Статті в журналах: "Radiation surveillance"

1

Hagan, Michael, Rishabh Kapoor, Jeff Michalski, Howard Sandler, Benjamin Movsas, Indrin Chetty, Brian Lally, et al. "VA-Radiation Oncology Quality Surveillance Program." International Journal of Radiation Oncology*Biology*Physics 106, no. 3 (March 2020): 639–47. http://dx.doi.org/10.1016/j.ijrobp.2019.08.064.

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Kaur, Amandeep, Sarika Sharma, and BR Mittal. "Radiation surveillance in and around cyclotron facility." Indian Journal of Nuclear Medicine 27, no. 4 (2012): 243. http://dx.doi.org/10.4103/0972-3919.115395.

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Pöllänen, Roy, Harri Toivonen, Kari Peräjärvi, Tero Karhunen, Tarja Ilander, Jukka Lehtinen, Kimmo Rintala, Tuure Katajainen, Jarkko Niemelä, and Marko Juusela. "Radiation surveillance using an unmanned aerial vehicle." Applied Radiation and Isotopes 67, no. 2 (February 2009): 340–44. http://dx.doi.org/10.1016/j.apradiso.2008.10.008.

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4

Pavel'ev, A. G., and A. I. Kucheryavenkov. "Two-position radio surveillance using cosmic radiation." Radiophysics and Quantum Electronics 29, no. 8 (August 1986): 665–70. http://dx.doi.org/10.1007/bf01039479.

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Hagan, M. P., J. M. Michalski, R. Kapoor, S. Mutic, W. C. Sleeman, D. Caruthers, W. R. Bosch, and J. R. Palta. "Establishing a Radiation Oncology Quality Surveillance Program." International Journal of Radiation Oncology*Biology*Physics 105, no. 1 (September 2019): E617. http://dx.doi.org/10.1016/j.ijrobp.2019.06.1147.

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Benito, G., J. C. Sáez, J. B. Blázquez, and J. Quiñones. "ADVANCED SURVEILLANCE OF ENVIROMENTAL RADIATION IN AUTOMATIC NETWORKS." Radiation Protection Dosimetry 179, no. 4 (December 11, 2017): 299–302. http://dx.doi.org/10.1093/rpd/ncx280.

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Brouwer, Yoeri, Alberto Vale, Duarte Macedo, Bruno Gonçalves, and Horácio Fernandes. "Radioactive Hot-spot Detection Using Unmanned Aerial Vehicle Surveillance." EPJ Web of Conferences 225 (2020): 06005. http://dx.doi.org/10.1051/epjconf/202022506005.

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This work proposes a solution to identify the number of sources of radiation, as well as their respective intensities and locations based on data acquired by Global Positioning System (GPS) receivers and affordable radiological sensors, such as Geiger-M¨uller counters (GMC). An optimization algorithm is required to minimize the estimation error in terms of location, intensity and number of sources of radiation given all the intensity measurements acquired in different locations, taking into account the sensors’ models, background radiation intensity values and noise. Experimental results were achieved in a laboratory with controlled sources of radiation. The solution was also tested with real data gathered by a GMC connected to a mobile phone with a software application developed by the authors to synchronize the sensor readings with GPS data. The sensor and the mobile phone are attached to a quadcopter flying over the scenario with sources of radiation.

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Kalender, G., Milan Lisy, U. A. Stock, A. Endisch, and A. Kornberger. "Identification of Factors Influencing Cumulative Long-Term Radiation Exposure in Patients Undergoing EVAR." International Journal of Vascular Medicine 2017 (2017): 1–10. http://dx.doi.org/10.1155/2017/9763075.

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Patients who undergo endovascular repair of aortic aneurysms (EVAR) require life-long surveillance because complications including, in particular, endoleaks, aneurysm rupture, and graft dislocation are diagnosed in a certain share of the patient population and may occur at any time after the original procedure. Radiation exposure in patients undergoing EVAR and post-EVAR surveillance has been investigated by previous authors. Arriving at realistic exposure data is essential because radiation doses resulting from CT were shown to be not irrelevant. Efforts directed at identification of factors impacting the level of radiation exposure in both the course of the EVAR procedure and post-EVAR endovascular interventions and CTAs are warranted as potentially modifiable factors may offer opportunities to reduce the radiation. In the light of the risks found to be associated with radiation exposure and considering the findings above, those involved in EVAR and post-EVAR surveillance should aim at optimal dose management.

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Glavič–Cindro, D., L. Benedik, J. Kožar Logar, B. Vodenik, and B. Zorko. "Detection of Fukushima plume within regular Slovenian environmental radioactivity surveillance." Applied Radiation and Isotopes 81 (November 2013): 374–78. http://dx.doi.org/10.1016/j.apradiso.2013.03.077.

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Shih, Ya-Chen T., Jim C. Hu, Chan Shen, and Scott E. Eggener. "Adoption of robot-assisted surgery and its impact on treatment patterns for newly diagnosed localized prostate cancer." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6513. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6513.

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6513 Background: With the rapid increase of robotic surgical systems in hospitals, it is important to understand the impact on treatment patterns for localized prostate cancer. The objective of this study is to determine whether the presence of robotic surgical systems independently influenced rates of surgery, radiation, and active surveillance for localized prostate cancer. Methods: We conducted an observational study using National Cancer Database (NCDB) state-level data, 2002-2010. Our study cohort includes patients newly diagnosed with clinical stage I-III prostate cancer from 48 states and Washington D.C. in the United States. The number of robotic systems installed in each state over time was obtained from publicly available information on-line. We characterized the state-level treatment pattern as the proportion of patients having surgery, radiation and active surveillance as their first course of treatment. Results: Between 2002 and 2010, the average number of robotic surgical systems per state increased from 2 to 26.3, while the unadjusted rate of surgery increased from 37.5% to 52.4%, radiation therapy decreased from 43.3% to 30.2%, and active surveillance increased from 7.0% to 9.3%. For every 10 additional robotic systems installed in a state, there would be a 2.5% increased rate of surgery (p<0.01), accompanied by a 1.3% (p=0.04) and 1.0% (p<0.01) decrease in the rate of radiation and active surveillance, respectively. Subgroup analyses suggest that the robotic adoption crowding out effect on radiation and active surveillance was driven primarily by men with stage I-II prostate cancer. If the adoption trajectory for robotic systems continues, the increased cost of treating localized prostate cancer in 2012 will be close to $27 million. Conclusions: During a period of rapid acquisition of robotic surgical systems, we found the number of robotic systems available at the state-level is significantly and directly associated with a higher rate of surgery for localized prostate cancer, and lower rates of radiation therapy and active surveillance.

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Snyder, C. F., K. D. Frick, A. L. Blackford, R. J. Herbert, B. A. Neville, M. A. Carducci, and C. C. Earle. "Costs of treatments for local/regional prostate cancer." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 6527. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.6527.

