To degas or not to degas? The effectiveness of pharmaceuticals in reducing the impact of bowel volume variations during liver SBRT treatment.

The indications for liver stereotactic body radiation therapy (SBRT) continue to expand in the management of liver cancer due to the improved rates of local control with acceptable normal tissue toxicity. Changes in internal anatomy, such as the bowel, may negatively impact the precision of treatment delivery of SBRT liver treatment by influencing daily image matching. Institutions have developed various approaches to promoting bowel volume consistency. One such strategy is the administration of pharmaceuticals. The administration of pharmaceuticals, such as Simethicone, has been adopted by the Princess Alexandra Hospital Radiation Oncology Department (ROPAIR) as a method to promote consistency in the amount of bowel gas observed in liver cancer patients. This case series examines a group of patients treated at ROPAIR with liver SBRT to determine whether current practices effectively reduce the impact of bowel volume variations for liver cancer patients. Initial observations from this hypothesis generating research suggest potential improved consistency of the small bowel's anatomical position for liver SBRT patients who were administered Simethicone (Bowel bag dice similarity coefficient - Simethicone group = 0.79-0.92, Standard group = 0.24-0.93). However, it appeared that this strategy alone may not be entirely effective achieving consistency in the amount of bowel gas present throughout the duration of treatment. Further investigation into the refinement of liver SBRT pre-treatment preparation is therefore recommended.

Identifying methods to best integrate indigenous knowledge and perspectives within the radiation therapy undergraduate curriculum.

The Australian healthcare system continues to work towards close the gap to improve and achieve equality in health and life expectancy for Aboriginal and Torres Strait Islander peoples. When culturally safe practice is forefront, it may be the driving force in improving Indigenous Australian healthcare outcomes. For students and practitioners to be equipped with the industry-required cultural safety skills, we believe Indigenous Australian knowledge and perspectives must be effectively integrated into undergraduate education. A scoping review of the literature was conducted to identify the most effective teaching and learning methods and assessment tools to best integrate Indigenous knowledge and perspectives into undergraduate radiation therapy curriculum at Queensland University of Technology (QUT). Embase, CINAHL, Scopus and PubMed-Medline were searched to access peer-reviewed studies published between 2017 and 2022. A total of 591 articles were identified with 39 full-text articles meeting the inclusion criteria. Methods of teaching and learning and independent assessment tools that promote cultural capability in undergraduate education were identified. Findings included intensive patient-specific workshops, which were reported to provide students with an immersive learning experience, better preparing them for clinical placements and future practice. Additionally, other allied healthcare professions have utilised tools such as the Cultural Capability Management Tool (CCMT) and Trans-Cultural Self-Efficacy Tool (TSET) to quantitatively assess positive shifts and highlight developmental needs. These findings will inform current educational endeavours to promote cultural safety and the cultural capability continuum in the undergraduate radiation therapy curriculum.

The implementation of MOSAIQ-based image-guided radiation therapy image matching within radiation therapy education.

Image-guided radiation therapy (IGRT) technologies are routinely used by radiation therapists (RTs) in clinical departments. However, there is limited literature on the acquisition and assessment of IGRT image-matching competencies in undergraduate educational environments. This commentary paper aims to share the authors' experiences in the development of teaching IGRT and image-matching concepts in an undergraduate radiation therapy programme. It outlines how MOSAIQ oncology information systems (OIS) have enabled the university to embed hands-on IGRT image matching on a range of clinical cases. The hands-on exposure to case-based planar and volumetric kilovoltage (kV) image matching has resulted in improved teaching and better preparation of students for clinical IGRT encounters. Students are likely to benefit from critical image assessment and decision-making as well as the improved engagement in teaching and learning.

Leadership in the radiation therapy profession: The importance of understanding the potential benefits and theoretical perspectives.

The incorporation of leadership concepts is at the forefront of agendas to advance the quality of patient care and innovation in many healthcare professions. In this Commentary, the authors draw upon evidence from the literature to discuss the theoretical perspectives of leadership and potential value in radiation therapy practice. For the patients to be provided with safe and high-quality treatment, continuous change and improvement are necessary. Leadership has the potential to influence behaviour change for practitioners and core organisational culture. Several leadership styles such as the transformational leadership can be applied to achieve a higher level of patient care and improve the likelihood of enhancing quality and efficiency in healthcare. These are also paramount to the success of radiation therapy practice. Hence, a higher priority should be placed on developing leadership in the Radiation Therapist (RT) workforce and educating new graduates of the potential benefits.

The Application of the Virtual Environment for Radiotherapy Training to Strengthen IGRT Education.

The use of simulation to enhance the quality of preclinical teaching and learning in radiation therapy is increasing. This article discusses the use of the Virtual Environment for Radiotherapy Training (VERT) in supporting teaching on image-guided radiation therapy (IGRT) and image matching concepts. The authors review the capabilities of VERT and discuss how it is currently applied in undergraduate radiation therapy teaching. The integration of IGRT theory with hands-on image matching practice using VERT simulation in educational environments has many potential benefits. These include the potential to strengthen the students' knowledge and skills in online-image acquisition and review of planar two-dimensional images and cone beam computed tomography images. It is anticipated that learner engagement will improve as well as refine analytical skills and confident practice in critical assessment of IGRT images. The authors encourage the utilization of technology that provides students with hands-on skills so they are better prepared for clinical environments.

