James A Hayman

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (192)862.94 Total impact

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    ABSTRACT: To evaluate the peripheral dose (PD) to a fetus during radiation therapy of pregnant patients when using a newly designed fetal lead shield (FLS). A custom FLS has been designed and fabricated for our department. The FLS (1.1 TVLs for 6 MV) is mounted on a mobile frame and can be adjusted vertically with a motor actuator. PD measurements were acquired for multiple simple square fields and for a variety of potential treatment sites a pregnant patient may be treated for including brain, head and neck (H&N) and thorax. For measurements of the brain, H&N, and thorax, an ionization chamber and OSLDs were positioned on average at a distance of 48, 29 and 26 cm, respectively, from the edge of treatment fields to mimic the approximate position of the fundus. Based on our measurements, applying a 90° collimator rotation and using tertiary MLCs to define the field aperture in combination with jaws resulted in an average dose reduction of 60%. When using these planning strategies in combination with the FLS, on average, the PD was reduced by additional 25% for simple square fields and 20% for clinical plans. The custom FLS is a safe, effective, and relatively easy system to position. Commissioning measurements have demonstrated that the PD to the fetus can be significantly reduced when using the FLS. The comprehensive dataset obviates the need for individual patient pre-treatment dose measurements as long as the geometry falls within the commissioning limits.
    Medical Physics 06/2015; 42(6):3636. DOI:10.1118/1.4925788 · 3.01 Impact Factor
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    ABSTRACT: To characterize the adoption and variation of intensity-modulated radiation therapy (IMRT) use in the state of Michigan. As a certificate-of-need state, Michigan requires every radiation oncology facility to report the number of external-beam and IMRT treatments delivered annually. We examined the percentage of treatments delivered using IMRT across centers from 2005 to 2012. We constructed a repeated-measures longitudinal linear regression model to evaluate bivariable and multiple variable associations with IMRT use. The median proportion of treatments delivered with IMRT rose from 16% in 2005 to 42% in 2012. All treatment centers in the state of Michigan possessed the capacity to deliver IMRT as of 2009. The fraction of treatments delivered with IMRT varied between 23% and 96% (standard deviation, 19%) in the lowest- and highest-use centers in 2012. Higher IMRT use was significantly associated with freestanding facilities and year of treatment, with a trend toward higher IMRT use in academic centers and low-volume facilities. IMRT use grew significantly across the state of Michigan over time, with four-fold variability among centers, which was related to facility characteristics. These data provide no indication of an ideal or appropriate level of IMRT use. Rather, the wide variation in IMRT use among centers indicates a lack of consensus regarding the situations in which IMRT provides significant clinical benefit. This supports further research and interventions to ensure that patients receive appropriate care, regardless of where they are treated. Copyright © 2015 by American Society of Clinical Oncology.
    Journal of Oncology Practice 03/2015; 11(3). DOI:10.1200/JOP.2014.002568
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    ABSTRACT: To characterize the regression rate of posterior uveal melanoma following radioactive iodine-125 (I-125) plaque. We retrospectively analyzed 95 patients with posterior uveal melanoma who were treated with only radioactive I-125 plaque and had more than 3 years follow-up. All patients were treated with plaque radiotherapy using tumor dose of 85 Gy at the tumor apex, following COMS protocol. Regression rate was assessed with standardized A-scan ultrasonography. Associations with tumor regression were evaluated by means of mixed linear regression modeling. Mean decrease in the tumor thickness (% original thickness) at 12, 24, and 36 months after radiotherapy for melanomas <3 mm in thickness was 29%, 38%, and 45%, for melanoma 3-8 mm in thickness was 32%, 44%, and 59%, and for melanoma more than 8 mm in thickness was 52%, 62%, and 68%, respectively. With a doubling of follow-up time (0.5-1 year, or 1-2 years of follow-up from treatment), tumors <3 mm in thickness at treatment showed a 0.5 mm decrease in tumor thickness, whereas melanomas 3-8 mm showed a 1 mm decrease, and melanomas >8 mm showed a 1.7 mm decrease. Uveal melanomas that developed systemic metastasis showed an additional 0.4 mm decrease with a doubling of follow-up time from treatment, compared with those that did not develop metastasis (P = 0.050). Posterior uveal melanomas with higher initial thickness show steeper and more reduction in tumor thickness following radioactive I-125 plaque. After the initial phases, the regression curve became similar for tumors with different thicknesses.
