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Shepherd M, Graham S, Ward A, Zwart L, Cai B, Shelley C, Booth J. Pathway for radiation therapists online advanced adapter training and credentialing. Tech Innov Patient Support Radiat Oncol 2021; 20:54-60. [PMID: 34917781 PMCID: PMC8665404 DOI: 10.1016/j.tipsro.2021.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/15/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Online Adaptive Radiation Therapy (oART) provides a solution to account for daily patient variations, but wide spread implementation is hindered by human resources and training. Physicians can mentor Radiation Therapists (RTTs) through traditional tasks such as contouring and plan approval. With evidence-based credentialing activities, decision support aids and ‘on-call’ caveats, RTTs can lead the oART workflow and a ‘Clinician-Lite’ approach. Compliance with legislative, regulatory and medico-legal governing bodies can be addressed through post-graduate study, advanced practice pathways, exemptions and delegation of task.
Online adaptive radiotherapy (oART) is an emerging advanced treatment option for cancer patients worldwide. Current oART practices using magnetic resonance (MR) and cone beam computed tomography (CBCT) based imaging are resource intensive and require physician presence, which is a barrier to widespread implementation. Global evidence demonstrates Radiation Therapists (RTTs) can lead the oART workflow with decision support tools and on ‘on-call’ caveats in a ‘clinician-lite’ approach without significantly compromising on treatment accuracy, speed or patient outcomes. With careful consideration of jurisdictional regulations and guidance from the multi-disciplinary team, RTTs can elevate beyond traditional scopes of practice. By implementing robust and evidence-based credentialing activities, they enable service sustainability and expand the real-world gains of adaptive radiotherapy to a greater number of cancer patients worldwide. This work summarises the evidence for RTT-led oART treatments and proposes a pathway for training and credentialing.
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Affiliation(s)
- Meegan Shepherd
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd, St Leonard, NSW 2065, Australia
| | - Siobhan Graham
- Queen's Hospital, BHRUT NHS Trust, Rom Valley Way, Romford RM1 0AG, UK
| | - Amy Ward
- Queen's Hospital, BHRUT NHS Trust, Rom Valley Way, Romford RM1 0AG, UK
| | - Lissane Zwart
- Medisch Spectrum Twente (MST), Koningstraat 1, 7512 KZ Enschede, Netherlands
| | - Bin Cai
- UT Southwestern Medical Center, Harry Hines Blvd, Dallas, TX 75390, USA
| | | | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd, St Leonard, NSW 2065, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Camperdown, NSW 2004, Australia
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Yeh J, Bressel M, Tai KH, Kron T, Foroudi F. A retrospective review of the long-term outcomes of online adaptive radiation therapy and conventional radiation therapy for muscle invasive bladder cancer. Clin Transl Radiat Oncol 2021; 30:65-70. [PMID: 34401535 PMCID: PMC8358463 DOI: 10.1016/j.ctro.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 12/16/2022] Open
Abstract
Risks with tight adaptive RT margins. Cancer control may be poorer if margins tight. Prospective studies required.
Background and Purpose To report long-term outcomes of online image-guided (IG) adaptive radiation therapy (aRT) versus conventional IG radiation therapy (cRT) for bladder preservation in muscle-invasive bladder cancer (MIBC). Materials and Methods A retrospective review of patients with histologically proven MIBC who were prescribed radical intent radiation therapy (RT) following trans-urethral resection of bladder tumour (TURBT) was conducted. There were three groups based on their RT treatment modality: conventional RT (cRT), margin 5 mm adaptive RT (aRT5mm) and margin 7 mm adaptive RT (aRT7mm). Results 171 patients were included in this study, with median age of 79.4 years (41–90). Approximately half of all patients received concurrent chemotherapy. N = 57 underwent cRT, n = 39 underwent aRT5mm, and n = 75 underwent aRT7mm. Response evaluable patients in all three groups (n = 133) had high rates of complete response (CR, 83%) on first post-RT cystoscopy with no significant differences between the groups. At a median follow-up of 54 months, the 5-year freedom from muscle-invasive failure survival (FFMIFS) in the cRT, aRT5mm, and aRT7mm groups were 75%, 59%, and 98%, respectively. The estimated cancer specific survival (CSS) at 5 years were 60%, 30%, and 59%, respectively. The estimated overall survival (OS) at 5 years were 43%, 26%, and 38%, respectively. The incidence of late grade 3 or 4 toxicity was n = 5 in aRT5mm, n = 2 in cRT group, and n = 1 in aRT7mm. Conclusion IG aRT with 7 mm expansion for MIBC provides higher rates of FFMIFS, similar 5-year CSS and OS, as well as toxicity outcomes when compared to cRT. aRT with 5 mm expansion with this RT protocol is not recommended for treatment.
