A learning programme qualifying radiation therapists to manage daily online adaptive radiotherapy

Boejen, A.; Vestergaard, A.; Hoffmann, Lone; Ellegaard, M; Rasmussen, A.B.; Møller, D.S.; Muren, L.P.; Grau, Cai

doi:10.3109/0284186x.2015.1062914

Cited by 22 publications

(26 citation statements)

References 12 publications

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“…This is due to the fact that the RTTs demonstrated a steep learning curve, where it was possible to reduce the time slots at the accelerator after three months. It is important however, to have a certain number of patients and/or methods to maintain the competencies in a large group of RTTs [24].…”

Section: Discussionmentioning

confidence: 99%

“…A learning programme with online self-education (2½ h) as well as class teaching and "hands on training" (7 h) was conducted, N.B.K. Jensen et al Physics and Imaging in Radiation Oncology 9 (2019) [14][15][16][17][18][19][20] similar to previous experience with ART education [24]. Two general online modules introduced adaptive RT and CBCT image quality.…”

Section: Education Of Rtts Prior To Cbct-based Monitoringmentioning

confidence: 99%

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Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

Jensen

Assenholt

Fokdal

et al. 2019

Physics and Imaging in Radiation Oncology

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A B S T R A C TBackground and purpose: Organ motion is a challenge during high-precision external beam radiotherapy in cervical cancer, and improved strategies for treatment adaptation and monitoring of target dose coverage are needed. This study evaluates a cone beam computed tomography (CBCT)-based approach. Materials and methods: In twenty-three patients, individualized internal target volumes (ITVs) were generated from pre-treatment MRI and CT scans with full and empty bladders. The target volumes encompassed high-risk clinical target volume (CTV-T HR) (gross tumor volume + remaining cervix) and low risk (LR) CTV-T (CTV-T HR + uterus + parametriae + upper vagina). Volumetric Modulated Arc Therapy (VMAT) was used to deliver a dose of 45 Gy in 25 fractions. CBCTs were used for setup and for radiation therapists (RTTs) to evaluate the target coverage (inside/outside the planning target volume). CBCTs were reviewed offline. Estimates of the dose delivered with minimum (point) doses across all fractions to CTV-T HR (aim 42.75 Gy) and CTV-T LR (aim 40 Gy) were assessed. In patients with insufficient dose coverage, re-plans were generated based on previous imaging. Results: Median (range) of the ITV-margins (mean of anterior-posterior margins) related to uterus and cervix was 1.2 (0.5-2.2 and 1.0-2.1) cm. RTTs were able to assess the target coverage in 90% of all CBCTs (505/563). With re-planning, one patient had considerable benefit (12.7 Gy increase of minimum dose) to CTV-T LR_vagina, four patients had improved dose to the CTV-T LR_uterus (1.2-1.8 Gy), and 3 patients did not benefit from re-planning. Conclusions: Daily CBCT-based monitoring of target coverage by the RTTs has proven safe with limited workload. It allows for reduction in the treated volumes without compromising the target dose coverage.

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Section: Discussionmentioning

confidence: 99%

Section: Education Of Rtts Prior To Cbct-based Monitoringmentioning

confidence: 99%

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

Jensen

Assenholt

Fokdal

et al. 2019

Physics and Imaging in Radiation Oncology

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“…However, no competency component is directly discussed, making firm comparisons with our training difficult. They do reference prior experience presented by Boejen et al [15], stating their learning programme was similar to this work.…”

Section: Discussionmentioning

confidence: 62%

“…Boejen et al [15] presents training and competency assessment in an established virtual reality learning centre [15]. The advantage of virtual reality training is having a protected environment where new skills can be tested out on clinical cases without risk to the patient or interference to clinical workflow [16], the restriction being cost and space implications.…”

