Technology Enhancements and Changes in Radiotherapy Throughput in New South Wales

Ability of radiation therapists to assess radiation-induced skin toxicity

INTRODUCTION

Radiation therapy has seen enhancement of the radiation therapist (RT) role, with RTs and nurses performing duties that were traditionally in the radiation oncologist's (RO) domain. This study aimed to assess whether RTs can consistently grade radiation-induced skin toxicity and their concordance with the gradings given by ROs.

METHOD

Digital photographs of skin reactions were taken at weeks 1, 3 and 6 of radiotherapy on nine patients with breast cancer. The randomly ordered photographs were reviewed once by eight ROs and four RO registrars and on two occasions separated by 6 weeks by 17 RTs. All graded the skin toxicities using the revised Radiation Therapy Oncology Group system.

RESULTS

No significant difference was seen between the median scores of the RTs at the first scoring session and the RO/Registrar group. The RTs at both measurement times showed greater inter-rater reliability than the RO/Registrars (W = 0.6866, time 1 and 0.6981 time 2, vs. 0.6517), with the experienced RTs the most consistent (W = 0.7078). The RTs also showed high intra-rater reliability (rho = 0.8461, P < 0.0010).

CONCLUSION

These results from RTs with no specific preparation indicate that experienced RTs could assess breast cancer skin toxicity as part of their role.

In-gantry or remote patient positioning? Monte Carlo simulations for proton therapy centers of different sizes

PURPOSE

We estimated the potential advantage of remote positioning (RP) vs. in-room positioning (IP) for a proton therapy facility in terms of patient throughput.

MATERIALS AND METHODS

Monte Carlo simulations of facilities with one, two or three gantries were performed. A sensitivity analysis was applied by varying the imaging and setup correction system (ICS), the speed of transporters (for RP) and beam switching time. Possible advantages of using three couches (for RP) or of switching the beam between fields was also investigated.

RESULTS

For a single gantry facility, an average of 20% more patients could be treated using RP: ranging from +45%, if a fast transporter and slow ICS were simulated, to -14% if a slow transporter and fast ICS was simulated. For two gantries, about 10% more patients could be treated with RP, ranging from +32% (fast transporter, slow ICS) to -12% (slow transporter, fast ICS). The ability to switch beam between fields did not substantially influence the throughput. In addition, the use of three transporters showed increased delays and therefore a slight reduction of the fractions executables. For three gantries, RP and IP showed similar results.

CONCLUSIONS

The advantage of RP vs. IP strongly depends on ICS and the speed of the transporters. For RP to be advantageous, reduced transport times are required. The advantage of RP decreases with increasing number of gantries.

When would you like to be treated?--A short survey of radiotherapy outpatients

AIMS

To determine whether patients undergoing radiotherapy would choose to attend appointments for a course of treatment scheduled outside the normal working day and working week.

MATERIALS AND METHODS

A survey of radiotherapy outpatients was conducted on two single days in late 2005 and early 2006. There were four departments in the first cohort and five in the second cohort. Departments were selected from across the UK and were chosen to reflect both city centre and out of town locations. Six of the nine departments were working extended hours at the time of the survey. The second cohort received a modified questionnaire that included two additional questions relating to appointments at weekends.

RESULTS

In total, 471 and 332 questionnaires were returned by the first and second cohorts, respectively. For all age groups, 9.00 am to 12.00 pm was the most preferred time for treatment. Outside the normal working day, the 8.00-9.00 am interval was the most selected, being chosen by 23.4% of respondents. Overall, 32.8% (n=260) of respondents would attend a reasonable appointment time outside the normal working day and 10.7% (n=85) were unsure. On Saturdays, 39.3% (n=130) would attend and 11.5% (n=38) were unsure. For Sundays, 31.1% (n=103) would attend and 10.9% (n=36) were unsure.

CONCLUSIONS

There is sufficient support from patients for attendance outside the normal working day to ensure appointment slots would not go unfilled during a moderate extension to the working day. However, the percentage of patients that would attend varied between departments. This demonstrates the need for local evaluation of patient preference before the introduction of extended working hours.

Extended hours working in radiotherapy in the UK

AIMS

To analyse extended hours working patterns within UK cancer centres and to assess alternatives to the normal 9.00 am to 5.00 pm working day.

MATERIALS AND METHODS

Questionnaires were sent to 62 radiotherapy managers in June and July 2005 to survey where extended hours working had been implemented, the objectives for using a longer working day and how departments organised their service issues, including staffing levels, costs and patients. This was followed by visits to six departments that were working extended hours. A second questionnaire sent to 60 radiotherapy physics managers in September 2005 requested information for the hours of daily, monthly and annual megavoltage machine servicing and quality assurance (QA). A third questionnaire was distributed to all radiotherapy outpatients from four departments who attended on a single day of survey in 2005. It looked at patient preference for treatment hours.

RESULTS

In total, 57 (92%) radiotherapy managers responded. Thirty-one departments (55%) were working extended hours, 22 (39%) had short-term experience and three (5%) departments had no experience. Increasing capacity to reduce waiting lists was the main reason for working extended hours. The additional hours were predominantly worked by radiographers, with little or no support from the other department disciplines. The servicing and QA spreadsheet was returned by 53% (n=32) of physicists. The average amount of servicing and Quality Assurance (QA) work being scheduled out of hours in each department was 35% (0-100%). The patient questionnaire was completed by 470 patients. When asked if patients would want to come to a reasonable appointment time outside of the normal working day, 29% (n=136) said 'yes' and 12% (n=55) were unsure.

CONCLUSION

It was concluded that two shifts covering an 11.5 h working day is a robust alternative to the normal working day, taking into consideration efficient use of radiographers and patient preference for out of hours appointments.