Journal of Medical Imaging and Radiation Sciences最新文献

{"title":"Quantifying Non-Clinical Activities of CSRTs/APRTs: A Data-Driven Approach within a Canadian Community of Practice in Canada","authors":"Saher Ali,&nbsp;Carrie Lavergne,&nbsp;Natalie Rozanec,&nbsp;Grace Lee,&nbsp;Henna Parmar","doi":"10.1016/j.jmir.2026.102359","DOIUrl":"10.1016/j.jmir.2026.102359","url":null,"abstract":"<div><h3>Purpose/Aim</h3><div>Clinical Specialist Radiation Therapists (CSRTs) and Advanced Practice Radiation Therapists (APRTs) contribute significantly to system improvements for cancer care by providing direct clinical care to patients while also contributing extensively to research, education, and quality improvement projects (QI). Although code capture systems have been developed to quantify clinical and technical impact, there are no standardized methods to track non-clinical workload contributions. To address this gap, the CSRT Community of Practice (CoP) launched an initiative to develop a systematic approach for capturing these activities, to support workforce advocacy, enhance collaboration, and inform CSRT/APRT role development.</div></div><div><h3>Methods/Process</h3><div>In late 2024, a survey of CoP members revealed that 100% of respondents (n=20) participated in non-clinical activities, including research, education, QI, and protocol revisions/development. Using the CAMRT APRT(T) competency profile, four domains were defined: leadership, education, research, and process improvement/best practice. Ten unique roles that further capture and describe the scope of non-clinical contributions were identified based on the CRediT taxonomy, and a template was developed. This framework and tracking template were shared with members for quarterly reporting.</div></div><div><h3>Results or Benefits/Challenges</h3><div>Initial submissions in early 2025 were limited due to the time-consuming nature of retrospective tracking and the unfamiliarity with the templates. Revisions were made to reduce barriers to submission, including a more user-friendly template and a how-to guide with examples. Along with transitioning to prospective tracking, these modifications improved engagement and increased reporting of diverse projects and roles. Using a Plan-Do-Study-Act (PDSA) methodology, the framework and definitions are refined quarterly to capture the breadth of activities.</div></div><div><h3>Conclusions/Impact</h3><div>By the end of 2025, participation peaked at 15 of 27 members, and the CoP continues to encourage further involvement. Systematic collection of non-clinical workload data offers a clearer understanding of the breadth and depth of CSRT/APRT roles beyond direct patient care. Future collection, analysis, and reporting of these findings will better inform workforce planning and may strengthen advocacy for funding. This standardized approach also fosters collaboration between CoP members, supports individuals developing their portfolios for advanced practice qualifications, and demonstrates the broader value of non-clinical contributions to healthcare systems.</div></div>","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102359"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Year Radiation Therapist Experience with CBCT-Guided Adaptive Radiation Therapy","authors":"Michael Velec,&nbsp;Vickie Kong,&nbsp;Samuel Appiah,&nbsp;Devin Hindle,&nbsp;Paul Kwan,&nbsp;Michelle Lara,&nbsp;Natassia Naccarato,&nbsp;Sidney Phung,&nbsp;Michael Sung,&nbsp;Lian Velasco,&nbsp;Alan Wong,&nbsp;Grace Wu,&nbsp;Simon Xie,&nbsp;Teuta Zoto Mustafayev,&nbsp;Dana Keilty,&nbsp;Monica Serban","doi":"10.1016/j.jmir.2026.102351","DOIUrl":"10.1016/j.jmir.2026.102351","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aim&lt;/h3&gt;&lt;div&gt;Adaptive radiation therapy (ART) enables precise management of complex organ motion and tumour response, potentially improving patient outcomes. Online ART is resource-intensive and requires radiation therapists (RTs) to develop technical competencies across treatment planning, delivery, and in some workflows, target segmentation. This work outlines our experience implementing ART and developing RT skills for safe, efficient clinical application.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods/Process&lt;/h3&gt;&lt;div&gt;Our institution implemented ART using a dedicated planning platform with a ring-based linear accelerator (Ethos, Varian Medical Systems). The system supports cone beam CT (CBCT)-guided online and offline ART with AI-assisted contouring and automated planning. Initial implementation and training were multidisciplinary, including 6 RTs. Daily online ART delivery followed a collaborative team model with RTs, a physicist, a radiation oncologist, and a dedicated radiation oncology fellow. The same RTs delivering ART also generated the initial reference plans. Training included system operation, anatomy and segmentation, reference planning, and online ART workflows. To support and evaluate training, we developed an ART-specific competency framework by adapting 27 competencies from the national RT entry-to-practice profile, which does not explicitly address ART. Competency validation was based on RT self-assessment after training and two months of clinical experience. RT training evaluation and skill development were conducted as an approved quality improvement initiative (QI #25-1064). Initial ART cases included genitourinary and sarcoma sites, with additional sites added as experience grew.