Amanda Webster of the National Radiotherapy Trials Quality Assurance (RTTQA) group presented ‘Implementation of plan of the day adaptive radiotherapy: Compliance to guidelines’ at the recent ESTRO 38 in Milan.
The work forms part of the RAIDER trial quality assurance programme. It is a multi-professional collaborative project between the RTTQA group and RAIDER team at the Institute of Cancer Research and the Royal Marsden, including clinicians, therapeutic radiographers, physicists and the ICR’s Clinical Trials and Statistics Unit.
RAIDER investigates an adaptive radiotherapy approach for bladder cancer, creating three personalised radiotherapy plans: small, medium, and large. Using daily cone beam computed tomography, the size and shape of the bladder is reviewed online and the most appropriate plan of the day (POD) is selected and verified by a pair of RTTQA accredited therapeutic radiographers.
Amanda said, “Using the PoD approach in a multicentre trial was a novel concept with only 11 out of 33 UK centres participating in RAIDER having previous PoD experience.
“We implemented a rigorous pre-trial and on-trial QA programme to support the radiographers in implementing this practice, and to support them in making guideline compliant PoD selections. We also considered we would require a strategy to sustain compliance throughout the trial.”
She continued, “To estimate the impact of the QA programme, we aimed to determine the guideline compliance of radiographer led online plan selection, in comparison with the offline plan selection of RTTQA reviewers. 439 CBCTs were initially evaluated, PoD selections were categorised and variations from guidelines were assessed. As a consequence of this analysis, the PoD selection guidance and QA programme were revised.”
They included:
- Updated trial documentation, providing detailed plan selection steps
- Formal PoD evaluation feedback reports for all centres
- An interactive workshop with centres
- A plan selection presentation
- One-to-one training sessions
Following release of the updates, a further 102 CBCTs were assessed for guideline compliance. On the initial review, 72% of PoD selections were guideline compliant. Following the revision of the QA programme, 96% of plan selections were guideline compliant.
“Our work reinforces the importance of implementing a thorough educational and QA programme when delivering novel radiotherapy techniques,” Amanda said.
“In this era of personalised radiotherapy, a rigorous QA programme and education is essential to ensure that these novel radiotherapy techniques are delivered safely and optimally; this allows us to achieve the best possible outcome for the patient.
“Therapeutic radiographers are at the forefront of these novel techniques and they must be empowered to act on radiotherapy delivery queries as they arise on-set,” she continued.
“Education, feedback and audit of PoD selections should be considered as part of routine practice to ensure that high standards are maintained. The results emphasise the efficacy of real-time monitoring of such training and adjusting as necessary, and for radiotherapy trials this work highlights the important role and impact of the RTTQA group in the delivery of high-quality trials in the UK.”
Attending and presenting at ESTRO 38, was a “thoroughly enjoyable experience,” Amanda says.
“It was an excellent opportunity to meet radiographers from other countries, network and discuss projects. It was also a really great experience to present this work during the Highlights of Proffered Papers, Award Lecture. As daunting as it may seem, I would highly recommend that other UK radiographers collate their work and submit an abstract for ESTRO 39. It really is a brilliant experience!”
RAIDER is a randomised phase II trial of adaptive Image guided standard or dose escalated tumour boost radiotherapy in the treatment of transitional cell carcinoma of the bladder. RAIDER is sponsored by the Institute of Cancer Research, funded by Cancer Research UK (CRUK/14/016) and coordinated by ICR-CTSU. The study is led by Professors Huddart and Hall. The RTTQA is a centralised UK group providing radiotherapy quality assurance programmes for all NIHR CRN Portfolio Radiotherapy trials. It is a multi-professional network of therapeutic radiographers, clinical scientists, clinicians, IT and admin staff working across several NHS sites. The RTTQA Group is funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
* Matt Beasley, advanced radiotherapy technology network research radiographer at ART-NET and Leeds Teaching Hospitals, won first prize at ESTRO 38 for his poster, ‘The impact of intra-thoracic anatomical changes upon the delivery of SABR’.
Go to www.estro.org/congresses to find out about submitting abstracts and posters for ESTRO 39.