Take Action Protocol: A radiation therapist led approach to act on anatomical changes seen on CBCT

Abstract

Until recently Traffic Light Protocols (TLP) have been developed to recognize and react to Anatomical Changes (ACs) seen on Cone Beam Computer Tomography (CBCT) scans for the most common treatment sites. This involves alerting the Radiation Oncologist (RO), handing over findings, and RO providing the final decision, making it quite labour-intensive for the ROs as well as the Radiation Therapists (RTTs). A new approach was developed to act on ACs: the Take Action Protocol (TAP). In this protocol the RTTs do not only have a role in detecting ACs, but also decide on the appropriate action and follow up, resulting in a significant shift in responsibility. In this study we present the TAP and evaluated the benefit and outcomes of the implementation of TAP compared to the TLP. During a pilot period of six months the TAP was applied for 34 bladder and prostate patients. In 2 bladder and 6 prostate patients further decision making by an RO was required (compared to all 34 in the TLP), showing a large reduction in workload. ACs were accurately assessed by RTTs in >99% of the cases. In 5/34 patients RTTs specialized in Image Guided Radiotherapy provided additional instructions to improve accurate use of the TAP. Two surveys conducted by both ROs and RTTs on the TLP and TAP showed that the perceived involvement of the ROs and burden of responsibility for RTTs was comparable between the two protocols. The identification of patients with truly clinical relevant ACs and the adaptation of treatment for the remaining fractions improved according to ROs and RTTs responses. The TAP provides a better balance between workload and efficiency in relation to the clinical relevance of acting on ACs.

Online adaptive MR-guided radiotherapy: Conformity of contour adaptation for prostate cancer, rectal cancer and lymph node oligometastases among radiation therapists and radiation oncologists

“…In current radiotherapy routine, registration and interpretation of cone-beam CT (CBCT) information is commonly performed by radiation therapists (RTTs) [1,2]. Subsequently, based on action levels, RTTs decides if the radiotherapy fraction can start, or if a medical physicist (MP) or radiation oncologist (RO) should be called for consultation.…”

The Radiation Therapist profession through the lens of new technology: A practice development paper based on the ESTRO Radiation Therapist Workshops

“…To achieve this, the radiation therapist will need to move beyond a task shifting role, to a more consultive role, bringing what is currently considered as advanced practice functioning to the standard practice radiation therapy team. There are many examples of advanced practice radiation therapists demonstrating a high level of autonomy and expert skill in formulating clinical decisions and appropriate patient management [30] , [31] , [32] , [33] . They provide comprehensive supportive care and toxicity management, streamline complex processes, reduce handovers and team interruptions, and improve continuity of care.…”