Change management for radiation therapists - transitioning to the new Royal Adelaide Hospital.

One of the largest change operations to take place in South Australia was the moving of the Royal Adelaide Hospital (RAH) to its new site in 2017. Change can influence workplace effectiveness and staff satisfaction and morale. Understanding the stages of change, staff experience and carefully managing the process is important. This paper aims to describe the successful move of the radiation therapy department at the RAH to its new site, focusing on the staff experience and management strategies to ensure the success of the move. A four-stage model of change was used to guide understand, manage and reflect upon the transition of the RAH radiation therapy department to a new site. Key change events and management strategies are described and aligned with the four stages of change. The move to the new site was a great success with a transition period working across two sites enabling a slower ramp up of activity at the new site supporting staff and patients in adjusting to the new environment. The four-stage model of change assisted in the smooth implementation of a transition plan for radiation oncology. At the RAH, innovation and development are encouraged, along with management having a comprehensive understanding of organisational change enabling the radiation oncology department to successfully navigate rapid change.

National survey on the practice of radiation therapists in Australia.

INTRODUCTION: Radiation therapy (RT), like many allied health professions, has lacked professional practice clarity, which until 2008 had not been comprehensively investigated. This manuscript describes the first phase of a three-phase project investigating the current and future practices of radiation therapists (RTs) in Australia. The aim of phase 1 was to define the practice of RTs in Australia. METHODS: A quantitative approach was used to gain an understanding of RT practice. A national survey was distributed to RTs in Australia. Descriptive statistics and content analysis were used to analyse the data. RT practice was analysed in relation to core and non-core roles, where non-core roles were further divided into basic and advanced practices. RESULTS: The data from the national survey were representative of the Australian RT population (n = 525). The current practice of RTs is presented in summary tables for each area of work (treatment, planning, simulation, mould room and general). CONCLUSION: This study provided clarification of RT practice and indicated there was a desire to relinquish administrative roles to focus on RT-specific practice. There was evidence that some advanced roles were currently practiced in Australia; however, there was no structure to support these roles and they were based only on local need. This study identified that the profession needs to consider how they will maintain core RT practice, while encouraging the development of new roles, and whether some roles need to be relinquished.

Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions.

Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as 'a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care'. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.

Synchronous prostate and rectal adenocarcinomas irradiation utilising volumetric modulated arc therapy.

Cases of synchronous prostate and colorectal adenocarcinomas have been sporadically reported. There are case reports on patients with synchronous prostate and rectal cancers treated with external beam radiotherapy alone or combined with high-dose rate brachytherapy boost to the prostate. Here, we illustrate a patient with synchronous prostate and rectal cancers treated using the volumetric arc therapy (VMAT) technique. The patient was treated with radical radiotherapy to 50.4 Gy in 28 fractions to the pelvis, incorporating the involved internal iliac node and the prostate. A boost of 24 Gy in 12 fractions was delivered to the prostate only, using VMAT. Treatment-related toxicities and follow-up prostate-specific antigen and carcinoembryonic antigen were collected for data analysis. At 12 months, the patient achieved complete response for both rectal and prostate cancers without significant treatment-related toxicities.

Letter in response to 'The conceptual model of advanced practice does include research'.

This letter refutes the suggestion made the authors of other letters to the Editor that the proposed model of the characteristics of advanced practitioners excludes research.

Australian radiation therapy - Part two: Reflections of the past, the present, the future.

INTRODUCTION: Documentation on the history of Australian radiotherapy is limited. This study provides radiation therapists' (RTs) perspectives of the people, workplace, and work practices in Australian radiotherapy centres from 1960 onwards. It provides a follow-up to our previous study: Australian radiation therapy: An overview - Part one, which outlines the history and development of radiotherapy from conception until present day. METHODS: Four focus groups were conducted on separate occasions in 2010, one in South Australia and three in Victoria, Australia. Participants who worked in radiotherapy were purposively selected to ensure a range of experience, age, and years of work. RESULTS: From a RT perspective, radiotherapy has evolved from a physically demanding 'hands-on' work environment, often with unpleasant sights and smells of disease, to a more technology-driven workplace. CONCLUSION: Understanding these changes and their subsequent effects on the role of Australian RTs will assist future directions in advanced role development.

The feasibility and benefits of using volumetric arc therapy in patients with brain metastases: a systematic review.

