Evaluating the use of exactrac software for CBCT analysis during the development of an oligometastatic spinal SABR service

Abstract

Introduction: Patients with oligometastases are candidates for targeted therapy (1) , such as SABR. This allows delivery of biologically more potent dose, which may provide better local control and is advantageous for these patients (2). A disadvantage of SABR however is the lengthy time to deliver each high dose treatment (3). Clinicians currently supervise treatment delivery but this is insufficient use of a clinician's time (4). With SABR treatments likely to increase over coming years implementation of a Radiographer-led SABR service in Belfast is key to confidently treating complex high dose treatments, similar to our established Lung SABR service. Methods and Materials: SABR service for oligometastases commenced in Belfast in January 2018 with 36 various metastases treated to date. SABR treatment competent Radiographers deliver treatment under supervision of clinician with a SABR competent Band 7 or above in attendance. Patients are scheduled to one treatment machine and one team leader has predominantly been involved since commencement of the service. She has undertaken the MSc Expert Practice Module at Sheffield Hallam University which has facilitated development of portfolio with detailed case studies and future development plan to expand this area of clinical expertise. Results: 15 bone, 11 node, 3 liver, 2 pelvic masses and 5 spine metastases have been treated to date. Establishment of and regular attendance at the weekly MDT allows Radiographer input, increased involvement and collaboration with clinicians, radiologists and physicists. This involvement and completion of competencies with direct and indirect supervision from a clinical mentor through the MSc module has deemed this team leader clinically competent in supervision and delivery of SABR for oligometastases. Conclusion and Discussion: Clinician and Radiographer competence and confidence is now well established for the treatment of bone and node metastases. The Team Leader with this clinical competence and level of knowledge and experience that has been achieved is in a position now to develop treatment and supervision competencies, train staff and supervise these treatments thus enabling implementation of a Radiographer-Led service. Numerical References (1).