ESTRO meets Asia 2024 - Abstract Book

JointFARO-ESTRO Congres @ ESTRO me tsAsia2024 23-25August2024 Kuala Lum pur,M alaysia

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Joint FARO-ESTRO Congress @ ESTRO meets Asia 2024

23-25 August 2024 Kuala Lumpur, Malaysia

Table of contents

Invited Speaker..................................................................................................................................................................01-44

INTERDISCIPLINARY

Biomarkers......................................................................................................................................................................... 45-52 Brachytherapy. .................................................................................................................................................................. 53-70 Breast.................................................................................................................................................................................. 71-90 CNS.................................................................................................................................................................................... 91-112 Education in radiation oncology..................................................................................................................................113-125 Global health..................................................................................................................................................................126-134 Gynaecological............................................................................................................................................................... 135-151 Haematology.................................................................................................................................................................. 152-157 Head & neck...................................................................................................................................................................158-195 Health economics & health services research............................................................................................................196-203 Lower GI.........................................................................................................................................................................204-210 Lung................................................................................................................................................................................ 211-218 Mixed sites/palliation....................................................................................................................................................219-226 Other............................................................................................................................................................................... 227-238 Paediatric tumours........................................................................................................................................................239-242 Particle Therapy.............................................................................................................................................................243-248 Radiobiology. ................................................................................................................................................................. 248-257 Sarcoma/skin cancer/malignant melanoma...............................................................................................................258-260 SBRT................................................................................................................................................................................ 261-270 Upper GI.........................................................................................................................................................................271-280 Urology........................................................................................................................................................................... 281-296

PHYSICS

Algorithms and applications for photon and electron planning..............................................................................297-300 Detectors, dose measurement and phantoms..........................................................................................................301-313 Image acquisition and processing...............................................................................................................................314-317 Machine learning models and clinical applications...................................................................................................317-322 Motion management and adaptive radiotherapy......................................................................................................323-337 Quality assurance and auditing...................................................................................................................................338-348 Radiomics, functional and biological imaging and outcome prediction..................................................................349-351

RTT

Patient care, preparation, immobilisation and IGRT verification protocols . ........................................................... 352-365 Patient experience and quality of life..........................................................................................................................366-372 Education, training, advanced practice and role developments..............................................................................373-378 Service evaluation, quality assurance and risk management...................................................................................379-382 Treatment planning, OAR and target definitions ....................................................................................................... 383-407

SPEAKER ABSTRACT Invited Speaker

S1

Invited Speaker

ESTRO meets Asia 2024

468

Transit dosimetry with EPID

Núria Jornet

Servei de Radiofísica i Radioprotecció, Hospital Sant Pau, Barcelona, Spain

Abstract

In vivo dosimetry (IVD) assesses the agreement between the planned dose and that delivered to the patient during radiotherapy treatment. Already for several decades, international organizations have recommended its use, and national and international regulators are starting to require it. When 3DCRT was the standard treatment IVD was performed with point detectors placed on the patient's skin at the entrance and exit side of the beams. When IMRT and VMAT started to be implemented in routine, point in vivo dosimetry was no longer appropriate to monitor the dose as delivered to the patient. At that moment Electronic Portal Imaging Device (EPID) based in vivo dosimetry was developed. EPID based IVD is an ensemble of computational techniques that, using the signal collected by the portal imager after passing through the patient (transit dosimetry) compare the dose measured by the IVD system with that expected from treatment planning. It can be divided into two classes: forward-projection (FP) and back-projection (BP) techniques. In the first class, the signal measured by the EPID is compared to an image predicted by the FP algorithm. The comparison is usually based on 2D Gamma Agreement Index (GAI), but profile analysis and point dose differences can also be used. In the second class, the BP methods reconstruct the absorbed dose in the patient anatomy, by back projecting the EPID acquisition to either a point, a plane or in 3D. BP reconstructed dose can be compared directly with the planned dose using point dose difference or 2D, 3D gamma agreement or Dose Volume Histogram (DVH) difference. In the last ten years the number of commercial solutions available on the market as well as the number of publications about the EPID IVD implementation have increased, signalling an increasing interest of the radiotherapy community on this topic. However, despite the wide availability of both the EPID and software for transit dose reconstruction, the broad clinical application of this methodology is still limited to few centres with large experience. One reason for the difficulties in implementing an EPID IVD clinical program is the lack of guidelines for acceptance and independent validation of these systems. In this talk an overview of the different IVD systems will be discussed. The implementation and clinical practice of a commercial IVD system will be presented. Special emphasis will be given on the type of errors that have been detected, the quality improvement actions generated from the results.