INTRODUCTION: Radiotherapy management of patients with brain metastases most commonly involve a whole-brain radiation therapy (WBRT) regime, as well as newer techniques such as stereotactic radiosurgery (SRS) and intensity modulated radiotherapy (IMRT). The long treatment times incurred by these techniques indicates the need for a novel technique that has shorter treatment times, whilst still producing highly conformal treatment with the potential to deliver escalated doses to the target area. Volumetric modulated arc therapy (VMAT) is a dynamic, highly conformal technique that may deliver high doses of radiation through a single gantry arc and reduce overall treatment times. The aim of this systematic review is to determine the feasibility and benefits of VMAT treatment in regard to overall survival rates and local control in patients with brain metastases, in comparison with patients treated with WBRT, SRS and IMRT. METHODS: A search of the literature identified 23 articles for the purpose of this review. Articles were included on the basis they were human-based studies, with sample sizes of more than five patients who were receiving treatment for 1-10 metastatic brain lesions. RESULTS: VMAT was found to be highly conformal, have a reduced treatment delivery time and incurred no significant toxicities in comparison with WBRT, SRS and IMRT. CONCLUSION: Compared to other treatment techniques, VMAT proved to have fewer toxicities than conventional WBRT, shorter treatment times than SRS and similar dose distributions to IMRT plans. Future prospective studies are needed to accurately assess the prognostic benefits of VMAT as well as the occurrence of late toxicities.

Carcinoma of the anal canal: Intensity modulated radiation therapy (IMRT) versus three-dimensional conformal radiation therapy (3DCRT).

INTRODUCTION: Patients with anal canal carcinoma treated with standard conformal radiotherapy frequently experience severe acute and late toxicity reactions to the treatment area. Roohipour et al. (Dis Colon Rectum 2008; 51: 147-53) stated a patient's tolerance of chemoradiation to be an important prediction of treatment success. A new intensity modulated radiation therapy (IMRT) technique for anal carcinoma cases has been developed at the Andrew Love Cancer Centre aimed at reducing radiation to surrounding healthy tissue. METHODS: A same-subject repeated measures design was used for this study, where five anal carcinoma cases at the Andrew Love Cancer Centre were selected. Conformal and IMRT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 54 Gray (Gy) over a course of 30 fractions to the primary site. RESULTS: The IMRT plans resulted in improved dosimetry to the planning target volume (PTV) and reduction in radiation to the critical structures (bladder, external genitalia and femoral heads). Statistically there was no difference between the IMRT and conformal plans in the dose to the small and large bowel; however, the bowel IMRT dose-volume histogram (DVH) doses were consistently lower. CONCLUSION: The IMRT plans were superior to the conformal plans with improved dose conformity and reduced radiation to the surrounding healthy tissue. Anecdotally it was found that patients tolerated the IMRT treatment better than the three-dimensional (3D) conformal radiation therapy. This study describes and compares the planning techniques.

Dose comparisons for conformal, IMRT and VMAT prostate plans.

PURPOSE: Volumetric-modulated arc therapy (VMAT) is a relatively new treatment technique in radiation therapy. A comparison study of conformal, intensity-modulated radiation therapy (IMRT) and single- and double-arc VMAT plans was undertaken to evaluate the dosimetric impact of this new technology in prostate cases. The research questions were as follows: how does VMAT dosimetry compare with IMRT and conformal plans?; does VMAT increase the volume of bowel receiving lower doses?; are one or two VMAT arcs required for standard prostate cases? METHODS: Eight prostate cancer and post-prostatectomy patients were randomly selected for this study. Conformal, IMRT and single and double Arc VMAT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 75.6 Gy over a course of 42 fractions to the planning target volume (PTV). RESULTS: The Healthy Tissue Conformity Index and the conformation number results revealed the IMRT and two VMAT techniques to have superior dosimetry to the PTV compared with the conformal plans. The maximum dose delivered to the PTV was significantly higher with the single-arc VMAT technique compared with the conformal or double-arc VMAT plans. There were no significant differences between the planning techniques for the bladder and small bowel dosimetry. However, IMRT and VMAT plans delivered less radiation to the rectum and femoral heads, and a single-arc VMAT plan was optimal for the right femoral head and the two VMAT techniques were optimal to the IMRT plans for the left femoral head. CONCLUSIONS: Single- and double-arc VMAT consistently resulted in favourable or slightly superior dosimetry when compared with static gantry IMRT for prostate cases. Both the VMAT techniques and static gantry IMRT resulted in superior critical tissue sparing when compared with conformal plans.

2D versus 3D radiation therapy for prostate carcinoma: a direct comparison of dose volume parameters.

That three dimensional (3D) planning for radiation therapy (RT) of carcinoma of the prostate (CaP) improves radiation dosimetry to the tumour and reduces dose to the rectum and bladder compared with 2D planning, has not been properly evaluated. We addressed this by downloading the CT data files of twenty-two patients who had completed 2D planned RT for CaP onto a 3D planning system and re-planning RT using the same four field technique and dose prescription as the 2D technique. The radiation dose at 100%, 90%, 50% and 0% volumes (D100, D90, D50 and D0) of the Dose Volume Histograms (DVH's) of the GTV, PTV, rectum and bladder, the area under the curves of each DVH and the field sizes were evaluated and compared between the two sets of plans. Repeated measured t-tests were used to compare the means of the different measurements. The D100, D90 and D50 of the GTV, PTV and rectum were increased for the 3D versus the 2D plans (p < 0.05 for each parameter). The area under the rectal DVH was also greater for the 3D plans (p < 0.05). These changes are attributable to the larger field sizes, particularly the length in the 3D compared with the 2D plans.