Smith A R, Gerber R L, Hughes D B, Kline R W, Kutcher G, Ling C, Owen J B, Hanlon A, Wallace M, Hanks G E
Massachusetts General Hospital, Dept. of Radiation Oncology, Boston 02114, USA.
Int J Radiat Oncol Biol Phys. 1995 Apr 30;32(1):255-62. doi: 10.1016/0360-3016(94)00472-W.
To conduct a study of the structure and process of treatment planning in the United States.
A Patterns of Care treatment planning consensus committee developed a survey form that was used to gather data for 106 items relating to the structure and process of treatment planning. These questions were general in nature and not specific to any particular disease site. Seventy-three facilities were randomly selected for site visits from the 1321 radiation therapy facilities in the United States: 21 academic, 26 hospital, and 26 free-standing. During the site visit the facility physicist, assisted by the site-visit physicist, completed the form.
Twenty-nine percent of facilities have cobalt-60 machines; 25% have 4 MV linacs; 75% have photon energies in the range of 5-8 MV; and less than 10% have energies greater than 20 MV. Academic facilities led hospital and free-standing facilities by about 30 percentage points in the availability of all electron energies (88 vs. 58%, approximately, in the range 4-13 MeV and scaling downward to about 60 vs. 30% at the highest energies). The national averages for the availability of Cs-137, Ir-192, and I-125 were 87, 73, and 44%, respectively. Computerized tomography (CT) scanning is not available or not used in 15% of hospital and free-standing facilities. Ninety-six percent of facilities have treatment planning computers; at 10% of facilities physicians do not participate in treatment planning. The estimated national averages of facilities having formal quality assurance (QA) programs for treatment planning systems, simulators, film processors, and blocking systems are 44, 79, 62, and 55%, respectively. Sixty-three percent of facilities obtain independent machine calibrations.
This is the first patterns of treatment planning study carried out in the United States and the results reported here will establish a baseline for future studies. The present study has identified some elements that were unexpected, such as the percentage of facilities lacking formal QA programs for treatment planning systems; however, it has not established any impact of such findings. It is recommended that future studies include the availability of new technologies such as multileaf collimation, dynamic wedges, digital portal imaging, and CT simulation. With the increasing nationwide concern with the cost of health care, we must continue to monitor the implementation, use, and impact on treatment outcome of new and expensive technologies.
对美国治疗计划的结构和流程进行研究。
一个治疗计划模式共识委员会制定了一份调查问卷，用于收集与治疗计划的结构和流程相关的106项数据。这些问题性质较为宽泛，并非针对任何特定的疾病部位。从美国1321家放射治疗机构中随机选取73家进行实地考察：21家学术机构、26家医院机构和26家独立机构。在实地考察期间，机构物理师在实地考察物理师的协助下完成问卷。
29%的机构拥有钴 - 60治疗机；25%拥有4兆伏直线加速器；75%拥有5 - 8兆伏范围内的光子能量；不到10%拥有大于20兆伏的能量。在所有电子能量的可获得性方面，学术机构比医院和独立机构领先约30个百分点（在4 - 13兆电子伏范围内，约为88%对58%，在最高能量时向下缩减至约60%对30%）。铯 - 137、铱 - 192和碘 - 125的可获得性全国平均水平分别为87%、73%和44%。15%的医院和独立机构没有计算机断层扫描（CT）设备或不使用CT扫描。96% 的机构拥有治疗计划计算机；10%的机构医生不参与治疗计划制定。治疗计划系统、模拟定位机、胶片处理器和挡块系统拥有正式质量保证（QA）程序的机构估计全国平均水平分别为44%、79%、62%和55%。63%的机构进行独立的机器校准。
这是美国首次开展的治疗计划模式研究，此处报告的结果将为未来研究建立一个基线。本研究发现了一些意外因素，例如缺乏治疗计划系统正式QA程序的机构比例；然而，尚未确定这些发现的任何影响。建议未来的研究纳入多叶准直、动态楔形板、数字射野成像和CT模拟等新技术的可获得性。随着全国范围内对医疗保健成本的日益关注，我们必须继续监测新技术和昂贵技术的实施、使用情况及其对治疗结果的影响。
