RESUMEN
PURPOSE: This study investigated the role of radiation therapists (RTs) in the computed tomographic (CT) simulation procedure for patients receiving radiation therapy for breast cancer at a large comprehensive cancer clinic. RTs had developed a "hybrid role" whereby they practiced autonomously during a "therapist-led CT simulation." As well as CT scanning, RTs assessed the images, performed isocentre and field placement, and contoured the organs at risk in preparation for dosimetrists to optimize the dose distribution. A comparison between the confidence of the radiation oncologists (ROs) in delegating tasks to RTs for this procedure was compared with the RTs' confidence (self-assessed) in performing the task. Changes to the patient's plan after the CT procedure were recorded to examine the level of autonomy that was achieved as well as to identify areas for the development of RT skill, knowledge, and judgment. METHODS: A prospective mixed method two phase study was performed. In phase 1, seven key areas of critical tasks performed by RTs in the CT simulation procedure were identified and documented by the study population. Changes made to these critical tasks after CT simulation was complete were categorized. Responsibility for the changes (RT or RO), the presence of the RO at the CT simulation, and other issues were documented. In phase 2, surveys were distributed to ROs and RTs to rank their confidence levels of RTs performing the identified critical tasks during the CT simulation. RESULTS: For phase 1, 330 CT simulation cases for breast cancer over a 4-month period were documented. Eighty-four percent of cases remained unchanged and were approved by the RO; the majority of changes were initiated by a second more experienced RT. The majority of changes were related to cardiac coverage for left-sided patients (4.8%) and scar coverage (3.3%). ROs were present for 42% of the cases. For phase 2, 9 RO surveys (75% response) and 21 RT surveys (81% response) were returned. The majority of ROs and RTs agreed that they had confidence in RTs' abilities to perform the identified critical tasks. Factors that influenced RTs' confidence were complexity of the patient; self-confidence; and experience of the RT, RO practice preferences, and RT training availability and consistency. CONCLUSIONS: RTs have achieved a level of autonomy in their practice illustrated in the CT simulation process for breast cancer patients. This may be expanded with continued training and education. Formal mentoring relationships in CT simulation may aid in knowledge development. Enhanced communication between ROs and RTs will improve the process. This will enable RTs to provide a more efficient process and better patient care through improvements to continuity, flow, and quality.