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Affiliation(s)
- Janice Yeh
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia.,Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Victoria, Australia
| | - Mathias Bressel
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Keen Hun Tai
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Tomas Kron
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Victoria, Australia
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Patel E, Tsang Y, Baker A, Callender J, Hafeez S, Hall E, Hansen VN, Lewis R, McNair H, Miles E, Huddart R. Quality assuring "Plan of the day" selection in a multicentre adaptive bladder trial: Implementation of a pre-accrual IGRT guidance and assessment module. Clin Transl Radiat Oncol 2019; 19:27-32. [PMID: 31388568 PMCID: PMC6675972 DOI: 10.1016/j.ctro.2019.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Hypofractionated bladder RT with or without image guided adaptive planning (HYBRID) is a multicentre clinical trial investigating "Plan of the Day" (PoD) adaptive radiotherapy for bladder cancer. To ensure correct PoD selection a pre-accrual guidance and assessment module was developed as part of an image guided radiotherapy quality assurance (IGRT QA) credentialing programme. This study aimed to evaluate its feasibility and effectiveness across multiple recruiting centres. MATERIALS AND METHODS Individuals from participating centres remotely accessed an image database in order to complete the PoD module. An assessment score of ≥83% was required in order to receive QA approval. A questionnaire was used to gather user feedback on the module. PoD decisions for the first patient at each recruiting centre were retrospectively reviewed for protocol adherence. RESULTS 71 radiation therapists (RTTs) from 10 centres completed the PoD module. The median assessment score was 92% (Range: 58-100%) with 79% of RTTs passing the assessment on first attempt. All questionnaire respondents reported that the PoD module prepared them for plan selection. In 51/60 of on-trial treatments reviewed, the PoD selected by the centre agreed with QA reviewers. CONCLUSIONS The PoD QA module was successfully implemented in a multicentre trial and enabled pre-accrual assessment of protocol understanding. This increased operator confidence and resulted in appropriate PoD selection on-trial.
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Affiliation(s)
- Emma Patel
- Radiotherapy Physics Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Yat Tsang
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, United Kingdom
| | - Angela Baker
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Shaista Hafeez
- Department of Radiotherapy and Imaging, The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Vibeke Nordmark Hansen
- Department of Radiotherapy and Imaging, The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Helen McNair
- Department of Radiotherapy and Imaging, The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, United Kingdom
| | - Robert Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Hargrave C, Mason N, Guidi R, Miller JA, Becker J, Moores M, Mengersen K, Poulsen M, Harden F. Automated replication of cone beam CT-guided treatments in the Pinnacle(3) treatment planning system for adaptive radiotherapy. J Med Radiat Sci 2016; 63:48-58. [PMID: 27087975 PMCID: PMC4775828 DOI: 10.1002/jmrs.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/01/2015] [Accepted: 08/08/2015] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Time-consuming manual methods have been required to register cone-beam computed tomography (CBCT) images with plans in the Pinnacle(3) treatment planning system in order to replicate delivered treatments for adaptive radiotherapy. These methods rely on fiducial marker (FM) placement during CBCT acquisition or the image mid-point to localise the image isocentre. A quality assurance study was conducted to validate an automated CBCT-plan registration method utilising the Digital Imaging and Communications in Medicine (DICOM) Structure Set (RS) and Spatial Registration (RE) files created during online image-guided radiotherapy (IGRT). METHODS CBCTs of a phantom were acquired with FMs and predetermined setup errors using various online IGRT workflows. The CBCTs, DICOM RS and RE files were imported into Pinnacle(3) plans of the phantom and the resulting automated CBCT-plan registrations were compared to existing manual methods. A clinical protocol for the automated method was subsequently developed and tested retrospectively using CBCTs and plans for six bladder patients. RESULTS The automated CBCT-plan registration method was successfully applied to thirty-four phantom CBCT images acquired with an online 0 mm action level workflow. Ten CBCTs acquired with other IGRT workflows required manual workarounds. This was addressed during the development and testing of the clinical protocol using twenty-eight patient CBCTs. The automated CBCT-plan registrations were instantaneous, replicating delivered treatments in Pinnacle(3) with errors of ±0.5 mm. These errors were comparable to mid-point-dependant manual registrations but superior to FM-dependant manual registrations. CONCLUSION The automated CBCT-plan registration method quickly and reliably replicates delivered treatments in Pinnacle(3) for adaptive radiotherapy.
