A Clinical Consensus Approach to Developing a New Funding Model for Radiation Services in Ontario.

In 2021, Ontario Health (Cancer Care Ontario) introduced a quality-based procedure model for the funding of radiation treatment (RT) in Ontario. This model ties reimbursement to patient care activities, ensuring equity and transparency in funding. Over 200 RT interprofessionals (oncologists, therapists and physicists) participated on 22 expert panels to establish or identify 288 evidence-based RT protocols and 672 quality expectations (QEs) to optimally deliver RT, which eventually led to the micro-costing of all protocols. Iterative review is required to ensure updated techniques and identify evolving standards of care, thereby providing the highest quality of RT care to Ontarians.

Dedicated Research Seed Funding to Support High-Priority Clinician-Led Research: A Survey of Clinician-Researchers.

BACKGROUND AND OBJECTIVES: Developing research capacity and supporting research engagement among health professionals are essential parts of bridging the evidence-to-practice gap. The objective of this study was to describe and assess the impact of research seed funding in promoting the engagement of nursing and allied health professionals in leading practice-based research studies within a health care organization. METHODS: An impact assessment survey was administered to health professional grant recipients (n = 30) to collect self-reported observations of changes related to clinical practice, patient care, and organizational priorities as a result of the funded research projects. The electronic survey was developed in collaboration with an interprofessional advisory committee and contained 23 closed- and open-ended questions. Survey data were analyzed descriptively, and responses to open-ended survey questions were used to characterize the funded research activities and the perceived successes and challenges experienced by the research teams. RESULTS: A large proportion of health professional grant recipients reported observing impact from their research studies on clinical practice, organizational priorities, and external networks. The grant funds were used to carry out knowledge dissemination activities such as conference presentations, publications, and sharing findings at professional meetings and networks. The majority of grant expenditures were used for research personnel, and the most common challenge to conducting research was related to the need for protected research time. Most grant recipients were interested in participating in another grant-funded research project in the future. CONCLUSION: Organizational funding and support for research led by health professionals have potential impact on clinical practice, patient care, and organizational priorities. This study provides evidence to support the value of investing in continued and expanded research funding programs for health professionals.

A prioritization framework for the analysis of near misses in radiation oncology.

INTRODUCTION: The term near miss implies the aversion of a harm event but often there is a lack of evidence when establishing a link between a failure in process and potential harm. The focus of this study was to use reported incident data to inform a prioritization framework for the triage of near miss events in a radiation therapy program. MATERIALS AND METHODS: Actual and near miss events during the study period were categorized using thematic analysis based on incident types. Near miss were characterized based upon their potential to result in harm to the patient using the concepts of failure modes and Analytic Hierarchy Process (AHP) theory. Near miss events were assessed for occurrence, detection and the potential impact and then assigned a summative normalized score reflecting prioritization recommendations, the normalized 10 point score (NTPS). RESULTS: 107 events were reported within the study timeframe. 65% of event type categories (n = 20) were attributed to near misses. 107 total events we analyzed using the framework with a maximum NTPS of 4 achieved across all event types. Of the 47 actual events 100% received a NTPS of 3 or greater. Of the 60 near miss invents 47% received an NTPS less than or equal to 1. Finally 15% of near miss events received a NTPS of 3 or greater. CONCLUSIONS: Near miss events provide a unique opportunity for learning however, can yield a great deal of data potentially limiting the resources for effective incident learning. A FMEA and AHP based prioritization framework for the triage of near miss events, including the likelihood of occurrence, probability of the event to go undetected and the potential impact if the incident did occur, allows for the optimal focus of programmatic resources in the analysis of these events.

Learning in 360 Degrees: A Pilot Study on the Use of Virtual Reality for Radiation Therapy Patient Education.

