ORCID Profile
0000-0003-4767-0776
Current Organisation
Monash University
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Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.RADI.2017.03.016
Abstract: Evidence demonstrates that health care professionals in the palliative care context are more burned out than other health professionals. The aims of this study were to examine: (1) occupational burnout levels among radiation therapists in Australia, (2) association between demographic factors on burnout and (3) radiation therapists' perceptions of burnout. A cross-sectional online survey including the Maslach Burnout Inventory was administered to Radiation Therapists in Australia. Data were analysed using SPSS Ver 20 and open ended comments were analysed thematically using Nvivo 10. A total of 200 radiation therapists participated in the survey. RTs had a high mean (±SD) burnout score for emotional exhaustion (38.5 ± 8.2), depersonalisation (17.5 ± 4.7) and personal achievement (30.5.3 ± 4.3) compared to RTs and health workers in other studies. High levels of emotional exhaustion, depersonalisation and low levels of personal achievement were present in 93% (186/200), 87% (174/200) and 61% (122/200) of participants respectively. RTs identified high workload and staff shortages, interpersonal conflict and technology as key sources of stress in the RT work environment. Australian RTs' level of burnout on all three stages of burnout exceed previously reported burnout levels for similar cohorts both locally and internationally. It is important that future interventions aimed at minimising or preventing stressors are identified and implemented in the radiation therapy work environment.
Publisher: Elsevier BV
Date: 07-2022
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.MEDDOS.2021.09.004
Abstract: Inter-fraction organ variations cause deviations between planned and delivered doses in patients receiving radiotherapy for prostate cancer. This study compared planned (D
Publisher: Springer Science and Business Media LLC
Date: 30-10-2020
DOI: 10.1186/S13014-020-01688-Z
Abstract: Radiation therapy to upper abdominal sites is technically challenging due to motion of tumors and surrounding organs resulting from normal respiration. Breath-hold, using an Active Breathing Coordinator is one strategy used to reduce motion in these tumor sites. Though widely used, no studies have prospectively compared the different breath-hold techniques (inspiration, deep-inspiration and expiration) using ABC in the same patient cohort. Patients planned for radiation therapy to upper abdominal tumors are invited to participate in this prospective study. Participants attempt three breath hold techniques: inspiration, deep-inspiration and expiration breath-hold, in random order. kV fluoroscopy images of the dome of diaphragm are taken of five consecutive breath-holds in each technique. Reproducibility and stability of tumour position are measured, and used to select the technique with which to proceed to planning and treatment. Reproducibility at planning and each treatment fraction is measured, along with breath hold time, treatment efficiency and patient experience. The screening method was validated after the first three participants. This screening process may be able to select the best breath-hold technique for an in idual, which may lead to improved reproducibility. The screening process is being piloted as a prospective clinical trial. Australian New Zealand Clinical Trials Registry (ANZCTR): 12618001691235. Registered 12th October 2018. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376109& isReview=true .
Publisher: Wiley
Date: 15-10-2021
DOI: 10.1002/JMRS.442
Abstract: An automated dose accumulation and contour propagation workflow using daily cone beam computed tomography (CBCTs) images for prostate cases that require pelvic lymph nodes irradiation (PLNs) was developed. This workflow was constructed using MIM® software with the intention to provide accurate dose transformations for plans with two different isocentres, whereby two sequential treatment phases were prescribed. The pre‐processing steps for data extractions from treatment plans, CBCTs, determination of couch shift information and management of missing CBCTs are described. To ensure that the imported translational couch shifts were in the correct orientation and readable in MIM, phantom commissioning was performed. For dose transformation, rigid registration with corrected setup shifts and scaled fractional dose was performed for pCT to daily CBCTs, which were then deformed onto CBCT 1 . Fractional dose summation resulted in the final accumulated dose for the patient allowing differences in dosimetry between the planned and accumulated dose to be analysed. Contour propagations of the prostate, bladder and rectum were performed within the same workflow. Transformed contours were then deformed onto daily CBCTs to generate trending reports for analysis, including Dice Similarity Coefficient (DSC) and Mean Distance to Agreement (MDA). Results obtained from phantom commissioning (DSC = 0.96, MDA = 0.89 mm) and geometrical analysis of the propagated contours for twenty patients prostate (DSC: 0.9 ± 0.0, MDA: 1.0 ± 0.3 mm), rectum (DSC: 0.8 ± 0.1, mm, MDA: 1.7 ± 0.6 mm) and bladder (DSC: 0.8 ± 0.1, MDA: 2.8 ± 1.0 mm) were within clinically accepted tolerances for both DSC ( .8) and MDA ( 0.3 mm). The developed workflow is being performed on a larger patient cohort for predictive model building, with the goal of correlating observed toxicity with the actual accumulated dose received by the patient.