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6527 Background: Men with prostate cancer have a variety of treatment options, including surgery, radiation, hormonal therapy, combinations thereof, or active surveillance. Treatment choice may have important cost implications. Methods: Using the SEER-Medicare database, we examined the Inpatient, Outpatient, Emergency, and Other costs of men diagnosed with local/regional prostate cancer in the year 2000 who were 66+ years old and enrolled in the fee-for-service Medicare program. Based on the treatments received in the first 9 months from diagnosis, men were assigned to these treatment groups: active surveillance, radiation, hormonal, hormonal+radiation, surgery (might also include radiation and hormonal therapy). We matched the prostate cancer cases to noncancer controls on age, race, sex, SEER region, comorbidity, and survival. We estimated the costs of prostate cancer care from 1 month pre- to 12 months post-diagnosis by calculating the incremental costs of care for cases vs. controls. Costs of care were estimated using Medicare payments. Results: 13,769 prostate cancer cases were matched with 13,769 controls and allocated to these treatment groups: active surveillance (n=2,805), radiation (n=2,582), hormonal (n=2,190), hormonal+radiation (n=3,992), and surgery (n=2,200). The most expensive treatment group was hormonal+radiation, with cases having a total average incremental cost of $17,795 vs. controls, followed by surgery ($15,467), radiation ($12,326), and hormonal therapy ($10,804). Active surveillance was the least expensive ($4,152). Outpatient costs were the major driver of increased costs for the hormonal+radiation group. Increased costs for surgery patients were driven by both Outpatient and Inpatient costs. Emergency Department and Other costs were generally similar between prostate cancer cases and controls. Conclusions: The treatment choice of men with local/regional prostate cancer has important implications for cost in the year following diagnosis. Additional analyses exploring long-term costs are needed. [Table: see text] No significant financial relationships to disclose.

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12

Kapur, Ajay, and Louis Potters. "Surveillance and evidence-based safety initiatives in radiation medicine." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 247. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.247.

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247 Background: Moving towards safer radiation medicine requires an active surveillance of associated failures, their causes and effects, and evidence-based approaches for mitigation. In this study, by using retrospective and prospective surveillance, we have implemented evidence-based risk mitigation strategies in our radiation medicine practice. Methods: Incident learning has shown us that failures occur due to delays or defects in the radiation medicine process and that cultural error-provoking conditions raise these risks. Our initiatives were directed towards mitigation of defects in the high-risk process steps identified through a planning process FMEA. These included the standardization of care pathways and grading scale for assessing toxicity; pre-planning contour, directive peer review; electronic whiteboard for planning coordination and incident reporting, a process interlock policy to thwart delay-rushed processes; and the use of 6 sigma metrics to monitor individual staff operational efficiencies. Results: There has been a 3-fold increase over a 9 month period in incident reporting relative to the previous 6 previous years, by the peer group historically least likely to report, with no increase in adverse events. Evidence-based care pathways have been used with under 5% clinical non-compliance rates. The implementation of contour and directive pre-planning peer review has enhanced early defect detection. There has been a twofold drop in the occurrence of high-risk procedural delays. Patient treatment start delays are routinely enforced on cases that would have historically been rushed. Temporal trends demonstrate over 30% improvement in process Z-scores over the past three years. Conclusions: Driving these risk mitigation initiatives has challenged traditional norms such as expediting treatment initiation in delay-rushed environments or sustaining care pathways that are more experience rather than evidence-based. Therefore their implementation has met with substantial barriers. It is the focus on patient safety, statistical process control, policy enforcement, regular incident reviews, and use of quantitative metrics that has been instrumental in realizing these changes and crossing barriers.

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Daugherty, N. M., R. B. Falk, F. J. Furman, J. M. Aldrich, and D. E. Hilmas. "FORMER RADIATION WORKER MEDICAL SURVEILLANCE PROGRAM AT ROCKY FLATS." Health Physics 80, no. 6 (June 2001): 544–51. http://dx.doi.org/10.1097/00004032-200106000-00004.

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Mulder, Renée L., Melissa M. Hudson, Smita Bhatia, Wendy Landier, Gill Levitt, Louis S. Constine, W. Hamish Wallace, et al. "Updated Breast Cancer Surveillance Recommendations for Female Survivors of Childhood, Adolescent, and Young Adult Cancer From the International Guideline Harmonization Group." Journal of Clinical Oncology 38, no. 35 (December 10, 2020): 4194–207. http://dx.doi.org/10.1200/jco.20.00562.

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PURPOSE As new evidence is available, the International Late Effects of Childhood Cancer Guideline Harmonization Group has updated breast cancer surveillance recommendations for female survivors of childhood, adolescent, and young adult cancer. METHODS We used evidence-based methods to apply new knowledge in refining the international harmonized recommendations developed in 2013. The guideline panel updated the systematic literature review, developed evidence summaries, appraised the evidence, and updated recommendations on the basis of evidence, clinical judgement, and consideration of benefits versus the harms of the surveillance interventions while attaining flexibility in implementation across different health care systems. The GRADE Evidence-to-Decision framework was used to translate evidence to recommendations. A survivor information form was developed to counsel survivors about the potential harms and benefits of surveillance. RESULTS The literature update identified new study findings related to the effects of prescribed moderate-dose chest radiation (10 to 19 Gy), radiation dose-volume, anthracyclines and alkylating agents in non–chest irradiated survivors, and the effects of ovarian function on breast cancer risk. Moreover, new data from prospective investigations were available regarding the performance metrics of mammography and magnetic resonance imaging among survivors of Hodgkin lymphoma. Modified recommendations include the performance of mammography and breast magnetic resonance imaging for survivors treated with 10 Gy or greater chest radiation (strong recommendation) and upper abdominal radiation exposing breast tissue at a young age (moderate recommendation) at least annually up to age 60 years. As a result of inconsistent evidence, no recommendation could be formulated for routine breast cancer surveillance for survivors treated with any type of anthracyclines in the absence of chest radiation. CONCLUSION The newly identified evidence prompted significant change to the recommendations formulated in 2013 related to moderate-dose chest radiation and anthracycline exposure as well as breast cancer surveillance modality.

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Tanigawa, K. "Medical and health surveillance in postaccident recovery: experience after Fukushima." Annals of the ICRP 47, no. 3-4 (April 16, 2018): 229–40. http://dx.doi.org/10.1177/0146645318756819.

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The accident at Fukushima Daiichi nuclear power plant occurred following the huge tsunami and earthquake of 11 March 2011. After the accident, there was considerable uncertainty and concern about the health effects of radiation. In this difficult situation, emergency responses, including large-scale evacuation, were implemented. The Fukushima Health Management Survey (FHMS) was initiated 3 months after the accident. The primary purposes of FHMS were to monitor the long-term health of residents, promote their well-being, and monitor any health effects related to long-term, low-dose radiation exposure. Despite the severity of the Fukushima accident and the huge impact of the natural disaster, radiation exposure of the public was very low. However, there were other serious health problems, including deaths during evacuation, increased mortality among displaced elderly people, mental health and lifestyle-related health problems, and social issues after the accident. The Nuclear Emergency Situations – Improvement of Medical and Health Surveillance (SHAMISEN) project, funded by the Open Project For European Radiation Research Area, aimed to develop recommendations for medical and health surveillance of populations affected by previous and future radiation accidents. This paper briefly introduces the points that have been learned from the Fukushima accident from the perspective of SHAMISEN recommendations.

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Chaosuwannakit, Narumol, Phatraporn Aupongkaroon, and Pattarapong Makarawate. "Determine Cumulative Radiation Dose and Lifetime Cancer Risk in Marfan Syndrome Patients Who Underwent Computed Tomography Angiography of the Aorta in Northeast Thailand: A 5-Year Retrospective Cohort Study." Tomography 8, no. 1 (January 5, 2022): 120–30. http://dx.doi.org/10.3390/tomography8010010.