BACKGROUND: Patient education for external beam radiation therapy (EBRT) is traditionally delivered in verbal and/or written form, which may not provide a full picture of the complex, technical aspects of treatment. The purpose of this pilot study was to create and evaluate a prototype 360-degree virtual reality (VR) video outlining the technical aspects of EBRT to the pelvis as a supplement to traditional education methods. MATERIALS AND METHODS: A prototype VR video was filmed to simulate the delivery of one fraction of image-guided EBRT to the pelvis. Patients having a radical course of image-guided EBRT to the pelvis were approached while on active treatment to participate in focus groups evaluating the prototype VR video. Focus group discussions were recorded, transcribed, and subjected to thematic analysis. RESULTS: All patients were accrued from a single academic cancer centre in a large metropolitan area. In total, seven patients were enrolled to participate in the focus groups. Thematic analysis revealed 71% of participants felt the traditional patient education met their needs. However, 86% mentioned the education did not fully capture the treatment experience. Participants identified potential benefits of VR could include an increased understanding of the treatment process, specifically the spatial and acoustic aspects of treatment, as well as the potential to reduce anxiety in new patients. Timing was also important, with 86% of participants recommending VR video viewing before the first day of treatment. Participants provided feedback such as including two-dimensional elements in the VR video and other changes which could potentially make the viewing experience more realistic. CONCLUSIONS: Traditional teaching methods are seen as satisfactory by patients at our institution, but it is recognized that there is a gap in current education methods. An immersive VR education tool has the potential to enhance standard patient education, increasing understanding of treatment and decreasing anxiety.

Artificial Intelligence and the Medical Radiation Profession: How Our Advocacy Must Inform Future Practice.

There is no escaping the fact that academics are devoting unrelenting attention to the impact artificial intelligence will have on health care. Radiological and radiation oncology organizations worldwide are devoting their time and resources to ensure their members are both informed and prepared for the inevitable changes to the respective professions. This commentary provides an overview of how artificial intelligence will affect medical radiation professions of both diagnostic and radiation therapy streams. It outlines how these professions can play an active role in ensuring optimal outcomes for the well-being of both the workforce and the patients.

It Only Takes a Minute: The Development and Implementation of a Patient Experience Survey in Radiation Therapy.

INTRODUCTION: Health care services use surveys to assess patient satisfaction and identify areas for improvement. While it is important to assess patient satisfaction to ensure their needs are met, lengthy questionnaires with closed-ended questions often focus on areas that may be considered important by institutions rather than patients. Recently, focus has shifted toward patient and caregiver experience, which institutions address via appreciative inquiry. The aim of this initiative was the development of a patient experience survey (PES) for radiation therapy patients and caregivers which would allow them to express their opinions and priorities. This patient feedback would then be addressed through quality improvement (QI) projects geared toward improving the overall patient and caregiver experience in radiation therapy. METHODS: A three-question minute survey was developed for use as a PES in the radiation therapy department of an academic oncology program located in a large metropolitan area. Feedback was obtained from patient education and person-centred care experts, as well as 10 radiation therapy patients. All feedback was incorporated to create the final PES; respondents rated their agreement on a five-point Likert scale with the statement "My overall experience in Radiation Therapy was great" and two open-ended questions allowed them to highlight departmental strengths and areas for improvement. An initial 3-month pilot was conducted where PESs were available on a self-serve basis to patients and caregivers in waiting areas and at radiation therapy treatment units. All responses were anonymous and completed surveys were returned via drop boxes. Descriptive statistics and thematic analysis were used to analyse responses. RESULTS: A total of 86 surveys were returned. Of those, 80 (93%) responded to the Likert scale question with 83% agreeing or strongly agreeing that their experience in radiation therapy was great. Several strengths were identified by respondents including teamwork, professionalism, and knowledge. Areas identified for improvement included management of appointment delays and communication of delays to patients, as well as environmental improvements. CONCLUSIONS: Although most respondents reported a favourable experience, this pilot demonstrated the minute survey can identify areas for improvement that can be addressed through QI. Including the patient perspective in QI is evidenced to enhance its outcome and aligns with institutional, provincial, and national strategic goals of improving the quality of cancer care through patient engagement.

Development of a Quality and Safety Competency Curriculum for Radiation Oncology Residency: An International Delphi Study.