Publisher: Cambridge University Press (CUP)
Date: 21-10-2014
DOI: 10.1017/S1460396914000399
Abstract: To determine and summarise the literature on prostatic seed stability by investigating seed marker migration and loss in prostate cancer patients. In addition, documenting the implications of significant seed migration and loss in clinical practise. PubMed and Sciencedirect databases were used to locate papers on the stability of gold seed markers in prostate patients treated with external beam radiation therapy. The search found 3,238 articles and ten articles were selected and reviewed based on inclusion and exclusion criteria for the scope of this literature review. Minimal migration and loss of seeds was observed in the literature reviewed, with the majority of authors reporting ·0 mm migration within the prostate however, there were in idual cases reported outside of the 2·0 mm threshold. It was also found that significant migration had an impact on image matching, as well as, planning treatment volume margins. Seed stability within the prostate has been proven, with most authors reporting minimal migration within a 2·0 mm threshold and minimal loss of seeds. Although in idual cases can have significant migration and loss, if marker migration exceeds the 2·0 mm threshold, a protocol is required to deal with both non-significant and significant migration.
Publisher: Wiley
Date: 18-10-2017
Abstract: Evidence demonstrates that health care professionals are more prone to burnout than other professionals due to the emotionally taxing interactions they have with their patients on a daily basis. The aims of this study were to measure occupational burnout levels among sonographers, radiographers and radiologists and to examine predictors of burnout according to demographic characteristics. A cross-sectional online survey was administered in 2010 to radiographers, sonographers and radiologists who were members of the following professional bodies: Australian Institute of Radiography, Australian Sonographers Association and The Royal Australian and New Zealand College of Radiologists. The Maslach Burnout Inventory was used to measure burnout levels for each profession. Data were analysed using SPSS Ver 20 (IBM, Chicago, IL, USA) statistical software. A total of 613 radiographers, 121 sonographers and 35 radiologists participated in the survey. Radiographers, sonographers and radiologists had a high mean (±SD) burnout score for emotional exhaustion (39.9 ± 8.5, 42.2 ± 8.5 and 44.9 ± 7.1 respectively) and depersonalization (18.9 ± 5.5, 20.3 ± 5.8 and 20.6 ± 5.6) compared to MBI norms. Radiographers also had low personal achievement (30.8 ± 5.5) compared to MBI norms. Radiographers and sonographers who were male, worked >10 hours overtime and spent <10% of their time training students per week had significantly higher depersonalization scores (p < 0.05). Burnout levels among radiographers, sonographers and radiologists are high and likely to vary according to some demographic and work-related factors. Further research is needed to examine ways to alleviate burnout in these professions so that loss of experienced staff due to burnout can be minimized and quality of patient care can be maintained.
Publisher: Wiley
Date: 30-07-2022
DOI: 10.1002/JMRS.611
Abstract: Anal cancer (AC) is 18 F‐FDG‐PET avid and has been used to evaluate treatment response several months after chemoradiotherapy. This pilot study aimed to assess the utility of semi‐automated contouring methods and quantitative measures of treatment response using 18 F‐FDG‐PET imaging at the early time point of 1‐month post‐chemoradiotherapy. Eleven patients with AC referred for chemoradiotherapy were prospectively enrolled into this study, with 10 meeting eligibility requirements. 18 F‐FDG‐PET imaging was obtained pre‐chemoradiotherapy (TP1), and then 1‐month (TP2), 3–6 months (TP3) and 9–12 months (TP4) post‐chemoradiotherapy. Manual and semi‐automated (Threshold) contouring methods were used to define the primary tumour on all 18 F‐FDG‐PET images. Resultant contours from each method were interrogated using quantitative measures, including volume, response index (RI), total lesion glycolysis (TLG), SUV max , SUV median and SUV mean . Response was assessed quantitatively as reductions in these measures and also qualitatively against established criteria. Nine patients were qualitatively classified as complete metabolic responders at TP2 and all 10 at TP3. All quantitative measures demonstrated significant ( P 0.05) reductions at TP2 for both Manual and Threshold methods. All reduced further at TP3 and again at TP4 for Threshold methods. TLG showed the highest reduction at all post‐chemoradiotherapy time points and classified the most responders for each method at each time point. All patients are recurrence‐free at minimum 4‐year follow‐up. Based on our small s le size, semi‐automated methods of disease definition using 18 F‐FDG‐PET imaging are feasible and appear to facilitate quantitative response classification of AC as early as 1‐month post‐chemoradiotherapy. Early identification of treatment response may potentially improve disease management.
