Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role

Abstract

Introduction Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers. Method A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied. Results Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: ‘Current MRIgRT’, ‘Training’ and ‘Future Practice’. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers. Conclusion Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge. Implications for practice Role development and changes in education for therapeutic radiographers.

Pathway for radiation therapists online advanced adapter training and credentialing

“…Additionally, McNair et al [21] detail the positive effect of weekly MDT meetings or meeting prior to a complex patient's treatment, to maintain team communications and refine safe work practices in oART.…”

“…The workflows for CBCT guided oART and MRIgART are well established [3] , [5] , [8] , [9] , [27] , [28] , [29] . Despite global differences in the oART team make up, Table 1 outlines a synthesis of evidenced-based practice covering general workflow tasks and responsibilities for CBCT oART and MRIgART [6] , [21] . Outlining clear task responsibilities is asserted in the literature [21] and highlights the potential credentialing opportunities for an RTT-led workflow.…”

“…Generally, oART requires specialist staff such as a Radiation Oncologist (RO), dosimetrist and Radiation Oncology Medical Physicist (ROMP) to be present in addition to the RTT treatment team. Human resources and training are clearly barriers to widespread implementation of oART [2] , [17] , [18] , [19] , [20] , [21] . It is widely acknowledged that global variances exist for role responsibilities during oART.…”

“…In conventional roles, two RTTs are responsible for image matching and treatment delivery, the prescribing RO finalises contouring and plan approval, with the ROMP completing plan quality assurance (QA). Evidence of RTTs successfully leading the oART workflow with training has been demonstrated [21] , with identification of additional skills and knowledge, in particular MRI guided adaptive radiotherapy (MRIgART) [6] , [21] . Some traditional RO tasks might be delegated to advanced practice RTT’s who are ‘Advanced Online Adapters’ and under controlled guidance of the physician with ‘on-call’ caveats can lead oART treatments [6] , [18] , [21] , [22] .…”

“…Evidence of RTTs successfully leading the oART workflow with training has been demonstrated [21] , with identification of additional skills and knowledge, in particular MRI guided adaptive radiotherapy (MRIgART) [6] , [21] . Some traditional RO tasks might be delegated to advanced practice RTT’s who are ‘Advanced Online Adapters’ and under controlled guidance of the physician with ‘on-call’ caveats can lead oART treatments [6] , [18] , [21] , [22] . Alternatively, ROs may still need to attend the treatment console satisfying local codes of practice [22] .…”