Rates of MRI simulator utilisation in a tertiary cancer therapy centre.

Magnetic resonance imaging (MRI) is increasingly being integrated into the radiation oncology workflow, due to its improved soft tissue contrast without additional exposure to ionising radiation. A review of MRI utilisation according to evidence based departmental guidelines was performed. Guideline utilisation rates were calculated to be 50% (true utilisation rate was 46%) of all new cancer patients treated with adjuvant or curative intent, excluding simple skin and breast cancer patients. Guideline utilisation rates were highest in the lower gastrointestinal and gynaecological subsites, with the lowest being in the upper gastrointestinal and thorax subsites. Head and neck (38% vs 45%) and CNS (46% vs 67%) cancers had the largest discrepancy between true and guideline utilisation rates due to unnamed reasons and non-contemporaneous diagnostic imaging respectively. This report outlines approximate MRI utilisation rates in a tertiary radiation oncology service and may help guide planning for future departments contemplating installation of an MRI simulator.

Quantifying and Assessing the Dosimetric Impact of Changing Gas Volumes Throughout the Course of VMAT Radiation Therapy of Upper Gastrointestinal Tumors.

PURPOSE: This retrospective patient study assessed the consistency of abdominal gas presence throughout radiation therapy for patients with upper gastrointestinal cancer and determined the impact of variations in gas volume on the calculated dose distribution of volumetric modulated arc therapy. METHODS AND MATERIALS: Eight patients with pancreatic cancer were included for analysis. A plan library consisting of 3 reference plans per patient (Ref0.0, Ref0.5, and Ref1.0) was created based on planning computed tomography (CT) with density overrides of 0.0, 0.5, and 1.0 applied to gas volumes, respectively. Corresponding cone beam CT (CBCT) data sets were obtained and density overrides were applied to enable fractional dose calculation. Variation in gas volume relative to initial volume determined from CT was assessed. Dose metrics for targets and organs at risk were compared between the accumulated CBCT dose and the planned dose of the 3 reference plans for each patient. RESULTS: There was a significant decrease in gas present from CT to treatment CBCT, with a mean decrease in volume of 48.6% for the entire cohort. Dosimetrically, all accumulated target and organ-at-risk parameters, aside from the kidneys, exhibited the smallest mean deviation from the Ref0.0 plan and largest mean deviation from the Ref1.0 plan. A statistically significant difference in mean accumulated dose to Ref0.0 and Ref1.0 was observed for the dose delivered to 95% of the planning target volume. CONCLUSIONS: Significant variation in gas volumes from CT to treatment can occur throughout volumetric modulated arc therapy for pancreatic cancer. Through the use of a plan library, it was determined that initial assessment of a patient's treatment plan with an assigned gas density of 0.0 provided the most accurate prediction of the accumulated dose.

Cautiously optimistic: A survey of radiation oncology professionals' perceptions of automation in radiotherapy planning.

INTRODUCTION: While there is evidence to show the positive effects of automation, the impact on radiation oncology professionals has been poorly considered. This study examined radiation oncology professionals' perceptions of automation in radiotherapy planning. METHOD: An online survey link was sent to the chief radiation therapists (RT) of all Australian radiotherapy centres to be forwarded to RTs, medical physicists (MP) and radiation oncologists (RO) within their institution. The survey was open from May-July 2019. RESULTS: Participants were 204 RTs, 84 MPs and 37 ROs (response rates ∼10% of the overall radiation oncology workforce). Respondents felt automation resulted in improvement in consistency in planning (90%), productivity (88%), quality of planning (57%), and staff focus on patient care (49%). When asked about perceived impact of automation, the responses were; will change the primary tasks of certain jobs (66%), will allow staff to do the remaining components of their job more effectively (51%), will eliminate jobs (20%), and will not have an impact on jobs (6%). 27% of respondents believe automation will reduce job satisfaction. 71% of respondents strongly agree/agree that automation will cause a loss of skills, while only 25% strongly agree/agree that the training and education tools in their department are sufficient. CONCLUSION: Although the effect of automation is perceived positively, there are some concerns on loss of skillsets and the lack of training to maintain this. These results highlight the need for continued education to ensure that skills and knowledge are not lost with automation.

Quality management in radiation therapy: A 15 year review of incident reporting in two integrated cancer centres.

Fifteen years of reported incidents were reviewed to provide insight into the effectiveness of an Incident Learning System (ISL). The actual error rate over the 15 years was 1.3 reported errors per 1000 treatment attendances. Incidents were reviewed using a regression model. The average number of incidents per year and the number of incidents per thousand attendances declined over time. Two seven-year periods were considered for analysis and the average for the first period (2005-2011) was 6 reported incidents per 1000 attendances compared to 2 incidents for the later period (2012-2018), p < 0.05. SAC 1 and SAC 2 errors have reduced over time and the reduction could be attributed to the quality assurance aspect of IGRT where the incident is identified prior to treatment delivery rather than after, reducing the severity of any potential incidents. The reasoning behind overall reduction in incident reporting over time is unclear but may be associated to quality and technology initiatives, issues with the ISL itself or a change in the staff reporting culture.

Estimating the cost of radiotherapy for 5-year local control and overall survival benefit.

BACKGROUND AND PURPOSE: Escalating health care costs have led to greater efforts directed at measuring the cost and benefits of medical treatments. The aim of this study was to estimate the costs of 5-year local control and overall survival benefits of radiotherapy for the cancer population in Australia. MATERIALS AND METHODS: The local control and overall survival benefits of radiotherapy at 5-years and optimal number of fractions per course have been estimated for 26 tumour sites for which radiotherapy is indicated. For this study, a hybrid approach that merges features from activity based costing (ABC) and relative value units costing (RVU) were used to provide cost estimates. ABC methodology was used to allocate costs to all radiotherapy activities associated with each patient's treatment course, while the RVUs represent the cost of each radiotherapy activity relative to the average cost of all activities and were used to achieve a weighted cost allocation. A patient's journey for the financial year was constructed by consolidating all the radiotherapy activities and their associated costs, and the average cost per activity (fraction) was determined. The cost of radiotherapy per 5-year overall survival and local control was then estimated. RESULTS: The estimated population 5-year local control and overall survival benefits of radiotherapy for all cancer were 23% and 6%, respectively. The optimal number of fractions per treatment course if guidelines were followed was 19.4 fractions. The average cost per fraction for all cancer was AU$276. The estimated cost of radiotherapy was AU$23,585 per 5-year local control and AU$86,480 per 5-year overall survival (equivalent to 5 life years) for all cancer. CONCLUSION: The cost of AU$86,480 per 5-year overall survival would translate to AU$17,296 1-year overall survival. Therefore, the cost of radiotherapy is inexpensive if delivered optimally. Policy implications from this study include knowledge about cost to deliver radiotherapy to allow one to quantify the expected benefit at a population level.