Publisher: Springer Science and Business Media LLC
Date: 13-01-2020
DOI: 10.1007/S00066-019-01558-Y
Abstract: The magnitude of intra-fractional prostate displacement (change from initial position over time) is associated with the duration of the patient lying on the radiotherapy treatment couch. This study reports a minute-by-minute association and calculates the impact of this displacement on duration-dependent margins using real-time intra-fractional position data monitored by four-dimensional transperineal ultrasound (4D TPUS). A total of 55 patients were recruited prospectively. Intra-fractional position of the prostate was monitored in real-time using a 4D TPUS Clarity® system. A total of 1745 monitoring sessions were analysed. Van Herk's margin recipe (2.5∑ + 1.64((σ The mean intra-fractional position was 0.76 mm Inferior (Inf), 0 mm Lateral (Lat) and 0.94 mm Posterior (Post) at the 15th minute. A minimum margin expansion of 2.42 mm (Superior/Inf), 1.02 mm (Left/Right) and 2.65 mm (Anterior/Post) was required for an 8‑minute treatment compared to 4.29 mm (Sup/Inf), 1.84 mm (Lt/Rt) and 4.63 mm (Ant/Post) for a 15-minute treatment. The required margin expansion increased linearly (R We report our experience in deriving the minimum duration-dependant margin to generate the required planning target volume for prostate radiotherapy. The required margin increases linearly in all directions within the 15-min duration thus, the margin will depend on the duration of the technique chosen (IMRT/VMAT/3DCRT roton).
Publisher: Wiley
Date: 25-05-2015
DOI: 10.1002/JMRS.108
Publisher: Wiley
Date: 05-10-2020
DOI: 10.1002/JMRS.439
Abstract: This technical evaluation aims to provide practice ‘how to’ guidelines for radiation therapists (RTs) when positioning a transperineal ultrasound (TPUS) probe during prostate radiotherapy. Recommendations and practical tips will be provided for the best practice in TPUS‐guided workflow to obtain optimal ultrasound images for accurate interpretation and registration of the prostate gland. This will assist the RTs in making consistent and accurate clinical decision in an ultrasound‐guided radiotherapy workflow for prostate treatment. The implementation process and the associated successes and challenges will also be described to assist institutions who may be investigating the potential of implementing this system.
