Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-26T12:35:12.306Z Has data issue: false hasContentIssue false
  • English
  • Français

Radiation therapist perspectives on cone-beam computed tomography practices and response to information

Published online by Cambridge University Press:  16 May 2013

Caitlin Gillan ,
Winnie Li  and
Nicole Harnett
Caitlin Gillan*
Affiliation:
Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
Winnie Li
Affiliation:
Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
Nicole Harnett
Affiliation:
Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
*
Correspondence to: Caitlin Gillan, ELLICSR, Toronto General Hospital, Clinical Services Building, Basement BCS021, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4. Tel: (416) 581-8137. Fax: (416) 340-5027. E-mail: caitlin.gillan@rmp.uhn.on.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

With recent technological advances in image-guided radiation therapy (IGRT), through cone-beam computed tomography (CBCT), more image-related clinical information is being collected, at more frequent intervals throughout the treatment course. As radiation therapy (RT) programmes further develop IGRT technology, the aim of this study is to assess whether the distribution and communication of professional responsibilities is evolving to ensure appropriate use of the technology.

Methods

Radiation therapists practicing at any of the 14 Ontario RT centres were sent an electronic survey (n = 400). Closed-ended quantitative items addressed perceptions regarding policies, comfort, and professional responsibility in addressing CBCT concerns. Focus was on gynaecological, lung, head and neck (H&N) disease sites. Options for qualitative comments and explanations were included where appropriate.

Results

Seventy-nine surveys were submitted. Respondents from 12/14 (85·7%) centres used CBCT for at least one of three disease sites, most commonly on a daily basis. Five of these centres (41·7%) did not require radiation oncologist CBCT review, with others requiring it Day 1 or weekly. Potential CBCT observations of concern were grouped as set-up issues, tumour changes, organ-at-risk (OAR) changes, contour changes and ancillary findings (especially lung and airway changes). Respondents believed they consulted another professional about a CBCT in 20·2% of H&N patients, 19·6% of lung patients and 9·7% of gynaecological patients. The level of comfort in doing so varied from 77·0% for H&N to 89·5% for lung. Respondents were most likely to believe themselves responsible for changes in OARs (92·2% believing themselves responsible), and least likely for ancillary findings (62·7%).

Conclusions

Through preliminary insight from Ontario therapists, a degree of inconsistency is apparent between perceptions, practices and assigned roles in the management of CBCT information. Clear definition of the scope and nature of therapists’ responsibility for interpreting and addressing changes on CBCT images should be developed within each centre.

