Radiation Hitting the Mark.

Slides:



Advertisements
Similar presentations
بسم الله الرحمن الرحيم ﴿و قل رب زدنى علماً﴾ صدق الله العظيم.
Advertisements

Understand broad treatment strategies in the treatment of tumors.
Nadya Dimitrova Marieta Petkova. 13 Regional cancer registries BNCR: -Established in 1952; cases a year; million population;
In the name of God Isfahan medical school Shahnaz Aram MD.
Joint Hospital Surgical Grand Round Accelerated partial breast irradiation: where should we go? Dr Ma Kwok Kuen Queen Mary Hospital.
Para-spinal Tumors Encircling the Spinal Cord IMRT Comparison of Several Target Definitions.
Radiation Oncology Demystified.
Morbidity / Complications
Radiotherapy in prostate cancer Dr.Mina Tajvidi Radiation oncologist.
Impact of imaging on newer radiation techniques in Gynaecological cancer.
Radiation Protection in Radiotherapy
Stereotactic Body Radiation Therapy (SBRT): The optimal indication for operable tumors in inoperable patients D.Katsochi 1, S.Kosmidis 1, A.Fotopoulou.
Introduction to Brachytherapy
Hysterectomy.
Intra-Operative Radiation Therapy for Treatment of Early Stage Breast Cancer: Short Term Results from a Single Institution Clinical Trial Using Electronic.
Section 6 Clinical Treatment Planning For External Beam, Brachytherapy & Hyperthermia Modified for Modified for :30 to 2:00 PM Carl.
CET Cancer Center Oakland California High Dose Rate (HDR) Brachytherapy Gynecological Cancer D. Jeffrey Demanes M.D
Suggested guidelines for appropriate patient selection for patients undergoing Accelerated Partial Breast Irradiation at DMC. Tonya Echols Cole, MD.
Routine Use of Intraoperative Ultrasound Guidance during Intracavitary Brachytherapy Applicator Placement in Cervical Cancer: the University of Alabama.
In the name of God Isfahan medical school Shahnaz Aram MD.
Conclusions HDR brachytherapy boost combined with moderate dose external beam irradiation resulted in a very high local control rate and few recurrences.
CTOS Soft Tissue Sarcoma of the Extremity Comparison of Conformal Post-operative Radiotherapy (CRT) and Intensity Modulated Radiotherapy (IMRT)
Mark L. Merlin, M.D. Radiotherapy Clinics of Georgia 7/14/2010 The Role of Radiation Therapy in the Management of Prostate Cancer.
Evidence Based For invasive breast cancer BCT is Tumor excision, axillary node dissection, whole breast radiation Modified mastectomy is total mastectomy.
Learn More At: CyberKnife Radiosurgery in the Treatment of Early and Advanced (Oligo-Metastases) Breast Cancer Sandra Vermeulen,
Targeted Intraoperative Radiotherapy versus Whole Breast Radiotherapy for Breast Cancer (TARGIT-A Trial): An International, Prospective, Randomised, Non-Inferiority.
Endometrial Cancer By Jessica Hall. Symptoms Unusual vaginal bleeding or discharge Difficult or painful urination Pain during intercourse Pain in the.
Permanent Interstitial Implants Ideal strategy to curatively manage small volume gynecologic malignancies Can deliver high cumulative radiation dose to.
Introduction/Aims There is less written about failure patterns after prostate brachytherapy (BT) alone or in combination with external beam radiotherapy.
High Dose Rate Brachytherapy Boost for Prostate Cancer: Comparison of Two Different Fractionation Schemes Tania Kaprealian 1, Vivian Weinberg 3, Joycelyn.
Adjuvant treatment for endometrial cancer Ameri A Associate Professor of Radiation Oncology Shahid Beheshti University of Medical Sciences Dec Pars.
