Prospective medical analysis of radiation therapist image repositioning during image-guided radiotherapy

The Pivotal Role of the Therapeutic Radiographer/Radiation Therapist in Image-guided Radiotherapy Research and Development

The ability to personalise radiotherapy to fit the individual patient and their diagnosis has been realised through technological advancements. There is now more opportunity to utilise these technologies and deliver precision radiotherapy for more patients. Image-guided radiotherapy (IGRT) has enabled users to safely and accurately plan, treat and verify complex cases; and deliver a high dose to the target volume, while minimising dose to normal tissue. Rapid changes in IGRT have required a multidisciplinary team (MDT) approach, carefully deciding optimum protocols to achieve clinical benefit. Therapeutic radiographer/radiation therapists (RTTs) play a pivotal role in this MDT. There is already a great deal of evidence that illustrates the contribution of RTTs in IGRT development; implementation; quality assurance; and maintaining training and competency programmes. Often this has required the RTT to undertake additional roles and responsibilities. These publications show how the profession has evolved, expanding the scope of practice. There are now more opportunities for RTT-led IGRT research. This is not only undertaken in the more traditional aspects of practice, but in recent times, more RTTs are becoming involved in imaging biomarkers research and radiomic analysis. The aim of this overview is to describe the RTT contribution to the ongoing development of IGRT and to showcase some of the profession's involvement in IGRT research.

[Retrospective study on the intensification of hypofractionated radiotherapy: The organizational change]

Objectif de l’étude

Le processus de réalisation de la radiothérapie externe est une chaine d’étapes dans laquelle chacune d’entre elles est réalisée seulement si la précédente a été complétée. Le développement des pratiques d’hypofractionnement ces dernières années a tendance à augmenter la charge de travail des étapes de préparation à une irradiation et à diminuer le nombre de séances par patient. Cette étude rétrospective vise à analyser l’évolution de ces pratiques dans un centre de lutte contre le cancer et d’en apprécier les enjeux organisationnels.

Matériel et méthodes

L’ensemble des données de gestion des dossiers de radiothérapie ont été extraites du système d’information de radiothérapie. Les séances de radiothérapie ont été identifiées par patient et par code CIM (Classification internationale des maladies). Le taux de remplissage des appareils de traitement a été calculé avec les données réelles du département de radiothérapie.

Résultats

De 2015 à 2019, une augmentation du nombre de scanographies (+16 %), du nombre de patients pris en charge (+11,6 %) et du volume d’heures disponibles pour les traitements (+12 %) ont été observées. Aussi, une diminution du nombre total de séances de radiothérapie (−5 %), de la moyenne de séances réalisées par séquence de traitement (−19 %), du taux de remplissage des appareils (−7 %) et de la moyenne de séances réalisées par patients traités des tumeurs malignes des bronches et du poumon (−38 %), des organes digestifs (−37 %), secondaires (−19 %) du sein (−15 %) et de la prostate (−15 %) ont été observées. Le nombre de séances administrées par séquence de traitement entre 2015 et 2019 a diminué significativement pour les patients des classes d’âge [20–69 ans] (p < 0,001) et [> 70 ans] (p < 0,001).

Conclusion

Un paradoxe apparait entre l’augmentation du nombre total de patients pris en charge et la diminution du taux de remplissage des appareils de traitement. Ce transfert de charge de travail a un impact sur la qualité et la sécurité des soins et sur les stratégies d’organisation et d’investissement. Il a également un impact économique lié au modèle de remboursement basé sur la tarification à la séance. Une réorganisation des services de radiothérapie s’avère inéluctable.

The clinical introduction of MR-guided radiation therapy from a RTT perspective

The latest development in radiation oncology departments towards high precision and adaptive radiation therapy is the clinical introduction of magnetic resonance image guided radiation therapy (MRgRT). Early 2016, patient treatment using MRgRT was started at Amsterdam UMC, location VU University Medical Center. Introducing this novel technique in clinical practice requires thorough preparation with regard to important topics, such as MR-safety and training, equipping the treatment vault and console room, development of MRgRT workflow and logistical issues. Certainly when MRgRT is combined with daily plan adaptation, this indicates adjusting existing workflows and protocols. The MRgRT workflow requires a multidisciplinary process, and while each discipline has had its own tasks and responsibilities, with growing clinical experience there has been a shift towards RTT responsibilities. In this overview we discuss preclinical training and preparation for the implementation of (adaptive) MRgRT, with a particular focus on the perspective of RTTs. Although the reviewed logistics are partly the result of the decision to perform daily plan re-optimization, our experience can be extrapolated to implementation of alternative approaches for MRgRT.

Real-time Online Matching in High Dose-per-Fraction Treatments: Do Radiation Therapists Perform as Well as Physicians?

PURPOSE

In our department, for high dose-per-fraction treatments such as stereotactic body radiation therapy, we require a physician to perform the pretreatment on-board imaging match. The purpose of this study was to determine whether patient-matching positioning performed by radiation therapists (RTTs) is as accurate as that performed by physicians.

METHODS AND MATERIALS

Sixteen RTTs and 5 physicians participated in this study. Data were collected from 113 patients, totaling 324 measurements. A total of 60 patients were treated for bone lesions and 53 for soft-tissue lesions, such as lung and liver. Matching was performed using kV-kV imaging for bones and cone beam computed tomography for soft tissue. All treatments were delivered on Varian linear accelerators. The initial match was performed by the RTTs, and the shifts were noted. Subsequently, the match was reset, and the physician performed an independent match blinded to the RTT match. Physician shifts were applied for treatment. We used the Wilcoxon rank sum test to determine the statistical significance between RTT and physician shifts.

RESULTS

The differences in patient shifts between physicians and RTTs were calculated in 3 translational 1 one rotational axis. The average vector shift was 0.88 ± 0.57 cm versus 0.91 ± 0.57 cm for RTTs versus physicians, respectively. Neither the average vector nor the individual axis shifts were statistically significantly different (P > .2). There was no significant difference when testing for bony or soft lesion matches separately.

CONCLUSIONS

RTT on-board imaging matching is as accurate as physician matching for both bone and soft tissue lesions. On the basis of these results, RTTs are as qualified as physicians to perform a pretreatment match. Thus, it may be feasible for the RTTs to perform the match and the physician to review it offline after treatment without being present at the machine during treatment. Our results show that this approach does not compromise patient safety.