Keywords

cone-beam computed tomographyimage-guided radiation therapyinterprofessional radiation medicine practiceprofessional roles and responsibilities
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 12 , Issue 3 , September 2013 , pp. 237 - 244
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Jaffray, D A, Siewerdsen, J H, Wong, J W, Martinez, A A. Flat-panel cone-beam computed tomography for image-guided radiation therapy. Int J Radiat Oncol Biol Phys 2002; 53 (5): 1337–1349.CrossRefGoogle ScholarPubMed
2.Boda-Heggemann, J, Kohler, F M, Wertz, Het al. Intrafraction motion of the prostate during an IMRT session: a fiducial-based 3D measurement with cone-beam CT. Radiat Oncol 2008; 3: 37.CrossRefGoogle Scholar
3.McBain, C A, Henry, A M, Sykes, Jet al. X-ray volumetric imaging in image-guided radiotherapy: the new standard in on-treatment imaging. Int J Radiat Oncol Biol Phys 2006; 64 (2): 625–634.CrossRefGoogle ScholarPubMed
4.Barker, J L Jr, Garden, A S, Ang, K Ket al. Quantification of volumetric and geometric changes occurring during fractionated radiotherapy for head-and-neck cancer using an integrated CT/linear accelerator system. Int J Radiat Oncol Biol Phys 2004; 59 (4): 960–970.CrossRefGoogle ScholarPubMed
5.Greenhalgh, T, Robert, G, Macfarlane, F, Bate, P, Kyriakidou, O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 2004; 82 (4): 581–629.CrossRefGoogle ScholarPubMed
6.Devereux, B, Frantzis, J, Sisson, T, Jones, M, Martin, J, Middleton, M. A comparison of kV and MV imaging in head and neck image guided radiotherapy. Radiography 2010; 16 (1): 8–13.CrossRefGoogle Scholar
7.Jaffray, D A. Emergent technologies for 3-dimensional image-guided radiation delivery. Semin Radiat Oncol 2005; 15 (3): 208–216.CrossRefGoogle ScholarPubMed
8.Dawson, L A, Jaffray, D A. Advances in image-guided radiation therapy. J Clin Oncol 2007; 25 (8): 938–946.CrossRefGoogle ScholarPubMed
9.Foroudi, F, Wong, J, Kron, Tet al. Development and evaluation of a training program for therapeutic radiographers as a basis for online adaptive radiation therapy for bladder carcinoma. Radiography 2010; 16 (1): 14–20.CrossRefGoogle Scholar
10.White, E, Kane, G. Radiation medicine practice in the image-guided radiation therapy era: new roles and new opportunities. Semin Radiat Oncol 2007; 17 (4): 298–305.CrossRefGoogle ScholarPubMed
11.Gillan, C, Wiljer, D, Harnett, N, Briggs, K, Catton, P. Changing stress while stressing change: the role of interprofessional education in mediating stress in the introduction of a transformative technology. J Interprof Care 2010; 24 (6): 710–721.CrossRefGoogle ScholarPubMed
12.Li, W, Harnett, N, Moseley, D J, Higgins, J, Chan, K, Jaffray, D A. Investigating user perspective on training and clinical implementation of volumetric imaging. J Med Imaging Radiat Sci 2010; 41 (2): 57–65.CrossRefGoogle ScholarPubMed
13.Bell, L J, Oliver, L, Vial, Pet al. Implementation of an image-guided radiation therapy program: lessons learnt and future challenges. J Med Imaging Radiat Oncol 2010; 54 (1): 82–89.CrossRefGoogle ScholarPubMed
14.Ding, G X, Duggan, D M, Coffey, C Wet al. A study on adaptive IMRT treatment planning using kV cone-beam CT. Radiother Oncol 2007; 85 (1): 116–125.CrossRefGoogle Scholar
15.Burridge, N, Amer, A, Marchant, Tet al. Online adaptive radiotherapy of the bladder: small bowel irradiated-volume reduction. Int J Radiat Oncol Biol Phys 2006; 66 (3): 892–897.CrossRefGoogle ScholarPubMed
16.Devereux, B, Sisson, T, Fenton, Pet al. Uniformity in the analysis of head and neck image guided radiotherapy across multiple departments. The Radiographer 2011; 58 (2): 5–9.CrossRefGoogle Scholar
17.Odle, T, Rosier, N. Radiation Therapy Safety: the Critical Role of the Radiation Therapist. ASRT Education and Research Foundation Health Care Industry Advisory Council Subcommittee on Patient Safety and Quality in Radiation Therapy. Albuquerque, NM: American Society for Radiological Technologists, 2012.Google Scholar
18.Cerase, C, Loudon, J, O'Sullivan, Bet al. The incidence of treatment modification based on daily cone beam CT assessment for head and neck cancer patients. Radiotherapy & Oncology 2012; 104 (suppl 2): S41.Google Scholar
19.Rybovic, M, Banati, R B, Cox, J. Radiation therapy treatment verification imaging in Australia and New Zealand. J Med Imaging Radiat Oncol 2008; 52 (2): 183–190.CrossRefGoogle ScholarPubMed
20. American Society for Radiation Oncology (ASTRO). Safety is No Accident: A Framework for Quality Radiation Oncology and Care. Fairfax VA: American Society for Radiation Oncology, 2012.Google Scholar
21.Burow, R, Cavenagh, J, Simpson, C, West, M, Cox, J, Szymura, K. Avenues for roles expansion in image guided radiation therapy: discussion and recommendations for kilovoltage and megavoltage imaging. The Radiographer 2009; 56 (3): 49–54.CrossRefGoogle Scholar
22.Liszewski, B, DiProspero, L, Bagley, R, Osmar, K, D'Alimonte, L. A preliminary evaluation of a clinical training program for volumetric imaging. J Med Imaging Radiat Sci 2012; 43 (Suppl): S31.Google Scholar