A study into the review and verification of breast images treated with isocentric technique

Abstract 

In radiation therapy practice, portal imaging is a common occurrence. Radiation Oncologists want to be able to view the actual treatment port and compare it to the simulated view for quality assurance. Historically, this has been the domain of oncologists only but with the changes in imaging technology, this area of practice is now more commonly shared with the radiation therapists.

Purpose

The primary aim of this study was to compare the Radiation Therapists' result versus the Radiation Oncologists' practice of review and verification of electronic portal imaging in the treatment of breast cancer. A secondary result was enhancement of electronic portal imaging use.

Methods

The study was divided into two parts. Part 1 reviewed imaging of tangential breast treatment and part 2 reviewed mono-isocentric four-field breast technique. The review and verification of the images were conducted by the Radiation Therapists and Radiation Oncologists and their subsequent results were compared.

Results

Overall the Radiation Oncologist agreed with 96.9% of the images approved by the Radiation Therapists. This makes for a rejection rate of 3.1%. In general, Radiation Therapists adhered to the guidelines more closely than the Radiation Oncologist hence the rejection rate of Radiation Therapists was greater than the Radiation Oncologist by 7.0%.

Conclusions

The practice of electronic portal imaging review and verification in the treatment of breast cancer can be streamlined and achieved more efficiently. The Radiation Therapists consistently demonstrated their ability to review and verify the portal images, as equivalent to the Radiation Oncologist. Given the high standard of accuracy demonstrated the process of portal image review should be transferred to the Radiation Therapist. This transfer leads to reduction in duplicity of task, an increase in the use of technology, an improvement in efficiencies, and an increase in the quality of care, which will potentially lead to more improvements in delivery of service.

Keywords: Radiation therapy, Portal imaging, Image approval, Breast cancer, Professional practice, Isocentric technique