July 2018

Updates from ASTRO's Committee on Health Equity, Diversity and Inclusion (CHEDI)

By Curtiland Deville, MD, Chair, CHEDI, ASTRO

Despite continued technological advances in radiation oncology, well-documented disparities and inequities in cancer care and outcomes continue to persist domestically and globally. While diversification of the physician workforce is seen as an important component to addressing health disparities, certain specialties, such as radiation oncology, remain disproportionately underrepresented by women and underrepresented racial and ethnic minorities. Importantly, the ASTRO Board of Directors identified Diversity and Inclusion as one of five core values in its Strategic Plan last year.
Since recently being elevated to the status of a full committee within ASTRO, the Committee on Health Equity, Diversity and Inclusion (CHEDI) has been working diligently to raise the awareness of our committee and achieve our recently updated mission: To advance the status of minorities and the underserved in oncology through educational and professional opportunities, advocacy and awareness. Our committee’s work is executed through several initiatives, a few of which are detailed below.
ASTRO Minority Summer Fellowship: This flagship program of the committee is designed to expose medical students from racial and ethnic backgrounds that are historically underrepresented in medicine to radiation oncology. Launched in 2010, the fellowship award provides awardees with an eight-week summer training program (with clinical exposure) and attendance at an ASTRO Annual Meeting. The majority of our program fellows have gone on to successfully apply and match in radiation oncology residency programs. This year’s winners are:
  • Zachary White from the University of Southern Alabama, who was selected as the Basic Science awardee for his project with mentor Markus Bredel, MD, PhD, at the University of Alabama Birmingham, entitled Impact of ANXA7 I1 Expression on PDGFRA and MET Endosomal Trafficking in GBM.
  • Amandeep Mahal from Yale University, who was selected as the Clinical awardee for his project with mentor James Yu, MD, MHS, entitled The Effect of Race and Decision Aids on Physician Recommendation for Prostate Cancer Treatment Planning.
If you are interested in being listed on ASTRO’s website as a potential faculty mentor for the Minority Summer Fellowship, please contact Natalie Cain at natalie.cain@astro.org. Each year, students across the country utilize this faculty mentor listing to identify potential mentors and research projects.
Educational Sessions at the ASTRO Annual Meeting: A few years ago, CHEDI made a concerted effort to increase content at the ASTRO Annual Meeting addressing health equity and disparities. We are pleased to report that for the second consecutive year, CHEDI will have three educational sessions at the upcoming ASTRO Annual Meeting, which were successfully selected through the peer-reviewed, session submission process:  
Pipeline Protégé Program: This novel program was recently developed by CHEDI leadership as an inclusive career development program aimed at bringing diversity to ASTRO’s Councils and diversifying ASTRO’s future leaders. Protégé’s must be be a board-certified radiation oncologist or medical physicist and have a demonstrated interest in diversity, inclusion, health equity and/or disparities. The program has a yearlong term beginning and ending at the ASTRO Annual Meeting and aligns a protégé with an ASTRO Council, where they will assist leadership with executing an important project within the Council. Protégés will have access to seasoned leaders and planning conversations that help shape ASTRO’s efforts in clinical affairs, quality, education, government relations, health policy and science, while ensuring the inclusion of diverse perspectives.
We look forward to the participation of all ASTRO members in these activities to benefit our Society, institutions, communities and, ultimately, the diverse patients we serve.

Dr. Curtiland Deville is an Associate Professor in the Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine. 
Posted: July 24, 2018 | 0 comments

Discovering research influence and trends in radiation oncology using alternative metrics

By Dawit Tegbaru, Managing Editor, Practical Radiation Oncology and Advances in Radiation Oncology

It’s no secret, the information age has enabled broad access to rich scientific content. Today, vast amounts of knowledge generates and disseminates across various platforms. Owing to evolving needs and technology, information cycles to and from consumers, with multiplying force. Enter the age of big data. With greater access to information, it’s become increasingly difficult for researchers to quickly glean important developments in their fields of interest and build a knowledge base without first employing analytics-based tools and strategies.

