American Society For Radiation Oncology Research Articles

Consensus Quality Measures and Dose Constraints for Lung Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and ASTRO Expert Panel

For patients with lung cancer, it is critical to provide evidence-based radiation therapy to ensure high-quality care. The US Department of Veterans Affairs (VA) National Radiation Oncology Program partnered with the American Society for Radiation Oncology (ASTRO) as part of the VA Radiation Oncology Quality Surveillance to develop lung cancer quality metrics and assess quality of care as a pilot program in 2016. This article presents recently updated consensus quality measures and dose-volume histogram (DVH) constraints. A series of measures and performance standards were reviewed and developed by a Blue-Ribbon Panel of lung cancer experts in conjunction with ASTRO in 2022. As part of this initiative, quality, surveillance, and aspirational metrics were developed for (1) initial consultation and workup; (2) simulation, treatment planning, and treatment delivery; and (3) follow-up. The DVH metrics for target and organ-at-risk treatment planning dose constraints were also reviewed and defined. Altogether, a total of 19 lung cancer quality metrics were developed. There were 121 DVH constraints developed for various fractionation regimens, including ultrahypofractionated (1, 3, 4, or 5 fractions), hypofractionated (10 and 15 fractionations), and conventional fractionation (30-35 fractions). The devised measures will be implemented for quality surveillance for veterans both inside and outside of the VA system and will provide a resource for lung cancer-specific quality metrics. The recommended DVH constraints serve as a unique, comprehensive resource for evidence- and expert consensus-based constraints across multiple fractionation schemas.

Focal Cryoablation of the Prostate: Primary Treatment in 163 Patients With Localized Prostate Cancer.

Objective Whole gland treatment of the prostate has known efficacy in treating many grades of prostate cancer. However, it is often associated with increased morbidity, including erectile dysfunction and urinary incontinence. Focal ablative therapies, including focal cryoablation (FC), are utilized to minimize the risk of tumor progression and preserve erectile and urinary function. There is little to no consensus on whether intermediate or high-risk prostate cancer should be treated with focal therapy. However, there is a growing body of literature on the effectiveness of FC as an effective means of prostate cancer control. We characterize our experience with 163 patients who underwent FC with a median follow-up of 39 months (IQR: 24-60). Methods A 163-patient retrospective cohort underwent FC of the prostate at a single clinic by a physician from November 2008 to December 2020. Each of these T1c patients in this single-tail study was monitored for biochemical recurrence (BCR) and oncologic outcomes. American Society for Radiation Oncology (ASTRO) definition of BCR is three consecutive prostate-specific antigens (PSA) increases of more than 0.5 ng/mL or, along with the utilization of the Phoenix definition, a PSA greater than nadir by 2 ng/mL was used to define BCR. This study's primary endpoint includes BCR or biochemical disease-free survival rates. Secondary endpoints include patient side effects, such as measuring for urinary incontinence and outcomes of salvage treatments. Cox proportional hazard analyses defined univariate HRs and 95% CIs for pre-operative PSA (POPSA), Decipher, and Gleason Grade Groups (GGGs) to determine the prognostic impact of pathologic factors. Statistical analysis and BCR timeline analysis also included logistic regression and the Kaplan-Meier method, with significance considered at p < 0.05. Select focal cryotherapy patients were monitored utilizing genomic sequencing tests. Results Our cohort included 27 patients (16.5%) with D'Amico low, 115 patients (70.5%) with intermediate, and 23 patients (14.1%) with high-risk prostate cancers. One month after FC, a 73% reduction in PSA resulted in a median post-operative PSA of 1.39 ng/mL (IQR: 0.46-2.80 ng/mL). At five years, our cohort yielded biochemical disease-free recurrence rates of 78%, 74%, and 55% for low, intermediate, and high-grade cancers, respectively. Genetic risk stratification results showed very similar BCR rates to patients whose tissues did not undergo genomic testing, at 27%, 26%, and 46% for low, intermediate, and high-grade cancers, respectively. Log-rank tests to map for BCR and HRs for pathologic factors did not yield any statistically significant predictive results. Urinary incontinence and erectile dysfunction were reported in 1.8% and 3.1% of patients in the focal cohort. Conclusions Our results add to the expanding body of literature around the efficacy of focal ablative therapies in contrast to whole gland treatment. The definitive extent of FC's efficacy still remains to be explored, but our conclusions demonstrate favorable PSA kinetics at five years follow-up.

