Promoting professional judgement through peer debate in radiation therapy undergraduate curriculum.

Radiation therapists (RTs) are often required to exercise professional judgement when faced with the ambiguity inherent in professional dilemmas not comprehensively accommodated by the professional Code of Conduct. Clinical educators therefore need to design curriculum that motivates students to apply professional judgement in ambiguous situations. Role play and peer debate enables development of competencies related to professional judgement. The aim of this short communication is to report on the rationale for and integration of peer teaching resources that prompt students to justify, through discussion and debate, the basis of their own judgement and those of their peers.

A National Cyberattack Affecting Radiation Therapy: The Irish Experience.

On Friday, May 14, 2021, the Health Service Executive, the organization providing public health services in the Republic of Ireland, was the victim of a significant cyberattack on its information technology systems. All systems were subsequently shut down to prevent further damage and to allow cybersecurity experts to investigate the attack. As a result, oncology services were severely disrupted, with the cessation of radiation therapy treatments in all public radiation therapy departments. Ireland has 5 large public and 6 smaller private radiation therapy centers in total. Because of the widespread adoption of electronic medical records in radiation therapy departments, it wasn't possible to retrieve patient details of those who were undergoing radiation therapy at the time of the cyberattack. In total, 513 patients nationally had their radiation therapy interrupted. A national radiation therapy cyberattack response team was formed immediately to oversee the response to the attack. The immediate concerns were radiation therapy emergencies and category 1 patients where gaps in treatment would have an adverse effect on outcome. Communication with patients and the public was also established as a priority and agreements were reached with the private sector for the treatment of patients affected by the cyberattack. The national media was used to alert patients of the need to communicate with their radiation therapy department. Dedicated phone lines were established. Locally, radiation therapy departments held daily crisis meetings with key staff members, including information technology personnel. Individual centers employed different technologies for treatment planning and data storage, so local solutions to the cyberattack to reestablish radiation therapy for patients were developed. In addition, national documentation on prioritization of patients to resume treatment was produced and a national approach was made to compensate for gaps in treatment caused by the attack. All 5 centers had reestablished radiation therapy by May 30, although there has been a long aftermath to the cyberattack. In this article, we provide an overview of the effects of the cyberattack on our national radiation therapy service and our strategy to resume patient treatment in a timely fashion.

Exposure of the heart in lung cancer radiation therapy: A systematic review of heart doses published during 2013 to 2020.

BACKGROUND AND PURPOSE: Lung cancer radiotherapy increases the risk of cardiotoxicity and heart radiation dose is an independent predictor of poor survival. This study describes heart doses and strategies aiming to reduce exposure. MATERIALS AND METHODS: A systematic review of lung cancer dosimetry studies reporting heart doses published 2013-2020 was undertaken. Doses were compared according to laterality, region irradiated, treatment modality (stereotactic ablative body radiotherapy (SABR) and non-SABR), planning technique, and respiratory motion management. RESULTS: For 392 non-SABR regimens in 105 studies, the average MHD was 10.3 Gy (0.0-48.4) and was not significantly different between left and right-sided tumours. It was similar between IMRT and 3DCRT (10.9 Gy versus 10.6 Gy) and lower with particle beam therapy (proton 7.0 Gy; carbon-ion 1.9 Gy). Active respiratory motion management reduced exposure (7.4 Gy versus 9.3 Gy). For 168 SABR regimens in 35 studies, MHD was 4.0 Gy (0.0-32.4). Exposure was higher in central and lower lobe lesions (6.3 and 5.8 Gy respectively). MHD was lowest for carbon ions (0.5 Gy) compared to other techniques. Active respiratory motion management reduced exposure (2.4 Gy versus 5.0 Gy). Delineation guidelines and Dose Volume Constraints for the heart varied substantially. CONCLUSIONS: There is scope to reduce heart radiation dose in lung cancer radiotherapy. Consensus on planning objectives, contouring and DVCs for the heart may lead to reduced heart doses in the future. For IMRT, more stringent optimisation objectives may reduce heart dose. Active respiratory motion management or particle therapy may be considered in situations where cardiac dose is high.

Evaluation of an eLearning teaching innovation to assist clinical radiation therapy educators in the provision of student feedback.

BACKGROUND: Clinical placement is an integral part of the Radiation Therapy undergraduate programme. Feedback and formative assessment during clinical placement are regarded as key to developing clinical skills and competencies. Students regularly report dissatisfaction with the feedback process while clinical educators report heavy clinical workloads and a lack of guidance on feedback mechanisms as barriers to providing meaningful student feedback. METHODS: An eLearning teaching intervention was developed to support radiation therapists in the provision of student feedback in the clinic. Thematic analysis was used to report attitudes to feedback and feedback practices collected in a pre and a post intervention evaluation. RESULTS: 30 radiation therapists completed the module and pre and post intervention evaluations. Prior to taking the module just over half of respondents stated that they offered regular and on-going feedback throughout the student's placement. Positive attitudes to feedback were reported. Following completion of the eLearning tool respondents reported a higher level of confidence in the provision of student feedback and almost 70% said the module had changed how they would approach the feedback process by using feedback models in the future. DISCUSSION: Good and timely feedback is essential and allows a student opportunity to improve prior to the end of the placement. It also teaches students how to self-assess and self-reflect - skills that they can use in continuous professional development after they graduate. Radiation therapists appreciate the structure that using a model in the feedback process offers. CONCLUSION: This eLearning teaching intervention was received favourably by radiation therapists who are key to creating a culture of feedback in the clinical environment that will facilitate students in becoming competent healthcare professionals.

