IntroductionConstantly evolving technology and techniques within radiation therapy require practitioners to maintain a continuous approach to professional development and training. Systems of performance appraisal and adoption of regular feedback mechanisms are vital to support this development yet frequently lack structure and rely on informal peer support.MethodsA Radiation Therapy Performance Appraisal Framework (RT-PAF) for radiation therapists in planning and simulation was developed to define expectations of practice and promote a supportive and objective culture of performance and skills appraisal. Evaluation of the framework was conducted via an anonymous online survey tool. Nine peer reviewers and fourteen recipients provided feedback on its effectiveness and the challenges and limitations of the approach.ResultsFindings from the evaluation were positive and suggested that both groups gained benefit from and expressed a strong interest in embedding the approach more routinely. Respondents identified common challenges related to the limited ability to implement suggested development strategies; this was strongly associated with time and rostering issues.ConclusionsThis framework successfully defined expectations for practice and provided a fair and objective feedback process that focussed on skills development. It empowered staff to maintain their skills and reach their professional potential. Management support, particularly in regard to provision of protected time was highlighted as critical to the framework's ongoing success. The demonstrated benefits arising in terms of staff satisfaction and development highlight the importance of this commitment to the modern radiation therapy workforce.

IntroductionTime‐consuming manual methods have been required to register cone‐beam computed tomography (CBCT) images with plans in the Pinnacle3 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 Pinnacle3 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.ResultsThe 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 Pinnacle3 with errors of ±0.5 mm. These errors were comparable to mid‐point‐dependant manual registrations but superior to FM‐dependant manual registrations.ConclusionThe automated CBCT‐plan registration method quickly and reliably replicates delivered treatments in Pinnacle3 for adaptive radiotherapy.

It is a challenge for radiation therapists (RTs) to keep pace with changing planning technology and techniques while maintaining appropriate skills levels. The ability of individual RTs to meet the demands of this constantly changing practice can only be assured through establishing clearly defined standards for practice and a systematic process for providing feedback on performance. Investigation into existing models for performance appraisal produced minimal results so a radiation therapy‐specific framework was developed. The goal for this initiative was to establish a framework that would reflect the complexity of practice and provide a clear measure of performance against them. This paper outlines the implementation of this framework into practice and discusses some lessons learned in the process. The framework was developed and implemented in six stages: (1) project team, (2) scope, (3) dosimetry pilot, (4) staff consultation, (5) finalisation and implementation and (6) future development and evaluation. Both cultural and organisational obstacles needed to be addressed before this framework could be successfully introduced. Even though this slowed progress, addressing these obstacles during the development process was essential to the success of this framework. The incremental approach provided the opportunity for each aspect to be tested and the development of subsequent stages to be informed by lessons learned during the previous one. This approach may be beneficial when developing and implementing projects involving performance appraisal to promote consistency, fairness and quality.