In vivo dosimetry can be considered as the last net to catch any errors before reaching the patient.

469

Motion management and tracking

Emily A Hewson

Image X Institute, The University of Sydney, Sydney, Australia

S2

Invited Speaker

ESTRO meets Asia 2024

Abstract

Radiation therapy treatments have seen a shift toward hypofractionation with promising patient outcomes being observed in recent studies. With increasingly conformal radiation delivery techniques and higher doses being delivered with smaller margins, the need for strategies that mitigate treatment uncertainties resulting from the dynamic nature of human anatomy is greater now more than ever. While motion management strategies have existed in some form for more than two decades, further developments have seen adaptation being performed on increasingly shorter time scales and with a variety of treatment systems and strategies. X-ray imaging of fiducial markers has commonly been used to guide tracking with markerless approaches also emerging to eliminate the need for marker implantation. Combined MR-linac systems have also been implemented clinically to provide high quality soft tissue imaging during radiation delivery. These motion monitoring methods are often used to guide gating, but motion can also be adapted to using MLC tracking or robotic and gimbaled linacs. The field has recently seen a growing presence of machine learning techniques being applied to monitor and adapt to motion. These methods have allowed for improved tumour targeting across a range of treatment sites including the prostate, lung, and liver. There are however still a number of technical and practical barriers to be overcome to enable widespread clinical implementation.

470

Statistics for outcome modelling/radiomics (/trials)

Ivan R Vogelius

Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Dept of Oncology, Rigshospitalet, Copenhagen, Denmark

Abstract

In this teaching lecture we will start by the basic methods of statistical inference. We will then quickly move on to discuss examples of outcome analyses in radiation oncology within both a physics-oriented questions, e.g. dose response or clinical outcomes such as survival. We will, of course, talk about the reproducibility crisis and how to best counter it and contribute to better research in the field.

471

SGRT implementation and clinical outcomes

Bartosz Bak

Radiotherapy Department II, Greater Poland Cance Center, Poznan, Poland. Electroradiology Department, University of Medical Science, Poznan, Poland

Abstract

S3

Invited Speaker

ESTRO meets Asia 2024

Surface Guided Radiotherapy (SGRT) represents a significant advancement in radiotherapy, providing a non-invasive method for patient setup and real-time monitoring during treatment. SGRT offers an alternative using surface imaging to guide treatment, enhancing accuracy and patient comfort. The adoption of SGRT has shown promising improvements in clinical outcomes. Key benefits include enhanced accuracy in patient positioning, improved treatment reproducibility, and reduced setup times. SGRT allows for precise alignment of patients based on their surface anatomy, reducing the likelihood of errors and the need for repositioning. This leads to more consistent and accurate radiation delivery, crucial for effective tumor targeting and minimizing damage to healthy tissues. SGRT has been particularly beneficial in treatments where patient movement is a concern, such as breast cancer and head-and-neck cancers. In breast cancer radiotherapy, SGRT helps achieve optimal positioning while minimizing radiation exposure to the heart and lungs. In head-and-neck cancers, SGRT assists in maintaining precise positioning despite potential patient discomfort and movement. SGRT has significantly improved the accuracy, efficiency, and patient experience in radiotherapy, by providing precise, real-time surface imaging. As technology advances, the role of SGRT in radiotherapy is expected to expand, offering even greater patient benefits. The continued integration and optimization of SGRT within radiotherapy practices will contribute to more effective and safer cancer treatments.

472

Advancing patient care: The expanding role of RTTs in advanced radiation modalities

Yat Man Tsang

Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada

Abstract

Radiation therapists (RTT) are responsible for planning and delivering radiotherapy (RT) and play a non-replaceable role in cancer patients’ RT pathways. Task shifting is a strategy where a professional group, that generally requires less training and fewer qualifications, expands their scope of practice to close gaps with other professional groups that requires longer training, in order to tackle bottlenecks or gaps in the delivery of high quality and timely care to patients. For the purposes of streamlining workflows in RT, this task shifting concept has been consolidated under the umbrella of expanding RTT roles including ‘advanced practice’ (AP). There is no doubt that each AP position is unique. The concepts of task shifting through AP roles should not be interpreted as replacing medical colleagues but rather as a way to rationalize who provides what service, in order to augment the efficiency and effectiveness of our healthcare system for patients getting the right care at the right time. The development of expanded RTT roles and AP is constantly evolving locally and globally. These roles can quickly be perceived as ‘standard’ practice. It is important to consider that the RTT roles should adapt over time due to the continuously evolving technology and service needs.