Intraoperative Radiation Therapy: A Large Integrated Health Care System's Approach and Outcomes.

Introduction Intraoperative radiation therapy (IORT) may not be as effective in the community compared with clinical trials. Methods The authors reviewed data from the electronic health records of patients who received IORT between February 2014 and February 2020 at a single center within a large integrated health care system. The primary outcome was ipsilateral breast tumor recurrence. Results Of 5731 potentially eligible patients, 245 (4.3%) underwent IORT (mean age: 65.4 ± 0.4 years; median follow-up time: 3.5 years ± 2.2 months). According to the American Society for Radiation Oncology's accelerated partial breast irradiation guidelines based on final pathology, 51% of patients were suitable candidates for IORT, 38.4% were cautionary, and 10.6% were unsuitable. For adjuvant therapy, 6.5% had consolidative whole breast irradiation, and 66.4% received endocrine treatment. At the median follow-up time of 3.5 years, overall ipsilateral breast tumor recurrence was 3.7%. Recurrences tended to be more frequent in patients who refused or did not complete endocrine treatment than in those who received it (7.4% vs 1.9%, p = 0.07). The complication rate was 14.7%, with seroma being the most common (8.2%). Discussion The IORT ipsilateral breast tumor recurrence rate of 3.7% confirms a higher-than-expected rate compared to randomized clinical trials, possibly due to less compliance with endocrine therapy. Conclusion The authors subsequently revised their IORT protocol to require endocrine treatment as a part of the IORT treatment plan and to strongly recommend adjuvant whole breast irradiation for all patients deemed cautionary or unsuitable for IORT according to the American Society for Radiation Oncology's accelerated partial breast irradiation guidelines.

Abstract P1-10-11: Optical stimulated luminescence dosimeters for skin dose measurements during accelerated partial breast brachytherapy: In vivo dosimetric validation and clinical outcomes

Abstract BACKGROUND: The role of multi-lumen catheter devices in the delivery of high dose rate (HDR) brachytherapy for adjuvant accelerated partial breast irradiation (APBI) for women with DCIS or early-stage breast cancer has been well established. In vivo dosimetry (IVD) using optically stimulating luminescence dosimeters (OSLD) is a feasible way to detect applicator instability that may cause translational and rotational inaccuracies during HDR brachytherapy delivery. Herein, we evaluate the accuracy and effectiveness of IVD to improve patient outcomes following APBI brachytherapy using the Strut Adjusted Volume Irradiation (SAVI) device. METHODS: Single-institution cohort study piloting the use of OSLD on the patient’s skin during HDR brachytherapy APBI to assess the estimated maximum skin dose (skin Dmax) and the achievable accuracy of OSLD for skin Dmax measurements. Women treated with SAVI-based APBI between November 1, 2018 and October 1, 2021 were eligible to enroll in our study. All patients met the American Society for Radiation Oncology “suitable” or “cautionary” criteria and were treated according to the American Brachytherapy Society consensus treatment planning guidelines. A SAVI preplan was created to estimate the probable point of skin Dmax. During CT simulation, a radiopaque marker was placed on the skin for visualization during treatment planning. Correction factors were applied to account for the OSLD tissue-air interface that is not present in the TG-43 expected dose calculations. Measured and calculated IVD doses were analyzed to assess agreement and cause for discrepancies found. Breast phantom IVD measurements repeated seven times with two independent dose points were analyzed to assess the best accuracy achievable under ideal conditions. RESULTS: We enrolled 41 patients with an average age of 68 years. Table 1 details the brachytherapy treatment delivery and dosimetry data. Higher skin Dmax as a percentage of the radiation prescription was associated with the occurrence of breast volume loss noted on subsequent clinical breast exams (OR 1.84 per each 5% increase in skin Dmax; 95% CI 1.21 – 3.32; p=0.016). The graphically estimated skin Dmax threshold was 80% with all cases of noted breast volume loss occurring above this threshold. The overall level of achievable IVD accuracy was ±3.32% based on breast phantom measurements. Under ideal conditions, all measurements were in the ±7% range. Three of 14 phantom measurement exceeded the 6% discrepancy range. Clinical IVD measurements detected 5 true positive cases (12.2% of cohort) that required intervention due to rotations in the SAVI applicator. For a ±7% tolerance criteria, 90.2% of the patients tested passed IVD. Of the eight patients that failed at the 7% level, IVD detected 3 OSLD placement errors, 2 rotational discrepancy cases, and 1 large air-gap at the point of measurement. CONCLUSIONS: Accuracy and reproducibility are imperative tenets of HDR brachytherapy APBI. IVD utilizing OSLD is an effective method for detecting treatment set-up and delivery errors for patients receiving SAVI-based APBI with dose accuracy within ±3.32%. Errors requiring intervention due to SAVI device rotation were detected in 12.2% of our cohort, and these errors would have likely gone undetected without IVD. Using OSLD as IVD to measure skin Dmax doses that may increase the risk of breast cosmetic defects should be investigated further. Table 1. Brachytherapy treatment delivery and dosimetry data. *PTV-Eval is a uniform 10 mm expansion on the CTV with exclusion of PTV within 5 mm of skin or chest wall. +Percent dose discrepancy refers to difference in dose between APBI plan calculations and IVD measurements. Citation Format: Tyler Gutschenritter, Afua Yorke, Nayak Polissar, Nirnaya Miljacic, Janice Kim, Lori Young. Optical stimulated luminescence dosimeters for skin dose measurements during accelerated partial breast brachytherapy: In vivo dosimetric validation and clinical outcomes [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-10-11.