Priem et al. highlighted the overconsumption challenge in Altmetrics: A Manifesto, stating that no one can read everything; people depend on filters. Consequently, stewards of scholarly publishing have taken a multi-role mentality of curating peer-reviewed literature and providing tools that aid discovery and measure impact, i.e., alternative metrics. Our very own Editor-in-Chief of Practical Radiation Oncology, W. Robert Lee, MD, MS, MEd, recently shared views on this in Scholarly Publishing and the Metric System. While alternative metrics or “altmetrics” have become a standard feature in publishing, it’s important for the community of RadOnc researchers to be knowledgeable about their existence and applications.
What are Altmetrics? 
Alternative metrics (altmetrics) represent evolutionary thinking when it comes to measuring the impact of scholarly materials. Traditionally, citations served as the primary indicator of impact. While citations still play an essential role in determining long-term impact, they cannot sufficiently measure or keep pace with the increasingly diverse types of research output that scholars, practitioners and society-at-large interact with electronically on a daily basis. Altmetrics have become the big data analytics tool that aid the discovery process, and shed light on reach, impact and engagement in near-real-time.
Altmetrics provide alternative views of impact by synthesizing big data, connecting scholarly output with various digital signals of engagement. ASTRO's journals are using altmetrics to track articles. Read on for how these journal articles are tracked and learn strategies on how to leverage the various metrics that are publicly available.
Intuitive learning: How readers engage with ASTRO journal articles  
Articles published in ASTRO's journals are tracked and grouped by the categories listed below:
  • Usage (clicks, downloads, views, library holdings)
  • Captures (bookmarks, favorites, readers)
  • Mentions (blog posts, Wikipedia links, news media)
  • Social Media (likes, shares, tweets)
  • Citations (citation indexes, patent citations, clinical citations, policy citations)
To access altmetrics for International Journal of Radiation Oncology•Biology•Physics (Red Journal)Practical Radiation Oncology or Advances in Radiation Oncology, simply go to their respective homepages and click the PlumX Metrics widget (Figure 1). You will see a high-level view of articles receiving social media buzz (Figure 2).  

Figure 1. PlumX Metrics widget available via the Practical Radiation Oncology homepage. Accessed July 11, 2018.
Figure 2. PRO’s Top Social Media Articles. Accessed July 11, 2018.
Alternatively, go to an individual article (full-text) webpage and click the PlumX Metrics icon that appears underneath the title and author lists. An example is shown in Figure 3 below. ​

screen shot of full-text article showing PlumX metrics icon
Figure 3. Screenshot of a full-text article showing the PlumX Metrics icon. Accessed on July 11, 2018.

When the PlumX icon is clicked at the article level, an activity summary page loads featuring options, showing data sources and illustrations of communities that are interacting with the research (Figure 4). For example, one can explore tweets, news articles, citations, etc.


Figure 4. PlumX article activity summary page. Accessed July 11, 2018.
Strategies: Leverage insights and promote your research
Members and affiliates of the radiation oncology community are encouraged to keep up with trending research using the PlumX metrics feature provided via ASTRO journals. One way of doing so is to regularly check the top social media articles lists. Members are also encouraged to think innovatively about gleaning insights at the article level to stimulate current research and identify potential opportunities for future research, collaboration and/or funding. Becoming more familiar with these near-real-time metrics can assist with identifying past and present trends and demonstrating research impact.
Our journals provide powerful tools enabling scholars to track the performance of their published research. We encourage you to use these metrics and insights to strengthen connections with the scientific community. Become more active on social media by sharing articles with your professional networks. When preparing a new manuscript, ensure it is search engine optimized. For more tips on preparing and promoting your research read: How to improve the impact of your paper.
Did you know? 
When publishing a paper in an ASTRO journal, authors are given a Share Link, granting anyone free access for 50 days (from the date of publication). Are you ready to promote via social media and want to arrange joint social media promotion? If so, reach out to the editorial team at redjournal@astro.orgpro@astro.org or advances@astro.org.  
As the field of radiation oncology grows and novel therapies emerge, non-traditional metrics such as clinical, patent and policy citation metrics will grow in importance. We’re hoping to help raise ASTRO member awareness. Tell us what you think by commenting below or contacting Dawit Tegbaru at dawit.tegbru@astro.org.

