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.
The Global Radiation Oncology Workforce In 2030: Estimating Physician Training Needs And Proposing Solutions To Scale Up Capacity In LMICS
Shekinah Nefreteri Cluff Elmore, MD, MPH, is at Harvard Medical School, Boston. Gregorius Ben Prajogi, MD; Jose Alfredo Polo Rubio, MD; Eduardo Zubizarreta, MD, are at the International Atomic Energy Agency, Vienna.
Estimated time for completion: 1 hour   •   Date of release and review: July 1, 2019   •   Expiration Date: June 30, 2020
This review examines the capacity gap in RT through the lens of human resource needs. The authors model radiation oncologist training needs, investigate the disparity between HMICs vs LMICs, and explore solutions for training/licensure and regional collaboration.
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Improving Access To Radiation Therapy In Indonesia
Soehartati Gondhowiardjo, MD, PhD; Sri Mutya Sekarutami, MD, PhD; Angela Giselvania, MD; Steven Octavianus, MD; Muhamad Iqbal Assegab
Estimated time for completion: 1 hour   •   Date of release and review: July 1, 2019   •   Expiration Date: June 30, 2020
To date, the exponential rates of population growth and cancer incidence often outpace the linear rate of radiation therapy services growth, especially in developing countries such as Indonesia. There are many challenges faced in closing this gap and improving radiation therapy facilities and services. This review article summarizes the challenges and the efforts to overcome them.
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Augmenting Cancer Control Efforts In A Limited Resource Setting By Leveraging International Collaborations In Radiation Oncology
Joel Yarney, MD; Hannah Ayettey Anie, MD; Verna Vanderpuye, MD; Francis Adumata Asamoah, MD; Baffuor Awuah, MD; Clement Edusa, MD; Samuel Tagoe, PhD; Samuel Denyo, BTech; Pearl Aba Scott, MD; Francis Doughan, MPhil; Kofi Adesi Kyei, PhD; Charles Aidoo, HND; Bismark Dwobeng, MD; Rebecca Wong, MD; Horia Vulpe, MD; Shivanshu Awasthi, MPH, PharmD; Angelina Fink, MPH; Stuart Wasserman, MS; Peter Johnstone, MD; Louis Harrison, MD; Kosj Yamoah, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: July 1, 2019   •   Expiration Date: June 30, 2020
Oncologists may not be familiar with the utilization and operation of radiation therapy facilities in limited-resource settings. Additionally, oncologists interested in global radiation oncology need to understand the challenges and opportunities pertinent to the field. This article describes innovative international efforts regarding quality assurance, capacity building, and research and training that address unmet needs and improve radiation treatment for patients in Ghana, a major hub for radiation treatment in Africa.
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The Safety and Efficacy of Combined Immunotherapy and Radiation Therapy
Shwetha Manjunath, MD; Jacob E. Shabason, MD, MTR
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2019   •   Expiration Date: February 29, 2020
To date, there is little consensus on how to best combine radiation and immune checkpoint blockade (ICB) to maximize therapeutic gains while minimizing the potential for serious overlapping toxicities. This review summarizes relevant clinical data related to both safety and efficacy of the combination of ICB and radiation.
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Combining Immunotherapy with Radiation Therapy to Induce the Abscopal Response: What Clinical and Treatment Variables Matter?
Jason Liu, BS; Heath B. Mackley MD, FACRO
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2019   •   Expiration Date: February 29, 2020
This review article identifies demographic, clinical, and treatment variables associated with the abscopal effect— the phenomenon in which radiation induces a regression of tumor cells outside the field of irradiation. Authors describe the current state of knowledge regarding these variables and examine research on the influence of tumor type, patient’s immune system, overall tumor burden, and radiation therapy parameters on the abscopal effect.
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A review of strategies for optimizing workflow, quality improvement, and patient safety within radiation oncology departments
Bindu V. Manyam, MD; Naichang Yu, PhD; Tim Meier, RTT; John H. Suh, MD; Samuel T. Chao, MD
Estimated time for completion: 1 hour   •   Date of release and review: December 1, 2018   •   Expiration Date: November 30, 2020
With increases in complexity of radiation delivery and patient volume, vulnerable sources for errors may exist within radiation oncology workflow. Patterns of care recommendations are outlined by the American College of Radiology and the National Comprehensive Cancer Network guidelines; however, departmental and institutional policies and standards for quality and patient safety may vary. This article examines initiatives to mitigate errors and enhance safety, and describes efforts to incorporate quality improvement and patient safety into resident education.