Breast Cancer Tumor Board: A Radiologist’s Guide to Postmastectomy Radiation Therapy

Radiation therapy represents a pillar in the current management of breast cancer. Historically, postmastectomy radiation therapy (PMRT) has been administered only in patients with locally advanced disease and a poor prognosis. These included patients with large primary tumors at diagnosis and/or more than three metastatic axillary lymph nodes. However, during the past few decades, several factors have prompted a shift in perspective, and recommendations for PMRT have become more fluid. Guidelines for PMRT in the United States are outlined by the National Comprehensive Cancer Network and the American Society for Radiation Oncology. Because evidence to support performing PMRT is frequently discordant, the decision to offer radiation therapy often requires team discussion. These discussions are usually held in multidisciplinary tumor board meetings in which radiologists play a pivotal role by providing critical information such as the location and extent of disease. Breast reconstruction after mastectomy is optional and is safe in cases in which the patient's clinical status allows it. The preferred method in the setting of PMRT is autologous reconstruction. If this is not possible, then a two-step implant-based reconstruction is recommended. Radiation therapy does involve a risk of toxicity. Complications can be seen in acute and chronic settings and range from fluid collections and fractures to radiation-induced sarcomas. Radiologists have a key role in detecting these and other clinically relevant findings and should be prepared to recognize, interpret, and address them. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Hypofractionated Postmastectomy Radiotherapy (HF-PMRT): What did We Learn from COVID-19 Era?

Objectives: In breast cancer (BC) patients receiving mastectomy, postmastectomy radiotherapy (PMRT) improves long-term outcomes by decreasing local failure and cancer mortality. However, the optimal PMRT schedule is still under investigation. The present review aims to discuss the evidence regarding hypofractionated (HF) PMRT in BC patients in order to identify the optimal treatment approach. Additional purpose is to highlight what we have learned from COVID-19 era regarding HF schedules for PMRT in BC patients. Mechanism: Between February and November 2021, literature and database research were conducted. Key references were detected from a PubMed query. Range of publication date was between 2000 and 2021. Selection criteria included English language publications in humans. Hand searching included meeting proceedings of the European Society for Radiotherapy and Oncology (ESTRO), European Society of Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO) and American Society for Radiation Oncology (ASTRO). The website clinicaltrials.gov was also searched. Randomized controlled trials evaluating HF-PMRT were included. Findings in brief: Our research returned 87 published papers. Fourteen trials were included in our final analysis. The comparisons of several different schedules of HF-PMRT with conventional fractionated PMRT provided similar results in terms of locoregional disease control without increasing toxicity. Particularly, an acute skin toxicity incidence grade 2 or higher ranged between 10 and 25% among the studies we analyzed. Conclusions: The present paper suggests that safety and efficacy of HF-PMRT is comparable with conventional schedules and standard practice guidelines are already available. COVID-19 pandemic has emphasised the need for increasingly tailored treatment protocols. Modern HF regimens should continue to be the standard of treatment in BC patients who receive PMRT also in the post-COVID-19 era.

Evaluating the impact of intraoperative inking in breast conserving surgery on re-excision and local recurrence rates

Background: The UK National Margin Collaborative demonstrated variation of practice regarding acceptable margins following breast conserving surgery (BCS) for invasive cancer and DCIS after the Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) margin consensus.