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results or Benefits/Challenges&lt;/h3&gt;&lt;div&gt;Over 12 months, 13 RTs were trained in ART delivery and reference planning. To date, 126 patients have been planned and treated in the system: 41 sarcoma, 41 genitourinary, 16 upper gastrointestinal, 8 gynecologic, 7 head-and-neck, 5 other, and 8 palliative cases using a CTsim-free technique. Of these, 92 received daily online ART, while 20 underwent offline replanning, mostly using CBCT directly rather than a new CTsim. RTs reported increased competency across all domains after two months. Skills in reference planning increased to an intermediate level, requiring occasional support and skill development, especially among RTs without prior dosimetry experience. This did not significantly affect online ART delivery due to the team-based model. Challenges included the steep learning curve for complex cases, managing different techniques for multiple disease sites, adapting to a new planning system with distinct workflows, and initially low case volumes limiting hands-on experience.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions/Impact&lt;/h3&gt;&lt;div&gt;CBCT-guided ART has been successfully implemented across multiple disease sites through an online, multidisciplinary model involving RTs, physicists, and oncologists.","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102351"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148566004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Variables Associated with Inter-Fraction Bladder-Related Interruptions in Prostate and Prostate Bed Radiation Therapy","authors":"Patrycia Sek,&nbsp;Alex Ashley,&nbsp;Samantha Skubish,&nbsp;Cindy Vavasis,&nbsp;Junyi Xia,&nbsp;Seungjun Ahn,&nbsp;Richard Stock,&nbsp;Maria Dimopoulos","doi":"10.1016/j.jmir.2026.102373","DOIUrl":"10.1016/j.jmir.2026.102373","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aim&lt;/h3&gt;&lt;div&gt;Maintaining a full bladder is standard practice in prostate and prostate bed radiation therapy to minimize bowel dose and reduce gastrointestinal toxicity. However, achieving consistent bladder filling can be challenging, leading to treatment interruptions, repeat imaging, and potential patient dissatisfaction. This study evaluated the impact of predictors, such as patient age, treatment timing (before or after noon), nursing and dietitian consults, treatment site (prostate or prostate bed), and total number of treatments (fractionation schedule) on inter-fraction interruptions due to bladder filling. Inter-fraction bladder interruptions were defined as treatment sessions deferred after patient positioning due to bladder filling.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods/Process&lt;/h3&gt;&lt;div&gt;Following IRB approval, researchers performed a retrospective analysis of patients treated with external beam radiation therapy to the prostate or prostate bed between January 2019 and January 2025 at a large academic medical institution. Data was extracted from electronic medical records (Mosaiq and Epic). Predictors included treatment timing, age, treatment site, and documentation of nursing and dietitian consults. Inter-fraction interruptions due to bladder filling were identified using the electronic record code “TB.” Linear and logistic regression models were used to assess the associations between predictors and the likelihood of TB interruptions or appointment cancellations. Analyses were conducted using R version 4.4.2.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results or Benefits/Challenges&lt;/h3&gt;&lt;div&gt;A total of 271 patients were included in analysis (median age 69 years, IQR 62–75); 59% (n = 159) were treated to the prostate and 41% (n = 112) to the prostate bed. Interruptions occurring before noon accounted for 52% of all interruptions (n=140). Nursing and dietitian consults were completed in 80% (n = 217) and 91% (n = 247) of patients, respectively. Overall, 4.1% (n = 11) of appointments were canceled due to bladder filling. In univariable analysis, morning treatment was associated with a small, non-significant increase in interruptions (β̂ = 0.152, p = 0.420), nursing consults were not associated (β̂ = 0.121, p = 0.594), dietitian consults were not associated (β̂ = 0.106, p = 0.739), and age showed a negative but non-significant relationship (β̂ = -0.013, p = 0.245). Treatment site (prostate vs. prostate bed) and total number of treatments were significantly associated with total interruptions in the univariable analysis and were therefore included in the multivariable regression. After backward elimination, total number of treatments was the only variable that remained significantly associated with TB interruptions (β̂ = 0.026, p = 0.010), with each additional treatment corresponding to a 0.026 increase in TB interruptions; treatment site did not retain significance. The most frequent TB interruption was a single occurrence among patients treated with five ","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102373"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Resource Utilization and Enhancing Patient Access to a Single Satellite Radiation Therapy Site","authors":"Brian Leung,&nbsp;Vanessa Hribar,&nbsp;Christine Black,&nbsp;Ruvette Coelho,&nbsp;Tanya Bigg,&nbsp;Shawn Binda","doi":"10.1016/j.jmir.2026.102367","DOIUrl":"10.1016/j.jmir.2026.102367","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aim&lt;/h3&gt;&lt;div&gt;Our institution (Site A) supported by its satellite site (Site B), faced significant challenges in delivering equitable and timely radiation therapy to patients from X and Y postal regions. Due to capacity constraints and limited staffing at Site B, patients from these areas were unable to receive treatment locally, leading to inequities, delayed care, and increased travel burdens. Meanwhile, Site B’s treatment capacity was underutilized during low volume periods, while Site A experienced surges that created bottlenecks and operational inefficiencies, including frequent staff reassignments and increased costs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods/Process&lt;/h3&gt;&lt;div&gt;To address these challenges, a quality improvement initiative was implemented from January to June 2025, designed to optimize resource utilization and enhance patient access. Key components included staggered treatment pathways allowing patients to start at Site A and transfer to Site B as slots opened, technology enhancements like a self-check-in kiosk to support patient flow after hours, contingency nursing for rare acute needs, and structured scheduling guidelines to ensure clinical appropriateness for late-hour appointments.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results or Benefits/Challenges&lt;/h3&gt;&lt;div&gt;This initiative directly targets patients from previously excluded postal regions and the healthcare system as a whole by improving equitable access to radiation therapy, enhancing clinical safety, and increasing operational efficiency. Since launching in June 2025, the program has enabled patients to receive care closer to home, reducing travel burden, improving adherence to treatment plans, and enhancing the overall patient experience. Healthcare providers benefit from more predictable patient volumes, smoother workflows, and reduced need for disruptive staff reassignments, contributing to improved job satisfaction and workforce stability. The health system gains through better distribution of patient volumes, mitigating appointment backlogs, reducing overtime costs at Site A, and maximizing utilization of existing infrastructure at Site B without incurring significant new expenses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions/Impact&lt;/h3&gt;&lt;div&gt;The initiative’s impact spans multiple dimensions of healthcare quality, including improved effectiveness by ensuring timely and reliable treatment completion; increased efficiency through better staff deployment and reduced travel; enhanced health equity by removing geographic barriers; greater safety via structured scheduling and after-hours protocols; timely care by minimizing delays; and person-centered care by providing more responsive and respectful treatment closer to patients’ homes. Importantly, this model achieves these improvements without additional capital investment, leveraging existing facilities and integrating enhancements through the MosaiQ EMR system. Continuous measurement through patient volume tracking, wait time analysis, staff reass","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102367"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an Audit and Feedback Program to Measure and Reinforce Radiation Treatment Delivery Practices","authors":"Lyndon Morley,&nbsp;Lauren Silver,&nbsp;Rachel Glicksman,&nbsp;Kathy Man,&nbsp;Zaynab Muraj,&nbsp;Maureen Savage,&nbsp;Winnie Li","doi":"10.1016/j.jmir.2026.102372","DOIUrl":"10.1016/j.jmir.2026.102372","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aim&lt;/h3&gt;&lt;div&gt;To evaluate the feasibility of the Radiation Therapy Clinical Practice Assessment (RT-CPA) and assess longitudinal changes in adherence to key safety practices during routine linear accelerator treatment delivery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods/Process&lt;/h3&gt;&lt;div&gt;RT-CPA was developed iteratively through pilot observations to refine observable criteria and implementation processes. Education emphasized that RT-CPA is a practice-focused, anonymous quality-improvement activity. Trained observers assessed 104 treatment delivery procedures over a year across a large department. Twelve clinical practices were assessed per procedure, and most (1,099 or 88.1% of 1,248 opportunities) were observed and scored as Met, Partially Met, Unmet, or Unobserved. Performance was summarized and shared regularly with therapists. Temporal trends were evaluated with logistic regression (Met vs not-Met). Reasons for deviations were categorized using a human-factors framework to distinguish knowledge-based mistakes, attention- or memory-related errors, and intentional deviations. These details supported targeted educational, cultural, or system-level responses. The project was guided by a multidisciplinary quality committee that included a patient partner.