PURPOSE: To develop an entry-to-practice quality and safety competency profile for radiation oncology residency. METHODS AND MATERIALS: A comprehensive list of potential quality and safety competency items was generated from public and professional resources and interprofessional focus groups. Redundant or out-of-scope items were eliminated through investigator consensus. Remaining items were subjected to an international 2-round modified Delphi process involving experts in radiation oncology, radiation therapy, and medical physics. During Round 1, each item was scored independently on a 9-point Likert scale indicating appropriateness for inclusion in the competency profile. Items indistinctly ranked for inclusion or exclusion were re-evaluated through web conference discussion and reranked in Round 2. RESULTS: An initial 1211 items were compiled from 32 international sources and distilled to 105 unique potential quality and safety competency items. Fifteen of the 50 invited experts participated in round 1: 10 radiation oncologists, 4 radiation therapists, and 1 medical physicist from 13 centers in 5 countries. Round 1 rankings resulted in 80 items included, 1 item excluded, and 24 items indeterminate. Two areas emerged more prominently within the latter group: change management and human factors. Web conference with 5 participants resulted in 9 of these 24 items edited for content or clarity. In Round 2, 12 participants rescored all indeterminate items resulting in 10 items ranked for inclusion. The final 90 enabling competency items were organized into thematic groups consisting of 18 key competencies under headings adapted from Deming's System of Profound Knowledge. CONCLUSIONS: This quality and safety competency profile may inform minimum training standards for radiation oncology residency programs.

Hazards and incidents: Detection and learning in radiation medicine, a comparison of 2 educational interventions.

PURPOSE: Interprofessional, educational live simulations were compared with group discussion-based exercises in terms of their ability to improve radiation medicine trainees' ability to detect hazards and incidents and understand behaviors that may prevent them. METHODS AND MATERIALS: Trainees and recent graduates of radiation therapy, medical physics, and radiation oncology programs were recruited and randomized to either a simulation-based or group discussion-based training intervention. Participants engaged in hazard and incident detection, analysis, and a discussion of potential preventive measures and the concept of the "highly reliable team." A video examination tool modeled on actual incidents, using 5-minute videos created by faculty, students, and volunteers, was created to test hazard and incident recognition ability before and after training. Hazard and incident detection sensitivity and specificity analyses were conducted, and a survey of the participants' and facilitators' perceptions was conducted. RESULTS: Twenty-seven participants were assigned to the simulation (n = 15) or discussion group (n = 12). Hazard and incident-detection sensitivity ranged from 0.04 to 0.56 before and 0.04 to 0.35 after training for the discussion and simulation groups, respectively. The pre- and posttraining difference in sensitivity between groups was 0.03 (P = .75) for the minimum and 0.33 (P = .034) for the maximum reaction time. Participant perceptions of the training's educational value in a variety of domains ranged from a mean score of 6.58 to 8.17 and 7 to 8.07 for the discussion and simulation groups, respectively. Differences were not statistically significant. Twenty-six of the 27 participants indicated that they would recommend this event to a colleague. CONCLUSIONS: Participants' ability to detect hazards and incidents as portrayed in 5-minute videos in this study was low both before and after training, and simulation-based training was not superior to discussion-based training. However, levels of satisfaction and perceptions of the training's educational value were high, especially with simulation-based training.

The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy.

PURPOSE: Incident investigation, reporting, and learning are core elements of quality improvement in radiation treatment. This report describes the development of a Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT), focusing especially on the taxonomy. METHODS AND MATERIALS: The NSIR-RT was developed to provide a framework in Canada for reporting and analyzing radiation treatment incidents. A key objective was to assure compatibility with other international reporting systems to facilitate future information exchange. The Canadian community was engaged at every step of the development process through Delphi consensus building and inter-user agreement testing to promote awareness of the system and motivate broad-based utilization across the country. RESULTS: The final taxonomy was comprised of 6 data groups (impact, discovery, patient, details, treatment delivery, and investigation) and 33 data categories with predefined menu options. There was a high level agreement within the Canadian community about the final suite of data categories, and broad alignment of these categories with the World Health Organization and other American and European radiation treatment incident classifications. CONCLUSIONS: The Canadian NSIR-RT taxonomy will be implemented as an online, web-based reporting and analysis system. It is expected that the taxonomy will evolve and mature over time to meet the changing needs of the Canadian radiation treatment community and support radiation treatment incident learning on a global scale.

The Quest for Quality: Principles to Guide Medical Radiation Technology Practice.

