Thomas J. FitzGerald

By Thomas J. FitzGerald, Maryann Bishop-Jodoin, Killian Dickson, Yuan-Chyuan Lo, Carla Bradford, Linda Ding, Jessica Hiatt, Harry Bushe, Jonathan Saleeby, I-lin Kuo, Elizabeth Bannon, Kenneth Ulin, David DeSantis, Sherri L. Shul, Bashera Nochomowitz, Julie Trifone, Thomas Quinn, Catherine Whelan, Joshua Taylor, Maureen Britton, Shannon Higgins, Karen Morano, Jean Quigley and Kathleen Briggs

The discovery of radiation has enabled great healthcare advances as well as catastrophic injury. This paper reviews major historical incidents of public radiation exposure and the evolution of standards affecting today’s public and health care workers. Current patient care and response assessment to radiation exposure are reviewed. The strengths of modern radiation therapy and the need for continuous process improvements to ensure optimal patient care and secure safe environments are identified. The discovery of radiation has brought significant scientific achievements as well as catastrophic injury.

Part of the book: Essentials of Accident and Emergency Medicine

By Thomas J. FitzGerald, Maryann Bishop-Jodoin, Fran Laurie, Matthew Iandoli, Ameer Elaimy, James Shen, Peter Lee, Alexander Lukez, Lakshmi Shanmugham, Beth Herrick, Jon Glanzman and David Goff

Radiation exposures, both intentional and unintentional, have influence on normal tissue function. Short-term and long-term injuries can occur to all cell systems of both limited and rapid self-renewal potential. Radiation effects can last a lifetime for a patient and can produce complications for all organs and systems. Often invisible at the time of exposure, the fingerprints for cell damage can appear at any timepoint after. Health-care providers will need comprehensive knowledge and understanding of the acute and late effects of radiation exposure and how these interrelate with immediate and long-term care.

Part of the book: Emergency Medicine and Trauma

By Thomas J. FitzGerald, Maryann Bishop-Jodoin, Fran Laurie, Richard Hanusik, Matthew Iandoli, Kathryn Karolczuk, Sandra Kessel, Fred Prior, Joel Saltz, Ashish Sharma, Michael Knopp, Mark Rosen, Ying Xiao, David Followill, Jeff Michalski, M. Giulia Cicchetti and Janaki Moni

Imaging in neuro-oncology clinical trials can be used to validate patient eligibility, stage at presentation, response to therapy, and radiation therapy. A number of National Clinical Trials Network trials illustrating this are presented. Through the Imaging and Radiation Oncology Core’s quality assurance processes for data acquisition and review, there are uniform data and imaging sets for review. Once the trial endpoints have been analyzed and published, the clinical trial information including pathology, imaging, and radiation therapy objects can be moved to a public archive for use by investigators interested in translational science and the application of new informatics tools for trial analysis.

Part of the book: Neuroimaging

By Thomas J. FitzGerald, Maryann Bishop-Jodoin, Fran Laurie, Richard Hanusik, Matthew Iandoli, Kathryn Karolczuk, Sandra Kessel, Fred Prior, Joel Saltz, Ashish Sharma, Michael Knopp, Mark Rosen, Ying Xiao, David Followill, Jeff Michalski, Ameer Elaimy, James Shen, Peter Lee, Maria Giulia Cicchetti and Janaki Moni

Oncology clinical trials provide opportunity to advance care for patients with cancer. Bridging basic science with bedside care, cancer clinical trials have brought new and updated scientific knowledge at a rapid pace. Managing subject data in translation science requires a sophisticated informatics infrastructure that will enable harmonized datasets across all areas that could influence outcomes. Successful translational science requires that all relevant information be made readily available in a digital format that can be queried in a facile manner. Through a translational science prism, we look at past issues in cancer clinical trials and the new National Institutes of Health/National Cancer Institute initiative to address the need of database availability at an enterprise level.

Part of the book: Translational Research in Cancer

By James Shen, Linda Ding, Kevin O’Connor, Ameer Elaimy, Carla Bradford, Fenhong Liu, Abdulnasser Khalifeh, Suhong Yu, Harry Bushe, Jonathan Saleeby, Kenneth Ulin, I-Lin Kuo, Yankhua Fan, Maryann Bishop-Jodoin, Paul Rava and Thomas J. FitzGerald

The discovery of radiation has led to many advances. Guidelines have been created to minimize radiation exposure and treatment management following both unintentional and intentional exposure. The effects of radiation exposure on specific tissues varies. Tragic consequences can result, ranging from severe, acute injury to long- lasting effects that present years after the initial exposure. In this chapter we provide observations that demonstrate the importance of understanding guidelines to minimize radioactive exposure and the expectations and treatment management following exposure. For the safety and well-being of patients, health care professionals need to remain well-informed to minimize the risks of this tool.