    Middle East African journal of ophthalmology 01/2015; 22(1):103-7. DOI:10.4103/0974-9233.148358
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    ABSTRACT: Given evidence from randomized trials that have established the non-inferiority of more convenient and less costly courses of hypofractionated radiotherapy to the whole breast in selected breast cancer patients who receive lumpectomy, we sought to investigate the use of hypofractionated radiation therapy and factors associated with its use in a consortium of radiation oncology practices in Michigan. We sought to determine the extent to which variation in use occurs at the physician or practice level versus the extent to which use reflects individualization based on potentially relevant patient characteristics (such as habitus, age, chemotherapy receipt, or laterality). We evaluated associations between receipt of hypofractionated radiation therapy and various patient, provider, and practice characteristics in a multilevel model. Of 1477 patients who received lumpectomy and whole-breast radiation therapy and were registered by the Michigan Radiation Oncology Quality Consortium (MROQC) from October 2011 to December 2013, 913 had T1-2, N0 breast cancer. Of these 913, 283 (31%) received hypofractionated radiation therapy. Among the 13 practices, hypofractionated radiation therapy use ranged from 2% to 80%. On multilevel analysis, 51% of the variation in the rate of hypofractionation was attributable to the practice level, 21% to the provider level, and 28% to the patient level. On multivariable analysis, hypofractionation was more likely in patients who were older (odds ratio [OR] 2.16 for age ≥50 years, P=.007), less likely in those with larger body habitus (OR 0.52 if separation between tangent entry and exit ≥25 cm, P=.002), and more likely without chemotherapy receipt (OR 3.82, P<.001). Hypofractionation use was not higher in the last 6 months analyzed: 79 of 252 (31%) from June 2013 to December 2013 and 204 of 661 (31%) from October 2011 to May 2013 (P=.9). Hypofractionated regimens of whole-breast radiation therapy have been variably administered in the adjuvant setting in Michigan after the publication of long-term trial results and consensus guidelines. Most of this variability is explained at the practice and provider level rather than by patient-level features, although care is being individualized to some degree. Copyright © 2014 Elsevier Inc. All rights reserved.
    International journal of radiation oncology, biology, physics 12/2014; 90(5):1010-6. DOI:10.1016/j.ijrobp.2014.09.027 · 4.18 Impact Factor
  • International journal of radiation oncology, biology, physics 09/2014; 90(1):S128. DOI:10.1016/j.ijrobp.2014.05.572 · 4.18 Impact Factor
  • International journal of radiation oncology, biology, physics 09/2014; 90(1):S11. DOI:10.1016/j.ijrobp.2014.05.090 · 4.18 Impact Factor
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    ABSTRACT: Purpose To report the final cosmetic results from a single-arm prospective clinical trial evaluating accelerated partial breast irradiation (APBI) using intensity modulated radiation therapy (IMRT) with active-breathing control (ABC). Methods and Materials Women older than 40 with breast cancer stages 0-I who received breast-conserving surgery were enrolled in an institutional review board-approved prospective study evaluating APBI using IMRT administered with deep inspiration breath-hold. Patients received 38.5 Gy in 3.85-Gy fractions given twice daily over 5 consecutive days. The planning target volume was defined as the lumpectomy cavity with a 1.5-cm margin. Cosmesis was scored on a 4-category scale by the treating physician. Toxicity was scored according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0). We report the cosmetic and toxicity results at a median follow-up of 5 years. Results A total of 34 patients were enrolled. Two patients were excluded because of fair baseline cosmesis. The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women at a median follow-up of 2.5 years. At a median follow-up of 5 years, further decline in the cosmetic outcome was observed in 5 women. Cosmesis at the time of last assessment was 43.3% excellent, 30% good, 20% fair, and 6.7% poor. Fibrosis according to CTCAE at last assessment was 3.3% grade 2 toxicity and 0% grade 3 toxicity. There was no correlation of CTCAE grade 2 or greater fibrosis with cosmesis. The 5-year rate of local control was 97% for all 34 patients initially enrolled. Conclusions In this prospective trial with 5-year median follow-up, we observed an excellent rate of tumor control using IMRT-planned APBI. Cosmetic outcomes, however, continued to decline, with 26.7% of women having a fair to poor cosmetic result. These results underscore the need for continued cosmetic assessment for patients treated with APBI by technique.
