External beam treatment planning is an integral part of the therapeutic radiography curriculum, and is fundamental to the understanding of radiation dosimetry, clinical techniques, imaging and radiobiology.
Integrating theory and clinical practice effectively prepares students for their career by equipping them with the knowledge, skills and confidence to plan and deliver treatment both safely and effectively, while at the same time understanding the impact that ionising radiation has on both the tumour and the surrounding tissue.
Glasgow Caledonian University, Hertfordshire University, Sheffield Hallam University, and St George’s University of London have recently invested in the Academic Hub, a cloud-based resource, hosted and managed by Varian.
Shared resource
This shared resource reduces the financial impact on university IT departments, aids collaborative working and removes hardware capital costs. It provides access to the latest software and regular updates and as educators from the various universities we are able to communicate via Microsoft Teams to problem solve, attend training sessions together and share best practice. We work together to schedule sessions at appropriate times to ensure all students have access to the Academic Hub.
The Academic Hub offers Aria, an electronic patient management system, and Eclipse treatment planning tools (contouring and external beam), but also far more sophisticated tools for brachytherapy planning, proton planning, DVH, arc therapy, for example. Students have the advantage of learning the latest advancements in radiotherapy technology as part of the patient’s care pathway.
Students create a treatment plan on anonymised patients undergoing radiotherapy treatment for numerous anatomical sites. As educators we can incorporate advanced planning tools into our sessions and the use of artificial intelligence within radiotherapy planning.
Anatomy knowledge
Students' anatomy knowledge will be increased through use of CT, MRI, and PET-CT images, which can be reviewed alongside the Anatomy Atlas tool. Students learn how to manipulate images for the best visualisation, analyse the appearance of areas of disease, and identify and contour organs at risk.
Plan evaluation skills are enhanced in both the external beam and brachytherapy workspaces. Students' dose appraisal skills are enhanced, while they learn to evaluate dose to the Planning Target Volume, the organs at risk and the healthy tissue through use of Dose Volume Histograms. Students are able to apply their theoretical learning of radiation physics through experimentation with different radiation types and energies. This enables them to learn first-hand the effect of altering dose, technique, energy, weighting, multi-leaf collimator positioning, gantry and collimator angles, and the effect of field sizes.
Simulation education
Simulation education is already an important part of the radiography programme. A virtual learning environment is essential in equipping students with the confidence and skills to accurately create safe and effective plans which will result in safe treatment for the patient, and essentially result in disease control and minimisation of side effects.
Concepts such as organ delineation, energy choice, dose and treatment angles can be safely taught without any unnecessary risk. These essential concepts can be difficult to understand as a novice practitioner and use of the radiotherapy planning suite is critical in allowing students to develop this understanding on a practical level.
Advantages
The launch of the Academic Hub could not have come at a better time for the universities, because it allows our students to learn from the comfort of their own home, reducing travel during Covid-19 lockdowns. Cloud-based access allows greater flexibility with radiotherapy planning assignments, and provides access to students at times which are suitable for them. It also allows educators to integrate radiotherapy planning into oncology lectures. Lecturers can demonstrate the radiotherapy plan from any lecture hall, at the same time as teaching about the oncology, technique, treatment options, etc, helping students to link their practical and theoretical learning.
Over the past decade there has been extensive advances in radiotherapy treatment planning, allowing for dose escalation, toxicity reduction and ultimately improved disease control. A major change has been the advance from forward planning to inverse planning. The cloud-based system will ensure all students can use the most up-to-date planning tools available, exploring new concepts such as the role of stereotactic ablative radiotherapy, deep inspiration breath hold and adaptive planning in dose escalation, toxicity reduction and disease control. The Academic Hub also incorporates offline review, which will allow many universities to incorporate practical treatment imaging matching into their curriculum for the first time.
The Academic Hub will enhance students’ learning experience by enabling them to practice safely and effectively within the modern radiotherapy planning department. By developing our students’ skills with this system we will be equipping them with increased employability skills for the modern health service.
Authors
Jo McNamara, Sheffield Hallam University
Alex Robinson, Sheffield Hallam University
Jennifer Turnbull, Glasgow Caledonian University.
Ruth Rowse, University of Hertfordshire
Yasmeen Malik, St George’s, University of London
Julie Hendry, St George’s, University of London
What the teachers say...
Jennifer Turnbull, Glasgow Caledonian University ‘The treatment planning and offline image review tools in this cloud-based solution allow our students to learn all the latest planning techniques from the comfort of their own homes, while developing their skills and knowledge, and equipping them with expertise for their future careers. We look forward to working collaboratively with the other academic teams to promote radiotherapy education.’
Alex Robinson, Sheffield Hallam University ‘Having access to the latest planning software available we are able to expand the level of teaching. We have used it at all stages of the programme to teach anatomy, physics and planning and students have enjoyed especially seeing the anatomy in a format that they see out in clinical practice developing not only knowledge but decision making and analytical skills. It is helping us to create thinking radiographers of the future.
Yasmeen Malik, St George’s University of London ‘The greatest advantage of having a cloud-based system has meant we will always have the latest software system. Our students will be at the forefront of those developments such as machine learning and artificial intelligence in radiotherapy treatment planning. This year has meant that we were able to deliver treatment planning in term one as planned, with no major changes to our curriculum. We quickly set about updating our treatment planning workbooks to reflect the new software, and created a number of video instructions and learning material to support learning.’
Ruth Rowse, University of Hertfordshire ‘With teaching now being pushed to online ‘distance learning’ we can now be confident that we can continue to deliver essential teaching that will create practitioners suitably trained for the workforce. Simulation has always been an essential part of our curricula and now this can continue into our radiotherapy planning teaching too. We also welcome the opportunity to collaborate with other radiotherapy higher education institutions as we continue to improve and develop teaching in this sector.’