Challenges and Solutions for Establishing Robust Diversity, Equity, and Inclusion Efforts in US Academic Radiation Oncology Departments

Challenges and Solutions for Establishing Robust Diversity, Equity, and Inclusion Efforts in US Academic Radiation Oncology Departments

Underrepresented Minority Composition of Invited Panelists at the 2021 ASTRO Annual Meeting

The American Society for Radiation Oncology (ASTRO) Annual Meeting is one of the primary venues for radiation oncologists to present new research, network, and share innovations. In this brief report, we describe the racial representation of invited physician speakers at the Annual Meeting relative to the specialty. The program list of all invited educational sessions and panel speakers in the ASTRO annual meetings from 2021 was accessed via the ASTRO website. Race was determined by a combination of facial recognition and Internet investigation. Speakers and panels were divided by race and specialty. Underrepresented in medicine (URiM) was defined as Black race and/or Hispanic ethnicity. We identified 182 cumulative speaking panels at the 2021 ASTRO annual meeting and 960 individuals who filled these panels. The majority of speakers were of White race (57%), followed by Asian race (34.2%). URiM speakers made up approximately 8.6% of speakers and were mostly congregated in diversity, equity, and inclusion in health care (DEI) panels. A total of 15.6% of panels were White-only, and 14.8% of panels had at least 1 URiM member. URiM race speakers were mostly congregated in DEI panels, comprising 44.9% of DEI speaker positions and 4.1% of non-DEI speaker positions; this difference reached statistical significance (P < .0001). The proportion of underrepresented minorities receiving panel invitations at ASTRO remains minimal and is virtually nonexistent outside of DEI-related panels. Targeted efforts to increase URiM representation will be needed to make tangible progress on this issue, just as they have yielded progress on increasing gender diversity in panel invitations.

Utilization Patterns of Single-Fraction and Short-Course Radiotherapeutic Schedules in the Management of Bone Metastases

Bone metastases are common, occurring in60% to 70% of patients with advanced malignancies. Historically, bone-directed radiation therapy regimens of30 Gyover 10fractions were used. However, prospective randomized data suggestequivalent pain relief with shorter-course regimens. The American Society for Radiation Oncology Choosing Wisely Campaign encourages clinicians to consider shorter-course palliative regimens in patientswith limited prognosis. A retrospective analysis was performedto assess patterns of short-course and single-fraction radiation therapy during the past 5 years. We queried ourelectronic medical record (MOSAIQ) from 2016 to 2020 for patients with bone metastases who received palliativeradiation therapy. Patients receiving >10 fractions or Medicare-approved palliative courses of radiation (30 Gy/10 fractions, 24 Gy/6 fractions, 20 Gy/5 fractions, 8 Gy/1 fraction) were included. Treatment departmentwasdefined as academic (n=2) versus community (n=12). Short-course treatment was defined as <6 fractions, whereas long-course included patients receiving >10 fractions. Patients were subdivided based on age and disease site. Physicians were grouped according to their year of residency completion. Multivariable logistic regression analysis identifiedpredictors of short-course and single-fraction treatment. We identified 1004 patients with 1768 bony metastasesmeeting inclusioncriteria.The spine was the most common site,followed by pelvis/hip, extremity, and other site. Use of short-course treatment increased from 40% in 2016 to 50% in 2020. Single-fraction treatmentincreased from 7% in 2016 to 11% in 2020. Predictors of shorter courses included treatment atacademic centers, more recent treatment, patient age >76 years, and nonspine anatomic site. Predictors of single-fraction treatment included treatment atacademic centers, treating physician residency completion after 2010, patient age >76 years, and treatment to extremity or other site. Rates of short-course and single-fraction bone-directed radiation therapy increased within ourhealth system over time. Treatment receipt atacademic centers was associated with both short-course and single-fraction regimens. Physicians completing residency after 2010 were more likely to deliver single-fraction therapy.