    International journal of radiation oncology, biology, physics 05/2014; 89(1). DOI:10.1016/j.ijrobp.2014.01.005 · 4.18 Impact Factor
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    ABSTRACT: To provide evidence-based recommendations to practicing oncologists, surgeons, and radiation therapy clinicians to update the 2005 clinical practice guideline on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer. The American Society of Clinical Oncology convened an Update Committee of experts in medical oncology, pathology, radiation oncology, surgical oncology, guideline implementation, and advocacy. A systematic review of the literature was conducted from February 2004 to January 2013 in Medline. Guideline recommendations were based on the review of the evidence by Update Committee. This guideline update reflects changes in practice since the 2005 guideline. Nine randomized clinical trials (RCTs) met systematic review criteria for clinical questions 1 and 2; 13 cohort studies informed clinical question 3. Women without sentinel lymph node (SLN) metastases should not receive axillary lymph node dissection (ALND). Women with one to two metastatic SLNs planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND (in most cases). Women with SLN metastases who will undergo mastectomy should be offered ALND. These three recommendation are based on RCTs. Women with operable breast cancer and multicentric tumors, with ductal carcinoma in situ (DCIS) who will undergo mastectomy, who previously underwent breast and/or axillary surgery, or who received preoperative/neoadjuvant systemic therapy may be offered SNB. Women who have large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or DCIS (when breast-conserving surgery is planned) or are pregnant should not undergo SNB. These recommendations are based on cohort studies and/or informal consensus. In some cases, updated evidence was insufficient to update previous recommendations.
    Journal of Clinical Oncology 03/2014; 32(13). DOI:10.1200/JCO.2013.54.1177 · 18.43 Impact Factor
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    ABSTRACT: Merkel cell carcinoma (MCC) is a rare malignancy of the skin, and prospective randomized clinical studies on management and treatment are very limited. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for MCC provide up-to-date, best evidence-based, and consensus-driven management pathways with the purpose of providing best care and outcomes. Multidisciplinary management with consensus treatment recommendations to individualize patient care within the framework of these guidelines is optimal. The University of Michigan multidisciplinary MCC program uses NCCN Guidelines in the management and treatment of its patients. This article discusses 4 patient presentations to highlight the implementation of the NCCN Guidelines for MCC at the University of Michigan.
    Journal of the National Comprehensive Cancer Network: JNCCN 03/2014; 12(3):434-41. · 4.24 Impact Factor
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    ABSTRACT: In 1999, the Institute of Medicine (IOM) published Ensuring Quality Cancer Care, an influential report that described an ideal cancer care system and issued ten recommendations to address pervasive gaps in the understanding and delivery of quality cancer care. Despite generating much fervor, the report's recommendations-including two recommendations related to quality measurement-remain largely unfulfilled. Amidst continuing concerns regarding increasing costs and questionable quality of care, the IOM charged a new committee with revisiting the 1999 report and with reassessing national cancer care, with a focus on the aging US population. The committee identified high-quality patient-clinician relationships and interactions as central drivers of quality and attributed existing quality gaps, in part, to the nation's inability to measure and improve cancer care delivery in a systematic way. In 2013, the committee published its findings in Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which included two recommendations that emphasize coordinated, patient-centered quality measurement and information technology enhancements: Develop a national quality reporting program for cancer care as part of a learning health care system; and,Develop an ethically sound learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings. These recommendations underscore the need for independent national oversight, public-private collaboration, and substantial funding to create robust, patient-centered quality measurement and learning enterprises to improve the quality, accessibility, and affordability of cancer care in America.
