Imaging Technology News 9/08

> > special report The Top IMRT/IGRT Centers to Watch Top IMRT/IGRT cancer treatment centers achieve a unique balance between innovation and patient care. by Cristen C. Bolan and Rick Dana Barlow T he challenge in radiation therapy is to deliver the optimal amount of dose with enough precision to avoid damaging healthy surrounding tissue. Add to that, the reimbursement pressures of a fiscally tight healthcare environment that forces clinicians to put a premium on patient throughput, and the window of accuracy narrows. Balancing speed and accuracy in treating patients with radiation therapy requires professionals with critical thinking and strategic planning skills who can fuse art with science. You will find these clinicians in our annual review of the “Top IMRT/IGRT Centers to Watch” for 2008. This review recognizes the most forward-thinking U.S. cancer treatment centers that are using advanced techniques and technology, such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT), to help their patients and to make a difference. Some of the high profile radiation oncology centers in the U.S. are well known leaders, such as M.D. Anderson (Houston, TX), the Memorial Sloan-Kettering Cancer Center (New York, NY), Johns Hopkins Hospital (Baltimore, MD) and the Mayo Clinic (Rochester, MN). In addition to these centers, we asked our readers to select this year’s “Top IMRT/IGRT Centers to Watch.” Readers nominated worthy facilities based on their achievements in innovation, operational efficiency, patient service and teamwork. From there, the editors have chosen the top facilities to watch in 2008, classifying them as influential market leaders. 1. University of Maryland (Baltimore, MD) The University of Maryland in Baltimore, leads off our “Top IMRT/IGRT Centers to Watch” list because this facility is exemplary in achieving the unique balance between technical innovation, efficiency, patient care and teamwork. Innovation: The University of Maryland was the first in the region to offer IMRT to its patients both in the main facility in Baltimore and at its community sites. Throughout the years, the faculty members in the department of radiation oncology Top IMRT/IGRT Centers have developed several unique IMRT methods and applied them clinically to optimize patient to Watch of 2008 care. One of the techniques is intensity modulat1. University of Maryland ed arc therapy (IMAT), a method invented by one (Baltimore, MD) of the physicists. Rather than using fixed intensity modulated beams, IMAT uses overlapping rota2. Rocky Mountain CyberKnife tional beams. Because all beam angles are con(Boulder, CO) sidered during plan optimization, IMAT has the 3. MIMA Cancer Center potential to improve plan quality. Because IMAT is (Melbourne, FL) delivered with continuous rotation, the total treatment time is less, allowing more patients to 4. Central Arkansas Radiation Therapy Institute (Little Rock, receive the benefits of IMRT. AR) Another innovation is Direct Aperture Optimization (DAO). Rather than using the con5. Baptist Centers for Cancer Care’s ventional two-step process in planning IMRT, Radiation Oncology Center DAO directly optimizes the treatment beam aper(Memphis, TN) tures and their weightings. Highly conformal IMRT plans can be generated with limited number of apertures. For many cases, the use of DAO allowed the reduction of treatment time from 30 minutes to less than 10 minutes. In the area of IGRT, University of Maryland is the first in the MidAtlantic region to adopt image-guided radiation therapy using conebeam CT from Varian Trilogy in 2005. For managing target motion, the radiation oncology department implemented gated radiation delivery using the Varian RPM system. The faculty members at the University of Maryland have successfully obtained NIH funding to develop a real-time tumor tracking technology. They are regarded as pioneers in the areas of four-dimensional CT and tumor tracking. Operational Efficiency: The department of radiation oncology meets regularly to carefully examine all treatment procedures for potential quality improvement and operational efficiency. The department also migrated to VARiS for better integration of the workflow with new Varian equipment. Patient Care: The University of Maryland has a patient-friendly waiting area highlighted by a two-story atrium with ample natural light. Each patient has an employee assist with his or her paperwork to answer any questions and to help the patient understand and to complete the process as efficiently as possible. The front desk staff is trained to always be cognizant of patient waiting time and comfort. Patients waiting are frequently checked to see if there is anything they need to make their wait more comfortable. To act as an aid in educating patients about radiation therapy, the department developed an award-winning video and handbook that received both local and national attention. The department also instituted a patient navigator to guide patients through a potentially complex system. The key component that assisted the patient navigator and all staff in efficiently managing the patient was the introduction of VARiS, which has led to increased patient satisfaction and throughput. Teamwork: Patient care is the primary focus of all employees who consistently look for ways to improve the overall experience for the patient, both in terms of visit satisfaction and treatment outcomes and satisfaction. Recurring meetings that focus on patient care are attended by physician leadership, administration leadership and representatives from the clinic (front desk, therapy and nursing) to solicit input on ways to make the clinic run more efficiently. 2. Rocky Mountain CyberKnife (Boulder, CO) Innovation: At Rocky Mountain CyberKnife doctors treat benign tumors, malignant tumors, vascular malformations and functional disorders located in the brain, spine, skull base, orbit, musculoskeletal, lung, liver, pancreas and prostate. This center employs the Accuray Cyberknife system because it offers rapid relief from pain and other symptoms, and recovery is often immediate, given its low risk of complications and damage to healthy tissue. Treatments tend to last between 30 and 60 minutes. The site started using the touchscreen monitor that is now included with all Cyberknife systems. They visualize the target motion before treating Synchrony patients. The Synchrony System is designed to allow physi- 32 > special report > S e p t e m b e r 2 0 0 8 http://new.reillycomm.com/imaging/special-report-b.php

Table of Contents Feed for the Digital Edition of Imaging Technology News 9/08

Imaging Technology News 9/08 Contents IGRT How IGRT Targets the Prostate ASTRO Oncology Information Management Systems (OIMS) Imaging Leading the Intense Race Against Cancer SBRT - The New Treatment of Choice Top IMRT/IGRT Centers to Watch Molecular Imaging: Ready for the Limelight CR or DR in the ER? Have You Hit the Glass Ceiling?

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