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

Abstract

Introduction: With recent technological advances in image-guided radiation therapy (IGRT), through conebeam computed tomography (CBCT), more image-related clinical information is being collected, at more frequent intervals throughout the treatment course. As radiation therapy (RT) programmes further develop IGRT technology, the aim of this study is to assess whether the distribution and communication of professional responsibilities is evolving to ensure appropriate use of the technology.Methods: Radiation therapists practicing at any of the 14 Ontario RT centres were sent an electronic survey (n 5 400). Closed-ended quantitative items addressed perceptions regarding policies, comfort, and professional responsibility in addressing CBCT concerns. Focus was on gynaecological, lung, head and neck (H&N) disease sites. Options for qualitative comments and explanations were included where appropriate.Results: Seventy-nine surveys were submitted. Respondents from 12/14 (85?7%) centres used CBCT for at least one of three disease sites, most commonly on a daily basis. Five of these centres (41?7%) did not require radiation oncologist CBCT review, with others requiring it Day 1 or weekly. Potential CBCT observations of concern were grouped as set-up issues, tumour changes, organ-at-risk (OAR) changes, contour changes and ancillary findings (especially lung and airway changes). Respondents believed they consulted another professional about a CBCT in 20?2% of H&N patients, 19?6% of lung patients and 9?7% of gynaecological patients. The level of comfort in doing so varied from 77?0% for H&N to 89?5% for lung. Respondents were most likely to believe themselves responsible for changes in OARs (92?2% believing themselves responsible), and least likely for ancillary findings (62?7%).Conclusions: Through preliminary insight from Ontario therapists, a degree of inconsistency is apparent between perceptions, practices and assigned roles in the management of CBCT information. Clear definition of the scope and nature of therapists' responsibility for interpreting and addressing changes on CBCT images should be developed within each centre.

Development and Implementation of an Electronic Learning Module for Volumetric Image-Guided Radiation Therapy

“…Volumetric image guidance has greatly impacted the roles and responsibilities of the radiation therapist [3,5]. It has also been previously identified that with an increasing scope of practice driven by technological advances, there is inconsistency in perceptions, practices, and role assignment when interpreting CBCT images [4]. As such, continuing professional development activities, such as the CBCT module presented in this study, is a step toward providing appropriate information through an appropriate medium at the right time.…”

“…In the changing environment of volumetric IGRT technology, skill development and integration of knowledge is essential to ensure clinical competence of radiation therapists [4]. At the onset of clinical implementation of CBCT technology at our institution, to ensure therapists were readily equipped to manage daily decision-making regarding patient setups, a two-level training program was designed and implemented [5].…”

Evidence-based region of interest matching guidelines for sarcoma volumetric image-guided radiation therapy

“…Benefits of standardizing guidelines in an image guidance era include ensuring the safety and effectiveness of IGRT [12]. As online IGRT increases volumetric information at the front line, radiation therapists are increasingly involved in image analysis and decision making that affects the accuracy and precision of patient treatment [8,11,12]. Dissemination of standardized documentation facilitates clinical implementation, ensures consistency in clinical practice, and aids in the education and professional development of radiation therapists [12,18].…”

“…Cone-beam computed tomography (CBCT) guidance systems allow for online volumetric visualization of patient anatomy, enabling daily setup variations to be quantified and corrected prior to treatment delivery, while monitoring daily patient changes and deformations [5,6]. Efficient incorporation of daily CBCT application and decision making into the clinical workflow is influenced by the confidence in image assessment by end users, and their experience and comfort with volumetric image visualization and literacy [7,8].…”

“…Safety considerations, education and consensus guidelines for IGRT have been identified as key issues to complement an expanding image guidance culture [12]. In particular, many have emphasized the importance of the quality paradigm in the era of IGRT to ensure that practice keeps pace with technology, and considerations are made for how to handle clinical information previously unavailable [4,8]. Specifically, a lack of literature exists on optimal regions of interest (ROI) for CBCT image registration to facilitate consistent practice for radiation therapists, ensuring reliable registration results and subsequent treatment targeting.…”