Future-proof Radiation therapist (RTT) practice in a pandemic - Lessons learnt from COVID-19.

BACKGROUND AND PURPOSE: The European SocieTy for Radiotherapy and Oncology Radiation Therapist Committee (ESTRO RTTC) published a guidance document and infographic providing recommendations to minimise risk of COVID-19 transmission in radiotherapy (RT) departments. The purpose of this study was to investigate the changes embedded in RT practice in the COVID-19 era and to recommend proactive measures to protect RT practice in future pandemics. MATERIALS AND METHODS: The study was initiated by the ESTRO Radiation Oncology Safety and Quality Committee (ROSQC). A survey consisting of multiple choice, open ended and Likert scale questions was created to analyse the extent of changes embedded in RT practice in response to the COVID-19 pandemic under the four domains: patient care, RTT workflow, remote working and RT practice. This online survey was distributed globally in May 2020. RESULTS: 229 respondents across 27 countries completed the survey. 60% of respondents reported continuing/commencing RT in COVID-19 patients. Routine testing of patients and RTTs was not common. Split teams' procedures, hot linacs and separate entrances were implemented by 50% of respondents. Remote working was implemented for RT team members where face to face patient contact was not essential. Lack of staff, connectivity issues and lack of confirmed positive cases in the department were the main reasons cited for not implementing recommended measures. CONCLUSION: It is suggested that RT departments have responded to the COVID-19 pandemic and implemented certain changes in RT practice. RT departments should act now to implement recommended proactive measures to protect patients and RTTs - frontline healthcare workers.

A review of Image Guided Radiation Therapy in head and neck cancer from 2009-201 - Best Practice Recommendations for RTTs in the Clinic.

Radiation therapy (RT) is beneficial in Head and Neck Cancer (HNC) in both the definitive and adjuvant setting. Highly complex and conformal planning techniques are becoming standard practice in delivering increased doses in HNC. A sharp falloff in dose outside the high dose area is characteristic of highly complex techniques and geometric uncertainties must be minimised to prevent under dosage of the target volume and possible over dosage of surrounding critical structures. CTV-PTV margins are employed to account for geometric uncertainties such as set up errors and both interfraction and intrafraction motion. Robust immobilisation and Image Guided Radiation Therapy (IGRT) is also essential in this group of patients to minimise discrepancies in patient position during the treatment course. IGRT has evolved with increased 2-Dimensional (2D) and 3-Dimensional (3D) IGRT modalities available for geometric verification. 2D and 3D IGRT modalities are both beneficial in geometric verification while 3D imaging is a valuable tool in assessing volumetric changes that may have dosimetric consequences for this group of patients. IGRT if executed effectively and efficiently provides clinicians with confidence to reduce CTV-PTV margins thus limiting treatment related toxicities in patients. Accumulated exposure dose from IGRT vary considerably and may be incorporated into the treatment plan to avoid excess dose. However, there are considerable variations in the application of IGRT in RT practice. This paper aims to summarise the advances in IGRT in HNC treatment and provide clinics with recommendations for an IGRT strategy for HNC in the clinic.

Intravenous contrast media in radiation therapy planning computed tomography scans - Current practice in Ireland.

INTRODUCTION: While Computerised Tomography (CT) remains the gold standard in radiation therapy (RT) planning, inferior soft tissue definition remains a challenge. Intravenous contrast (IVC) use during CT planning can enhance soft tissue contrast optimising Target Volume (TV) and Organ at Risk visualisation and delineation. Despite this known benefit, there are no guidelines for when and how to use IVC in RT planning scans in Ireland. AIM: The study aims to examine the patterns of practice in relation to the use of IVC in RT planning scans in Ireland and to determine the level of compliance with international guidelines. Radiation Therapists (RTT) IVC training will also be investigated. MATERIALS AND METHODS: An anonymised online survey was designed based on previously-reported literature. This was distributed to all RT departments in Ireland. The survey contained open, closed and Likert scale questions that investigated IVC practices in each department. RESULTS: 75% (n = 9/12) of Irish departments responded. All responding departments reported using IVC. RTTs cannulated patients in 67% (n = 6/9) of the departments and administration contrast in all departments. Variations from recommended guidelines were found in disease sites where IVC was routinely used and in the assessment of renal functioning prior to contrast administration. IVC training varied in duration and number of supervised procedures required to fulfill competencies. CONCLUSION: IVC is used extensively in Irish RT departments. There are variations in IVC practice between departments and with international recommended guidelines.