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Objective: To evaluate computed tomography angiography (CTA) data focusing on radiation dose parameters in Thais with Marfan syndrome (MFS) and estimate the distribution of cumulative radiation exposure from CTA surveillance and the risk of cancers. Methods: Between 1st January 2015 and 31st December 2020, we retrospectively evaluated the cumulative CTA radiation doses of MFS patients who underwent CTA at Khon Kaen University Hospital, a leading teaching hospital and advanced tertiary care institution in northeastern Thailand. We utilized the Radiation Risk Assessment Tool (RadRAT) established at the National Cancer Institute in Bethesda, Maryland, to evaluate the risk of cancer-related CTA radiation. Results: The study recruited 29 adult MFS patients who had CTA of the aorta during a 5-year study period with 89 CTA studies. The mean cumulative CTDI vol is 21.5 ± 14.68 mGy, mean cumulative DLP is 682.2 ± 466.7 mGy.cm, the mean baseline future risk for all cancer is 26,134 ± 7601 per 100,000, and the excess lifetime risk for all cancer is 2080.3 ± 1330 per 100,000. The excess lifetime risk of radiation-induced cancer associated with the CTA surveillance study is significantly lower than the risk of aortic dissection or rupture and lower than the baseline future cancer risk. Conclusions: We attempted to quantify the radiation-induced cancer risk from CTA surveillance imaging performed for MFS patients in this study, with all patients receiving a low-risk cumulative radiation dose (less than 1 Gy) and all patients having a low excessive lifetime risk of cancer as a result of CTA. The risk–benefit decision must be made at the point of care, and it entails balancing the benefits of surveillance imaging in anticipating rupture and providing practical, safe treatment, therefore avoiding morbidity and mortality.

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Greenberg, David D., and Brooke Crawford. "Surveillance Strategies for Sarcoma: Results of a Survey of Members of the Musculoskeletal Tumor Society." Sarcoma 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/8289509.

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Background. Surveillance is crucial to oncology, yet there is scant evidence to guide strategies.Purpose. This survey identified sarcoma surveillance strategies for Musculoskeletal Tumor Society (MSTS) members and rationales behind them. Understanding current practice should facilitate studies to generate evidence-based surveillance protocols.Methods. Permission was granted by the Research and Executive Committee of the MSTS to survey members on surveillance strategies. First, the questionnaire requested demographic and clinical practice information. Second, the survey focused on clinicians’ specific surveillance soft tissue and bone sarcoma protocols.Results. 20 percent of MSTS members completed the survey. The primary rationale for protocols was training continuation, followed by published guidelines, and finally personal interpretation of the literature. 95% of the respondents believe that additional studies regarding appropriate surveillance protocols are needed. 87% reported patient concerns regarding radiation exposure from surveillance imaging. For soft tissue and bone sarcoma local recurrence, responders identified surgical margin, histologic grade, and tumor size as the most important factors. For metastases, important risk factors identified included histologic grade, tumor size, and histologic type. Protocols demonstrated wide variation.Conclusion. This survey demonstrates that surveillance strategies utilized by MSTS members are not evidence-based, providing rationale for multi-institutional studies. It also confirms the public health issue of excessive radiation exposure.

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Tringale, K. R., F. Chino, A. J. Xu, E. F. Gillespie, C. J. Tsai, D. R. Gomez, Y. Yamada, J. T. Yang, and D. Yerramilli. "Radiation Oncology-Specific Surveillance After Palliative Radiation Treatment for Spine and Non-Spine Bone Metastases." International Journal of Radiation Oncology*Biology*Physics 111, no. 3 (November 2021): e490. http://dx.doi.org/10.1016/j.ijrobp.2021.07.1355.

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Miralbell, Raymond, Herman D. Suit, D. Phil, Henry J. Mankin, Lawrence R. Zuckerberg, Michael A. Stracher, and Andrew E. Rosenberg. "Fibromatoses: From postsurgical surveillance to combined surgery and radiation therapy." International Journal of Radiation Oncology*Biology*Physics 18, no. 3 (March 1990): 535–40. http://dx.doi.org/10.1016/0360-3016(90)90057-q.

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Houin, J. M. "Système digital de surveillance des rayonnements RAMSYS (Radiation Monitoring System)." Radioprotection 33, no. 3 (July 1998): 307–14. http://dx.doi.org/10.1051/radiopro:1998113.

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Magnavita, Nicola. "POST-EXPOSURE MEDICAL SURVEILLANCE OF WORKERS EXPOSED TO IONIZING RADIATION." Health Physics 84, no. 2 (February 2003): 266. http://dx.doi.org/10.1097/00004032-200302000-00015.

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Wang, Jixian. "POST-EXPOSURE MEDICAL SURVEILLANCE OF WORKERS EXPOSED TO IONIZING RADIATION." Health Physics 84, no. 2 (February 2003): 266. http://dx.doi.org/10.1097/00004032-200302000-00016.

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Sun, Maxine, Giorgio Gandaglia, Pierre I. Karakiewicz, Jim C. Hu, Simon P. Kim, Paul Linh Nguyen, Toni K. Choueiri, Firas Abdollah, and Quoc-Dien Trinh. "Comparative effectiveness of radical cystectomy versus bladder-sparing treatment for muscle-invasive urothelial carcinoma: A population-based report." Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 334. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.334.

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334 Background: Radical cystectomy (RC) represents the standard of care for patients with muscle-invasive urothelial carcinoma of the urinary bladder (UCUB). Alternative organ-conserving treatments such as chemotherapy and/or radiotherapy have gained interest. We sought to compare survival outcomes of patients according to treatment modalities, in a stage-for-stage analysis. Methods: We relied on the Surveillance, Epidemiology, and End Results Medicare-linked database to identify 12,950 patients diagnosed with T2–T4a N0/x M0 UCUB between years 1992 and 2009. Treatment types include RC (n=5207), chemotherapy/radiation (n=2,669), and surveillance (n=5,074). Following instrumental variable analysis, Cox- and competing-risks regression analyses were performed for prediction of overall survival (OS) and cancer-specific mortality (CSM), respectively. All analyses were stratified according to disease stage (T2, T3, T4a). Results: After adjusting for potential confounders, OS was more favorable for RC relative to chemotherapy/radiation (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.02–2.40) or surveillance (HR: 1.82, 95% CI: 1.20–2.78) in patients with T2 UCUB. For the same stage, CSM rates were lower in the surgery group compared to chemotherapy/radiation (HR: 2.05, 95% CI: 1.14–3.67) or surveillance (HR: 1.95, 95% CI: 1.09–3.48). When analyses focused on individuals with more advanced disease (T3–T4a), no statistically significant difference was observed between chemotherapy/radiation relative to RC for both OS and CSM. Conclusions: In the current retrospective population-based cohort, RC was associated with improved survival outcomes relative to its alternative treatment counterparts. However, this effect was only observable in patients with T2 disease. Conversely, no difference between chemotherapy/radiation vs. surgery was noted in patients with more advanced disease stage.

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Guyette, Frank, Joe Suyama, Jerry Rosen, and Michael Allswede. "Prevalence of Radioactive Signals from Surveillance of an Emergency Department." Prehospital and Disaster Medicine 21, no. 4 (August 2006): 276–81. http://dx.doi.org/10.1017/s1049023x00003836.

