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Grading System Designed to Assess Patient Reactions to Radiotherapy

By MedImaging International staff writers
Posted on 15 Oct 2013

A novel study was designed to assess the effectiveness of different systems used by caregivers to evaluate toxicity for patients receiving radiation therapy.

The study, conducted by researchers from North Shore-Long Island Jewish (LIJ) Health System (New Hyde Park, NY, USA), was presented at the 55th annual meeting of the American Society of Therapeutic Radiation Oncology (ASTRO), held September 2013 in Atlanta (GA, USA).

During the course of radiation therapy, patients may experience reactions to their treatments. Typically, the severity of reactions is assessed by a radiation oncologist and nurse using a formal grading scheme. Research conducted by North Shore-LIJ’s radiation oncologists evaluated the reliability of these grading systems by independent caregivers. The study assessed whether independent caregivers would assign the same grade to the same adverse reaction using a common grading scheme. Images of breasts that had undergone radiation in 30 breast cancer patients on skin care protocols were presented to radiation oncologists and nurses who were asked to assign grades independently based on their evaluation of the images and provide feedback explaining their choices. The assessments were then analyzed and the level of agreement among caregivers was determined using statistical methods.

As presented at ASTRO, the study determined that overall there was a significantly better agreement in the assessments based on the use of the Common-Terminology-Criteria-for-Adverse Events (CTCAE) scale, which was developed by the National Cancer Institute to standardize the assignment of grades across various caregivers. Analysis of the comments provided by the caregivers revealed a reliance on assessment criteria that was not necessarily explicit in the grading definitions.

“Establishing the reliability of the scale used to assess adverse reactions among different caregivers is an important step to enhance uniformity and consistency of the care to our patients,” said Ajay Kapur, PhD, lead author of the study and director of medical physics research and education in the North Shore-LIJ department of radiation medicine. “The specific grading scheme used must demonstrate a high level of reliability amongst various caregivers.”

The study’s senior author and chair of radiation medicine, Louis Potters, MD, said, “In order to deliver the highest quality of care to our patients, we all need to speak the same language. This study enhances our ability to provide Consistent care to all our patients and further validates the CTCAE grading system.”

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70 (347.13745117188): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (267.02880859375): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (56.028366088867): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (57.220458984375): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.954879760742): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (77.962875366211): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

105 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

106 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294748646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (45.061111450195): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294748646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

109 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

110 (46.968460083008): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294748646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (524.04403686523): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294748646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (542.16384887695): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (327.11029052734): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

115 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

116 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

117 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

118 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

119 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

120 (282.04917907715): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 18254.041671753): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

123 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

124 (393.86749267578): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748646 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748646 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 461357.11669922): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (77.009201049805): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (44.107437133789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (29.802322387695): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (508.78524780273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (504.97055053711): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (236.03439331055): SELECT name FROM jos_deeppockets WHERE id=213

136 (34.093856811523): SELECT name FROM jos_deeppockets WHERE id=213

137 (442.9817199707): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (406.98051452637): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

140 (55.789947509766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

141 (!!!!! 8610.0101470947): TRUNCATE TABLE jos_trademed_module

142 (100.13580322266): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294748646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (51.975250244141): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294748646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (981.09245300293): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

147 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

148 (!!!!! 1339.9124145508): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

150 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

151 (41.007995605469): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748646 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748646 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (34.809112548828): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

153 (40.054321289062): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

154 (52.928924560547): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

156 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748646 AND published='1' LIMIT 1

157 (61.988830566406): select jos_twitters.link from jos_twitters where cat=10

158 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

159 (36.001205444336): select jos_google_plus.link from jos_google_plus where cat=10

160 (35.04753112793): select jos_linkedin.link from jos_linkedin where cat=10

161 (286.81755065918): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1447.9160308838): insert into jos_banners_delta values (14615,'2025-06-19 20:15:58','216.73.216.120','view'),(14202,'2025-06-19 20:15:58','216.73.216.120','view'),(14203,'2025-06-19 20:15:58','216.73.216.120','view')

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