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.
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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Chemoradiation Treatment of Glioblastoma Multiforme: Treatment Guidelines and Considerations
Krissia Margarita Rivera Perla, ScB; Ollin Gomez Venegas, BA; Steven A. Toms, MD, MPH
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2019   •   Expiration Date: August 31, 2021
Authors review the North American and European guidelines for chemoradiation of GBM created as a result of the new 2016 WHO classification system, focusing specifically on age, performance status, molecular markers, and disease recurrence. They also discuss factors such as socioeconomic and insurance status that impact radiation treatment compliance and GBM outcomes.
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Multimodality Management of Colorectal Liver Oligometastases
Shauna R. Campbell, DO; Ehsan H. Balagamwala, MD; Neil M. Woody, MD, MS; Kevin L. Stephans, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2019   •   Expiration Date: August 31, 2021
Authors examine modern treatment approaches to limited liver metastases from colorectal cancer, discussing the intent and sequencing of treatment, chemotherapy, surgical resection, radiofrequency ablation/cryoablation, chemoembolization, radioembolization, external-beam radiation therapy, stereotactic body radiation therapy (SBRT), and proton therapy and the indication for each modality. The review also describes circumstances in which SBRT is preferred over other liver-directed therapies.
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Proton Therapy for Colorectal Cancer
Saira E. Alex, BS; Eric D. Brooks, MD; Emma B. Holliday, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2019   •   Expiration Date: August 31, 2021
Based on current standards, colon cancer is treated with surgical resection and chemotherapy, and rectal cancer is treated with preoperative radiotherapy. This review of the literature suggests the potential for improved local control and reduced toxicity when treating colorectal cancer with proton therapy compared to the current treatment paradigms. Additionally, surgery and ablative techniques have traditionally been used to treat metastatic colorectal cancer. This review discusses how proton therapy could offer an alternative approach to reduce toxicity and act in lieu of surgery in the metastatic setting.
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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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