Colin Harari, MD

Radiation Oncology Resident

Department of Human Oncology


MD, University of Wisconsin-Madison, (2020)

BS, Tufts University, Astrophysics (2010)

  • Navigating the Complexities of Lymph Node Management in Vulvar Cancer: Insights and Perspectives Practical radiation oncology
    Harari CM, Brower JV, Gaffney DK, Bradley KA
    2024 May-Jun;14(3):e220-e225. doi: 10.1016/j.prro.2024.01.007. Epub 2024 Feb 7.
  • Empowering the Radiation Oncology Triage Nurse Role: A Single-Center Analysis Clinical journal of oncology nursing
    Weber BW, Blitzer GC, Harari CM, Ruesga SL, Huenerberg KJ, Anderson B, Schuster JM
    2023 Nov 16;27(6):637-643. doi: 10.1188/23.CJON.637-643.
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      BACKGROUND: Triage nurses play a crucial role in addressing patient telephone calls. However, topics that radiation oncology (RO) triage nurses encounter have not been thoroughly investigated.

      OBJECTIVES: This project established baseline patient issues addressed via telephone by RO triage nurses in a clinically busy academic RO department; identified themes and potential areas for workflow improvement; and evaluated interprofessional perceptions of RO triage from nurses, physicians, and radiation therapists.

      METHODS: This two-part study was conducted from September through November 2021 using a retrospective chart review that analyzed patient communications to the RO nurse triage line. Physicians, nurses, and radiation therapists completed an online survey about their experiences with nurse triage.

      FINDINGS: Analysis revealed 13 message themes, with scheduling questions being the most common theme. Survey results indicated that average provider satisfaction with the effectiveness of triage was 3 of 5, perceived triage nurse preparedness to resolve encounters was 3 of 5, and perception of the triage program by physicians was 2.4 of 5.

      PMID:38009877 | DOI:10.1188/23.CJON.637-643

      View details for PubMedID 38009877
  • Evaluation of kV Triggered Fiducial Tracking for Prostate SBRT Intrafraction Motion Management International journal of radiation oncology, biology, physics
    Harari C, Blum S, Cooley G, Floberg JM, Besemer A
    2023 Oct 1;117(2S):e391. doi: 10.1016/j.ijrobp.2023.06.1512.
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      PURPOSE/OBJECTIVE(S): Stereotactic body radiation therapy (SBRT) is a safe and effective treatment for localized prostate cancer. Given the high dose per fraction, a high degree of precision is needed during SBRT treatment delivery. Fiducial marker tracking is a means of monitoring intrafraction motion, ensuring precise treatment delivery and potentially allowing for decreased planning target volume (PTV) margins. We present a 5-year single institution experience to characterize the performance of fiducial tracking.

      MATERIALS/METHODS: We analyzed 132 consecutive patients treated at our institution with prostate SBRT between July 2017 and November 2022 using fiducial tracking with the TrueBeam Auto Beam Hold feature. Patients were treated using a 5-fraction dose escalation protocol, with many receiving a simultaneous integrated boost to the GTV up to 45 Gy. All patients underwent pre-treatment cone-beam CT and planar kV imaging with rigid registration to the fiducial markers. Cine kV images were acquired every 3-5 seconds during treatment delivery and the beam was paused when a fiducial deviated from a given 4 mm diameter tolerance region. Additional intrafraction 2D or 3D imaging techniques were then used to realign the fiducials. Data was retrieved from the record and verify system including: number and type of intrafraction images, number of treatment interruptions, number of and magnitude of shifts, and total treatment time.

      RESULTS: The average number of cine kV images acquired per fraction and for the total 5 fraction SBRT course were 86.6 ± 26.8 and 425.6 ± 136.8 respectively. Assuming 1.3 mGy/kV image, the fiducial tracking process delivered an average additional 55.3 cGy over the full treatment course. On average, the beam was paused 5.0 ± 2.5 times per fraction (range 1-21 interruptions) and shifts were applied 4.1 ± 2.1 times (range 0-10.2 times) per fraction. Over the 2560 total shifts applied for all the patients, the average(max) translations were 0.6 (12) mm vrt, 0.7 (22) mm lng, and 0.9 (5) mm lat and the average(max) rotations were 0.19 (5.9)° pitch, 0.01 (2.4)° roll, and 0.16 (6.4)° rtn. Overall, 2.4% of shifts were greater than the 4 mm PTV margin and 4.2% of vertical shifts were greater than the 2.5 mm posterior margin. Average fraction treatment time was 27 ± 9.7 minutes.

      CONCLUSION: Fiducial tracking affords the potential to increase daily treatment precision when delivering prostate SBRT. Our data indicate that the beam is typically paused several times during a prostate SBRT fraction, with occasional large shifts required, suggesting the importance of intrafraction motion management. Downsides of kV triggered fiducial tracking include extension of treatment times and delivery of additional radiation dose to the patient. We are investigating if this method of motion management might allow for a reduction in PTV margins to reduce normal tissue dosing.