Quality and Safety Considerations in Image Guided Radiation Therapy: An ASTRO Safety White Paper Update

PurposeThis updated report on image guided radiation therapy (IGRT) is part of a series of consensus-based white papers previously published by the American Society for Radiation Oncology addressing patient safety. Since the first white papers were published, IGRT technology and procedures have progressed significantly such that these procedures are now more commonly used. The use of IGRT has now extended beyond high-precision treatments, such as stereotactic radiosurgery and stereotactic body radiation therapy, and into routine clinical practice for many treatment techniques and anatomic sites. Therefore, quality and patient safety considerations for these techniques remain an important area of focus. Methods and MaterialsThe American Society for Radiation Oncology convened an interdisciplinary task force to assess the original IGRT white paper and update content where appropriate. Recommendations were created using a consensus-building methodology, and task force members indicated their level of agreement based on a 5-point Likert scale from “strongly agree” to “strongly disagree.” A prespecified threshold of ≥75% of raters who selected “strongly agree” or “agree” indicated consensus. SummaryThis IGRT white paper builds on the previous version and uses other guidance documents to primarily focus on processes related to quality and safety. IGRT requires an interdisciplinary team-based approach, staffed by appropriately trained specialists, as well as significant personnel resources, specialized technology, and implementation time. A thorough feasibility analysis of resources is required to achieve the clinical and technical goals and should be discussed with all personnel before undertaking new imaging techniques. A comprehensive quality-assurance program must be developed, using established guidance, to ensure IGRT is performed in a safe and effective manner. As IGRT technologies continue to improve or emerge, existing practice guidelines should be reviewed or updated regularly according to the latest American Association of Physicists in Medicine Task Group reports or guidelines. Patient safety in the application of IGRT is everyone's responsibility, and professional organizations, regulators, vendors, and end-users must demonstrate a clear commitment to working together to ensure the highest levels of safety.

Quality and Safety Considerations in Intensity Modulated Radiation Therapy: An ASTRO Safety White Paper Update

This updated report on intensity modulated radiation therapy (IMRT) is part of a series of consensus-based white papers previously published by the American Society for Radiation Oncology (ASTRO) addressing patient safety. Since the first white papers were published, IMRT went from widespread use to now being the main delivery technique for many treatment sites. IMRT enables higher radiation doses to be delivered to more precise targets while minimizing the dose to uninvolved normal tissue. Due to the associated complexity, IMRT requires additional planning and safety checks before treatment begins and, therefore, quality and safety considerations for this technique remain important areas of focus. ASTRO convened an interdisciplinary task force to assess the original IMRT white paper and update content where appropriate. Recommendations were created using a consensus-building methodology, and task force members indicated their level of agreement based on a 5-point Likert scale, from "strongly agree" to "strongly disagree." A prespecified threshold of ≥75% of raters who select "strongly agree" or "agree" indicated consensus. This IMRT white paper primarily focuses on quality and safety processes in planning and delivery. Building on the prior version, this consensus paper incorporates revised and new guidance documents and technology updates. IMRT requires an interdisciplinary team-based approach, staffed by appropriately trained individuals as well as significant personnel resources, specialized technology, and implementation time. A comprehensive quality assurance program must be developed, using established guidance, to ensure IMRT is performed in a safe and effective manner. Patient safety in the delivery of IMRT is everyone's responsibility, and professional organizations, regulators, vendors, and end-users must work together to ensure the highest levels of safety.

Consensus Quality Measures and Dose Constraints for Prostate Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Expert Panel

PurposeThere are no agreed upon measures to comprehensively determine the quality of radiation oncology (RO) care delivered for prostate cancer. Consequently, it is difficult to assess the implementation of scientific advances and adherence to best practices in routine clinical practice. To address this need, the US Department of Veterans Affairs (VA) National Radiation Oncology Program established the VA Radiation Oncology Quality Surveillance (VA ROQS) Program to develop clinical quality measures to assess the quality of RO care delivered to Veterans with cancer. This article reports the prostate cancer consensus measures. Methods and MaterialsThe VA ROQS Program contracted with the American Society for Radiation Oncology to commission a Blue Ribbon Panel of prostate cancer experts to develop a set of evidence-based measures and performance expectations. From February to June 2021, the panel developed quality, aspirational, and surveillance measures for (1) initial consultation and workup, (2) simulation, treatment planning, and delivery, and (3) follow-up. Dose-volume histogram (DVH) constraints to be used as quality measures for definitive and post-prostatectomy radiation therapy were selected. The panel also identified the optimal Common Terminology Criteria for Adverse Events, version 5.0 (CTCAE V5.0), toxicity terms to assess in follow-up. ResultsEighteen prostate-specific measures were developed (13 quality, 2 aspirational, and 3 surveillance). DVH metrics tailored to conventional, moderately hypofractionated, and ultrahypofractionated regimens were identified. Decision trees to determine performance for each measure were developed. Eighteen CTCAE V5.0 terms were selected in the sexual, urinary, and gastrointestinal domains as highest priority for assessment during follow-up. ConclusionsThis set of measures and DVH constraints serves as a tool for assessing the comprehensive quality of RO care for prostate cancer. These measures will be used for ongoing quality surveillance and improvement among veterans receiving care across VA and community sites. These measures can also be applied to clinical settings outside of those serving veterans.

