Defining and Evolving MR Personnel in Radiation Therapy

Purpose/Aim

The superior soft-tissue contrast of Magnetic Resonance Imaging (MR) has prompted radiation therapy (RT) departments globally to invest in MR simulators (MRSIM) and integrated MR-Linacs (MRL). Maintaining MR safety within RT departments adds a layer of complexity to operations, particularly staffing. Radiology guidelines stratify staff into 2 levels of MR personnel: Level 1 (those who work in an area that has an MR scanner) and Level 2 (those who have more extensive training and typically operate the MR technology). Historically, certified MR technologists (RTMR) have been identified as Level 2 MR personnel and assume responsibility for machine operation and for MR safety. It has been recognized, however, that this strategy may not meet the needs of complex hybrid MR settings such as RT given the type and number of personnel that are employed. The aim of this work was to define a pathway for radiation therapists (RTT) who are not certified as RTMRI to take on the responsibilities of Level 2 MR personnel including operation of MR technology and MR safety.

Methods/Process

Upon implementation of our MR planning program in 2016, all RTTs who were not certified as RTMR were identified as Level 1 personnel and RTMR as Level 2 personnel. Although, Level 1 personnel do not work on any MR technology, they are required to complete basic MR safety training on a yearly basis to ensure that they do not constitute a danger to themselves or others in the MR environment. As our MR fleet grew to 3 MRSIM (0.5T, 1.5T and 3T) and 1 MRL, alternate pathways to upskill RTTs to Level 2 responsibility were explored. In order to define requirements of Level 2 MR personnel, an environmental scan was conducted to understand the approaches in other jurisdictions. The 2 main commonalities were a didactic component that included MR physics and MR safety as well as defined number of supervised MR contact hours. The University of Toronto's MR-integrated Radiation Therapy (MRIRT) training program was leveraged for the advanced MR didactic knowledge but pre-requisite rotations and mandatory contact hours needed to be established.

Results or Benefits/Challenges

The benefits of identifying RTTs other than RTMR as Level 2 is that it increases the pool of MR trained staff who can work in the MR areas. This allows more flexibility in staff scheduling and decreases the need for overtime. The transition has facilitated a more equal sharing of tasks in the MRL workflow and an overall general increase in MR safety knowledge across the department. Some of the challenges include RTMR staff feeling underappreciated, skepticism on knowledge base of RTTs following new pathway and the general misunderstanding of the legislation that governs practice in Ontario by the RT community as a whole.

Conclusions/Impact

The pathway to assume role of Level 2 on MRL and MRSIM are slightly different due to increased complexity of protocols and safety risks in MRSIM. After completing our in-house orientation program for MRL, graduates of the MRIRT program must complete 3 months of supervised MR time (ie. they must be partnered with a Level 2 RTT) before being signed off. In order for an MRIRT graduate to rotate to MRSIM, they must first complete either a 1 year rotation in MRL or planning, to gain experience with MR fusion and MR-only planning. Once working in MRSIM, they must also complete 3 months of supervised MR time before they independently screen patients. To date 2 RTTs have met the criteria to assume Level 2 responsibility in MRL and 2 in MRSIM, an approximately 20% increase in Level 2 staff. Future plans are to increase this number and formally evaluate the model.