Against this background, this presentation aims:

• To discuss the roles of RTTs in ensuring precision and effectiveness of advanced radiation therapy treatments • To examine the involvements of RTTs in enhancing team-based care and improving radiation therapy treatment outcomes.

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• To showcase examples of how extended/expanded/advanced practice of RTTs can contribute to a more integrated and personalized patient-centred care approach

473

Brachytherapy with intracavitary-interstitial applicators

Supriya Chopra

Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India

Abstract

In this teaching lecture the evolution of intracavitary and interstitial brachytherapy techniques for cervical cancer and clinical outcomes will be discussed. Speaker will be discussing expert tips and tricks for treatment planning and how to adapt these applicators for clinically challenging and complex cases including gynaecological reirradiation.

474

Commissioning of applicators

Jeevanshu Jain

Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India

Abstract

Image-guided brachytherapy (IGBT) necessitates accurate applicator reconstruction and contouring to achieve successful outcomes. Deviations in dose-volume histogram (DVH) parameters for targets and organs at risk (OARs) have been noted due to uncertainties in applicator reconstruction. While random errors can be minimized by reducing image slice thickness, systematic errors require robust quality assurance of the afterloader, treatment planning system, imaging procedures, and brachytherapy applicators. Comprehensive applicator commissioning plays a critical role in mitigating these systematic errors, thereby reducing uncertainties in DVH parameters. Applicator commissioning involves validating the applicator geometry against the vendor's design and ensuring its clinical suitability. The applicator commissioning process includes (i) physical verification, (ii) offset calculation, (iii) imaging artifact evaluation, (iv) verification of source dwell positions relative to the applicator geometry, and (v) establishing a standard loading pattern for the applicators. Physical verification entails visual inspection for damage and ensuring dimensional integrity (the length, diameter and angulation of various applicator components) using tools like rulers, calipers, and gauges. Radiographs or CT scans can confirm the applicator's structural integrity.

Autoradiography, using radiochromic films, is essential for offset calculation and dwell position verification, ensuring alignment between vendor-specified offsets and actual measurements.

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Invited Speaker

ESTRO meets Asia 2024

Applicator materials can produce artifacts in MRI and CT, necessitating preclinical evaluation. Scanning applicators in a tissue-equivalent medium phantom helps quantify these artifacts, with CT-MRI image registration providing further insights. This step becomes more significant if needles are being used for interstitial brachytherapy. Needle visualization in CT and MRI needs to be assessed for evaluation of the artifacts. This information aids in accurate applicator and needle reconstruction during clinical use. Verification of source dwell positions is conducted using a source dummy wire (CT) and water line markers (MRI). Imaging scans with these markers allow for precise verification of distances and source positions using the treatment planning station.

The final step in implementing a new applicator involves standardizing the loading pattern.

Applicator commissioning is performed before clinical use of a new applicator and can be repeated annually as part of the quality assurance protocol. The results of applicator commissioning can be utilized to validate the library of applicators provided by the vendor. Errors in commissioning can lead to systematic reconstruction errors, highlighting the importance of its meticulous planning and execution. The process of applicator commissioning fosters confidence in brachytherapy treatment planning and execution among oncologists and medical physicists, supporting a seamless clinical workflow.

In summary, applicator commissioning is a vital component of the IGBT workflow, essential for reducing DVH parameter and treatment uncertainties in clinical practice.

