RTTs at the helm: moving towards RTT-led MR-guided radiotherapy
Hales, Rosie Rodgers, John Whiteside, L. Budgell, Geoff J Berresford, J. Choudhury, Ananya Eccles, Cynthia L
Hales, Rosie
Rodgers, John
Whiteside, L.
Budgell, Geoff J
Berresford, J.
Choudhury, Ananya
Eccles, Cynthia L
Citations
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Abstract
Purpose or Objective
Adaptive Magnetic Resonance-guided radiotherapy
(MRgRT) requires a multi-disciplinary approach and
significant clinical resources. To facilitate sustainable
MRgRT delivery models, specific magnetic resonance linear
accelerator (MR-Linac) based competencies must be
developed such that therapeutic radiographers (RTTs) can
undertake MRgRT predominantly independently. This work
describes the implementation of a protocol-driven
‘clinician-lite’ MRgRT workflow following the
identification of MRgRT-based skills and competencies.
Material and Methods
The implementation of an MRgRT service from the groundup
required the recognition of the new knowledge, skills
and competencies needed for safe, efficient MRgRT. To
determine the parts of the pathway that could be devolved
to RTTs and the skills required to do this, a needs
assessment and informal survey of the inter-disciplinary
team were undertaken. Competence in these skills was
achieved using a mixed-methods educational approach
that included tutorials, workshops, focused self-directed
reading, and end-to-end workflow testing. The MRgRT
pathway was critically evaluated by relevant professionals
to encourage multidisciplinary input and discussion,
allowing an iterative development of the RTT–led
workflow. Starting with the simplest online adaptation
strategy ‘adapt-to-position’ (ATP), which consists of a
virtual couch shift and online re-planning, clear guidelines
were established for the delivery of radical prostate
radiotherapy following a ‘clinician-lite’ protocol.
Results
The enhanced RTT skills identified for MRgRT delivery,
developed and practiced throughout the implementation
period, included MRI safety and screening, MR image
acquisition, MRI-based anatomy, multi-modality image
interpretation and registration, and treatment plan
evaluation. The roles and responsibilities of the three
professional groups (clinicians, RTTs and physicists) and
how they have evolved to achieve a ‘clinician-lite’
workflow are in Figure 1. Responsibility for CT-MR
registration has been devolved solely to RTTs, and applying
a definitive framework identifying agreed threshold and
action levels for anticipated treatment scenarios similar to
those in CBCT-based image-guided radiotherapy (IGRT),
responsibility for approving the new plan has been
transferred to physicists and RTTs. To date, a clinician was
required for online approval in <4% of fractions. Early
indications are that this methodology has the potential to
improve patient throughput and improve efficiency (Table
1). This ‘clinician-lite’ approach will be repeated during
the establishment of additional clinical sites for ATP
MRgRT.
Conclusion A ‘clinician-lite’ MRgRT ATP prostate treatment workflow
has been successfully implemented at our institution.
Further devolution of roles and responsibilities such as
validation of online contouring, planning and plan review
competence is in development to enable RTTs to fully lead
in the online workflow including in more complex adaptive
scenarios.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Hales R, Rodgers J, Whiteside L, Budgell G, Berresford J, Choudhury A, et al. OC-0683: RTTs at the helm: moving towards RTT-led MR-guided radiotherapy. Radiotherapy and Oncology . 2020 Nov;152:S380–1.