RTT-led IGRT for cervix cancer; training, implementation and validation
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 competenc...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-12-01
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| Series: | Technical Innovations & Patient Support in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405632419300198 |
| _version_ | 1818133926898565120 |
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| author | S.E. Alexander N. Hopkins S. Lalondrelle A. Taylor K. Titmarsh H.A. McNair |
| author_facet | S.E. Alexander N. Hopkins S. Lalondrelle A. Taylor K. Titmarsh H.A. McNair |
| author_sort | S.E. Alexander |
| collection | DOAJ |
| description | 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. Keywords: Image guided radiotherapy, Cervical cancer, Cone-beam computed tomography, Radiation Therapists (RTT), RTT training, Competency assessment, RTT-led |
| first_indexed | 2024-12-11T09:00:29Z |
| format | Article |
| id | doaj.art-fceb45d37a1f48c4957eabaee4ce7107 |
| institution | Directory Open Access Journal |
| issn | 2405-6324 |
| language | English |
| last_indexed | 2024-12-11T09:00:29Z |
| publishDate | 2019-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Technical Innovations & Patient Support in Radiation Oncology |
| spelling | doaj.art-fceb45d37a1f48c4957eabaee4ce71072022-12-22T01:13:47ZengElsevierTechnical Innovations & Patient Support in Radiation Oncology2405-63242019-12-01124149RTT-led IGRT for cervix cancer; training, implementation and validationS.E. Alexander0N. Hopkins1S. Lalondrelle2A. Taylor3K. Titmarsh4H.A. McNair5The Royal Marsden NHS Foundation Trust, United Kingdom; Corresponding author at: Radiotherapy Department, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom.The Royal Marsden NHS Foundation Trust, United KingdomThe Royal Marsden NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United KingdomThe Royal Marsden NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United KingdomFormerly Kingston and St Georges University of London, United KingdomThe Royal Marsden NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United KingdomIntroduction: 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. Keywords: Image guided radiotherapy, Cervical cancer, Cone-beam computed tomography, Radiation Therapists (RTT), RTT training, Competency assessment, RTT-ledhttp://www.sciencedirect.com/science/article/pii/S2405632419300198 |
| spellingShingle | S.E. Alexander N. Hopkins S. Lalondrelle A. Taylor K. Titmarsh H.A. McNair RTT-led IGRT for cervix cancer; training, implementation and validation Technical Innovations & Patient Support in Radiation Oncology |
| title | RTT-led IGRT for cervix cancer; training, implementation and validation |
| title_full | RTT-led IGRT for cervix cancer; training, implementation and validation |
| title_fullStr | RTT-led IGRT for cervix cancer; training, implementation and validation |
| title_full_unstemmed | RTT-led IGRT for cervix cancer; training, implementation and validation |
| title_short | RTT-led IGRT for cervix cancer; training, implementation and validation |
| title_sort | rtt led igrt for cervix cancer training implementation and validation |
| url | http://www.sciencedirect.com/science/article/pii/S2405632419300198 |
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