475

Dosimetry audit projects for safe and effective radiotherapy treatments

Krzysztof Chelminski 1 , Alexis Dimitriadis 1 , Roua Abdulrahim 1 , Anna Becker 1 , Egor Titovich 1 , Liset de la Fuente Rosales 1 , Jonathan Kalinowski 2,3 , Shirin Abbasi Enger 2,3 , Evelyn Granizo-Roman 1 , Benjamin Kellogg 1 , Pavel Kazantsev 1 , Godfrey Azangwe 1 , Mauro Carrara 1 , Jamema Swamidas 1 1 Department of Nuclear Sciences and Applications, Division of Human Health, International Atomic Energy Agency, Vienna, Austria. 2 Department of Oncology, Medical Physics Unit, McGill University, Montreal, Canada. 3 Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada Background and Purpose: The International Atomic Energy Agency/World Health Organisation (IAEA/WHO) dosimetry audit programme operates since 1969 and provides dosimetry audit services in various processes of radiotherapy, prioritizing Low- and Middle-income Member States (MS). In response to MS’s requests to extend the current audit service to brachytherapy, a Coordinated Research project (CRP-E24023) was launched in 2021, with the aim to develop a multi-level dosimetry audit methodology for High Dose Rate (HDR) brachytherapy including evaluation of Reference Air Kerma Rate (RAKR), source position verification and an end-to-end dosimetry audit for cervical cancer. Material and Methods: Under the framework of this CRP, a simple, light weight, cost-effective phantom suitable for remote postal dosimetry audits was proposed. The audit methodology aims to assess accuracy of the RAKR for both 60 Co and 192 Ir sources by measuring the dose delivered to the phantom. Correction factors accounting for deviations from AAPM TG-43 full scatter conditions, non-water equivalent of the phantom and the detector material, were Abstract

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Invited Speaker

ESTRO meets Asia 2024

carried out using Monte Carlo (MC) simulations. Further, optimum audit setup and the influence of the underlying table material thickness also were simulated. All MC simulations were validated experimentally where applicable. To evaluate the influence of the radiation energy spectra on the RPLD, various HDR source models were simulated. A 16 × 8 × 3 cm phantom made of Polymethyl Methacrylate (PMMA) with a radiophotoluminescent dosimeter (RPLD) at the centre and two catheters on either side was developed. A treatment plan consisting of 13 dwell positions in each catheter with uniform dwell times with 5 mm step size, calculated using the TG-43 algorithm for a prescription dose of 2 Gy to the centre of the RPLD was prepared. The source position shifts were monitored with the dosimetry film inserted in the phantom. The methodology was tested in a pilot study with participants from eleven countries. A total of 59 dosimeter sets were irradiated with 45 192 Ir and with 14 60 Co HDR sources, using 49 brachytherapy afterloaders of various models. Results: The correction factors for non-water equivalence of detector, the use of PMMA and lack of full scatter were 1.062 ± 0.013, 0.993 ± 0.009 and 1.059 ± 0.008 for 192 Ir and 1.129 ± 0.005, 1.005 ± 0.005 and 1.009 ± 0.005 and for 60 Co respectively. Placing the phantom on a table with water-equivalent backscatter thickness of 5 cm was found to be adequate and increasing thickness of backscatter did not have an influence on the RPLD dose. The mean (SD) dose ratio of the participant to the IAEA reference dose in the pilot study was 1.008 (0.015), and 1.007 (0.011) for the 192 Ir and 60 Co respectively. An absolute average shift of source position in respect to the plan was of 1.2 mm ± 2.5 mm. Conclusions: The IAEA /WHO postal dosimetry audit methodology for HDR brachytherapy has been developed and was successfully tested in an international multicentre pilot study. This experience is crucial for the development of more advanced end-to-end audit, which is currently under development.

476

Advances in SGRT technology

Yao Guorong

Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

Abstract

Surface Guided Radiation Therapy (SGRT) is a cutting-edge technique in radiotherapy that employs optical surface monitoring for patient positioning and real-time monitoring without radiation. With its extensive clinical applications, SGRT has been instrumental in treating various cancers, including breast, head and neck, brain metastases, thoracoabdominal, and limb tumors. It excels in reducing positioning errors, enhancing respiratory motion management, and is particularly beneficial for special patient populations like children and the elderly. The technology's future is poised for significant advancements, with a focus on personalized treatment, AI integration, and improved efficiency. The combination with deep inspiration breath hold (DIBH) technology further minimizes radiation exposure to healthy tissues. SGRT's non-radiative nature makes it an ideal choice for pediatric and geriatric patients, enhancing patient safety and comfort. Research trends indicate a promising direction towards using deformable surfaces as motion surrogates and leveraging AI neural networks with various sensors to track anatomical changes more accurately. As SGRT continues to evolve, it is expected to integrate with other technologies and establish stricter quality assurance procedures, ensuring a comprehensive and efficient treatment approach. The potential of SGRT in the radiotherapy field is vast, promising to revolutionize patient care with its precision and adaptability.

