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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: [email protected]
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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 

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