      PMID:37785315 | DOI:10.1016/j.ijrobp.2023.06.1512

      View details for PubMedID 37785315
  • Empowering the Role of Nurse Triage in Radiation Oncology - A Single Center Analysis International journal of radiation oncology, biology, physics
    Harari C, Blitzer GC, Weber BW, Ruesga S, Anderson BM, Schuster JM
    2023 Oct 1;117(2S):e391. doi: 10.1016/j.ijrobp.2023.06.1511.
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      PURPOSE/OBJECTIVE(S): Hours spent on the increasing volume of electronic medical record (EMR) messages and phone calls is a significant contributor to clinician burnout1. Within radiation oncology, nurses often serve a critical team role in patient education and EMR and phone call response. With the goal of maintaining high quality care and rapid EMR and phone response, our clinic utilizes a rotating triage nurse position; patterns of practice and team member perspectives are investigated.

      MATERIALS/METHODS: A retrospective chart review was conducted analyzing EMR messages and phone calls to the RO department between Sept-Dec 2021. Messages were identified for theme, author of message recorded (patient, family, provider), number of message iterations, and message pathway. Separately, an online survey was administered via REDCap to physicians (50% response rate), nurses (57% response rate), and radiation therapist (60% response rate) to assess nurse triage efficacy and efficiency.

      RESULTS: Four of the most common message themes were scheduling (26%), medications (21%), side effects/symptoms (15%), and treatment decision making (13%). Only 12% of messages were resolved by the RO triage nurse without further message forwarding. The average number of message iterations by healthcare personnel was 2.93 with mode of 2 (i.e., RN -> patient -> MD is a 2 message iteration). Across all themes physicians concluded 67% of the routed messages and nursing concluded 29%. By theme, physicians concluded 95% of treatment questions, 77% of medication questions, 69% of side effect/symptom questions, and 57% of scheduling questions. Survey results indicated average satisfaction with 'effectiveness of triage' was 3 (max 5), perceived triage nurse preparedness to resolve encounters was 3 (max 5), and perception of the overall EMR triage program by physicians was 2.2 (max 5).

      CONCLUSION: Staff survey established clear opportunity to improve effectiveness of RN triage through better alignment of nurse and physician expectations and improving nurse preparedness. Two-thirds of patient messages were ultimately concluded by physician response whereas 12% were resolved by nurse triage alone. Preparing nursing staff about common patient messages should increase autonomy to resolve patient queries and may improve work satisfaction for all providers through enhanced multidisciplinary collaboration and empowering individuals to practice at top of his/her license.

      PMID:37785314 | DOI:10.1016/j.ijrobp.2023.06.1511

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  • Pulsed Reduced Dose Rate Re-Irradiation for Recurrent Grade 4 Gliomas: A Retrospective Analysis of Safety and Efficacy International journal of radiation oncology, biology, physics
    Morris BA, Burr A, Harari C, Grogan PT, Bhatia A, Bayliss AB, Tome WA, Robins I, Howard SP
    2023 Oct 1;117(2S):e138-e139. doi: 10.1016/j.ijrobp.2023.06.946.
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      PURPOSE/OBJECTIVE(S): Despite maximal treatment, nearly all patients with grade 4 gliomas develop recurrent disease. Treatment options for these patients are limited and overall survival is poor. Re-irradiation may be considered in certain patients, though risk of side effects often limits the effective dose able to be delivered. Pulsed reduced dose rate (PRDR) radiation is a treatment technique that reduces effective dose rate and increases treatment time allowing for intrafraction repair. Here, we report safety and efficacy of PRDR re-irradiation for recurrent grade 4 gliomas.

      MATERIALS/METHODS: We performed a retrospective review of patients treated with PRDR between 2001 and 2022. Patients were treated with reduced dose rate radiation delivered in 0.2 Gy pulses every 3 minutes in 2 Gy daily fractions. Both 3D conformal and step and shoot IMRT radiation plans were utilized. Toxicities were evaluated based on Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria. Kaplan Meier analysis was used to calculate overall survival (OS). Cox regression analysis was performed for multivariate analysis.

      RESULTS: A total of 168 grade 4 glioma patients treated with PRDR re-irradiation were identified. The median age was 55 years old. The median initial radiation dose was 60 Gy (range 36 Gy - 72 Gy) and the median PRDR dose was 54 Gy (range 37.5 - 60 Gy). Seventy percent of patients received systemic therapy for recurrent disease prior to PRDR, while 30% received PRDR as first treatment for recurrent disease (or following re-resection without other treatment). The median survival following PRDR was 6.3 months. Multivariate analysis showed time since initial radiation of 14+ months (HR 0.66, p = 0.005, 95% CI 0.44 - 0.98), pre-PRDR use of steroids (HR 1.78, p = 0.005, 95% CI 1.2 - 2.66), and Karnofsky performance status of 70 or greater to be a significant predictor of survival (HR = 0.6, p = 0.008, 95% CI 0.44 - 0.98). No grade 4 or 5 toxicity was noted. Grade 3 new onset seizures was noted in 6% of patients, all subsequently controlled with medication. The most common grade 1-2 side effect after treatment was fatigue.