Publisher: Wiley
Date: 06-10-2015
DOI: 10.1002/JMRS.129
Publisher: Wiley
Date: 20-09-2023
DOI: 10.1002/JMRS.723
Publisher: Wiley
Date: 22-07-2014
DOI: 10.1002/JMRS.63
Publisher: MedCrave Group, LLC
Date: 12-01-2021
DOI: 10.15406/IJRRT.2021.08.00288
Abstract: Purpose Clinician inexperience, intra–observer and inter–observer variations in tumour definition may affect staging, radiotherapy target definition, and treatment outcomes, particularly in rare cancers. The purpose of this study was to assess the correlation between semi–automated methods of primary anal cancer (AC) definition and our current clinical standard of manual clinician definition using 18F–FDG–PET imaging and to provide recommendations for clinical use. Methods All patients referred for chemoradiotherapy for AC between 2012 and 2016 were prospectively enrolled, with all 18F–FDG–PET imaging acquired within one year of chemoradiotherapy collected. Three methods of primary AC definition were performed on all PET datasets. Manual definition by an experienced radiologist was considered the clinical standard for comparison of volume and coincidence (Dice coefficient) in our study. Semi–automated techniques assessed included a gradient–based SUV (SUV–gradient) method and a SUV threshold method with a range of thresholds relative to SUVmax (40 (T40), 50 (T50) and 60% (T60)). Results Ten patients were enrolled with 33 PET study sets available for analysis. While all methods created contours on pre– and post–treatment scans, manual definition of PET–avid disease was only necessary on 11 of the 33 study sets. SUV–gradient and T40 defined contours were not statistically different in volume to the clinical standard (p = 0.83 & 0.72 respectively). The observed Dice coefficient relative to the manual clinician contours were 0.75 and 0.73 for the SUV–gradient and T40 methods respectively. Conclusions It is possible to define gross AC using SUV–based methods, with the SUV–gradient–based method followed by the T40 method most closely correlating with our current clinical standard. The SUV–gradient–based method studied is housed within a proprietary clinical system. A semi–automated approach that uses a vendor neutral T40 method and the clinician’s knowledge and skill appears optimal in defining AC. With this approach AC may be defined reliably to enhance efficiencies in radiotherapy and nuclear medicine processes, and to support clinicians in identifying and defining this rare disease. Trial registration ANZCTR, ACTRN12620000066987. Registered 28 January 2020–Retrospectively registered, www.anzctr.org.au/ACTRN12620000066987.aspx
Publisher: Wiley
Date: 02-2009
DOI: 10.1111/J.1754-9485.2009.02048.X
Abstract: The Tattersall's Cancer Centre has been performing image-guided radiation therapy (IGRT) using an in-room CT on rails since 2003 to verify accurate patient setup position (relative to bony anatomy) immediately prior to treatment delivery for prostate cancer patients. While the concept of online correction for bony anatomy is well established, the use of an in-room CT scanner also enables the collection and offline analysis of soft tissue volumetric data. Although initially IGRT was implemented under a research protocol, in-room CT verification has continued to be used to measure and correct for patient setup variations for all patients undergoing intensity modulated radiation therapy (IMRT) treatments. The present paper outlines the protocol that was used to implement IGRT using an in-room CT scanner at the Tattersall's Cancer Centre. Online corrections that minimize patient setup uncertainties allow confidence in delivering dose escalation as well as decreasing the margins required around the target volume. With improvements in auto-contouring tools, IGRT will also have the ability to measure and correct for variations in target and critical structure positioning online, rather than the current offline methods utilized.
Publisher: Wiley
Date: 07-01-2015
DOI: 10.1002/JMRS.89
Publisher: Elsevier BV
Date: 2018
Publisher: Wiley
Date: 26-09-2014
DOI: 10.1002/JMRS.69
Publisher: Elsevier BV
Date: 2023
Publisher: Springer Science and Business Media LLC
Date: 13-08-2012
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.BREAST.2016.03.002
Abstract: The purpose of this systematic review was to summarise the evidence from studies investigating the integration of tumour bed boosts into whole breast irradiation for patients with Stage 0-III breast cancer, with a focus on its impact on acute and late toxicities. A comprehensive systematic electronic search through the Ovid MEDLINE, EMBASE and PubMed databases from January 2000 to January 2015 was conducted. Studies were considered eligible if they investigated the efficacy of hypo- or normofractionated whole breast irradiation with the inclusion of a daily concurrent boost. The primary outcomes of interest were the degree of observed acute and late toxicity following radiotherapy treatment. Methodological quality assessment was performed on all included studies using either the Newcastle-Ottawa Scale or a previously published investigator-derived quality instrument. The search identified 35 articles, of which 17 satisfied our eligibility criteria. Thirteen and eleven studies reported on acute and late toxicities respectively. Grade 3 acute skin toxicity ranged from 1 to 7% whilst moderate to severe fibrosis and telangiectasia were both limited to 9%. Reported toxicity profiles were comparable to historical data at similar time-points. Studies investigating the delivery of concurrent boosts with whole breast radiotherapy courses report safe short to medium-term toxicity profiles and cosmesis rates. Whilst the quality of evidence and length of follow-up supporting these findings is low, sufficient evidence has been generated to consider concurrent boost techniques as an alternative to conventional sequential techniques.
Location: Australia
No related grants have been discovered for Kellie Knight.