The Impact of Artificial Intelligence and Machine Learning in Radiation Therapy: Considerations for Future Curriculum Enhancement.

Artificial intelligence (AI) and machine learning (ML) approaches have caught the attention of many in health care. Current literature suggests there are many potential benefits that could transform future clinical workflows and decision making. Embedding AI and ML concepts in radiation therapy education could be a fundamental step in equipping radiation therapists (RTs) to engage in competent and safe practice as they utilise clinical technologies. In this discussion paper, the authors provide a brief review of some applications of AI and ML in radiation therapy and discuss pertinent considerations for radiation therapy curriculum enhancement. As the current literature suggests, AI and ML approaches will impose changes to routine clinical radiation therapy tasks. The emphasis in RT education could be on critical evaluation of AI and ML application in routine clinical workflows and gaining an understanding of the impact on quality assurance, provision of quality of care and safety in radiation therapy as well as research. It is also imperative RTs have a broader understanding of AI/ML impact on health care, including ethical and legal considerations. The paper concludes with recommendations and suggestions to deliberately embed AI and ML aspects in RT education to empower future RT practitioners.

Utilising the Virtual Environment for Radiotherapy Training System to Support Undergraduate Teaching of IMRT, VMAT, DCAT Treatment Planning, and QA Concepts.

The use of three-dimensional virtual reality technologies in education has been widely reported in the literature. The goal of this article is to review how the virtual environment for radiotherapy training (VERT) can be utilised to support the teaching of intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy, and dynamic conformal arc therapy techniques. Utilising Pinnacle v14 (Philips Radiation Oncology Systems, Madison, WI) and Monaco v 5.10 (Elekta CMS, Maryland Heights, MO), we exported IMRT, volumetric-modulated arc therapy, and dynamic conformal arc therapy treatment plans to VERT. Quality assurance (QA) plans were also exported from the Monaco planning software to demonstrate theoretical concepts and virtual plan delivery using the ArcCHECK phantom (Sun Nuclear Corp, Melbourne, FL) and solid water IMRT phantom. Several VERT features were utilised to critically evaluate dose coverage and organ at risk sparing on inverse treatment plans. The display of gantry and multileaf collimator motion and fluence maps could be a useful feature in the education of treatment planning concepts. QA could be delivered on VERT to demonstrate patient-specific QA concepts in a virtual environment. Anecdotal evidence shows that the use of VERT for collaborative plan evaluation sessions is likely to engage the students and improve their ability to evaluate treatment plans. VERT can be utilised to reinforce understanding of treatment plan evaluation skills, QA, and treatment delivery of inverse plans in educational environments.

Exploring the Role and Application of the Deliberate Practice Concept in Radiation Therapy.

The concept of deliberate practice (DP) has been extensively applied to the development of skill and expert performance in many domains of professional practice. Although it has been widely reviewed in other health professions, there is a lack of evidence on its application in radiation therapy practice. This article aims to explore the concept of DP and how it can be applied to radiation therapy practice. The authors define DP, why it is essential, and how it can be implemented in radiation therapy. Evidence from the DP literature in the health professions was used to clarify the guiding principles for successful DP implementation within both the clinical and educational contexts. While the authors encourage radiation therapy practitioners to engage in DP approaches, every profession utilizing DP will develop strategies unique to the individual discipline. Hence, rather than imitating other professions, it is essential that radiation therapists engage evidence-based approaches that will generate empirical evidence to model radiation therapy-specific DP approaches.

Radiation Therapy Students as Partners in the Development of Alternative Approaches to Assessing Treatment Planning Skills.

AIM: The involvement of undergraduate students in assessment design is not a new concept. However, there is a paucity of evidence on radiation therapy students' participation in the design of teaching and learning activities. This article reports the development and initial evaluation of alternative approaches to assessing treatment planning skills and knowledge in undergraduate radiation therapy education. METHODS: A group of undergraduate radiation therapy students participated in a series of semistructured focus group meetings. The students nominated a practical examination and an oral plan critique assessment approach. The lecturers embedded two formative tasks to test the approaches in a second-year treatment planning subject. Two surveys assessed the experiences of the students, authenticity, engagement, and the practicality of the tasks in the treatment planning subject. RESULTS: The responses show that 92% of participants perceived the practical treatment planning examination as an authentic or real-world assessment approach. Moreover, 96% of the participants supported the notion of incorporating the tasks into the treatment planning subject. Most students (96%) perceived an oral critique of a treatment plan as an authentic approach and also supported the notion of incorporating oral critiques as an assessment task. Student engagement was high in both the practical and oral critique tasks, suggesting that lecturers could also include such tasks as formative activities to enhance learning. CONCLUSION: Involving student voices in pedagogic assessment design positively influenced the development of new assessments for the treatment planning subject. The oral critiques and practical-based approaches nominated are likely to enhance authenticity to students' learning experiences and provide opportunities for students to develop desirable professional capabilities.