Uniformity in the analysis of head and neck image guided radiotherapy across multiple departments

Abstract

Purpose: Head and Neck Image Guided Radiation Therapy (IGRT) is of vital importance particularly with the advent of Intensity Modulated Radiation Therapy (IMRT). The responsibility of IGRT rests with the treating radiation therapy team, therefore it is essential that they undertake IGRT in a uniform manner. This study represents an assessment of head and neck IGRT analysis across multiple radiation oncology departments, inclusive of radiation therapist seniority, image modality and anatomical variation within the treatment volume. Methods: Site visits were undertaken at three radiation oncology departments. At each site kV and MV image datasets were analysed by one senior radiation therapist and one junior radiation therapist. The influence of differing sites, radiation therapist seniority, image modality and cervical vertebra position on head and neck IGRT was then assessed. Results: Statistical analysis of the diagnosed field placement errors indicated that head and neck IGRT was undertaken consistently regardless of site, radiation therapist seniority, image modality and the position of the cervical vertebra. Conclusion: In the era of sophisticated treatment planning it is vital that the treatment delivery mechanism (IGRT) is performed consistently. Head and neck IGRT is the responsibility of the treating radiation therapist regardless of site, seniority, image modality and positioning challenges.

Radiation therapist perspectives on cone-beam computed tomography practices and response to information

“…In a recent white paper published by the American Society of Radiologic Technologists (ASRT) on the role of radiation therapists in radiation therapy safety, it was acknowledged that ‘the radiation therapist is the ultimate gatekeeper’ in treatment delivery 17 . As professionals who practice at the interface between treatment technology and patients, therapists are best positioned to observe patient changes or issues, optimising the use of the image guidance technology 10 , 11 , 16 . Therapists in this investigation reported contacting the RO for up to one-fifth of their patients, to address an observation made on a volumetric image during the course of treatment.…”

“…The use of volumetric imaging using kV-CBCT in Ontario is moving from a period of rapid implementation to a push for standardisation in many centres 16 . Among other things, this requires consideration of the most appropriate distribution of professional responsibilities and potential shifts in resources to optimise a model of care for patients.…”

“…16 Among other things, this requires consideration of the most appropriate distribution of professional responsibilities and potential shifts in resources to optimise a model of care for patients. 16 Among other things, this requires consideration of the most appropriate distribution of professional responsibilities and potential shifts in resources to optimise a model of care for patients.…”

“…16 Historically, with megavoltage portal imaging, the inherently poor contrast provided only enough information to assess positioning relative to bony anatomy in a limited field of view. 16 Historically, with megavoltage portal imaging, the inherently poor contrast provided only enough information to assess positioning relative to bony anatomy in a limited field of view.…”

“…16,21 The potential impact on the entire radiation therapy department of equipping therapists 'with the knowledge and skills necessary to manage the wealth of new information now presented to them at the time of treatment delivery' was acknowledged by White and Kane, 10 but they stopped short of identifying what the content of that education and training needs to be. 16,21 The potential impact on the entire radiation therapy department of equipping therapists 'with the knowledge and skills necessary to manage the wealth of new information now presented to them at the time of treatment delivery' was acknowledged by White and Kane, 10 but they stopped short of identifying what the content of that education and training needs to be.…”