Therapeutic Radiographers at the Helm: Moving Towards Radiographer-Led MR-Guided Radiotherapy
Therapeutic Radiographers at the Helm: Moving Towards Radiographer-Led MR-Guided Radiotherapy
复制标题
DOI：
10.1016/j.jmir.2020.05.001
复制
发表时间：
2020-09-01
影响因子：
1.8
通讯作者：
Eccles, Cynthia L.
中科院分区：
文献类型：
--
作者：
Hales, Rosie B.;Rodgers, John;Eccles, Cynthia L.
简介：磁共振引导自适应放射治疗（MRgART）有可能改善各种肿瘤部位的治疗过程和结果;然而，它需要大量的临床资源。磁共振直线加速器（MR-直线加速器）治疗需要每天多学科的存在交付。为了促进可持续的MRgART模式，必须制定促进放射治疗师（RTT）主导的交付的商定协议，以建立类似于传统图像引导放射治疗（IGRT）的服务。这项工作提供了一个临床的角度来看，在一个institution.Methods协议驱动的“临床医生精简”MRgART工作流程的实施：为了确定在MRgART工作流程中的每一步所需的知识，技能和能力，跨学科的非正式调查和需求评估进行，以确定额外的或增强的MRgART所需的技能，超过传统的锥形束CT为基础的IGRT所需的。相关专业人员对MRgART途径进行了严格评估，以鼓励多学科的投入和讨论，从而允许RTT主导的工作流程的迭代开发。从最简单的在线适应策略，包括一个虚拟的沙发移位和在线重新规划，明确的指导方针，建立了提供根治性前列腺放射治疗的工作人员数量减少present.Results：确定的MRgART的具体技能，包括MRI的安全性和筛选，MR图像采集，MRI为基础的解剖，多模态图像的解释和登记，和治疗计划的评价。这些技能是通过教程、研讨会、专注的自我导向阅读、同事教学和端到端工作流程测试在RTT中开发的。经过初步处理和讨论，三个专业组的作用和责任（临床医生、RTT和物理学家）已经发展到实现简单的根治性前列腺治疗的“临床医生精简”工作流程。通过应用一个明确的框架，并在类似于基于锥形束计算机断层扫描的IGRT的预期治疗方案中建立商定的阈值和行动水平，我们已经实现了用于MR直线加速器上的简单自适应治疗的“临床医生-精简”工作流程。在线计划评估和批准的责任现在由物理学家和RTT来简化MRgART。早期评估的框架治疗后的10名患者需要最小的在线临床医生输入（1.5%的200个分数交付）。结论：一个'临床医生精简'前列腺治疗工作流程已成功地介绍了MR直线加速器在我们的机构，将作为其他肿瘤部位的模型，使用更复杂的自适应策略。早期迹象表明，该框架具有提高患者吞吐量和效率的潜力。随着适应性放射治疗变得越来越复杂，进一步确定和验证在线轮廓绘制等角色和职责以及更具互动性的在线计划将有助于RTT在在线工作流程中发挥充分作用。
Introduction: Magnetic resonance-guided adaptive radiotherapy (MRgART) has the potential to improve treatment processes and outcomes for a variety of tumour sites; however, it requires significant clinical resources. Magnetic resonance linear accelerator (MR-linac) treatments require a daily multidisciplinary presence for delivery. To facilitate sustainable MRgART models, agreed protocols facilitating therapeutic radiographer (RTT)-led delivery must be developed to establish a service similar to conventional imageguided radiotherapy (IGRT). This work provides a clinical perspective on the implementation of a protocol-driven 'clinician-lite' MRgART workflow at one institution.Methods: To identify knowledge, skills, and competence required at each step in the MRgART workflow, an interdisciplinary informal survey and needs assessment were undertaken to identify additional or enhanced skills required for MRgART, over and above those required for conventional cone-beam computed tomography-based IGRT. The MRgART pathway was critically evaluated by relevant professionals to encourage multidisciplinary input and discussion, allowing an iterative development of the RTT-led workflow. Starting with the simplest online adaptation strategy, consisting of a virtual couch shift and online replanning, clear guidelines were established for the delivery of radical prostate radiotherapy with a reduction in staff numbers present.Results: The MRgART-specific skills identified included MRI safety and screening, MR image acquisition, MRI-based anatomy, multimodality image interpretation and registration, and treatment plan evaluation. These skills were developed in RTTs via tutorials, workshops, focussed self-directed reading, teaching of colleagues, and endto-end workflow testing. After initial treatments and discussions, roles and responsibilities of the three professional groups (clinicians, RTTs, and physicists) have evolved to achieve a 'clinician-lite' workflow for simple radical prostate treatments.Discussion: Through applying a definitive framework and establishing agreed threshold and action levels for action within anticipated treatment scenarios similar to those in cone-beam computed tomography-based IGRT, we have implemented a 'clinician-lite' workflow for simple adaptive treatments on the MR-linac. The responsibility for online plan evaluation and approval now rests with physicists and RTTs to streamline MRgART. Early evaluation of the framework after treatment of 10 patients has required minimal online clinician input (1.5% of 200 fractions delivered).Conclusion: A 'clinician-lite' prostate treatment workflow has been successfully introduced on the MR-linac at our institution and will serve as a model for other tumour sites, using more complex adaptive strategies. Early indications are that this framework has the potential to improve patient throughput and efficiency. Further identification and validation of roles and responsibilities such as online contouring, and more interactive online planning, will facilitate RTTs to fully lead in the online workflow as adaptive radiotherapy becomes ever more complex.