Society for Palliative Radiation Oncology: Report from the Ninth Annual Meeting (2022).

The Society for Palliative Radiation Oncology (SPRO) is an international group of clinicians whose primary aim is to advance the field of palliative radiation oncology by promoting evidence-based palliative radiation therapy and excellence in primary palliative care through research, education, collaboration, and patient advocacy. SPRO held its 9th Annual Meeting on October 23, 2022 in association with the American Society for Radiation Oncology (ASTRO) 64th Annual Meeting. Accomplishments and goals from the previous year were discussed and newly appointed officers were announced. Dr. Dirk Rades from the University of Lubeck in Germany gave the keynote address, reviewing critical trials and evidence for the use of stereotactic body radiotherapy (SBRT) in the palliative and oligometastatic settings. Recipients of the Lifetime Service Award and the Rising Star Award were announced and presented. This Meeting Report summarizes the proceedings of SPRO's 9th Annual Meeting.

Demographic Trends Among American Society for Radiation Oncology Clinical Practice Guideline Task Force Participants From 2010 to 2022

The American Society for Radiation Oncology (ASTRO) has produced evidence-based clinical practice guidelines since 2009. It is unknown whether task force members for these guidelines are representative of the diversity of the radiation oncology field, particularly in comparison to the ASTRO membership demographics. We sought to characterize the demographic composition of all task force members to date. The author list for ASTRO-led published guidelines from 2010 to 2022 was assessed. Main practice location/institution was extracted from the guideline publication. Self-identified gender and race/ethnicity were obtained from the ASTRO membership database. Years of experience were measured as the number of years post-board certification at time of guideline development. For United States (US)-based physicians, gender was confirmed with the National Provider Identifier database. Proportions of task force members overall and by individual guideline were described by gender, underrepresented in medicine (URM) status, geography (US vs international), US region (if US based), years of experience (separated into ≤5 years including residents, 6-12 years, and >12 years), and type of practice. Proportions for gender, URM, and geography were compared with ASTRO membership demographics. Between 2010 and 2022, there were 25 guideline task forces, with a total of 366 participants: 233 men, 126 women, and 7 unknown gender. There were more men than women serving on most individual task force topics, with 28% of all task forces having >80% composition of men. Of those with self-identified race/ethnicity, 9/204 (4.4%) were URM, which was lower in proportion to URM self-identified ASTRO members (336/3277, 10.3%; P=.007). Most participants were based in the US (n=323, 88.3%), had >12 years of experience (n=141, 38.5%), and were from academic institutions (n=302, 82.5%). Community practitioners were less likely to be women or URM. Improved data collection and more intentional efforts are needed to ensure that the diversity of guidelines task forces is representative of ASTRO membership and the specialty.

The Environmental Impact of a Hybrid Medical Conference: Reduced Carbon Emissions of ASTRO's Digital XP 2021 Conference Model