Radiotherapy Physics Chris Fox Department of Physical Sciences Peter MacCallum Cancer Centre.
SARC018: A SARC PILOT MULTICENTER STUDY OF PREOPERATIVE RADIATION AND SURGERY IN PATIENTS WITH HIGH- RISK DESMOID TUMORS Robert S. Benjamin, M.D.
Debra Freeman, MD – Naples Christopher King, MD, PhD - Stanford.
PURPOSE PURPOSE METHODSMETHODS CONCLUSIONSCONCLUSIONS Long-term results of daily HDR brachytherapy in the postoperative setting of endometrial carcinoma.
Image Guided Interstitial Brachytherapy For Locally Advanced Gynaecological Cancer With A MUPIT Applicator M.A.D. Haverkort, MD 1, E. Van der Steen - Banasik,
Taipei VGH Practice Guidelines: Oncology Guidelines Index Cancer of Cervix Version Table of Content StagingStaging, Manuscript Taipei Veterans General.
Cyberknife Therapy for Prostate Cancer David Spellberg M.D., FACS Naples Urology Associates, P.A.
방사선종양학과 - 혈액종양내과 Joint Conference 경희의료원 방사선종양학과 R4 공 문 규.
Taipei Veterans General Hospital Practices Guidelines Oncology Cervical Cancer Version VGH Survival Data as of YYYY/MM/DD Proofing on 2010/MM/DD.
Dose Calculations for Cyberknife Stereotactic Body Radiation Therapy For CK, one can fractionate the therapy yet remain convenient and non-invasive for.
Treatment Chart Record of patients radiation therapy history. Must contain: History and diagnosis Rationale for treatment Treatment plan Consent Documentation.
Understanding Radiation Therapy Lecturer Radiological Science
External Beam Radiotherapy for Differentiated Thyroid Cancer
Modern Radiation Oncology
Radiation therapy for Early Stage Prostate Cancer
THREE OR FOUR FRACTIONS PER WEEK IN POSTOPERATIVE HIGH DOSE RATE BRACHYTHERAPY (HDRBT) FOR ENDOMETRIAL CARCINOMA (EC). Rovirosa A1, Vargas M1, Ascaso C2,
RCR breast radiotherapy consensus guidelines
Intensity modulated radiation therapy for definitive treatment of paraortic relapse in patients with endometrial cancer  Shervin M. Shirvani, MD, Ann.
Creating the perfect text…
The Role of Cyberknife Stereotactic Body Radiation Therapy in the Treatment of Prostate Cancer Jay L. Friedland, MD.
IMRT delivery of preoperative, high dose radiotherapy to a large volume, with Simultaneous Integrated Boost (SIB) in retroperitoneal sarcomas: The Ottawa.
Surgical Cancer Treatment
Surgical Cancer Treatment
RTOG 0126 A Phase III Randomized Study of High Dose 3D-CRT/IMRT versus Standard Dose 3D-CRT/IMRT in Patients Treated for Localized Prostate Cancer Bijoy.
أجهزة العلاج الإشعاعي Clinical Radiation Generator
Prostate Cancer: Highlights from 2006
Insert tables Insert figure
Intensity modulated radiation therapy for definitive treatment of paraortic relapse in patients with endometrial cancer  Shervin M. Shirvani, MD, Ann.
Volume 72, Issue 5, Pages (November 2017)
Volume 68, Issue 4, Pages (October 2015)
What is New in Hormone Therapy for Prostate Cancer in 2007?
Radiation Therapy for Cutaneous T-Cell Lymphomas
Management of endometrial cancer found on routine hysterectomy for benign disease Prof Dr M Anıl Onan MAY ANTALYA.
Clinical Radiation Oncology NMT232 L 10
Figure 2 The evolution of brachytherapy for prostate cancer
Hemithoracic Radiotherapy After Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma: A Dosimetric Comparison of Two Well-Described Techniques 
Constantinos Zamboglou, Matthias Eiber, Thomas R
Principles of Radiation Therapy
Presentation transcript:

Radiation Hitting the Mark

Resources STandards for Oncology Registry Entry STORE 2018 www.facs.org/~/media/files/quality%20programs/cancer/ncdb/store_manual_2018.ashx CTR Guide to Coding Radiation Therapy Treatment in the STORE https://www.facs.org/-/media/files/quality- programs/cancer/ncdb/case_studies_coding_radiation_treatment.ashx

Resources CTR Guide to Coding Radiation Therapy Treatment in the STORE This document was prepared as a platform for “learning by example”. Gives clinical examples that will provide guidance for 95% or more of the clinical situations you will encounter. Provides a Summary of Coding Principles that clarifies misconceptions and misinterpretations within STORE 2018 CTR Guide to Coding Radiation Therapy Treatment in the STORE trumps the STORE 2018.

Radiation Hitting the Mark Uses the CTR Guide to Coding Radiation Therapy Treatment in the STORE in its approach and design. Addresses the more challenging principles. Allows you to learn by example. Gives rationale and references.

Case 1

Case 1 cont.

Case 1 cont.

Case 1 cont.

Case 1 cont. Rationale: #1: Code 3 in this field, Margins and LVI are stated thus, we know surgery was performed. #5: Code 20181120. Though page 1 states the date completed as 11/19/2018, page 2 states end date as 11/20/2018. #7: Code 01 (Radiation treatment completed). The “End of Treatment Summary” (pg #1) indicates that only 3/4 of the fractions were administered the “Treatment Summary” (pg #2) states 4/4 fractions were administered. It is important to remember that the reports you have may not give clear, concise or detailed information so you may have to piece together the puzzle from other reports that are available to you.

Case 1 cont. Rationale: #8: Code 005256. Add Total Phase 1 Dose (#15) and Total Phase 2 Dose (#22) = Total Dose (#8). Both used the same modality of External Beam Radiation Therapy (EBRT), though one was photons and the other was electrons. Also, both were to the same volume, though one was to the whole breast and one was to partial breast. (See: “CTR Guide to Coding Radiation Therapy Treatment in the STORE” page 6).

Case 1 cont.

Case 1 cont. #9: Code Volume to 40 (Whole Breast). FiF (Field-in-Field/forward planning) is treatment involving the whole breast. #10: Code 00. No nodes positive thus, there are no cancerous nodes that need to be treated. If nodes are “exposed” to radiation that does not mean they are being intentionally “targeted”. (See: “CTR Guide to Coding Radiation Therapy Treatment in the STORE” page 9).

Case 1 cont. #11: Radiation Energy listed with Megavolts (MV) or X = external beam, photons. #12: Code 05 (IMRT). Though FiF is usually 3-D, the summary states it is IMRT. Rules state that it “Should be clearly described as conformal or 3-D therapy”. (See: STORE 2018 page 288).

Case 1 cont.

Case 1 cont. #16: Code 41 for Volume (Breast - Partial). Phase 2 was a “boost” or “cone down” which delivers additional radiation to the region at the greatest risk for recurrence (i.e.: the surgical bed). #17: Code 00 (No radiation treatment to draining lymph nodes). Though in Phase 1, the regional lymph nodes were targeted and treated, phase 2 is a BOOST and with a BOOST the tumor/tumor bed is the primary target. Thus, in Phase 2 lymph nodes may be “exposed” to radiation but they are not being intentionally “targeted”.

Case 1 cont. #18: Radiation Energy listed with Electron (E or e-) = external beam, electrons. #20: Code 004. “Treatment Summary” states 4/4 fractions were administered. #22: Code 001000. “Treatment Summary” states 4/4 fractions were administered. 4 fractions x 250 dose per fraction = 1000 Total Phase 2 Dose .

Case 2

Case 2 cont.

Case 2 cont.

Case 2 cont.

Case 2 cont. Rationale: #1: Code 3 in this field, “Toxicities Summary” (pg 1) and “Special Points” (pg 2) refers to the prostate bed as area that received treatment. Prostate bed is a surgical reference to indicate a prostatectomy thus, we know surgery was performed

Case 2 cont.

Case 2 cont. Rationale: #9: Code 86 (Pelvis NOS). The prostate was removed during the prostatectomy thus, here is no prostate to target. Treatment will be targeted to the Pelvis NOS. NOTE: If the the prostatectomy was not preformed and the prostate remained intact, you would code Volume to 64 (Whole Prostate). Even if the report lists the treatment site as pelvis, the prostate is still the primary target. (See: “CTR Guide to Coding Radiation Therapy Treatment in the STORE” page 11).