      CONCLUSION: In this large, retrospective cohort, PRDR re-irradiation for recurrent grade 4 gliomas was well tolerated with low rates of grade 3 toxicity. Overall survival outcomes were encouraging, especially in heavily pre-treated patients. Prospective studies are ongoing to further evaluate the efficacy of PRDR for recurrent glioma treatment.

      PMID:37784707 | DOI:10.1016/j.ijrobp.2023.06.946

      View details for PubMedID 37784707
  • Quantitative 4D-Digital Subtraction Angiography to Assess Changes in Hepatic Arterial Flow during Transarterial Embolization: A Feasibility Study in a Swine Model Journal of vascular and interventional radiology : JVIR
    Meram E, Harari C, Shaughnessy G, Wagner M, Brace CL, Mistretta CA, Speidel MA, Laeseke PF
    2019 Aug;30(8):1286-1292. doi: 10.1016/j.jvir.2019.01.018. Epub 2019 Jun 1.
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      PURPOSE: To determine the feasibility of using time-resolved 3D-digital subtraction angiography (4D-DSA) for quantifying changes in hepatic arterial blood flow and velocity during transarterial embolization.

      MATERIALS AND METHODS: Hepatic arteriography and selective transarterial embolization were performed in 4 female domestic swine (mean weight, 54 kg) using 100-300-μm microspheres. Conventional 2D and 4D-DSA were performed before, during, and after each embolization. From the 4D-DSA reconstructions, blood flow and velocity values were calculated for hepatic arterial branches using a pulsatility-based algorithm. 4D-DSA velocity values were compared to those measured using an intravascular Doppler wire with a linear regression analysis. Paired t-tests were used to compare data before and after embolization.

      RESULTS: There was a weak-to-moderate but statistically significant correlation of flow velocities measured with 4D-DSA and the Doppler wire (r = 0.35, n = 39, P = .012). For vessels with high pulsatility, the correlation was higher (r = 0.64, n = 11, P = .034), and the relationship between 4D-DSA and the Doppler wire fit a linear model with a positive bias toward the Doppler wire (failed to reject at 95% confidence level, P = .208). 4D-DSA performed after partial embolization showed a reduction in velocity in the embolized hepatic arteries compared to pre-embolization (mean, 3.96 ± 0.74 vs 11.8 2± 2.15 cm/s, P = .006).

      CONCLUSION: Quantitative 4D-DSA can depict changes in hepatic arterial blood velocity during transarterial embolization in a swine model. Further work is needed to optimize 4D-DSA acquisitions and to investigate its applicability in humans.

      PMID:31160194 | DOI:10.1016/j.jvir.2019.01.018

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  • Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems Radiology
    Harari CM, Magagna M, Bedoya M, Lee FT, Lubner MG, Hinshaw JL, Ziemlewicz T, Brace CL
    2016 Jan;278(1):95-103. doi: 10.1148/radiol.2015142151. Epub 2015 Jul 2.
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      PURPOSE: To compare microwave ablation zones created by using sequential or simultaneous power delivery in ex vivo and in vivo liver tissue.

      MATERIALS AND METHODS: All procedures were approved by the institutional animal care and use committee. Microwave ablations were performed in both ex vivo and in vivo liver models with a 2.45-GHz system capable of powering up to three antennas simultaneously. Two- and three-antenna arrays were evaluated in each model. Sequential and simultaneous ablations were created by delivering power (50 W ex vivo, 65 W in vivo) for 5 minutes per antenna (10 and 15 minutes total ablation time for sequential ablations, 5 minutes for simultaneous ablations). Thirty-two ablations were performed in ex vivo bovine livers (eight per group) and 28 in the livers of eight swine in vivo (seven per group). Ablation zone size and circularity metrics were determined from ablations excised postmortem. Mixed effects modeling was used to evaluate the influence of power delivery, number of antennas, and tissue type.

      RESULTS: On average, ablations created by using the simultaneous power delivery technique were larger than those with the sequential technique (P < .05). Simultaneous ablations were also more circular than sequential ablations (P = .0001). Larger and more circular ablations were achieved with three antennas compared with two antennas (P < .05). Ablations were generally smaller in vivo compared with ex vivo.

      CONCLUSION: The use of multiple antennas and simultaneous power delivery creates larger, more confluent ablations with greater temperatures than those created with sequential power delivery.

      PMID:26133361 | PMC:PMC4699493 | DOI:10.1148/radiol.2015142151

      View details for PubMedID 26133361

Contact Information

Colin Harari, MD

600 Highland Avenue,
Madison , WI 53792