Preface

Modern dosimetry requires many different tools including skills in mathematics and science. The skill set for the modern treatment planning team has matured to include multiple areas of expertise, including planning in four dimensions, motion management, intensity modulation, adaptive planning, brachytherapy, and theranostics. Schools and teaching programs are constantly adapting to meet the needs of modern physics and dosimetry teams. Modern clinical practice programs need to support students at this level to better prepare students for the changing work environment. In this book, we want to touch on these points and identify what is needed for modern patient care.

The book describes multiple concepts and challenges of modern dosimetry. As treatment planning systems have become more commercialized and dose computation systems have become more uniform, a different scope of challenges faces modern physics and dosimetry teams participating in patient care at all institutions. The chapters in this book address an array of clinical challenges including processes in pre-clinical plan and dose validation, reference dosimetry, thermoluminescence, modern issues affecting pediatric populations, comparative dosimetry, including 60Co and 192Ir, modern applications of dosimetry relative to intensity modulation, and current challenges in therapy planning including image applications for planning radiation therapy in all disease areas.

Our goal is to shed light on problem-solving strategies from a diverse group of practitioners and move toward a more generalized understanding of how issues are addressed by global colleagues. Modern patient care protocols will require worldwide participation as we work to understand the roles of local and systemic therapy on diverse populations. More comprehensive standardization in our pretreatment and treatment processes will decrease and potentially eliminate variables in data interpretation. In this book, we describe the current status of dosimetry standards as we work towards uniform application of dosimetry in developing consistent treatment planning standards. The role of imaging in this effort cannot be understated, as modern imaging will both define standards for contour as well as serve to validate radiation dose.

We appreciate the opportunity to present this effort to you.

**Thomas J. FitzGerald MD and Maryann Bishop-Jodoin** Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, MA, USA

**1**

**Chapter 1**

**Abstract**

Clinical Considerations for Modern

Dosimetry and Future Directions

*Linda Ding, Carla D. Bradford, Kenneth Ulin, Koren Smith,* 

*I-Lin Kuo, Yankhua Fan, Abdulnasser Khalifeh, Fenghong Liu,* 

*Suhong Lu, Harry Bushe, Salvatore Larosa, Camelia Bunaciu,* 

*Maureen Britton, Joshua Taylor, Marious Croos, Katie Figura,* 

*Thomas Quinn, Linda O'Connor, Kathleen Briggs, Sherri Suhl,* 

*Joel Saltz, Maryann Bishop-Jodoin and Thomas J. FitzGerald*

Technology and computational analytics are moving forward at an extraordinary

**Keywords:** radiation treatment, artificial intelligence, clinical trials, quality assurance,

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

these issues will need to be added to modern training programs.

treatment planning, image-based volumetric dosimetry, outcome

*Jean Quigley, Heather Reifler, Shawn Kirby, Fred Prior,* 

for Treatment Planning

*Jonathan Saleeby, Shannon Higgins, Julie Trifone,* 