<h3>Purpose/Objective(s)</h3> The climate crisis poses an imminent and growing threat to human health. It is imperative the healthcare sector evaluates the environmental impact of current practices, including travel to conferences. Today, conference travel accounts for 35% of scientists' total carbon footprint. In response to the pandemic, the American Society for Radiation Oncology (ASTRO) adopted a hybrid model for the annual meeting to allow for in-person and virtual attendance (ASTRO Digital XP). Our analysis highlights the reduced environmental impact of this hybrid model. <h3>Materials/Methods</h3> The total number of attendees and the split of attendance types (i.e., total virtual attendees versus in-person) for ASTRO's Annual 2021 Meeting was collected. However, data on proximity and mode of transportation for in-person attendees was not available. Therefore, we made a set of general assumptions for in-person attendees. Distance traveled per in-person attendee was estimated using the location of the attendees' home institutions/headquarters and their mode of transportation was hypothesized based on distance traveled (i.e., automobile for distances < 300 miles; airline for distances ≥ 300 miles). No travel was assumed for Digital XP (virtual) attendees. It was hypothesized that in-person attendees would stay 3 nights in a 4-star hotel and that a 50,000 square feet conference space was utilized for 8 hours/day for 3 days. For in-person attendees, approximate carbon dioxide (CO2) emissions were calculated for airline travel, accommodations, and conference space. For virtual attendees, CO2 emissions were estimated based on assumed internet usage (8 hours/day for the 3-day conference period). <h3>Results</h3> Data for 2,210 attendees was available for analysis – of which, 1,120 were Total Digital XP registrants (57% domestic, 43% international). Total miles traveled for in-person attendance was estimated to be 3,193.5 miles accounting for an average 1041.3 Ib/0.47 t (metric tons) of CO₂ per person (interquartile range, 1.15 t). In total, in-person attendance resulted in the consumption of 1,134,838.7 Ib/514.8 t of CO₂, the equivalent of 112 passenger vehicles driven for one year. Whereas, the virtual component resulted in the sparing of 1,244,619.7 Ib/564.55 t of CO₂, the equivalent of 123 passenger vehicles driven for one year. <h3>Conclusion</h3> Incorporating virtual and hybrid attendance at medical conferences has the potential to significantly reduce the environmental impact of conferences. While many believe that virtual networking cannot replace in-person interactions, a hybrid model uniquely offers face-to-face networking, while simultaneously mitigating the environmental impact. Moving forward it will be imperative for professional societies, and healthcare professions alike, to investigate and promote greater sustainability of our medical conferences.

Characteristics of the Association of Residents in Radiation Oncology Educator of the Year Award Recipients

The Association of Residents in Radiation Oncology (ARRO) presents the Educator of the Year Award to outstanding faculty members at each participating institution every year. The aim of this study was to characterize the recipients of this award. The recipients of the annual ARRO Educator of the Year Award were identified from the years 2008 to 2019. Publicly available website domains were accessed to obtain data regarding clinical treatment site, number of sites treated, whether they were at the same institution where they trained, academic rank, sex, American Society for Radiation Oncology fellow status, repeat awardee status during the period, and number of years since board certification. H- and m-indices were obtained from Scopus and calculated based on the time of the award. General workforce data were obtained from American Society for Radiation Oncology and recently published articles. The authors performed correlative analyses stratified by sex and logistic regression to determine predictors of repeat awardee status. There were a total of 607 ARRO educator awards from the years 2008 to 2019. The majority of recipients were male (77.6%) and assistant professors (39.0%). The median number of years from board certification was 7 (interquartile range, 3-17) and the median h- and m-indices were 14 and 1, respectively. When stratified by sex, publication metrics were significantly higher for men (P < .05), and men were more likely to be repeat awardees (P < .001) and have higher academic rank (P=.007). On multivariate analysis, those of higher rank were more likely to be repeat awardees (associate odds ratio [OR], 3.55; P < .001; full professor OR, 2.04; P=.046) and less likely to be women (OR, 0.41; P=.002), and h- and m-indices were not associated with repeat awardee status. Recipients of the ARRO educator award appear to be diverse in rank and experience; however, associate professor rank and sex were associated with continued recognition of educational excellence.

Recent Trends of “Manels” and Gender Representation among Panelists at North American Annual Radiation Oncology Meetings