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results or Benefits/Challenges&lt;/h3&gt;&lt;div&gt;High-reliability practices in radiation therapy (RT)—particularly communication, verification, and team coordination—are essential to safety and quality but are rarely measured routinely in the treatment environment. We developed a structured, non-punitive direct-observation tool to provide actionable, aggregate feedback on key clinical practices expected to be routine in safe RT delivery. RT-CPA was feasible to implement during clinical operations and supported timely feedback without disrupting care. Observations created opportunities for immediate, constructive discussion of practice rationale and importance, including when all standards were met, reinforcing shared understanding of safe practice. Conducting debriefs without interrupting workflow or creating distraction during treatment delivery requires flexibility.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions/Impact&lt;/h3&gt;&lt;div&gt;Overall adherence across all practices was 86.3%, improving from 68.4% in Q1 to 95.0% in Q4. The odds of meeting a practice increased significantly over time (OR 1.27 per month; 95% CI 1.20–1.35; p&lt;0.001). Practices with the lowest baseline adherence showed the largest improvements, including documentation (47.6%→100%), initial setup verification (40.0%→100%), patient identification (44.8%→82.6%), and verbal-visual verification (46.7%→76.9%). Several practices achieved 100% adherence by Q4. Observed deviations were primarily associated with awareness and routine non-adherence to expected practice and were addressed through targeted education and reinforcement. RT-CPA provides a practical approach to directly measuring and reinforcing safety-critical practices in RT treat","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102372"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Other Problem with “Problem Type”: Improving Incident Reporting in Radiation Therapy","authors":"Brian Liszewski,&nbsp;Misty Riach,&nbsp;Alison Giddings","doi":"10.1016/j.jmir.2026.102381","DOIUrl":"10.1016/j.jmir.2026.102381","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aim&lt;/h3&gt;&lt;div&gt;A substantial proportion of radiation therapy incidents within a pan-Canadian incident-learning system are coded under the problem type “Other,” limiting the ability to identify trends, benchmark performance, and support shared learning across jurisdictions. This practice innovation aimed to improve the quality and usefulness of incident-learning data by addressing inconsistent use of the “Other” problem-type classification. Specifically, the project sought to clarify whether events coded as “Other” reflected misclassification, gaps in existing problem-type definitions, or reports that did not meet criteria for reportable safety incidents.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods/Process&lt;/h3&gt;&lt;div&gt;All incident reports coded as “Other” over a two-year period were extracted and reviewed using a structured, two-stage classification process. In the first stage, a large language model was used to generate suggested problem-type classifications and to flag cases where use of “Other” appeared appropriate. In the second stage, radiation oncology subject-matter experts independently reviewed and validated these assignments using established incident-classification principles. Each report was assigned to one of three outcomes: (1) reassigned to an existing problem-type category, (2) identified as a novel event type not represented in the current taxonomy, or (3) deemed not a reportable safety incident. Discrepancies were resolved through consensus discussion, with particular attention to distinguishing problem type (patient impact) from contributing factors (underlying causes).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results or Benefits/Challenges&lt;/h3&gt;&lt;div&gt;The process highlighted key educational gaps, particularly confusion between patient impact and contributing factors, as well as inconsistent understanding of what constitutes a reportable safety incident. Challenges included variable report quality and inconsistent narrative detail, which limited confident reclassification. Expert review remained essential to ensure consistent application of incident classification principles.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions/Impact&lt;/h3&gt;&lt;div&gt;Approximately half of incidents initially coded as “Other” could be reassigned to existing problem-type categories, most commonly involving treatment delays, imaging issues, or positioning deviations. A substantial proportion of remaining reports were determined not to represent reportable safety incidents, often describing expected or unavoidable aspects of clinical care. Only a minority reflected truly novel event types. Emerging areas for refinement included incidents related to implanted devices, quality-assurance processes that prevented treatment, and minor variations not well captured by existing definitions. Overall, findings indicate that targeted education on incident theory and classification would yield the greatest improvement in data quality, with only modest updates