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AbstractIntroduction:Since the 11 September 2001 terrorist attacks in the United States, concerns have been raised regarding the threat of a radiological terrorist weapon. Although the probability of the employment of a nuclear device is remote, the potential of a radiological dispersal device (RDD) or “dirty bomb” is of concern. While it is unlikely that such a device would produce massive numbers of casualties, it is far more likely that it would result in pub- lic panic and perhaps even disable the local healthcare system. The utility of surveillance with radiation detectors in the healthcare setting has not been fully evaluated.Objective:The objective of this study was to characterize the prevalence of radioactive sources entering an urban emergency department (ED).Methods:A retrospective review of data obtained from a radiation detector positioned to detect radioactive people entering an ED of an urban academic hospital that serves 45,000 patients/year was performed. Graphical outputs of radioactivity were recorded in Microsoft ExcelTM (Microsoft, Redmond, WA, US) spreadsheets in microREM/hour. Data were collected continuous-ly from 22 December 2003 to 22 January 2004. An event was defined as any elevation in radiation levels >95% confidence interval from the mean level of background radiation over 72 hours (h).Results:A total of 215 events were observed over a 28-day period, with a mean value of 7.7 events/day, and a maximum of 15 events/day. During the 28-day period, the baseline mean level of background radiation was 2–4 microREM/h. Readings ranged from 2,148.28–17,292.25 microREM/h with a maximum sustained detector exposure of 684.37 microREM. Distinct signal patterns were seen at both detectors including tonic, phasic, dual, and short duration spikes.Conclusion:The number of radioactive signals detected from persons entering the ED was much higher than expected. While the vast majority of these signals pose no health threat, they may make routine screening for a radiological terrorist event difficult.Further study is needed to determine this correlation.

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Durani, Urshila, Dennis Asante, Herbert C. Heien, Carrie A. Thompson, Thorvardur R. Halfdanarson, Prema Peethambaram, J. Fernando Quevedo, Jose C. Villasboas, and Ronald S. Go. "Changes in Imaging Surveillance of Diffuse Large B-Cell Lymphoma Survivors after Publication of the American Society of Hematology Choosing Wisely® Recommendations." Blood 132, Supplement 1 (November 29, 2018): 618. http://dx.doi.org/10.1182/blood-2018-99-119179.

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Abstract Introduction: The role of surveillance imaging in diffuse large B-cell lymphoma (DLBCL) after treatment with curative intent is debated. In 2013, the American Society of Hematology (ASH) Choosing Wisely® campaign (Hicks LK, et al. Blood 2013) released a recommendation to "limit surveillance CT scans in asymptomatic patients following curative-intent treatment for aggressive lymphoma." This was based on previous studies demonstrating a lack of survival benefit as well as a significant impact on the patient in terms of cost, anxiety, incidental findings and radiation exposure. Similar findings have been described regarding the use of PET imaging, especially in low risk patients. We aimed to study the changes in practice patterns of surveillance imaging for DLBCL survivors treated with curative intent before and after the publication of the ASH Choosing Wisely® campaign. Methods: Administrative claims data from a large U.S commercial insurance database (OptumLabs Data Warehouse) were used to retrospectively identify adult patients with an incident diagnosis of DLBCL between 2008 and 2016 and at least one year of follow-up. We excluded those who did not receive treatment with curative intent: RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) x 6 cycles or RCHOP x 3-5 cycles plus radiation. Patients were also excluded if they had a co-existing or second cancer, or if they received any chemotherapy/radiation during their surveillance period, as to exclude anyone with a recurrence of their lymphoma. The surveillance period started 90 days after the last chemotherapy or radiation and continued for the duration of follow-up. Surveillance imaging was defined as any PET, PET-CT, CT chest, CT abdomen, and/or CT pelvis. To examine trends over time, three time periods were defined: 2008-2010, 2011-2013 and 2014-2016. The Cochran Armitage test was used to test the trend hypothesis. Results: A total of 1,472 patients were included. Cohort characteristics by time period are described in Table 1. Surveillance imaging frequency decreased from 84% in Year 1 of surveillance to 43% in Year 5 (Figure 1). Overall, surveillance imaging during the first 3 surveillance years significantly decreased over the three time periods (Figure 2) (P<0.01 for Years 1 and 2, P=0.04 for Year 3). Imaging surveillance for the first two years of surveillance did not significantly decrease from 2008-2010 to 2011-2013 (P>0.05), but significantly decreased from 2011-2013 to 2014-2016 (P<0.01). Of the groups that received imaging surveillance during year 1, the median number of scans during the first year was 2 (inter-quartile range, 1-2) and did not significantly change over time. In addition, PET/PET-CT surveillance decreased from 49% in Year 1 to <10% in Year 5. PET/PET-CT also decreased over the three time periods, from 62% (2008-2010) to 48% (2011-2013) to 43% (2014-2016) during the first year of surveillance and 40% to 31% to 25% during the second year. Younger age (<65 years versus ≥65 years) was associated with higher imaging utilization (86% versus 81%, respectively), and specifically PET/PET-CT utilization (55% versus 43%, respectively), during the first year of surveillance. However, race (white versus non-white) did not significantly affect imaging (85% versus 83%) or PET utilization (50% versus 47%) during the first year of surveillance. Conclusions: Our study demonstrates that the rate of surveillance CT and PET imaging in DLBCL patients treated with curative intent decreased significantly in the years after the publication of the ASH Choosing Wisely® campaign. However, over half of the DLBCL patients diagnosed in 2014-2016 continued to undergo surveillance imaging, indicating either incomplete guideline dissemination or ongoing debate regarding optimal surveillance practice. Future studies are necessary to determine whether such a decline in surveillance imaging is sustained and to examine factors (patient, provider, and payer) associated with surveillance imaging in DLBCL. Disclosures No relevant conflicts of interest to declare.

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Minteuan, Gheorghe, Tudor Palade, Emanuel Puschita, Paul Dolea, and Andra Pastrav. "Monopulse Secondary Surveillance Radar Coverage—Determinant Factors." Sensors 21, no. 12 (June 18, 2021): 4198. http://dx.doi.org/10.3390/s21124198.

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This paper presents a comprehensive study on monopulse secondary surveillance radar (MSSR) coverage. The design and radiation pattern of an improved MSSR antenna is presented herein, highlighting the horizontal and vertical factors of the SUM beam. Moreover, the impact of other determinant factors, such as signal reflection and atmospheric refraction, on the radar coverage were assessed in this work. Real positioning measurement data and coverage simulations were used to support and exemplify theoretical findings.

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Yan, Zhangfa, Zhaohui Zhang, Shuyu Xu, Juxiang Ma, Yansong Hou, Yingcai Ji, Lifeng Sun, Tiantian Dai, and Qingyang Wei. "Nuclear radiation detection based on the convolutional neural network under public surveillance scenarios." Open Physics 20, no. 1 (January 1, 2022): 49–57. http://dx.doi.org/10.1515/phys-2022-0006.

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Abstract Nuclear energy is a clean and popular form of energy, but leakage and loss of nuclear material pose a threat to public safety. Radiation detection in public spaces is a key part of nuclear security. Common security cameras equipped with complementary metal oxide semiconductor (CMOS) sensors can help with radiation detection. Previous work with these cameras, however, required slow, complex frame-by-frame processing. Building on the previous work, we propose a nuclear radiation detection method using convolution neural networks (CNNs). This method detects nuclear radiation in changing images with much less computational complexity. Using actual video images captured in the presence of a common Tc-99m radioactive source, we construct training and testing sets. After training the CNN and processing our test set, the experimental results show the high performance and effectiveness of our method.

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Lee, Eugene W., and William C. Huang. "Minimally Invasive Ablative Therapies for Definitive Treatment of Localized Prostate Cancer in the Primary Setting." Prostate Cancer 2011 (2011): 1–7. http://dx.doi.org/10.1155/2011/394182.