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Affiliation(s)
- Catriona Hargrave
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia; Faculty of Health School of Clinical Sciences Queensland University of Technology Brisbane Queensland Australia; Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia
| | - Nicole Mason
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Robyn Guidi
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Julie-Anne Miller
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Jillian Becker
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Matthew Moores
- Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia; School of Mathematics, Science and Engineering Queensland University of Technology Brisbane Queensland Australia
| | - Kerrie Mengersen
- Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia; School of Mathematics, Science and Engineering Queensland University of Technology Brisbane Queensland Australia
| | - Michael Poulsen
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Fiona Harden
- Faculty of Health School of Clinical Sciences Queensland University of Technology Brisbane Queensland Australia; Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia
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Gomes CM, Nunes RV, Tse V. Pelvic Irradiation and Its Effects on the Lower Urinary Tract: a Literature Review. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kessel KA, Jäger A, Habermehl D, Rüppell J, Bendl R, Debus J, Combs SE. Changes in Gross Tumor Volume and Organ Motion Analysis During Neoadjuvant Radiochemotherapy in Patients With Locally Advanced Pancreatic Cancer Using an In-House Analysis System. Technol Cancer Res Treat 2015; 15:348-54. [PMID: 25824268 DOI: 10.1177/1533034615577515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/14/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE During radiation treatment, movement of the target and organs at risks as well as tumor response can significantly influence dose distribution. This is highly relevant in patients with pancreatic cancer, where organs at risk lie in close proximity to the target. MATERIAL AND METHODS Data sets of 10 patients with locally advanced pancreatic cancer were evaluated. Gross tumor volume deformation was analyzed. Dose changes to organs at risk were determined with focus on kidneys both without adaptive radiotherapy compensation and with replanning based on weekly acquired computed tomography scans. RESULTS During irradiation, gross tumor volume changes between 0% and 26% and moves within a radius of 5 to 16 mm. Required maximal dose to organs at risk for kidneys can be met with the current practice of matching computed tomography scans during treatment and adjusting patient position accordingly. Comparison of the mean doses and V15, V20 volumes demonstrated that weekly replanning could bring a significant dose sparing of the left kidney. CONCLUSION Manual matching with focus on bony structures can lead to overall acceptable positioning of patients during treatment. Thus, tolerance doses of organs at risk, such as the kidneys, can be met. With adequate margins, normal tissue constraints to organs at risk can be kept as well. Adaptive radiotherapy approaches (in this case with weekly rescanning) reduced dose to organs at risk, which may be especially important for hypofractionated approaches.
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Affiliation(s)
- Kerstin A Kessel
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany
| | - Andreas Jäger
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany
| | - Jan Rüppell
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany
| | - Rolf Bendl
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany Department of Medical Informatics, Heilbronn University, Heilbronn, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany
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Foroudi F, Pham D, Rolfo A, Bressel M, Tang CI, Tan A, Turner S, Hruby G, Williams S, Hayne D, Lehman M, Skala M, Jose CC, Gogna K, Kron T. The outcome of a multi-centre feasibility study of online adaptive radiotherapy for muscle-invasive bladder cancer TROG 10.01 BOLART. Radiother Oncol 2014; 111:316-20. [DOI: 10.1016/j.radonc.2014.02.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/31/2013] [Accepted: 02/12/2014] [Indexed: 11/29/2022]
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