to current categories required. This initiative demonstra","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102381"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Sustainability Quality Improvement Approach to Reducing Examination Table Paper Use in Radiation Oncology","authors":"Rachel Woo MRT(T), BSc (Hons),&nbsp;Agnes Cheung MSc (QIPS), BSc (Hons), MRT(T),&nbsp;Dr. Zahra Kassam MBBS, MSc, FRCR (UK), FRCP(C), DipABLM","doi":"10.1016/j.jmir.2026.102454","DOIUrl":"10.1016/j.jmir.2026.102454","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Climate change is recognized as a major threat to human health, with healthcare systems contributing substantially to greenhouse gas (GHG) emissions and solid waste&lt;sup&gt;1,2&lt;/sup&gt;. Cancer care is particularly resource-intensive, and cancer patients are especially vulnerable due to higher baseline health risks &lt;sup&gt;3&lt;/sup&gt;. Sustainability Quality Improvement (S-QI) integrates environmental sustainability objectives into routine healthcare quality improvement efforts, providing a structured approach to reducing environmental impacts&lt;sup&gt;1,4&lt;/sup&gt;.&lt;/div&gt;&lt;div&gt;Within Radiation Oncology, disposable examination table paper is commonly used during patient set-up, representing a potential source of low-value disposable waste. Limited evidence exists of infection prevention benefit when patient-contact surfaces and accessories are cleaned between patients according to standard infection prevention and control Canada (IPAC) protocols &lt;sup&gt;1&lt;/sup&gt;.&lt;/div&gt;&lt;div&gt;At our cancer centre, disposable examination table paper was routinely used across clinical areas, with frequent roll replacement generating ongoing costs and waste. As part of our department’s Sustainability and Planetary health Working Group, we undertook an S-QI initiative to reduce unnecessary use while maintaining safety and workflow efficiency.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;This S-QI initiative was implemented across all radiation oncology clinical locations, including five radiation treatment units and two CT simulators. A baseline assessment of examination table paper usage was conducted over a one-month period by recording the date of each paper roll replacement in each clinical area.&lt;/div&gt;&lt;div&gt;Following baseline measurement, a department-wide quality improvement memo outlined a practice change whereby disposable examination table paper would no longer be routinely used for every patient set-up. This intervention was supported by IPAC standards. Paper use was not eliminated entirely and remained available at the radiation therapist’s discretion.&lt;/div&gt;&lt;div&gt;Post-intervention paper usage was monitored using the same roll-replacement tracking approach.&lt;/div&gt;&lt;div&gt;Paper roll usage served as a proxy measure for disposable paper consumption. Cost savings were calculated using institutional purchasing data.&lt;/div&gt;&lt;div&gt;GHG emissions savings were estimated by converting the reduction in paper roll usage to an equivalent mass of paper and applying a conservative lifecycle emissions factor for paper production. Based on supplier specifications and standard estimates, paper use was converted to kilograms and an emissions factor of approximately 1.0 kg CO₂e per kg of paper was applied&lt;sup&gt;5&lt;/sup&gt;. Emissions estimates were inferred rather than directly measured and are reported as approximate monthly reductions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Implementation of the S-QI intervention was associated with a substantial and sustained reduction in disposable exa","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102454"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board/Masthead","authors":"","doi":"10.1016/S1939-8654(26)00360-7","DOIUrl":"10.1016/S1939-8654(26)00360-7","url":null,"abstract":"","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102546"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Proton Therapy in Ontario: Current Status and Future Directions","authors":"Tatiana Ritchie","doi":"10.1016/j.jmir.2026.102356","DOIUrl":"10.1016/j.jmir.2026.102356","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aim&lt;/h3&gt;&lt;div&gt;Proton therapy is widely used worldwide for treating pediatric cancers because of its significant clinical benefits, yet Canada remains the only G7 country without a proton therapy centre. This abstract explores why proton therapy is particularly beneficial for pediatric patients by reviewing supporting literature, examines Ontario’s current out-of-country referral process for accessing treatment abroad, and discusses progress toward establishing Canada’s first proton therapy centre.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods/Process&lt;/h3&gt;&lt;div&gt;Ontario Health has recommended proton therapy for pediatric cases based on strong clinical evidence. In 2022, the provincial government provided a $5 million planning grant as part of a $17.1 million investment to start design and feasibility work for Canada’s first hospital-based proton therapy centre at University Health Network (UHN) in Toronto. The plan includes up to five treatment suites and could serve about 1,500 pediatric and adult patients each year. Economic modeling suggests that having a domestic program would improve access, reduce delays, and save costs compared to sending patients to the U.S.