Standardizing dose prescriptions: An ASTRO white paper

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Presentation transcript:

Standardizing dose prescriptions: An ASTRO white paper Suzanne B. Evans, MD, MPH, Benedick A. Fraass, PhD, Paula Berner, CMD, FAAMD, Kevin S. Collins, PhD, RT(R)(T), CMD, Teamour Nurushev, PhD, Michael J. O’Neill, MD, Jing Zeng, MD, Lawrence B. Marks, MD Practical Radiation Oncology Volume 6, Issue 6, Pages e369-e381 (November 2016) DOI: 10.1016/j.prro.2016.08.007 Copyright © 2016 American Society for Radiation Oncology Terms and Conditions

Figure 1 The three types of communication between or within people and machines are shown. The IHE-RO initiative addresses communication between devices. In the lower corner are listed additional electronic systems (eg, hospital electronic medical records) where communication or connectivity issues can also be challenging. Also important is communication between people and between people and machines. A standard format/language for radiation therapy prescriptions is intended to facilitate clear human-to-human and computer-to-human communication. CT, computed tomography; IHE-RO, Integrating the Healthcare Enterprise-Radiation Oncology; PACS, picture archiving and communication system; RT, radiation therapy; R&V systems, radiation therapy record and verify systems. Adapted with permission from Marks and Chang, Practical Radiation Oncology (2011) 1, 232-234. Practical Radiation Oncology 2016 6, e369-e381DOI: (10.1016/j.prro.2016.08.007) Copyright © 2016 American Society for Radiation Oncology Terms and Conditions

Figure 2 Screen shots from vendors within the field, all illustrating the manner in which radiation therapy prescriptions are either entered or displayed. The degree of intervendor variation is self-evident despite the limited sampling of vendors shown. Interestingly, there are several examples in which there is intravendor variation as well, with the same prescription being depicted in different formats in different locations within the product. Some clinics have software from multiple vendors. The highlights, lines, and call out balloons are added to emphasize the point. Adapted with permission from Marks et al; Engineering Patient Safety in Radiation Oncology 2015. (A) Mosaiq, Elekta AB, Stockholm, Sweden, used with permission. (B) TomoTherapy, Accuray, Sunnyvale, CA, used with permission. The dose per fraction is not part of the display. (C) CyberKnife, Accuray, Sunnyvale, CA, used with permission. In the lower left-hand corner, the number of fractions is not noted in the prescription, nor is the fraction size, only the total dose. (D) Aria, Varian Medical Systems, Palo Alto, CA, used with permission. (E) Aria, Varian Medical Systems, Palo Alto, CA, used with permission. Practical Radiation Oncology 2016 6, e369-e381DOI: (10.1016/j.prro.2016.08.007) Copyright © 2016 American Society for Radiation Oncology Terms and Conditions

Figure 2 Screen shots from vendors within the field, all illustrating the manner in which radiation therapy prescriptions are either entered or displayed. The degree of intervendor variation is self-evident despite the limited sampling of vendors shown. Interestingly, there are several examples in which there is intravendor variation as well, with the same prescription being depicted in different formats in different locations within the product. Some clinics have software from multiple vendors. The highlights, lines, and call out balloons are added to emphasize the point. Adapted with permission from Marks et al; Engineering Patient Safety in Radiation Oncology 2015. (A) Mosaiq, Elekta AB, Stockholm, Sweden, used with permission. (B) TomoTherapy, Accuray, Sunnyvale, CA, used with permission. The dose per fraction is not part of the display. (C) CyberKnife, Accuray, Sunnyvale, CA, used with permission. In the lower left-hand corner, the number of fractions is not noted in the prescription, nor is the fraction size, only the total dose. (D) Aria, Varian Medical Systems, Palo Alto, CA, used with permission. (E) Aria, Varian Medical Systems, Palo Alto, CA, used with permission. Practical Radiation Oncology 2016 6, e369-e381DOI: (10.1016/j.prro.2016.08.007) Copyright © 2016 American Society for Radiation Oncology Terms and Conditions

Figure 2 Screen shots from vendors within the field, all illustrating the manner in which radiation therapy prescriptions are either entered or displayed. The degree of intervendor variation is self-evident despite the limited sampling of vendors shown. Interestingly, there are several examples in which there is intravendor variation as well, with the same prescription being depicted in different formats in different locations within the product. Some clinics have software from multiple vendors. The highlights, lines, and call out balloons are added to emphasize the point. Adapted with permission from Marks et al; Engineering Patient Safety in Radiation Oncology 2015. (A) Mosaiq, Elekta AB, Stockholm, Sweden, used with permission. (B) TomoTherapy, Accuray, Sunnyvale, CA, used with permission. The dose per fraction is not part of the display. (C) CyberKnife, Accuray, Sunnyvale, CA, used with permission. In the lower left-hand corner, the number of fractions is not noted in the prescription, nor is the fraction size, only the total dose. (D) Aria, Varian Medical Systems, Palo Alto, CA, used with permission. (E) Aria, Varian Medical Systems, Palo Alto, CA, used with permission. Practical Radiation Oncology 2016 6, e369-e381DOI: (10.1016/j.prro.2016.08.007) Copyright © 2016 American Society for Radiation Oncology Terms and Conditions

Figure 3 A summary of the recommendations within the standardizing dose prescriptions white paper. Please note that within delivery method, formalism for brachytherapy is consistent with the Nuclear Regulatory Commission. Within the external beam delivery method, some formalism is provided, but there remain too many permutations to address this presently, and, as such, is beyond the scope of this paper. Practical Radiation Oncology 2016 6, e369-e381DOI: (10.1016/j.prro.2016.08.007) Copyright © 2016 American Society for Radiation Oncology Terms and Conditions