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477

SGRT and patient experience

Filipe Moura

CrossI&D Lisbon Research Center, Portuguese Red Cross Higher Health School Lisbon, Lisboa, Portugal. Functional Biology and Health Sciences, University of Vigo, Vigo, Spain. Center for Translational Health and Medical Biotechnology Research, Higher Health School of Polytechnic Institute of Porto, Porto, Portugal

Abstract

Optical surface detection systems have been widely used in the radiation oncology clinical practice, providing safe and reliable patient positioning and localization accuracy throughout the whole treatment. This modality, called as Surface Guided Radiation Therapy (SGRT), is a powerful tool for treatment reproducibility with real time patient motion management. Reduction of both systematic and random errors, can be reached with this fast non-ionizing imaging modality, by providing means for marker- and tattooless positioning, intrafraction motion monitoring and deviceless 4D dynamic approach, including gated treatments by tracking patient´s breathing. From a protocol management perspective, a isocentric high correlation has been observed between SGRT and IGRT systems, which contributed to the substancial reduction of re-imaging and re-positioning, as well a remarkable reduction on the number of ionizing imaging procedures with further time consumption. Besides precision and safety optimization related to the system itself, it can promote a better patient experience throughout the whole treatment course. The SGRT will allow for faster and more precise deliveries, by using patient population specific workflows with NO skin marking, which improves patients’ interaction and better cooperation along the clinical applications. This transition from “ancient” temporary and/or permanent marking to real-time body digitalization, introduced a new era in radiotherapy coupled with an increased patient satisfaction with less psychosocial distress during and after treatment, and throughout life. Several approaches will be covered during this lecture, for a global awareness of this fast-evolving technology for better understanding of newer potentials and optimized treatment outcomes to improve quality of life of cancer patients.

480

Addressing the education and training needs of RTT in particle radiation therapy

Taeyoon Kim 1 , Hyokuk Park 2 , Jihyun Park 3

1 Proton therapy center, radiation oncology, National Cancer Center, South Korea, Ilsan, Korea, Republic of. 2 Heavy ion therapy center, radiation oncology, Yonsei Cancer Center, Seoul, Korea, Republic of. 3 Proton therapy center, radiation oncology, Samsung Medical Center, Seoul, Korea, Republic of

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Invited Speaker

ESTRO meets Asia 2024

Abstract

Proton therapy, including carbon ion therapy, has seen significant advancements and rapid growth over the past decade. Proton therapy, in particular, is a cutting-edge technology that uses the unique physical characteristics called Bragg peaks to precisely target tumors with minimal damage to surrounding healthy tissues. These advances require an evolution in the roles and responsibilities of radiation therapists, who are essential to providing precise and accurate treatments. This presentation will explore the current roles and limitations of radiation therapists in particle radiation therapy, with a specific focus on proton therapy. It will delve into the challenges encountered in clinical practice and examine how these challenges are being addressed. The presentation will provide a comprehensive review of the current educational status for radiation therapists in Korea, specifically focusing on programs at the National Cancer Center and other key facilities. Additionally, the presentation will summarize the outcomes of a recent workshop organized by the Particle Radiation Therapy Research Committee. This workshop aimed to identify the goals and educational content necessary to enhance the skills and knowledge of radiation therapists. Key highlights will include discussions on the evolving roles of radiation therapists, emphasizing the importance of specialized training to meet the demands of advanced proton therapy techniques. Finally, the presentation will propose the development and implementation of more practical education and training programs for radiation therapists. This includes strategies to enhance training and practice through both domestic and international collaboration. The proposed programs aim to address the evolving needs of radiation therapists, ensuring they are well-equipped with the proficiency required in particle radiation therapy. By improving the educational framework, the goal is to enhance the overall quality of patient care in this rapidly advancing field.

