RTT advanced practice and how it can change the future of radiotherapy.

The radiation therapy (RT) landscape is continuously evolving, necessitating adaptation in roles and responsibilities of radiation therapists (RTTs). Advanced Practice Radiation Therapists (APRTs) have taken on a proactive role in expanding services and assuming responsibilities within multi-professional teams. A European Society for Radiotherapy and Oncology (ESTRO) brought geographically diverse and experienced RTTs together, to discuss how advanced practice (AP) in the RTT profession should be future-proofed and create a global platform for collaboration. Challenges in achieving consensus and standardisation of APRT was identified across jurisdictions, emphasising the importance of international collaboration. Whilst highlighting the pivotal role of APRTs in driving innovation, improving patient care, and navigating the complexities of modern RT practice, this position paper presents outcomes and recommendations from the workshop. Discussions highlighted the need for standardised role definitions, education frameworks, regulatory support, and career development pathways to enable the advancement of APRT effectively. Increasing networks and collaboration is recommended to ensure APRTs can shape the future of RT.

The Impact of a National Cyberattack Affecting Clinical Trials: The Cancer Trials Ireland Experience.

PURPOSE: Cyberattacks are increasing in health care and cause immediate disruption to patient care, have a lasting impact, and compromise scientific integrity of affected clinical trials. On the May 14, 2021, the Irish health service was the victim of a nationwide ransomware attack. Patient care was disrupted across 4,000 locations, including 18 cancer clinical trials units associated with Cancer Trials Ireland (CTI). This report analyses the impact of the cyberattack on the organization and proposes steps to mitigate the impact of future cyberattacks. METHODS: A questionnaire was distributed to the units within the CTI group; this examined key performance indicators for a period of 4 weeks before, during, and after the attack, and was supplemented by minutes of weekly conference call with CTI units to facilitate information sharing, accelerate mitigation, and support affected units. A total of 10 responses were returned, from three private and seven public hospitals. RESULTS: The effect of the attack on referrals and enrollment to trials was marked, resulting in a drop of 85% in referrals and 55% in recruitment before recovery. Radiology, radiotherapy, and laboratory systems are heavily reliant on information technology systems. Access to all was affected. Lack of preparedness was highlighted as a significant issue. Of the sites surveyed, two had a preparedness plan in place before the attack, both of these being private institutions. Of the eight institutions where no plan was in place, three now have or are putting a plan in place, whereas no plan is in place at the five remaining sites. CONCLUSION: The cyberattack had a dramatic and sustained impact on trial conduct and accrual. Increased cybermaturity needs to be embedded in clinical trial logistics and the units conducting them.

A review of surface guidance in extracranial stereotactic body radiotherapy (SBRT/SABR) for set-up and intra-fraction motion management.

INTRODUCTION: Surface guidance (SG) radiotherapy (RT) is now used by many radiotherapy departments globally and has expanded in popularity over the last number of years. A number of commercial systems are available. SG has routinely been used and is well established for cranial stereotactic radiosurgery (SRS) patient set ups and intra-fraction motion monitoring.However, data is limited in relation to its clinical use for extracranial stereotactic body radiotherapy (SBRT), particularly for targets which are impacted by respiratory motion such as the lung and liver. OBJECTIVE & INFORMATION SOURCE: A review of available literature was carried out on 24th October 2021 to assess the clinical feasibility and use of SG in SBRT via PubMed. METHODS: Eligibility CriteriaThe search criteria involved identifying articles where SG is used in extracranial SBRT.Risk of BiasTo eliminate the risk of bias, any particular commercial system was not the focus of the review and not included in the search criteria. Numerous clinical terms for similar things were used to reduce the risk of missing papers e.g. SBRT and SABR.Search CriteriaThe PRISMA checklist was used. Searching for "surface guidance and radiotherapy" yielded 3271 results, where as "SGRT" alone returned 72 results, when the search term was narrowed down using different iterations of SG and SBRT, only 6 results were available. Of these, 4 had reviewed clinical data in relation to SG and SBRT for patient set up and intra-fraction motion monitoring. RESULTS: The 4 studies indicate positive results for using SG with sufficient image guidance (IG) for both patient set up and intra-fraction monitoring during SBRT. This was observed both in free breathing and in patients with respiratory motion management being employed such as deep inspiration breath-hold (DIBH) techniques. All used multiple IGRT solutions to verify localisation pre-treatment in conjunction with SG.LimitationsThe number of studies available which report using SG in SBRT is extremely limited. All centres had also installed SG systems therefore this could result in an unconditional bias in using the system positively. CONCLUSION: SG can be used for SBRT set-ups and intra-fraction motion monitoring once sufficient IG is used to verify target localisation for treatment.

Dose Sparing Potential of Deep Inspiration Breath-hold Technique for Left Breast Cancer Radiotherapy Organs-at-risk.

BACKGROUND/AIM: To assess if deep inspiration breath-hold (DIBH) technique achieved dose sparing for organs-at-risk in left breast radiotherapy patients in order to reduce long-term complications. PATIENTS AND METHODS: DIBH and Free-breathing (FB) as a control, CT planning scans obtained for 28 left breast/chest wall (+/- supraclavicular field) patients treated January 2008-December 2013 were retrospectively re-contoured and re-planned. Organs-at-risk examined: lungs, left lung, heart and left anterior descending coronary artery (LADCA). Quantitative statistical analysis of plan dose differences was performed. RESULTS: Lung dose was not affected by DIBH. Heart Dmax reduced by 34.5% (FB=41.81Gy, SD=3.963Gy vs. DIBH=27.39Gy, SD=12.393Gy, p<0.000004). Heart Dmean reduced by 32.6% (FB=1.817Gy, SD=0.627Gy vs. DIBH=1.224Gy, SD=0.344Gy, p=0.00000083067. LADCA Dmax reduced by 47.8% (DIBH mean=15.56Gy, SD=10.62Gy vs. FB mean=29.82Gy, SD=10.05Gy, p=0.000031, and LADCA Dmean by 52% (DIBH mean=5.23Gy, SD=1.94Gy vs. FB mean=10.88Gy, SD=3.95Gy p=0.000000036027. Amplitude depths were not correlated with dose reductions. CONCLUSION: DIBH significantly reduces heart and LADCA dose. Further research is required to evaluate potential long-term implications for patients treated DIBH.