    03/2014; 2(1):53-62. DOI:10.1016/j.hjdsi.2013.11.003
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    ABSTRACT: Background Diffusion MRI, although having the potential to be a biomarker for early assessment of tumor response to therapy, could be confounded by edema and necrosis in or near the brain tumors. This study aimed to develop and investigate the ability of the diffusion abnormality index (DAI) to be a new imaging biomarker for early assessment of brain metastasis response to radiation therapy (RT).Methods Patients with either radiosensitive or radioresistant brain metastases that were treated by whole brain RT alone or combined with bortezomib as a radiation sensitizer had diffusion-weighted (DW) MRI pre-RT and 2 weeks (2W) after starting RT. A patient-specific diffusion abnormality probability function (DAProF) was created to account for abnormal low and high apparent diffusion coefficients differently, reflecting respective high cellularity and edema/necrosis. The DAI of a lesion was then calculated by the integral of DAProF-weighted tumor apparent diffusion coefficient histogram. The changes in DAI from pre-RT to 2W were evaluated for differentiating the responsive, stable, and progressive tumors and compared with the changes in gross tumor volume and conventional diffusion metrics during the same time interval.ResultsIn lesions treated with whole brain RT, the DAI performed the best among all metrics in predicting the posttreatment response of brain metastases to RT. In lesions treated with whole brain RT + bortezomib, although DAI was the best predictor, the performance of all metrics worsened compared with the first group.Conclusions The ability of DAI for early assessment of brain metastasis response to RT depends upon treatment regimes.
    Neuro-Oncology 12/2013; 16(1). DOI:10.1093/neuonc/not153 · 5.29 Impact Factor
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    ABSTRACT: Multidisciplinary tumor board conferences foster collaboration among health care providers from a variety of specialties and help to facilitate optimal patient care. Typical cases from thoracic tumor board conferences include patients with known or suspected bronchogenic and esophageal carcinomas, as well as less common diseases such as thymomas and mesotheliomas. In most instances, the clinical questions revolve around the best options for establishing a diagnosis, staging the disease and directing treatment. This article describes and illustrates the clinical scenarios of three patients who were presented at our tumor board, focusing on management issues and the role of imaging. These patients had non-small cell lung cancer and mediastinal lymph node metastases; a small, growing ground glass nodule; and oligometastatic non-small cell lung cancer, respectively.
    Cancer Imaging 12/2013; 13(3):1-11. DOI:10.1102/1470-7330.2013.0037 · 1.29 Impact Factor
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    ABSTRACT: Multidisciplinary tumor board conferences foster collaboration among health care providers from a variety of specialties and help to facilitate optimal patient care. Generally, the clinical questions revolve around the best options for establishing a diagnosis, staging the disease and directing treatment. This article describes and illustrates the clinical scenarios of three patients who were presented at our thoracic Tumor Board, focusing on management issues and the role of imaging. These patients had invasive thymoma; concurrent small cell lung cancer and non-small cell lung cancer; and esophageal cancer with celiac lymph node metastases, respectively.