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Traditionally, the patient with a new diagnosis of localized prostate cancer faces either radical therapy, in the form of surgery or radiation, or active surveillance. A growing subset of these men may not be willing to accept the psychological burden of active surveillance nor the side effects of extirpative or radiation therapy. Local ablative therapies including cryotherapy, high-intensity focused ultrasound, and vascular-targeted photodynamic therapy have emerged as a means for minimally invasive definitive treatment. These treatments are well tolerated with decreased morbidity in association with improvements in technology; however, long-term oncologic efficacy remains to be determined.

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Wallis, Christopher J. D., Laurence Klotz, Raj Satkunasivam, and Zachary Klaassen. "Not So “Active” Surveillance." International Journal of Radiation Oncology*Biology*Physics 110, no. 3 (July 2021): 716–17. http://dx.doi.org/10.1016/j.ijrobp.2021.01.030.

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Saad, Fred, Kittie Pang, Margaret Fitch, Veronique Ouellet, Simone Chevalier, Darrel Drachenberg, Antonio Finelli, et al. "Perspectives of health care professionals on active surveillance for the management of prostate cancer." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 81. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.81.

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81 Background: Active surveillance has gained widespread acceptance as a safe approach for patients with low risk prostate cancer. Despite presenting several advantages for both patients and the health care system, active surveillance is not adopted by all eligible patients. In this study, we evaluated the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach. Methods: We conducted five focus groups with a total of 48 health care providers (HCP) including family physicians, urologists, surgeons, radiation oncologists, fellows, and residents/medical students. These participants were all providing care for men with low risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of these HCP from academic hospitals in four Canadian provinces was captured. A content and theme analysis was performed on the verbatim transcripts to understand HCP decisions in proposing active surveillance and reveal the facilitators that affect the adherence to this approach. Results: Participants agreed that active surveillance is a suitable approach for low risk prostate cancer patients, but expressed concerns on the rapidly evolving and non-standardized guidelines for patient follow-up. They raised the need for additional tools to appropriately identify the patients best suited for active surveillance. Collaborations between urologists, radiation-oncologists, and medical oncologists were favoured, however, the role of general practitioners remained controversial once patients were referred to a specialist. Conclusions: Integration of more reliable tools and/or markers, and more specific guidelines for patient follow-up would help both patients and physicians in the decision-making for active surveillance.

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Lowe, Scott. "Immune Surveillance of Senescent Cells." Innovation in Aging 5, Supplement_1 (December 1, 2021): 246. http://dx.doi.org/10.1093/geroni/igab046.952.

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Abstract Cellular senescence involves a stable cell cycle arrest and a secretory program that modulates the tissue environment. In cancer, senescence acts as a potent barrier to tumorigenesis and, though many cancers evade senescence during the course of tumor evolution, ionizing radiation and conventional chemotherapy can, to varying degrees, induce senescence in tumor cells leading to potent anticancer effects. Conversely, the aberrant accumulation of senescent cells can reduce regenerative capacity and lead to tissue decline, contributing to tissue pathologies associated with age or the debilitating side-effects of cancer therapy. Our laboratory studies mechanisms of cellular senescence with the ultimate goal of developing strategies to modulate senescence for therapeutic benefit. We have focused on how senescent cells trigger immune surveillance to facilitate their own elimination or, when that fails, how synthetic immune cells (i.e. CAR T cells) can be directed to eliminate senescent cells. Recent advances in understanding senescent cell surveillance by the immune system will be discussed.

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Bi, Jinling, Hong Dai, Junchao Feng, Huahui Bian, Weibo Chen, Youyou Wang, Yulong Liu, and Yong Huang. "Rapid and High-Throughput Detection of Peripheral Blood Chromosome Aberrations in Radiation Workers." Dose-Response 17, no. 2 (April 1, 2019): 155932581984085. http://dx.doi.org/10.1177/1559325819840852.

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There is a pressing need to establish automated solutions for the rapid, high-throughput, and automatic detection of chromosome aberrations (CAs) in the occupational health surveillance of large-scale radiation workers. Here, we described and verified the accuracy of a new measurement system based on the automatic scanning and analysis of dicentric chromosomes (DICs). The effects of cell number on DIC detection by automatic scanning and analysis were studied, and the distribution of DIC values per cell was calculated. In total, 1088 cases were detected by automatic DIC scanning and analysis in 26 663 radiation workers, and 73 cases were further confirmed by a technician, including 5 cases in which radiation exposure lead to harmful medical consequences. Our approach reduces the workload by 96% and increases the speed of assessment approximately 7-fold. Overall, this study validates the utility of a novel rapid and high-throughput CA detection procedure as a means of occupational health surveillance of large-scale radiation workers.

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Vargas, A., D. Arnold, X. Ortega, and C. Parages. "Influence of natural radioactive aerosols on artificial radioactivity detection in the Spanish surveillance networks." Applied Radiation and Isotopes 66, no. 11 (November 2008): 1627–31. http://dx.doi.org/10.1016/j.apradiso.2007.08.020.

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McPartlin, Andrew, Ali Hosni, Philippe L. Bedard, Aaron Richard Hansen, Michael A. S. Jewett, Robert James Hamilton, Martin O'Malley, Joan Sweet, Padraig Richard Warde, and Peter W. M. Chung. "Optimization of an imaging protocol for stage I seminoma surveillance based on variations in relapse location over time." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 475. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.475.

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475 Background: Surveillance is recommended for patients with stage I seminoma post orchidectomy but CT imaging involves ionising radiation, with risk of associated secondary malignancies. We assessed site of disease relapse during surveillance to guide development of a risk adapted imaging protocol. Methods: Data was obtained from a prospectively maintained database of patients with stage I seminoma on surveillance after orchidectomy from 1981-2011. Relapse was determined by clinical and/or radiographic finding with or without pathological confirmation or tumour marker elevation. Results: 753 patients were identified. The median age at orchidectomy was 33.7 years. With a median follow up of 10.5 years, range 1.1-30.1, 115 (15.3%) patients relapsed. Relapse was detected radiologically in 114 (99.1%), with 9 (7.8%) having simultaneously elevated tumour markers. A clinical diagnosis of relapse was made in 1 case (inguinal node – 0.9%). The location and time to relapse are shown in table. Conclusions: In stage I seminoma surveillance, pelvic nodal relapse was restricted to the early period of follow up. Excluding the pelvis during CT imaging after the third year of surveillance may optimise the detection of relapse whilst minimising total radiation exposure. This has now been adopted at our centre since 2011 without any subsequent late pelvic relapses. [Table: see text]

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Shenoy, Pareen J., Tulasi Gude, Rajni Sinha, and Christopher R. Flowers. "Lymphoma and Whole Body CT Scan Mortality Risk." Blood 112, no. 11 (November 16, 2008): 1321. http://dx.doi.org/10.1182/blood.v112.11.1321.1321.

