limitations, data, and future directions for treatments are reviewed with a focus on peripheral, central, and ultracentral lung cancers.
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Integrating MR-Guided Radiation Therapy Into Clinical Practice: Clinical Advantages and Practical Limitations
Leila T. Tchelebi, MD; Nicholas G. Zaorsky, MD, MS; Jennifer Rosenberg, MD; Kujtim Latifi, PhD; Sarah Hoffe, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2021   •   Expiration Date: August 31, 2023
While MR-guided radiation therapy (MRgRT) offers many benefits, it is a costly and resource-intensive investment that can strain radiation oncology clinics not adequately prepared to incorporate this treatment. This work reviews clinical advantages and practical limitations of MRgRT, and suggests ideal patients for this technology. The authors also provide a practical guide for centers acquiring MRI-based linear accelerators to foster seamless integration.
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MR-Guided Radiation Therapy for Oligometastatic Malignancies
Brittany R. Derynda, BA; *Casey L. Liveringhouse, MD; John M. Bryant, MD; Stephen A. Rosenberg, MD, MS
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2021   •   Expiration Date: August 31, 2023
This review article describes technical advantages for MR-guided radiation therapy (MRgRT) that lead to the rationale for use in the oligometastatic setting. The authors summarize existing data demonstrating the feasibility, safety, and efficacy of MRgRT for various disease sites. Finally, the authors discuss ongoing clinical trials utilizing MRgRT, which will continue to define and expand its role.
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FLASH Radiation Therapy: Review of the Literature and Considerations for Future Research and Proton Therapy FLASH Trials
Ronald Chow, MS; Minglei Kang, PhD; Shouyi Wei, PhD; J. Isabelle Choi, MD; Robert H. Press, MD; Shaakir Hasan, DO; Arpit M. Chhabra, MD; Keith A. Cengel, MD, PhD; Haibo Lin, PhD; Charles B. Simone, II, MD
Estimated time for completion: 1 hour   •   Date of release and review: June 1, 2021   •   Expiration Date: May 31, 2023
In this manuscript, the authors review the proposed mechanisms of action for FLASH radiation therapy (FLASH RT), summarize early preclinical results, discuss the first-in-human treatments with a focus on proton FLASH, and highlight challenges and future considerations of FLASH RT.
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Technological Basis for Clinical Trials in FLASH Radiation Therapy: A Review
*Yufan (Fred) Wu, MD; *Hyunsoo Joshua No, MD, CMD; Dylan Y. Breitkreutz, PhD; Anthony E. Mascia, PhD; Raphaël Moeckli, PhD; Jean Bourhis, MD, PhD; Emil Schüler, PhD; †Peter G. Maxim, PhD; †Billy W. Loo Jr., MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: June 1, 2021   •   Expiration Date: May 31, 2023
With a steady increase in FLASH-RT human clinical trials underway, this review discusses the technological basis for FLASH-RT clinical trials and explores the modalities, treatment parameters, technical limitations, and potential indications of current ultrahigh dose RT (UHDR-RT) technologies
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Managing Anxiety and Minimizing Sedation Requirements in the Pediatric Radiation Oncology Population
Nathaniel Goldman, BA*; Matthew Gallitto, MD*; Cheng-Chia Wu, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2021   •   Expiration Date: February 28, 2023
This review article provides a thorough outline of various modalities to help guide implementation of strategies to reduce anxiety in treatment facilities. Categories include interventions before treatment (psychoeducational interventions, play therapy) and during treatment (specialized staff, environmental modifications, distraction, reward/incentive systems).
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Applications of Artificial Intelligence in Head and Neck Radiation Therapy
Adam C. Riegel, PhD, DABR
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2021   •   Expiration Date: February 28, 2023
The purpose of this article is to review recent advancements in artificial intelligence (AI) as they specifically pertain to head-and-neck radiation oncology. The main focus will be applications and clinical impact of these techniques. Specifically, this article addresses autosegmentation of organs at risk (OARs), autosegmentation of target volumes, treatment planning and predictive dose calculation, image-guided adaptive radiation therapy, prognosis and outcome prediction, and quality assurance.