    Cancer Imaging 12/2013; 13(3):298-305. DOI:10.1102/1470-7330.2013.0030 · 1.29 Impact Factor
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    ABSTRACT: Purpose/Objective(s) Pulmonary toxicity and decreased pulmonary function are important side effects of thoracic radiation. The ability to predict which patients are at higher risk of having pulmonary dysfunction caused by radiation therapy (RT) would be of great benefit to clinicians. The purpose of this study is to determine whether pulmonary function changes that occur during RT (1) correlate with post-RT changes, and (2) are predictive of clinically significant lung toxicity. Materials/Methods The study population included patients enrolled onto prospective studies of NSCLC with complete pulmonary function tests (PFT) 2 weeks prior to (“pre”), during (“dur”), and 3 months after (“post”) a definitive course of either fractionated conformal radiation therapy (CRT) or stereotactic body radiation therapy (SBRT). Correlations between continuous variables such as mean lung dose (MLD) and changes in PFTs obtained pre, dur, and post RT were tested by linear regression. Logistic regression was used to estimate the significance of PFTs on pulmonary toxicity in the form of radiation pneumonitis (RP). Additionally, the differences in the changes in PFTs observed in patients receiving CRT and SBRT were compared. The data is presented as mean (±95% CI) unless otherwise specified. Results Data from 44 (CRT n = 34, SBRT n = 10) patients treated from 2007 to 2012 were analyzed. The mean changes in FEV1%, FEV1/FVC, and DLCO% were 4.2 ± 4.9, 0.78 ± 2.76, and -4.8 ±5.0 and 2.86 ± 6.6, 0.48 ± 2.9 and -11.7 ± 5.9 during RT and post RT, respectively. Only DLCO had a significant decrease after RT (p = 0.024). The reduction in DLCO measured during RT was correlated with post-RT changes (R = 0.46). DLCO reduction after RT had an inverse correlation with the MLD (R = -0.45). Patients with a greater reduction of DLCO (more than 10%) after RT had a higher incidence of RP compared to patients with less reduction (38% vs 23%). In this study of limited sample size, the SBRT patients did not have a statistically significant change in DLCO either during (p = 0.55) or post (p = 0.64) RT. SBRT patients had less of a decrement in DLCO compared to CRT patients (-2.9 ±12.8 vs -14.2 ± 6.5, p = .11 trend for pre to post, 3.85 ±14.6 vs -10.5 ±5.2, p = 0.027 dur to post) that may be related to a trend in the decrease in MLD in SBRT plans (14.5 Gy CRT vs 9.95 Gy SBRT p = 0.079). Conclusions We have confirmed the previous finding that DLCO may be the most sensitive PFT parameter to evaluate lung function after RT. Radiation induced reduction in DLCO measured during RT and high MLD in RT plans appears to be predictive of a reduction in lung function and RP after radiation. We also observed that during and post RT changes in DLCO for SBRT patients were substantially less than in CRT patients.
    International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S33-S34. DOI:10.1016/j.ijrobp.2013.06.090 · 4.18 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S76. DOI:10.1016/j.ijrobp.2013.06.197 · 4.18 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S495-S496. DOI:10.1016/j.ijrobp.2013.06.1310 · 4.18 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S498-S499. DOI:10.1016/j.ijrobp.2013.06.1317 · 4.18 Impact Factor
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    ABSTRACT: Survival of patients with brain metastasis particularly from historically more radio-resistant malignancies remains dismal. A phase I study of concurrent bortezomib and whole brain radiotherapy was conducted to determine the tolerance and safety of this approach in patients with previously untreated brain metastasis. A phase I dose escalation study evaluated the safety of bortezomib (0.9, 1.1, 1.3, 1.5, and 1.7 mg/m2) given on days 1, 4, 8 and 11 of whole brain radiotherapy. Patients with confirmed brain metastasis were recruited for participation. The primary endpoint was the dose-limiting toxicity, defined as any >= grade 3 non-hematologic toxicity or grade >= 4 hematologic toxicity from the start of treatment to one month post irradiation. Time-to-Event Continual Reassessment Method (TITE-CRM) was used to determine dose escalation. A companion study of brain diffusion tensor imaging MRI was conducted on a subset of patients to assess changes in the brain that might predict delayed cognitive effects. Twenty-four patients were recruited and completed the planned therapy. Patients with melanoma accounted for 83% of all participants. The bortezomib dose was escalated as planned to the highest dose of 1.7 mg/m2/dose. No grade 4/5 toxicities related to treatment were observed. Two patients had grade 3 dose-limiting toxicities (hyponatremia and encephalopathy). A partial or minor response was observed in 38% of patients. Bortezomib showed greater demyelination in hippocampus-associated white matter structures on MRI one month after radiotherapy compared to patients not treated with bortezomib (increase in radial diffusivity +16.8% versus 4.8%; p = 0.0023). Concurrent bortezomib and whole brain irradiation for brain metastasis is well tolerated at one month follow-up, but MRI changes that have been shown to predict delayed cognitive function can be detected within one month of treatment.