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Abstract Background: Recent concerns regarding the risks of cancer and cancer-related death due to radiation from computed tomography (CT) scans (Brenner, NEJM 2007) and the lack of data demonstrating a survival advantage for surveillance CT scans following lymphoma therapy have raised questions regarding their benefit. We compared the radiation-related lifetime cancer incidence (LCI) and mortality risks (LCMR) associated with CT scans for staging and surveillance of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) with the cumulative probability of lymphoma death (CPLD) during monitoring. Methods: Using 2008 NCCN Guidelines for HL and NHL, we estimated that the average number of scans a patient would need during 5 years of treatment and follow-up would be 10. We utilized published estimates of the cumulative organ-specific radiation doses from full-body CT scans (Brenner, Radiology 2004) and calculated the LCI and LCMR using sex-, age-, and organ-dependent cancer risks per 0.1Gy provided by the Biological Effects of Ionizing Radiations VII report. Site-specific cancer risks were summed to yield the overall LCI and LCMR as described by Brenner (Med Phys 2001). Surveillance, Epidemiology, and End Results (SEER) data were used to identify cases between 2000 and 2005 from 17 SEER Registries and calculate CPLD for specified cohorts. Results: LCI and LCMR were lower for males and were markedly less than the CPLD at 5 years for most patients, but relevant for younger women with HL given their low risk of HL death (Table 1). The relationship between LCMR and the number of CT scans is shown in Figure 1. Additional implications of surveillance strategies on specific cancer risks will be presented. Conclusion: While the LCMR from CT scans is small compared to lymphoma-related deaths for most subgroups, these data should be discussed with patients in formulating plans for surveillance following lymphoma therapy. Table 1 LCI and LCMR due to CT scans compared with CPLD for lymphoma subtypes by age at diagnosis and gender Lymphoma Subtype (Age at Diagnosis) LCI from CT* LCMR from CT* 5-year Cumulative Probability of Lymphoma Death** Males Females Males Females Males Females * per person exposed to the cumulative radiation dose associated with 10 full-body CT scans during 5 years from diagnosis ** Age group studied were HL (20–29 & 80–84), DLBCL (60–79), FL (60–79), NHL (60–79) NHL (70 yrs) 0.0044 0.0057 0.0032 0.0044 0.31 0.28 FL (70 yrs) 0.22 0.18 DLBCL (70 yrs) 0.39 0.37 HL (20 yrs) 0.0133 0.0242 0.0070 0.0108 0.07 0.07 HL (80 yrs) 0.0022 0.0030 0.0019 0.0026 0.47 0.55 Figure 1 LCMR due to CT scans by age at diagnosis of lymphoma and gender Figure 1. LCMR due to CT scans by age at diagnosis of lymphoma and gender

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Zhang, Xiaofeng, Beili Lv, Lijun Rui, Liming Cai, and Fenglan Liu. "Regression Analysis of Factors Based on Cluster Analysis of Acute Radiation Pneumonia due to Radiation Therapy for Lung Cancer." Journal of Healthcare Engineering 2021 (October 13, 2021): 1–12. http://dx.doi.org/10.1155/2021/3727794.

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We conducted in this paper a regression analysis of factors associated with acute radiation pneumonia due to radiation therapy for lung cancer utilizing cluster analysis to explore the predictive effects of clinical and dosimetry factors on grade ≥2 radiation pneumonia due to radiation therapy for lung cancer and to further refine the effect of the ratio of the volume of the primary foci to the volume of the lung lobes in which they are located on radiation pneumonia, to refine the factors that are clinically effective in predicting the occurrence of grade ≥2 radiation pneumonia. This will provide a basis for better guiding lung cancer radiation therapy, reducing the occurrence of grade ≥2 radiation pneumonia, and improving the safety of radiotherapy. Based on the characteristics of the selected surveillance data, the experimental simulation of the factors of acute radiation pneumonia due to lung cancer radiation therapy was performed based on three signal detection methods using fuzzy mean clustering algorithm with drug names as the target and adverse drug reactions as the characteristics, and the drugs were classified into three categories. The method was then designed and used to determine the classification correctness evaluation function as the best signal detection method. The factor classification and risk feature identification of acute radiation pneumonia due to radiation therapy for lung cancer based on ADR were achieved by using cluster analysis and feature extraction techniques, which provided a referenceable method for establishing the factor classification mechanism of acute radiation pneumonia due to radiation therapy for lung cancer and a new idea for reuse of ADR surveillance report data resources.

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Li, Jie, and Yang Li. "Study of Application in Network Intrusion Prevention." Applied Mechanics and Materials 738-739 (March 2015): 1209–12. http://dx.doi.org/10.4028/www.scientific.net/amm.738-739.1209.

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Network intrusion prevention application are studied, analyzed vibration optical fiber, cable radiation, infrared radiation, tension fences, high-voltage pulse and other key technologies, proposed safe city, government investment, government rent, lease operator platform, operating mode, and applications in key areas of finance, police, parks and other surveillance industry.

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Yu, Karina, Marisa Westbrook, Shauna Brodie, Sarah Lisker, Eric Vittinghoff, Vivian Hua, Marika Russell, and Urmimala Sarkar. "Gaps in Treatment and Surveillance: Head and Neck Cancer Care in a Safety-Net Hospital." OTO Open 4, no. 1 (January 2020): 2473974X1990076. http://dx.doi.org/10.1177/2473974x19900761.

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Objective Treatment delays and suboptimal adherence to posttreatment surveillance may adversely affect head and neck cancer (HNC) outcomes. Such challenges can be exacerbated in safety-net settings that struggle with limited resources and serve a disproportionate number of patients vulnerable to gaps in care. This study aims to characterize treatment delays and adherence with posttreatment surveillance in HNC care at an urban tertiary care public hospital in San Francisco. Study Design Retrospective chart review. Setting Urban tertiary care public hospital in San Francisco. Subjects and Methods We identified all cases of HNC diagnosed from 2008 to 2010 through the electronic medical record. We abstracted data, including patient characteristics, disease characteristics, pathology and radiology findings, treatment details, posttreatment follow-up, and clinical outcomes. Results We included 64 patients. Median time from diagnosis to treatment initiation (DTI) was 57 days for all patients, 54 days for patients undergoing surgery only, 49 days for patients undergoing surgery followed by adjuvant radiation ± chemotherapy, 65 days for patients undergoing definitive radiation ± chemotherapy, and 29 days for patients undergoing neoadjuvant chemotherapy followed by radiation or chemoradiation. Overall, 69% of patients completed recommended treatment. Forty-two of 61 (69%) patients demonstrated adherence to posttreatment visits in year 1; this fell to 14 out of 30 patients (47%) by year 5. Conclusion DTI was persistently prolonged in this study compared with prior studies in other public hospital settings. Adherence to posttreatment surveillance was suboptimal and continued to decline as the surveillance period progressed.

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Stosky, Jordan, Kevin Martell, Siraj Husain, and Michael Peacock. "36: Increasing use of Active Surveillance Amongst Radiation Oncologists in Canada." Radiotherapy and Oncology 120 (September 2016): S14. http://dx.doi.org/10.1016/s0167-8140(16)33435-1.

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Miaris, G., T. Kailas, Z. Zaharis, D. Babas, E. Vafiadis, T. Samaras, and J. N. Sahalos. "Design of radiation-emission measurements of an air-traffic surveillance radar." IEEE Antennas and Propagation Magazine 45, no. 4 (August 2003): 35–46. http://dx.doi.org/10.1109/map.2003.1241309.

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Owens, Cormac, Bryan K. Li, Karen E. Thomas, and Meredith S. Irwin. "Surveillance imaging and radiation exposure in the detection of relapsed neuroblastoma." Pediatric Blood & Cancer 63, no. 10 (June 15, 2016): 1786–93. http://dx.doi.org/10.1002/pbc.26099.

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Lee, Grace, Nayan Lamba, Andrzej Niemierko, Daniel W. Kim, Paul H. Chapman, Jay S. Loeffler, William T. Curry, et al. "Adjuvant Radiation Therapy Versus Surveillance After Surgical Resection of Atypical Meningiomas." International Journal of Radiation Oncology*Biology*Physics 109, no. 1 (January 2021): 252–66. http://dx.doi.org/10.1016/j.ijrobp.2020.08.015.