481

The role of RTT in online adaptive radiotherapy

Helen McNair

Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom. Radiotherapy, Royal Marsden NHS Foundation Trust, London, United Kingdom

Abstract

Adaptive radiotherapy (ART) promises to enable more targeted radiotherapy and potentially escalate/de-escalate dose and/or reduce margins. However, early adopters have reported an increase in staff required to be present at time of treatment delivery, which can become a barrier to implementation when combined with increased treatment times. One of the requirements for online adaptive is currently to recontour the target and organs at risk online which a clinical oncologist must be present at the time of treatment. The optimisation of ART delivery offers an opportunity to re-define staff roles and responsibilities. The role of the therapeutic radiographer, required to deliver radiotherapy, has previously been successfully extended for tasks originally performed by a clinician. For example, approving port films, image verification for stereotactic radiotherapy, and plan selection from a library of plans. The opportunity to extend the role further and relieve the clinician from contouring has been taken and results demonstrate that this role can be equally performed by a therapeutic radiographer. The first study reporting evaluation of online prostate contours on MRI assessed 150 structures contoured independently online by eight radiographers. The contours

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Invited Speaker

ESTRO meets Asia 2024

drawn by the radiographers were reviewed offline by a clinical oncologist and 94.2% of fractions were deemed acceptable. In our centre, following a comprehensive training programme and with patient specific instructions available at time of treatment, 117 images from six patients treated on a MR Linac were contoured online by either radiographer or clinician and the same images contoured offline by the alternate profession. Volumetric and dosimtric parameters were compared. There was no significant difference in volume size between the two groups and 57 plans created using the radiographer online contours and overlaid with clinicians’ offline contours were all deemed acceptable. Work has commenced with bladder cancer and oligometastases patients. Radiographer contouring has also demonstrated an advantage of increasing machine capacity and offering more flexible appointment times to patients.

482

The APRT role in advanced breast treatment

Li Hoon Lim

Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore

Abstract

The concept of advanced practice is well-established in the United Kingdom, Australia and Canada. It has been slowly gaining traction in Singapore with our first advanced practice radiation therapist (APRT) appointed in 2011. In the past decade, Breast radiotherapy has seen remarkable improvement in areas such as immobilization, treatment techniques, fractionation and motion management. The availability of technology has also driven image verification and therefore accuracy in treatment, impacting treatment outcomes. The APRT role is to lead and support change with careful considerations, collect data to ensure right directions, educate to ensure growth and understanding as well as engage in continuous research to ensure evidence-based practice. The establishment of APRT in NCCS has enhanced workflow efficiency, improved professional knowledge of the radiation therapists, created a clinical career progression pathway, promoted inter-professional communication and collaboration in clinical care and enhanced service quality with a patient-centered care delivery.

483

Image-guided adaptive radiation therapy (IGRT)

Fu Jin

Department of Radiation Physics, Chongqing University Cancer Hospital, Chongqing, China

Abstract

Image-guided adaptive radiation therapy (IGART) has revolutionized the field of oncology by enabling the precise delivery of radiation to tumor targets while minimizing damage to surrounding healthy tissues. This presentation will outline the key concepts and advancements in IGART, focusing on Surface Guided Radiation Therapy (SGRT), the combination of SGRT with Cone Beam Computed Tomography (CBCT), and emerging technologies such as Magnetic Resonance (MR) guidance.

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Invited Speaker

ESTRO meets Asia 2024

(1) Surface Guided Radiation Therapy (SGRT): SGRT represents a paradigm shift in radiation therapy by employing surface imaging for patient positioning and motion monitoring. SGRT systems allows for the tracking of patient motion with sub-millimeter accuracy. The ability to track subtle surface changes is particularly advantageous for treatments like breast IMRT, where even minor anatomical variations can lead to significant dosimetric consequences. SGRT's continuous monitoring capabilities are superior to intermittent imaging methods. This is crucial for managing respiratory-induced motion and other dynamic changes that can affect treatment accuracy. Moreover, the non invasive nature of SGRT reduces the need for additional radiation exposure, which is a significant benefit, especially for pediatric and repeat treatments. (2) SGRT and CBCT Integration: The combination of SGRT and Cone Beam Computed Tomography (CBCT) offers a robust solution for patient movement management in radiotherapy. SGRT provides continuous, non-ionizing monitoring of the patient's surface, allowing for real-time adjustments to patient position and compensating for intrafraction motion. CBCT, while used for precise pre-treatment verification, confirms the adjustments suggested by SGRT and ensures accurate target localization. The high correlation between SGRT and CBCT shift measurements indicates that SGRT is a reliable adjunct to CBCT, enhancing the precision of adaptive radiotherapy. This integrated approach optimizes treatment delivery by ensuring that radiation doses are effectively and safely administered to the target area, while minimizing exposure to surrounding healthy tissues. Despite its advantages, CBCT remains the gold standard for verification, highlighting the complementary nature of these technologies in contemporary radiotherapy practice. (3) Emerging Technologies: The integration of MR imaging into the radiation therapy process is a significant development. MR offers superior soft-tissue contrast and the ability to visualize organ motion, which is particularly beneficial for tumors in areas susceptible to movement, such as the lungs, liver, and prostate. Moreover, gastrointestinal ultrasound provides real-time imaging of the abdominal and pelvic regions, playing a crucial role in the detection and monitoring of gastrointestinal cancers. This technique is particularly valuable for adapting to the daily variations in tumor position due to physiological processes such as respiration and bowel movement. The development of tools like SurVolT, which converts daily surface data into volumetric changes for treatment planning, represents the forefront of IGRT innovation. Such tools are essential for implementing adaptive radiotherapy strategies that respond to daily patient anatomical changes. In conclusion, IGART continues to evolve with a focus on increasing precision and adapting to individual patient needs. SGRT stands as a significant advancement, with its integration with CBCT providing a robust solution for clinical practice. The ongoing development of some emerging technologies (eg.MR-guided systems) ensures that the future of radiation therapy will be even more tailored and effective, ultimately improving patient outcomes and reducing side effects.