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results or Benefits/Challenges&lt;/h3&gt;&lt;div&gt;Children undergoing cancer treatment are highly vulnerable to long-term side effects and secondary cancers, making precision in radiation delivery critical. Proton therapy addresses this need by offering superior dose conformity and reducing radiation exposure to healthy tissues compared to conventional photon therapy. Evidence from systematic reviews and meta-analyses shows proton therapy helps preserve neurocognitive function and lowers endocrine toxicity. For example, children treated with protons for brain tumors tend to maintain higher IQ and memory scores over time, while those treated with photons often show declines. Endocrine issues such as hypothyroidism and sex hormone deficiency are also reported far less often after proton craniospinal irradiation than after photon therapy. These findings highlight why access to proton therapy is so important for pediatric patients. In Ontario, patients eligible for proton therapy can access this specialized treatment by traveling to the United States. While treatment costs are covered through out-of-country programs, families must pay for travel, accommodations, and meals, which can create a significant financial burden. In some cases, these costs—along with social factors such as caregiving responsibilities or inability to take time off work—make it impossible for families to travel, resulting in patients receiving photon therapy in local treatment centers instead. Building a Canadian proton therapy centre is essential to eliminate these barriers, and although it requires significant upfront investment, it would ultimately reduce long‑term costs for the province.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions/Impact&lt;/h3&gt;&lt;div&gt;Ontario Health’s advisory committee has endorsed publicly funded proton t","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102356"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Putting Money Where our Mouths Are: Health Economic Analysis of APRT","authors":"Caitlin Gillan,&nbsp;Scott Jones,&nbsp;Mary Job,&nbsp;Nicole Harnett","doi":"10.1016/j.jmir.2026.102404","DOIUrl":"10.1016/j.jmir.2026.102404","url":null,"abstract":"<div><h3>Purpose</h3><div>This project aims to create an evidence-based baseline costing model for RT that can serve as the standard to conduct health economic analyses of practice innovations along the workflow.</div></div><div><h3>Methods</h3><div>This project involved three phases. In Phase I, a critical review of the literature informed the status of consideration of workflow in costing models for radiation therapy. Phase II consisted of an international Think Tank of RTT and health economics experts who contributed to an understanding of APRT workflow considerations with potential economic implications for the cost of care. Phase III will convene a virtual Canadian-based expert panel to build consensus for the model and assess the feasibility of implementation, with the intention of future piloting.</div></div><div><h3>Results</h3><div>The initial literature review focused on the re-review of papers identified in two key systematic reviews published in 2016. Minimal attention to workflow considerations were noted, as only 13/46 papers considered RTT-related costs, and none mentioned advanced practice. Only 5/46 papers made any reference to the potential contribution of workflow variations, generally related to the use of different technologies or devices, rather than personnel. Two papers referred to the impact of different personnel performing different aspects of a workflow.</div><div>Twenty-one medical radiation technologists attended the HEA Workshop held in conjunction with the Leading the Way in Radiographer Advanced Practice (LTWRAP) Conference in Bradford, United Kingdom, in September 2025, with representation from Canada, the United States, the United Kingdom, Singapore, and Australia. There was a slight but statistically insignificant increase in the perceived importance of HEA in APRT (average of 4.69/5 from 4.53/5). Participants noted a number of data to be collected moving forward as a result of the workshop, including patient throughput, patient experience, allocation of 'freed' physician time etc. Workflow mapping conducted during the workshop highlighted the potential cost implications of more efficient triaging and treatment planning, improved care coordination, and reduction in unused machine time, amongst other factors.</div><div>Further work to map costing models and engage in model consensus-building and piloting is ongoing.</div></div><div><h3>Conclusion</h3><div>The primary endpoint of this work is a fit-for-purpose RT costing model, with preliminary validation by RTT and health economics experts and pilot-testing in a single Canadian RT department.</div></div>","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 4","pages":"Article 102404"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148566009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}