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The impact of cybersecurity in radiation oncology: Logistics and challenges
Elizabeth M. Nichols, MD; Shafiq Ur Rahman, MBA, MS; Byongyong Yi, PhD
Estimated time for completion: 1 hour   •   Date of release and review: December 1, 2018   •   Expiration Date: November 30, 2020
On the rise, health-related cyberattacks are generally categorized into four groups: data loss, monetary theft, attacks on medical devices and infrastructure attacks. Breaches in cybersecurity can levy drastic consequences in radiation treatment delivery and health care overall. This review article describes experiences and unique needs and strategies pertaining to radiation oncology IT infrastructure, electronic medical records, automatic time outs, treatment planning and delivery, plan verification, screen locking and more to help prevent and overcome a cyber disaster.
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Improving The Therapeutic Index For Nonoperable Esophageal Cancer Patients With Modern Radiation Technologies
Michael D. Chuong, MD; Shahed Badiyan, MD; Matthew Hall, MD, MBA; Smith Apisarnthanarx, MD
Estimated time for completion: 1 hour   •   Date of release and review: Sept. 1, 2018   •   Expiration Date: August 31, 2020
Although there is general awareness that modern radiation technologies both reduce normal organ dose while permitting safe dose escalation in nonoperable EC patients, there is lack of consensus about how these technologies should be routinely employed in the clinic. There clearly is need for well-designed clinical trials to guide clinical decision making in this regard, several of which are being planned (NCT01102088) or already underway (NCT01512589). This course examines how contemporary radiation technologies can improve the therapeutic index, including both reduced cardiopulmonary and hematologic toxicity and higher tumor control, for nonoperable esophageal cancer patients receiving definitive chemoradiation.
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Controversies In The Preoperative Radiotherapeutic Management of Resectable Esophageal Cancer
Stephanie R. Rice, MD; Adeel Kaiser, MD; Elizabeth Nichols, MD
Estimated time for completion: 1 hour   •   Date of release and review: Sept. 1, 2018   •   Expiration Date: August 31, 2020
This review examines the role of trimodality therapy in the management of esophageal cancer, focusing on controversies surrounding the optimal total neoadjuvant RT dose employed. Current and past technologies for radiation treatment delivery and their impact on overall survival and toxicity are discussed. The authors also detail the data driving the management of resectable esophageal carcinoma, reviewing studies comparing neoadjuvant CRT followed by surgery to definitive CRT, neoadjuvant CRT followed by surgery to surgery alone, and controversies in radiation dose and planning considerations for preoperative resectable esophageal cancer.
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Comprehensive Care For The Child Or Adolescent Diagnosed With A Childhood Malignancy Requiring Palliative Radiation Therapy: A Review
Tamara Vern-Gross, DO, FAAP
Estimated time for completion: 1 hour   •   Date of release and review: June 1, 2018   •   Expiration Date: May 31, 2020
Because of the low incidence of pediatric malignancies, no consensus has been reached on the best practices for the delivery of pediatric palliative radiation therapy. As a result, current practice is extrapolated from adult literature and single institutional series. In addition to the technologies for palliation of pediatric patients are essential components of communication for meeting medical and psychosocial needs of the families and patients; these needs are not always addressed. A multidisciplinary approach with appropriate care and communication addressing patient questions and needs provides meaning and improved quality of life during this phase of treatment.
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Indications, Barriers and Paths To Advancement In Palliative Radiation Oncology
Muhammed M. Fareed, MD; Monica Krishnan, MD; Tracy A. Balboni, MD, MPH; Hsiang-Hsuan Michael Yu, MD
Estimated time for completion: 1 hour   •   Date of release and review: June 1, 2018   •   Expiration Date: May 31, 2020
Palliative radiation oncology is an integral part of radiation oncology practice with practical implications in common clinical scenarios including bone metastases, brain metastases, malignant spinal cord and cauda equina compression, tumor related bleeding, fungation, obstruction and visceral metastases. Further education and research is needed as part of residency training and beyond to enhance the spectrum of care for advanced cancer patients delivered by radiation oncologists. Supportive and palliative care skills must expand beyond the technical aspects of radiation therapy delivery to generalist palliative care competencies, including symptom manage-ment basics, communication and goals of care, advance care planning, psychosocial issues, cultural considerations, spiritual needs and ethical/legal issues.
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Imaging of Hydrocephalus
Wende N. Gibbs, MD, MA, and Lawrence N. Tanenbaum, MD, FACR
Estimated time for completion: 1 hour   •   Date of release and review: May 1, 2018   •   Expiration Date: April 30, 2020
Hydrocephalus is a a mechanical complication of differ-ent pathologic conditions and a disease process itself. The morphologic features are easily recognizable, but the patho-physiology remains incompletely understood. Nearly all hydrocephalus is due to cerebrospinal fluid (CSF) obstruc-tion at some point between the ventricles and the systemic venous circulation. Classification is important as it informs optimal treatment.
Optimized imaging is vital to the success of flow diver-sion. Current treatments are limited and invasive: CSF di-version via catheter or endoscopic third ventriculostomy. Decision-making relies upon high resolution imaging to determine the site of obstruction and anatomic features that may complicate the procedure.