Part of the book: Trauma and Emergency Surgery

By Thomas J. FitzGerald, Linda Ding, Christopher Riberdy, Jack Bailey, Michael Anderegg, Ameer Elaimy, James Shen, Kevin O’Connor, Carla Bradford, I-Lin Kuo, Yankhua Fan, Fenghong Liu, Suhong Yu, Harry Bushe, Jonathan Saleeby, Paul Rava, Shirin Sioshansi, M. Giulia Cicchetti, Janaki Moni, Eric Ko, Allison Sacher, Daniel Han and Maryann Bishop-Jodoin

Proton therapy is increasing in utilization worldwide at a rapid rate. With process improvements in costs, footprints, and continued advances in the delivery of care, including intensity modulation and image guidance, proton therapy may evolve into standard treatment with photon radiation therapy. This chapter reviews process improvements in proton therapy and the application in modern care.

Part of the book: Proton Therapy

By Ameer L. Elaimy, Linda Ding, Jonathan Glanzman, Lakshmi Shanmugham, Beth Herrick, Jody Morr, Dan Han, Jeffrey C. Buchsbaum and Thomas J. FitzGerald

Due to space requirements and a substantial financial burden, the feasibility of health systems adopting proton therapy has been called into question. However, advances in facility design and treatment delivery have allowed institutions offering proton therapy to reduce footprint while incorporating technological improvements at reduced costs. As the number of centers and patients treated continue to increase, this chapter will review the layout and interface of proton therapy facilities providing a detailed overview of the design, costs and faculty and staff considerations.

Part of the book: Proton Therapy

By Linda Ding, Carla D. Bradford, Kenneth Ulin, Koren Smith, I-Lin Kuo, Yankhua Fan, Abdulnasser Khalifeh, Fenghong Liu, Suhong Lu, Harry Bushe, Salvatore Larosa, Camelia Bunaciu, Jonathan Saleeby, Shannon Higgins, Julie Trifone, Maureen Britton, Joshua Taylor, Marious Croos, Katie Figura, Thomas Quinn, Linda O’Connor, Kathleen Briggs, Sherri Suhl, Jean Quigley, Heather Reifler, Shawn Kirby, Fred Prior, Joel Saltz, Maryann Bishop-Jodoin and Thomas J. FitzGerald

Technology and computational analytics are moving forward at an extraordinary rate with changes in patient care and department workflows. This rapid pace of change often requires initiating and maintaining the educational support at multiple levels to introduce technology to radiation oncology staff members. Modern physics quality assurance and dosimetry treatment planning now require expertise beyond traditional skill based in computational algorithms and image management including quality assurance of the process of image acquisition and fusion of image datasets. Expertise in volumetric anatomy and normal tissue contouring are skills now performed by physics/dosimetry in collaboration with physicians and these skills are required in modern physics dosimetry training programs. In this chapter, challenges of modern radiation planning are reviewed for each disease site. Skills including future applications of image integration into planning objects and the future utility of artificial intelligence in modern radiation therapy treatment planning are reviewed as these issues will need to be added to modern training programs.

Part of the book: Dosimetry

By Thomas J. FitzGerald, Fran Laurie, Matthew Iandoli, Maryann Bishop-Jodoin, Koren Smith, Kenneth Ulin, Janaki Moni, Maria Giulia Cicchetti, Stephen Kry, Michael Knopp, Ying Xiao, Mark Rosen, Fred Prior and Joel Saltz

Clinical trials in radiation oncology have improved our translational science and patient care. All patients referred to departments of radiation oncology can be invited to participate in a clinical trial with multiple venues. Study endpoints can include intradepartmental endpoints to improve workflow and patient access as well as interdepartmental clinical translational trials that include the National Clinical Trials Network (NCTN) and industry. The quality of the trial is important to trial outcome and influences interpretation of the results of the study and how the results can be applied to patient care moving forward. Clinical trials in radiation oncology to date have accomplished much, however many important questions remain as patient care matures and systemic therapies become more sophisticated and associated with specific biomarkers and cellular expression products. In this chapter we review the history of clinical trials in radiation oncology and review the current status of the structure of quality assurance in clinical trials. We will review unanswered questions and areas to study in each disease area and how to design strategy for trials to address modern unmet needs in our discipline.

Part of the book: Frontiers in Clinical Trials

By Koren Smith, Linda Ding, Maryann Bishop-Jodoin, Matt Iandoli, Fran Laurie, Stephen Kry, Michael Knopp, Mark Rosen, Ying Xiao, Fred Prior, Joel Saltz and Thomas J. FitzGerald

Clinical trials in radiation oncology are the best vehicle to optimize our strengths in therapeutic technology, define progress in our field, and improve patient outcome. Trials advance our knowledge in each disease site and provide us information to improve the radiation dose-volume for both tumor control and therapeutic sequelae to normal tissue. An increasing number of systemic and targeted therapies have been developed and are currently in early phase clinical trial design. Ultimately, these new therapies will need to be tested with standard-of-care therapy including radiation oncology. Therefore, during a study, it is essential that radiation therapy is delivered in a uniform and consistent manner for the credibility of the study. If the radiation therapy component of the study does not have a structure or management for maintaining therapeutic compliance, including a real-time data management strategy, it becomes difficult to trust the study outcome and apply the outcome to daily clinical practice. In this chapter, we review the strategy and process involved in the management of dosimetry in radiation oncology clinical trials and how this can impact clinical trial management, primary study endpoints, and the overall success of the study.

Part of the book: Advances in Dosimetry and New Trends in Radiopharmaceuticals