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Disparities in Colorectal Cancer Outcomes Among Young Adults and African Americans in the United States
Maya C. Graves, MS; Janna Z. Andrews, MD
Estimated time for completion: 1 hour   •   Date of release and review: December 1, 2020   •   Expiration Date: November 30, 2022
This article reviews current literature continuing to highlight persistent disparities in the diagnosis, treatment and survival outcomes in colorectal cancer in young adults and Black individuals. Topics discussed include screening recommendations, age disparity, racial disparity, and differences in outcomes between Black and White patients in the growing cohort of young adult patients.
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Disparities In Lung Cancer for Black Patients In The US: An Overview of Contributing Factors and Potential Strategies for Radiation Oncologists To Bridge the Gap
Victor E. Chen, MD; Joseph F. Lombardo, DO, PharmD; Serguei A. Castaneda, MD; Karen M. Winkfield, MD, PhD; Scot A. Fisher, DO; Eric L. Gressen, MD; Shari B. Rudoler, MD; Weisi Yan, MD, PhD; Shefali R. Gajjar, MD
Estimated time for completion: 1 hour   •   Date of release and review: December 1, 2020   •   Expiration Date: November 30, 2022
This review article describes key factors that contribute to lung cancer disparities for Black patients and discusses strategies and future directions for radiation oncologists to bridge the gap. Topics discussed are contributing factors for disparities in lung cancer incidence, disparities in lung cancer prevention, disparities in lung cancer treatment and outcomes, and potential strategies to overcome barriers.
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Radiotherapeutic Management of Oligometastatic Disease in Low- and Middle-Income Countries: The Current State of Affairs and Perspectives on Future Implementation
Angela Y. Jia, MD, PhD; Matthew P. Deek, MD; and Ryan M. Phillips, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2020   •   Expiration Date: June 30, 2022
This review provides a perspective regarding barriers to expansion of radiation treatments in low- and middle-income countries (LMICs). The authors review the benefit of expanding radiation treatment to patients with oligometastatic disease based on several recent clinical trials including SABR-COMET, ORIOLE, and others. The authors also discuss limitations and barriers to receiving radiation treatment in less developed countries including the sparsity of treatment machines, personnel expertise, and distribution of resources in urban vs rural environments. They further discuss technological advances that may help to develop and increase access to radiation therapy in LMICs.
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Management of Oligometastatic Prostate Cancer
James R. Broughman, MD; Christopher W. Fleming, MD; Omar Y. Mian, MD, PhD; Kevin L. Stephans, MD; Rahul D. Tendulkar, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2020   •   Expiration Date: June 30, 2022
Recent data suggests that aggressive treatment of the primary tumor or metastasis-directed therapy may confer a survival advantage in carefully selected patients with metastatic prostate cancer. This review outlines treatment approaches for these patients, while highlighting existing literature, ongoing trials, and important areas for future study.
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Transcriptional Mechanisms of Radioresistance and Therapeutic Implications
Daniel Y. Kim, BS*; Jimmy A. Guo, BA*; Daniel Zhao, BA; Errol J. Philip, PhD; Yun R. Li, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2020   •   Expiration Date: February 28, 2022
While numerous mechanisms impact sensitivity to radiation, the authors examine the transcriptional alterations and gene expression programs that allow neoplastic cells to withstand radiation. They review the recurring mechanisms co-opted by cancer cells in radiation resistance: upregulation of DNA repair, suppression of apoptotic programs, hypoxia, immune evasion and exhaustion, cellular plasticity, as well as aberrant intracellular signaling. They also explore the therapeutic implications of these preclinical findings.
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Management of Head and Neck Cancer Patients During the Epidemic of COVID-19 in Wuhan
Qiuji Wu, MD, PhD; Xiting Yang, MS; Fengyang Wu, MS; Yahua Zhong, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: June 1, 2020   •   Expiration Date: May 31, 2022
The rapid spread of the new coronavirus disease (COVID-19) identified toward the end of 2019 significantly impacted everyone in China, and all over the world. Head and neck (HN) cancers are a common malignant tumor type in China, with chemoradiation the standard of care for locally advanced disease. However, the COVID-19 epidemic interrupted the routine diagnosis and treatment of all cancers, including HN cancers, which can progress quickly if treatment is significantly delayed. Cancer patient care at the epicenter of COVID-19 was particularly challenged. Based on the management experience of patients with HN cancer during the outbreak of COVID-19 at a cancer institute in Wuhan, the authors summarize management strategies of patients with HN cancer to provide reference for health care providers facing similar challenges.