Morphologic and physiologic imaging are used to evaluate suspected normal pressure hydrocephalus (NPH). Several morphologic measures individually and in combination have shown high positive predictive value in identifying individuals who will respond to treatment with ventricular shunting and in differentiating NPH from Alzheimer disease, which can have a similar imaging appearance.
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Stereotactic Ablative Radiation Therapy In The Treatment of Liver Tumors
Benjamin O. Spieler, MD; Lorraine Portelance, MD; Eric A. Mellon, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2018   •   Expiration Date: April 30, 2020
This review article discusses the major indications for stereotactic ablative radiation therapy for liver cancer, as well as the technologies available and/or necessary for safe treatment delivery. Specific areas discussed include hepatocellular carcinoma, intrahepatic cholangiocarcinoma, dose, image guidance and respiratory management, emerging techniques, and radiation induced liver disease.
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Stereotactic Body Radiation Therapy In Early Stage Non-small Cell Lung Cancer: A Brief Primer For The Multidisciplinary Tumor Board
Andrew Kennedy, MD; Susan Garwood, MD; Allison Grow, MD, PhD; Ryan Lipscomb, MS
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2018   •   Expiration Date: April 30, 2020
Multidisciplinary team members treating lung cancers may not be aware of the complexity and coordination required for delivery of stereotactic body radiation therapy (SBRT) to lung masses. Shifts in practice have occurred in management of early stage non small cell lung cancer (NSCLC), particularly with regard to the role of the specialized pulmonologist (interventional pulmonology), which involves different staging techniques than traditional mediastinoscopy. This review provides key information to foster a deeper understanding and appreciation for patient selection, work up, behind-the-scenes critical quality assurance tasks, and clinical pearls for stereotactic radiation therapy for lung cancer.
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Emotional-intelligence-centric Leadership Training for Radiation Oncologists
Sarah E. Hoffe, MD; Joanne Quinn, PhD, MBA; Jessica Frakes, MD; Thomas J. Dilling, MD; Nadia A. Saeed, BA; Louis B. Harrison, MD
Estimated time for completion: 1 hour   •   Date of release and review: December 1, 2017   •   Expiration Date: November 30, 2019
Current residency training in radiation oncology does not incorporate leadership competency skills. Additionally, increasing administrative burdens in healthcare correlate with growing physician burnout and stress, but residency training has no systematic strategy to increase resiliency. Although simulation based medical education (SBME) can incorporate teamwork, communication, and collaboration exercises at the undergraduate medical level, it has not been studied/incorporated at the national graduate level in radiation oncology. This article addresses the role of an emotional-intelligence (EI) based leadership curriculum during such training.
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Augmented and Virtual Reality: Exploring a future role in radiation oncology education and training
William Jin, Brandon Birckhead, MD; Bradford Perez, MD; Sarah Hoffe, MD
Estimated time for completion: 1 hour   •   Date of release and review: December 1, 2017   •   Expiration Date: November 30, 2019
The range of differences on the augmented/virtual reality AR/VR spectrum are mainly attributed to its depth of immersion. AR/VR technology is being used, through all spectrums of their devices, in surgery, imaging, medical student/resident/fellow education. The utility of AR/VR lies in its advantage to be massively scalable, reproducible, and realistic in simulating clinical environments. This article discusses how AR/VR technologies can cost-effectively enhance radiation oncology training.
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Current Controversies In Prostate Brachytherapy For Prostate Cancer
Ibrahim Abu-Gheida, MD; Christopher Fleming, MD; Paul Ramia, MD; Omar Mian, MD PhD; Rahul Tendulkar, MD; and Jay Ciezki, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2017   •   Expiration Date: August 31, 2019
Indications for low dose rate prostate brachytherapy (LDR-BT) monotherapy for high-risk or unfavorable intermediate-risk prostate cancer are currently not based on level I evidence. Guidelines discussing brachytherapy indications do not highlight the important RTOG 0232 interim analysis regarding the role of LDR monotherapy and toxicity profile advantage, nor do guidelines highlight the dosimetric value of brachytherapy. This article summarizes the role of LDR-BT in managing prostate cancer and examines patient selection.
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High Dose Rate Brachytherapy For Prostate Cancer: Current Techniques and Applications To Varying Disease Presentations
Daniel J. Krauss, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2017   •   Expiration Date: August 31, 2019
No direct clinical evidence supports the superiority of high-dose rate brachytherapy (HDR-BT) over low dose rate brachytherapy (LDR-BT), or vice versa, in terms of improved tumor control or reduced toxicity in patients with prostate cancer. This review fosters understanding of patient selection and technical description, examining HDR-BT in conjunction with external beam, and HDR-BT as monotherapy.
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