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Kurvinen, K., P. Smolander, R. Pöllänen, S. Kuukankorpi, M. Kettunen, and J. Lyytinen. "Design of a radiation surveillance unit for an unmanned aerial vehicle." Journal of Environmental Radioactivity 81, no. 1 (January 2005): 1–10. http://dx.doi.org/10.1016/j.jenvrad.2004.10.009.

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Casey, Ruth Therese, Deborah Saunders, Benjamin George Challis, Deborah Pitfield, Heok Cheow, Ashley Shaw, and Helen Lisa Simpson. "Radiological surveillance in multiple endocrine neoplasia type 1: a double-edged sword?" Endocrine Connections 6, no. 3 (April 2017): 151–58. http://dx.doi.org/10.1530/ec-17-0006.

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Context Multiple endocrine neoplasia type 1 (MEN1) is a hereditary condition characterised by the predisposition to hyperplasia/tumours of endocrine glands. MEN1-related disease, moreover, malignancy related to MEN1, is increasingly responsible for death in up to two-thirds of patients. Although patients undergo radiological and biochemical surveillance, current recommendations for radiological monitoring are based on non-prospective data with little consensus or evidence demonstrating improved outcome from this approach. Here, we sought to determine whether cumulative radiation exposure as part of the recommended radiological screening programme posed a distinct risk in a cohort of patients with MEN1. Patients and study design A retrospective review of 43 patients with MEN1 attending our institution between 2007 and 2015 was performed. Demographic and clinical information including phenotype was obtained for all patients. We also obtained details regarding all radiological procedures performed as part of MEN1 surveillance or disease localisation. An estimated effective radiation dose (ED) for each individual patient was calculated. Results The mean ED for the total patient cohort was 121 mSv, and the estimated mean lifetime risk of cancer secondary to radiation exposure was 0.49%. Patients with malignant neuroendocrine tumours (NETS) had significantly higher ED levels compared to patients without metastatic disease (P < 0.0022). Conclusions In MEN1, radiological surveillance is associated with clinically significant exposure to ionising radiation. In patients with MEN1, multi-modality imaging strategies designed to minimise this exposure should be considered.

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Syed, Jamil, Kevin Nguyen, Juan Javier-Desloges, Michael Leapman, Jay D. Raman, and Brian M. Shuch. "The nonsurgical management of upper tract urothelial carcinoma: A role for active surveillance?" Journal of Clinical Oncology 37, no. 7_suppl (March 1, 2019): 485. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.485.

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485 Background: Approximately 7% of patients with localized upper tract urothelial cancer (UTUC) are treated without definitive therapy. Understanding outcomes and alternative therapy would aid in counseling older patients with co-morbidities. Methods: We utilized the National Cancer Database to identify patients with localized UTUC managed non-surgically between 2004 and 2013. Patient demographics, co-morbidity, tumor grade, and chemotherapy and radiation utilization were recorded. Survival analyses were performed with the Kaplan-Meier method and a cox proportional hazard regression model. Results: We identified 3,157 (10.9%) patients with localized UTUC who did not receive definitive surgery. Median age was 79 years, 55% were males, 79% had government health insurance, and 68% had a CDS of 0. Tumor grade was low (grade 1 or 2) in 632 (36.4%) and high (grade 3 or 4) in 1104 (63.6%). Median overall survival (OS) for the cohort was 2.2 years, significantly shorter for patients with greater co-morbidities. Chemotherapy or radiation was performed in 294 (9.3%) and 197 (6.3%) patients respectively. There were no OS differences for individuals receiving chemotherapy. Of patients who received radiation therapy, the median OS was 1.4 vs 2.0 years, (p<0.001) favoring no radiation. Those with high grade tumors had worse survival (1.9 vs 3.8 years (p<0.001). Significant predictors of shorter OS included older age, male gender, higher CDS, and government insurance. Conclusions: In this population-based cohort, 10.9% of patients with localized UTUC were managed non-surgically. Radiation and chemotherapy were not routinely utilized, and did not demonstrate improved survival. Median OS was significantly shorter for those with higher grade disease, increasing co-morbidity profile, male gender, and those with government insurance status.

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Aragon-Ching, Jeanny B., Heather M. Hussey, Hong Nguyen, Dechang Chen, Donald Henson, and Samuel J. Simmens. "Treatment utilization patterns for prostate cancer (PCa): An analysis from the National Cancer Database (NCDB)." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 99. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.99.

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99 Background: We previously reported the effects of the PSA screening guidelines on the patterns of diagnosis and treatment for PCa based on analyses from the NCDB dataset (Aragon-Ching et al., ASCO GU 2016). Given increasing use and advocacy for active surveillance, we now report on the treatment utilization patterns for PCa by facility type and overall incidence of active treatment (surgery or radiation), no treatment, or active surveillance by PCa stage using the NCDB dataset. Methods: Using a de-identified dataset acquired from NCDB from 1998 to 2012, treatment status of all 337,568 men for which information was available was tabulated according to whether active treatment, no treatment, or active surveillance (i.e. watchful waiting) was performed. Patient characteristics, stage, and treatment status by facility type was determined. Results: There were 1,802,596 patients diagnosed with prostate cancer between 1998 and 2012 in the NCDB. Of the 337,568 men for which treatment status was available, 92% received treatment, nearly 4% were under active surveillance, and another 4% did not receive any form of treatment or active surveillance. Of patients diagnosed with TNM Stage I and II PCa, only 7.5% and 2.22%, respectively, were followed under active surveillance. Overall, active surveillance was most utilized (n = 7,524; 5.7% of men) in academic research programs compared to other treatment facilities. Of the 310,898 men who received any form of active treatment, 193,889 men (62.3%) received surgery and 108,925 men (35%) received radiation. Conclusions: Active surveillance as a treatment modality comprised only a minority of patients who underwent treatment for PCa from 1998–2012, even among men with early Stage I and II Pca. Interestingly, the majority of the men who did receive active surveillance as their treatment option were treated at academic research programs, perhaps alluding to increased recognition and adherence to the PSA screening and active surveillance guidelines compared to other treatment facility types. Datasets including PCa patients beyond 2012 will be explored to further evaluate these changes in treatment modalities.

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Nekhlyudov, Larissa, Laurel A. Habel, Ninah S. Achacoso, Inkyung Jung, Reina Haque, Laura C. Collins, Stuart J. Schnitt, Charles P. Quesenberry, and Suzanne W. Fletcher. "Adherence to Long-Term Surveillance Mammography Among Women With Ductal Carcinoma In Situ Treated With Breast-Conserving Surgery." Journal of Clinical Oncology 27, no. 19 (July 1, 2009): 3211–16. http://dx.doi.org/10.1200/jco.2008.18.5876.

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Purpose Breast-conserving surgery (BCS) is an effective treatment for ductal carcinoma in situ (DCIS) but women who undergo BCS remain at risk for recurrences. Whether mammographic surveillance after BCS occurs and by whom is not known. Methods We reviewed medical records of women diagnosed with DCIS between 1990 and 2001 and treated with BCS. Using descriptive statistics, generalized estimating, and logistic regression modeling, we examined the rates and predictors of surveillance mammography over a 10-year period after BCS. Results The cohort included 3,037 women observed for a median of 4.8 years (range, 0.5 to 15.7). Of the 2,676 women observed for at least 1 year after BCS, most (79%) had at least one surveillance mammogram during the first year of follow-up; 69% in year 5 and 61% in year 10. Among those observed for 5 years, surveillance mammograms were more likely among women age 60 to 69 years (odds ratio [OR], 1.72; 95% CI, 1.26 to 2.34), users of menopausal hormone therapy at diagnosis (OR, 1.26; 95% CI, 1.01 to 1.57) as well as those treated with adjuvant radiation (OR, 1.28; 95% CI, 1.08 to 1.53) and adjuvant radiation with tamoxifen (OR, 1.61; 95% CI, 1.13 to 2.30). Surveillance mammograms were less likely among obese women (OR, 0.70; 95% CI, 0.56 to 0.86). The findings were similar among women observed for 10 years. Only 34% and 15% of women observed for 5 and 10 years, respectively, had a surveillance mammogram during each year of follow-up. Conclusion Surveillance mammography after BCS among insured women with DCIS often did not occur yearly and declined over time after treatment. Patients and providers must remain vigilant about surveillance after BCS.