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Leading a Radiation Medicine Department from the Epicenter of the COVID-19 Pandemic in the United States
Daniel Koffler, MD; Sewit Teckie, MD; Louis Potters, MD, FACR, FASTRO, FABS
Estimated time for completion: 1 hour   •   Date of release and review: June 1, 2020   •   Expiration Date: May 31, 2022
Cardiotoxicity can be an unfortunate side effect from cancer therapies including chemotherapy, hormonal therapy, and radiation therapy (RT). Sub-acute cardiotoxicity can occur during systemic therapies but is often considered a late effect from RT. This manuscript reviews the current literature regarding the clinical impact of radiation-induced cardiotoxicity in the setting of breast cancers and thoracic malignancies including lung cancer, esophageal cancer and mediastinal lymphomas.
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Cardiotoxicity and Radiation Therapy: A Review Of Clinical Impact In Breast and Thoracic Malignancies
Elizabeth M. Nichols, MD; Arezoo Modiri, PhD; Pranshu Mohindra, MD, MBBS
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2020   •   Expiration Date: February 28, 2022
Cardiotoxicity can be an unfortunate side effect from cancer therapies including chemotherapy, hormonal therapy, and radiation therapy (RT). Sub-acute cardiotoxicity can occur during systemic therapies but is often considered a late effect from RT. This manuscript reviews the current literature regarding the clinical impact of radiation-induced cardiotoxicity in the setting of breast cancers and thoracic malignancies including lung cancer, esophageal cancer and mediastinal lymphomas.
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Noninvasive Cardiac Radioablation at Washington University: Past, Present and Future Directions for the Treatment of Ventricular Tachycardia
Pamela Samson, MD, MPHS; Geoff Hugo, PhD; Kaitlin Moore, BSN; Nels Knutson, PhD; Philip Cuculich, MD; Clifford Robinson, MD
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2020   •   Expiration Date: February 28, 2022
Noninvasive cardiac radioablation using stereotactic body radiation therapy (SBRT) techniques has emerged as a potential salvage treatment option for patients with ventricular tachycardia who have either failed procedural or medical management, or have contraindications to receive those therapies again. The recently published phase I/II Electrophysiology-Guided (EP) Noninvasive Cardiac Radioablation for Ventricular Tachycardia trial (ENCORE-VT, NCT02919618) demonstrated early safety and efficacy of this novel use of SBRT. This article reviews the lessons learned from ENCORE-VT, current use and workflow for treatment refractory ventricular tachycardia patients, and future directions for this emergent treatment modality.
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An Emergent Role For Radiomic Decision Support In Lung Cancer
Gleb A. Kuzmin, PhD;* Mishka Gidwani, BS;* Tianjun Ma, PhD;* Tingliang Zhuang, PhD; Mohamed E. Abazeed, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: December 1, 2019   •   Expiration Date: November 30, 2021
This review article discusses recent developments in radiomics—a computational image evaluation technique that integrates medical images, clinical data, and machine learning—its applications to lung cancer treatments, and the challenges associated with radiomics as a tool for precision diagnostics and theranostics.
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Genomics and Radiomics: Tools To See The Unseen To Personalize Radiation Therapy
G. Daniel Grass, MD, PhD; Matthew N. Mills, MD; Jacob G. Scott, MD, DPhil; Steven A. Eschrich, PhD; Javier Torres-Roca, MD
Estimated time for completion: 1 hour   •   Date of release and review: December 1, 2019   •   Expiration Date: November 30, 2021
Genomics and radiomics provide an opportunity to increase the precision of radiation delivery in selection of dose and spatial delivery. Further understanding of host and tumor differences with interrogative approaches may provide opportunity to precisely deliver radiotherapy beyond spatial and anatomic features to one guided by intrinsic tumor biology. This article addresses how tumor genomic blueprints can be exploited for radiation therapy; radiomics as a noninvasive means to assessing tumor biology; clinical applications regarding treatment response, treatment planning, and toxicity; and radiogenomics utility.
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