The Development of Therapeutic Radiographers in Imaging and Adaptive Radiotherapy Through Clinical Trial Quality Assurance

AIMS

Adaptive radiotherapy (ART) is an emerging advanced treatment option for bladder cancer patients. Therapeutic radiographers (RTTs) are central to the successful delivery of this treatment. The purpose of this work was to evaluate the image-guided radiotherapy (IGRT) and ART experience of RTTs before participating in the RAIDER trial. A plan of the day (PoD) quality assurance programme was then implemented. Finally, the post-trial experience of RTTs was evaluated, together with the impact of trial quality assurance participation on their routine practice.

MATERIALS AND METHODS

A pre-trial questionnaire to assess the experience of the RTT staff group in IGRT and ART in bladder cancer was sent to each centre. Responses were grouped according to experience. The PoD quality assurance programme was implemented, and the RAIDER trial commenced. During stage 1 of the trial, RTTs reported difficulties in delivering PoD and the quality assurance programme was updated accordingly. A follow-up questionnaire was sent assessing experience in IGRT and ART post-trial. Any changes in routine practice were also recorded.

RESULTS

The experience of RTTs in IGRT and ART pre-trial varied. For centres deemed to have RTTs with more experience, the initial PoD quality assurance programme was streamlined. For RTTs without ART experience, the full quality assurance programme was implemented, of which 508 RTTs completed. The quality assurance programme was updated (as the trial recruited) and it was mandated that at least one representative RTT (regardless of pre-trial experience) participated in the update in real-time. The purpose of the updated quality assurance programme was to provide further support to RTTs in delivering a complex treatment. Engagement with the updated quality assurance programme was high, with RTTs in 24/33 centres participating in the real-time online workshop. All 33 UK centres reported all RTTs reviewed the updated training offline. Post-trial, the RTTs' experience in IGRT and ART was increased.

CONCLUSION

Overall, 508 RTTs undertook the PoD quality assurance programme. There was a high engagement of RTTs in the PoD quality assurance programme and trial. RTTs increased their experience in IGRT and ART and subsequently updated their practice for bladder cancer and other treatment sites.

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.

Comment les MERM travaillant en radiothérapie perçoivent-ils leurs compétences dites "soft"?

OBJECTIVES

Research in the last decade shows growing interest for soft skills in healthcare, due to awareness of the influence of adverse events in healthcare. However, there was no specific study about non-technical skills used by therapists in the French radiation oncology departments. What are these behavioral competencies that medical radiation technologists (MRT) use in their work to deliver safe and efficient healthcare?

METHOD

We built a self-assessment grid of 40 non classified soft skills for the active MRT to fulfill. This tool was sent to a total of 8 private and public radiation oncology department's head therapists. First, the 42 sampled MRTs had to choose how much they felt reflected in each of the listed soft skills. Second, they were asked to select 5 skills that they felt were the most important for a radiation therapist from the 40 soft skills in the initial grid.

RESULTS

The 5 soft skills MRTs think they have include the following: conscientiousness, working autonomously, listening, diligence, and working in a multidisciplinary team. The three they think they have the least are: being creative, managing conflicts, and being bold. For the skills that they felt were the most important , MRT selected: being conscientious, listening, working in a multidisciplinary team, showing empathy, and anticipating.

CONCLUSION

These results show that the skills known in the Big Five personality traits model as "conscientiousness" and "agreeableness" come first. Conscientiousness and listening skills are the biggest skills for the radiation therapists, because these are the skills they think they have the most, and also because they consider these skills as the most useful for an MRT. The radiation therapists surveyed did not think they were bold, nor creative, nor able to manage conflicts. The way the MRT perceives themselves is as a conscientious technician and a nice caregiver, compliant with what is expected from them professionally and in the society.