<h3>Purpose/Objective(s)</h3> Underrepresentation of women in academic medicine has been a longstanding issue. While there has been an increase in the fraction of women in medical school and residency programs, this has not translated to female representation in national and international conferences across many medical specialties, with continued presence of all-male speaking panels or "manels". The American Society for Radiation Oncology (ASTRO) and the Canadian Association of Radiation Oncology (CARO) host two large annual radiation oncology conferences. We aimed to assess the prevalence and longitudinal trends of manels and gender representation at these meetings during 2018-2021. We hypothesized that both conferences would have a decrease in manels and increased representation of female panelists over time <h3>Materials/Methods</h3> Using ASTRO and CARO online programs, 2018-2021 faculty information was obtained. Data collected included perceived or self-reported gender, panel role (chair vs. non-chair), type of session, and topic. Primary outcomes included percentage of manels and proportion of female panelists over time. Female representation among chairs, and topics were also evaluated. <h3>Results</h3> During 2018-2021, across both conferences there were a total of 905 sessions with 3,061 faculty members, of which 1,338 (44%) were females, and 222 (25%) panel sessions were manels. At ASTRO meetings, with a total of 2,825 faculty members and 815 sessions, 1223 (43%) were females and 199 (24%) panel sessions were manels, with similar results seen at CARO meeting, with a total of 236 faculty members and 90 sessions, 115 (49%) were females and 23 (26%) panel sessions were manels. Over time, there was a significant decrease in the proportion of manels, at ASTRO from 38% in 2018 to 12% in 2021 (p<0.001) with a corresponding increase in proportion of female panelists from 38% to 48% (p=0.01). At CARO, the proportion of manels decreased from 29% in 2018 to 18% in 2021 (p=0.2), and the proportion of female panelists increased from 40% to 61% (p=0.005). The role of chair was majority male in every year from 2018 to 2021 at ASTRO (56% overall) and CARO (74% overall). Among session type, the highest proportion of manels was observed for leadership sessions (37%, p=0.3) at ASTRO and for educational and scientific sessions (27%, p=0.003) at CARO. The lowest proportion of female panelists were on the topics of genitourinary cancers (34%, p=0.034) at ASTRO and genitourinary cancers and physics (33%, p=0.038) at CARO. <h3>Conclusion</h3> Overall, at both ASTRO and CARO conferences the proportion of manels has decreased over time and both have seen an increase in the number of female panelists. However, there are specific topics/specialties where females remain particularly underrepresented. ASTRO and CARO should strive to further increase female involvement reflective of the expertise and representation in the field, and consider eliminating manels altogether.

Self-Reported COVID-19 Infections and Social Mixing Behavior at Oncology Meetings

Purpose/Objective(s)The COVID-19 pandemic largely suspended conventional in-person scientific meetings because of the risk of disease spread. In the era of vaccination and social distancing practices, meetings have slowly begun to return to in-person formats. We surveyed attendees and potential attendees of two United States oncology meetings to identify rates of mixing behavior and the subsequent rate of self-reported COVID-19 infection.Materials/MethodsWe collected reported social mixing behavior and COVID-19 positivity of actual and potential in-person oncology meeting attendees of the American Society of Clinical Oncology (ASCO) Quality Care Symposium in Boston, Massachusetts on September 24-25, 2021, and the American Society for Radiation Oncology (ASTRO) Annual Meeting in Chicago, Illinois on October 24-27, 2021 via survey. Participants were identified through publicly available meeting materials and targeted via email when possible. Recruitment was also conducted through Twitter and a radiation oncology newsletter, as well as an anonymous link made available to emailed recruits, with sharing encouraged. In-person respondents to the later ASTRO survey who had attended the ASCO meeting were excluded from the analysis. Statistical significance was determined using Fisher's exact test for rates of COVID-19 positivity and the chi-squared statistic for differences in group characteristics, with a cutoff for statistical significance p<0.05.ResultsResponse rates from attendees with publicly available emails were 27.4% for the ASCO meeting and 14.3% for the ASTRO meeting. The ASCO survey produced 94 responses, with 48 responding as in-person attendees. The ASTRO survey produced 370 responses, with 267 responding as in-person attendees. Across both meetings, 3 of 308 (1.0%) of in-person attendees versus 2 of 141 (1.4%) of non-attendees tested positive for COVID-19 (p=0.65). Among in-person attendees, there were similar low COVID-19 positivity rates among those spending more (>20) vs less (≤20) hours attending live sessions (2.2% vs 0%, p=0.25) and between those who went to indoor social events vs those who did not during the meeting periods (0.8% vs 1.9%, p=0.44). Attendees largely felt that they would feel comfortable attending additional in-person meetings after experiencing the ASCO (87.5%) or ASTRO (91.9%) meetings and that mask compliance was good or excellent at the ASCO (100%) and ASTRO (94.6%) meetings.ConclusionThis study indicates that in-person meetings do not seem to be contributing to high rates of new COVID-19 infections in the setting of mask mandates, vaccine mandates, and decreased room capacity allowances. The rate of self-reported COVID-19 infection of both in-person attendees and non-attendees was very low and the meetings were successful at creating an environment where participants felt safe. These findings support the possibility of a path forward for at least partially in-person conferences as new variants emerge and COVID-19 becomes endemic.

Assessing the Impact of Diverse Approaches of Promoting Virtual Radiation Oncology Educational Content to Medical Students

Assessing the Impact of Diverse Approaches of Promoting Virtual Radiation Oncology Educational Content to Medical Students