Development and evaluation of a training program for therapeutic radiographers as a basis for online adaptive radiation therapy for bladder carcinoma☆

Abstract 

Aims

Online adaptive radiotherapy requires a new level of soft tissue anatomy recognition and decision making by therapeutic radiographers at the linear accelerator. We have developed a therapeutic radiographer training workshop encompassing soft tissue matching for an online adaptive protocol for muscle invasive bladder cancer. Our aim is to present the training program, and its evaluation which compares pre and post training staff soft tissue matching and bladder contouring using Cone Beam Computer Tomography (CBCT).

Materials and Methods

Prior to commencement of an online adaptive bladder protocol, a staff training program for 33 therapeutic radiographers, with a separate ethics approved evaluation component was developed. A multidisciplinary training program over two days was carried out with a total of 11h of training, covering imaging technology, pelvic anatomy and protocol specific decision making in both practical and theoretical sessions. The evaluation included both pre training and post training testing of staff.

Results

Pre training and post training, the standard deviations in the contoured bladder between participants in left–right direction were 0.64 vs 0.59cm, superior–inferior 0.89 vs 0.77cm and anterior–posterior direction was 0.88 vs 0.52cm respectively. Similarly the standard deviation in the volume contoured decreased from 40.7cc pre training to 24.5cc post training. Time taken in contouring was reduced by the training program (19.8 vs 17.2min) as was the discrepancy in choice of adaptive radiotherapy plans. The greatest reduction in variations in contouring was seen in staff whose pre training had the largest deviations from the reference radiation oncologist contours.

Conclusion

A formalized staff training program is feasible, well received by staff and reduces variation in organ matching and contouring. The improvement was particularly noticed in staff who pre training had larger deviations from the reference standard.

Keywords: Bladder carcinoma, Cone beam CT, Adaptive radiation therapy, Staff training