484

ePROMs: What is possible?

Elizabeth Forde

Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland. Trinity St James' Cancer Institute, Trinity College Dublin, Dublin, Ireland

Abstract

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The use of questionnaires and toxicity assessment scales have been the mainstay of reporting outcomes of treatment for many years. Traditionally these questionnaires were observer-based, and whilst still commonly used today, this approach has been criticised due to the lack of concordance between observer-rated or patient-rated events. This shortcoming has prompted the emergence of patient reported outcome measures (PROMs) which aim to capture patients’ perspective on treatment effects. The implementation of PROMs has been facilitated by the explosion of digital technologies integrated in healthcare today, resulting in the use of electronic PROMs (e-PROMs). One of the most used tools to record adverse events from cancer treatment is the CTCAE. In order to capture the effect of treatment on patients’ quality of life (QoL), among other endpoints, this system considers the impact on “activities of daily living”. Despite this, the observer-rated approach risks there being a disconnect between the healthcare practitioner and the patient. To reduce the risk of undervaluing the impact of treatment on patient QoL, several questionnaires have emerged addressing this domain separately. The EORTC Quality of Life Questionnaire (EORTC QLQ-C30) and its site-specific modules are prime examples here. The pioneering work of the EORTC, has motivated other groups to follow suit, and today we now have several tools which have given a voice to the patient perspective, ultimately contributing to the expansion of PROMs available. Often using a combination of Likert scales and free text responses, additional probing questions are intended to comprehensively capture the breadth of difficulties associated with specific adverse events. Given the sheer volume of data potentially recorded, digitisation of data collection and storage is a necessity. Here we refer to the use of e-PROMS. The electronic nature of this approach allows for conditional branching logic within the e-PROM to increase efficacy in reporting, whilst also allowing room for cancer specific considerations. Several industry partners have invested efforts into this technology with the intention of providing seamless integration of e PROMs into the existing radiation oncology workflow. Quality of life is multidimensional, and this can only be fully appreciated by capturing the voice of patients directly. The use of PROMS should not be confined to those enrolled on clinical trials but must be integrated into routine care of all our patients. Radiation oncology today must embrace ePROMs to exploit the potential for real-time monitoring, enhancing patient engagement and optimizing treatment outcomes. Only in doing so, will we be able to provide holistic, patient-focused healthcare.

485

Global dialogue on PROMs

Jeffrey Tuan

Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore. ACP Oncology, Duke NUS Medical School, Singapore, Singapore

Abstract

I will describe a real-world example of using PROMs in a busy Radiation Oncology Centre in Singapore. The National Cancer Centre Singapore (NCCS) is the largest public cancer centre in the country. We see about 60% of all publicly funded cancer patients, which approximates to 10,000 a year. In the radiation oncology department, we see around 4,000 patients annually. We recognize the importance of PROMs in patient care as well as for health economic assessment, especially with the introduction of new and expensive technologies such as Proton Beam Therapy (PBT).

