Adapting to the Unknown: Development of an Education and Training Plan for the Implementation of a Cone-Beam Computed Tomography Based Online Adaptive Treatment System

Abstract

Purpose/Aim

Rapid technological advancements within radiation therapy present challenges in education and training. Historically, advancements within existing technology allow for the relation of current practice to new advancements in a linear fashion. The implementation of a new treatment platform is not a linear transition, requiring novel thinking, planning, and workflows This discussion aims to explore processes developed for the implementation of an Ethos treatment platform with online adaptive technology from a Radiation Therapist's (MRT(T)) perspective.

Methods/Process

Implementation of the Ethos treatment platform and online adaptive workflow required a multidisciplinary approach including Radiation Therapists, Medical Physicists (MP), and Radiation Oncologists (RO). A working group comprised of key stakeholders was formed and tasked with outlining the basic structure for implementation, draft treatment protocols, and standard operating procedures and training checklists. Within the adaptive workflow, MRT(T)s would be responsible for contouring organs at risk (OAR) known as influencer structures in addition to routine patient setup, imaging and treatment delivery. Initially, the MRT(T)s were to contour practice cases which would be reviewed by a certified Medical Dosimetrist. After completing a number of approved cases, the MRT(T) was signed off as competent. Unfortunately, it became evident that this process was resource intensive and unsustainable. MRT(T)s were however able to utilize a virtual imaging and treatment environment to practice the adaptive process including contouring. While still available, its use has been limited as we are now able to practice live in the treatment environment under the guidance of the RO.

Results or Benefits/Challenges

A significant benefit has been the implementation of a truly multi-disciplinary treatment environment. The adaptive workflow necessitates the teamwork of the MRT(T)s, MP, and RO for the treatments to be efficient and successful. For the MRT(T)s, there was a unique opportunity to be involved in implementation from the “ground up”. Other opportunities included research, policy development, novel working groups, and the opportunity to be part of a first in the world Ethos with Hypersight treatment platform. Within the adaptive workflow, MRT(T)s developed new skills in contouring and an improved understanding of clinical decision making and plan evaluation from the MP and RO groups. Developing a training process for the MRT(T)s was at times a “trial and error” process. While vendor training and practice sessions were paramount to our success, it was still difficult anticipate what the live treatment environment would be like. This led to uncertainties when attempting to develop training processes. Training was also a resource intensive process in a time of staffing shortages. Other challenges arose with integrating other disciplines into the MRT(T) workspace and adjusting to our “new normal” of practice.

Conclusions/Impact

The successful implementation of our Ethos treatment system and online adaptive workflow has reinforced the benefits of multidisciplinary collaboration. The education and training processes developed were imperative to enable the MRT(T)s to feel confident in their new role within the adaptive workflow. The increase in MRT(T) skills and capacity increases the possibility for future autonomy and increased scope of practice.