ESTRO 2024 - Abstract Book

S5775

RTT - Education, training, advanced practice and role developments

ESTRO 2024

An Advanced Practice Radiation Therapist Improves Contouring Timing for Online Adaptive Radiotherapy

Robert Beckert, Joshua Schiff, Eric Morris, Pamela Samson, Hyun Kim, Eric Laugeman

Washington University School of Medicine in St. Louis, Radiation Oncology, St. Louis, USA

Purpose/Objective:

Adaptive radiotherapy (ART) is a resource and time intensive process requiring therapists, physicists, and physicians to be at the machine for extended periods of time. To help manage this additional time requirement, an Advanced Practice Radiation Therapist (APRT) position was created to specialize in cone beam computed tomography (CBCT) guided adaptive contouring for radiation therapy treatments. We hypothesized that by task shifting ART contouring from a physician to an APRT, an improvement in contouring times and treatment times will be obtained while simultaneously reducing the burden of ART on physicians.

Material/Methods:

An APRT position was created for our high-volume adaptive radiotherapy practice with the primary assignment of optimizing the ART process and adaptive contouring on the CBCT-guided ART platform. The APRT would evaluate the initial CBCT image quality to determine the acceptability of the scan for contouring. With regards to adaptive contouring, once a case was ready for ART contours, the APRT would confirm target alignment and then contour the necessary organs-at-risk (OARs) adjacent to the planning target volume (PTV) as per standard institutional adaptive protocol. Once contouring was complete, the APRT would then brief the covering physician on the patient (i.e., patient name, treatment site, dose, and fraction), relay any discrepancies with target alignment due to image quality or tumor growth, and discuss any potential issues from previous fractions. The covering physician would review and approve the APRT’s contours, confirm target alignment and target contours, and then proceed with the remainder of the ART workflow. Over a ten-month period, the contouring, adaptive process, and total treatment times for all ART fractions treated on a CBCT-guided ART unit were recorded. Contouring time for this study was defined as the time from when the APRT or covering physician began OAR contouring to completion of OAR and target contouring by the covering physician. The adaptive process time was defined as the time from CBCT acquisition for adaptation to the time of treatment delivery start. Total treatment time was defined as the time from the start of patient set-up to completion of treatment delivery. All timing data were stratified and compared depending on whether the APRT was present and contouring or if the APRT was absent (non-APRT). For patients who had at least one fraction with and without the presence of the APRT, intra-patient timing data was also analyzed. Statistical tests using related samples were used to evaluate differences in mean contouring times between groups.

Results:

There were 183 total adaptive treatment sessions (136 APRT; 47 non-APRT). The average time required for the APRT to contour was 8 minutes and the non-APRT contouring time was statistically significantly longer at 20 minutes (p<0.001). There was no statistically significant difference in the time required for the adaptive process (31 minutes APRT; 33 minutes non-APRT) and the total treatment time (48 minutes APRT; 49 minutes non-APRT). Contouring times and adaptive process times are further stratified by thoracic, abdominal, and pelvic disease sites as demonstrated in Figure 1 (contouring times) and Figure 2 (adaptive process times). Concerning the related samples test where average times for the APRT and physician were compared for the same patient, the APRT provided a statistically significant