title: Establishment of practice standards in nomenclature and prescription to enable construction of software and databases for knowledge-based practice review.
abstract: BACKGROUND
  Establishment of standards within a practice and across disease site groups for nomenclatures, prescription formatting, and measured dose-volume histogram (DVH) metrics is a key enabling step for creating software and database solutions to make routine aggregation of dosimetric data for all patients treated in a practice, practical. A process of physician-driven, iterative dialogs coupled with development of technical tools is required to implement the cultural and procedural changes. The cumulative reward for this effort is a database that can be used for defining practice norms, benchmarking against national standards, and tracking dosimetric effects of longitudinal practice pattern changes.
  
  
  METHODS
  A 4-year project was carried out to develop and introduce standardizations, modify processes, and develop computer-based tools for reporting, aggregation, and analysis of prescription and DVH metrics. Physician disease site groups developed 42 target and 81 normal tissue templates. From the database of 32,002 DVH metrics, benchmarking was illustrated for a subgroup of breast (281) and prostate (324) patients treated with conventional fractionation over a 16-month period. Breast patients were segregated according to prescription template used: simple (S, tangents only) vs complex (C, tangents + supraclavicular ± intramammary nodes) and left (S-L or C-L) versus right (S-R or C-R).
  
  
  RESULTS
  Prostate patients' median and 50% confidence intervals (CIs) for bladder, stated according to the nomenclature: the percentage of bladder volume receiving doses of ≥40 Gy (V40[%]), V65Gy[%], V70Gy[%], V75Gy[%], and V80Gy[%] were 45.5 (24.9-57.0), 15.6 (9.0-23.8), 7.6 (3.3-13.6), 2.0 (0.0-7.9), and 0.0 (0.0-1.4), respectively. Values for rectum: V50Gy[%], V60 Gy[%], V65Gy[%], V70Gy[%], and V75Gy[%] were 37.1 (27.8-43.5), 21.8 (15.6-25.5), 14.6 (9.6-18.0), 7.7 (1.9-12.3), and 1.0 (0-7.0), respectively. For breast patients, heart:mean Gray values were 1.5 (1.0-2.0), 3.1 (2.2-4.8), 0.4 (0.3-0.7), and 1.1 (0.8-2.2) for S-L, C-L, S-R, and C-R, respectively. Longitudinal, moving window plots of median, 50% CI, and 90% CI for 6-month periods demonstrated the effect of practice changes to reduce heart doses.
  
  
  CONCLUSIONS
  Standardization was challenging as a practice change, but has resulted in significant improvements for both our clinical and research efforts.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. Electronic address: cmayo@med.umich.edu.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Mayo
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Pisansky
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ivy A
authors.initials: IA
authors.lastname: Petersen
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Yan
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Davis
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Stafford
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Yolanda I
authors.initials: YI
authors.lastname: Garces
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Miller
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: James A
authors.initials: JA
authors.lastname: Martenson
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Mutter
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Richard
authors.initials: R
authors.lastname: Choo
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Hallemeier
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Laack
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sean S
authors.initials: SS
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ma
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Olivier
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Sameer R
authors.initials: SR
authors.lastname: Keole
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Mirek
authors.initials: M
authors.lastname: Fatyga
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Foote
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
mesh_terms: D019992:Databases as Topic / Q000592:standards*; D005260:Female; D006801:Humans; D051188:Knowledge Bases; D008297:Male; D012984:Software / Q000592:standards*; D009626:Terminology as Topic