Quality assuring “Plan of the day” selection in a multicentre adaptive bladder trial: Implementation of a pre-accrual IGRT guidance and assessment module

Abstract

a b s t r a c tBackground and purpose: Hypofractionated bladder RT with or without image guided adaptive planning (HYBRID) is a multicentre clinical trial investigating ''Plan of the Day" (PoD) adaptive radiotherapy for bladder cancer. To ensure correct PoD selection a pre-accrual guidance and assessment module was developed as part of an image guided radiotherapy quality assurance (IGRT QA) credentialing programme. This study aimed to evaluate its feasibility and effectiveness across multiple recruiting centres. Materials and methods: Individuals from participating centres remotely accessed an image database in order to complete the PoD module. An assessment score of 83% was required in order to receive QA approval. A questionnaire was used to gather user feedback on the module. PoD decisions for the first patient at each recruiting centre were retrospectively reviewed for protocol adherence. Results: 71 radiation therapists (RTTs) from 10 centres completed the PoD module. The median assessment score was 92% (Range: 58-100%) with 79% of RTTs passing the assessment on first attempt. All questionnaire respondents reported that the PoD module prepared them for plan selection. In 51/60 of on-trial treatments reviewed, the PoD selected by the centre agreed with QA reviewers. Conclusions: The PoD QA module was successfully implemented in a multicentre trial and enabled preaccrual assessment of protocol understanding. This increased operator confidence and resulted in appropriate PoD selection on-trial. Crown

International survey; current practice in On-line adaptive radiotherapy (ART) delivered using Magnetic Resonance Image (MRI) guidance

“…Until recently this process has been completed off-line, either by rescanning and re-planning [2] or by using treatment verification images to create a new plan [3,4]. Initial clinical implementation of online adaption of treatment has been restricted to selecting the best fit planning target volume (PTV) from a library of pre prepared plans ('plan of the day') [5,6]. However, the ability to deliver adaptive radiotherapy on-line has been realised with the introduction of combined Magnetic Resonance imaging (MRI) scanners and radiotherapy treatment units (Co 60 and Linac) with an integrated adaptive workflow (On-line MRIgRT) [7,8].…”

Clinical Outcomes of a Randomized Trial of Adaptive Plan-of-the-Day Treatment in Patients Receiving Ultra-hypofractionated Weekly Radiation Therapy for Bladder Cancer

“…As previously reported, all sites undertook a quality assurance program, including a training package on plan selection for which staff members needed to attain a preset level of concordance with an expert-defined selection to gain approval to select plans for the purposes of trial treatment. 27 , 28 A central review shows this training was relatively effective, with 78% concordance, but in most discrepant cases the expert reviewer selected a smaller plan, evidencing the need for ongoing peer support and feedback in the implementation of this technique.…”

Advancing Radiotherapy for Bladder Cancer: Randomised Phase II Trial of Adaptive Image-guided Standard or Dose-escalated Tumour Boost Radiotherapy (RAIDER)

“…Plan selection competency was completed through an online training package, practical workshops, and credentialing assessment [42,43]. The contemporaneous collection and offline review of planning and delivery data enabled central concordance of plan selection to be examined during the trial.…”