Dawit Tegbaru is ASTRO’s Managing Editor for Practical Radiation Oncology and Advances in Radiation Oncology. 
Posted: July 23, 2018 | 0 comments

A red herring in the complex case of radiopharm access?

By David Beyer, MD, FASTRO, ASTRO Immediate Past Chair

Concerning potential changes to training and experience (T&E) requirements were again on the agenda when I met with Commissioners of the Nuclear Regulatory Commission (NRC) on June 26 to discuss radiation oncology’s priorities. 

ASTRO meets annually with Commissioners, and we have frequent interaction with NRC staff. We always appreciate the opportunity to strengthen our relationship with this critical agency that must balance safety and access to radioactive isotopes in medicine. As she does every year, Cindy Tomlinson, ASTRO’s senior patient safety and regulatory affairs manager, joined me in these meetings with NRC Chairman Christine Svinicki and Commissioners Jeff Baran and Annie Caputo, who was recently confirmed by the U.S. Senate. We had positive conversations about safety culture, medical event reporting, supervision requirements, and T&E requirements for radiopharmaceuticals, which has been a hot topic for the agency.

NRC regulations require that an authorized user (AU) be certified by a medical specialty board recognized by either the NRC or an agreement state or have completed 700 hours of T&E in “basic radionuclide handling techniques applicable to the medical use of unsealed byproduct material requiring a written directive” (10 CFR 35.390(b)). In recent years, the NRC has been under pressure to reduce the T&E requirements for radiopharmaceuticals through the “alternate pathway,” based on concerns about limited access to certain radiopharmaceuticals driven by a perceived shortage of AUs. The NRC’s Advisory Committee on the Medical Use of Isotopes (ACMUI), on which several radiation oncologists and medical physicists serve, formed a permanent subcommittee to look at these requirements and make suggestions for changes, if warranted. The subcommittee is expected to finish its work on this section by ACMUI’s fall 2018 meeting. If the NRC decides to make changes to the requirements, those changes will have to go through the rule making process.

It is difficult to determine whether there is an actual or perceived shortage of AUs. The American Board of Radiology (ABR) estimates that between 2007 and 2017, approximately 1,650 radiation oncologists were certified by the ABR with an Authorized User Eligibility designation and may become AUs. In addition, ASTRO estimates that there are approximately 2,200 radiation oncology facilities in the United States, which means beyond the nuclear medicine-trained AUs nationwide, there are likely enough AUs just among the radiation oncologists to administer radiopharmaceuticals.

ASTRO’s Government Relations and Health Policy leadership believes that what’s at play with the utilization of radiopharmaceuticals is a much more complicated mix of economic and practical factors. Other factors impacting use likely include changing referral patterns and comparable alternative treatment options – neither of which involve the number of AUs available to administer these treatments. Changing the T&E requirements could be a red herring and might compromise safety without addressing the multifactorial issues.

In our meetings with the Commissioners, we reiterated that the current 700-hour requirement is appropriate, protects the safety of patients, the public, and practitioners, and should not be lowered. The rigorous T&E requirements contribute to the excellent safety record of radiopharmaceuticals. Further, ASTRO believes that it is important that the person administering the radiopharmaceutical is appropriately trained in the safe handling, exposure risks, and the management of side effects of radiation.

Still, this is a challenging issue that requires our attention. During our meetings with the Commissioners, we were asked what an ideal training program would look like for those seeking AU status under the alternate pathway. Would an ideal training program mirror existing radiation oncology and nuclear medicine training programs and curriculum? Or, would a program contain different requirements, and if so, what would those requirements be? Or, would the requirements remain at 700 hours without a specific curriculum?

As theranostics and other novel therapies emerge, these questions will only grow in importance, and we’re looking for ASTRO member input on this important topic. Tell us what you think by commenting below or contacting Cindy Tomlinson at cindy.tomlinson@astro.org.

Dr. Beyer serves on ASTRO’s Board of Directors and practices in Sedona, AZ.
Posted: July 10, 2018 | 0 comments