Section: Discussionmentioning

confidence: 99%

RTT-led IGRT for cervix cancer; training, implementation and validation

Alexander

Hopkins

Lalondrelle

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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Introduction: IGRT in cervical cancer treatment delivery is complex due to significant target and organs at risk (OAR) motion. Implementing image assessment of soft-tissue target and OAR position to improve accuracy is recommended. We report the development and refinement of a training and competency programme (TCP), leading to on-line Radiation Therapist (RTT) led soft-tissue assessment, evaluated by a prospective audit. Methods and materials: The TCP comprised didactic lectures and practical sessions, supported by a comprehensive workbook. The content was decided by a team comprised of Clinical Oncologists, RTTs, and Physicists. On completion of training, RTT soft-tissue review proficiency (after bony anatomy registration) was assessed against a clinician gold-standard from a database of 20 cervical cancer CBCT images. Reviews were graded pass or fail based on PTV coverage assessment and decision taken in concordance with the gold-standard. Parity was set at !80% agreement. The initial TCP (stage one) focussed on offline verification and decision making. Sixteen RTTs completed this stage, four achieved !80%. This was not sufficient to support clinical implementation. The TCP was redesigned, more stringent review guidelines and greater anatomy teaching was added. TCP stage two focussed on online verification and decision making supported by a decision flowchart. Twenty-one RTTs completed this TCP, all achieved !80%. This supported clinical implementation of RTT-led soft-tissue review under prospective audit conditions. The prospective audit was conducted between March 2017 and August 2017. Daily online review was performed by two trained RTTs. Online review and decision making proficiency was evaluated by a clinician. Results: Thirteen patients were included in the audit. Daily online RTT-led IGRT was achieved for all 343 fractions. Two-hundred CBCT images were reviewed offline by the clinician; the mean number of reviews per patient was 15. 192/200 (96%) RTT image reviews were in agreement with clinician review, presenting excellent concordance. Discussion and conclusion: Multidisciplinary involvement in training development, redesign of the TCP and inclusion of summative competency assessment were important factors to support RTT skill development. Consequently, RTT-led cervical cancer soft-tissue IGRT was clinically implemented in the hospital.

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“…When implementing an adaptive plan selection strategy, workflow and possibilities at the clinical department are of great importance [28]. The CT-based strategy requires dedicated software for the interpolation of bladder and GTV contours, which is not widely available.…”

Section: Discussionmentioning

confidence: 99%

A biological modeling based comparison of two strategies for adaptive radiotherapy of urinary bladder cancer

et al. 2016

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Background Adaptive radiotherapy is introduced in the management of urinary bladder cancer to account for day-to-day anatomical changes. The purpose of this study was to determine whether an adaptive plan selection strategy using either the first four cone beam computed tomography scans (CBCT-based strategy) for plan creation, or the interpolation of bladder volumes on pretreatment CT scans (CT-based strategy), is better in terms of tumor control probability (TCP) and normal tissue sparing while taking the clinically applied fractionation schedules also into account. Material and methods With the CT-based strategy, a library of five plans was created. Patients received 55 Gy to the bladder tumor and 40 Gy to the non-involved bladder and lymph nodes, in 20 fractions. With the CBCT-based strategy, a library of three plans was created, and patients received 70 Gy to the tumor, 60 Gy to the bladder and 48 Gy to the lymph nodes, in 30-35 fractions. Ten patients were analyzed for each adaptive plan selection strategy. TCP was calculated applying the clinically used fractionation schedules, as well as a rescaling of the dose from 55 to 70 Gy for the CT-based strategy. For rectum and bowel, equivalent doses in 2 Gy fractions (EQD2) were calculated. Results The CBCT-based strategy resulted in a median TCP of 75%, compared to 49% for the CT-based strategy, the latter improving to 72% upon rescaling the dose to 70 Gy. A median rectum V30Gy (EQD2) of 26% [interquartile range (IQR): 8-52%] was found for the CT-based strategy, compared to 58% (IQR: 55-73%) for the CBCT-based strategy. Also the bowel doses were lower with the CT-based strategy. Conclusions Whereas the higher total bladder TCP for the CBCT-based strategy is due to prescription differences, the adaptive strategy based on CT scans results in the lowest rectum and bowel cavity doses.

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A learning programme qualifying radiation therapists to manage daily online adaptive radiotherapy

Cited by 22 publications

References 12 publications

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

RTT-led IGRT for cervix cancer; training, implementation and validation

A biological modeling based comparison of two strategies for adaptive radiotherapy of urinary bladder cancer

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