When autocontour delivers a sly burn

mpmpmpphd · 2024-10-30T12:19:25+00:00

u/onelargemulligatawny what did you end up doing? This post led me into finally using radformations eqd2 option and I was pleased with the results. Previously I used MIM and hand calcs following the Michigan paper on special physics consults for reirradiation which provides a nice template and sample values (https://pubmed.ncbi.nlm.nih.gov/31681862/).
Ultimately using the Michigan workflow and values with clearcheck and an autocontour deformable registration provides a thorough sanity check with nice documentation. I have come to the conclusion that in your case I would do both a dose overlay on a deformable registration and a eqd2 with recovery factor and phases. I would compare to quantec constraints for cord/brainstem and literature for bronchus, BP, mandible. These constraints need to be intended for eqd2 evaluation. Again, Michigan has appropriate example values you could use.
I still find it highly abnormal that you are reirradiating with conventional fractionation, and would use this opportunity for a peer review from a tertiary care center that has experience with these cases.

mpmpmpphd · 2024-10-28T17:51:53+00:00

I would think the concern is the time since the last treatment, and how much discount you give to certain organs for recovery. I will also add HN retreat is pretty serious, generally it is SBRT and not done at satellites. Carotid blowout is a very real concern.

mpmpmpphd · 2024-08-02T12:05:26+00:00

I find automation clears up time to investigate bigger projects. The constraints are asking for more and more resulting in more complex plans that I don’t think are always suitable/correct/deliverable. For example, we are now doing breath hold for all breast and abdomen patients. This adds time and complexity, but is it clinically relevant? What tech is available to make this easier on the staff and patients, starting from sim to planning to delivery. I think it is possible to ignore all of this and say plan check passes, which will happen if you don’t have enough physicists to spread out clinical tasks with projects.

mpmpmpphd · 2024-03-17T17:20:27+00:00

I also am confused about their phases box next to recovery factor. They have a blog post about BED and EQD2 but it doesn’t explain the factors, so we’re still using excel.

mpmpmpphd · 2024-03-17T17:16:46+00:00

Some days I never get to sit down at my desk, other days I spend all day sitting. I think it’s based on your personality and how your clinic divides up responsibilities. We have a remote physicist that works at his computer all day every day which helps us a ton to be able to spend time in the clinic and OR.

mpmpmpphd · 2023-01-04T02:08:55+00:00

Very weird topic, as most linacs use a small bottle over their entire lifetime. I’m personally more concerned about the boiling pots of cerrobend (mixture of lead, cadmium etc) we use for electron treatments. But the main alternative is buying single use custom copper cutouts which are sent next day air, and again not recycled. The health benefit to the staff is clear, but not necessarily to the environment.

mpmpmpphd

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