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Kim, Simon P., R. Jeffrey Karnes, Paul Linh Nguyen, Bradley C. Leibovich, Jeanette Y. Ziegenfuss, R. Houston Thompson, Stephen A. Boorjian, Leona C. Han, Brian Addis Costello, and Jon C. Tilburt. "A national survey of radiation oncologists and urologists on active surveillance for low-risk prostate cancer." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 4657. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.4657.

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4657 Background: While active surveillance (AS) is well recognized as an acceptable treatment strategy for low-risk prostate cancer (PC), the extent to which radiation oncologists and urologists perceive AS as effective and routinely recommend it to patients is unknown. Therefore, we sought to assess the attitudes and treatment recommendations for low-risk PC from a national survey of PC specialists. Methods: A mail survey was sent to a population-based sample of 1,439 physicians in the U.S. from late 2011 and early 2012. Physicians were queried about their attitudes regarding AS and treatment recommendations for patients diagnosed with low-risk PC (PSA<10 ng/dl; T1c; Gleason 6 in one of twelve cores). Pearson Chi-square and multivariate logistic regression were used to test for differences in attitudes and treatment recommendations by physician demographics, compensation structure, primary place of employment, and specialty. Results: Overall, 321 radiation oncologists and 322 urologists completed the survey for a 45% response rate. Most physicians reported that AS is effective for low-risk PC (71%) and stated that they were comfortable routinely recommending AS (67%). Urologists were more likely to agree that AS is effective (77% vs. 67%; p=0.005) and were comfortable recommending AS (74% vs. 61%; p=0.001) compared with radiation oncologists. Most physicians recommended radical prostatectomy (47%) or radiation therapy (32%), but fewer endorsed AS (21%) for low-risk disease. After adjusting for physician covariates, radiation oncologists were more likely to recommend radiation therapy (OR: 10.97; p<0.001), while urologists were more likely to recommend surgery (OR: 4.69; p<0.001) and AS (OR: 2.18; p=0.001) for low-risk PC. Conclusions: Although AS is widely viewed as effective by both radiation oncologists and urologists, most urologists continue to recommend surgery, while most radiation oncologists recommend radiation therapy. Our results may explain in part the relatively low contemporary use of AS in the U.S.

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Arvold, N. D., P. J. Catalano, C. Sweeney, K. E. Hoffman, P. L. Nguyen, T. A. Balboni, S. D. Fossa, L. B. Travis, and C. Beard. "Physician and patient factors influencing management recommendations in stage I testicular seminoma: A survey among radiation oncologists in the United States." Journal of Clinical Oncology 29, no. 7_suppl (March 1, 2011): 225. http://dx.doi.org/10.1200/jco.2011.29.7_suppl.225.

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225 Background: Post-orchiectomy adjuvant radiotherapy (RT) for stage I seminoma is associated with long-term toxicity, and management strategies with a lower treatment burden achieve the same excellent cure rate. Because studies suggest that radiation oncologists in the United States (U.S.) continue to recommend RT for these patients, we sought to identify factors associated with management recommendations. Methods: We conducted a one-time internet-based survey among 578 randomly selected U.S. radiation oncologists specialized in genitourinary oncology. Results: Response rate was 45% (n = 261). Forty-nine percent of respondents worked in university-affiliated practices. Sixty-two percent of respondents always/usually recommended adjuvant RT for stage I seminoma patients, whereas 21% always/usually recommended surveillance and 3% always/usually recommended chemotherapy. One-third (33%) expressed concerns that patients who relapsed during surveillance could not be salvaged, and 97% recommended against surveillance if they felt a patient was unreliable for regular follow-up. Although 88% of physicians were aware of a risk of second malignant neoplasms (SMN) after adjuvant RT, 85% underestimated the magnitude of this risk. Only 20% of physicians were aware of a possible association between sub-diaphragmatic RT and an increased risk of cardiovascular disease. Compared to physicians not typically recommending RT, physicians who always/usually recommended RT were more likely to believe that patients may not be salvaged at relapse during surveillance (p = 0.008) and were less aware of the association between RT and SMN (p = 0.04). Conclusions: Respondents who always/usually recommend post-orchiectomy RT for stage I seminoma patients are more likely to underestimate late RT morbidity and to believe surveillance is associated with increased mortality. Given the equivalent efficacy and reduced morbidity of surveillance compared to RT, our findings underscore the need for ongoing physician education to increase appropriate clinical implementation of surveillance strategies. No significant financial relationships to disclose.

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Kim, Albert, Robert Abouassaly, and Simon P. Kim. "A national survey of radiation oncologists and urologists on active surveillance for low-risk prostate cancer." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 133. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.133.

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133 Background: Due to the growing concerns about over-diagnosis and overtreatment of localized prostate cancer (PCa), active surveillance (AS) has become an integral part of clinical practice guidelines. However, many men with low-risk PCa still receive primary therapy with surgery or radiation. Little is known about the barriers regarding the use of AS in clinical practice. To address this, we performed a national survey of radiation oncologists and urologists assessing the current attitudes and treatment for patients diagnosed with low-risk PCa. Methods: From January to July of 2017, 915 radiation oncologists and 940 urologists were surveyed about perceptions of AS for low-risk PCa. The survey queried respondents about their opinions and attitudes towards AS and treatment recommendations for a patient having low-risk PCa with clinical factors varying from patient age (55, 65 and 75 years old), PSA (4 and 8 ng per dl), and tumor volume for Gleason 3+3 disease (2, 4 and 6 cores). Pearson chi-square and multivariable logistic regression were used to identify respondent differences in treatment recommendations for low-risk PCa. Results: Overall, the response rate was 37.3% (n = 691) and similar for radiation oncologists and urologists (35.7% vs. 38.7%; p = 0.18). While both radiation oncologists and urologists viewed AS as effective for low-risk PCa (86.5% vs. 92.0%; p = 0.04), radiation oncologists were more likely to respond that AS increases patient anxiety (49.5% vs. 29.5%; p < 0.001). Overall, recommendations varied markedly based on patient age, PSA, number of cores positive for Gleason 3+3 prostate cancer and respondent specialty. For a 55-year-old male patient with a PSA 8 and 6 cores of Gleason 6 PCa, recommendations of AS were low for both radiation oncologists and urologists (4.4 % vs. 5.2%; adjusted OR: 0.6; p = 0.28). For a 75-year-old patient with a PSA 4 and 2 cores of Gleason 6 PCa, radiation oncologists and urologists most often recommended AS (89.6% vs. 83.4%; adjusted OR: 0.5; p = 0.07). Conclusions: While both radiation oncologists and urologists consider AS effective in the clinical management of low-risk PCa, its use varies markedly by patient age, PCa volume, PSA and physician specialty.

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