ESTRO 2024 - Abstract Book

S5819

RTT - Education, training, advanced practice and role developments

ESTRO 2024

The objective of this project was to develop a training and competency programme able to bridge the gap in therapeutic radiographer (RTT) adaptive competency to support safe and efficient implementation of CPOD RT. Then, once implemented, to quality assure RTT online plan selection accuracy and plan library suitability.

Material/Methods:

A multidisciplinary team (MDT) was assembled to develop, and quality assure the CPOD protocol. RTT training and competency development was led by an RTT and radiation oncologist (RO), with MDT support.

A competency database was created based on imaging from cervical cancer patient cases. For each case, the low-risk CTV, comprising the cervix, uterus, parametria and upper vagina was contoured on full, empty and mid-bladder volume planning scans. A 10mm margin was added to the uterocervix complex CTV and combined with the elective nodal PTV to create a library of three RT plans, corresponding to the full, mid and empty-bladder scans (named PTV45_1, PTV45_2 and PTV45_3). Modified plan libraries, registered (bony anatomy) with treatment CBCT images, were imported into Practice Mosaiq (Elekta, Stockholm, Sweden). From 30 registrations available, 19 images were chosen to represent a range of clinical scenarios. Two ROs selected the optimal plans for each registration to generate the gold standard. An assessment flowchart was designed, to standardise RTT image review and rules for optimal plan selection. Training which included the training guide and competency assessment, was open to RTTs with cervical cancer IGRT competencies [2] . The assessment flowchart, a synopsis of the patient’s demographic and diagnosis data and an image of the high-risk volume (HR-CTV) (GTV and remaining normal cervix) contoured on MRI were given to support decision making. A pass mark of 80% concordance was set, aligned with previous successful training programmes [2,3] . For clinical implementation the contouring process was refined, generating internal target volumes (ITV) to encompass motion subranges and a fourth motion-robust plan (PTV45_R) added, encompassing all other ITVs with a further margin. RTTs were educated on updates before go-live. Online, CBCT images were rigidly registered to stable bony anatomy. Two trained RTTs verified patient position and selected the plan-of-the-day based primarily on coverage of the CTV following the assessment flowchart. Clinical implementation was audited in stages: 1. For patients 1-5 all online plan selections were audited offline by the RO, blinded to the online decision. Fractions with a plan available covering the entire target volume, and time taken to select the plan and deliver treatment was recorded. 2. For patients 6-10 online plan selection for fractions 1-5, 9, 13, 17, 21 and 25 were audited offline by the RO, blinded to the online decision. 3. For patients 1-20 plan use frequency was calculated. A 60-minute training guide for plan selection was developed covering relevant anatomy, motion studies, management options, image interpretation, target and organ-at-risk assessment and worked clinical examples.

Results:

CPOD was introduced to clinical practice in April 2022. Fifteen RTTs have completed the CPOD training and competency programme to date. The median grade was 89% (range 84-100%).