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Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology
PURPOSE: The Nuclear Regulatory Commission deems it to be a medical event (ME) if the total dose delivered differs from the prescribed dose by 20% or more. A dose-based definition of ME is not appropriate for permanent prostate brachytherapy as it generates too many spurious MEs and thereby creates...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808748/ https://www.ncbi.nlm.nih.gov/pubmed/24174998 http://dx.doi.org/10.1016/j.prro.2011.05.001 |
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author | Nag, Subir Demanes, D. Jeffrey Hagan, Michael Rivard, Mark J. Thomadsen, Bruce R. Welsh, James S. Williamson, Jeffrey F. |
author_facet | Nag, Subir Demanes, D. Jeffrey Hagan, Michael Rivard, Mark J. Thomadsen, Bruce R. Welsh, James S. Williamson, Jeffrey F. |
author_sort | Nag, Subir |
collection | PubMed |
description | PURPOSE: The Nuclear Regulatory Commission deems it to be a medical event (ME) if the total dose delivered differs from the prescribed dose by 20% or more. A dose-based definition of ME is not appropriate for permanent prostate brachytherapy as it generates too many spurious MEs and thereby creates unnecessary apprehension in patients, and ties up regulatory bodies and the licensees in unnecessary and burdensome investigations. A more suitable definition of ME is required for permanent prostate brachytherapy. METHODS AND MATERIALS: The American Society for Radiation Oncology (ASTRO) formed a working group of experienced clinicians to review the literature, assess the validity of current regulations, and make specific recommendations about the definition of an ME in permanent prostate brachytherapy. RESULTS: The working group found that the current definition of ME in §35.3045 as “the total dose delivered differs from the prescribed dose by 20 percent or more” was not suitable for permanent prostate brachytherapy since the prostate volume (and hence the resultant calculated prostate dose) is dependent on the timing of the imaging, the imaging modality used, the observer variability in prostate contouring, the planning margins used, inadequacies of brachytherapy treatment planning systems to calculate tissue doses, and seed migration within and outside the prostate. If a dose-based definition for permanent implants is applied strictly, many properly executed implants would be improperly classified as an ME leading to a detrimental effect on brachytherapy. The working group found that a source strength-based criterion, of >20% of source strength prescribed in the post-procedure written directive being implanted outside the planning target volume is more appropriate for defining ME in permanent prostate brachytherapy. CONCLUSIONS: ASTRO recommends that the definition of ME for permanent prostate brachytherapy should not be dose based but should be based upon the source strength (air-kerma strength) administered. |
format | Online Article Text |
id | pubmed-3808748 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-38087482013-10-28 Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology Nag, Subir Demanes, D. Jeffrey Hagan, Michael Rivard, Mark J. Thomadsen, Bruce R. Welsh, James S. Williamson, Jeffrey F. Pract Radiat Oncol Special Article PURPOSE: The Nuclear Regulatory Commission deems it to be a medical event (ME) if the total dose delivered differs from the prescribed dose by 20% or more. A dose-based definition of ME is not appropriate for permanent prostate brachytherapy as it generates too many spurious MEs and thereby creates unnecessary apprehension in patients, and ties up regulatory bodies and the licensees in unnecessary and burdensome investigations. A more suitable definition of ME is required for permanent prostate brachytherapy. METHODS AND MATERIALS: The American Society for Radiation Oncology (ASTRO) formed a working group of experienced clinicians to review the literature, assess the validity of current regulations, and make specific recommendations about the definition of an ME in permanent prostate brachytherapy. RESULTS: The working group found that the current definition of ME in §35.3045 as “the total dose delivered differs from the prescribed dose by 20 percent or more” was not suitable for permanent prostate brachytherapy since the prostate volume (and hence the resultant calculated prostate dose) is dependent on the timing of the imaging, the imaging modality used, the observer variability in prostate contouring, the planning margins used, inadequacies of brachytherapy treatment planning systems to calculate tissue doses, and seed migration within and outside the prostate. If a dose-based definition for permanent implants is applied strictly, many properly executed implants would be improperly classified as an ME leading to a detrimental effect on brachytherapy. The working group found that a source strength-based criterion, of >20% of source strength prescribed in the post-procedure written directive being implanted outside the planning target volume is more appropriate for defining ME in permanent prostate brachytherapy. CONCLUSIONS: ASTRO recommends that the definition of ME for permanent prostate brachytherapy should not be dose based but should be based upon the source strength (air-kerma strength) administered. Elsevier 2011-10 /pmc/articles/PMC3808748/ /pubmed/24174998 http://dx.doi.org/10.1016/j.prro.2011.05.001 Text en © 2011 Published by Elsevier Inc. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/3.0/This is an open access article under the CC BY NC ND license (https://creativecommons.org/licenses/by-nc-nd/3.0/). |
spellingShingle | Special Article Nag, Subir Demanes, D. Jeffrey Hagan, Michael Rivard, Mark J. Thomadsen, Bruce R. Welsh, James S. Williamson, Jeffrey F. Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology |
title | Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology |
title_full | Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology |
title_fullStr | Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology |
title_full_unstemmed | Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology |
title_short | Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology |
title_sort | definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: a report from the american society for radiation oncology |
topic | Special Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808748/ https://www.ncbi.nlm.nih.gov/pubmed/24174998 http://dx.doi.org/10.1016/j.prro.2011.05.001 |
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