Case 2 cont. #10: Code 06 (Pelvic lymph nodes). Toxicities Summary states radiation completed to the regional nodes. Thus, they are being intentionally “targeted”.

Case 2 cont.

Case 2 cont. #17: Code 00 (No radiation treatment to draining lymph nodes). Though in Phase 1, the regional lymph nodes were targeted and treated, phase 2 is a BOOST and with a BOOST the tumor/tumor bed is the primary target. Thus, in Phase 2 lymph nodes may be “exposed” to radiation but they are not being intentionally “targeted”.

Case 3

Case 3 cont.

Case 3 cont.

Case 3 cont.

Case 3 cont.

Case 3 cont. Rationale: #1: Code 3 in this field. Summary states that a Total Abdominal Hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO) was performed. #5: Code 20190422. The date on the summary for Phase 2 and 3 states 04/22/2019. #6: Code 03. Toxicities Summary states that HDR treatments with vaginal cylinder, followed 25 Gy of external beam. Phase 2 was mentioned in the text for phase 3 but no individual summary for this phase was included in the record.

Case 3 cont. #8: Code 012500. Phase 1 and 2 are to the same volume and use the same modality (EBRT), even though one modality is external beam NOS and the other is external beam photon. This field is recorded in centi- Gray (cGy), so pay close attention to each phases unit of measure (Gy ,cGy, cGe, etc).

Case 3 cont.

Case 3 cont. #9: Code Volume 86 (Pelvis NOS). The corpus uteri was removed during the TAH, there is no uterus to target. Treatment will be targeted to the Pelvis NOS. #10: Code 06 (Pelvic lymph nodes). Positive pelvic lymph nodes was excised thus, lymph nodes will be targeted for treatment.

Case 3 cont.

Case 3 cont. #16: Code 86 (Pelvis NOS). Phase 2 is a BOOST. #17: Code 00 (No radiation treatment to draining lymph nodes). BOOST treatment focuses on tumor bed. #18: Code 01. Summary just says “external beam”. #19: Code 01. Summary just says “external beam”. #21: Code 02500. Phase unit of measure is stated in Gy and you must convert to centi-Gray. 1 Gy=100 cGy thus, 25 Gy x 100 cGy = 2500 cGy .

Case 3 cont.

Case 3 cont. #23: Code to volume 72 (Vagina). Treatment delivered with brachytheraphy via a vaginal cylinder. #24: Code 00 (No radiation treatment to draining lymph nodes). Vagina is primary target. #25: Code 09 (Brachytheraphy, intracavitary, HDR). #26: Code 88 (Not Applicable). Treatment not by external beam. (See: “STORE 2018”, page 286)

Case 3 cont. #28: Code 99998 (Not applicable, radioisotopes administered to the patient). There is no agreed upon standard for documenting a dose by brachytherapy. (See: “CTR Guide to Coding Radiation Therapy Treatment in the STORE” page 6). #29. Code 999998 (Not applicable, radioisotopes administered to the patient). There is no agreed upon standard for documenting a dose by brachytherapy. (See: “CTR Guide to Coding Radiation Therapy Treatment in the STORE” page 6). NOTE: List phase in chronological order.

Take home points Compare ALL records to verify dates. Read the summaries to look for hidden phases or information. Determining if surgery was completed will help to identify the volume. If nodes are “exposed” to radiation that does not mean they are being intentionally “targeted”. They must be part of the treatment plan. Look for statement of positive lymph nodes. Total dose is a cumulative dose for the phases that were performed using the same modality (i.e. external beam, brachytherapy, etc.). If combining phases to calculate Total dose the phases must have been performed on the same volume.

Questions?

Contact Information: Shelly Gray 859-218-2101 sgray@kcr.uky.edu Tonya Brandenburg 859-218-3195 tbrand@kcr.uky.edu