Quality is a ubiquitous term in medical radiation technology; technologists, programs, and organizations emphasize the importance of "quality care," yet the concept of what is encompassed by the term, how it is built and measured, and who is the judge of whether it has been achieved, are often left undefined. This article will present theoretical definitions of quality, considering the value of professional, patient, and organization perspectives. Foundational quality principles and frameworks will be explored to highlight tools necessary to engage in "quality-related" activities and research at the individual, institutional, and systems level. Being equipped with an understanding of the work of Deming, the underpinnings of the lean strategy and the idea of continuous quality improvement will support technologists in contributing to evidence-based, high-quality, and safe practice. Building on these basics, concepts of complexity and standardization will be explored as they relate to achieving and maintaining quality given changing practice, focusing on personalized medicine, technological innovation, and best practice guidelines. Means to measure and evaluate quality will be presented, emphasizing the need for a structured approach. Using the work of the Canadian Partnership for Quality Radiotherapy as an example, key quality-related considerations, such as incident reporting, organizational structure, and quality culture will be discussed, with specific attention to roles within the team. When appropriately defined, measured, and evaluated, the quest for quality has the potential to improve safety and mitigate risk. Engaging technologists to assume strong roles in providing the highest quality of care will contribute positively at the level of the individual patient, the organization, and the system.

Examining the Effectiveness of Action Plans Derived from the Root Cause Analysis of Incidents Occurring in a Radiation Therapy Department.

PURPOSE: In 2011, the Canadian Partnership for Quality Radiotherapy developed guidelines for quality improvement. In the same year, a large academic cancer centre initiated a program of root cause analysis (RCA) and incident learning for major incidents. RCAs were performed on seven incidents; more than 40 action items were developed with the intent to prevent these incidents from recurring. The aim of this study was to determine the efficacy of implementation of the six action items, evaluate radiation therapists' (RTTs') awareness of these new action items, and determine whether communication among staff members was satisfactory. METHODS AND MATERIALS: The study consisted of two components. Part one examined four action items using a questionnaire distributed to all RTTs at the cancer centre. Part two examined two action items by auditing the radiation treatment software, MOSAIQ. RESULTS: Staff communication and RTTs' awareness of the action items ranged from 71% to 98%. For the first four action items, although most RTTs were aware of them, only 40%-70% of RTTs always or often used these action items and considered them effective. The fifth action item, implementation of the new breast tolerance setting, had 51% more overrides after implementation. Further investigation indicated only 40% of the tangent breast setups had new tolerance settings applied. CONCLUSIONS: Communication plays an important role in the dissemination and application of interventions identified from an RCA. A standardized route of communication is required to ensure that all RTTs fully understand an action item. A follow-up program and continuous monitoring of the action items are key to an effective RCA program.

A Retrospective Analysis of Prostate Cone Beam Computed Tomography (CBCT) Image Registration: A Tale of Two Techniques.

PURPOSE: To determine the feasibility of the gray-value registration technique as a correction method for prostate image-guided radiotherapy. BACKGROUND: The current practice at this institution involves a two-step process beginning with an automated bone registration, followed by a manual therapist manipulated registration. PROBLEM: This process is susceptible to subjective judgement and inter-observer variability, which introduces inconsistencies in image registrations and subsequent treatment delivery. Variation in the time required to complete image registrations may increase the chance for prostate intra-fractional movement, which may increase treatment inaccuracies. METHODS: A retrospective image review was completed for 20 patients. Translational shifts and duration data for therapist registrations were retrieved for 15 scans for each patient, totaling 300 scans. Gray-value registrations were completed on the same 300 scans to recalculate shift values and the time to complete this technique was recorded. The analysis of variance test was used to analyze the extent of variance between the two registration techniques. RESULTS: No difference between the two registration techniques in the lateral (right-left) direction (P = .364) and superoinferior directions (P = .455) were found. Gray-value registrations took significantly less time to complete and were more consistent than the two-step therapist registrations (P < .001). A statistically significant difference in z shifts exists (P = .003) between the two techniques. CONCLUSION: Gray-value registration can minimize and standardize the image registration durations and produce x and y shifts similar to those produced by therapists. Lacking the ability to preferentially match to the prostate-rectum interface, therapists still need to perform a simple inspection in the z (anteroposterior) plane to ensure an adequate registration to the interface.