Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Pract Radiat Oncol. 2022 Sep-Oct;12(5):e355-e362. doi: 10.1016/j.prro.2022.05.007. Epub 2022 May 26.
Online adaptive radiation therapy (ART) allows real-time plan generation and delivery to account for daily anatomic changes. Owing to the time-intensive nature of this process, physicians frequently cover adaptive treatments for patients whose original treatment plan was prescribed by another provider. There is currently no published guidance on the contents of physician sign-outs, or adaptive guidelines, to ensure the safe and consistent delivery of adaptive treatments.
A group of radiation oncologists, each with at least 3 years of experience prescribing and covering online adaptive radiation treatments, formed a working group to identify the critical components of adaptive guidelines. The members of the working group collectively were experienced with the 3 commercially available real-time ART platforms. Key components of the adaptive guidelines necessary to preserve the prescribed treatment intent were identified.
Eleven radiation oncologists from 9 cancer centers, with a range of 3 to 6 years ART experience, formed the adaptive guidelines working group. Three categories of information that are essential for safely delivering an online ART approach were identified: recontouring instructions (including anatomic considerations for specific cases), defining replanning rules, and establishing motion management guidelines.
When physician coverage is needed for ART, clear communication is critical for treatment to be delivered according to the original intent of the prescription. The proposed ART recommendations that include physician sign-out for this highly technical treatment process can be especially beneficial in improving communication across potentially multiple transitions of care.
在线自适应放疗（ART）允许实时生成和交付计划，以考虑日常解剖变化。由于这个过程时间密集，医生经常为那些原始治疗计划是由其他提供者制定的患者提供适应性治疗。目前还没有关于医生签字或适应性指南内容的发布指南，以确保适应性治疗的安全和一致交付。
一组放射肿瘤学家，每位医生至少有 3 年的在线自适应放射治疗处方和覆盖经验，组成了一个工作组，以确定适应性指南的关键组成部分。工作组的成员都熟悉 3 种市售的实时 ART 平台。确定了必要的适应性指南的关键组成部分，以保留规定的治疗意图。
来自 9 个癌症中心的 11 名放射肿瘤学家，具有 3 至 6 年的 ART 经验，组成了适应性指南工作组。为了安全地提供在线 ART 方法，确定了三类必不可少的信息：重新勾画说明（包括特定情况下的解剖考虑因素）、定义重新计划规则以及建立运动管理指南。
当需要医生为 ART 提供覆盖时，为了按照处方的原始意图进行治疗，清晰的沟通至关重要。对于这种高度技术化的治疗过程，提出的 ART 建议包括医生签字，可以特别有助于改善潜在多个治疗过渡过程中的沟通。