    Radiation Oncology 08/2013; 8(1):204. DOI:10.1186/1748-717X-8-204 · 2.36 Impact Factor
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    ABSTRACT: PURPOSEAlthough radiation therapy (RT) can palliate symptoms and may prolong life, it is not curative for patients with metastatic lung cancer. We investigated patient expectations about the goals of RT for incurable lung cancers. PATIENTS AND METHODS The Cancer Care Outcomes Research and Surveillance Consortium enrolled a population- and health system-based cohort of patients diagnosed with lung cancer from 2003 to 2005. We identified patients with stage wet IIIB or IV lung cancer who received RT and answered questions on their expectations about RT. We assessed patient expectations about the goals of RT and identified factors associated with inaccurate beliefs about cure.ResultsIn all, 384 patients completed surveys on their expectations about RT. Seventy-eight percent of patients believed that RT was very or somewhat likely to help them live longer, and 67% believed that RT was very or somewhat likely to help them with problems related to their cancer. However, 64% did not understand that RT was not at all likely to cure them. Older patients and nonwhites were more likely to have inaccurate beliefs, and patients whose surveys were completed by surrogates were less likely to have inaccurate beliefs. Ninety-two percent of patients with inaccurate beliefs about cure from RT also had inaccurate beliefs about chemotherapy. CONCLUSION Although patients receiving RT for incurable lung cancer believe it will help them, most do not understand that it is not at all likely to cure their disease. This indicates a need to improve communication regarding the goals and limitations of palliative RT.
    Journal of Clinical Oncology 06/2013; 31(21). DOI:10.1200/JCO.2012.48.5748 · 18.43 Impact Factor
  • C Lee, H Demirci, J Hayman
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    ABSTRACT: Purpose: To design and construct a novel ophthalmic brachytherapy applicator for the treatment of conjunctival melanoma using I‐125 radioactive seed sources to overcome the dosimetric limitations of the commonly used standard Collaborative Ocular Melanoma Study (COMS) plaques. Methods: A commercially available polymethylmethacrylate conformer (Gulden Ophtalmics, Elkins Park, PA) was employed to hold a total of 12 low dose I‐125 seeds (model IAI‐125A, IsoAid, LLC, Port Richey, FL) distributed along the periphery of the conformer. Three dimensional dose distribution was calculated using the Plaque Simulator software (EyePhysics, LLC, Los Alamitos, CA) to optimize seed distribution pattern. The AAPM TG‐43 dose calculation formulism was utilized within the software. Results: The seed distribution pattern was designed in a way that dose would be delivered to the conjunctival tissue,while limiting the dose to the cornea and lens. Once the design was finalized, each slot for the seed was fabricated using a 6‐axis computer numerical control (CNC) machine available at our institution. The slots were milled into the convex side of the conformer to minimize any patient discomfort and to protect the cornea from direct contact with the seeds. Conclusion: The difficulty of treating conjunctival melanomas with COMS eyeplaques due to its unique anatomical distribution called for a custom design brachytherapy applicator. The applicator designed in the current study can effectively deliver radiation dose to affected area while minimizing the dose to the centrally located unaffected tissues.
    Medical Physics 06/2013; 40(6):286. DOI:10.1118/1.4814789 · 3.01 Impact Factor

Publication Stats

5k Citations
862.94 Total Impact Points

Institutions

  • 1999–2015
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 1997–2015
    • University of Michigan
      • Department of Radiation Oncology
      Ann Arbor, Michigan, United States
  • 1997–2013
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2011
    • Peter MacCallum Cancer Centre
      • Peter MacCallum Cancer Center
      Melbourne, Victoria, Australia
  • 2008–2009
    • Fudan University
      Shanghai, Shanghai Shi, China
  • 2006
    • University of Chicago
      Chicago, Illinois, United States
  • 2004
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2003
    • Netherlands Cancer Institute
      • Department of Radiotherapy
      Amsterdamo, North Holland, Netherlands
  • 2002
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States