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The barriers to PROM uptake by patients, including consent, language, length of PROM questionnaires, and health literacy, will be addressed. There are challenges in the implementation of electronic PROMs with increased IT security concerns. Other logistic issues such as manpower, budgeting for PROM use as part of routine clinical duties, and the length of consultation time will be discussed.

486

Keys to success in PROMS: A patient’s view lying on the LINAC

Julie McCrossin

Australia

Abstract

As an 11-year survivor of HPV-related oropharyngeal cancer and a Head and Neck Cancer patient advocate, Julie will share examples of Patient Reported-Outcome Measures (PROMS) in routine radiation therapy treatment in Australia. The focus will be on the key factors that need to be in place to make this use of PROMS successful and the benefits to patients and multidisciplinary clinicians.

487

Burnout amongst radiation oncology professionals

Elizabeth Forde

Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland. Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland

Abstract

Burnout is an occupational phenomenon prevalent across all professions in Radiation Oncology. While not a new concept, the causes and impact of professional burnout are becoming increasingly better understood. To effectively tackle professional burnout a proactive approach must be adopted, whilst also having reactive strategies in place to support staff. Burnout is typically accompanied by a range of signs including emotional exhaustion, compassion fatigue, increased anxiety, lack of motivation, and poor professional performance. The physical and psychological consequences of burnout on the individual are significant. Not only does mental health decline but coping mechanisms and changed behaviours impact physical wellbeing. Individuals experiencing burnout are more likely to experience illness and are more likely to leave the profession, which then has a knock-on effect for our workforce and patients. Given the roles and responsibilities of individual staff are varied, the root causes of burnout may be profession specific. For example, for radiation therapists a lack of sense of belonging, unrecognition of their profession, and poor team collaboration will contribute to burnout. Radiation oncologists often find themselves constantly advocating for radiation therapy as a viable treatment option for cancer in tumour board meetings, in which they become progressively “battle-weary”. Furthermore, the ever-increasing number of administrative duties and non-

S13

Invited Speaker

ESTRO meets Asia 2024

medical tasks expected of radiation oncologists create a sense of professional invalidation. Finally, alexithymia among medical physicists has been identified as a trait which will increase the likelihood of developing burnout and less professional satisfaction. Despite these differences, many commonalities among professions are also apparent. Whilst higher levels of empathy are thought to improve professional quality of life, the emotional toll we carry when caring for patients during a particularly vulnerable time in their lives will lead to increased risk of burnout. The complex and intense relationships we form with our patients simultaneously provide job satisfaction as well as job stress. To mitigate burnout, we must first remove the stigma associated with it. Employers and managers must also address organisational culture to prioritise a positive work environment. Strategies to manage burnout may be reactive, such as temporary reduced workload and time off; however, a more proactive approach is needed to protect our staff and patients. These may include the provision of professional development opportunities and mentorship. Additionally, the provision of training related to stress management and resilience is also critical to protect our workforce.

488

Priorities of our generation: Work life balance and impact of staff retention

Caroline A Wright

Medical Imaging and Radiation Sciences, Monash University, Melbourne, Australia

Abstract

Introduction: Work–life balance (WLB) is achieved when there is alignment of one’s work, family commitments, other personal responsibilities and activities. Achieving this balance proves challenging for many in radiation therapy and oncology (RTO), with an over-emphasis on work resulting in reduced quality of life. Personal well-being and retention within organisations and the profession can be impacted by disruptions in WLB. Supporting personal well-being has been shown to reduce stress, increase personal and job satisfaction, quality and quantity of work and patient outcomes. So, how do we as busy practitioners achieve a WLB and sustain this without burning out, and how do our employers assist us in achieving a WLB? 1. Reviewing current priorities relating to WLB 2. Identifying factors that impact WLB 3. Analysing generational expectations of WLB 4. Discussing the pressures of promotion and organisational support for development 5. Outlining the impact of economic stability on WLB 6. Evaluating the impact of disruptors such as COVID-19, artificial intelligence (AI), and technological advancements 7. Identifying strategies to improve WLB and retention within the RTO professions Discussion: Factors which impact on WLB include work patterns, hours and workload (affected by staffing levels and increased service demand). In RTO emotional demands and mental health challenges relating to the daily pressures of work and high stakes patient care impact on WLB, causing burnout and workforce attrition (which is higher in RT than other professions). Economic instability as a result of perceived inequitable remuneration in health care The aim of this presentation is to explore current issues associated with WLB and its impact on staff retention through: