Oral Abstracts

Friday 20 May, 11:15–12:45 Rural and Remote

A review of mammographic image quality in Papua New Guinea

Ruth Pape,¹ Kelly Spuur,² Jenny Wilkinson,³ Aileen Zuhukepe⁴

¹ University of Papua New Guinea, Papua New Guinea ² Charles Sturt University, Boorooma, Australia ³ Endeavour College of Natural Health, Melbourne, Australia ⁴ Port Moresby General Hospital, Papua New Guinea

Objectives: To assess the image quality of mammograms performed in Papua New Guinea (PNG) using the Perfect, Good, Moderate, Inadequate image evaluation system and to benchmark findings against the requirements of BreastScreen Australia’s National Accreditation Standards (BSA NAS).

Method: 102 mammograms performed at Port Moresby General Hospital were retrospectively reviewed. Craniocaudal and mediolateral oblique (MLO) images were each assigned a PGMI grade; with the lowest grade overall applied to each four‐view series. The rationale for the grade and women’s age in years was recorded. Simple frequency analysis was undertaken, and results benchmarked to BSA NAS 2.4.

Results: There were 111 craniocaudal and 109 MLO mammograms reviewed. The craniocaudal view was most frequently graded G (83.8%) and the MLO view M (72.4%); combined P and G grades for all four‐view series (14.8%). Rationales for an M grade were non‐visualisation of the image evaluation system (28%), nipple not in profile (26%) and short length of pectoral muscle (12%). Women aged 25 to 74 years.

Conclusion: In this snapshot of mammography images from PNG, image quality was not commensurate (P and G 14.8%) with that required by the BSA NAS (P and G > 50%). Education and training can be implemented to overcome positing errors, however the complex challenges facing radiographers performing mammography in PNG must also be recognised. The results of this study bring focus to the need for national standards, access to dedicated contemporary equipment and radiographer education to improve mammography services for the women of PNG.

Improvements in radiation therapy services in Myanmar: 2012 to 2020

Craig Opie¹

¹ Northern Sydney Cancer Centre/Royal North Shore Hospital, St Leonards, Australia

Objectives: To describe radiation therapy services in Myanmar since 2012 in these categories: cancer incidence and radiation therapy statistics; radiation therapy centres; radiation therapy technical practices; clinical staffing; clinical and academic education and future directions.

Methods: Limited cancer registry data, observations from in‐person visits and data from key informants in Myanmar radiation therapy centres are used to report on developments in radiation therapy services in recent years.¹

Results: Reported national cancer incidence estimates are supplemented with annual cancer case and radiation therapy course completion statistics from three hospital/regional contexts. Strategies that increased radiation therapy services are described. Data regarding radiation therapy centres geographic locations and their equipment and software inventories are tabulated. Impacts on clinical practice standards through upgraded equipment and software for treatment planning and delivery is discussed. Clinical staffing, and their increases in recent years at each centre, are catalogued, and staff role descriptions are documented. Present clinical and academic education challenges for radiation therapy staff, and the importance of these issues for technical practice advancements are discussed.

Conclusion: Myanmar’s successes and continued challenges in radiation therapy service delivery are emulated in other low‐ and middle‐income countries. Strategic planning for new and existing radiation therapy centres, further staff increases and improved education for radiation therapy staff should assist in meeting these challenges. Further international engagement could also enhance these processes.

Reference

1. Improvements in radiation therapy services in Myanmar: 2012 to 2020. J Med Imaging Radiat Oncol 2021;65(4):445–53.

Training of radiation therapists in Asia‐Pacific region low‐ and middle‐income countries

Craig Opie¹

¹ Northern Sydney Cancer Centre/Royal North Shore Hospital, St Leonards, Australia

Introduction: Medical linear accelerator (linacs) purchase and operating costs have reduced in recent years. This has permitted low‐ and middle‐income countries (LMICs) to transition external beam radiation therapy from telecobalt to linacs and to pursue practices approximating those of high‐income countries (HICs). This has also required expanded professional education of radiation oncologists, radiation oncology medical physicists and radiation therapists (RTs), including six key Asia‐Pacific region LMICs, that have received direct education and training assistance from Australasian RTs.¹

Case presentation: The transition from telecobalt to linacs in HICs resulted in an iterative expansion of specialised, interlocking academic and clinical education programs. Radiation oncologists and radiation oncology medical physicists in the key LMICs have enjoyed professional knowledge structure enhancements, however RTs in these settings haven’t seen the same improvements. This situation produces significant treatment quality and safety implications and requires rectification.

Management/Outcome: This presentation will discuss the merits and drawbacks of attempts to address RTs’ learning needs in the six key LMICs – through international organisation interventions, vendor training, study visits by LMIC RTs to HICs, and voluntary clinical mentoring assignments by Australasian RTs.

Discussion: Efforts to improve radiation therapy clinical knowledge in LMICs have yielded limited successes. Elements of these approaches should be continued, though international efforts must be better co‐ordinated, and ultimately aim to support the establishment and maintenance of radiation therapy‐specific baccalaureate programs in each LMIC.

Reference

1. Training of radiation therapists in Asia‐Pacific region low‐ and middle‐income countries. J Med Imaging Radiat Oncol 2021;65(4):436–8.

Sole practitioner rural radiographers: a qualitative descriptive review and analysis

Luke Barclay,¹ Nicholas Barlow,² Janni Jensen,³ Rob Milner²

¹ Deakin University, Geelong, Australia ² The Rotherham NHS Foundation Trust, Rotherham, United Kingdom ³ Odense University Hospital, Denmark

Objectives: The objective of the study was to describe the experiences of sole rural radiographers’ experiences in their daily professional roles.

Methods: The study took place via semi‐structured interviews with current sole radiographers employed across regional and remote Australia. Data was collected from January to March 2021, and a qualitative descriptive methodology was employed in the gathering of data and review of results.

Results: The participants all reported experiencing episodes of professional isolation, unrelenting pressure related to the non‐ending expectations due to being constantly on‐call and fulfilling the trust of the community in which they practise. Themes included long hours of work and limited professional development opportunities, and of precipitating factors such as familial isolation and limited collegial connections. Organisational issues included challenges of recruitment and retention; lack of formal recognition and consideration of the specialised role undertaken by these professionals.

Conclusion: In the context of the sole radiographer department where patients can be the next‐door neighbour or someone that you have a close personal connection with, it is important that recognition is given to a role these individuals perform. Despite the often lack of ‘high‐end’ modalities, the sole radiographer’s position requires unique skills that should be recognised more consistently. Strategies to support staff and manage this professional group subset should be a priority to provide a more attractive working environment.

Friday 20 May, 11:15–12:45 Respiratory Gated RT – Breath to success

Feasibility of magnetic resonance‐guided stereotactic ablative body radiotherapy of liver cancer

Maddison Picton,¹ Vikneswary Batumalai,¹ David Crawford,¹ Claire Pagulayan,¹ Louise Hogan,¹ Urszula Jelen,¹ Conrad Loo,¹ Nicolle Dunkerley,¹ Lori Geddes,¹ Sandy Sampaio,¹ Monique Heinke,¹ Tania Twentyman,¹ Michael Jameson,¹ Jeremy de Leon¹

¹ GenesisCare St Vincent's, Darlinghurst, Australia

Objective: Stereotactic ablative body radiotherapy is an effective treatment method for liver cancer. However, tumour motion and proximity of organs at risk can be a limiting factor when delivering high doses of radiation. Magnetic resonance guided adaptive radiotherapy (MRgART) can improve the accuracy and dose coverage of tumour volumes. This study assessed the feasibility of MRgART for liver cancer.

Methods: Five patients with liver cancer were treated with MRgART. Image sequencing included a T2 navigated scan that produced images at expiration. A balance turbo fast field echo image was also acquired every fraction to measure liver motion for the internal target volume margin. All plans were prescribed to 50 Gy in five fractions. Plans were adapted in real time for every fraction with treatment time and dosimetric criteria recorded.

Results: Median patient age was 61 years (range 54 to 85 years). Twenty‐five fractions (adapted plans) were delivered to a total of five patients. Dosimetric parameters are summarised in Table 1. Median dose to 98% of the gross tumour volume and planning target volume were 52.4 Gy and 46.5 Gy, respectively. Organs at risk targets were met for all 25 fractions. The median time from ‘patient set‐up’ to ‘beam‐off’ time was 49.3 minutes (range 39.2 to 57.0 minutes). All patients completed treatment with no interruptions.

Conclusion: Our early experience suggests that MRgART for liver cancer is feasible and safe with acceptable dosimetric parameters and treatment time. We continue to collect data and evidence on patient and clinician reported outcome, safety and tolerability of MRgART.

Wireless respiration belt coaching for gated stereotactic ablative radiation therapy patients

Daniel Sapkaroski,^1,2,3 Madison Smith,^1,4 Nigel Anderson^1,2,3

¹ Peter MacCallum Cancer Centre, Melbourne, Australia ² Sir Peter MacCallum Department of Radiation Oncology (Melbourne University), Melbourne, Australia ³ Monash University, Clayton, Australia ⁴ Australian Catholic University, Melbourne, Australia

Introduction: Liver cancer, or more specifically hepatocellular carcinoma, produces one of the largest disease burdens worldwide, being reported as the fifth most prevalent cancer globally and accounting for 9.1% of all cancer deaths.^1,2 For patients who do not meet the respectability (surgery) criteria, radiation therapy is commonly recommended. Stereotactic body radiation therapy (SBRT) combined with expiration breath hold (EBH) offers the ability to administer the highest possible doses while minimising damage to surrounding healthy, functional tissue (including unaffected liver).³ Patient education, therefore, remains a critical component in the efficient and safe execution of SBRT.

Aims: This project aimed to achieve improved patient preparedness for breath hold in SBRT via the use of the take home wireless Bluetooth respiration training belt and instructional video on treatment procedures.

Methods: EBH compliance and key treatment variables such as treatment time and amount of cone beam computed tomography were compared for n = 30 prospective patients n = 30 retrospective patients, additionally a patient survey assessed patient acceptance and perception for prospective patients.

Results: No definitive quantitative outcome has yet been reached because of low recruitment levels due to the COVID‐19 pandemic, however the study will be extended to 2022 and initial qualitative patient feedback indicates optimistic patient acceptance and perception.

Conclusion: It is unclear if wireless respiration belt coaching improves SBRT EBH patient treatment compliance and ability to perform EBH. Ongoing research will determine if a true benefit exists, however initial qualitative data indicates the potential for improved patient literacy and anxiety alleviation.

References

1. Ferlay J, Soerjomataram I, Ervik M, et al. Lyon, France: International Agency for Research on Cancer; 2013. Cancer Incidence and Mortality Worldwide: IARC Cancer Base 2012(11).

2. Cocker F, Chien Yee K, Palmer AJ, de Graaff B. Increasing incidence and mortality related to liver cancer in Australia: time to turn the tide. Australian and New Zealand Journal of Public Health 2019;43(3):267–73.

3. Health AIo, Welfare. Cancer data in Australia. Canberra: AIHW; 2020.

Implementation and clinical use of polymer‐based fiducial markers for breath hold liver stereotactic ablative body radiotherapy

Benjamin Tacon,¹ Simon Tang,¹ Erin Seymour,¹ Benjamin Zwan,¹ Rebecca Cone,¹ Mitchell Gibbons¹

¹ Central Coast Cancer Centre, Gosford, Australia

Background: Fiducial markers can improve the accuracy of liver stereotactic ablative body radiotherapy (SABR).¹ Typically gold markers are used, however they produce undesirable image artefacts. There were two aims in this work: 1) to investigate the benefits of biocompatible polymer fiducials (Polymark) compared to gold, and 2) report our experience with implementation of these markers for five breath hold liver SABR patients.

Methods: The benefits of using Polymark fiducials were assessed using CT, CBCT, MRI and KV planar images with both Polymark and gold fiducials inserted into an abdominal phantom and within liver SABR patients. Images were assessed in terms of marker visibility and artefacts.

Five breath‐hold liver SABR patients with Polymark fiducials were treated, each receiving a diagnostic MRI, three planning CTs, set‐up CBCT, mid‐/post‐treatment CBCT and KV triggered imaging during treatment.

Results: Gold fiducials produced more artefacts than Polymark which impacted target delineation and image matching (Figure 1). From a survey of three radiation oncologists and five radiation therapists, all participants rated Polymark fiducials favourably. Polymark fiducials form an integral part of the liver SABR workflow. They significantly reduce artefacts in CT without compromising MRI visibility for registration. Polymark fiducials could be placed within 1 cm of the target, compared to gold fiducials which need to be over 2 cm. CBCT matching was improved due to reduction in artefacts and markers were visible using triggered imaging.

Conclusion: Based on our experience and the benefits of Polymark fiducials, these markers have been adopted as standard of care for liver SABR at our centre.

Reference

1. Seppenwoolde Y, Wunderink W, Wunderink‐van Veen SR, et al. Treatment precision of image‐guided liver SBRT using implanted fiducial markers depends on marker‐tumour distance. Physics in Medicine and Biology 2011;56(17):5445.

Introduction of an end expiration breath hold workflow using a surface guidance radiotherapy system for liver SBRT

Megan Mcdonald,¹ Vanessa Panettieri,¹ Sasha Senthi,¹ Jeremy Ruben,¹ Cherie Evans,¹ Catherine Russell¹

¹ Alfred Health Radiation Oncology, Melbourne, Australia

Introduction: Standard of care for liver stereotactic body radiotherapy patients at Alfred Health Radiation Oncology has been a 4DCT using an ITV approach and treatment with daily cone‐beam computed tomography matching in free breathing. In the past, dose escalation and safe, effective treatment has been limited by liver and surrounding organs at risk dose restrictions due to liver motion.¹ End expiration breath hold (EEBH) is recognised as an effective technique for reducing liver motion.² We investigated feasibility of an EEBH process using the AlignRT surface guided radiation therapy system.

Objectives:

• to develop an EEBH workflow using AlignRT

• to determine whether liver motion can be reduced during EEBH

• to determine whether radiographic liver dome position in EEBH correlates with surface anatomy.

Methods: After a review of the literature³ and consultation with another institution with EEBH experience, a workflow was developed and adapted for use with AlignRT. Patients attend a pre‐CT session on the linac, were coached, and five anteroposterior fluoroscopies taken in EEBH while using AlignRT. Liver dome measurements were taken for reproducibility. If the patient could reproduce EEBH within a tolerance, they proceeded to CT, planning and treatment in EEBH.

Results: The first patient completed their EEBH treatment at Alfred Health Radiation Oncology in July 2021. The external surface was an acceptable surrogate for liver position and the PTV volume was reduced by 22.1% using EEBH.

Conclusion: In suitable patients, AlignRT can be utilised to deliver stereotactic body radiotherapy in EEBH. The reduced liver motion allows a smaller PTV size to be treated with less toxicity to the liver.

References

1. Eccles C, Brock KK, Bissonnette J‐P, Hawkins M, Dawson LA. Reproducibility of liver position using active breathing coordinator for liver cancer radiotherapy. Int J Radiat Oncol Biol Phys 2006;64:751–99.

2. Case RB, Sonke JJ, Moseley DJ, et al. Inter‐ and intrafraction variability in liver position in non–breath‐hold stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2009;75:302–8.

3. Keall PJ, Mageras GS, Balter JM, et al. The management of respiratory motion in radiation oncology report of AAPM Task Group 76. Med Phys 2006;33(10):3874–900.

Feasibility of respiratory motion tracking using the live view camera on Varian Halcyon

Sonja Cheers,¹ Yunfei Hu,¹ Madelyn Wuth¹

¹ Icon Cancer Centre, Gosford, Australia

Objective: To validate the respiratory motion tracking capability of the integrated live view system (LVS) for motion management techniques in radiation therapy treatments, opening the possibility of having an integrated system on the Halcyon that removes the need for tertiary motion management systems.

Method: LVS will run simultaneously with a real‐time position management system (RPM) installed in a research capacity to validate respiratory motion tracking. A sample size of 32 patients having deep inspiration breath hold and respiratory gating treatments will participate in the study. For patients that RPM is used clinically as the standard of care, LVS will passively collect data simultaneously for every treatment fraction. Anonymised amplitude, period, phase and frequency data will be extracted from both systems and statistically analysed as a paired two‐group. Percentage difference and absolute difference will be calculated between the two matched data sets to determine if the motion parameters are similar within clinically acceptable limits (less than 5% variation).

Initial results: Commissioning results of LVS have indicated satisfactory agreement of results between the two systems. Phantom based breathing traces from RPM and LVS have shown a reduction in noise level in the vertical direction for LVS compared to RPM. During the commissioning phase several LVS software issues were encountered which will be rectified before clinical trial use.

Conclusion: Statistical analysis of patient results will indicate if LVS is clinically comparable to the current clinically accepted gold standard leading the way to having an integrated respiratory gating system on the Halcyon.

Friday 20 May, 11:15–12:45 Quality in MI 1

Proposed diagnostic reference levels for commonly performed paediatric X‐rays

Edel Doyle^1,2

¹ Lumus Imaging, Melbourne, Australia ² Monash University, Melbourne, Australia

Objective: The aim of this project is to collect de‐identified data from public and private X‐ray departments in Victoria in order to establish diagnostic reference levels (DRLs) for commonly performed paediatric X‐rays.

Methods: Ethical approval and a waiver of consent was granted by the Royal Children’s Hospital (HREC/73695/RCHM‐2021). De‐identified data collected included patient age, weight, radiation dose (kerma area product) and exposure factors including kV, mAs, SID (cm), grid/no grid and, if automatic exposure control was used, which chambers were selected. The data was collected either manually using a Microsoft Excel spreadsheet or electronically using dose extraction software for all children under the age of 16 years presenting for a routine X‐ray, as listed below:

• hand

• wrist

• forearm

• elbow

• humerus

• foot

• ankle

• tibia/fibula

• knee

• femur

• pelvis

• chest

• abdomen

• skull.

Results: The radiation dose data for a minimum of 10 patients from each department for each X‐ray projection will be collated according to the weight bands recommended by the International Commission of Radiological Protection¹: < 5 kg, 5 to < 15 kg, 15 to < 30 kg, 30 to < 50 kg, and 50 to < 80 kg.

Conclusion: When a Victorian DRL has been established, a comparison of departmental DRLs to the Victorian DRL will be provided to the chief radiographer. The DRLs will be published in a peer‐reviewed journal.

Reference

1. International Commission on Radiation Protection. 2017. ICRP Publication 135. Diagnostic reference levels in medical imaging. Available at https://www.icrp.org/publication.asp?id=ICRP%20Publication%20135 [Accessed 20 February 2021].

Achieving significant radiation dose reductions for patients undergoing uterine artery embolisation – an Australian experience

Don Nocum^1,2

¹ Sydney Adventist Hospital, Wahroonga, Australia ² The University of Sydney, Sydney, Australia

Introduction: From 2014 to 2020, Australian Medicare data showed only an average of 163 Medicare‐funded uterine fibroid embolisation (UFE) procedures each year for the treatment of symptomatic fibroids. This was compared to an average of 30,757 uterine surgeries, where 13,126 were hysterectomies.^1–3 There was an average of 6124 surgeries for fibroid disease per year, and an unknown number for adenomyosis.^1,3 A united and stronger advocacy for UAE (uterine artery embolisation)/UFE procedures is needed in Australia, by increasing people’s awareness of interventional procedures as alternatives to surgery, with minimal risks, lower cost and shorter recovery time.⁴

Methods: This study sought to demonstrate the low risks to ionising radiation when undergoing treatment with UAE/UFE procedures by achieving significant radiation dose reductions at our Australian centre using optimal interventional radiologist and interventional radiographer technique and an upgraded angiography system.

Results: UAE practice on the previous system, Group I (Allura, n = 95), and the upgraded system, Group II (Azurion, n = 95) demonstrated a significant reduction in dose‐area product and air kerma by (143.2 Gy·cm² vs 52.9 Gy·cm²; P < 0.001, d = 0.8) and 67% (0.6 Gy vs 0.2 Gy; P < 0.001, d = 0.8), respectively.

Conclusion: This study validated the upgraded system and its advanced capabilities and showed that interventional radiologist and interventional radiographer expertise are critical for dose optimisation at all centres performing UAE/UFE procedures. This Australian experience forms a united front to make this interventional procedure more appealing to people suffering from symptomatic benign uterine conditions.

References

1. Clements W, Ang WC, Law M, Goh GS. Treatment of symptomatic fibroid disease using uterine fibroid embolisation: an Australian perspective. Aust N Z J Obstet Gynaecol 2020;60(3):324–9.

2. Yusuf F, Leeder S, Wilson A. Recent estimates of the incidence of hysterectomy in New South Wales and trends over the past 30 years. Aust N Z J Obstet Gynaecol 2016;56(4):420–5.

3. Australian Government Department of Human Services. Medicare Item Reports. Available at http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp [Accessed 11 October 2021].

4. Nocum DJ, Robinson J, Halaki M, et al. Identifying predictors of patient radiation dose during uterine artery embolisation. J Med Radiat Sci 2021;68(2):131–8.

Continuous quality improvement for uterine artery embolisation procedures reduces patient radiation dose while maintaining image quality

Don Nocum^1,2

¹ Sydney Adventist Hospital, Wahroonga, Australia ² The University of Sydney, Sydney, Australia

Objectives: Uterine artery embolisation (UAE) is an effective treatment for patients with symptomatic uterine fibroids and/or adenomyosis and has united people across the land suffering from these benign conditions to seek alternatives to surgery.^1,2 Our interventional radiology department performs the highest number of UAE procedures in Australia and has successfully treated patients with this minimally‐invasive, interventional procedure.³ The purpose of this study was to introduce a continuous quality improvement (CQI) program and assess its impact on radiation dose reduction as well as image quality with the use of visual grading characteristics (VGC) analysis.

Methods: The interventional radiographer and interventional radiologist developed a CQI program to investigate the effects of optimising radiation dose parameters on the dose‐area product and overall image quality by comparing a CQI intervention group (n = 50) and control group (n = 50).

Results: A significant reduction in dose‐area product by 17% (P = 0.041, d = 0.2) and air kerma by 20% (P = 0.027, d = 0.2) was shown between the two groups. The VGC analysis resulted in an area under the VGC curve (AUC‐VGC) of 0.54 when using the control group as a reference, indicating no significant difference in image quality between the two groups (P = 0.670).

Discussion/Conclusion: The implementation of the CQI program and optimisation of radiation dose parameters improved and unified the UAE radiation dose practices at our centre. The dose reduction demonstrated no detrimental effects on image quality.

References

1. Liang E, Brown B, Rachinsky M. A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: results in 117 women. Aust N Z J Obstet Gynaecol 2018;58(4):454–9.

2. Ma J, Brown B, Liang E. Long‐term durability of uterine artery embolisation for treatment of symptomatic adenomyosis. Aust N Z J Obstet Gynaecol 2021;61(2):290–6.

3. Nocum DJ, Robinson J, Halaki M, et al. Identifying predictors of patient radiation dose during uterine artery embolisation. J Med Radiat Sci 2021;68(2):131–8.

Benchmarking the radiographer's performance in assessing mammographic positioning image quality criteria

Ziba Gandomkar,¹ Mo'ayyad Suleiman,¹ Mary Rickard,¹ Patrick Brennan¹

¹ The University of Sydney & DetectED‐X, New South Wales, Australia

Objectives: Breast cancer detection relies on optimal breast positioning to produce high‐quality images. National and international quality standards have suggested various criteria for evaluating mammographic positioning.^1–3 This study explores radiographers’ performances in the visual assessment of these criteria on craniocaudal and mediolateral oblique (MLO) views.

Methods: An online self‐assessment platform was designed and implemented for radiographers to evaluate their performances in assessing mammographic positioning based on 10 criteria, such as the width of pectoral muscle on MLOs or whether nipple is in the midline of breast on craniocaudals. Seventeen radiographers were recruited and assessed five cases using the self‐assessment platform. A panel of experts provided the ground truth for these cases. For each criterion, the median value and the interquartile range (IQR) of the performance were identified.

Results: The most difficult criterion to assess was examining whether the inframammary angle is well demonstrated on MLO. The median performance for this criterion was 60% (IQR = 30%). The second most difficult criterion was assessing whether the 1 cm rule was followed. The median performance of the participant in assessing the 1 cm rule was 70% (IQR = 20%) and this was the second most difficult criterion to assess. For six criteria, the IQR was 20% or more. Assessing whether the nipple is in profile, the existence of the skin fold, and overall symmetry were the easiest criteria with a median performance of 100%.

Conclusion: Quality assurance schemes and targeted educational interventions could help in reducing the relatively wide IQR evident among radiographers when judging radiographic quality.

References

1. Li Y, Poulos A, McLean D, Rickard M. A review of methods of clinical image quality evaluation in mammography. Eur J Radiol 2010;74(3):e122–31.

2. Taylor K, Parashar D, Bouverat G, et al. Mammographic image quality in relation to positioning of the breast: a multicentre international evaluation of the assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment. Radiography 2017;23(4):343–9.

3. Bentley K, Poulos A, Rickard M. Mammography image quality: analysis of evaluation criteria using pectoral muscle presentation. Radiography 2008;14(3):189–94.

Quality control in computed tomography angiography post processing

Jerome Breitenberger¹

¹ Sydney Adventist Hospital, Wahroonga, Australia

Introduction: Post processing work‐ups for computed tomography angiography (CTA) include curved plane reconstructions and 3D maximum intensity projections. When employed correctly they provide valuable additional information to radiologists and referrers. When performed incorrectly they have the potential to impede an accurate diagnosis or influence an improper course of treatment.¹ Quality control in post processing outputs becomes essential due to operator variability which has previously been investigated for aortic measurements² and renal stone analysis.³ Unlike the established RANZCR CT image review audit,⁴ there are no current guidelines on systematically reviewing the standardisation of CTA work‐ups.

Method: An auditing process was developed and implemented for carotid CTA work‐ups by using a standardised set of criteria, with Google Forms as the audit tool. This was completed monthly for 30 to 40 work‐ups by the same auditor. The expected benchmark was 90% for each criterion. After the first month’s baseline results were obtained, general feedback was delivered to radiographers involved for the following three months. Individual results and feedback were delivered after six months.

Results: Results for each criterion were generated as percentages on Microsoft Excel. From the baseline results, curved plane reconstructions were close to the expected benchmark, however maximum intensity projections required further improvement.

Conclusion: There is a gap in the literature on how to standardise CTA post processing. Auditing systems with individualised feedback and education may help reduce operator variability and avoid misdiagnosis.

References

1. Mezrich R, Juluru K, Nagy P. Should post‐processing be performed by the radiologist? Journal of Digital Imaging 2011;24(3):378–81.

2. Quint L, Liu P, Booher A, Watcharotone K, Myles J. 2012. Proximal thoracic aortic diameter measurements at CT: repeatability and reproducibility according to measurement method. International Journal of Cardiovascular Imaging 2012;29(2):479–88.

3. Lidén M, Andersson T, Geijer H. Making renal stones change size‐impact of CT image post processing and reader variability. Eur J Radiol 2011;21(10):2218–25.

4. CT image review self‐audit. 3rd edn. Sydney: The Royal Australian and New Zealand College of Radiologists; 2018. Available at www.ranzcr.com/fellows/clinical-radiology/quality-assurance-and-accreditation/ct> [Accessed 7 September 2021].

Realising the benefit and scalability of radiographer commenting at patient point‐of‐care

Ingrid Klobasa,^1,2 Gary Denham,² Marilyn Baird,² Allie Tonks,⁴ Caitlin Tu,⁴ Jim Abood,⁵ Chris Houghton,⁶ Andrew Pidgeon,⁶ Luke Nichols,⁶ Joshua Best,⁷ Aaron Weiershauser,⁷ Andris Jaunalksnis⁸

¹ Agency for Clinical Innovation, St Leonards, Australia, ² Manning District Hospital, Taree, Australia, ³ Monash University, Clayton, Australia, ⁴ Sydney Adventist Hospital, Wahroonga, Australia, ⁵ Bathurst Hospital, Bathurst, Australia, ⁶ Wagga Wagga Hospital, Wagga Wagga, Australia, ⁷ Wyong Hospital, Wyong, Australia, ⁸ Hunter New England Local Health District, New Lambton, Australia

Introduction: The verbal communication of significant medical imaging findings can cause misinterpretation and lacks transparency.¹ The Agency for Clinical Innovation Radiographer Real‐time Flag (RRF) project aimed to identify a radiographer commenting solution at point‐of‐care, quantify patient benefits and ensure scalability.

The longitudinal study seeks to provide a consistent implementation strategy for radiographer commenting across a range of healthcare settings.

The RRF commenting model of care requires radiographers to electronically communicate clinically significant findings to the referrer and radiologist and to call the referring team for critical conditions.

Methods: Mixed‐methods research design has been utilised to ensure the validity of patient‐centred outcomes. Multi‐disciplinary stakeholders were invited to a RRF Steering Group to determine key barriers and develop the notification strategy: image flag, electronic comment and verbal communication of critical findings. The RRF Working Group designed the Phase 1 multi‐site pilot study with targeted education for four RIS vendor solutions.²

Empirical data collections include positive predictive value, reporting turn around times, emergency department admission to discharge time and significant case identification. Qualitative and economic data will be collected in Phases 2 and 3.

Results: Preliminary positive predictive value for abnormality detection was high (94.8). The radiology reporting turn around time range was three minutes to 18.3 hours.

Discussion/Conclusions: Close inter‐professional collaboration has resulted in the successful implementation of the RRF at three pilot sites. The RRF model of care is unifying radiographers as a healthcare team. Scalability and sustainability across New South Wales will ensure equitable access to patients.

References

1. NSW Government. Final report of the Special Commission of Inquiry: acute care in NSW public hospitals. 2008. Sydney. Garling Enquiry.

2. Murphy A, Neep M. Radiographic image interpretation by Australian radiographers: a systematic review. J Med Radiat Sci 2019;66(4):269–83.

Friday 20 May, 1:45–3:15 Cultural

Service mapping of radiation therapy services to improve care for First Nations peoples with cancer

Hayley Fairless,¹ Stephanie Bale,¹ Luke McGhee,¹ Bena Brown,² Haryana Dhillon,³ Michael Penniment,^1,4 Sabe Sabesan,^1,5 Georgia Halkett,⁶ Siddhartha Baxi,⁷ Joanne Shaw,³ Joan Cunningham,⁸ Emily Callander,⁹ Sian Smith,¹⁰ Jim Frantzis,¹ Kar Giam,¹¹ Gail Garvey²

¹ Icon Cancer Centre, Cairns, Australia ² The University of Queensland, Herston, Australia ³ The University of Sydney, Sydney, Australia ⁴ South Australia Health, Adelaide, Australia ⁵ Queensland Health, Townsville, Australia ⁶ Curtin University, Perth, Australia ⁷ GenesisCare, Gold Coast, Australia ⁸ Menzies School of Health Research, Australia ⁹ Monash University, Melbourne, Australia ¹⁰ University of Bath, Bath, England ¹¹ Northern Territory Health, Darwin, Australia

Aboriginal and Torres Strait Islander peoples (respectfully referred to as First Nations peoples) account for 53.6% of the population in Far North Queensland.¹ This region also has an above Australian average excess death rate due to cancer.² Specifically, First Nations peoples are known to have poorer cancer outcomes when compared to their non‐Indigenous Australian counterparts.³ Decreased health literacy and engagement with treatment options can be attributed to these poorer outcomes.³ Cancer services in the region endeavour to improve health literacy and knowledge regarding the radiation therapy process for First Nations peoples presenting for cancer treatment.

Our centre has investigated the patient care pathway, focussing on the process and procedures for identifying First Nations patients, the level of cultural awareness training provided to staff and the treatment experiences of both staff and patients.

The initial results illustrated the crucial role Indigenous Liaison Officers hold in the co‐ordination of complex public/private cancer care. Additionally, staff feedback also highlighted their desire to participate in local cultural awareness training and updated resources.

Guided by the results of these initial stages, a radiation therapy talking book was developed. The implementation of this additional resource will be supported with staff training to assist and further identify areas of complex need.

References

1. Australian Bureau of Statistics, 2016. People: demographics and education. Available at https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/31501?opendocument#:~:text=In%20the%202016%20Census%2C%20there,up%2053.6%25%20of%20the%20population [Accessed 26 October 2021].

2. The Australian Cancer Atlas. Available at https://atlas.cancer.org.au

3. Australian Department of Health and Welfare, 2018. Cancer in Aboriginal & Torres Strait Islander people of Australia. Available at https://www.aihw.gov.au/reports/cancer/cancer-in-indigenous-australians/contents/table-of-contents

Integration of Indigenous knowledge and perspectives into undergraduate radiation therapy curriculum

Thashmira Naidoo¹

¹ Queensland University of Technology, Brisbane, Australia

Introduction: Health practitioners play a significant role in closing the gap aiming to reduce inequalities and disparities faced by Aboriginal and Torres Strait Islander peoples within Australia’s healthcare system. A scoping review of the literature was conducted to identify how Indigenous Australian knowledge and perspectives can be effectively integrated into an undergraduate radiation therapy curriculum, to ensure radiation therapy students graduate with the required industry and registration requirements.

Methods: Embase, Cochrane, Cinahl, Scopus, PubMed‐Medline were searched to access peer‐reviewed studies published between 2017 and 2021. The literature search was performed and reported conforming with PRISMA standards for scoping review methods.

Findings: A total of 591 articles were identified with 39 full text articles meeting the inclusion criteria. Two methods of teaching and learning and three independent assessment tools that promote cultural capability in undergraduate education were identified. Findings include intensive patient‐specific workshops which were reported to provide students with an immersive learning experience, better preparing them for clinical placements and future practice. Additionally, tools such as the Cultural Capability Management Tool and the Trans‐cultural Self‐efficacy Tool are currently being utilised in other allied healthcare professions to quantitively assess positive shifts and highlight developmental needs.

Conclusion: These findings will inform current educational endeavours to promote cultural safety and the cultural capability continuum in the undergraduate radiation therapy curriculum.

Visual information for culturally and linguistically diverse patients undergoing radiation therapy

Nainaben Dhana,¹ Evette Kelly,² Haley Wilson¹

¹ Austin Health, Heidelberg, Australia ² Townsville Hospital and Health Service, Townsville, Australia

Introduction: Patients from culturally and linguistically diverse (CALD) backgrounds may have unmet informational needs potentially resulting in a lower quality of care due to language barriers and poor health literacy, negatively impacting their comprehension of the consumer information.

There are various formats of written information available for patients; however, this information can be confusing and difficult to understand, particularly for patients of low educational backgrounds.

Aim: The aim of the literature review was to assess the value of visual information and inform the development of additional video resources to meet the visual information needs for CALD patients through translation of an existing ‘radiation therapy treatment pathway’ video.

Methods: Review of current published literature assessing the effectiveness of utilising a multimedia intervention for CALD patients experiencing radiation therapy treatment for the first time.

Results: There was limited conclusive evidence that multimedia information significantly reduces patient anxiety levels. There is evidence to suggest that it increased patients understanding of treatment and increased satisfaction levels.

Conclusion: Due to the technical nature of radiation therapy treatment, patients often struggle to absorb all the information required before treatment commences, particularly when there is a language barrier present. High‐quality visual resources can enhance and support the understanding of verbal and written information. Information in an audio‐visual and/or media format is effective in delivering patient care information to patients who have a low‐level educational background and therefore low literacy skills. The literature suggests that it can be more effective when compared to written formats alone, such as pamphlets.

Friday 20 May, 1:45–3:15 Adaptive Radiotherapy and Novel Strategies for IGRT

Feasibility of magnetic resonance‐guided stereotactic body radiotherapy of pelvic lymph node oligometastases

Vikneswary Batumalai,^1,2 David Crawford,¹ Claire Pagulayan,¹ Louis Hogan,¹ Urszula Jelen,¹ Conrad Loo,¹ Nicole Dunkerley,¹ Maddie Picton,¹ Lori Geddes,¹ Stacy Alvares,¹ Sandy Sampaio,¹ Monique Heinke,¹ Tania Twentyman,¹ Michael Jameson,^1,2 Jeremy de Leon¹

¹ GenesisCare, Australia ² The University of New South Wales, Australia

Objective: Stereotactic body radiotherapy (SBRT) is an effective treatment for oligometastatic disease. However, target proximity to organs at risk OAR within the pelvis may limit safe delivery of an ablative dose. Magnetic resonance guided adaptive radiotherapy (MRgART) may improve the therapeutic ratio. This study assessed the feasibility of MRgART for pelvic lymph node oligometastases.

Methods: Nine patients with pelvic lymph node oligometastases were treated with MRgART. Plans were prescribed to 30–40 Gy (3–5 fractions) with the goal of 95% planning target volume (PTV) to receive 100% of the prescribed dose, subject to strict OAR constraints. Daily real‐time adaptive plans were created. Treatment times, dosimetric comparisons and acute toxicity were reviewed. Acute toxicity was reported according to Common Terminology Criteria for Adverse Events v.5 at three‐month follow‐up.

Results: A total of 37 fractions were delivered to nine patients. Pre‐treatment plans met all the OAR criteria for all patients, while PTV dose criteria were met for seven patients. 34/37 adapted plans met all OAR criteria while 29/37 adapted plans met PTV dose criteria. Violations were primarily caused by surrounding OAR overlapping or adjacent to the PTV. Mean treatment duration was 43.5 minutes and well tolerated by all patients. Eight patients had complete toxicity data at three‐month follow up, no patients experienced grade 3+ toxicity.

Conclusion: SBRT for pelvic lymph node oligometastases using MRgART is feasible based on dose criteria, plan quality metrics, treatment duration and acute toxicity. Follow‐up is awaited to allow evaluation of late toxicity and patient reported outcomes.

Implementation of daily soft tissue image guidance radiation therapy for T1/2 larynx

Glen Osbourne,¹ Lachlan McDowell,¹ Albert Tiong¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

Cone beam computed tomography (CBCT) demonstrates that bony landmarks are inadequate surrogates for larynx position during radiotherapy.¹ This finding is consistent with the results of our independent departmental analysis of larynx position in 20 head and neck patients undergoing weekly CBCT. As a result, our centre has recently transitioned to a daily image‐guided radiation therapy (IGRT) protocol to provide increased certainty in treatment delivery to this geometrically small, mobile target volume.

A multi‐disciplinary team was formed to implement daily IGRT for early‐stage laryngeal cancers (T1/T2) using a pre‐treatment CBCT matched to the soft tissue structures of the larynx. Training and support materials developed to facilitate this new process will be outlined, with a particular focus on radiation therapist skill development to ensure optimal daily IGRT. Protocol development, implementation and ongoing support was undertaken with the support and guidance of the head and neck radiation oncologists. Departmental operational impact because of this change in practice will also be discussed.

The introduction of an IGRT protocol has enabled better care for this cohort of patients and is a critical and compulsory step in facilitating partial laryngeal irradiation (reduced volumes and margins). In the setting of partial laryngeal irradiation, soft tissue matching has been shown to result in superior rates of local control compared to bone matching, enabling a potential reduction in short and long term morbidity.²

References

1. Rock K, et al. Partial laryngeal IMRT for T2N0 glottic cancer: impact of image guidance and radiation therapy intensification. Int J Radiat Oncol Biol Phys 2018;102(4):941–9.

2. Osman S, et al. IMRT for image‐guided single vocal cord irradiation. Int J Radiat Oncol Biol Phys 2012;82(2):989–97.

An evaluation of the image‐guided radiation therapy online decision‐analysis time

Sarah Clark,¹ Natalie Pollard,¹ Elizabeth Brown^1,2

¹ Queensland University of Technology, Brisbane, Australia ² ROPAIR, Brisbane, Australia

Objectives: The ability to capture more anatomical information in cone‐beam CT (CBCT) imaging has seen a shift towards predominately CBCT image verification workflows. It has been documented that staff adopt a more extensive image analysis process with CBCT imaging.¹ The timeframe associated with assessing these online CBCT images, termed the ‘online decision‐analysis time’, if drawn out, can affect treatment efficiency and treatment accuracy. The aim of this study was to determine the current online decision‐analysis time for CBCT imaging at our institution and investigate which factors may influence this timeframe.

Methods: A retrospective clinical audit was conducted by collecting treatment parameters from 201 CBCT images. The online decision‐analysis time was calculated by subtracting the image acquisition timestamp from the verification shift application timestamp. The quantitative data was analysed using the mean, standard deviation and range in the following categories: all CBCTs, CBCTs grouped by treatment site, and CBCTs that required a rescan. Content analysis was performed on the comments associated with the CBCT images.

Results: The average online decision‐analysis time was 2:37 ± 1:28 minutes. Head and neck treatment sites had the shortest online decision‐analysis time with abdomen having the longest. Pelvis treatment sites had the highest frequency (57%) of rescanned images. Common categories found reported in staff comments included anatomical changes, repositioning, and the size of the organs at risk.

Conclusion: Results suggest the online decision‐analysis time has increased. Further refinement is required to determine if image quality, image review process and treatment site considerations influence this timeframe.

Reference

1. Li W, Jaffray D, Wilson G, Moseley D. How long does it take? An analysis of volumetric image assessment time. Radiother Oncol 2016;119(1):4.

Online adaptive radiation therapy implementation for cervical cancer: utility or futility?

Alexandra Turk,¹ Ryan Brown,¹ John Atyeo,¹ Leigh Ambrose,¹ Isabelle Fent,¹ Shelley Wong,¹ Adam Briggs,¹ Marita Morgia,¹ Mark Stevens,¹ Brian Porter,¹ Jeremy Booth¹

¹ Northern Sydney Cancer Centre, Sydney, Australia

Background: Current standard of care in the treatment of locally advanced cervical cancer is concurrent chemoradiotherapy.¹ Organ motion presents a challenge regarding target motion particularly for the cervix‐uterine position. An internal target volume (ITV) can often mitigate most of the motion, but excessive movement remains unpredictable,² and ITV concept increases the irradiated volume and therefore normal tissue dose. Online adaptive radiotherapy (oART) offers a solution to account for this inter‐fractional change by re‐optimising to the anatomy of the day.³

Method: Implementation of oART used a multi‐disciplinary approach. An auto‐planning template was built based on a hierarchical taxonomy of targets and anatomical volumes.⁴ A rigorous testing phase against departmental gold standard VMAT plans (RapidPlan) for 10 previously treated patients was undertaken to create an auto‐plan template. This template was curated to over 50 fractions of the retrospective treatment cone beam CTs to evaluate the robustness of our model.

Results: The template development phase provided a feedback loop in which technical challenges arising would subsequently inform the clinical process. Challenges included difficult delineation of structures due to significant artefact from gas, poor propagation of structures increasing editing time and inconsistencies with synthetic CTs. Limiting factors on daily adaption included staff availability per session, uncertainties in target volume delineation and editing time for complex and long volumes.

Conclusion: A robust and safe process was established to treat cervical cancer with oART. While potentially providing improved quality of care to these patients, daily adaption is not yet feasible.

References

1. eviQ. 2019. Gynaecological cervix definitive EBRT with or without chemoradiation. Available at https://www.eviq.org.au/radiation-oncology/gynaecological/105-gynaecological-cervix-definitive-ebrt-with-or#clinical-information

2. Lim K, et al. Consensus guidelines for delineation of clinical target volume for intensity‐modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Int J Radiat Oncol Biol Phys 2011;79(2):348–55.

3. Tee Tan L, et al. Image guided adaptive radiotherapy in cervical cancer. Semin Radiat Oncol 2019;284–98.

4. Pötter R, et al. The EMBRACE II study: the outcome and prospect of two decades of evolution within the GEC‐ESTRO GYN working group and the EMBRACE studies. Clinical and Translational Radiation Oncology 2018;9:48–60.

The adaptive experience: implementing online adaptive planning and treatment into a department

Leigh Ambrose,¹ John Atyeo,¹ Thomas Eade,¹ Andrew Kneebone,¹ George Hruby,¹ Marita Morgia,¹ Mark Stevens,¹ Sarah Bergamin,¹ Dasanthe Jayamanne,¹ Brian Porter,¹ Alexandra Turk,¹ Bella Fent,¹ Shelley Wong,¹ Kenny Wu,¹ Jeremy Booth,¹ Regina Bromley,¹ Alexandra Quinn,¹ Adam Briggs,¹ Ryan Brown,¹ Alannah Kjeda,¹ Stephanie Roderick¹

¹ Northern Sydney Cancer Centre, St Leonards, Australia

Background: Implementation of the Ethos online adaptive planning and treatment system in 2020 required a focussed team of radiation therapists, physicists and radiation oncologists. Adopting the system early brought about many challenges and opportunities. Embracing this technology in such a comprehensive way resulted in our department being the first site in the southern hemisphere to treat using Ethos online adaption.

Discussion: Implementation focused on sites that would be best suited for adaption. Ethos uses AI to create plans for both adaptive and non‐adaptive sites. Varian provided a test environment that emulated the Ethos planning and treatment process. This allowed our team to develop robust planning and treatment protocols. Initial anatomical sites included head and neck, rectum, cervix and bladder. Thorough evaluation of planning for reference and adaptive patient geometries occurred in the test environment to create robust clinically acceptable plans that met stringent site‐specific objectives. An in‐house education program for radiation therapists was developed to enable both treatment and planning of adaptive sites.

Conclusion: Introducing adaptive planning and treatment required, and created, significant resources, knowledge, learning and flexibility. As pioneers of online adaption, we have gained key learnings in adaptive radiotherapy and have established a department that not only treats many sites adaptively but has released adaption as a standard of care for rectum, cervix, bladder and palliative (clinical trial). Current protocols are being developed in the emulation environment for prostate and other pelvic sites, with additional sites to be developed.

‘Busting for a PeeTV’: implementation of adaptive RT for bladder

Leigh Ambrose,¹ John Atyeo,¹ Ryan Brown,¹ Andrew Kneebone,¹ Thomas Eade,¹ Brian Porter,¹ Jeremy Booth,¹ Alexandra Turk,¹ Bella Fent,¹ Shelley Wong,¹ Regina Bromley,¹ Alexandra Quinn,¹ Adam Briggs,¹ Alannah Kjeda,¹ Stephanie Roderick¹

¹ Northern Sydney Cancer Centre, St Leonards, Australia

Background: Bladder cancer is diagnosed in approximately 2800 Australians every year, with diagnosis more common in men. In our department, approximately 23 cases are treated annually, including a mixture of radical, re‐irradiation and palliative cases.

Discussion: Treatment protocols in our department specify the inclusion of a higher dose gross tumour volume (GTV), necessitating the use of an image‐guided radiation therapy matching protocol customised to the position of the GTV within the bladder. Considering this, locating the GTV on treatment can be a challenge as well as alignment to the bladder itself because of the variable nature of the organ. Image matching and real time changes to planning volumes are important areas where online adaption can provide improvement.

Key focusses for adaption included creating a stable bladder size to account for any intra‐fraction motion and assessing how well the Ethos system generated the GTV in real time. Plans were emulated for comparison. Given that ‘time to adapt’ has always been an important consideration, adaptive bladder fractions were monitored for overall time taken in the clinical setting and subsequent analysis of bladder volume change over time was undertaken.

Conclusion: Within our department, an adaptive planning and treatment workflow for both palliative and radical bladder cases using the Ethos planning system has been created. This system has produced clinically acceptable plans and has shown to successfully generate target and influencer volumes.

Bladder stability has been achieved using a neutral bladder position. A reasonable overall treatment time was achieved with an average of 30 minutes for the total appointment.

Friday 20 May, 1:45–3:15 Training and Education

Professional skills development in medical imaging education: What is important, and what is being achieved?

Brooke Osborne,¹ Steve Milanese,¹ Kerry Thoirs,¹ Gisela Van Kessel,¹ Sharron King¹

¹ The University of South Australia, Adelaide, Australia

Background: The effective teaching of clinical skills to medical imaging students is influenced by the unification of tertiary education academics, the supervisors who oversee the training of students and the students themselves. The success of a student’s clinical education is determined by how well they have been able to achieve the specific learning goals established by their educational institution, usually in line with the Medical Radiation Practice Board of Australia’s professional capabilities for medical radiation practitioners.¹

Objectives: This study aimed to identify which specific skill areas medical imaging education stakeholders feel are important to develop, and in which skill areas clinical educators and radiographers feel students/early career radiographers are lacking.

Methods: Three separate stakeholder groups were surveyed: radiographers, academic educators, and students. A Delphi survey process was used as a common and effective approach for seeking consensus in medical professions literature.²

Discussion: This presentation will discuss the differences in the identification of and level of importance placed on different skills by each of the stakeholder groups. Additionally, the differences noted in the perceived ability for students/early career radiographers to demonstrate these skills will be presented. The observed differences of opinions between these groups have the potential to inform approaches to the teaching and learning of radiography clinical skills.

References

1. Medical Radiation Practice Board of Australia. Professional capabilities for medical radiation practitioners. 2020. Available at https://www.medicalradiationpracticeboard.gov.au/Registration-Standards/Professional-Capabilities.aspx

2. Block ZA, Brinkmann JT, Gard SA. The utilization of consensus techniques in education and research in medical professions. J Prosthet Orthot 2021;33(3):175–183.

Unearthing the research demographics of Australian medical radiation practitioners

Elizabeth Brown,^1,2 Minh (Shayne) Chau,^2,3,4 Rachael Beldham‐Collins,^2,5,6 Nigel Anderson^2,7

¹ The Princess Alexandra Hospital, Brisbane, Australia ² ASMIRT Research Committee, Melbourne, Australia ³ The University of South Australia, Adelaide, Australia ⁴ Flinders Medical Centre, Adelaide, Australia ⁵ The Crown Princess Mary Cancer Centre, Westmead, Australia ⁶ Blacktown Haematology and Cancer Centre, Blacktown, Australia ⁷ Peter MacCallum Cancer Centre, Melbourne, Australia

Objectives: Rapid, ongoing technological advances has seen an increased need for medical radiation practitioners (MRPs) to develop research skills.¹ The aim of this study was to ascertain the current research demographics of Australian MRPs, determine perceived barriers to participating in research to establish needs‐based initiatives to support MRPs in undertaking research into the future.

Methods: A quantitative and qualitative cross‐sectional survey of Australian MRPs using an electronic survey tool was distributed between November and December 2020. Participants were recruited via an invitation email to Australian Society of Medical Imaging and Radiation Therapy members.

Results: A total of 431 participants responded to the survey, representing 2.3% of all Australian MRPs. Most respondents had a bachelor’s degree or higher (71.9%); 8.4% had a postgraduate research qualification (PhD 3.2%, professional doctorate 0.7%, master’s degree 4.5%); 15.4% plan to undertake postgraduate research in the future, with 68.2% having no plans for postgraduate research study. Respondents blamed lack of time (47.0%), lack of interest (33.4%), cost (24.2%) and workplace support (23.9%) as contributing factors as to why they are yet to undertake postgraduate research.

Conclusion: An encouraging increase in the number of MRPs who have been awarded or will be awarded a postgraduate degree was found over recent decades. However, many still indicate a lack of interest in being actively involved in research. Targeted support mechanisms need to be implemented to address perceived barriers to continue to unite Australian MRPs in becoming an internationally recognised research force.

Reference

1. Halkett G, Berg M, Ebert M, et al. Radiation therapists' perspectives on participating in research. J Med Radiat Sci 2017;64:299–309.

A SMARTer approach to modality training and credentialing

Jessica Mccann,¹ Kath Macdonald¹

¹ Western Health, Melbourne, Australia

Standard 1 of the National Safety and Quality Health Service Standards requires that the ‘clinical workforce have the right qualifications, skills and approach to provide safe, high‐quality healthcare’.¹ Training our workforce through various modalities is the only way imaging services can ensure the ongoing provision of a robust, flexible and well‐credentialed workforce available to meet service demands. Using SMART goals aligned with the application of the Victorian Department of Health and Human Services Credentialing, Competency and Capability Framework,² a unique, modality‐specific training plan was implemented throughout medical imaging in a major public hospital to ensure this need is met.

Modality training utilises significant resources and it is imperative that any program delivers the desired outcomes. This program was developed with modality leads, ensuring a training regimen personalised to each modality, yet with the ability to tailor to specific individual needs as desired. The program utilises specific training rosters, coupled with a weekly breakdown of SMART goals to be met by each trainee. SMART goals assess the progress of the trainees using a combination of practical skills to be demonstrated and theoretical knowledge tested via a quiz.

Each training plan has been established to credential radiographers and sonographers to a ‘beginner level,’ for base credentialing within that modality, through to ‘intermediate or advanced’ and ‘on call’ levels. Each radiographer’s scope of practice can then be defined by credentialing obtained through that modality, ensuring a workforce and roster that has the right skills to provide safe, high‐quality care.

References

1. Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC, 2017.

2. Credentialing, Competency and Capability Framework. 1st ed. Melbourne Health.vic, 2016.

Uniting university assessments: developing an expectation document to assist the supervision and management of students

Adam Steward,¹ Claire de Booy,¹ Leonora Abdulai,¹ Jessica Mccann¹

¹ Western Health, Melbourne, Australia

Western Health is a major public hospital servicing Melbourne’s greater western suburbs. The radiology department provides radiography clinical education for a number of student radiography clinical placements across first to fourth years of their degree. This clinical training time is also offered to students from four different university courses.

The difficulties to effectively manage such a substantial amount of training are immense, particularly to ensure that students are held to a consistent standard and afforded appropriate feedback. We needed to find a way to unite the assessments and expectations of the varying universities that we provide placements for, as well as the standards that we expect of students under our care and development.

The Victorian Department of Health and Human Services Credentialing, Competency and Capability Framework was released in 2016 and the framework was utilised by our education team to develop an expectation document to meet the challenging needs of providing high quality, standardised clinical placement to students across a range of prior experiences and differing clinical assessment forms.

This presentation introduces our document that was developed using the framework and seeking to unite the assessment criteria of our university partners. The document has been in use for students within our department since 2018 and underwent a review in 2021. The presentation chronicles its development, explains the document, and describes the effectiveness of use of the document in our clinical setting.

Maximising undergraduate medical radiation students’ learning experiences using cloud‐based CT software

Elio Arruzza,¹ Shayne Chau²

¹ The University of South Australia, Adelaide, Australia ² RMIT University, Bundoora, Australia

Objectives: Simulation‐based learning is a crucial educational tool for disciplines involving work‐integrated learning and clinical practice.¹ Though its uptake is becoming increasingly common in a range of fields, this uptake is less profound in diagnostic radiography and computed tomography. CT simulator software may be a viable option to facilitate the development of practical clinical skills in an effective, safe and supported environment. This project aimed to collect evidence on the efficacy of cloud‐based CT simulation by exploring undergraduate medical radiation students’ experiences and insights in the simulation‐based environment.

Methods: A cross‐sectional mixed methods design was employed. Students in their third year of study undertook formal simulation CT learning using the Siemens SmartSimulator, before a six‐week off‐campus clinical experience. A pre‐ and post‐clinical placement Likert scale survey was completed, as well as focus groups to gather qualitative data. Thematic analysis was employed to explore how the simulator developed students’ knowledge of CT concepts and preparedness for clinical placement.

Results: Survey scores were high, particularly in terms of satisfaction and relevancy. Focus groups drew attention to the software’s capacity to build on foundational principles, prepare students for placement and closely emulate the clinical environment. Students highlighted the need for continual guidance and clinical relevance.

Discussion/Conclusion: Students maintained that interactive simulation was inferior to real‐world clinical placement. The integration of CT simulator software has the potential to increase knowledge, confidence and student preparation for the clinical environment.

Reference

1. Chamunyonga C, Singh A, Gunn T, Edwards C. Strategies to develop student support mechanisms in medical radiation sciences clinical education. J Med Imaging Radiat Sci 2020;51(4):512–7.

Mentoring as a tool to support Australian medical radiation practitioners – a QI project evaluation

Allie Tonks,¹ Franziska Jerjen²

¹ Sydney Adventist Hospital, Sydney, Australia ² Nepean Hospital, Sydney, Australia

Objectives: The National Mentoring Program was established in 2021 as a peer‐led initiative to help medical radiation practitioners (MRPs) address capability requirements and support their personal and professional development.^1–4 As a new initiative, it is necessary to evaluate how organised mentoring impacts MRPs and how program design contributes to successful experiences.

Methods: A longitudinal mixed‐methods cohort design was used. All 77 mentors and 77 mentees participating in the National Mentoring Program were invited to anonymously complete role‐specific mid and end‐point surveys online. Surveys contained Likert and multichoice quantitative questions and open‐ended qualitative questions.

Results: The study is ongoing, however, results are available from the mid‐point survey with a 36% mentor and 31% mentee response rate. A large majority of participants found mentoring 'very' or 'extremely' useful for supporting their personal and professional development. While mentees reported particular benefits in guided problem solving, goal achievement, and increased support, mentors experienced a larger range of benefits at consistently higher levels. Program design elements perceived most favourably were accessibility, tailored matching and clear communication. Resource provision was variably perceived and partner location did not influence experience.

Conclusion: Participation in organised mentoring appears to positively impact MRPs by supporting numerus aspects of personal and professional development that differ between mentors and mentees. Participant experience can be meaningfully influenced by elements of program design, including flexible structure and careful matching. Survey findings support mentoring as a tool to empower MRPs and can be used to inform more accessible, valuable and effective services in the future.

References

1. Kostrubiak DE, Kwon M, Lee J, et al. Mentorship in radiology. Current Problems in Diagnostic Radiology 2017;46(5):385–90.

2. Hirsch B, Whittington KD, Walker J. Mentoring in radiologic science. J Med Imaging Radiat Sci 2020;51(3):354–7.

3. Ward EC, Hargrave C, Brown E, Halkett G, Hogg P. Achieving success in clinically based research: the importance of mentoring. J Med Radiat Sci 2017;64(4):315–20.

4. Medical Radiation Practice Board of Australia. Professional capabilities for medical radiation practitioners. Australian Health Practitioner Regulation Agency; 2020. Available at https://www.medicalradiationpracticeboard.gov.au/Registration-Standards/Professional-Capabilities.aspx

Friday 20 May, 3:45–5:15 Professional Challenges

Holding boundaries with compassion: reducing the impact of inappropriate sexual patient behaviour

Elizabeth Jimmieson¹

¹ Sunshine Coast University Hospital, Birthinya, Australia

Medical radiation professionals from all disciplines may encounter inappropriate sexual patient behaviour as they provide care. Examples of inappropriate sexual behaviour include sexual gestures, suggestive stories or jokes and intrusive personal questions.¹ Despite reports from around the world that up to 85% of healthcare workers have experienced this behaviour, research on this topic is limited.^1–3 For numerous reasons, encounters of inappropriate sexual behaviour from patients are rarely discussed or reported and remain taboo.⁴

Inappropriate sexual patient behaviour has been shown to interfere with the provision of care, impact on patient outcomes and have a detrimental effect on health professionals’ wellbeing.⁵ This presentation aims to provide information that can be used to raise awareness of this topic in any workplace. In order to achieve this aim, a descriptive narrative summary of peer‐reviewed and grey literature will be presented. A definition of inappropriate sexual patient behaviour will be offered and further examples of what constitutes this behaviour will be described. Health practitioners’ rights will be explored with reference to current national, state and system policies. Various methods of managing inappropriate sexual patient behaviour will be discussed, however evidence supporting these methods is scarce. Finally, the need for further investigation of this issue and the importance of engaging all key stakeholders when developing solutions will be highlighted. All medical radiation professionals have the right to feel safe and respected in their interactions with patients.

References

1. Adler M, Vincent‐Höper S, Vaupel C, et al. Sexual harassment by patients, clients, and residents: investigating its prevalence, frequency and associations with impaired well‐being among social and healthcare workers in Germany. International Journal of Environmental Research and Public Health 2021;18(10):5198.

2. Cambier Z, Boissonnault JS, Hetzel SJ, Plack MM. Physical therapist, physical therapist assistant, and student response to inappropriate patient sexual behavior: results of a national survey. Phys Ther 2018;98(9):804–14.

3. Weerakoon P, O'Sullivan V. Inappropriate patient sexual behaviour in physiotherapy practice. Physiotherapy 1998;84(10):491–9.

4. Nielsen MBD, Kjær S, Aldrich PT, et al. Sexual harassment in care work – dilemmas and consequences: a qualitative investigation. Int J Nurs Stud 2017;70:122–30.

5. Uslu E, Buldukoglu K. The gray zone of patient‐nurse communication: inappropriate sexual behavior. Perspect Psychiatr Care 2021;57(2):948–52.

Burnout in medical radiation scientists: results from a recent systematic review

Melissa Shields,¹ Daphne James,¹ Lynne McCormack,¹ Helen Warren‐Forward¹

¹ The University of Newcastle, Callaghan, Australia

Objective: Burnout is described as an occupational phenomenon resulting from workplace stress that has not been successfully managed.¹ This systematic review aimed to evaluate the prevalence of burnout in the four disciplines of medical radiation science (MRS) (radiographers, radiation therapists, nuclear medicine technologists, and sonographers).

Methods: Keywords were used to search several electronic databases to locate studies published in peer‐reviewed journals from 2000 that used a questionnaire to measure burnout in the MRS population. The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines were followed, and the review was registered with PROSPERO.

Results: Following the removal of duplicates, title, abstract and full text screening as well as the application of a critical appraisal tool, 15 articles were included in the systematic review. All MRS disciplines were represented in these 15 articles, with the majority focussed on radiation therapists. Within the radiation therapist group, seven of the nine studies reported low to moderate burnout among their participants. However, two studies did show high levels of burnout in certain domains. Within the other MRS disciplines, five of the six studies reported moderate burnout.

Conclusion: Levels of burnout have remained steady over the past 20 years, with the majority of studies reporting moderate levels of burnout in the MRS profession. However, stress in the workplace will need to be managed on an organisational and individual level before burnout becomes a significant issue in medical radiation scientists.

Reference

1. World Health Organization. Burn‐out an “occupational phenomenon”. International classification of diseases, 2019. Available at https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

The bush to the beach: effect of rural placements on graduate practice location

Peter Devlin,¹ Lauren Farrugia,¹ Tony Smith,¹ Julie Depczynski,¹ Emma Cooper,¹ Georgina Boyle¹

¹ The University of Newcastle, Callaghan, Australia

Health workforce shortages contribute to high prevalence of preventable disease, more avoidable hospitalisations, and shorter life expectancy for rural populations.¹ About 28% of Australians live outside major cities² but only some 21% of all allied health professionals live in those locations.³ Therefore, building a sustainable rural allied health workforce, including medical radiation practitioners, is a national priority.⁴ Funded by the Australian Government, the University Department of Rural Health (UDRH) program encourages medical radiation science (MRS) students to undertake part of their studies in rural areas. As well as academic and clinical education, those students participate in interprofessional, community engagement and Indigenous cultural learning.

Data show an association between undergraduate MRS rural experience and having a graduate rural principal place of practice (PPP). Of 164 graduates who completed a three‐year degree in 2017, the 43 who had a registered rural PPP in 2019 had experienced a median of 50 undergraduate rural placement days, while those with a major city PPP had experienced a median of just 25 rural placement days (Wilcoxon, P = 0.002). For the combined 120 graduates of 2018 and 2019, who completed a four‐year degree, a greater number (X2; P = 0.02) and longer duration (X2; P = 0.06) of rural placements were associated with having a rural PPP. Overall, location of origin (city vs rural) was also predictive of graduate practice location (P < 0.01).

While undergraduate rural placement experience is influential, students who enter rural practice are commonly of rural origin. Targeting those students for tailored UDRH rural placements may be strategically synergistic.

References

1. Australian Medical Association. Rural workforce initiatives 2017. Canberra: Australian Medical Association. 2017. Available at https://www.ama.com.au/position-statement/rural-workforce-initiatives-2017 [Accessed 12 November 2021].

2. Australian Institute of Health and Welfare. Australia’s health 2020: rural and remote health. Available at https://www.aihw.gov.au/reports/australias-health/rural-and-remote-health [Accessed 18 November 2021].

3. Sutton K, Smith A, Waller S. Australia’s health workforce. In: Willis E, Reynolds L, Rudge T, editors. Understanding the Australian health care system. 4th ed. Chatswood: Elsevier Australia; 2020.

4. Australian Government, National Rural Health Commissioner. Improvement of access, quality and distribution of allied health services in regional, rural and remote Australia. Department of Health. 2020. Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/National-Rural-Health-Commissioner-publications [Accessed 12 November 2021].

The COVID‐19 pandemic: ongoing impact on education and development within a multi‐site radiotherapy department

Jotham Bonett,¹ Glenn Trainor¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

Throughout 2020–2021, the COVID‐19 pandemic has afforded many global challenges. The Victorian health sector, including radiation therapy (RT) services at the Peter MacCallum Cancer Centre, have not been immune to these challenges.

Spanning across five departments (four metropolitan and one rural), the RT education and development (E&D) team found that ongoing lockdowns and increased staff furloughing due to increased staff/patient exposure to tier 1 and 2 sites meant that the challenges of 2020 were further heightened in 2021.

The ever‐changing circumstances in Victoria meant that the RT E&D team had to remain agile, implementing new initiatives across the five departments to continue providing E&D initiatives for staff and ongoing support for students requiring clinical placement. Due to the events of 2020, the E&D team were required to take on higher university student numbers in 2021 (93), due to the cancelled placements of 2020, where only 36 students were able to complete rotations. The introduction of hybrid student clinical placements, the transition from face‐to‐face CPD events to a virtual platform, increased clinical backfill expectations due to ongoing staff furloughing/working from home, and increased reliance on new technologies/processes, all provided additional burden to the RT E&D capability across the five campuses.

This presentation will focus on the issues that have and continue to arise 18 to 24 months after the initial stages of the pandemic, but also the improvements and changes made due to the pandemic when it comes to E&D across a multi‐site radiation therapy department.

Sentinel events in patient safety – cases in risk‐based regulatory policy development

Adam Reinhard^1,2

¹ Medical Radiation Practice Board of Australia, Melbourne, Australia ² Australian Health Practitioner Regulation Agency, Melbourne, Australia

The primary objective of the Medical Radiation Practice Board of Australia is to protect the public through regulation of the medical radiation practice profession. The Board provides assurance to the community and health consumers through the development and implementing a range of standards, codes and guidelines, as well as setting educational requirements for approved programs of study.

The Victorian Coroner’s Court published its findings into the death of Peta Hickey in November 2021.¹ The death of Peta Hickey was a tragedy and all the more so because it was a preventable death. While the inquest looked at issues dealing with the justification of medical radiation and the management of anaphylaxis, it’s the coroner’s finding that industry appeared to be putting profit before the safety and welfare of patients that is most concerning.

This presentation looks at the role played by sentinel events, such as coronial findings, notifications and other healthcare complaints, in developing guidance for practitioners. Good healthcare and health practice works best when all those on the team are working towards the same goal. For this reason, Ahpra’s policy development work looks not only at the mechanics of healthcare, but also the culture in which healthcare is provided.

Reference

1. Inquest into the death of Peta Hickey, 22 November 2021, COR 2019 2336 (Victoria).

Maintaining the unity of your values during the performance management and termination process

Nadine Thompson¹

¹ Sydney Adventist Hospital, Wahroonga, Australia

There are numerous instances where an employee requires performance management, however, some instances are more serious than others. Performance management is one of the most intense and emotionally taxing management tasks. This process is often difficult for the manager, the employee and associated team members. When the standards required for safe and satisfactory work performance are not being met a performance management strategy is required. While this aims to improve performance, sometimes this is not achieved, and the organisation is left with only one option: termination.

During the performance management process those involved are at risk of losing unity of their values, rights and responsibilities. It is critical that managers have a clear understanding of the resources available to support the management of poor performance and unsafe practice in the workplace, specifically Fair Work Ombudsman, AHPRA, MRPBA and APRANSA.

This presentation explores the performance management process from first concern to termination; specifically focussing on how we can unite our values during this time. This presentation offers a unique learning opportunity for practitioners or aspiring managers and perhaps a different perspective for those with many years of management experience.

Friday 20 May, 3:45–5:15 MRI to Improve Radiotherapy Outcomes

MRI organ at risk delineation for nasopharyngeal radiotherapy: measuring the effectiveness of an educational intervention

Olivia Ryan,^1,2,3 Kylie Dundas,^2,3,4 Yolanda Surjan,¹ Doaa Elwadia,² Michael Cardoso,^2,4,5 Kimberley Nguyen^2,3,4

¹ The University of Newcastle, Callaghan, Australia ² Liverpool and Macarthur Cancer Therapy Centres, Liverpool, Australia ³ Ingham Institute of Applied Medical Research, Liverpool, Australia ⁴ The University of New South Wales, Sydney, Australia ⁵ The University of Wollongong, Wollongong, Australia

Introduction: Magnetic resonance imaging (MRI) provides excellent soft‐tissue contrast, so the unity of MRI with radiotherapy is increasingly being utilised for radiotherapy planning. This study evaluated the impact of an education workshop in minimising inter‐observer variation (IOV) for nasopharyngeal organs at risk (OAR) delineation on MRI.

Methods: 10 observers delineated 14 OAR on four retrospective nasopharyngeal MRI datasets. Standard contouring guidelines were provided pre‐workshop. Following an education workshop on MRI OAR delineation, observers blinded to their original contours repeated the 14 OAR delineations. For comparison, reference volumes were delineated by two head and neck radiation oncologists. IOV was evaluated using dice similarity coefficient (DSC), Hausdorff distance (HD), and relative volume. Observer confidence pre‐ and post‐workshop was also recorded using a 6‐point Likert scale. The workshop was deemed beneficial for an OAR if ≥ 50% of observers mean scores improved in any metric and > 50% of observers’ confidence improved.

Results: All OAR had ≥ 50% of observers improve in at least one metric. Base of tongue, larynx, spinal cord, and right temporal lobe were the only OAR achieving a mean DSC score of > 0.7. Base of tongue, left and right lacrimal glands, larynx, left optic nerve, and right parotid gland all exhibited statistically significant HD improvements post‐workshop (P < 0.05). Brainstem and left and right temporal lobes all had statistically significant relative volume improvements post‐workshop (P < 0.05). Post‐workshop observer confidence improvement was observed for all OAR (P < 0.001).

Conclusion: The educational workshop reduced IOV and improved observers' confidence when delineating nasopharyngeal OAR on MRI.

Novel methodology to quantify dehydration in head and neck cancer radiotherapy patients using DIXON MRI

Sophie Duncan,^1,2,3 Kylie Dundas,^2,3,4 Amy Walker,^2,3,4,5 Shivani Kumar,^2,3,4 Katherine Bell,⁶ Yolanda Surjan,¹ Andrew Wallis,² Farhannah Aly,^2,3,4 Mark Lee^2,4

¹ The University of Newcastle, Callaghan, Australia ² Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia ³ Ingham Institute of Applied Medical Research, Sydney, Australia ⁴ The University of New South Wales, Sydney, Australia ⁵ The University of Wollongong, Wollongong, Australia ⁶ Liverpool Hospital, Sydney, Australia

Objectives: Head and neck cancer patients are at risk of weight change due to inadequate nutrition intake or dehydration when receiving radiotherapy (RT).¹ This study aimed to unite a multi‐disciplinary team to develop methodology to measure water content changes on magnetic resonance imaging (MRI) scans of the head and neck region over the course of RT.

Methods: Retrospective datasets of 54 patients were analysed. Eligible patients had been treated for head and neck cancer with cisplatin chemoradiation or RT alone and underwent a minimum of two MRI scans from weeks 0, three and six of their treatment. Anatomical regions consisting of ≥ 90% water, on T2 weighted DIXON MRI sequences were contoured. Water volume changes of all patients were evaluated, within an anatomically standardised external volume, by comparing the absolute water fraction volume (cc) (VEx90WF) and relative water fraction volume (%) (RelVEx90WF) at weeks 0 and six of RT.

Results: There was a statistically significant difference between the RelVEx90WF at weeks 0 and six (P = 0.005). However, no statistically significant difference was identified between week 0 and six VEx90WF (P = 0.064). There were no statistically significant differences identified between patients who received chemoradiation versus RT alone.

Discussion/Conclusion: This study developed a novel method for measuring changes in water fraction volumes over time, using T2 weighted DIXON MRIs. The methodology created in this study requires further validation through phantom imaging, with known fat and water values. If validated, this methodology could unite multi‐disciplinary teams to provide optimal patient care.

Reference

1. Almada‐Correia I, Neves PM, et al. Body composition evaluation in head and neck cancer patients: a review. Front Oncol 2019;9:1112.

Defining active bone marrow on magnetic resonance imaging for cervix radiotherapy

Felicity Hudson,^1,2 Amy Walker,^1,2,3 Tania Erven,¹ Doaa Elwadia,¹ Michaela Beavan,¹ Sarah Payne,¹ Karen Lim,^1,2 Lois Holloway,^1,2,3 Viet Do^1,2

¹ Liverpool and Macarthur Cancer Therapy Centres, Liverpool, Australia ² The University of New South Wales, Sydney, Australia ³ Ingham Institute of Applied Medical Research, Liverpool, Australia

Objectives: Concurrent chemo‐radiotherapy (CRT) is the gold standard treatment for locally advanced cervix cancer.¹ CRT improves tumour control but also increases acute haematological toxicity (HT). By reducing radiotherapy (RT) dose to active bone marrow (ABM) HT can be minimised.¹ Methodology for ABM delineation using fluorodeoxyglucose‐positron‐emission‐tomography (FDG‐PET) and computed tomography (CT) vary, and utilisation in RT is difficult.^1,2 This study aims to develop a robust magnetic resonance imaging (MRI) protocol to identify ABM in the pelvis for RT.

Methods: 10 healthy female volunteers were scanned using T1 and T2 weighted sequences. ABM was defined using fat fraction (FF) maps generated in MATLAB. Pelvic bones (L5 to head of femur) were contoured and ABM volume was generated using sub‐thresholds of FF to test feasibility of auto‐generated contours. To reduce false positive contours, the ABM contours were edited to avoid the bone/tissue interface. Volumes were validated based on previous literature (FF minimum 24%;² mean 44.5%³).

Results: For each volunteer image dataset, 40 contours were created. Table 1 illustrates the mean percentage of total pelvic bone the FF threshold contours represented for T1 and T2 datasets. The most feasible population‐based threshold for delineation of MRI ABM contours for RT planning was 30–70% FF, and volunteer specific FF below the mean total pelvic FF.

Discussion/Conclusion: MRI imaging can be used to generate semi‐automated ABM contours for RT planning in cervix cancer treatment. Further validation of this methodology with patient data and FDG‐PET comparison is required.

References

1. Corbeau A, Kuipers SC, deBoer SM, et al. Correlations between bone marrow radiation dose and haematologic toxicity in locally advanced cervical cancer patients receiving chemoradiation with cisplatin: a systematic review. Radiother Oncol 2021;164(2021):128–37.

2. Andreychenko A, Kroon PS, Maspero M, et al. The feasibility of semi‐automatically generated red bone marrow segmentations based on MR‐only for patients with gynaecologic cancer. Radiother Oncol 2017;123(2017):164–8.

3. Beavan M, Dundas K, Hudson F, et al. Feasibility of bone marrow sparing volumetric modulated arc therapy to spare active bone marrow in cervical and vaginal cancer patients: a retrospective dosimetric analysis. J Med Radiat Sci 2021;00:1–10.

Integrating MRI into a radiation therapy department

Brayden Geary,¹ Kerryn Brown,¹ Drew Smith,¹ Glenn Cahoon,¹ Marly Basile,¹ Sandie Fisher,¹ Stephen Chin,¹ Sweet Ping Ng¹

¹ Austin Health, Heidelberg, Australia

Magnetic resonance imaging (MRI) is most commonly used as a complementary imaging modality in radiotherapy treatment planning. MRI provides enhanced soft tissue contrast to better visualise tumour and adjacent critical structures. The use of MRI‐guided radiation therapy treatment is an emerging field, utilising enhanced soft tissue visualisation and daily adaptive planning to ensure accurate treatment delivery daily.

The first clinical service in Australia with a full in‐house MRI‐guided planning and treatment capabilities utilises an Elekta Unity MR‐linac and a Philips 1.5T Ingenia Ambition X MRI simulator. There are certain challenges and limitations in acquiring MR images for a purpose other than diagnostic intent. The development of our service required a collaborative multi‐disciplinary approach to ensure the safe and effective integration of these exciting technologies. Our early experience has shown the benefits of timely access to MRI simulation and MR‐guided radiation therapy treatment.

Improvement in male pelvis magnetic resonance image contouring following radiologist‐delivered training

Bronwyn Shirley,¹ Amy Brown,¹ Glen Newman,¹ Alan Boles,² Christopher Rumley,¹ Rachel Doyle,¹ Scott Cooper,¹ Alex Tan^1,3

¹ Townsville University Hospital, Townsville, Australia ² Queensland XRay, Townsville, Australia ³ James Cook University, Townsville, Australia

Objectives: The magnetic resonance linear accelerator combines both magnetic resonance imaging and a linear accelerator, allowing for daily treatment adaptation based on positional or anatomical changes. This study aimed to assess the impact of radiologist‐delivered training in magnetic resonance (MR) contouring of relevant structures within the male pelvis.

Method: Two radiation oncologists, two registrars and seven radiation therapists completed contouring on 10 male pelvis MR datasets both pre‐ and post‐training. Image quality and contour confidence was assessed, and contouring time recorded. A two‐hour MR anatomy training session was delivered by a radiologist, who also completed contours on the datasets, providing a ‘gold standard’. The pre‐ and post‐training contours were compared against the gold standard with dice similarity co‐efficient (DSC) and average Hausdorff distances calculated; and the pre‐ and post‐scores and timing compared.

Results: The improvements in both Hausdorff and DSC were significant (P < 0.05) in prostate, rectum and seminal vesicles, with a post‐training DSC of 0.87 ± 0.06, 0.92 ± 0.04 and 0.80 ± 0.14, respectively, compared to pre‐training DSC of 0.84 ± 0.06, 0.90 ± 0.05 and 0.78 ± 0.12. Overall, confidence scoring improved (P < 0.001) and timing decreased by an average of 4.4 ± 16.3 minutes post‐training. Improvements in confidence, efficiency and contours were particularly noted in radiation therapy participants.

Discussion/Conclusion: Overall, radiologist‐delivered MR training increased confidence, improved contouring efficiency and both DSC and Hausdorff distances. These findings are of importance in the MR linear accelerator adaptive workflow, particularly with a future direction of radiation therapist‐led daily adaptation.

Functional brain imaging interventions for radiation therapy planning in patients with glioblastoma multiforme: a review

John Ryan,^1,2 Sweet Ping Ng,³ Moshi Geso,² Nick Hardcastle⁴

¹ Monash University, Melbourne, Australia ² RMIT University, Melbourne, Australia ³ Olivia Newton‐John Cancer Wellness & Research Centre, Melbourne, Australia ⁴ Peter MacCallum Cancer Centre, Melbourne, Australia

Objective: This presentation will cover a narrative and systematic review that has been completed on functional image‐guided radiotherapy for radiation therapy planning in patients with glioblastoma. The narrative review was used to inform the scope of the systematic review and sets the scene for the audience. The systematic review aims to synthesise the outcomes of the different strategies of incorporating functional biological markers in the radiation therapy plans to support clinicians and guide further research.

Methods: This work has been completed as part of a PhD project over the past two years. The systematic review protocol was registered on PROSPERO (CRD42021221021). A structured search for publications was performed following PRISMA guidelines. Data analysis focussed on radiation therapy target volumes, toxicity, dose distributions, recurrence and survival mapped to functional image‐guided radiotherapy interventions. A meta‐analysis of 10 studies that reported on survival was completed.

Results: There were 5733 citations screened, with 53 citations (n = 32 studies) meeting review criteria. See Figure 1 for an overview of screening, inclusion criteria and number of texts used for data extraction. The approaches to target outlining and dose escalation were heterogeneous. The meta‐analysis indicated an improvement in median overall survival of over two months in comparison to standard treatment outcomes.

Conclusions: It is recommended that functional imaging data be incorporated into the gross tumour volume with appropriate technology‐specific margins used to create the clinical target volume when designing radiation therapy plans for patients with glioblastoma multiforme.

Friday 20 May, 3:45–5:15 Proton Therapy

The Particle Therapy Working Group update

Jessica Cantwell¹

¹ The University of Newcastle, Callaghan, Australia

The Particle Therapy Working Group, established in 2018, has been working hard to ensure the radiation therapy profession is prepared for the introduction of particle therapy in Australia. This new and exciting treatment modality will soon be treating Australian patients in Adelaide from 2025. The Particle Therapy Working Group is actively communicating and collaborating with our particle therapy colleagues at RANZCR and ACPSEM, contributing to position papers, national guidelines and proposed national referral pathways. With new technology comes plenty of opportunity but also challenges, and our group is united in our dedication to advocate for our profession, and for our patients. Training and education remain one of our priorities, and the group is currently working on producing content for a particle therapy certification, which is presently under development. Additionally, our group is involved in the National Particle Therapy Symposium and the associated comparative proton‐to‐photon planning workshops, contributing to knowledge sharing and upskilling staff around the nation in proton planning.

Discovering positivity: protons in private health care

Angela Whitehead¹

¹ Rutherford Cancer Centres, Marshfield, Wales, United Kingdom

Introduction: In April 2018, I moved to the United Kingdom to broaden my experience as a radiation therapist. After a short period of working as a locum with the National Health Service (NHS), I secured a position working for a company with a network of private centres across the UK. These centres offer radiation therapy including proton beam therapy (PBT) and are the first to treat PBT in the UK.

Aim: To raise awareness of the benefits of treating patients with PBT in a private healthcare setting as the UK healthcare system is similar to that of Australia.

Discussion: The first site was built in Wales with an agreement in place with the Welsh Government that any public patients considered eligible for PBT under the NHS would receive publicly funded treatment at the private centre as opposed to going abroad for treatment. The benefits of offering PBT locally are that these patients and their families do not need to travel, reducing stress and high costs and treatment can start quickly following diagnosis. In addition to NHS patients, the centre also treated privately insured and self‐paying patients. Many patients were previously going abroad to seek self‐funded PBT.

Conclusion: By establishing private centres offering PBT, both private and public patients are given the opportunity to stay closer to home while accessing high precision treatment. They do not require hospitalisation or ongoing management of long‐term side effects or possible secondary cancers, and this ultimately reduces the burden on the NHS.

Comparative proton and photon planning case study

Emma Shierlaw,¹ Rosanna Crain,¹ Melanie Penfold¹

¹ Australian Bragg Centre for Proton Therapy and Research, Adelaide, Australia

Introduction: The Medical Treatment Overseas Program (MTOP) currently requires the generation of a comparative planning study for every applicant for funding to this program. The impending availability of proton therapy within Australia and New Zealand will result in the generation of high‐quality comparative planning studies gaining even greater importance.

Case presentation: This talk will feature a detailed presentation of a comparative planning study completed as part of an MTOP application. The presenters will cover a range of aspects specific to proton planning, including beam angle selection, spot placement considerations, proton optimisation techniques and robust optimisation. A detailed case analysis of the resulting plans will form the basis of the presentation.

Management/Outcome: The presentation will cover the logistical aspects of the comparative planning workflow. This will include discussion of all steps within the process, including the potential outcome of the MTOP process.

Discussion: The comparative planning process can highlight the inherent differences between the achievable dosimetric outcomes when utilising photons and protons. An essential component of the comparative planning process is to assess the potential benefits or weaknesses of proton therapy when compared to the currently available photon therapy treatments within Australia and New Zealand. Consideration also needs to be given to the global pandemic situation, given that currently most clinical proton therapy treatment institutions are in the United States or Europe, adding an extra layer of complication to an already challenging process of transporting patients and their families internationally for cancer treatment.

Friday May 20, 3:45–5:15 Incident Reporting/Forensic Imaging

Review of contrast reactions across a national private imaging business

Edel Doyle,¹ Sharon Grail¹

¹ Lumus Imaging, Melbourne, Australia

Background: Reactions to contrast agents is the second most common adverse event in medical imaging departments. These contrast reactions can range from mild to moderate to severe but may also result in death.¹ In order to minimise the risks associated with the administration of contrast agents, incidents should be investigated to inform future practice.

Objective: The aim was to review contrast reactions reported in Q‐Pulse from January 2019 to September 2021 to establish the rate of contrast reactions within our business and to compare them to published reference standards.

Methods: A report was run on Q‐Pulse and the results exported in a Microsoft Excel spreadsheet. The details of the incidents were manually reviewed. The contributing factors were filtered for review. Incidence rates were calculated for CT and MRI.

Results: In CT, the incidence of mild contrast reactions averaged 0.07%, moderate reactions (0.01%), and severe reactions (0.002%). The total incidence of CT contrast reactions reported in Q‐Pulse was 0.09%. The incidence of mild contrast reactions in MRI averaged 0.14%, moderate reactions (0.017%), and severe reactions (0.003%). The total incidence of contrast reactions in MRI reported in Q‐Pulse was 0.165%.

Conclusion: The incidence of contrast reactions in both CT and MRI is lower than that suggested by The Royal Australian and New Zealand College of Radiologists.¹

Reference

1. The Royal Australian and New Zealand College of Radiologists. 2018. RANZCR iodinated contrast guidelines. Available at https://www.ranzcr.com/college/document-library/ranzcr-iodinated-contrast-guidelines

Reflective learning opportunities for radiographers from coronial inquests

Edel Doyle^1,2

¹ Lumus Imaging, Melbourne, Australia ² International Association of Forensic Radiographers, Melbourne, Australia

The role of the coroner is to inquire into the cause and circumstances of a reportable death. They are responsible for establishing who died, how they died, when, where and what caused the person to die.

The purpose of an inquest is to inform the family and the public how the death occurred and seek to reduce or prevent similar deaths. A coroner can make preventive recommendations, concerning public health and safety, the administration of justice or ways to prevent deaths occurring in similar circumstances.

When a coronial case involves patients in medical imaging department, we should review the findings of the inquest and identify areas where we can implement improvements to our standard of care delivered to our patients. It is by sharing this learning that our profession benefits too.

Efficacy and usage of post‐mortem computed tomography angiography in traumatic causes of death

Faye Sow Fei Jong,¹ Debbie Starkey,¹ Anthony Buxton²

¹ Queensland University of Technology, Brisbane, Australia ² Queensland University of Technology, Newcastle, Australia

Aims: Post‐mortem computed tomography angiography (PMCTA) is a minimally invasive method that has a potential to reduce the number of conventional autopsies performed. This review aimed to evaluate the diagnostic value of PMCTA compared to unenhanced post‐mortem computed tomography (PMCT) and conventional autopsy methods in traumatic deaths and to assess the viability of PMCTA as a routine post‐mortem imaging tool in Australia by assessing the associated costs.

Methods: A narrative literature review was performed and databases such as EMBASE, PubMed, Cochrane and Scopus were searched for relevant information using key words such as “post‐mortem computed tomography”, “post‐mortem imaging”, “traum*”, “angiograph*”, *injur*”, and “autops*”.

Results: PMCTA proved superior compared to unenhanced PMCT and autopsy in detecting vascular and bony pathologies except in soft tissue and parenchymal lesions.¹ In blunt force trauma, only lesions that were less than 1 cm were failed to be detected by PMCTA and only seen during autopsy.² In penetrating trauma, extravasation of contrast media into the would channels in PMCTA allowed depiction of trajectories and entrance and exit wounds important in medico‐legal examinations.³ Costs involved in PMCTA could potentially be reduced with more research surrounding use of immersion pump and 3D printed parts utilising alternative contrast media.⁴

Conclusion: PMCTA acts as a great review tool allowing information to be reviewed at any time even when the body was no longer available. With further studies and development of protocol needed, future implementation of PMCTA would hopefully reduce financial and emotional impacts to the communities, creating a more dignified way of investigating death.

References

1. Chevallier C, Christine C, Doenz F, et al. Postmortem computed tomography angiography vs. conventional autopsy: advantages and inconveniences of each method. International Journal of Legal Medicine 2013;127(5):981–9.

2. Shokry DA, Hussein MN, Hassan FM, et al. Diagnostic value of multiphase postmortem computed tomography angiography in selected cases of blunt traumatic deaths. Legal Medicine 2018;34:1–6.

3. Minoiu AC, Hostiuc S, Baumann P, et al. Usefulness of MPMCTA as an adjuvant to forensic autopsies in cases of gunshot deaths. Romanian Journal of Legal Medicine 2015;23(3):181–5.

4. Schweitzer W, Enders M, Thali M. Very affordable post mortem CT angiography kit: feasibility study using immersion pump and 3D printed parts. Journal of Forensic Radiology and Imaging 2019;16:11–18.

Value in medical radiation sciences: more than just a buzzword

Scott Jones,¹ Amy Brown,² Jackie Yim^3,4

¹ The Princess Alexandra Hospital, Brisbane, Australia ² Townsville University Hospital, Townsville, Australia ³ Royal North Shore Hospital, Sydney, Australia ⁴ University of Technology Sydney, Sydney, Australia

There is an increasing drive for value‐based healthcare (VBHC) across Australia, including in medical radiation sciences.¹ In the era of precision medicine, it is anticipated that the demand for both medical imaging and radiotherapy services will continue to increase. Increased demand naturally leads to further investments and expenditure by the health system to provide new techniques and technologies. In the face of rising costs and the reality of the Australian taxpayer‐funded health system, we must consider carefully: ‘What is value?’

While VBHC is an important consideration for policy and decision‐makers, health professionals also have a responsibility to ensure VBHC is incorporated and reflected in our clinical practice, research and education. This presentation will give an overview of VBHC concepts and research methodologies and opportunities within the medical radiation sciences setting, to ensure that VBHC is more than just a buzzword within our professions. The perspectives of patient, health professional, and health system will be addressed to demonstrate the different forms that value can take, and how much of what we already do in the pursuit of high‐quality care for our patients can provide the basis for VBHC analyses.

Reference

1. Woolcock K. 12 value‐based health care – setting the scene for Australia. Int J Integr Care 2021;20(S1):4.

The Empathy Project – staff confidence and training needs in psychosocial patient care

Nicola Jones,¹ Melissa Scott¹

¹ The Princess Alexandra Hospital, Brisbane, Australia

Objectives: Radiation therapists (RT) must balance highly technical procedures and psychosocial patient care. While RTs are in a unique position to form rapport with patients and provide support and information, many RTs lack confidence in the psychosocial care of patients and struggle to identify and address emotional cues.^1–3 This study aims to assess the confidence, competence, and training needs of RTs regarding psychosocial patient care.

Methods: All RTs at the surveyed hospital were invited to participate in an electronic survey in May 2021. The survey was distributed using Survey Monkey and consisted of a series of Likert‐style and open‐ended questions.

Results: Staff reported high confidence in addressing technical treatment issues (100% of respondents) and communicating with anxious (75%) and distressed (75%) patients. However, lower confidence was indicated with managing patient conflict (63%) and communicating with patients who were depressed (65%) or suffering mental health conditions (70%). Staff experienced stress when they couldn’t adequately communicate with patients requiring psychosocial support, worrying about saying the wrong thing.

Barriers to providing adequate psychosocial care included time, staff numbers, and workload. 83% of staff members indicated they did not have enough training and skills to confidently provide psychosocial care, with staff requesting training in emotional cues, communication, anxiety and depression, and understanding psychosocial and mental health conditions.

Conclusion: While staff perceptions and motivations of psychosocial care were overwhelmingly positive, further training is required to improve patient psychosocial care. Future steps include implementing psychosocial training resources in the department, and to reassess staff confidence post training.

References

1. Larsen T, Fineberg H, Rinaldo A, Menon T, Jones G. Perceptions of radiation therapists about providing psychosocial and supportive care to patients at peel regional cancer center. J Med Imaging Radiat Sci 2015;46(1):37–44.

2. Hulley L, Cashell A, Feuz C, et al. Communicating with emotional patients: thoughts, skills, and influencing factors for Ontario radiation therapists. J Med Imaging Radiat Sci 2016;47(4):315–22.

3. Halkett G, Merchant S, Jiwa M, et al. Effective communication and information provision in radiotherapy ‐ the role of radiation therapists. Journal of Radiotherapy in Practice 2010;9(1):3–16.

Identifying a need: surveying knowledge and experience levels of radiation therapists concerning mental health disorders

Amelia Rew,¹ Kristie Matthews,² Nigel Anderson³

¹ Peter MacCallum Cancer Centre, Melbourne, Australia ² Monash University, Melbourne, Australia ³ Austin Health, Melbourne, Australia

Background: Patients with severe and chronic mental health illnesses have a diminished capacity to receive optimal cancer care, as the psychiatric tendencies and physical manifestations linked to their disease are often detrimental to their autonomy, capacity for self‐care and medical compliance.¹ While we observe a growing global awareness around mental health issues, stigma and fear of discrimination within the healthcare system remains a reality for patients with complex mental health needs (CMHN) trying to access cancer care, particularly those with socially‐isolating symptoms.² The current education and levels of understanding within allied health professionals when concerned with CMHN is under‐reported in the literature, yet has been hypothesised as a contributing factor to the compromised care that is seen for these patients.³

Objectives: To establish a quantifiable baseline for the experiences and knowledge levels within the radiation therapist cohort at the Peter MacCallum Cancer Centre when dealing with patients with CMHN.

Methods: All radiation therapists (N > 220) were invited to undertake a non‐identifiable mixed‐methods survey via Qualtrics.

Results: 97% of surveyed radiation therapists indicated that they have encountered a patient with CMHN, a majority responding with multiple recalled experiences. Of this group, over half indicated that they have not engaged in any specific mental health training and on average this group were the least confident delivering care and connecting patients with CMHN to available supports.

Conclusion: There exists scope to better address the needs of patients with CMHN by improving radiation therapist education and training surrounding CMHN.

References

1. Torres‐González F, Ibanez‐Casas I, Saldivia S, et al. Unmet needs in the management of schizophrenia. Neuropsychiatric Disease and Treatment 2014;10:97–110.

2. Law MR, Soumerai SB, Ross‐Degnan D, Adams AS. A longitudinal study of medication nonadherence and hospitalization risk in schizophrenia. Journal of Clinical Psychiatry 2008;69(1):47–53.

3. Chou F, Tsai K, Wu H, Shen S. Cancer in patients with schizophrenia: What is the next step? Psychiatry Clin Neurosci 2016;70:473–88.

Expert witness invitation – my experience and what you need to consider before you say “yes”

Christine Vanderley‐Reichner¹

¹ Royal Hobart Hospital, Hobart, Australia

There is no doubt that being asked to be an expert witness is an honour, but you need to think carefully before you say “yes”. If you have no conflict of interests, have an interest in the type of or reason for the case, consider it.

This is about my experience.

As most of these cases are about incidents that happened during a patient event or treatment, it is important that you have knowledge and understanding of the process involved and the area of the treatment or diagnosis. For example, as a diagnostic radiographer I would not want to be involved in a radiation therapy event. But whatever the situation, it will take you more time than you ever thought, make you look for data that you didn't know existed, make you read more paperwork than you ever thought possible, try to understand legalese, look for gaps in evidence, keep you awake at night, and question your own knowledge, standard work practices, patient centred care and your own performance.

In all the cases I was involved, I have been a witness for the plaintiff (patient), and all have been settled out of court.

I will share with you how the process works, and how your opinion will be used in a case. It can be confronting, but it can also be very rewarding and an experience like no other.

The role of radiotherapy in the treatment of ovarian clear cell cancer

Florence Ko,¹ Mark Stevens,¹ Meegan Shepherd,¹ Alexandra Turk,¹ Ryan Brown¹

¹ Royal North Shore Hospital, St Leonards, Australia

Background: Ovarian cancer is the most prevalent gynaecological cancer in Western societies with a high mortality rate.¹ Ovarian clear cell cancer (OCCC) is the least common but most lethal subtype of ovarian cancer. OCCC is posited to be phenotypically resistant to platinum‐based chemotherapy.^2,3 The latter has re‐activated interest in the utility of adjuvant whole abdominal radiation therapy (WART) as a definitive strategy in women with OCCC.

Aim: The aim of this pragmatic observational study was to investigate the feasibility and clinical outcome of first‐line WART in OCCC after optimal de‐bulking surgery using a novel volumetric modulated arc therapy (VMAT) technique.

Methods: All patients were selected to receive WART after diagnosis. A 4DCT and an extended 3DCT were obtained for planning purposes.

Dual isocentre was used due to the requirement for extended field length. The maximum field length for treatment machine allocation also had to be checked before planning. The organs at risk were contoured for radiation dose constraints.

Antiemetic medication was administrated before treatment. Daily cone‐beam computed tomography and kilovoltage images were performed to check for field alignment.

Results: Patients tolerated treatment well, with no interruption of treatment due to acute toxicity. Late toxicity was reported in some patients, but all patients remained cancer‐free at their last follow up.

Conclusion: Adjuvant WART using VMAT followed by surgery is the strategy for the management of OCCC. The technique achieved the planning target volume coverage, organ sparing and acceptable rate of acute toxicity.

References

1. Cancer Australia. Ovarian cancer. Sydney NSW: Cancer Australia; 2021. Available at https://www.canceraustralia.gov.au/cancer-types/ovarian-cancer/statistics

2. Stevens MJ, West S, Gard G, et al. Utility of adjuvant whole abdominal radiation therapy in ovarian clear cell cancer (OCCC): a pragmatic cohort study of women with classic immune‐phenotypic signature. Radiation Oncology 2021;16(29):1–12.

3. Takano M, Tsuda H, Sugiyama T. Clear cell carcinoma of the ovary: Is there a role of history‐specific treatment? Journal of Experimental & Clinical Cancer Research 2012;31(53):1–7.

A value‐based approach to prostate cancer image‐guidance in a regional Australian radiation therapy centre

Shannon Robards,¹ Amy Brown,¹ Tilley Pain,^1,2 Deepti Patel,¹ Alex Tan,^1,2 Hannah Carter³

¹ Townsville Hospital Health Service, Townsville, Australia ² James Cook University, Townsville, Australia ³ Queensland University of Technology, Brisbane, Australia

Objectives: Usual practice for the insertion of prostate fiducial markers (FM) involves at least one‐week delay between insertion and radiotherapy simulation. An evidence‐based practice change was implemented whereby FM insertion occurred on the same day as simulation. This study aimed to quantify the health service costs and clinical outcomes associated with this practice change.

Methods: A cost‐consequence analysis was undertaken from the perspective of the local health service. A retrospective chart audit was conducted to collect data on 149 patients in the pre‐implementation and 138 patients in the post‐implementation cohorts. Associated costs with insertion and simulation were calculated and compared. FM positions on planning computed tomography (CT) and first treatment cone beam computed tomography (CBCT) were measured as a surrogate clinical outcome measure.

Results: There was no significant difference in fiducial marker position pre‐ and post‐implementation, with the mean FM area of 1.6 ± 0.80 cm² on CT and 1.6 ± 0.79 cm² on CBCT in the pre‐cohort (P = 0.757) and 1.9 ± 0.91 cm² on CT and 1.8 ± 0.93 cm² on CBCT in the post‐cohort (P = 0.491). The health service saved an average of $AU 361 (CI $311 – $412) per patient post‐implementation.

Discussion/Conclusion: Performing insertion and radiotherapy simulation on the same day resulted in substantial savings to the health system, without compromising clinical outcomes. The decrease in number of in‐person attendances is of real consequence to rural and remote populations. The practice change increased both the value and accessibility of best practice healthcare to those most at risk of missing out.

Impact of dose delivery due to positional variations of breast expanders during radiotherapy treatment

Kendell Dowton,¹ Yaw Chin,¹ Joel Poder,¹ Katie Beer,¹ Stami Trakis,¹ Laurel Schmidt,¹ Zoe Campbell¹

¹ St George Cancer Care Centre, Kogarah, Australia

Objectives: Breast tissue expanders are a method for breast reconstruction following mastectomy. Expanders are inserted before radiotherapy. The metallic port of the expander has a high density and movement can lead to dosimetric changes, compromising radiation treatment plans. The objective of this study was to investigate dosimetric effect of positional variations of expanders.

Methods: A retrospective assessment on three patients who were identified to have breast tissue expander positional variation was conducted using Eclipse Treatment Planning System (Figure 1). Both intensity modulated radiation therapy (IMRT) (two cases) and volume modulated arc therapy (VMAT) (one case) treatment techniques were utilised. The effect of expander positional variations on planning target volume (PTV) coverage and organs at risk doses were analysed using dose‐volume histogram (DVH) indices.

Results: All plans demonstrated reduction in D 98% PTV coverage, with the IMRT plans having 86.8% and 53.8% reduction and the VMAT plan having a 3.4% reduction. The study demonstrated differences in global max doses in the IMRT plans with maximums decreasing from 114% to 104.5% and 113.5% to 110.7%, compared to the VMAT plan maximums increasing from 116.3% to 119%. Interestingly, our study showed slight changes in doses to the lungs, heart and left anterior descending coronary artery due to the expander movement.

Conclusion: There was a decrease in PTV coverage and variability in dose maximums due to positional changes of the breast expanders. Replans may need to be considered if significant expander movement is observed during treatment, however further investigation using a larger cohort of patients is recommended.

Radiation oncology staff perceptions: incident learning systems and safety culture across Australia and New Zealand

Laura Adamson,^1,2 Rachael Beldham‐Collins,¹ Jonathan Sykes,^1,2 David Thwaites^1,2

¹ The Crown Princess Mary Cancer Centre, Sydney, Australia ² The University of Sydney, Sydney, Australia

Objectives: Complex patient pathways exist in radiation therapy with the potential for incidents to occur. Departments utilise detailed quality assurance and incident learning systems (ILS) to mitigate risk. Departmental safety culture (SC) influences the effectiveness of patient safety and risk mitigation.

Methods: A validated healthcare tool (the Hospital Survey on Patient Safety Culture)¹ was electronically distributed to tripartite radiation oncology professionals in Australia and New Zealand during 2020, with additional ILS‐focussed supporting questions. Participation was anonymous, with profession and location demographics collected.

Results: A total of 220 responses were analysed, an approximate response rate of 5–10% of estimated full time equivalent workforce in 2020 from RANZCR data.² One or more ILS reporting barriers were indicated by 59% of respondents, with many stating having to use multiple reporting systems. Mandatory hospital‐level systems were characterised as not optimal for radiation oncology reporting and learning needs, with varied understanding of what and when to report. Overall, a positive SC was indicated, with teamwork having the most substantial SC value (83.7%). The three weakest areas were communication about errors (63.9%), hospital‐level management support (60.5%) at handovers and information exchange at interfaces (58%).

Conclusion: The findings establish an Australia and New Zealand perspective on ILS and SC in radiation oncology. Barriers to ILS and weakness in SC have highlighted areas for further investigation. Differences in what and when to report suggest that a unified state, national or bi‐national ILS specific to radiation oncology might eliminate multiple reporting systems, reduce reporting barriers and increase SC.

References

1. AHRQ. Surveys on patient safety culture (SOPS). Hospital Survey Rockville, MD: Agency for Healthcare Research and Quality; 2019. Available at https://www.ahrq.gov/sops/surveys/hospital/index.html

2. RANZCR. Planning for the best. Tripartite National Strategic Plan for Radiation Oncology 2012–2022. Sydney, Australia Radiation Oncology Tripartite Committee: The Royal Australian and New Zealand College of Radiologists, 2012.

Supporting our people into survivorship: understanding the complex needs of head and neck cancer patients

Melanie Cook,¹ Sharon Czerniec,^1,2,3 Tia Covi,¹ Craig Kukard^1,2

¹ NSW Health, Gosford, Australia ² The University of Newcastle, Callaghan, Australia ³ Macquarie University, North Ryde, Australia

Objectives: Advances in treatment options for head and neck cancer patients is improving patient survival five years after treatment.¹ The survivorship needs of local head and neck cancer patients were evaluated in a high incidence area. A survivorship care plan was developed that is individualised, and adaptable to the patient’s survivorship needs.

Methods: 111 head and neck cancer survivors completed the European Organisation for Research and Treatment of Cancer (EORTC) H&N35 quality of life (QoL) survey post radiotherapy, chemotherapy or surgery. A chart audit was also conducted. Structured interviews of health professionals and consumers were conducted to understand the care required for this cohort of patients. A survivorship care plan was developed in consultation with the multi‐disciplinary care team and consumers.

Results: Receiving all three treatments (radiotherapy, chemotherapy and surgery) was associated with poorer QoL. QoL was still affected for survivors three years after treatment. A diagnosis of oral, tonsil or oropharyngeal cancer had a greater impact on QoL. The needs of survivors were similar in both the EORTC results and structured interviews. Consumers, carers and general practitioners were supportive of the need of a survivorship care plan.

Conclusion: As health professionals our job is not done once the patient finishes treatment. There is a growing expectation from patients and carers that survivorship needs are managed. The survivorship care plan developed will allow for patients to be more informed and supported; providing information for regular screening, support and recurrence pathways. The survivorship care plan will undergo continual evaluation and improvement.

Reference

1. Koh J, Walsh P, D'Costa I, Bhatti O. Head and neck squamous cell carcinoma survivorship care. AJGP 2019;48(12):846–8.

Developing a radiation therapy talking book for Aboriginal and Torres Strait Islander people undergoing radiotherapy

Bena Brown,¹ Haryana Dhillon,² Michael Penniment,^3,4 Sabe Sabesan,^4,5 Georgia Halkett,⁶ Siddhartha Baxi,⁷ Jim Frantzis,⁴ Kar Giam,⁸ Gail Garvey¹

¹ The University of Queensland, Herston, Australia ² The University of Sydney, Sydney, Australia ³ South Australia Health, Adelaide, Australia ⁴ Icon Group AU, Australia ⁵ Queensland Health, Townsville, Australia ⁶ Curtin University, Perth, Australia ⁷ GenesisCare, Gold Coast, Australia ⁸ Northern Territory Health, Darwin, Australia

Objectives: Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as First Nations peoples) have higher cancer incidence and mortality rates compared to non‐First Nations people.¹ Health communication is an integral part of delivering patient‐centred care, however cross‐cultural communication and differences in perspectives of health and wellbeing have been implicated in poorer cancer outcomes of First Nations peoples.^2,3 The objective was to improve clinician‐patient communication during radiotherapy by adapting a radiation therapy talking book to be culturally‐safe for First Nations people with cancer.

Methods: The content/design of a previously developed Radiation Therapy Talking Book⁴ was adapted through yarning circles with First Nations cancer patients and health professionals across three northern Queensland cancer centres. Three half day consultations with Yolgnu linguists/interpreters and cross‐cultural facilitators were undertaken. Further feedback was sought from First Nations community engagement. Iterative content adaptations and First Nations graphic design were undertaken. Simple English and Yolgnu Matha translation, audio‐recording and back‐translation has been conducted using a collaborative approach with ARDS Aboriginal Corporation.

Results: 15 First Nations peoples participated in the yarning circles, consultations or provided direct feedback regarding the content/design of the Radiation Therapy Talking Book. Feedback directly addressed content, complexity, design, format, representation of First Nations peoples. A 45‐page First Nations Radiation Therapy Talking Book has been developed. The book will be evaluated against usual care in early 2022.

Discussion/Conclusion: Developing a resource that addresses the priorities and needs for First Nations peoples undergoing cancer treatment requires building of meaningful relationships, elevating First Nations voices and flexible time commitments.

References

1. Australian Institute of Health and Welfare. Cancer in Australia 2019. Cancer series no.119. Cat. no. CAN 123. Canberra: AIHW, 2019.

2. Shahid S, et al. Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting. Med J Aust 2009;190(10):574–9.

3. Olver I, Gunn KM, Chong A. Communicating cancer and its treatment to Australian Aboriginal and Torres Strait Islander patients with cancer: a qualitative study. Support Care Cancer 2021.

4. Smith SK, Cabrera‐Aguas M, Shaw J, et al. A low literacy targeted talking book about radiation therapy for cancer: development and acceptability. Support Care Cancer 2019;27(6):2057–67.

Men’s preferences for image‐guidance in prostate radiation therapy: a discrete choice experiment

Amy Brown,^1,2 Tilley Pain,^1,2 Lux Anable,¹ Emily Callander,³ Alex Tan,^1,2 Kerrianne Watt,² Deborah Street,⁴ Richard De Abreu Lourenco⁴

¹ Townsville Hospital and Health Service, Townsville, Australia ² James Cook University, Townsville, Australia ³ Monash University, Melbourne, Australia ⁴ University of Technology Sydney, Sydney, Australia

Objectives: Men with prostate cancer (PCa) undergo monitoring of the prostate position during radiation therapy, with several options for real‐time prostate monitoring including fiducial markers (FMs) and transperineal ultrasound (US). In a previous study, 45% of PCa men were ambivalent on preference regarding FMs compared to US.¹ This study aimed to determine preferences around various aspects of prostate image‐guidance, focussing on FMs and US.

Methods: A discrete choice experiment survey was conducted, with the attributes of: pain; out of pocket cost; accuracy, side effects; additional appointments; and additional time (Figure 1). Male participants were recruited from PCa patients presenting to a regional cancer centre and the general Australian population. Analysis included multinomial logit modelling, Latent Class Analysis and marginal willingness to pay calculations.

Results: 476 respondents completed the survey (236 PCa patients and 240 general population, mean age of 73.8 and 44.3 years, respectively). The most important attributes were pain, cost and accuracy for both cohorts (P < 0.01). PCa patients were willing to pay a higher cost to avoid pain than the general population and were also more willing to pay a higher cost for increased accuracy. Latent Class Analysis revealed three groups: two were focussed more on the process‐related attributes of pain and cost, and the third was focussed on the clinical efficacy attributes of accuracy and side effects.

Discussion/Conclusion: Overall, both populations preferred less cost and pain, and improved accuracy. Radiation oncology centres should consider the preferences of patients when considering image‐guidance techniques in addition to the clinical and technical evidence.

Reference

1. Brown A, Pain T, Preston R. Patient perceptions and preferences about prostate fiducial markers and ultrasound motion monitoring procedures in radiation therapy treatment. J Med Radiat Sci 2021;68(1):37–43.

Inspiration at the app store: breath hold education and instruction for radiation oncology patients and health professionals

Andrew Puffett¹

¹ The Princess Alexandra Hospital, Brisbane, Australia

Providing education and instruction to patients about radiation therapy practices is a challenging task that requires clear, concise and consistent communication. Health professionals are often required to impart complex information in a succinct manner that is appropriate for patients of different ages, cognitive abilities and cultural backgrounds.

The need to adequately inform and prepare patients for interactive radiation therapy techniques such as deep inspiration breath hold (DIBH) or end expiration breath hold (EEBH) is vital for its successful delivery. Without education, issues may arise that hinder the ability to deliver these techniques in an accurate and effective manner.

To assist in this education process, an app‐based platform has been designed to prepare patients receiving breath hold radiation therapy procedures utilising the (Elekta Active Breathing Co‐ordination System). This mobile application provides several digital resources for patients and health professionals including:

• an explanation of radiation therapy and the breath hold technique in an e‐book format

• an interactive training tool for patients to practice the breath hold routine

• department presentations for health professionals describing techniques used in the clinical environment

• a voice command module for health professionals that enables them to provide automated breath hold instruction to patients in their native language.

This presentation will discuss some of the common concerns patients have about DIBH/EEBH radiation therapy, why this app was created, its features, how it is being used in clinical practice and the benefits of using this type of platform for patient education.

Developing translated video resources ‘radiation therapy treatment pathway’ for culturally and linguistically diverse patients

Nainaben Dhana,¹ Sam Penso,¹ Maria Maggio De Leo,¹ Maria Meselidis¹

¹ Austin Health, Heidelberg, Australia

Introduction: Radiation therapy, due to its technical nature, is generally poorly understood and often feared by many patients about to undertake this treatment. Many patients present with high stress and anxiety levels during the initial planning and treatment appointments. The more informed a patient is, the better their outcome in terms of satisfaction with and participation in treatment, better self‐care efficacy, leading to improvements in quality of life.

Aims: The project aim is to improve access of our radiation therapy treatment pathway video by translating it initially into our four most requested languages. Information available in the patient's own language will help to ensure equal access and consistent quality of care and allows the patient to feel more informed and in control.

Methods: The English video in question was developed with extensive consumer and stakeholder engagement throughout the process. The content has been driven by what patients have said they needed. Engagement with the language services team enabled translation into our four most requested languages – these currently being Greek, Italian, Simplified Chinese and Arabic.

The company that produced the original English video provided professional voice‐over to ensure quality of sound and minimal loss of impact of the video.

Results: Successful grant notification enabled expediting the project during the COVID‐19 pandemic. Translations, voiceover and production is complete. Videos are now available on the organisation's website.

Discussion: Consumer engagement and stakeholder collaboration and embracing health literacy principles is vital from conception and development of visual resources for culturally and linguistically diverse patients.

Open‐face masks for head and neck cancers: a review of the literature

Michaela Beavan,¹ Andrew Wallis,¹ Shivani Kumar^1,2,3

¹ Liverpool and Macarthur Cancer Therapy Centres, Liverpool, Australia ² Ingham Institute of Applied Medical Research, Liverpool, Australia ³ The University of New South Wales, Sydney, Australia

Objectives: Conventional head and neck radiotherapy (HNRT) and stereotactic radiosurgery (SRS) are highly complex treatments requiring thermoplastic masks for accurate immobilisation. However, these masks can cause distress and anxiety in patients, potentially leading to disruptions during treatment.^1,2 Open‐face masks (OM) are an alternative immobilisation tool to reduce patient distress, however little is known about the impacts on set‐up stability. This review aims to investigate the use of open‐face masks in HNRT and SRS treatments and its impact on patient set‐up.

Methods: Studies were searched across the PubMed, Google Scholar and Cochrane Library databases. Search terms included: “open‐face (+/‐thermoplastic) mask” and “head‐and‐neck” or “brain” and “radiotherapy” or “stereotactic”. Studies were included based on relevance to the topic, and reference searched.

Results: The number of articles identified are shown in Figure 1. Most articles found that inter‐ and intra‐fractional motion in OM was limited ≤ 2 mm in all translational directions, ≤ 1–3° for rotational directions – non‐significantly different to standard masks on comparison. Patients reported overall improved comfort and reduced claustrophobia scores in OM compared to standard masks.

Discussion: Research in this area suggests that OM provide immobilisation stability comparable to that of standard thermoplastic masks. Few studies currently exist in this area, and variation in methodologies using either surface guided, cone beam, or planar imaging may not truly reflect the full range of motion that occurs.

Conclusions: OM immobilisation provides sufficient stability for HNRT and SRS with improved comfort, although further research is required to investigate it applicability for all HNRT and SRS treatments.

References

1. Clover K, Oultram S, Adams C, et al. Disruption to radiation therapy sessions due to anxiety among patients receiving radiation therapy to the head and neck area can be predicted using patient self‐report measures. Psycho Oncology 2011;20(12):1334–41.

2. Nixon JL, Cartmill B, Turner J, et al. Exploring the prevalence and experience of mask anxiety for the person with head and neck cancer undergoing radiotherapy. J Med Radiat Sci 2018;65(4):282–90.

Image interpretation by Australian radiographers: a systematic review

Andrew Murphy,¹ Michael Neep²

¹ The Princess Alexandra Hospital, Brisbane, Australia ² Logan Hospital, Meadowbrook, Australia

Objectives: Radiographer image interpretation is embedded in the contemporary radiographer role within Australia.¹ The implementation of radiographer image evaluation methods such as preliminary image evaluation (PIE) is slow.² In 2018, The Royal Australian and New Zealand College of Radiologists published a statement in protest of this practice, citing papers from the United Kingdom and older Australian literature.³

The lack of concise collated evidence on this topic inspired this systematic review exploring radiographic image interpretation by radiographers in Australia. This review aims to identify the barriers to PIE implementation, discover how the radiological profession became divided on the matter, and discuss how we can unite to deliver quality patient care.

Methods: A systematic review of articles via Scopus, Ovid Medline, PubMed, ScienceDirect and the Informit databases were performed. Articles eligible for inclusion were peer‐reviewed and explored radiographic image interpretation by radiographers in the context of Australia.

Results: 926 studies were screened for relevance; 19 met the inclusion criteria, consisting of 11 cohort studies, seven cross‐sectional surveys and one randomised control trial. Studies exploring radiographers’ image interpretation performance utilised mixed methodological and reported accuracy from 57% to 98%.

Primary barriers included lack of accessible educational resources, understanding of PIE and support from both radiologists and radiographers.

Conclusions: This is the first systematic review of this subject. Australian radiographers can undertake PIE however, educational and clinical support are important. Access to targeted educational resources and a clear definition of radiographers’ image evaluation role is key to improving radiographer image evaluation use.

References

1. Australian Health Practitioner Regulation Agency. Professional capabilities for medical radiation practice. In: Medical Radiation Practice Board of Australia, 2020.

2. Murphy A, Neep M. An investigation into the use of radiographer abnormality detection systems by Queensland public hospitals. J Med Radiat Sci 2018;65:80–5.

3. The Royal Australian and New Zealand College of Radiologists. Image Interpretation by Radiographers – Not the Right Solution, 2018.

Acute stroke accuracy in computed tomography imaging

Cameron Brown,¹ Hannah To¹

¹ Logan Hospital, Meadowbrook, Australia

Introduction: Due to the time sensitive nature of patients suffering an ischaemic stroke, early detection, diagnosis and medical intervention is critical to achieving favourable patient outcomes. Globally, computed tomography (CT) perfusion imaging is the preferred method in detecting ischaemic stroke due to its faster speed, wider availability (when compared to magnetic resonance imaging [MRI]) and ability to be performed on most modern CT scanners.¹ However, recent studies into the accuracy of CT brain perfusion have highlighted it’s reduced sensitivity in detecting acute ischaemic events.² This study sought to assess the accuracy of ischaemic stroke detection in CT brain perfusion studies when compared to MRI brain imaging at a major public hospital.

Methods: A retrospective audit was conducted of 549 patients (from 2018 to 2021) who received both CT brain perfusion and MRI brain studies while admitted. Authorised radiologist CT and MRI reports were assessed and compared to confirm or exclude the presence of an acute stroke. The MRI brain report was considered the gold standard in which CT brain perfusion reports would be compared.

Discussion/Conclusion: The audit reported an overall CT diagnostic sensitivity, specificity and accuracy of 56.25%, 97.11% and 82.15%, respectively. Secondary analysis revealed an accuracy of 52.05%, 82.35%, 30.61% and 15.79% for partial anterior circulation stroke, total anterior circulation stroke, posterior circulation stroke and lacunar infarctions, respectively.

These findings were reported back to the stroke team to assist in clinical pathway optimisation. Suspected ischaemic insults with low yield accuracy (such as lacunar infarcts) were given increased preference for MRI.

References

1. Birenbaum D, Bancroft LW, Felsberg GJ. Imaging in acute stroke. The Western Journal of Emergency Medicine 2011;12(1):67–76.

2. Campbell BC, Christensen S, Levi CR, et al. Comparison of computed tomography perfusion and magnetic resonance imaging perfusion‐diffusion mismatch in ischemic stroke. Stroke 2012;43(10):2648–53.

Implementation of radiographer commenting – the San experience

Caitlin Tu,¹ Allie Tonks,¹ Ingrid Klobasa,² Gary Denham,³ Nadine Thompson¹

¹ Sydney Adventist Hospital, Wahroonga, Australia ² NSW Agency for Clinical Innovation, Sydney, Australia ³ Taree Base Hospital, Taree, Australia

There is growing momentum to implement written commenting systems in Australian healthcare settings to unite multidisciplinary teams, efficiently support referrers, and empower medical radiation practitioners for the improvement of patient care. This practice aligns with the National Quality and Safety Healthcare Standards as well as the National Law, as articulated by the Medical Radiation Practice Board of Australia, which requires all registered medical radiation practitioners to assess images and convey significant findings to clinical staff.^1,2 As such, the Agency for Clinical Innovation co‐ordinated a multi‐site pilot study to consistently introduce commenting systems within New South Wales hospitals. Sydney Adventist Hospital was the first site to begin this project in November 2021. The commenting system is primarily used to describe abnormal findings on general X‐ray examinations from emergency but is also being utilised for preliminary image evaluation in other modalities and contexts. Insights can now be shared from this journey with the aim to assist and inform other sites preparing to establish formalised commenting.

This presentation will outline the lessons and insights gained from the project, discuss uptake and reception from various stakeholders on site, and explore some interesting cases with implications for improved patient management and care. Involvement in this growing project represents an opportunity to enhance contribution to the interdisciplinary team and support acute and changing patient care in real time.

References

1. Medical Radiation Practice Board of Australia. Professional capabilities for medical radiation practice. 2019. Available at https://www.medicalradiationpracticeboard.gov.au/Registration-Standards/Professional-Capabilities.aspx

2. Australian Commission on Safety and Quality in Healthcare. Communicating for Safety Standard 2019. Available at https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard

Predicting necessity for CT perfusion in ‘code‐stroke’ patients from symptoms and non‐contrast brain CT signs

Megan Kenna,¹ Mallory Batchelor¹

¹ The Royal Brisbane & Women's Hospital, Brisbane, Australia

Objectives: CT perfusion (CTP) and multi‐phase brain CT angiography (mpbCTA) can help guide management in stroke patients. CTP is a routine component of the ‘code‐stroke’ imaging protocol at the study site. Compared to mpbCTA, CTP has higher radiation dose, longer examination and report times, and requires larger bore vascular access. We aim to determine if the likelihood of a code‐stroke patient being stroke positive can be determined from risk factors, common symptoms and/or non‐contrast brain CT signs, to optimise the imaging pathway.

Methods: CTP examinations performed at the study site over a one‐year period were identified from the picture archive and communication system. The clinical notes and radiology reports for eligible participants were assessed for five CT signs of stroke, seven stroke symptoms and six stroke risk factors. The association between the aforementioned factors and having a positive CTP was assessed with logistic regression analysis.

Results: 535 code‐stroke patients were included; 375 (70.1%) CTPs were negative for stroke. Facial palsy, asymmetrical weakness/numbness/paralysis, and loss of insular ribbon sign and hyperdense artery sign on non‐contrast CT were associated with a higher likelihood of having a positive CTP.

Discussion/Conclusion: It may be feasible to stratify code‐stroke patients into being at low‐risk or high‐risk of stroke based on key clinical symptoms and CT signs. Based on this, we propose high risk patients undergo CT perfusion; however, in low‐risk patients the CTP could be replaced by mpbCTA.

Necessity is the mother of invention

Alan Malbon¹

¹ ASMIRT, Melbourne, Australia

The COVID‐19 pandemic has changed the way that medical imaging examinations and procedures are performed, both here in Australia and world‐wide.

The pandemic has also impacted on ASMIRT and the way it offers their educational and professional certification products to the membership.

ASMIRT has conducted professional certification examinations since 1998, and now offers professional certification in magnetic resonance imaging, computed tomography, vascular angiography, cardiac angiography and, recently, in preliminary imaging evaluation (PIE).

PIE is ASMIRT’s certification examination process aligned to the diagnostic findings in the following subjects, as stated by the Medical Radiation Practice Board of Australia Professional capabilities for medical radiation practitioners (Domain 1, Key Capability 7).¹ It requires the practitioner to evaluate medical images and identify any urgent and/or unexpected findings and take appropriate and timely action to ensure the immediate management of the patient.

The examination is designed to test the candidate’s ability to evaluate case study images in both the acute emergency department setting and the acute high dependency/intensive care unit environment. The PIE topics are plain film imaging evaluation of the upper limb, the lower limb, the spinal column and chest, and chest line insertion imaging.

This presentation covers two major areas of change: The first is the change from a third‐party information technology examination provider to an open‐source learning/examination management system. The second is to explain these changes as they apply to the PIE examination, as well as explaining the rationale and system processes in this examination.

Reference

1. Medical Radiation Practice Board of Australia. 2019. Professional capabilities for medical radiation practitioners. Available at https://www.medicalradiationpracticeboard.gov.au/Registration-Standards/Professional-Capabilities.aspx

Spectral computed tomography pulmonary angiography: promoting improved patient care through contrast flow rate reduction

Bree Hochkopper,¹ Karen Dobeli¹

¹ The Royal Brisbane & Women's Hospital, Brisbane, Australia

Objectives: There is potential to reduce contrast injection rates for spectral computed tomography pulmonary angiography (CTPA) due to its ability to create virtual monoenergetic (MonoE) images, which increase the CT density of iodine. Patient care may be improved as a result, because lower injection rates permit the use of smaller venous access devices. This retrospective study aims to determine the minimum injection rate that provides 250 Hounsfield unit (HU) contrast density in the pulmonary arteries (the minimum required for diagnostic accuracy) on 45 keV MonoE reconstructions.

Methods: Correlation of contrast density within the pulmonary arteries between the polychromatic 120 kVp and virtual MonoE 45 keV reconstructions was calculated using Pearson's correlation coefficient for 100 CTPA examinations at the participating hospital. All examinations were performed with a contrast injection rate of 5 mL/s. The minimum injection rate that would have achieved CT density of at least 250 HUs on the MonoE reconstruction for all patients in the study group was calculated.

Results: The mean HU for the polychromatic and MonoE reconstructions was 385 (range 144–754) and 1129 (range 348–2392), respectively. There was a strong positive correlation in HUs between the two reconstruction methods (r = 0.9906, P = < 0.0001). The minimum injection rate that would have achieved at least 250 HUs on the MonoE was 3.2 mL/s.

Discussion/Conclusion: The routine contrast injection rate for CTPA can be reduced by approximately 36% when using spectral CT. This permits the use of smaller venous access devices, which may reduce the number of cannulation attempts on patients for CTPA.

A registry for analysis of data to advance personalised therapy with MR‐linac

Tania Twentyman,¹ Michael Jameson,¹ Vikneswary Batumalai,¹ Amanda Woods,¹ Vicki Sproule,¹ Patrick Foley,¹ Neil Kennedy,¹ Maria Marney,¹ Kris Barooshian,¹ Michael Plit,¹ Jayd Lynch,¹ Raj Jagavkar,¹ Helen Ormandy,¹ John Christodouleas,² Florian Pietzch,¹ Jeremy de Leon¹

¹ GenesisCare, Australia ² Elekta, Atlanta, USA

Objectives: The innovation of the MR‐linac offers the promise of high precision treatment, however, it is important to evaluate the clinical outcomes achieved in the short and long term. Analysis of Data to Advance Personalised Therapy with MR‐linac (ADAPT‐MRL) is a multi‐site, multi‐national, observational cohort registry designed to collect data on the use of MR‐linac for radiation therapy and patient outcomes. The registry will provide a linked repository of technical and clinical data that will form a platform for prospective studies and technology assessment.

Methods: Ethics approval was granted by St Vincent’s Hospital Human Research Ethics Committee. This registry aims to include 10,000 eligible participants globally with a range of cancers, over a seven‐ to 10‐year period. Participants will undergo treatment in accordance with standard practice. Toxicity, survival, and patient reported outcome measures will be assessed at baseline, during treatment and with follow‐up until 24 months.

Results: In 2020, the ADAPT‐MRL registry was established in coordination with investigators of the MOMENTUM Study,¹ another observational registry of MR‐linac treatments. Since then, 92 patients have consented to participate, 55 patients have completed three‐month follow‐up and five patients have reached 12‐month follow‐up.

Conclusion: Data obtained from the ADAPT‐MRL registry is expected to provide evidence on the safety and efficacy of the MR‐linac. We expect this registry will generate data that will be used to optimise treatment techniques, MR‐linac software algorithms, evaluate participants’ outcomes and toxicities and create a repository of adapted plans and MR sequences linked to participants’ outcomes.

Reference

1. Sophie R, Christodouleas JP, Blezer EL, et al. The MOMENTUM Study: an international registry for the evidence‐based introduction of MR‐guided adaptive therapy. Frontiers in Oncology 2020;10.

Past, present and future of MRL: one centre’s experience

Glen Newman¹

¹ Townsville Cancer Centre, Townsville, Australia

With magnetic resonance linear accelerators (MRLs) being the latest advancement in treatment machines for radiation therapy and multiple machines currently being installed within Oceania, this presentation will focus on one centre’s experience using an MRL.

The MRL’s superior imaging and adaptive planning capabilities provide a unique opportunity to deliver radiation therapy to patients who would conventionally be unable to have treatment. Case studies of patients (permission provided) who received radiation therapy to their ankle, reirradiation of metastatic breast cancer and sub‐centimetre tumours will be presented.

While the advantages of the MRL are well documented, the negatives are less so. Where experienced, these will be explained along with how they were overcome.

Given the specialisation of the MRL and the resources required for full functionality, its utilisation and integration within the department is paramount. Areas where the greatest benefit can be achieved will be highlighted along with its future uses, so that as the technology matures there will hopefully be greater uptake with our region.

A comparison of accelerated partial breast irradiation planning for conventional and magnetic resonance linear accelerator

Jenna Dean,¹ Michael Chao,¹ Stephen Chin,¹ Felicity Height,¹ Drew Smith,¹ Farshad Foroudi¹

¹ The Olivia Newton‐John Cancer & Wellness Centre, Melbourne, Australia

Objectives: Accelerated partial breast irradiation (APBI) is an accepted short‐course treatment option for patients with early breast cancer,^1–3 and may benefit when paired with the superior soft tissue contrast of magnetic resonance (MR) imaging for enhanced treatment verification. This pilot study evaluates the patient and planning considerations for treatment in a magnetic environment for sites implementing APBI treatment on an MR‐linac.

Methods: Five patients were APBI parallel planned in the supine position (30 Gy in five fractions) for both conventional and MR‐linacs. A 6 MV volumetric modulated arc therapy (VMAT) plan was generated for the conventional linac and a seven field 7 MV FFF step and shoot IMRT plan for the MR‐linac. Beam angles were limited to the ipsilateral side for both techniques. Target and organs at risk doses were analysed.

Results: All plans in the study met the protocol criteria. Target coverage and organs at risk doses were similar. MR‐linac plans were marginally hotter on average (D2 of 104.5% vs 103%). MR‐linac plans were more likely to be impacted by the target volume/lung tissue interface. Target position provided more challenges for MR‐linac plans due to physical machine limitations such as avoidance of beam entry through the cryostat pipe and a fixed isocentre.

Conclusion: Clinically acceptable APBI plans can be generated for patients for the MR‐linac that are comparable to conventional linac plans. Additional planning considerations must be met to ensure robust MR‐linac dosimetry.

References

1. Livi L, Meattini I, Marrazzo L, et al. Accelerated partial breast irradiation using intensity‐modulated radiotherapy versus whole breast irradiation: 5‐year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer 2015;51(4):451–63.

2. Meattini I, Marrazzo L, Saieva C, et al. Accelerated partial‐breast irradiation compared with whole‐breast irradiation for early breast cancer: long‐term results of the randomized phase III APBI‐IMRT‐Florence Trial. J Clin Oncol 2020;38(35):4175–83.

3. Meattini I, Saieva C, Miccinesi G, et al. Accelerated partial breast irradiation using intensity modulated radiotherapy versus whole breast irradiation: health‐related quality of life final analysis from the Florence phase 3 trial. Eur J Cancer 2017;76:17–26.

Emerging technology: evaluating the role of Elekta Unity MR‐linac in an established RT department

Felicity Height¹

¹ The Olivia Newton‐John Cancer & Wellness Centre Melbourne, Australia

The Elekta Unity MR‐linac is an emerging technology that offers the advantage of magnetic resonance imaging (MRI) capabilities integrated with a 7 MV FFF linear accelerator (linac). In comparison to conventional linac based treatments that utilise X‐ray‐based image verification, MRI offers the advantage of soft tissue definition in the online treatment process to enhance both target and organs at risk definition. The Elekta Unity system utilises step‐and‐shoot intensity modulated radiation therapy (IMRT) compared to volumetric modulated arc therapy (VMAT) commonly employed on conventional linacs. VMAT is generally considered superior due to the improvement in high dose conformity to targets and avoidance of organs at risk. Our initial clinical experience with the Elekta Unity has shown MRI to be advantageous in identifying and adapting treatment to changes in soft tissue structures Our early clinical experience suggests this enhanced imaging counters the relatively ‘simple’ step‐and‐shoot treatment delivery.

Feasibility and safety of MR‐guided stereotactic ablative body radiotherapy for prostate cancer

Lori Geddes,¹ David Crawford,¹ Vikneswary Batumalai,¹ Claire Pagulayan,¹ Louise Hogan,¹ Urszula Jelen,¹ Conrad Loo,¹ Nicole Dunkerley,¹ Maddison Picton,¹ Stacy Alvares,¹ Sandy Sampaio,¹ Monique Heinke,¹ Tania Twentyman,¹ Michael Jameson,¹ Jeremy De Leon¹

¹ Genesis Cancer Care, Sydney, Australia

Purpose: Stereotactic ablative body radiotherapy (SABR) is an effective treatment for patients with prostate cancer. The use of the MR‐linac allows for daily assessment of the target and organs at risk, allowing for recontouring and plan re‐optimisation. This study assessed the feasibility of magnetic resonance guided adaptive radiotherapy (MRgART) for prostate cancer.

Methods: 15 patients were treated with stereotactic prostate MRgART. Planning target volume was prescribed 36.25 Gy and clinical target volume boosted to 38–40 Gy in five fractions. Organs at risk constraints were as per published guidelines. All fractions were delivered using an adapt to shape workflow which involved daily recontouring and replanning. Treatment times were recorded. Acute genitourinary (GU) and gastrointestinal (GI) toxicity were recorded after treatment, using Common Terminology Criteria for Adverse Events v.5.0.

Results: A total of 76 fractions were successfully delivered to 15 patients. Median patient age was 73 years (range 61–87 years). Median total treatment time including patient set‐up, imaging, contouring, plan adaptation and beam‐on was 50.2 minutes (range 43.2–63.7 minutes), and median beam‐on only time was 14.1 minutes (range 7.3–16.8 minutes). Three‐month follow‐up data were complete for 13 patients. Four patients reported grade 1 GU toxicity, and no grade 2 or worse early GU toxicity was reported. The main GU toxicities reported were pain, frequency and urgency. One patient reported grade 1 GI toxicity (diarrhoea).

Conclusion: Our initial experience with SABR prostate using MRgART demonstrates the safety and feasibility of this treatment technique. We continue to collect follow‐up data to assess late toxicity and patient reported outcome.

Patterns of care and acute toxicity of MR‐linac

Vikneswary Batumalai,^1,2 Michael Jameson,^1,2 David Crawford,¹ Louise Hogan,¹ Conrad Loo,¹ Maddison Picton,¹ Lori Geddes,¹ Stacy Alvares,¹ Jayd Lynch,¹ Amanda Woods,¹ Claire Pagulayan,¹ Urszula Jelen,¹ Nicole Dunkerley,¹ Sandy Sampaio,¹ Monique Heinke,¹ Tania Twentyman,¹ Jeremy de Leon¹

¹ GenesisCare, Australia ² The University of New South Wales, Australia

Objectives: To date, the availability of hybrid magnetic resonance‐linear accelerator (MR‐linac) is still limited with only three such systems in Australia. Little is known about the patterns of care and toxicity of treatments on MR‐linac in Australia. Based on an analysis of the first 1000 fractions treated, we report the initial experience at GenesisCare St Vincent’s, Australia.

Methods: Patient demographics, disease site, prescribed dose and fractionation scheme, and duration of each treatment were analysed. Acute toxicity was reported at three‐month follow‐up.

Results: From June 2020 to September 2021, 104 patients were treated with 1099 fractions. Patients were primarily male (83%) with a median age of 69 years (range 36–90 years). The most frequent treatment sites were prostate (35%), oligometastatic lymph node (27%), bone (8%) and adrenal gland (8%). Median prescribed dose was 36.25 Gy (range 15–50 Gy) in median five fractions (range 3–5 fractions) for stereotactic ablative RT (SABR) (72%). For non‐SABR (28%), the median prescribed dose was 55 Gy (range 30–80 Gy) in median 25 fractions (range 6–40 fractions). Mean total treatment time was 49 minutes and mean beam‐on time was 11 minutes for SABR. For non‐SABR, mean total treatment time was 37 minutes and mean beam‐on time was six minutes. Forty‐one patients had complete data on toxicity at three‐month follow‐up, no grade 3+ toxicity was observed.

Conclusion: In the first 15 months since implementation of the MR‐linac, patterns of care were diverse. Early toxicity outcomes highlight the safety of the treatment. We continue to collect data and evidence on patient reported outcome and toxicity.

Surfaced‐mapped to success: one clinic’s journey to surface guided breath hold

Tina Chen¹

¹ Icon Cancer Centre Cairns, Cairns, Australia

In Far North Queensland, there is an average of 182 newly diagnosed female breast cancers every year.¹ With the addition of the newly opened Icon private clinic in Cairns, we can provide timely access to radiation therapy services to Queensland’s largest catchment area. In October 2021, the Cairns Private Icon Cancer Centre completed a world first in integrating the Varian surface guided system, IDENTIFY, with the deep inspiration breath hold (DIBH) technique to treat left‐sided breast cancer on Halycon. With the support of surface guided radiation therapy (SGRT), radiation therapists can deliver treatment to sub‐millimetre accuracy as well as monitor patient set‐up and intrafraction motion. This case study explores the journey in which DIBH radiotherapy and SGRT were integrated and commissioned on the Halcyon. The process of commissioning SGRT DIBH required teams of radiation therapists, physicists and Varian clinical systems experts to collaborate and develop a workflow best for patient experience. Through this process, the team was able to quickly overcome challenges which arose through methodical investigation before the first clinical patient. As a result of these efforts, the Icon Cairns Private team successfully delivered several SGRT DIBH treatments – bringing new benefits of shorter, less intensive, and precise treatment to left‐sided breast cancer patients in the region. This success brings exciting prospects for the integration of SGRT DIBH into new areas and bringing world class care to this regional cohort.

Reference

1. Cancer Council Queensland. Far North Queensland Cancer Statistics, 2020. Available at https://cancerqld.blob.core.windows.net/site/content/uploads/2020/11/Regional_Cancer_States_FNQ_20.pdf

30 years of BreastScreen Australia

Beverlee Macdonell‐Scott,¹ Sue Macaulay²

¹ NSW Cancer Institute, St Leonards, Australia ² BreastScreen Victoria, Carlton South, Australia

BreastScreen Australia is the national breast cancer screening program. Every state and territory operate a BreastScreen Australia service, and invites women aged between 50 and 74 years to have a mammogram every two years.

BreastScreen Australia is a joint federal and state government funded program.

Breast cancer is the most diagnosed form of cancer in Australian women, with one in seven women diagnosed at some stage in their life.

Since 1990, BreastScreen Australia now operates in over 750 locations, has provided more than 20 million mammograms and detected more than 200,000 cancers. Since the commencement of the program, the five‐year relative survival rates from breast cancer have improved from 75% to 94%. Women diagnosed with breast cancer now have more treatment options than ever before.

This is not possible without the expertise and dedication of multi‐disciplinary teams many of whom have been part of the BreastScreen team since its inception.

BreastScreen offers a wide range of opportunities for radiographers to work not only as part of a highly specialised multi‐disciplinary team but also as ambassadors in the community to promote healthy lifestyles. BreastScreen is committed to ongoing quality improvement in all aspects of the program. It is this ongoing commitment to training and quality that makes BreastScreen a rewarding field to be a part of.

This presentation will celebrate 30 years of BreastScreen achievements as well as highlighting future directions of the program.

The impact of prophylactic skin dressings on surface guided patient positioning in breast radiation therapy

James Cumming¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

Background: Adverse skin reaction impacts 70% to 99% of radiation therapy (RT) patients, ranging in severity from mild erythema to ulceration.¹ Prophylactic use of Mepitel Film (Mölnlycke, SE) during breast cancer radiation therapy can reduce reaction severity² and long‐term side effects.³ Following clinical implementation of surface guided radiation therapy (SGRT) at our centre, radiation therapists noted contour changes to reconstructed or intact breast tissue after Mepitel was applied. A change in patient contour in the region of interest that defines surface guided set‐up may introduce systematic positioning errors.

Objectives: To evaluate the impact of Mepitel‐induced contour changes on SGRT accuracy for breast radiation therapy.

Methods: A retrospective analysis was conducted to examine kV image‐guided online correction (OLC) trends for patients with reconstructed or intact breasts undergoing radiation therapy and utilising SGRT for patient set‐up. These OLC variations were compared to OLCs for intact breast patients undergoing the same treatment without Mepitel. Ethics approval was not required as the study met exemption criteria of institutional policy.

Results: From preliminary data of 89 patients treated for breast cancer with SGRT, 15 had Mepitel dressings applied. Of these, six had reconstructed or intact breast tissue. Mean OLC magnitudes were comparable in the lateral and anterior‐posterior axes, however the mean OLC in the superior‐inferior axis was greater for patients with Mepitel than for non‐Mepitel patients (0.37 cm and 0.24 cm, respectively).

Conclusion: Further analysis with larger patient numbers is warranted, however preliminary data indicates that the application of Mepitel to reconstructed or intact breasts may influence SGRT setup accuracy for breast radiation therapy.

References

1. Andersen E, Eilertsen G, Myklebust A, Eriksen S. Women’s experience of acute skin toxicity following radiation therapy in breast cancer. Journal of Multidisciplinary Healthcare 2018;11:139–148.

2. Herst P, Bennett N, Sutherland A, et al. Prophylactic use of Mepitel Film prevents radiation‐induced moist desquamation in an intra‐patient randomised controlled clinical trial of 78 breast cancer patients. Radiother Oncol 2014;110(1):137–43.

3. Yee C, Lam E, Gallant F, et al. A feasibility study of Mepitel Film for the prevention of breast radiation dermatitis in a Canadian center. Practical Radiation Oncology 2021;11(1):e36‐e45.

The challenges of delivering radiation therapy to breast expanders

Sarah Gooch,¹ Millie Taylor‐Brown,¹ Rick Sims¹

¹ Icon Cancer Centre, Cairns, Australia

Objectives: The presence of magnetic valves in breast tissue expanders introduces dosimetric uncertainties and complications to the planning and delivery of radiation therapy.¹ It is important to consider the type of expander and its potential motion during the planning process.

Methods: In line with routine planning and quality assurance processes, clinical patients were planned using hybrid‐intensity modulated radiation therapy (H‐IMRT) or volumetric modulated arc therapy (VMAT) planning techniques. Weekly in vivo dose measurements were conducted using Gafchromic (Ashland, Bridgewater, NJ) film, comparing the dose to the magnetic valve to that calculated in the treatment planning system.

Results: Weekly Gafchromic film measurements of entry and exit dose have demonstrated a 2.2% to 5.5% dose variation between the film measurements and the dose calculated by the treatment planning system. Minimal difference was shown between the use of H‐IMRT or VMAT however different optimisation methods were required for the two techniques.

Conclusion: The complications and uncertainties of planning and delivering radiation therapy to tissue expanders are overcome with the use of inverse planning techniques and daily imaging. This ensures that dose to the magnetic valve is minimised without compromising the overall coverage of the target volume.

Reference

1. Trombetta DM, Cadoso SC, Facure A, da Silva AX, da Rosa LAR. Influence of the presence of tissue expanders on energy deposition for post‐mastectomy radiotherapy. PLoS ONE 2013;8(2):e55430.

Pregnancy declarations and screening for patients undergoing radiotherapy: a case study

Amie Sims¹

¹ Icon Cancer Centre, Cairns, Australia

Introduction: Radiation exposure to a developing fetus can result in growth delay, impaired cognitive function, intrauterine growth restriction, organ malformation, genetic diseases, childhood cancers and prenatal death.¹ Despite these potential risks, pregnancy screening practices for radiation therapy patients before commencing treatment are not uniform across radiation oncology institutions.²

Case presentation: One week after completion of her radiation therapy course, a 20‐year‐old female patient returned a positive pregnancy result and subsequently informed radiation oncology staff. She had received 59.4 Gy/33# to a brain lesion in the left frontal lobe. Dating scans estimated that she was seven to eight weeks gestation upon completion of treatment, indicating that she was pregnant before commencing radiation therapy.

Management/Outcome: Within the incident review, we performed a series of absorbed dose measurements which indicated that the absorbed dose to the fetus was estimated to be 50 mGy. This correlated with estimates between 30–280 mGy based on peer‐reviewed literature and internal documentation.

The radiation oncologist discussed the potential risks to the fetus with the patient, including the fact that there are uncertainties associated with the dose estimates. Due to the patient requiring further medical interventions, the pregnancy was terminated.

Discussion: This case prompted a review within our institution of the current patient consent, pregnancy declarations and pregnancy screening protocols. We evaluated the processes undertaken within Australian radiation oncology departments to enable us to develop and implement a comprehensive pregnancy declaration policy.

References

1. Australian Clinical Guidelines for Radiological Emergencies. Prenatal radiation exposure. Australian Commonwealth Government, Department of Health; 2012.

2. Zaki P, Zhu J, Mackley HB, Rosenberg JC. Pregnancy screening practices and treatment of pregnant patients among radiation oncologists: results of an international survey. ecancer 2021;15:1169.

A national approach to template development in the Monaco treatment planning system

Tatiana De Martin¹

¹ GenesisCare, Sydney, Australia

Introduction: For a global radiotherapy provider with 36 centres across Australia, it is essential that, regardless of which centre the patient attends, the same consistent, high‐quality plan is achieved. The challenges of collaboration and standardisation across such large geographical settings can be challenging, however with clear outcomes and common goals established, as well as collaboration across multiple clinics, has led to the successful roll‐out of standardised planning templates.

Case presentation: In November 2020, Monaco treatment planning system was rolled out within the planning workspace, working towards a national standardised planning solution instead of state‐based protocols. The shared vision was to improve efficiency and consistency of plan quality. Representatives from each state, including planners, physicists, IT and radiation oncologists collaborated on the implementation of clear tumour group guidelines to be attained during template development.

Management/Outcomes: For each tumour group, 10 test patients were identified from each state used to validate the national planning template. The template then proceeded through several iterations until national consensus was achieved. Quality assurance and supporting documentation were completed for each template. Since go‐live, more than 50 national templates have been published in our planning library producing optimal quality assurance results as well as high radiation oncologist satisfaction with plan quality.

Discussion: The implementation of planner feedback forms has meant fast feedback on the quality of the national planning templates. This information helps amend current and shape future templates and continually challenges the quality of our plan output.

Implementation framework for volumetric modulated arc therapy planning templates

Angela Viotto,¹ Leah McDermott¹

¹ Austin Health, Heidelberg, Australia

In radiation oncology, the use of planning templates is known to improve plan quality, efficiency and treatment time. In March 2020, a radiation therapist and radiation oncology medical physicist (ROMP) were tasked with implementing volumetric modulated arc therapy (VMAT) across all anatomical sites. The framework developed standardised the VMAT implementation process. The framework ensures collaboration across disciplines (radiation therapist, ROMP, radiation oncologist), consistent presentation of reports for peer review before clinical implementation, and a clear communication process during the roll‐out phase.

The VMAT template roll‐out included creating a Monaco VMAT template; template testing with 10 plans; discussion and approval of plans with radiation oncologist and ROMP quality assurance of 10 plans; creation and peer review of planning documentation; submission to and approval of reports to department leads; and communication and education about the new VMAT template. A checklist was created to monitor progress during roll‐out. Radiation therapists were surveyed about the roll‐out process and planning templates.

Nine anatomical sites have been released and three have been reviewed/improved. All anatomical sites converted to VMAT have demonstrated similar or improved plan quality and planning efficiency. Reduced treatment delivery time was also achieved by reduced plan modulation.

The framework has allowed for a comprehensive and consistent roll‐out procedure of VMAT planning templates and can be adopted for implementation of any new technique. It unites three radiation oncology disciplines in the implementation process with the potential to involve other groups such as nursing and consumers in the future.

Uniting plan quality metrics using a cloud‐based software for improving radiotherapy planning efficiency and quality

Meegan Shepherd,^1,2 Alexander Podreka,¹ Brian Porter,¹ John Atyeo,^1,2 Thomas Eade¹

¹ Northern Sydney Cancer Centre, St Leonards, Australia ² Monash University, Melbourne, Australia

Objectives: Evaluation of plan metrics is a key step in the radiotherapy workflow.¹ Despite best efforts, judgements of treatment plan quality can be largely subjective with inter and intra‐practitioner inconsistencies.² Plan variability is further impacted by time pressures and lack of automation, which may effect patient outcomes.^3,4

Cloud‐based dosimetry software (Proknow) provides the power to compare plans using new evaluation tools such as pre‐determined plan scoring, unique scorecard metrics and population comparisons. We hypothesise dosimetric review using ProKnow will reduce quantity and frequency of re‐plans in our department, facilitating treatment planning efficiencies, improving radiation therapist plan evaluation decision‐making skills and patient time to treatment.

Methods: Varian’s AURA reporting workspace was retrospectively queried for all re‐plan tasks in a patients’ care‐path between February 2021 and September 2021. Review of re‐plan rationale identified suitable cases, excluding non‐dose‐related or off‐protocol cases. Patients were included if the rejected plan was still available in ARIA Eclipse and clinical protocol deviations identified. Time between ‘RT‐plan’ task available and completed was reviewed to measure planning efficiency.

Preliminary results: Between February and September 2021, 223 re‐plan tasks were flagged with 83 patient plans eligible for plan assessment. 55 patients had both original and re‐plan available for dose metric and time comparison. Plan metric comparison between Proknow and Eclipse and time evaluations to follow.

Conclusion: Novel cloud‐based software (Proknow) may facilitate radiotherapy treatment plan quality and efficiencies through customisable scorecards, plan scoring and group‐based evaluations. Future implications include radiotherapist training and credentialing for lightning‐fast online decision‐making during adaptive workflows.

References

1. Hernandez V, Hansen CR, Widesott L, et al. What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans. Radiother Oncol 2020;153:26–33.

2. Moore KL, Brame RS, Low DA, Mutic S. Quantitative metrics for assessing plan quality. Semin Radiat Oncol 2012;22(1):62–9.

3. Huynh E, Hosny A, Guthie C, et al. Artificial intelligence in radiation oncology. Nat Rev Clin Oncol 2020;17:771–781.

4. Momin S, Fu Y, Lei Yet al. Knowledge‐based radiation treatment planning: a data‐driven method survey. J Appl Clin Med Phys 2021;22(8):16–44.

The role of the radiation therapist in Level III audits and why it’s so important

Katherine Metzger,¹ Cate Davey,¹ Fayz Kadeer,¹ Rhonda Brown¹

¹ Australian Clinical Dosimetry Service, Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Australia

The Australian Clinical Dosimetry Service (ACDS) is a dosimetry auditing service that provides independent quality assurance checks for radiation therapy departments, ensuring that treatment delivered to patients is as planned. The Level III audit is the most comprehensive audit offered and is a true end‐to‐end test of the planning to treatment pathway, designed to detect errors that may exist along this pathway within your organisation. The radiation therapist is essential for ensuring successful completion of the audit. Involvement in a Level III audit is an ASMIRT CPD approved activity. This recognises the complexity of the audit and the challenges of planning and treating a phantom; according to departmental protocol; as if it were a patient.

Results of all ACDS audits completed across Australia and New Zealand are contained in a shared database, allowing radiation therapy providers to compare their performance with other facilities. The results of successful audits contribute to consistent incremental improvements in the accuracy of treatment planning and delivery across Australia and New Zealand. Immediate detection of errors during an audit prevents potential patient harm while contributing valuable information to the database.

Some audit results demonstrate simple errors, caused by lack of understanding of the significance of the audit and the associated results. This presentation will discuss the importance of the role of the radiation therapist in successful audit completion and how this contributes to national uniformity in the accuracy of radiation therapy treatment in facilities across Australia and New Zealand.

Staying connected – onboarding for a remote environment

Charlotte Skidmore¹

¹ Icon, South Brisbane, Australia

Icon is Australia’s largest cancer care provider and ever expanding. Through the pandemic, Icon’s footprint continued to grow, and onboarding and training delivery needed to be adjusted to suit this new environment. The task was to create onboarding training material that could be delivered remotely, either as self‐directed or online tutorials, and still a complete package of training fulfilling all the requirements radiation therapists need to perform their job. Further to this was still bringing together a team, many sites had to complete their orientation from their own homes, owing to split teams or sites not yet accessible. This required training that would also foster a sense of community and could bring all disciplines together.

A robust package was created, with a flexible four‐week orientation timetable. As staff gained access to site at different times, modules within the timetable could be moved based on what could be accessed and when depending, for the desired learning outcome. Online learning pathways were created to ensure radiation therapists completed their learning in an appropriate order and tutorials were given by a consistent member of the education team. These were recorded to allow for future content creation to be made and hence deliverable to anyone. Although this was created in response to new sites, given the timetable structure, new staff members employed at existing site could also attend the online tutorials to further complete their orientation. Feedback surveys were given to staff on completion and led to future development directions of the package.

A dosimetric and resource comparison of DCAT and gamma knife techniques for choroidal melanoma patients

Rob Nigro¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

Objectives: The purpose of this study is to optimise the clinical service offered to choroidal melanoma patients undergoing radiation therapy by comparing linac‐based photon dynamic conformal arc therapy (DCAT) and gamma knife (GK) stereotactic radiotherapy techniques.

Methods: A resource (planning and treatment workflow efficiency based on time) and dosimetric analysis was performed on 15 (five x right‐sided, 10 x left‐sided) retrospective choroidal melanoma patients (50 Gy/5 fractions) treated at our institution.

Results: Overall, radiation oncology and physics resource implications did not suggest any significant time differences. However, radiation therapists reported anecdotal increased planning efficiency with the GK technique due to the Leksell Gamma Knife Lightning software. Regarding dosimetry, a statistically significant improvement in the Paddick Conformity Index (P = 0.011) and gradient index (P < 0.0001) was found with the GK technique. With respect to critical organs, a statistically significant reduction in mean (GK = 5.3 Gy; DCAT = 10.5 Gy, P = 0.007) and dose maximum (GK = 6.1 Gy; DCAT = 13.2 Gy, P = 0.0015) of the ipsilateral lacrimal gland, together with dose maximum of the ipsilateral optic nerve (GK = 25.2 Gy; DCAT = 30.5 Gy, P < 0.0001) was reported in GK patients compared to DCAT.

Conclusions: The GK technique for the treatment of choroidal melanoma delivers some key operational and dosimetric advantages over the linac‐based alternative (DCAT). There lies an exciting opportunity to continue to develop the choroidal melanoma GK service at our institution as our experience with GK continues to evolve.

Implementation and characterisation of multi‐target single‐isocentric radiosurgery

Sarah Docherty,¹ Kankean Kandasamy,¹ Erin Seymour,¹ Michael Back,¹ Benjamin Zwan,¹ Monica Le Mottee¹

¹ Central Coast Cancer Centre, Gosford, Australia

Objectives: Multi‐target single‐isocentric (MTSI) stereotactic radiosurgery (SRS) is an effective treatment option for intracranial metastatic disease.¹ However, it is essential to quantify and mitigate geometric uncertainty in targeting multiple small lesions.² We aimed to characterise the advantages of multi‐leaf collimator (MLC) based MTSI (Varian’s HyperArc), quantify the uncertainties and make recommendations on implementation.

Methods: A retrospective plan comparison study (n = 5) between MLC‐based MTSI and cone‐based SRS planning was conducted. The accuracy of our MTSI delivery system (Varian Edge with Encompass fixation) was quantified with end‐to‐end phantom testing with hidden targets at increasing distances from isocentre. Intra‐fraction motion was assessed using pre‐ and post‐treatment CBCTs. Treatment efficiency gains were quantified with a timing study.

Results: MTSI plan quality compared favourably to cone‐based plans and justified implementation of HyperArc (Figure 1a). End‐to‐end phantom study showed geometric uncertainty increased with off‐axis distance (OAD) from isocentre (Figure 1b). Measured intra‐fraction motion was < 1 mm for targets < 7 cm from isocentre. The combined uncertainties observed from our phantom and imaging studies necessitated an OAD dependant margin (1 mm for OAD < 4 cm, 2 mm for OAD < 7 cm) and a recommendation to not plan with targets greater than 7 cm from isocentre. MTSI was faster than cones by a factor of 3.7 for average treatment duration per target.

Conclusion: MLC‐based MTSI is now used as standard of care for SRS at our centre with OAD‐dependent margins. This treatment technique offers greater plan quality and improves treatment efficiency for cranial SRS patients.

References

1. Palmer JD, Sebastian NT, Chu J, et al. Single‐isocenter multitarget stereotactic radiosurgery is safe and effective in the treatment of multiple brain metastases. Advances in Radiation Oncology 2020;5(1):70–6.

2. Roper J, Chanyavanich V, Betzel G, Switchenko J, Dhabaan A. Single‐isocenter multiple‐target stereotactic radiosurgery: risk of compromised coverage. Int J Radiat Oncol Biol Physics 2015;93(3):540–6.

Stereotactic radiation therapy treatment planning using Varian HyperArc treatment planning: evaluation of first 12 months

Karen McGoldrick,¹ Glen Osbourne,¹ Kenton Thompson¹

¹ Peter MacCallum Cancer Centre, East Bentleigh, Australia

Objectives: Brain metastases (BM) are the most common intracranial tumours in adults with approximately 30% of patients affected by cancer developing BM. In recent years the role of single‐fraction radiosurgery and fractionated stereotactic radiation therapy (SRT) has gained importance in the treatment of BM.¹ SRT has been successfully implemented using HyperArc treatment planning (Varian Medical Systems, Palo Alto, USA) at our campus for BM and post‐operative cavities. The aim of this study was to evaluate clinical treatment plans for the first 12 months.

Methods: All patients were planned using a single plan per target with an isocentre placed centrally to the target. Arc geometry was selected based on our pre‐implementation planning study and in most case three arcs were used. Plan quality metrics were retrospectively analysed for all treatment plans for all patients treated with SRT from October 2020 to October 2021.

Results: For the first 10 plans analysed the plan quality metrics for mean and range were: GTV D 100%, 102.15% (99.7–105.9), PTV D 99%, 100.27% (99.3–101.3), CI100RTOG, 1.11 (1.05–1.21), CI50RTOG, 3.29 (2.53–4.41) and plan complexity using modulation factor (MUs/dose per fraction in cGy), 2.52 (2.1–3.5).

Discussion/Conclusion: Successful implementation of SRT treatment has been achieved using HyperArc treatment planning. Development work continues as we aim to safely increase the patient acceptance criteria so we can expand this service locally and to other campuses across our institution.

Reference

1. O’Beirn M, Benghiat H, Meade S, et al. The expanding role of radiosurgery for brain metastases. Medicines 2018;14(3)90.

Developing radiotherapy pathways for adrenal gland metastases using stereotactic body radiotherapy

Sophie Mangan,¹ Adam Briggs,¹ Siobhan Burke,¹ Brian Porter,¹ John Atyeo,¹ Dasantha Jayamanne¹

¹ Northern Sydney Cancer Centre, Sydney, Australia

Objectives: The use of SBRT has shown high clinical efficacy in the treatment of oligometastatic adrenal gland lesions, with good clinical statistics of local control reported in literature.^1–3 The clinical efficacy and safety is underpinned by effective motion management strategies to respect nearby sensitive normal tissue structures.

Methods: A retrospective review of patient 4DCTs (n = 13) acquired with use of the Varian Real‐time Position Management (RPM) system was performed. Time‐resolved anatomical motion was determined by contouring whole organs on all 10 phases of the 4DCT. The external surrogate (i.e. RPM) motion was compared to internal anatomical motions for the diaphragm, left and right kidneys. The population motion mean and standard deviation are reported.

Results: The complete dataset is available for nine out of 13 patients, with four patients missing the RPM data and two patients had one kidney removed. The measured motion (mean ± 1 standard deviation) was 1.2 ± 0.5 cm, 1.0 ± 0.3 cm, 0.9 ± 0.4 cm and 0.7 ± 0.4 cm for the RPM, diaphragm, right kidney and left kidney, respectively.

Conclusion: The external and internal surrogates of the adrenal gland exhibit similar motion characteristics, with the RPM, having the largest motion in majority of cases. This dataset can support the development of motion management pathways, including respiratory gating methods such as expiration breath hold, which may reduce the treatment volume and overlap with sensitive normal tissues.

References

1. Zhao X, Zhu X, Zhuang H, et al. Clinical efficacy of stereotactic body radiation therapy for adrenal gland metastases: a multi‐center retrospective study from China. Scientific Reports 2020;10(1).

2. König L, Häfner M, Katayama S, et al. Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients. Radiat Oncol 2020;15(1).

3. Ippolito E, D’Angelillo R, Fiore M, et al. SBRT: a viable option for treating adrenal gland metastases. Reports of Practical Oncology Radiotherapy 2015;20(6):484–90.

Planning automation for prostate stereotactic ablative body radiotherapy

Andrew O'Toole,¹ Andrew Kneebone,^1,2 George Hruby,^1,2 Thomas Eade,^1,2 Nicole Dougheney,¹ Tiarna Jade,¹ Kim Buman,¹ Tom Mastwyk,¹ Matthew Price¹

¹ GenesisCare, Crows Nest, Australia ² Royal North Shore Radiation Oncology, St Leonards, Australia

Aim: To successfully implement an automated planning process across multiple centres for five fraction prostate stereotactic ablative body radiotherapy (SABR) patients that unites the steps from plan contour creation to calculation into one process.

Method: An automated workflow was created with the automation team for the Eclipse prostate SABR protocol and implemented at multiple sites in the network. The workflow united the steps from the point after doctor contouring to the calculation of a plan into one process. The automation launched in MIM and included such steps as couch insertion, machine selection, beam placement, RapidPlan model selection, optimisation and plan calculation.

The success of the planning automation system to generate a calculated plan was recorded for the first 25 patients and the number of plans that were deemed clinically acceptable without therapist intervention were noted. The reasons why plans had been assessed as not clinically acceptable were documented along with the number of re‐optimisations needed.

Results: The automated workflow was successful in its creation of a calculated plan for 17 patients. Of the eight patients that automation was unsuccessful for, four had prescription errors, three had metal hips and one had an issue with the CT dataset.

Six patients needed no intervention after automation and a further six needed only one more optimisation before being deemed clinically acceptable for sign off. None of the 17 patients needed more than three optimisations.

Conclusion: Planning automation was successfully implemented for prostate SABR patients.

How the use of a test bolus in paediatric patients benefits everyone

Stephen Lacey¹

¹ The Royal Children's Hospital, Parkville, Australia

The prevalence of acute pulmonary embolism in hospitalised children with COVID‐19 is higher than hospitalised children in general.¹ This results in the inevitable increase in computed tomography pulmonary angiogram (CTPA) studies for investigation, as the alternative nuclear medicine ventilation perfusion scans are avoided for patients with COVID‐19.

The use of a test bolus technique in CT angiography studies in adults is not unusual, with many studies reporting on its benefits when compared to bolus tracking.^2–4 However, in the paediatric population, this practice is not well utilised.

With the increased demand in CTPA studies in our institution, the test bolus technique was introduced. This change has resulted in a beneficial outcome for both the clinical staff and patient. There is a reduction in the contrast volume for each patient, whilst enhancing image quality at the pulmonary arteries. Furthermore, this method allows for the patient to experience the effect of contrast introduction prior to the scan, thereby reducing their anxiety and increasing their compliance.

References

1. Chima M, Williams D, Thomas NJ, Krawiec C. COVID‐19 – associated pulmonary embolism in pediatric patients. Hospital Pediatrics 2021;11(6):e90.

2. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006;354:2317–27.

3. Lee CH, Goo JM, Lee HJ, et al. Determination of optimal timing window for pulmonary artery MDCT angiography. American Journal of Roentgenology 2007;188:313–7.

4. Godoy MC, et al. Dual‐energy MDCT: comparison of pulmonary artery enhancement on dedicated CT pulmonary angiography, routine and low contrast volume studies. Eur J Radiol 2011;79:e11–7.

Establishing local paediatric fluoroscopic diagnostic reference levels – a journey to benchmarking Australian doses

Yolanda Gomes,¹ Greg Brown,¹ Josephine Davies,² Nayana Parange,¹ Shayne Chau³

¹ The University of South Australia, Adelaide, Australia ² Flinders Medical Centre, Bedford Park, Australia ³ RMIT University, Melbourne, Australia

Background: Diagnostic reference levels (DRLs) identify the administration of unusually high patient doses and are required for dose optimisation. Data concerning DRLs for paediatric fluoroscopic examinations in Australia is scarce.

Objective: To compare DRLs for paediatric fluoroscopic examinations in a South Australian tertiary hospital to published data and promote the establishment of a national database for benchmarking paediatric doses. To explore relationships between dose area product (DAP), age and fluoroscopy time.

Methods: The study was reviewed and given exemption by the hospital and university ethics boards. Dose data from 365 paediatric patients undergoing five fluoroscopic examinations were retrospectively analysed from a three‐year period and age categorised for the development of local DRLs (LDRLs). Shapiro‐Wilk’s test for normality was conducted. Relationships between DAP, age and fluoroscopy time were explored using scatter plots, Spearman’s correlation and regression tests.

Results: LDRLs were significantly lower than published data, possibly reflecting technological and procedural advancements. Each one‐year increase in age was associated with 0.77 μGy.m² increase in DAP for barium meal and follow through studies, (95% CI = 0.055, 1.48) (P = 0.035), and 1.37 increase in DAP for barium swallow studies (95% CI = 0.61, 2.12) (P < 0.001). Low correlation was demonstrated between DAP and fluoroscopy time for micturating cystourethrography studies (r = 0.35, 95% CI = 0.15, 0.51, P < 0.001) and barium meal and follow through studies (r = 0.37, 95% CI = ‐0.011, 0.65, P = 0.050). Age and fluoroscopy time were not significantly related.

Conclusion: This study provides updated Australian paediatric fluoroscopic DRLs, with the intention of promoting a national database for benchmarking paediatric doses.

Is there benefit to concurrent X‐ray imaging of the upper limb in paediatrics post FOOSH?

Daniel Sgualdino¹

¹ Logan Hospital, Meadowbrook, Australia

Objectives: Concurrent X‐ray imaging of the upper limb in paediatric patients following a fall on the outstretched hand (FOOSH) is intended to minimise the risk of an undetected concomitant injury and is typically performed on patients aged 0 to 10 years.^1,2 The purpose of this study was to explore the benefit of concurrent imaging and to identify if age could provide evidence for imaging.

Methods: A 12‐month retrospective review of all X‐ray examinations of the wrist, forearm and distal humerus of patients aged 0 to 10 years referred from the Logan Hospital Emergency Department was undertaken. The frequency, type and location of radiographic abnormalities and the requested examinations region of interest, referral notation and patients age were recorded. Analysis was by descriptive statistics.

Results: 476 examinations met the studies inclusion criteria, 4.8% (23/476) identified an abnormality outside of the documented region of interest. On review of the admission and treatment notes 1.7% (8/476) were deemed to have detected traumatic abnormalities as a direct outcome of concurrent imaging. No age‐related imaging cut offs were identified.

Conclusion: This study demonstrates limited benefit (1.7%) to concurrent upper limb imaging. The results suggest that a thorough physical clinical evaluation of the paediatric upper limb performed by the referrer alone presents as sufficient to accurately guide X‐ray imaging. These findings have the potential to positively impact a reduction in the number of x‐rays performed on paediatric patients and in turn contribute to limiting radiation dose. Further studies to include additional facilities is required to validate this study.

References

1. Golding L, Yasin Y, Singh J, et al. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources? Pediatric Radiology 2015;45(8):1169–73.

2. Roposch A, Reis M, Molina M, et al. Supracondylar fractures of the humerus associated with ipsilateral forearm fractures in children: a report of forty‐seven cases. Journal of Pediatric Orthopaedics 2001;21(3):307–12.

Image quality assessment of low‐dose whole‐body computed tomography skeletal surveys

Edel Doyle^1,2

¹ Lumus Imaging, Melbourne, Australia ² Monash University, Melbourne, Australia

Background: With advances in low‐dose computed tomography (CT) technology, it has been proposed that a CT skeletal survey could replace a skeletal survey X‐ray series in the investigation of non‐accidental injury or suspected physical abuse.¹

Objective: The aim was to perform a phantom study using whole‐body CT skeletal survey to establish the threshold below which image quality became undiagnostic.

Methods: A paediatric non‐accidental injury phantom was scanned using three different CT scanners at a range of dose levels. These datasets were screened to eliminate any undiagnostic scans as the fracture sites were known. The diagnostic data sets were then reviewed by paediatric radiologists using specific criteria in the DetectED‐X software. Subjective noise was measured by MyXrayDose. The effective radiation doses for the diagnostic CT scans were calculated using NCI dose and impact scanner and compared to a manual calculation performed by MyXrayDose. The radiation risks were then estimated using the BEIR VII report.

Results/Conclusion: The research is yet to be completed; the results and conclusion of the literature reviews are yet to be confirmed.

Reference

1. Lawson M, Tully J, Ditchfield M, Kuganesan A, Badawy MK. Using computed tomography skeletal surveys to evaluate for occult bony injury in suspected non‐accidental injury cases – a preliminary experience. J Med Imaging Radiat Oncol 2022;66(1):41–8.

Going round the twist with intestinal malrotation

Stephen Lacey¹

¹ The Royal Children's Hospital, Parkville, Australia

Bilious vomiting in the newborn is often one of the primary indicators of intestinal malrotation. While not all cases of bilious vomiting are due to intestinal malrotation, this needs to be excluded as a priority.^1,2 Commonly, the fluoroscopic upper gastrointestinal (UGI) study is considered the gold standard in the investigation of bilious vomiting.

In Australia, investigations for possible intestinal malrotation following bilious vomiting of the newborn most often occur at tertiary paediatric hospitals. This is primarily due to the expertise of medical imaging staff and the subsequent availability of a paediatric surgical team if surgery is required. However, the transport and neonatal care of these patients, sometimes from rural and remote areas, is time consuming and costly, with many newborns being returned to their birthplace following a normal fluoroscopic study. This can also take an emotional toll on the parents, who are suddenly separated from their newborn.

More recently, ultrasound has been considered as an alternative to the UGI, with many studies reporting on its advantages, including an increased sensitivity and specificity over the UGI, and the luxury of no oral contrast.³ Conversely, ultrasound diagnosis of intestinal malrotation is limited by the air interface and requires significantly trained sonographers and radiology fellows and consultants.^3,4

This presentation outlines the benefits and pitfalls of both the UGI and ultrasound for the investigation of bilious vomiting and presents possible efficient alternatives to maintain a high standard of care.

References

1. Godbole P, Stringer MD. Bilious vomiting in the newborn: How often is it pathologic? Journal of Pediatric Surgery 2002;37(6):909–11.

2. The Royal Children’s Hospital. Pre‐referral guidelines for bilious vomiting. 2009. Available at https://www.rch.org.au/kidsconnect/prereferral_guidelines/Bilious_vomiting_prereferral/

3. Nguyen HN, Kulkarni M, Jose J, et al. Ultrasound for the diagnosis of malrotation and volvulus in children and adolescents: a systematic review and meta‐analysis. Archives of Disease in Childhood 2021;106:1171–8.

4. Strouse PJ. Ultrasound for malrotation and volvulus: has the time come? Pediatric Radiology 2021;51:503–5.

Proposed radiation doses from a phantom study for non‐accidental injury skeletal survey X‐ray series

Edel Doyle^1,2

¹ Lumus Imaging, Melbourne, Australia ² Monash University, Melbourne, Australia

Background: A series of 31 X‐rays is recommended by the Royal College of Radiologists (RCR) when investigating non‐accidental injury (NAI).¹ To establish if a low‐dose CT skeletal survey could replace the X‐ray series, the effective radiation doses were calculated, as there is no Australian diagnostic reference level for paediatric X‐rays.

Objective: This phantom study aims to propose a radiation dose representative of that delivered for NAI skeletal surveys in Victoria using local equipment and protocols.

Methods: A paediatric NAI phantom was X‐rayed at five radiology sites using both the RCR recommended protocol and, where applicable, the local departmental NAI protocol. As these exposures were made using local NAI protocols and pre‐programmed exposure factors, image quality was assumed to be diagnostic. The radiation doses were measured and recorded. Effective radiation dose was then calculated using the PCXMC software. Radiation risks were estimated using the BEIR VII report and PCXMC software.

Results: The average cumulative ‘true’ KAP measured across the five sites for the RCR protocol was 610 mGy^.cm², whereas the median cumulative ‘true’ KAP was 457 mGy^.cm². The corresponding effective doses were 0.17 and 0.13 mSv.

The estimated risk of radiation‐induced cancer for one‐ to five‐year‐old children having a skeletal survey X‐ray series is one in 40,000 to one in 15,000.

Conclusion: The average effective radiation dose to the phantom was 0.17 mSv and the median was 0.13 mSv. The authors will now aim to acquire a diagnostic low‐dose CT skeletal survey with a similar effective radiation dose.

Reference

1. The Royal College of Radiologists and the Society and College of Radiographers. 2017. The radiological investigation of suspected physical abuse in children. Available at https://www.rcr.ac.uk/publication/radiological-investigation-suspected-physical-abuse-children

A grounded theory approach to unite patient centred care for patients undergoing specialised prostate imaging

Nadine Thompson,¹ Lisa Tarlinton,¹ Tyrel Cromie, Henry Woo^1,2

¹ Sydney Adventist Hospital, Wahroonga, Australia ² Australian National University Sydney Adventist Hospital Clinical School, Wahroonga, Australia

Objectives: As the number of Australians being diagnosed with prostate cancer increases in prevalence, there continues to be an increase in the number of patients undergoing specialised prostate imaging including multi‐parametric magnetic resonance imaging and positron emission tomography with computed tomography.¹ There is no guarantee that patient care will improve as a result of the technology evolution within medical imaging.² Therefore, exploration of the patient experience from the patient's perspective is required.

Methods: To provide insight into how we can improve patient centred care in the context of prostate specific imaging, patient reported experience measures were explored. 15 patients who underwent prostate specific imaging at a single site participated in 15‐minute digitally recorded interview regarding their experience. Constant comparative analysis via a grounded theory approach was used to thematise the data.

Results: A conceptual framework (Figure 1) was developed in order to depict the relationship between the concepts and key concepts derived from the data. It was found that patients undergoing these investigations valued timely and simple access to care and effective communication to provide a professional patient centred care experience.

Discussion/Conclusion: The patient’s experience with an imaging service commences with the referral process and not when they first interact with the imaging provider. Therefore, uniting the professional relationships and improved communication between referrers and imaging providers enhances patient centred care.

References

1. Bouchelouche K, Turkbey B, Choyke P. Advances in imaging modalities in prostate cancer. Curr Opin Oncol 2015;27(3):224–31.

2. Deshpande PR, Rajan S, Sudeepthi BL, Abdul Nazir CP. Patient‐reported outcomes: a new era in clinical research. Perspect Clin Res 2011;2(4):137–44.

Projection mapping to relieve paediatric bunker anxiety – birds, butterflies, ghosts and everything in between!

Daniel Sapkaroski¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

A butterfly flutters its wings, and a leaf falls from the trees. A magpie darts along the wall with a branch in its beak. As it passes the trees, more leaves fall slowly and cascade down the wall – snow fall signalling winter is here. But wait! Halloween is here! A dancing ghost pops around the corner…

This world‐first radiation therapy project aimed to alleviate adolescent and young adult cancer patients’ fear of the radiation therapy treatment room and increase treatment engagement with the aid of audio‐visual projection art. This was facilitated using projection mapping and audio technology to illustrate stories and engaging artwork.

This presentation outlines how we can positively change the narrative of the treatment room for our youngest to the oldest of our patients.

Enhancing patient care pathways: patient care radiation therapists and other health professionals unite

Maiko Crispin,¹ Lorraine Lewis,¹ Claire King,¹ Kylie Grimberg,¹ John Atyeo¹

¹ Northern Sydney Cancer Centre, St Leonards, Australia

Objectives: To determine whether a unique patient care radiation therapist (PCRT) role can improve the patient care experience and unite other health professionals in ensuring optimal patient care.

Methods: The PCRT role was implemented in September 2019 as a new model of radiation therapist driven patient care. A PCRT is assigned to each treatment and planning team and fosters effective communication across the wider multidisciplinary team. To determine if the PCRT could streamline the patient care experience earlier, a team was established and a research project initiated, consisting of a staff perception survey and an observational study, to identify current and future patient care pathways.

Results: The response rate to the survey was 55%, with representation from all craft groups. Eight themes emerged from the qualitative data submitted in the staff survey that included: effective communication, patient centred care, role delineation, collaboration, personalised care, role expansion, information provision, and time constraints.

The observational study determined that patient care pathways would benefit from PCRTs being involved in new patient clinics, multi‐disciplinary teams and clinical meetings.

Discussion/Conclusion: A patient’s cancer care journey can be complex and difficult to navigate, with the rapid advancement of treatment techniques and processes being more onerous for patient compliance. By identifying gaps in our current cancer services, we can identify how a PCRTs unique technical knowledge and skills, combined with their patient care skills, can be utilised earlier in the radiation therapy care pathway to improve the patient care experience while working collaboratively with all craft groups.

Comprehensive information leaflets improve patient education and reduce maternal anxiety in fetal magnetic resonance imaging

Stephanie Plunkett¹

¹ The Royal Brisbane & Women's Hospital, Herston, Australia

Objectives: Fetal MRI scans can induce feelings of fear, concern and anxiety in pregnant patients. This research aimed to determine if providing patients with an information leaflet reduced maternal anxiety regarding fetal MRI.

Methods: Institutional ethics approval was obtained. A prospective, three‐arm comparative pilot study was performed in the MRI department of a quaternary public hospital in Australia. Three groups of 30 participants (total 90 participants) received differing levels of information: Group A – no specific information (current practice at site); Group B – basic information leaflet; Group C – comprehensive information leaflet. All participants completed a survey exploring their pre‐scan anxiety immediately after their MRI scan.

Results: Over 50% of participants in each group felt anxious before the MRI. Participants expressed anxiety towards the general process of the MRI, the outcome or results of the scan, and the safety of the modality. The basic and comprehensive leaflets were both efficacious in reducing reported anxiety for most participants. The comprehensive leaflet was more successful in reducing reported anxiety and answering participants’ questions about fetal MRI.

Discussion/Conclusion: While not all patients express anxiety regarding the MRI scan itself, emotional distress surrounding the entire process is prevalent. Providing patients with comprehensive information about what the MRI scan entails, including the scan environment and duration, positioning and breath holding requirements, and fetal safety, reduces reported anxiety for most patients. The findings of this study can be used to determine other ways in which anxiety can be reduced to improve patient experience.

Implementing an exercise and nutrition program to improve quality of life outcomes for radiation therapy patients

Laura Feighan,¹ Yolanda Surjan,¹ Lesley MacDonald‐Wicks,¹ Robin Callister¹

¹ The University of Newcastle, Callaghan, Australia

Objectives: Radiation therapy (RT) treatment for breast cancer negatively impacts patients’ health‐related quality of life (HRQoL).^1,2 There is evidence of benefit from exercise and nutrition (EN) interventions on HRQoL, and scope for specific investigation of EN intervention effects on the HRQoL of breast cancer patients undergoing RT treatment.^3–7 This study investigated whether RT practitioners support the implementation of such a program, and explored their level of knowledge and confidence to recommend an EN program.

Methods: Data were collected by an online survey circulated throughout public and private radiation oncology departments (New South Wales and Queensland). Radiation oncologists, radiation therapists and radiation oncology nurses completed the survey, which had three sections: demographics, assessing patients, and their understanding of EN.

Results: Of 192 staff, 85 attempted and 76 completed the survey, deriving a response rate of 39.6%. From 76 respondents, only 14% (re exercise) and 9% (re nutrition) reported being extremely confident in their knowledge of EN as HRQoL interventions, and 58% (exercise) and 56% (nutrition) indicated they would benefit from more training in these areas. 47% of participants thought patients would benefit from a customised EN program and 62% agreed they would refer patients to a program if it were available.

Discussion/Conclusion: The findings demonstrate that RT practitioners feel they need more training in EN to better understand how this can benefit the HRQoL of patients. Also, the findings indicate that, staff would utilise such programs and refer patients who may benefit from this intervention if available.

References

1. Yucel B, Akka EA, Okur Y, et al. The impact of radiotherapy on quality of life for cancer patients: a longitudinal study. Support Cancer Care 2014;22:2479–87.

2. Schmidt ME, Chang‐Claude J, Vrieling A, et al. Fatigue and quality of life in breast cancer survivors: temporal courses and long‐term pattern. Journal of Cancer Survival 2012;6:9–11.

3. Stuart JH, Mutrie B, Mutrie N. Psychology of physical activity. British Library Cataloguing in Publication Data 2008;2.

4. Mustian KM, Peppone L, Darling TV, et al. A 4‐week home‐based and resistance exercise program during radiation therapy: a pilot randomised clinical trial. Journal of Supportive Oncology 2009;7:158–67.

5. Campbell A, Mutrie N, White F, McGuire F, Kearney N. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Journal of Oncology Nursing 2005;9:56–63.

6. Potter J, Brown L, Williams RL, Byles J, Collins CE. Diet quality and cancer outcomes in adults: a systematic review of epidemiological studies. International Journal of Molecular Sciences 2016;17:1052–182.

7. Cunningham RS, Bell R. Nutrition in cancer: an overview. Semin Oncol Nurs 2000;16:90–8.

Mixing it all together – the drama, pressures and outcomes of a mock clinic experience

Eileen Giles,¹ Lisa Cunningham¹

¹ The University of South Australia, Adelaide, Australia

Background: Cancelled clinical placements during the COVID‐19 pandemic in 2020 resulted in innovative strategies to continue clinical skill development globally.¹ In radiation therapy programs, examples included remote access to dosimetry software partly replacing clinical time, as well as both physical and virtual simulated learning.^2,3 At UniSA, clinical placements for the year three cohort were further delayed when final year students’ completion was prioritised. Through a united approach involving academics as well as current and retired clinicians, a novel program was created that took the form of a mock clinic. This provided additional practical application to address the gap in training.

Content: This presentation outlines the activities and structure of the mock clinic highlighting the value of employing elements of the real world to increase authenticity of the learning experience.⁴ Students were immersed in simulated scenarios and completed clinical tasks that would be encountered on placement. The impact of the scenarios was increased with added time pressure applied, or unexpected problems presented to them. Assessment requirements were met by several clinical activities also. Student evaluation data revealed high value for patient interaction scenarios employing retired clinicians as patient actors, applying problem solving to clinical tasks, and the mock clinic overall.

Conclusion: Simulated scenarios and clinical tasks with added elements of authenticity provided valuable learning when no clinical placements were available. The novel element of current and retired clinicians participating as patient actors and facilitators brought an innovative idea to life and highlighted the benefits of clinicians and academics coming together.

References

1. Short M, Giles E. Innovative strategies implemented by universities to support medical radiation science students during the COVID‐19 pandemic J Med Radiat Sci 2021;(00)1–7.

2. Ng CKC. A review of the impact of the COVID‐19 pandemic on pre‐registration medical radiation science education. Radiography (Lond) 2021;S1078‐8174(21)00106‐1.

3. Webster TL, Clark KR. COVID‐19 planning among radiologic science programs: response mitigation activities. Radiologic Technology 2020;92(2):100–12.

4. Norman G, Dore K, Grierson L. The minimal relationship between simulation fidelity and transfer of learning. Med Educ 2012;46(7):636–47.

Unmasking the fight against COVID‐19: radiographer response to the Victorian pandemic

Jo Ryn Tan¹, Louise Murray¹

¹ The Royal Melbourne Hospital, Melbourne, Australia

Home to the Victorian Infectious Diseases Service, one major metropolitan hospital battled through each wave of COVID‐19 like no other Victorian hospital. This presentation follows our team of radiographers who were pivotal in the fight against the virus; how we rallied together to face dynamic changes, new processes and unique challenges.

The exponential growth in COVID‐19 cases during the state’s ‘second wave’ prompted the emergency department (ED) to split into respiratory (RED) and normal (NED) zones, with radiology functioning in both. A dedicated radiographers’ area in the RED zone served as a base for ED mobile chest X‐rays. More complex patients were transported to a ‘hot’ X‐ray room where teamwork was paramount as RED and NED radiographers had specific roles to position and X‐ray the patient. A similar concept was adopted in computed tomography.

The emergence of the more contagious Delta variant during the state’s ‘third wave’ required a completely different approach. The aerosol nature of Delta united RED and NED as one zone with PPE required at all times. As open cubicles were converted into closed spaces and McMonty ventilation hoods widely utilised, radiographers further adapted X‐ray techniques. With as many as eight wards around the hospital caring for COVID‐19 patients and ‘pandemic mode’ activated in the intensive care unit, the number of mobile X‐rays also skyrocketed.

The aim is to share our experiences at a dedicated COVID‐19 streaming hospital, how we adapted to ‘living’ with the virus and how the tide changed with each strain.

COVID‐19 mitigation measures implemented by radiotherapy centres in low and middle‐income countries: a systematic review

Craig Opie¹

¹ Northern Sydney Cancer Centre/Royal North Shore Hospital, St Leonards, Australia

Objectives: This review is adapted from the publication with a similar title in Rep Pract Oncol Radiother 2021;26(2):303–315 (doi: 10.5603/RPOR.a2021.0032). It aimed to identify strategies by radiotherapy centres in low‐ and middle‐income countries (LMICs) to mitigate the effects of COVID‐19. Studies summarising COVID‐19 mitigation strategies designed and implemented by radiotherapy centres in LMICs are lacking.

Methods: A systematic review was conducted and reported using the preferred reporting items for systematic review and meta‐analysis guidelines. Ovid Embase, Ovid Medline and CINAHL were searched for peer‐reviewed articles that reported measures adopted by radiotherapy centres in LMICs to reduce COVID‐19 risk. Information on strategies were extracted from the included studies and textual narrative synthesis was conducted.

Results: Of 60 articles retrieved, 11 were included. Most of the studies were conducted in China. Ten of the studies included employed a qualitative design. Four themes were identified: preparing and equipping staff, reinforcing infection prevention and control policies, strengthening co‐ordination and communication, and maintaining physical distancing. Studies reported that radiotherapy centres had formed COVID‐19 response multidisciplinary teams, maximised the use of telehealth, adjusted the layout of waiting areas, divided staff into teams, dedicated rooms for isolating suspected cases, and adopted triage systems.

Conclusion: Local adaptation of established global strategies coupled with timely development of guidelines, flexibility and innovation have allowed LMIC radiotherapy service delivery to continue during the COVID‐19 crisis. Robust data collection must be encouraged in LMICs to provide an evidence‐based knowledge for use in the event of another pandemic.

What hooks Australian radiation therapists to participate in research: motivators and enablers

Rachael Beldham‐Collins,^1,2 Georgia Halkett,³ Kellie Knight,² Val Gebski,^1,4 Caroline Wright⁵

¹ The Crown Princess Mary Cancer Centre, Westmead, Australia ² Blacktown Haematology and Cancer Centre, Blacktown, Australia ³ Curtin University, Perth, Australia ⁴ The University of Sydney, Sydney, Australia ⁵ Monash University, Melbourne, Australia

Objectives: The importance of research in radiation therapy is well publicised,¹ however limited information is available on the importance of engaging radiation therapists (RTs) in research. Nationally there are limited clinical research positions and few practitioners are experienced in research.^1,2 This study aimed to investigate the enablers and motivators for RTs to participate in research in relation to the proportion of research within an individual’s role, work location and health sector.

Methods: Practising RTs within Australia were invited by email to complete the online Research Capacity Culture Tool³ in October 2020. Individuals completed 51 Likert questions, 20 multiple‐choice and five open‐ended questions. The survey was conducted using Qualtrics with completed data exported to SPSS for analysis.

Results: Of 122 RTs who completed the study 26.3% had greater than 10% of research within their role, with the proportion of RTs who had more research time located in tertiary and research centres, followed by public, metropolitan, rural/regional and private centres. The highest ranked research motivators of participants that had more than 10% research in their role were (i) develop skills, (ii) increase job satisfaction, and (iii) clinical problems identified that needed changing. The provisions that were most readily available to support research in this group were (i) library access, (ii) research supervision, (iii) time, and least available were (i) administrative support, (ii) research funding, and (iii) training.

Discussion/Conclusion: This study has identified the motivators and enablers of research for Australian RTs that should be incorporated into future research capacity building strategies by maximising RTs exposure and access to motivators and enablers.

References

1. Halkett G, Berg M, Ebert M, et al. Radiation therapists' perspectives on participating in research. J Med Radiat Sci 2017;64(4):299–309.

2. Wright CA, Hilder B, Schneider‐Kolsky ME. Meeting the research agenda in Australian radiation therapy: the current picture. J Radiother Pract 2009;8:67–77.

3. Holden L, Pager S, Golenko X, Ware RS. Validation of the research capacity and culture (RCC) tool: measuring RCC at individual, team and organisation levels. Aust J Prim Health 2012;18(1):62–7.

A united approach to clinical training – the role of former clinicians in RT teaching

Lisa Cunningham,¹ Eileen Giles¹

¹ The University of South Australia, Adelaide, Australia

Background: Clinical simulation and authentic assessment are an important part of the radiation therapy (RT) teaching program at UniSA. Involving former clinicians in these activities has proved valuable to student learning. This presentation will describe the use of former clinicians as simulated patients (SPs) in communication role plays, and assessors in mock interviews.

Content: Role play with SPs is an effective form of communication skills training for RT students, improving students’ skills and confidence in clinical communication.^1,2 Students at UniSA participate in role plays during pre‐clinical workshops across all years of their training. Retired clinicians assume the role of SPs in scenarios such as a patient presenting mid‐treatment with a difficult question about side effects. Student evaluation data shows that these activities are highly valued by students, and it increases their confidence in participating in these conversations in the clinic.

In the final year of the program, students develop job application skills. As well as preparing an application for a fictional RT job as an assessment piece, students also participate in a mock job interview via Zoom. Questions include scenario‐based and technical examples, and the interviewers are former radiation therapists who no longer work in the clinical setting.

As SPs and assessors, former clinicians can provide feedback to students on both communication skills and the technical aspects of answers, with no conflict of interest regarding clinical assessment or future employment.

Conclusion: Former clinicians are a valuable asset to RT teaching and assessment, adding authenticity to the simulated experiences.

References

1. Kelly T, Surjan Y, Rinks M, et al. Communication: preparing undergraduate radiation therapy students for initial clinical patient interactions. Radiography 2019;25(4):320–6.

2. Dungey GM, Neser HA. Radiation therapy students’ perceptions of their learning from participation in communication skills training: an innovative approach. J Med Radiat Sci 2017;64(2):138–45.

An honours framework uniting university and clinical research

Cathy Hargrave,^1,2 Julie Burbery²

¹ The Princess Alexandra Hospital, Brisbane, Australia ² Queensland University of Technology, Brisbane, Australia

Radiation therapy (RT) tertiary education programs have continued to evolve to meet the needs of a changing clinical environment, practice standards and professional requirements in Australia. In the medical radiation professions, this has seen a change from a three‐year bachelor’s degree requiring a graduate supervised practice program to a four‐year degree where students graduate fully accredited to practice. Students undertaking this four‐year program have the opportunity to participate in an honours program and receive a Level 8 Australian Quality Framework qualification enabling direct entry into a PhD degree. This has also provided an opportunity to grow research capacity and capabilities within the RT profession.

This presentation outlines the framework developed to support clinically based RT honours projects. Consultation with established clinical partners was critical from the outset, particularly with departmental RT directors. Through this process the honours project framework was developed to include the following key components: project scoping to ensure timely completion of university milestones, data access and equipment resourcing, supervisor training and support, multi‐institutional research ethics and governance workflows and the establishment of departmental and university roles and responsibilities. Since its introduction in 2019, eighteen honours students have successfully completed research projects in radiation oncology departments across the state and encouraged to establish a research track record via conference presentations and publications relating to their projects. This successfully implemented RT honours framework highlights what can be achieved when academic and clinical radiation therapists unite to grow research capacity in the profession.

United global training pathway for radiation therapists to achieve online advanced adapter status

Meegan Shepherd,^1,2 Siobhan Graham,³ Amy Ward,³ Lissane Zwart,⁴ Bin Cai,⁵ Charlotte Shelley,⁶ Jeremy Booth^1,7

¹ Northern Sydney Cancer Centre, St Leonards, Australia ² Monash University, Melbourne, Australia ³ Queen’s Hospital, Romford, United Kingdom ⁴ Medisch Spectrum Twente, Enschede, Netherlands ⁵ UT Southwestern Medical Center, Dallas, USA ⁶ Royal Surrey County Hospital, Guilford, United Kingdom ⁷ The University of Sydney, Camperdown, Australia

Background: Online adaptive radiotherapy (oART) is an emerging and advanced treatment option for cancer patients worldwide. oART is intended to provide personalised radiotherapy that adapts to the patient's daily position for high conformity and accuracy. Currently, there are several tumour sites that daily online re‐planning is well‐suited due to anatomical variation during standard radiotherapy such as weight‐loss, tumour regression and organ shape changes.¹ Online re‐planning can address any type of anatomical change,² with oART evidenced‐based sites including bladder, rectum, prostate, head and neck and abdominal.^3–7

Discussion: There is a growing body of evidence supporting oART in providing favourable outcomes for patients,⁸ however challenges to implementation such as comprehensive radiation therapist (RT) training is seen as a real clinical barrier.⁹ Current full adaptation practices using magnetic resonance and computed tomography based imaging are resource intensive and require physician presence, a roadblock to widespread implementation to patients. Global evidence demonstrates that RTs can lead the oART workflow, using ‘on‐call’ caveats in a ‘clinician‐lite’ approach, with treatment accuracy, speed or patient outcomes not significantly compromised. With careful consideration of codes of practice and targeted guidance from the multi‐disciplinary team, RTs can elevate beyond traditional scopes of practice to achieve advanced adapter status. Implementing evidence‐based credentialing activities enables service sustainability and expands the global real‐world gains of adaptive radiotherapy to a greater number of cancer patients. This presentation summarises the evidence for RT‐led oART treatments and proposes a pathway for training and credentialing.

References

1. Sibolt P, Andersson LM, Calmels L, et al. Clinical implementation of artificial intelligence‐driven cone‐beam computed tomography‐guided online adaptive radiotherapy in the pelvic region. Phys Imaging Radiat Oncol 2020;(18):17:1–7.

2. Webster A, Hafeez S, Lewis R, et al. The development of therapeutic radiographers in imaging and adaptive radiotherapy through clinical trial quality assurance. Clin Oncol (R Coll Radiol) 2021;S0936‐6555(21)00052‐2.

3. Intven MPW, de Mol van Otterloo SR, Mook S, et al. Online adaptive MR‐guided radiotherapy for rectal cancer; feasibility of the workflow on a 1.5T MR‐linac: clinical implementation and initial experience. Radiother Oncol 2021;154:172–8.

4. Willigenburg T, de Muinck Keizer DM, et al. Evaluation of daily online contour adaptation by radiation therapists for prostate cancer treatment on an MRI‐guided linear accelerator. Clin Transl Radiat Oncol 2021;27:50–56.

5. Acharya S, Fischer‐Valuck BW, Kashani R, et al. Online magnetic resonance image guided adaptive radiation therapy: first clinical applications. Int J Radiat Oncol Biol Phys 2016;194(2):394–403.

6. Yoon SW, Lin H, Alonso‐Basanta M, et al. Initial evaluation of a novel cone‐beam CT‐based semi‐automated online adaptive radiotherapy system for head and neck cancer treatment ‐ a timing and automation quality study. Cureus 2020;12(8):e9660.

7. Placidi L, Romano A, Chiloiro G, et al. On‐line adaptive MR guided radiotherapy for locally advanced pancreatic cancer: clinical and dosimetric considerations. Technical Innovations and Patient Support in Radiation Oncology 2020;15:15–21.

8. Winkel D, Bol GH, Kroon PS, et al. Adaptive radiotherapy: the Elekta Unity MR‐linac concept. Clinical and Translational Radiation Oncology 2019;18:54–9.

9. McNair HA, Hafeez S, Taylor H, et al. Radiographer‐led plan selection for bladder cancer radiotherapy: initiating a training programme and maintaining competency. Br J Radiol 2015;88:20140690.

Uniting to educate in a new planning system during a global pandemic

Melanie Rennie¹

¹ Liverpool Macarthur Cancer Therapy Centre, Liverpool, Australia

Liverpool and Macarthur Cancer Therapy centre is a multi‐site radiation therapy department servicing the southwestern Sydney region of New South Wales. In 2019, the department purchased a new treatment planning system (RayStation) to utilise for image registration, contouring and conformal and inverse planning techniques.

The scale of the project to transfer up to 30 different site‐specific planning techniques across three different treatment planning system (Pinnacle, TomoTherapy and MiM) has been challenging and resource intensive. One of the most significant challenges has been in the best methods to ensure the multi‐disciplinary team are capable in using the new treatment planning system.

In February to March 2020, the implementation team undertook intensive education sessions to familiarise 70 radiation therapists and 15 radiation oncologists in its basic use. Then a global pandemic took hold and the ability to train staff face‐to‐face had to be re‐evaluated. Staff capability has been assessed through determined pathways and the use of video and online technologies to assist with this.

An implementation of a new planning system during unforeseen circumstances has challenged the radiation therapy educators to develop new methods to deliver education and ensure staff capability, the processes used, and lessons learned during education and clinical implementation will be shared from the department.

Implementing advanced practice: a framework for success

Kristie Matthews¹

¹ Monash University, Melbourne, Australia

Objectives: The implementation of radiation therapy advanced practice (RTAP) has seen limited progress in Australia to date, despite the perceived benefits to patient experience and outcomes.¹ Research has identified that implementation is hampered by uncertainty of concept and contextual integration.² An evidence‐based framework has been proposed to help mitigate the uncertainty associated with the implementation of RTAP.

Methods: Ethics approved data collection occurred via national online (video mediated) focus groups, and during interviews and observation at five intentionally selected, geographically dispersed clinical case study locations. Qualitative data analysis was informed by constructivist grounded theory methodology.

Results: The research identified the implementation of RTAP was influenced by four key features. Uncertainty was apparent in conceptualising the meaning of advanced practice to self and service. Power of influential others was evident where leaders – particularly radiation oncologists – were the gatekeepers to RTAP initiatives. Value to self and service was shown to be a feature of RTAP implementation. Lastly, the perceived legitimacy of the transitional professional identity of the advanced practitioner influenced acceptance by self and others.

Discussion: Each feature was demonstrated to enable or impede RTAP implementation, dependent on the perceived contextual interpretation of each feature. As a result, the research has informed the development of a framework to guide the implementation of RTAP, where each feature is overtly recognised and integrated as part of the implementation strategy. It is anticipated the framework will provide guidance to services seeking the implementation of RTAP, leading to an increased likelihood of successful outcomes.

References

1. Hilder B, VanDam P, Doherty K. Advanced practice radiation therapists: an Australian context. J Med Radiat Sci 2018;65(2):137–47.

2. Matthews K, Duchesne G, Baird M. Navigating uncertainty: the implementation of Australian radiation therapy advanced practitioners. Tech Innov Patient Support Radiat Oncol 2021;17:82–88.

Feasibility of expiration breath hold liver SABR treatment using SGRT: a case study

Jessica Lurie,¹ James Andrew O'Toole,¹ George Hruby,¹ Nicole Holt,¹ Tina Gorjiara,¹ Nicole Dougheney,¹ Tiarna Shearer¹

¹ GenesisCare, North Shore Health Hub, Australia

Motion of the liver during respiration can cause increased radiation dose to adjacent normal tissue. Fiducial markers are routinely used to track intrafraction motion.¹ In this study, feasibility of using surface guided radiation therapy (SGRT) and expiration breath hold (EBH) for motion management was evaluated.

A 68‐year‐old female with secondary liver malignancy was prescribed 50 Gy delivered using SABR technique. Two CT simulations were performed, 4DCT to assess respiratory induced liver motion and EBH to minimise motion. Target volumes were contoured by the radiation oncologist on both datasets and plans created for each dataset.

When analysing a fiducial marker on the 4DCT, movements of 3.5 cm, 1 cm and 0.6 cm in superiorly/inferiorly, anteriorly/posteriorly and left/right directions were observed, respectively. Comparing the two datasets/plans showed the PTV on EBH dataset was 64 cm³ smaller than the one on the 4DCT dataset. The mean liver dose on the EBH plan was 8.2 Gy compared to 15 Gy on the 4DCT ITV‐based plan.

The EBH plan proceeded to treatment and SGRT used for set‐up and breath hold gating. During treatment delivery, triggered imaging was used to monitor positioning of fiducials while in EBH. An agreement between the two systems was observed.

In this case study, EBH using SGRT was shown to be adequate in maintaining liver stability, improving plan quality for liver SABR. SGRT technique can be used to detect intrafraction motion which can be used instead of triggered imaging.² This improves patient experience as it removes the need for invasive insertion of fiducial markers into the liver.

References

1. Naumann P, Batista V, Farnia B, et al. Feasibility of optical surface‐guidance for position verification and monitoring of stereotactic body radiotherapy in deep‐inspiration breath‐hold. Front Oncol 2020;10(573279):1–9.

2. Yang J, Cai J, Wang H, et al. Is diaphragm motion a good surrogate for liver tumor motion? Int J Radiat Oncol Biol Phys 2014;90(4):952–8.

Educational experiences of radiation therapists adapting to surface guided radiation therapy

Cameron Vu¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

Objectives: Innovation in radiotherapy aims to improve patient experience and outcomes. Our institution has recently implemented surface guided radiation therapy (SGRT), which has instigated newfound education and training of radiation therapists. Previous work has highlighted the challenges of education keeping pace with the rate of change in the oncology discipline.¹ This is heightened by different learning styles of adult learners.² The purpose of this assessment was to evaluate the educational experiences of radiation therapists SGRT training with AlignRT Advance SGRT system (Vision RT, UK).

Methods: A retrospective online survey was sent to radiation therapists that had undergone SGRT training before using the technology. The survey sought feedback on training experiences and perceptions in learning and using AlignRT. The survey was a mixture of open‐ended questions and Likert scale questions to assess radiation therapists’ experiences.

Results: Qualitative and quantitative data gathered explored learning expectations and standards amongst adult learners. Preliminary qualitative findings suggest that transformative teaching would have a greater impact on preparing staff for understanding new radiotherapy techniques and workflows.

Discussion/Conclusion: Training program design should focus on different learning styles to ensure learnt knowledge and skills are consolidated effectively, particularly in disciplines where change is frequent. Ongoing evaluation of impacted stakeholders, especially radiation therapists using SGRT is critical to successful clinical change.

References

1. Walls GM, Cole AJ, McAleer JJ, Hanna GG. A qualitative assessment of radiotherapy training at a UK regional cancer centre. Clinical Oncology 2020;33(4):261–9.

2. Collins J. Education techniques for lifelong learning: principles of adult learning. Radiographics 2004;24(5):1483–9.

Investigation of staff experiences with changes in departmental workflow: implementation of surface guided radiation therapy

Ashlee Dunn,¹ Samantha Hallett¹

¹ The Prince of Wales Hospital, Sydney, Australia

To investigate and report user feedback regarding the implementation of surface guided radiation therapy (SGRT) required changes in departmental workflow and individual radiation therapist experiences.

With the ever‐changing and evolving technology and techniques that drive the field of radiation therapy, the growing recognition and acceptance of Vision RT’s SGRT has gained support as a promising patient monitoring (intrafraction), patient positioning (real time feedback) and treatment assisting motion management.¹ SGRT uses non‐ionising, visual monitoring of the patient’s skin surface contour and in real‐time compares to the acquired or calculated reference image.²

The introduction of SGRT in 2021 across multiple body sites has resulted in the adaptation of previously standardised departmental workflows. All patients receiving treatment transitioned to at least an adapted SGRT workflow, reflective of a tattoo‐free department in line with current SGRT practices.

An unbiased survey was created. A sample of 25 radiation therapists with ranging career experience from newly graduated to over 20 years will complete a survey comparing conventional practice against SGRT methods in radiotherapy treatment and CT simulation. Answering multiple questions varying from the education and training provided, to the comfort and ease of use, with an open‐ended question to provide feedback including patient interactions.

The data collection and analysis process is still in progress but with the concluding results, this research will be able to determine the effectiveness and efficiency of implementing SGRT within a departmental workflow combined with the user friendliness and individual staff experiences.

References

1. Freislederer P, Kügele M, Öllers M, et al. Recent advances in surface guided radiation therapy. Radiat Oncol 2020;15(1).

2. Herron E, Murray M, Hilton L, et al. Surface guided radiation therapy as a replacement for patient marks in treatment of breast cancer. Int J Radiat Oncol Biol Physics 2018;102(3):e492‐e3.

Considerations for effective implementation of surface guided radiation therapy

Kenton Thompson¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

Current standard of care for patient set‐up is by means of three‐point localisation using permanent tattoos or marks.¹ Tattoos are most commonly used but are not popular among patients for various reasons. Despite surface guided radiation therapy (SGRT) being a proven and well‐suited replacement for tattoos, many clinics transition slowly to tattoo and mark free treatments, if at all.²

Our organisation decided to go‐live with tattoo and mark free treatment on the first day of SGRT implementation in August 2021. Clinical implementation presented a unique opportunity to implement a range of workflows and techniques such as Postural Video (Vision RT, London, UK) and Send‐to‐Couch. Adopting these new workflows presented challenges, however it enabled a smooth transition from pre‐existing workflows.

Following implementation of SGRT for breast treatments, workflows were developed and implemented for other patient cohorts. This included other common SGRT cohorts, such as stereotactic radiotherapy treatments and less common, such as paediatrics.³

To optimise SGRT workflows, routine habits must be unlearned and replaced by new knowledge and practice.² Through education, training and clinical use, trust in new workflows and techniques is established. Communication among multi‐disciplinary team members is important to implement, sustain and further optimise.

This presentation will detail the steps undertaken to implement SGRT at our organisation including educational and operational considerations and the benefits of going live with tattoo and mark free treatments. Key recommendations and lessons learnt will be shared, such that others can learn from our experience.

References

1. Hosaik J, Pawlicki T. The role of optical surface imaging systems in radiation therapy. Semin Radiat Oncol 2018,28:185–93.

2. Batista V, Meyer J, Kugele M, Al‐Hallaq H. Clinical paradigms and challenges in surface guided radiation therapy: Where do we go from here? Radiother Oncol 2020;153:34–42.

3. Padilla L, Havnen‐Smith A, Cervino L, Al‐Hallaq H. A survey of surface imaging use in the United States. J Appl Clin Med Phys 2019;20(12):70–7.

Clinical implementation of a novel surface guided radiation therapy system – a Southern Hemisphere first

Dean Robb¹

¹ Icon Cancer Care, Cairns, Australia

Background: The clinical implementation of the Identify (Varian Medical Systems, Palo Alto, CA) surface guided radiation therapy (SGRT) system is the first in the Southern Hemisphere as well as being the second worldwide to be used in conjunction with a Halcyon (Varian Medical Systems, Palo Alto, CA) linear accelerator. The first patient to be treated with the system coincided with the centre opening in September 2021, shortly followed by the first deep inspiration breath hold patient in the world in October 2021. This presentation discusses the system considerations and resultant impact on traditional workflows.

Discussion: The unique workflow of the Halcyon resulted in the need to develop, test and analyse customised workflows to successfully utilise the Identify SGRT system. Initially rolled out for passive patient monitoring, use of the system quickly expanded to intra‐fraction monitoring and deep inspiration breath hold treatments before progressing to tattoo‐free set‐ups. Preliminary analysis of Identify correlation to image guided radiation therapy has shown a mean difference within 0.26 cm and 1.1° in all directions. Intra‐fraction monitoring was performed for all patients and demonstrated motion within acceptable thresholds (sub‐mm for some patients). Treatment session times have shown an initial reduction for particular anatomical sites, such as the average breast treatment fraction time being reduced by approximately five minutes.

Conclusion: Clinical implementation of Identify has provided positive results showing a benefit to the patient. Development and refinement of work instructions within the department will be utilised for future sites implementing the system.

Anterior placenta and maternal obesity have higher prevalence of normal decreased fetal movement ultrasound scans

Grace Arnett,¹ Karen Doheny,¹ Karen Dobeli¹

¹ The Royal Brisbane & Women's Hospital, Brisbane, Australia

Objectives: Reduced fetal movement is a common indication for ultrasound imaging in pregnant women because it may be an indicator of fetal ill‐health. However, anterior placenta location and maternal obesity may influence the mother’s perception of fetal movements.^1,2 The aim of this study was to assess for any association between maternal obesity and anterior placental location with a normal decreased fetal movement ultrasound scan (DFMUS).

Methods: The imaging reports for 315 DFMUS performed at the surveyed hospital between January and August 2021 were reviewed. Imaging reports were classified as normal or abnormal according to standard ultrasound criteria for fetal wellbeing. Maternal obesity was classified as body mass index (BMI) ≥ 35 kg/m². Placenta location was classed as anterior or non‐anterior. The relationship between a normal DFMUS outcome and maternal obesity and placenta location was assessed by logistic regression analysis.

Results: Institutional ethics approval was obtained. 313 participants were included. 166 (53.0%) participants had anterior placenta location, 155 (93%) of whom had a normal DFMUS. 129 (86.6%) of the 149 patients with non‐anterior placenta location had a normal scan. 44 (10.9%) participants had a BMI > 35 kg/m²; 42 (95.5%) of whom had a normal scan. 242 (89.3%) patients with a BMI ≤ 35 kg/m² had a normal scan. No relationship between maternal obesity or placenta location with DFMUS outcome was found.

Discussion/Conclusion: Most DFMUS were normal, irrespective of placenta location or maternal BMI. Further investigation into the impact of a normal scan on patient management may assist in an evaluation of the clinical indications for decreased fetal movement ultrasound scans.

References

1. Heazell E, Green M, Wright C, Flenady V, Frederik Frøen J. Midwives’ and obstetricians’ knowledge and management of women presenting with decreased fetal movements. Acta Obstetricia Gynecol Scand 2008;87:331–9.

2. Sterpu I, Pilo C, Koistinen IS, et al. Risk factors for poor neonatal outcome in pregnancies with decreased fetal movements. Acta Obstet Gynecol Scand 2020;99:1014–21.

Screening ultrasound of the neonatal head: literature review of optimised scan timing and inclusion criteria

Rebecca Biles¹

¹ The Royal Brisbane & Women's Hospital, Brisbane, Australia

Background: Prematurely born neonates have a fragile brain structure and are at risk of developing haemorrhagic and ischaemic brain injuries, such as intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL). These pathologies can be clinically silent, so screening cranial ultrasound is performed to ensure timely clinical management and to provide prognostic information on neurodevelopmental outcomes.^1,2 Currently, there is no published evidence‐based optimal screening protocol. The aim of this literature review was to identify the optimised scan timing and high‐risk inclusion criteria for the screening and detection of IVH and PVL.

Methods: A search of Pubmed, Embase and professional organisation websites was undertaken to identify research and professional guidelines focussed on ultrasound screening of IVH and PVL in premature neonates. Twenty publications were included in the review after initial screening.

Results/Conclusions: The literature contained varied information on both optimal scan timing and inclusion criteria for screening. It was agreed that pathology is most frequently identified in neonates born before 32 weeks gestation, as the highly vascular germinal matrix involutes shortly afterwards, at approximately 34 to 35 weeks gestational age. There is an increasing risk of IVH and PVL with lower gestational age and birth weight.^1,3 It was most common to include neonates born before 32 weeks gestation in screening. Most sources recommended a scan by day seven of life to detect IVH, and a scan either on day 28 or at term‐equivalent age to detect PVL. Sequential scanning varied, and often involved a scan in the second week of life.

References

1. Guillot M, Chau V, Lemyre B. Position Statement: Routine imaging of the preterm neonatal brain. Canadian Paediatric Society. 2021. Available at https://cps.ca/documents/position/routine-imaging-of-preterm-neonatal-brain

2. Mohammad K, Scott JN, Leijser LM, et al. Consensus approach for standardizing the screening and classification of preterm brain injury diagnosed with cranial ultrasound: a Canadian perspective. Front Pediatr 2021;9:(618236).

3. McLean G, Malhotra A, Lombardo P, Schneider M. Cranial ultrasound screening protocols for very preterm infants. Ultrasound Med Biol 2021;47(7):1645–56.

Sonographers' perceptions of patient safety: What we say, what we do, are they the same?

John McInerney^1,2

¹ Monash University, Melbourne, Australia ² The Royal Melbourne Hospital, Melbourne, Australia

Objectives: Patient safety is a priority for all healthcare professionals but has previously been an under‐recognised component of quality healthcare. Self‐reported behaviours and intentions do not always match what occurs in action. Understanding the link between self‐reported and observed behaviours is of major importance in patient safety. The initial aim of this study was to explore and describe the perceptions of Australian sonographers regarding patient safety in ultrasound imaging.

Methods: Data was acquired during semi‐structured, one‐on‐one interviews. The interviews were carried out between September 2019 and February 2020. A thematic analysis was applied to the data.

Results: Sonographers identified what they believe are the most common areas of risk to patient safety during ultrasound imaging. Sonographers’ perceptions of how they manage the risk in real life are reported.

Discussion/Conclusion: During the data analysis it became clear that there were two things happening: the interviewees were making statements about patient safety that did not always seem to match the unfolding narratives during the interview.

X‐ray imaging of the shoulder: a national survey of Australian radiographers imaging practices and protocols

Zoe Moran,¹ Paul Kelly,¹ Amber Loh,¹ Amy Dennett¹

¹ Eastern Health, Box Hill, Australia

Objectives: There is little consensus of what projections to perform during shoulder X‐ray examinations. This study aimed to describe the type of shoulder X‐ray projections performed by Australian radiographers to inform standardisation of shoulder imaging protocols.

Methods: Radiographers were surveyed in October 2020. An online survey (Qualtrics) was distributed via a national newsletter. The survey comprised two sections: demographics and imaging preferences. Five pathological shoulder scenarios were presented: arthritis, impingement, dislocation, trauma and replacement. Results were described using proportions.

Results: Valid responses were received by 225 radiographers. Most participants had six years or more postgraduate experience (n = 141, 63%) and worked in public settings (n = 175, 78%). There was wide variation in imaging preferences within each pathological presentation. The lateral ‘Y’ scapula view was most preferred for all presentations (arthritis n = 114, 51%; impingement n = 74, 33%; trauma n = 95, 42%; dislocation n = 101, 45%; replacement n = 99, 44%). The anteroposterior (AP) 'general survey' (neutral rotation) was second preference for dislocation (n = 93, 41%) and replacement (n = 66, 29%). True AP/Grashey method/Glenoid view was second preference for impingement (internal rotation view n = 74, 33%) and trauma (neutral view n = 3,14%). Standard AP general survey external (n = 77, 34%) was second preference for arthritis. Impingement had the least consensus. Imaging preferences were mostly described as reflective of departmental protocol.

Conclusion: The most common view for all scenarios as described by Australian radiographers for shoulder pathology was the lateral ‘Y’ scapula view, with variation in responses for the AP orthogonal view. More consistency in department protocols for AP and supplementary projections is required.

Filling in the blanks: exploring radiological referral inadequacies

Magdalena Dolic¹

¹ Western Health, Taylors Lakes, Australia

As a medicolegal document, the radiological referral is an essential tool in communicating patient and procedural data. With the progressive digitisation of the radiology department, there has been a shift from paper‐based referral ordering to electronic initiation through computerised order entry (CPOE).

By contrasting the completion of paper‐based and digitised referrals, this presentation aims to explore the impact of CPOE on referral quality. Further, it will also discuss referral components commonly left unfilled or inadequately completed and their implications for radiographic practice.

A search of the literature was conducted on Scopus and PubMed using keywords such as “referral”, “medical imaging”, “inadequate”, “complete” and “CPOE”. Abstracts and texts were screened to identify 30 articles for utilisation in the completion of the review. The analysis of articles was separated into three key headings. These include CPOE and paper referral differences and similarities, inadequacies in clinical detail provision and the implications of paper referral inadequacies on radiographic practice.

Though CPOE integration assists in the reduction of unnecessary examinations and streamlining workflow, educating physicians on the importance of the referral as a medicolegal document remains essential in addressing inadequate referring practices. Globally, a significant number of referrals are suboptimal. Several fields of incompletion were observed across paper referrals, including patient and ordering physician identifiers, clinical information provision, patient location, referral dating and legibility. Within the context of radiographic practice, the adequate completion of referrals contributes to exam justification, planning and timely provision of both imaging and care.

Radiographer confidence in providing radiation risk information to patients

Harry Johnston¹

¹ The Royal Brisbane & Women's Hospital, Brisbane, Australia

Objectives: Radiation dose risk is the most common concern patients have with medical imaging examinations and radiographers are often the first point‐of‐contact when this information is required The aim of this study is to assess radiographer confidence in providing radiation risk.¹ information to patients for general X‐ray examinations.

Methods: A link to an anonymous survey was emailed to radiographers within the Metro North Hospital and Health Service in Queensland. The survey included questions on radiographer confidence at providing radiation risk to patients, how and when radiographers explain radiation risk, and currency of knowledge in radiation risk. Institutional ethics approval was obtained for this study.

Results: 128 responses were received (49% response rate). 84.25% of respondents were very or somewhat confident at explaining radiation risk. 83.01% of these respondents had accessed radiation education resources within the past six to 12 months. 68.42% of the respondents who were not confident had not accessed radiation risk resources within the past six months. 28.04% of respondents who were confident at explaining radiation risk had less than five years’ experience; 30% of respondents who were not confident had less than five years’ experience.

Discussion/Conclusion: Most radiographers surveyed are confident at providing radiation risk advice, independent of years of experience. Recency of resource use appears to improve confidence in providing radiation risk information to patients. Further research into the accuracy of information provided by radiographers is warranted.

Reference

1. Reitan A, Sanderud A. Communicating radiation risk to patients: experiences among radiographers in Norway. J Med Imaging Radiat Sci 2020;51(4):S84‐S9.

What the Fankle

Magdalena Dolic¹

¹ Western Health, Taylors Lakes, Australia

The role of the radiographer in the justification and modification of examinations is often poorly understood. It goes beyond patient positioning and involves accurate interpretation of referrals and tailoring of protocols to each individual’s needs.

This poster introduces the ‘Fankle’, a term that often appears on radiological request forms. A hybrid mixture of the words ‘foot’ and ‘ankle’, it calls for imaging that demonstrates the patient’s foot and ankle in a weightbearing, lateral projection with the inclusion of distal lower leg and foot. The misinterpretation of the word Fankle has previously resulted in incorrect, unnecessary radiation exposure as well as repeat journeys to the medical imaging department. Likewise, there is a lack of literature and research describing the projection and its benefits over routine foot and ankle imaging.

Under the Medical Radiation Practice Board of Australia Professional Capabilities, medical radiation practitioners are required to collaborate with other healthcare practitioners to provide care that is patient centred. The role of the Fankle within the scope of radiographic practise emphasises the importance of communication between referrers and radiographers when clarifying requested examinations. Further, collaboration between practitioners is essential when ensuring that images are justified and beneficial to a patient’s diagnostic journey. This poster discusses both how the projection is correctly acquired as well as how challenges are overcome with complex patient presentations.

Is there dosimetric advantage in using CyberKnife for stereotactic radiosurgery? A systematic review and meta‐analysis

Lauren Gingell¹

¹ RMIT University, Melbourne, Australia

Background: It is a very interesting time for radiation therapy in Australia. Several sites across Australia are investing in niche technologies so that Australians can receive world class care without needing to travel overseas. Although this seems to be the direction radiation therapy is going, the considerable investment of implementing a new technology must be justified by markedly improved patient outcomes.

Objectives: The aim of this review is to compare dosimetry of CyberKnife treatments with what is achievable using a linear accelerator for stereotactic radiosurgery of multiple intracranial metastases. Ultimately, this review begins to answer the question: Is it justified to implement this technology at an additional site in Australia?

Methods: A search of PubMed was conducted and conformity index, gradient index, volume of healthy brain tissue and beam on time were all recorded. Metanalysis of conformity index and gradient index was performed.

Results: There was little differentiation between techniques for conformity index. However, CyberKnife had lower gradient index and less dose to healthy brain tissue. Linac beam on time was considerably shorter than for CyberKnife.

Conclusions: CyberKnife treatment has preferable dosimetry compared to what is possible for linac treatments. It could be beneficial for this technology to be used more widely for the treatment of patients in the future.

An evaluation of radiation therapy patient body mass index trends and potential departmental resourcing impact

Branagh Laing,¹ Debra Vincent,² Gregory Rattray,² Peter Caldwell¹

¹ Queensland University of Technology, Brisbane, Australia ² The Royal Brisbane & Women's Hospital, Brisbane, Australia

Objectives: Radiation therapy (RT) offers a less invasive management option for bariatric cancer patients. As the proportion of Australians categorised overweight or obese approaches 70%,¹ it is not well understood how this growth will impact RT departments. The aim of this study was to evaluate the current and potential future body mass index (BMI) of RT patients at one centre, with the purpose of identifying variables that may impact resource planning decisions.

Methods: De‐identified demographic data including gender, age, diagnosis code, activity code and BMI was obtained from MOSAIQ oncology information system for 5548 courses of RT commenced between 2017 and 2020, and retrospectively analysed. Descriptive statistics were used to summarise the data. Simple and multiple linear regression was used to analyse for statistically significant relationships between variables.

Results: Of all patient courses, 64% were overweight or obese. Average BMI increased over time by 0.3 kg/m² per year. Courses related to the young and elderly had a lower average BMI. Breast, brain and pelvis/prostate treatment sites had a significant association with a higher average BMI. Thorax treatment sites had a lower average BMI but are increasing at the fastest rate of all treatment sites. Prone breast courses had an average BMI 5.58 kg/m² higher than IMRT/VMAT courses.

Conclusion: Results demonstrate that patient BMI is increasing. Resources related to breast courses (breast board, prone board) and thorax courses (lung‐board) may experience increased strain in the future. Modifications to department workflow and scheduling are likely required. Further research into staffing implications is recommended.

Reference

1. Australian Institute of Health and Welfare. 2019. Cancer in Australia. Available at https://www.aihw.gov.au/getmedia/8c9fcf52‐0055‐41a0‐96d9‐f81b0feb98cf/aihw‐can‐123.pdf.aspx?inline=true

Closing the gap: understanding health outcome differences between non‐Indigenous and Indigenous Australians in the radiotherapy department

Georgia Garrels¹

¹ The University of South Australia, Adelaide, Australia

Background: Barriers still exist in terms of healthcare accessibility for Indigenous Australians. Non‐compliancy is often due to varying causes and, as a result, patient outcomes are compromised. Despite advancements in health care, Indigenous Australians still face death from cancer at 1.3 times the rate of non‐Indigenous Australians as recorded in 2014 to 2018. A significant gap is evident and continues to wedge the health outcomes of these two groups apart.

Discussion: This presentation aims to understand the difference in health outcomes of Indigenous and non‐Indigenous Australians in the radiotherapy department. This standard of health care differs substantially due to potential lack of understanding and respect by clinicians and ignorance for cultural beliefs, guiding the compliancy of patients. External factors such as reluctance to abandon relatives, language barriers and comorbidities also contribute to patients presenting at later stages and therefore increasing fatality rates. Radiotherapy treatment relies on attendance and can easily be abandoned due to these specific factors.

Despite vocational programs in radiotherapy departments, qualitative data supports a lack of understanding in cultural awareness. Through increased exposure, radiation therapists could be instrumental in closing the gap. An avenue to be explored is the potential implementation of an Aboriginal liaison officer to minimise cultural and language barriers. This approach possibly has not been fully explored in departments and analysis into Indigenous experiences could inform staff in reducing non‐compliancy in departments, bettering Indigenous health outcomes.

Conclusion: Qualitative data can support the presence of barriers in Indigenous health and, as a result, patients are presenting at later stages, worsening chances of survival. Action is needed to address these issues otherwise the mortality gap between non‐Indigenous and Indigenous Australians will continue to grow.

Uniting immersive virtual reality and computed tomography education: barriers, enablers and recommendations

Bridget Taylor¹

¹ Monash University, Clayton, Australia

To be registered as a radiation practitioner, the Medical Radiation Board of Australia requires radiographers to be capable of operating computed tomography (CT) imaging systems safely and effectively.¹ Universities meet this requirement by offering practical CT training to pre‐registration radiography students on‐campus and during clinical placements. However, institutions face challenges when facilitating this. Virtual reality (VR) has been suggested as a possible solution for radiography students to gain CT scanning experience in virtual environments.^2,3

This presentation reports on the literature review which was conducted to explore the potential for immersive VR to be incorporated into CT practicum. Benefits and limitations of the technology were also examined with recommendations made for integration into the radiography curriculum.

It was found that the VR offers flexible simulations that could enhance CT learning for students, increase confidence and raise motivation for the simulated CT task. It was debatable, however, as to whether immersive VR truly enhances student learning compared to other VR modalities, such as computer‐based CT simulation. Additionally, a lack of training, availability of resources and technical problems were flagged as limitations. It was concluded that before immersive VR is integrated into CT education, significant optimisation of the simulation is needed, including ensuring VR scenarios are based on learning paradigms and integrate feedback into simulation learning. Further, inviting clinical partners to engage with universities and students during roll‐out is imperative to improve the quality of the graduating CT workforce against the current context of COVID‐19 imposed restrictions and reduced CT placement opportunities.

References

1. Medical Radiation Practice Board of Australia. Professional capabilities for medical radiation practitioners. 2020. Available at https://www.medicalradiationpracticeboard.gov.au/registration/professional-capabilities.aspx [Accessed 20 October 2021].

2. Gunn T, Rowntree P, Starkey D, Nissen L. The use of virtual reality computed tomography simulation within a medical imaging and a radiation therapy undergraduate programme. J Med Radiat Sci 2021;68(1):28–36.

3. Lee K, Baird M, Lewis S, McInerney J, Dimmock M. Computed tomography learning via high‐fidelity simulation for undergraduate radiography students. Radiography 2020;26(1):49–56.

The implementation of deep‐learning based models for the classification of COVID‐19 using chest radiography in Australia

John Ivan Igros¹

¹ The University of South Australia, Adelaide, Australia

Background: Since the declaration of the COVID‐19 outbreak as a global pandemic in March 2020, it has caused significant stress on public health systems.¹ Spreading of the virus is primarily through droplet transmission which can cause serious pneumonic symptoms and has led to the importance for early detection.² Current screening methods applied by researchers is the use of CT‐scans and X‐rays to evaluate images of lungs for COVID‐19; however, these require several radiology specialists and significant time to manually analyse each report which can be challenging especially during a pandemic.

Objective: The purpose of this paper is to discuss the efficacy and limitations of deep‐learning based approaches using chest X‐rays for detecting COVID‐19 and propose its implementation in Australian public health systems.

Summary: Due to the limited supply of testing kits, which can take up to 4–10 hours before results, the use of an automatic detection network using chest images has been proposed to detect COVID‐19 more accurately and obtain much faster results with minimal costs.³ The concept of deep transfer learning focusses on the application of a convolutional neural network, which uses chest X‐ray images as input data, which is then analysed within a larger data‐set containing information on normal, pneumonic and COVID‐19 lung patterns for the detection of the virus in under five seconds.^2,3 Proposed models such as nCOVnet and CoroDet have produced correct positive and negative results for the detection of COVID‐19 in patients with an overall 97% confidence and where the network is not confident, then current testing kits can be used to cover the ~3% error.^1,3

Conclusion: With the fast detection of COVID‐19, this will hopefully help reduce community transmission by being able to quickly contact and isolate infected people. Many of the early studies with the proposed models did not consider possible data leakage which should be addressed for future studies.^1,3 However, the implementation of deep transfer learning models could help medical experts take the essential steps in the management of COVID‐19 patients and overcome the pandemic.

References

1. Hussain E, Hasan M, Rahman MA, et al. CoroDet: a deep learning based classification for COVID‐19 detection using chest x‐ray images. Chaos, Solitons & Fractals 2021;142.

2. Ismael AM, Sengür A. Deep learning approaches for COVID‐19 detection based on chest x‐ray images. Expert Systems with Applications 2021;164.

3. Panwar H, Gupta PK, Siddiqui MK, et al. Application of deep learning for fast detection of COVID‐19 in x‐rays using nCOVnet. Chaos, Solitons & Fractals 2020;138.

Together or separate: what is best practice when imaging bilateral hands for rheumatoid arthritis examinations?

Annabel Keir,¹ Vicki Braithwaite¹

¹ Queensland University of Technology, Brisbane, Australia

Objectives: A current gap identified in medical imaging literature is a standardised approach to bilateral hand examinations. This examination performed concurrently or unilaterally was hypothesised to have different effects on radiation dose and image quality, both of which are important to the diagnostic and follow up imaging of rheumatoid arthritis patients. The aim of this study was to determine which technique is better practice.

Methods: At the Queensland University of Technology medical imaging simulation laboratory, an experimental study was undertaken simulating each bilateral hand series for rheumatoid arthritis with anthropomorphic hand phantoms. Radiation dose was calculated by observing dose area product on an AGFA digital radiography system, with additional use of an exposure meter as a secondary data collection. Image quality was quantified through measuring distortion caused by beam divergence, by observing the separation of two metal rings fixated on a hand phantom.

Results: The overall examination dose was higher for the unilateral technique by 10.15% at the console and 11.96% recorded by the exposure meter. In the second part of the experiment, the unilateral technique produced 0 mm of distortion under the central ray. The concurrent technique demonstrated an average of 3.65 mm of distortion, with the greatest separation measuring 4.25 mm.

Discussion/Conclusion: The unilateral technique should be performed for bilateral hand examinations. The increase in distortion from the concurrent technique is clinically significant, as the diagnostic grading of rheumatoid arthritis is measured in millimetre increments.¹ The additional overall examination dose is negligible when compared to the improvement in image quality.

Reference

1. Salaffi F, Carotti M, Beci G, Di Carlo M, Giovagnoni A. Radiographic scoring methods in rheumatoid arthritis and psoriatic arthritis. Radiol Med 2019;124:1071–86.

Quantification and inter‐rater reliability of image quality criteria scores in musculoskeletal plain radiography

Jessica Ritchie,¹ Elijah Hallinan,¹ Emma Cooper,¹ Gina Boyle,¹ Tony Smith¹

¹ The University of Newcastle, Callaghan, Australia

Objective: Plain radiographic images are assessed against evaluation criteria, which lack standardisation and are inconsistently applied. The aim of this study was to develop and trial an image quality evaluation tool and compare inter‐rater reliability.

Methods: Phase 1 used deidentified images of the hand, wrist, elbow, foot and knee, including five cases of each. Ninety images were evaluated by a final year student, a practising radiographer and a full‐time academic. Phase 2 used 25 images from five wrist and five knee examinations, scored by five undergraduates.

The tool synthesised criteria from multiple textbooks, with each criterion scored on a four‐point scale, as well as dichotomous (Yes/No) responses as to whether views should be repeated. In Phase 2, that question was asked before and after provision of a clinical history.

Results: In Phase 1, Cohen's kappa co‐efficient indicated ‘fair’ to ‘good’ agreement between viewers and overall ‘moderate’ agreement for Light's kappa (k = 0.44). There was no difference in mean criterion scores between pairs of viewers (Mann‐Whitney; P < 0.05) or all three viewers combined (Kruskal‐Wallis; P = 0.31).

In Phase 2, intra‐class correlation co‐efficient (ICC = 0.711; P < 0.001) and Kendall’s co‐efficient (P < 0.001) showed agreement for combined scores. A difference was evident in overall mean score distributions (Kruskal‐Wallis; P = 0.025) but not for pairwise comparisons (P > 0.05). After considering clinical history, Light’s kappa fell from ‘moderate’ (k = 0.413) to ‘slight’ (k = 0.199).

Conclusions: Radiographic image quality can be quantified for comparative analysis, which may have education and quality control applications. Clinical history is variously interpreted by students, suggesting a need for further investigation.

Uniting technologies for cancer treatment in interventional oncology

Nathan Brunskill¹

¹ Sydney Adventist Hospital, Sydney, Australia

Globally, approximately 9.5 million deaths were attributed to cancers in 2017, an increase from 5.7 million in 1990.¹ Of these cancers almost 820,000 are attributed to liver cancer.¹ In Australia, over 35,000 years of life were lost due to liver cancer in 2017.²

Traditionally, doctors treating cancer had three treatment options: systemic chemotherapy, external beam radiation and conventional surgery. Today there is another option, interventional oncology. The effective combination of technological advancement, intraoperative imaging and skilled professionals is the catalyst for interventional oncology. Technological developments allow physicians to deliver therapeutics through vessels with more precision when targeting tumours, subsequently minimising impact on healthy tissue.³ In particular, cone beam CT (CBCT) combined with software programs, facilitates treatment planning and delivery of chemotherapy/radiation by providing a three‐dimensional visualisation of tumour‐feeding arteries and the capability to detect lesions that are occult on DSA.⁴

Intraoperative tumour assessment has historically been limited to two‐dimensional angiography. However, visualisation of anatomical positions derived from CBCT imaging can now be achieved by projecting software‐enhanced volume rendered images onto live fluoroscopy. By spatially aligning two imaging datasets with each other, and uniting them as one display, all tumour vessels can be depicted and navigated easily to the targeted arteries with live image guidance.

This presentation will explore the possibilities of hepatic tumour visualisation and treatment with interventional technique combined with software utilisation. It will investigate the burgeoning visualisation capabilities of detection and simultaneous treatment of multiple lesions.

References

1. Ritchie H, Roser M. Our world in data. Causes of death. 2019. Available at https://ourworldindata.org/causes-of-death#cancers

2. Institute for Health Metrics and Evaluation. Seattle WA: University of Washington; 2019 Available at http://ghdx.healthdata.org/gbd-results-tool

3. Cryer C. Global Liver Institute. 2017. Available at http://www.globalliver.org/news/2017/3/7/a-fourth-pillar-of-liver-cancer-care

4. Schernthaner RE, Haroun RR, Duran R, et al. Improved visibility of metastatic disease in the liver during intra‐arterial therapy using delayed arterial phase cone‐beam CT. Cardiovascular Interventional Radiology 2016;39:1429–37.

Artificial intelligence for clinical decision‐making: a united approach or ethicality conflict

David Nguyen¹

¹ GenesisCare, Rockhampton, Australia

Computing advances are allowing a data‐driven, near‐universal clinical decision process arising from automated, immediate and personalised patient care models with the potential to impact healthcare. Artificial intelligence (AI) and machine learning are well suited for this data‐driven process.

Proponents of AI share similar perspectives that the current outdated process of clinical decision gathering and interpretation is limited by human analytic capabilities, ingenuity and oversight. AI adheres to optimally reduce medical uncertainties, providing a united decision‐making process.¹ Furthermore, AI may assist in optimising patient outcomes through individualised patient care.

Despite the advancements, AI has proven to have the potential for misapplication and raises concerns for application bias and ethicality for machine‐based clinical decision making. The philosophical framework suggests AI lacks the ability to make decisions regarding human consciousness, morality and ethics.

AI capabilities can aid healthcare workers in evaluating risks and goals by facilitating multiple outcome optimisations which may be too difficult to recognise on an isolated basis.² Plausible bias and appropriate application must be considered when implementing into clinical decision‐making. Maintaining and cultivating emotional intelligence and compassion is vital while relaying AI assisted results and interventions to patients and family members who want to make informed decisions.

References

1. Giodano C, Brennan M, Mohamed B, et al. Accessing artificial intelligence for clinical decision‐making. Front Digit Health 2021;3:645232.

2. Valdes G, Simone C, Chen J, et al. Clinical decision support of radiotherapy treatment planning: a data‐driven machine learning strategy for patient‐specific dosimetric decision making. Radiother Oncol 2017;125(3):392–7.

Comparable efficacy of low dose radiotherapy for the treatment of recurrent ocular adnexal lymphoma

Alice Trieu¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

Introduction: External beam radiation therapy (EBRT) is commonly used as first‐line therapy for the treatment of ocular lymphomas (OALs), particularly, mucosa‐associated lymphoid tissue lymphomas. EBRT is considered the standard of care due to excellent clinical outcomes.¹ Dose regimens have de‐intensified over past decades. There is increasing interest in lower doses of radiation for the treatment of low‐grade OALs, given the lower but persistent risk of long‐term orbital complications such as cataracts and dry eye syndrome in the treated eye.²

Case presentation: A 41‐year‐old patient was diagnosed with a recurrence of orbital marginal zone lymphoma following the previous radiotherapy of 24 Gy to the contralateral orbit. PET showed abnormal uptake in the right lacrimal gland and conjunctiva. Since completing her recent EBRT treatment, the patient reported feeling well with evolving response to treatment.

Management/Outcome: An evaluation was conducted to compare the benefit of volumetric modulated arc therapy (VMAT) over 3D conformal therapy (3DCRT) (4 Gy/2#), dose fractionation and its ability to reduce treatment‐related toxicities.

Discussion: A randomised phase III trial observed a trend toward reduced toxicity with 24 Gy;³ however, patients do experience acute side effects which include mild conjunctivitis and eyelid irritation due to the radiosensitive nature of the eye apparatus.⁴ Considering the short and long‐term orbital toxic effects of the radiosensitivity nature of these lymphomas, the ultra‐low doses of 4 Gy (also due to COVID‐19 triaging) has demonstrated encouraging overall response rates. This is fundamental in ocular adnexal lymphomas where the target may be in close proximity to radiosensitive ocular structures.⁵

References

1. Pinnix C, Dabaja B, Milgrom S, et al. Ultra‐low‐dose radiotherapy for definitive management of ocular adnexal B‐cell lymphoma. Head Neck 2017;39(6):1095–110.

2. Tanenbaum R, Galor A, Dubovy S, Karp C. Classification, diagnosis, and management of conjunctival lymphoma. Eye and Vision 2019;6(1).

3. Lowry L, Smith P, Qian W, et al. Reduced dose radiotherapy for local control in non‐Hodgkin lymphoma: a randomised phase III trial. Radiother Oncol 2011;100(1):86–92.

4. Jeon Y, Yang H, Choi B, et al. Comparison of selection and long‐term clinical outcomes between chemotherapy and radiotherapy as primary therapeutic modality for ocular adnexal malt lymphoma. SSRN Electronic Journal 2018.

5. Fasola C, Jones J, Huang D, et al. Low dose radiation therapy (2Gy x 2) in the treatment of orbital lymphoma. Int J Radiat Oncol Biol Physics 2013;86(5):930–5.

A simple, robust and high‐quality planning class solution to unify breast radiation therapy

Brooke Griffiths,¹ Cameron Stanton,¹ Linda Bell,¹ Andrew Le,¹ Kenny Wu,¹ Jessica Adams,¹ Leigh Ambrose,¹ Denise Andree‐Evarts,¹ Brian Porter,¹ Regina Bromley,¹ Kirsten van Gysen,¹ Marita Morgia,¹ Gillian Lamoury,¹ Thomas Eade,^1,2 Jeremy Booth,^1,3 Susan Carroll^1,2

¹ Northern Sydney Cancer Centre, St Leonards, Australia ² Northern Clinical School, St Leonards, Australia ³ Institute of Medical Physics, Camperdown, Australia

Objectives: Balancing target coverage and organs at risk (OAR) sparing in breast/nodal radiotherapy can be difficult using traditional base‐tangential techniques.¹ This work aimed to develop a simple class solution robust to patient anatomical variation to reduce complexity and improve quality using volumetric modulated arc radiotherapy (VMAT) and knowledge‐based planning.

Methods: 40 breast patient data sets were retrospectively volumed per ESTRO guidelines to develop knowledge‐based RapidPlan VMAT models in Varian Eclipse for breast, simultaneous integrated boost and nodal settings. To prevent compromise in low‐dose wash, the models were iteratively re‐trained and refined per SKAGEN² order of priority using base‐tangential techniques as benchmark.^2,3 For validation, a comparative study was completed on 20 additional patients comparing three plan types: RapidPlan ipsilateral‐VMAT (proposed class solution), RapidPlan bowtie‐VMAT (published standard), and hybrid‐IMRT/VMAT (departmental standard).⁴ Blinded radiation oncologists plan preference was evaluated taking into consideration planning target volume coverage, OAR sparing, and remaining‐volume‐at‐risk.

Results: Ipsilateral‐VMAT plan quality was equivalent to bowtie‐VMAT without the need for complex beam avoidance. Compared to hybrid‐IMRT/VMAT, ipsilateral‐VMAT provided a simple and robust planning solution that achieved greater nodal coverage and dose conformity with improved dose sparing to ipsilateral lung (P < 0.05). Significantly, KBP VMAT was preferred in 19 of 20 patients with low‐dose wash to OAR and remaining‐volume‐at‐risk comparable in all plan types.

Discussion/Conclusion: The simple ipsilateral‐VMAT KBP class solution efficiently and consistently produces high quality breast plans independent of patient size/shape and target configuration/prescription without an increase in low‐dose wash otherwise associated with increased second malignancy risk.

References

1. Cozzi L, Lohr F, Fogliata A, et al. Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer. Radiat Oncol 2017;12:200.

2. Danish Breast Cancer Cooperative Group. The SKAGEN Trial 1. Moderately hypofractionated loco‐regional adjuvant radiation therapy of early breast cancer combined with a simultaneous integrated boost in patients with an indication for boost: DBCG HYPO II, a randomised clinically controlled trial. Available at https://clinicaltrials.gov/ct2/show/NCT02384733

3. Fogliata A, Cozzi L, Reggiori G, et al. RapidPlan knowledge based planning: iterative learning process and model ability to steer planning strategies. Radiat Oncol 2019;14:187.

4. Stanton C, Bell L, Le A, et al. Comprehensive nodal breast VMAT: solving the low‐dose wash dilemma using an iterative knowledge‐based radiotherapy planning solution. J Med Radiat Sci 2022;69(1):85–97.

Implementation of RayStation in a large multicentre site – our experience so far

Josip Juresic,¹ Joanne Veneran,¹ Mark Udovitch,¹ Philip Vial,¹ Anthony Espinoza¹

¹ Liverpool and Macarthur Cancer Therapy Centres, Liverpool, Australia

Liverpool and Macarthur Cancer Therapy Centres (LMCTC) are sister radiation therapy (departments servicing the largest local health district within New South Wales. LMCTC currently utilises multiple treatment planning systems consisting of Pinnacle and TomoTherapy, as well as MIM for image registration and contouring. LMCTC utilises up to 30 different site‐specific planning techniques, with highly protocolised processes that require testing and training for each technique and site prior to clinical release. Due to increasing plan numbers, plan complexity and training requirements for three systems, LMCTC took steps to implement a combined treatment planning system solution.

In order to implement a streamlined planning process at LMCTC, RayStation was chosen as the new treatment planning system. Appropriate governance structure was established utilising our large multi‐disciplinary workforce to focus on key components of the implementation process. These included system architecture installation and acceptance testing, beam modelling and machine configuration, contouring and image registration, treatment planning, adaptive treatment planning and scripting. A radiation therapy treatment planning system Implementation Project Manager role was created to help co‐ordinate the task groups and lead the radiation therapy planning development team. A soft implementation was seen as the only feasible approach in transitioning to RayStation without impacting on patient throughput.

The scale of this project has been resource intensive and there have been challenges. As an implementation of this scale is not common, we would like to share the processes we have followed and the lessons we have learned en route to our clinical implementation of a combined treatment planning system solution in a large multi‐centre site.

Clinical evaluation of deep learning and atlas‐based auto‐segmentation for critical organs at risk

Eddie Gibbons,¹ Andrew Hodgson,¹ Matthew Hoffmann,¹ Justin Westhuyzen,² Brendan Chick¹

¹ Mid North Coast Cancer Institute, Port Macquarie, Australia ² Mid North Coast Cancer Institute, Coffs Harbour, Australia

Objectives: Contouring organs at risk OAR is a critical but time‐intensive part of radiation therapy. Atlas‐based automatic‐segmentation has shown some success at reducing this time burden, however this method often requires significant manual editing to reach clinical accuracy.^1–3 Deep learning (DL) auto‐segmentation has recently emerged as a promising solution. This study compares locally generated atlas contours to a commercially available DL segmentation algorithm.

Methods: 90 computed tomography datasets (30 head and neck, 30 thoracic, 30 pelvic) were automatically contoured using atlas and DL segmentation techniques. Sixteen critical OAR were quantitatively measured for accuracy using dice similarity co‐efficient (DICE) and Hausdorff distance (HD). Qualitative visual analysis was performed as a subjective tool to classify each structure into one of four explicitly defined categories. Additionally, the time to edit atlas and DL contours to a clinically acceptable standard was recorded for a subset of nine OAR.

Results: Of the 16 OAR analysed, DL delivered statistically significant improvements (P < 0.05) over atlas segmentation in 13 OAR measured with DICE, 12 OAR measured with HD, and 12 OAR measured qualitatively (Figure 1). The mean editing time for the subset of DL contours was 50%, 23% and 61% faster than that of atlas contouring for the head and neck, thorax, and pelvis, respectively.

Discussion/Conclusion: DL comprehensively outperformed atlas‐based segmentation for most evaluated OAR. Improvements to geometric accuracy, visual acceptability and contour adjustment times have been observed. The implementation of DL auto‐segmentation will likely lead to increased efficiency within a clinical radiation therapy workflow.

References

1. Young A, Wortham A, Wernick I, et al. Atlas‐based segmentation improves consistency and decreases time required for contouring post‐operative endometrial cancer nodal volumes. Int J Radiat Oncol Biol Phys 2011;79(3):943–7.

2. Sharp G, Fritscher K, Pekar V, et al. Vision 20/20: perspectives on automated segmentation for radiotherapy. Med Phys 2014;41(5):1–13.

3. Van Dijk L, Bosch L, Aljabar P, et al. Improving automatic delineation for head and neck organs at risk by deep learning contouring. J Radiot Oncol 2020142(1):115–23.

Evaluation of the implementation of volumetric‐modulated arc therapy technique for bladder cancer radiation therapy

Henry Hung Do¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

Objectives: Bladder cancer is one of the most common cancers globally with 3066 estimated new cases in Australia in 2021.^1,2 A volumetric‐modulated arc therapy (VMAT) technique has been implemented to replace an adaptive ‘plan‐of‐the day’ three‐dimensional conformal radiotherapy (3D‐CRT) protocol for bladder cancer irradiation. The aim of this study was to undertake a dosimetric and efficiency comparison between a bladder VMAT planning protocol with that of the previously used 3D‐CRT technique.

Methods: A retrospective analyses of 20 adaptive 3D‐CRT and 33 VMAT plans using the Varian Eclipse treatment planning system (Varian Medical Systems, Palo Alto, USA) of bladder cancer patients were utilised in this study. Conformity index (CI) to planning target volume, dose to organs at risk (femoral heads and rectum) were compared. Actual treatment delivery time was also calculated for comparison.

Results: The preliminary results have indicated that VMAT plans delivered a 30% improvement to CI of PTV (VMAT = 1.1; 3D‐CRT = 1.55). The mean dose of rectum reduced from 43.5% TD (3D‐CRT) to 30.5% TD (VMAT) and the mean dose of femoral heads reduced from 36% TD (3D‐CRT) to 27% TD (VMAT). The VMAT average actual treatment delivery time (four minutes) was 20% less than equivalent 3D‐CRT plans (5 minutes). Results from the complete analysis to be presented with additional metrics.

Conclusions: VMAT technique provides a more optimal dosimetric solution compared to adaptive 3D‐CRT for bladder cancer irradiation, simultaneously conforming dose to targets, while enabling a dose reduction to organs at risk. Furthermore, VMAT plan delivery is more efficient and can minimise the impact of bladder filling and improve overall patient experience.

References

1. Antoni S, et al. Bladder cancer incidence and mortality: a global overview and recent trends. European Urology 2017;71(1):96–108.

2. Cancer Council. Available at www.cancer.org.au/cancer-information/types-of-cancer/bladder-cancer [Accessed 18 August 2021].

Health‐related quality of life in childhood cancer survivors following photon and proton radiation therapy

Mikaela Doig,^1,2 Eva Bezak,¹ Nayana Parange,¹ Michala Short¹

¹ The University of South Australia, Adelaide, Australia ² Icon Cancer Centre, Windsor Gardens, Australia

Objectives: To identify and evaluate the health‐related quality of life (HRQoL) in childhood cancer survivors following photon radiation therapy (XRT) and proton radiation therapy (PRT).

Methods: Medline, Embase and Scopus were systematically searched. As HRQoL is subjective and personal, studies were included if they collected HRQoL data using a validated patient‐reported outcome measure. Studies were included if they were published in the English language and if patients had external beam radiation therapy after the year 2000.

Results: 711 original studies were identified, with 28 meeting the inclusion criteria. Pearling identified one additional study. The reporting of treatment regimens and radiation therapy variables were highly inconsistent, with 11 of the 29 included studies not providing any details of prescribed dose and/or the treatment delivery technique. Due to variability in study design, there were no quantifiable differences in HRQoL after XRT or PRT. HRQoL for patients with a central nervous system tumour, captured by PedsQL Generic Core total score, increased with time from treatment. No studies analysed the implementation of routine HRQoL capture during paediatric radiation oncology clinical practice.

Discussion: There are limited quality studies containing long‐term HRQoL outcomes for XRT or PRT. A key limitation of many studies was combining patients at variable timepoints following treatment, with variable treatment regimens, to produce an overall outcome. Future studies are required to analyse longitudinal HRQoL from baseline, as a function of dose prescribed and dose received by organs at risk. Improved reporting will assist in determining if PRT produces improved HRQoL outcomes for childhood cancer survivors.

Patient experiences and perceptions of the new MR‐linac: an interim analysis

Savannah Brown,¹ Jessie McKinnon,¹ Amy Brown,¹ Robyn Preston²

¹ Townsville University Hospital, Townsville, Australia ² Central Queensland University, Townsville, Australia

Objectives: There is minimal literature on the patient's preferences and experiences within radiation oncology and there is currently little evidence on patient perspectives of treatment on the MR‐linac (MRL). This research aims to explore the patients’ experiences of the MRL in a regional hospital setting.

Methods: A sequential explanatory mixed‐methods study is being conducted with a quantitative patient experience survey at the start and end of their treatment course, and a qualitative interview during treatment. A range of patients have been recruited across both MRL and standard linac (SL) treatments to compare both machine experiences. Interim descriptive statistics for the survey and thematic analysis for the interviews have been undertaken.

Results: 19 SL and 11 MRL patients have completed surveys and/or interviews from a range of treatment sites including prostate, breast, head and neck, and others. Overall, positive responses to the survey have been noted, however some patients report negative experiences with aspects such as treatment position and comfort. There was a general trend of a decrease in anxiety throughout treatment in both cohorts of patients. The MRL patients have a sound understanding of the benefits of their treatment and that their treatment is more ‘localised/targeted/pinpoint’. SL patients reflected on aspects including comfort, efficiency and physical environment of the machine and bunker.

Discussion/Conclusion: Interim analysis demonstrates both SL and MRL patients find their treatment tolerable, and further perspectives on factors such as time and comfort on the treatment couch, MRL claustrophobia and acoustics will be explored in further data collection.

Designing an escape room to facilitate interprofessional learning in rural higher education: an educator journey

Emma Cooper,¹ Alex Little,¹ Sonja Littlejohns,¹ Elesa Crowley¹

¹ The University of Newcastle, Tamworth, Australia

In recent years educational escape rooms (ER) have been successfully incorporated, into the interprofessional learning program of a multi‐site university department of rural health. ER employ active, collaborative strategies to engage a range of learning styles and when care is taken to underpin design with sound educational principals there are many positive outcomes for learners.¹ But it does not come without its challenges.²

With the challenges in mind, the authors, a collaborative team of interprofessional educators, set out to create a new ER to get students working together to learn about teamwork, critical thinking, problem solving and leadership. The design journey took our educators into the constructivist paradigm and challenging world of game‐based learning, where it was discovered that the design of the ER would influence how students were able to sufficiently ‘suspend belief’ to realise the intended goals.

To achieve a degree of difficulty in which success necessitates active collaboration, the solution to the ER had to be multi‐level, incorporating a mix of simple and layered clues and puzzles that came to life via swells of motivation, excitement, creativity and thinking ‘outside the box’. Although COVID brought a premature end to the testing phase, the positive outcomes experienced by trial participants and, surprisingly, the educators themselves, exceeded expectations. Debates, differences of opinion, intellectual and physical resource implications and constructive criticism were successfully navigated using the same skills that the educators were hoping to develop in their students.

At times, we were left wondering, ‘who are the ones learning here?’

References

1. Clarke SJ, Peel DJ, Arnab S, et al. EscapED: a framework for creating educational escape rooms and interactive games for higher/further education. International Journal of Serious Games 2017;4(3).

2. Veldkamp A, van de Grint L, Knippels MC, van Joolingen W. Escape education: a systematic review on escape rooms in education. Educational Research Review 2020;31:1–8.

Radiation therapists’ perceptions of students’ skills after VERT implementation

Carissa Arthur,¹ Yobelli Jimenez,² Mikaela Dell'Oro,^1,3 Richard Oates,^4,5 John Atyeo,⁶ Michala Short¹

¹ The University of South Australia, Adelaide, Australia ² The University of Sydney, Sydney, Australia ³ The Royal Adelaide Hospital, Adelaide, Australia ⁴ Peter MacCallum Cancer Centre, Melbourne, Australia ⁵ Monash University, Melbourne, Australia ⁶ Northern Sydney Cancer Centre, St Leonards, Australia

Objectives: Virtual environment for radiotherapy training (VERT) is a radiation therapy simulation tool offered by Australian universities to mimic clinical scenarios aiming to train and upskill students prior to clinical placements. The aim of this project was to evaluate radiation therapists (RTs) perceptions of students’ clinical skills following the 2012 introduction of VERT into university curriculum.

Methods: Two online surveys collected RTs perceptions of the clinical and communication skills of students during their first clinical placement. The results of the first survey (2012) before VERT installation (pre‐VERT) were compared with the second (2014) following installation of VERT (post‐VERT). Thematic analysis was used to determine the main skills perceived by RTs in the post‐VERT survey. A content comparison was then performed between the pre‐VERT and post‐VERT surveys to identify trends in how RTs perceived students’ skills across the two time points.

Results: A total of 63 participants were surveyed. Post‐VERT indicated RTs perceived students to have mastered common basic communication and practical skills, developed a wide range of intermediate skills, while only observing more complex situations. Comparison of post‐VERT to pre‐VERT data suggested a perceived improvement in students communication with patients and patient set‐up procedures following VERT’s introduction.

Discussion/Conclusion: These findings could influence the way VERT is applied in universities by providing an understanding of the skills RTs report have strengthened for students. Further research into VERT utilisation and its impact on student clinical skills is required for ongoing support of student learning.

Radiographer‐reviewed automatic contouring in cardiac MRI is equivalent to cardiologist manual contouring for functional analysis

Rachael Anstey,¹ John F Younger,¹ Kristyan Guppy‐Coles¹

¹ The Royal Brisbane & Women's Hospital, Brisbane, Australia

Objectives: Left ventricular contouring for cardiac functional MRI analysis is commonly performed by a specialist cardiologist. However, this is time consuming, which increases time to report and healthcare costs. The aim of this study was to determine if left ventricular contouring using an automated contouring system with radiographer review (ARRC) could be substituted for manual specialist cardiologist contouring (MSCC).

Methods: Institutional ethics review board approval was obtained. The left ventricle short axis contour was manually delineated by a specialist cardiologist on the steady state free precession (SSFP) sequence from 36 cardiac MRI examinations performed. Left ventricular contouring was also independently performed on the SSFP data sets using automatic contouring software with radiographer review of contouring accuracy. Pearson product‐moment correlation analysis was performed on four left ventricular ejection fraction (LVEF) characteristics to determine the strength of linear relationships between the ARRC and MSCC methods.

Results: The automated contouring failed in six patients due to the presence of cardiac effusion. There was strong positive correlation between the ARRC and MSCC methods for all four LVEF characteristics for the remaining 31 cases: End‐diastolic volume (r = 0.97), end‐systolic volume (r = 0.98), ejection fraction (r = 0.95), end‐diastolic muscle mass (r = 0.91). All correlations were statistically significant (P < 0.01).

Discussion/Conclusion: Combining automatic contouring with radiographer review of software accuracy could be substituted for specialist cardiologist contouring of the left ventricle in cardiac MRI to improve efficiency without compromising accuracy. Automatic contouring failure is a potential pitfall in the presence of cardiac effusion.

Assessing impact of calculation grid size and algorithm in radiotherapy planning: a united multidisciplinary approach

Christie Hall,¹ Lotte Fog²

¹ GenesisCare Radiation Oncology, Malvern, Australia ² Alfred Health Radiation Oncology, Melbourne, Australia

Objective: Calculation grid size and algorithm may affect dose distribution in radiotherapy planning.¹ Smaller grid size calculations are more accurate but more time‐consuming.² This study unites radiation therapist and physics staff for investigating effects of grid size on dose coverage and calculation time.

Method: CT data from an antropomorphic phantom was collected. Planning target volumes (PTVs) with diameters 0.5–7 cm were created in Eclipse (Varian, PaloAlto), adjacent to a brainstem structure. Four plans were created for each PTV, using the Anisotropic Analytical Algorithm (AAA) and Acuros Algorithm (v13.6.23); using grid sizes of 1.25/2.5 mm. Plans delivered 2 Gy in two modulated arcs. The 1.25 mm plans were calculated using the monitor units (MUs) from the 2.5 mm plans with a 32 GB RAM/2GHz CPU PC. Optimisation and planning times were recorded and D98 and D2 PTV parameters were examined.

Results: D98 varied less than 8 Gy with PTV diameter for all algorithms and grid sizes (Table 1), except for the 0.5 cm diameter/small grid size, for which it was 12.3 Gy larger (AAA) and 18.1 Gy smaller (Acuros), respectively. D2 varied by less than 8 Gy for all plans except for AAA/1.25 mm, where it was 13.4 Gy greater. Calculation times were 66 to 512 minutes and were longer for small grid size calculations.

Conclusion: PTV coverage is strongly dependent on grid size particularly for PTVs with diameters less than 1 cm. This indicates the importance of small grid size for these targets despite longer calculations. Further, this study emphasises the benefit in uniting physicist knowledge and radiotherapist planning expertise for improved radiotherapy practice.

References

1. Huang B, Wu L, Lin P, Chen C. Dose calculation of Acuros XB and Anisotropic Analytical Algorithm in lung stereotactic body radiotherapy treatment with flattening filter free beams and the potential role of calculation grid size. Radiat Oncol 2015;10(53):1–8.

2. Snyder KC, Liu M, Zhao B, et al. Investigating the dosimetric effects of grid size on dose calculation accuracy using volumetric modulated arc therapy in spine stereotactic radiosurgery. Journal of Radiosurgery and SBRT 2017;4(4):303–13.

The implementation of ASPIRE single/multi trials for palliative radiation therapy

Toby Lowe,¹ Thomas Eade,¹ Sarah Bergamin,¹ Kylie Grimberg,¹ John Atyeo¹

¹ Northern Sydney Cancer Centre, St Leonards, Australia

Background: One‐third of our patients are treated with palliative intent. Advanced disease in these patients results in significant suffering from pain, with reduced quality of life. Radiation therapy plays an important role in symptomatic relief while improving quality of life.

Purpose: The priority outcome of this study is improving symptom control in these patients for improved quality of life. ASPIRE single compares single fraction dynamic dose escalation (GTV = 14 Gy, CTV = 10 Gy, PTV = 8 Gy) with a 3D‐CRT single fraction (PTV = 8 Gy) and investigates if single fraction plans result in greater benefit with the same or less toxicity. ASPIRE multi compares the single fraction dose escalation against the standard treatment of 20 Gy/5 Fx, to investigate if the dose escalation single fraction treatment can provide more durable benefits to the patient with the same or less toxicity compared to the multi‐fraction treatment.

Process: Potential participants are contacted by a member of the ASPIRE trials team to discuss information regarding the trial. If the patient wishes to proceed, verbal consent is obtained using the ASPIRE Patient Verbal Consent script, with written consent completed before day one treatment. To remove bias in plan production and acceptance, patients are randomised to a treatment arm after both plans are signed off by the radiation oncologist. Randomisation occurs in a 2:1 (dose escalated single fraction arm: multi‐fraction arm) with 100 patients to be recruited into each trial. Fifteen patients have so far been recruited with preliminary data to soon be available.

Towards safer radiotherapy: a multidisciplinary 12‐month evaluation of a new incident learning system

Krystle Crouch,¹ Laura Adamson,^1,2 Rachael Beldham‐Collins,¹ Jonathan Sykes,^1,2 David Thwaites^1,2

¹ Western Sydney Local Health District, Sydney, Australia ² The University of Sydney, Sydney, Australia

Objectives: Tripartite practice standards provide criteria for safety and quality management to proactively mitigate risk in radiation oncology (RO), a specialty continuously challenged by technology advances.¹ Incident learning systems (ILS) collect and analyse reported incidents and utilise feedback loops to promote quality improvement for better patient safety and clinical service.² In 2020, an RO‐specific electronic ILS was designed in‐house and implemented. Its impact on departmental reporting and safety culture has been investigated after one year’s use.

Methods: The ILS design took into account findings from a prior e‐survey, distributed to multi‐disciplinary RO staff within the local health district. It aimed to assess initial attitudes to ILS and safety culture to understand perceived barriers to reporting. A repeat survey was conducted 12‐months post ILS introduction and results were compared, using descriptive statistics and thematic analysis to assess any changes.

Results: 70 staff (64% response) completed the initial baseline e‐survey and 65 staff (63%) at follow‐up. Findings showed increased ILS understanding and participation, decreased perception of reporting barriers and increased perception of no‐blame culture. Greater confidence in the department’s ability to learn from the ILS was evident.

Conclusion: Surveyed staff (radiation therapists, medical physicists and radiation oncologists) showed an increased positive perception to incident learning over the 12‐month period. However, there are still opportunities for improvement as variation in knowledge between cohorts was observed. This can be used to inform future allocation of training and resources. Extended review of the ILS is warranted to assess longer‐term changes.

References

1. The Royal Australian and New Zealand College of Radiologists. Revised radiation oncology practice standards. Sydney NSW: RANZCR. Available at www.ranzcr.com/whatson/news-media/240-new-revised-radiation-oncology-practice-standards

2. Terezakis SA, Harris KM, Ford E, et al. An evaluation of departmental radiation oncology incident reports: anticipating a national reporting system. Int J Radiat Oncol Biol Phys 2013;85(4):919–23.

Capturing patient reported outcome data from a single institution dual arm palliative trial

Sean Finn,¹ Thomas Eade,¹ Sarah Bergamin,¹ Kylie Grimberg,¹ John Atyeo,¹ Siobhan Burke¹

¹ Northern Sydney Cancer Centre, St Leonards, Australia

Background: Patients with metastatic cancer are living longer with their disease. Data collection in palliative care trials has traditionally been difficult, with poor questionnaire completion, and lack of follow‐up. Accurately capturing and tracking this data over time is essential to improving outcomes for radiation therapy patients.

Purpose: ASPIRE is a single institution clinical trial involving patients requiring palliative radiation therapy. The primary outcome of both trials is improvement in symptom control to improve quality of life. The two arms of the trial compare current standard palliative fractionation regimens (8 Gy in one fraction and 20 Gy in five fractions) with a single fraction, dose escalated plan (14 Gy, 10 Gy, 8 Gy to GTV, CTV and PTV, respectively). Symptom control and toxicity are compared to determine if there is a benefit to using targeted high dose treatments in this patient cohort.

Process: Trial participants are sent surveys via Research Electronic Data Capture (REDCap) to either their email or mobile phone. A pre‐treatment survey records baseline data of current symptoms and quality of life. Follow‐up surveys are then sent at two weeks, one month, three months, six months, nine months, one year, 18 months and two years post‐treatment. Survey questions focus on current symptoms, with follow up surveys asking patients to rate symptom improvement. Patients are also asked if any treatment side effects are bothering them and whether they regret undergoing treatment. Phone consultations occur if patients experience significant side effects or post‐treatment regret. Preliminary results will be available after recruiting 50 patients.

Australian Clinical Dosimetry Service involvement in implementing emerging technologies safely in the clinic

Kate Francis,¹ Maddison Shaw,¹ Andrew Alves,¹ Sabeena Beverage,¹ Rhonda Brown¹

¹ ARPANSA, Yallambie, Australia

Ensuring radiotherapy is delivered safely and accurately means that dose delivery must be measured and compared to national and international standards. The Australian Clinical Dosimetry Service (ACDS) maintains ongoing development of new audits to meet the needs of clinics implementing emerging technologies.

It is challenging for the ACDS to develop a range of comprehensive audits that provide independent quality assurance across all modalities offered at each facility. It requires collaboration between the facility physicists and radiation therapists, the ACDS Clinical Advisory Group, TROG and state and federal health regulators. Before an audit going live, baseline data is collected to establish clinical metrics suitable to the technique/modality being audited.

This presentation will discuss how the ACDS designs audits for new technologies and what is required for an audit to progress through field trials and be ready for clinical release.

Evaluating MRI anatomy in machine learning models assessing hydrogel spacer benefit for prostate cancer patients

Madison Bush,¹ Catriona Hargrave,^1,2 Scott Jones²

¹ Queensland University of Technology, Brisbane, Australia ² The Princess Alexandra Hospital, Brisbane, Australia

Objectives: Prostate cancer radiation therapy may induce rectal toxicities as the rectum sits adjacent to the prostate and seminal vesicles. Hydrogel spacers create a physical gap between the rectum and prostate, reducing rectal doses. This study aims to determine the feasibility of incorporating diagnostic MRI (dMRI) information in statistical machine learning (SML) models for toxicity prediction, developed with planning CT (pCT) anatomy, to facilitate HS insertion before radiation therapy procedures for men who are most likely to benefit from this procedure.

Methods: Key regions of interest (ROIs) were retrospectively collected and contoured respectively on the pCT and dMRI scans for 20 patients. ROI Dice and Hausdorff distance comparison metrics were calculated. The ROI volumes and patient clinical risk factors were inputted into three SML models. The pCT and dMRI‐based dose and toxicity model performance were then compared.

Results: The mean volumes of dMRI prostate, seminal vesicles and rectum ROIs were 35.60 cm³, 7.91 cm³ and 51.27 cm³ in comparison to 36.65 cm³, 8.14 cm³ and 57.32 cm³ for pCT data respectively. Dice values of 0.81, 0.47 and 0.71 and average Hausdorff distance of 2.15, 2.75 and 2.75 cm³ were generated for the prostate, seminal vesicles and rectum. The average accuracy model performance result of 0.83 for dMRI toxicity predictions were comparable to the 0.85 pCT value.

Conclusion: Differences between pCT and dMRI anatomical ROI variables did not impact SML model performance in this feasibility study. Retraining the current predictive models on dMRI anatomic is recommended to improve model accuracy.

Cranial stereotactic radiation therapy implementation – the experience of a regional standalone radiotherapy centre

Joanna MacCarthy¹

¹ Andrew Love Cancer Centre, Geelong, Australia

In 2020, a team of radiation oncologists, radiation therapists and medical physicists united to implement a planning, treatment and imaging protocol for cranial stereotactic radiation therapy.

Previously the people of Geelong and southwest Victoria with small metastatic tumours were forced to choose between surgery, whole brain radiotherapy, or travelling to Melbourne for treatment.

This presentation will discuss the steps taken to develop and test different RapidArc volumetric modulated arc therapy optimisation methods, and the design of an intrafraction kV‐MV imaging protocol for non‐coplanar beams using a Varian TrueBeam linac.

It will also cover protocol changes that occurred in the first 12 months and patient follow up from the first two years of implementation.

The implementation and evaluation of a standardised immobilisation equipment solution for a multi‐site radiotherapy service

Alice Oliver,¹ Cathy Markham,¹ Nigel Anderson¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

A 2018 upgrade to a universal cloud‐based treatment planning system across our institution’s five campuses was followed by a clinical rollout of a uniform immobilisation equipment solution in 2019. This would further unify patient care regardless of where they received their radiation therapy. Previously, radiation therapy immobilisation devices (RTIDs) used at our institution varied between campuses and, depending on local service requirements and clinical workload, was a combination of commercially available RTIDs and equipment produced in‐house by our institution’s Biomedical Engineering service. In unifying this solution each campus was supplied with a range of standardised, commercially manufactured RTIDs from the chosen vendor, CDR Systems (Calgary, Canada).

A multi‐campus evaluation took place after the initial roll‐out of the new RTIDs. Ethics approval for the evaluation was granted through our institution’s ethics committee. The project aimed to evaluate the new RTIDs versus the previous in‐house equipment to a) evaluate the value and improvements (if any) in RTID standardisation and b) identify areas for improvement to optimise RTID functionality. A large group of clinical radiation therapists from all five campuses, supported by radiation physicists and the radiation therapy research department, was assembled into five working groups for the most commonly utilised treatment setups at our institution: supine breast, prone pelvis/bellyboard, head and neck, supine pelvis and chest/arms‐up. This presentation will describe the rationale, protocol development, data acquisition and analysis methodology to enable a targeted, relevant evaluation following this instrumental change in clinical practice.

An evaluation of radiation therapy immobilisation devices across a multi‐campus service

Olivia Mayberry,¹ Alice Oliver,¹ Jack Moller,¹ Cameron Vu,¹ Gabrielle Drum,¹ Jacinta Krstic,¹ Nigel Anderson,¹ Cathy Markham¹

¹ Peter MacCallum Cancer Centre, Melbourne, Australia

Objectives: Our institution relied on a combination of commercially available and in‐house produced radiation therapy immobilisation devices (RTID). To establish uniformity across the five campuses, RTIDs were acquired from CDR Systems (Calgary, Canada) and rolled out across 2019 to 2020.

This quality improvement study aimed to evaluate patient positioning accuracy and reproducibility for multiple anatomical sites, comparing previous RTIDs to the newly acquired CDR equipment.

Methods: 246 patients (breast, prone/supine pelvis, chest) were retrospectively analysed, with a prospective cohort of 20 head and neck patients. Set‐up reproducibility or inter‐fraction motion was assessed by measuring translational (cm) and rotational (degrees) deviations. This allowed comparison of the bony anatomy match from kV/CBCT shift data for patients using pre‐existing RTIDs to the new CDR solutions. Independent t‐tests determined any significant differences. Ethics approval was granted by our institution’s ethics committee (approval number 20/114R).

Results: A total of 14,447 translational data points were used in this analysis (breast angled = 1329; flat = 2016; prone pelvis = 2970; supine pelvis = 3330; chest = 486; head/neck = 4316). Shift comparison varied across treatment sites between RTID solutions. Increased translational mean deviations were observed in flat breast (CDR: 0.25 +/‐ 0.22 cm; previous: 0.28 +/‐ 0.23 cm; P < 0.001), prone pelvis (CDR: 0.28 +/‐ 0.24 cm; previous: 0.26 +/‐ 0.23 cm; P < 0.001) and chest/arms‐up (CDR: 0.28 +/‐ 0.22 cm; previous: 0.23 +/‐ 0.17 cm; P = 0.014). Rotational deviations in chest patients reported a slight decrease (n = 486, CDR :0.69 +/‐ 0.57 degrees; previous: 0.82 +/‐ 0.61 degrees; P = 0.024).

There was no significant difference in the angled breast (CDR: 0.25 +/‐ 0.22 cm; previous: 0.25 +/‐ 0.22 cm), supine pelvis (CDR: 0.24 +/‐ 0.20 cm; previous: 0.25 +/‐ 0.24 cm) or head/neck cohorts (CDR: 0.19 +/‐ 0.17 cm; previous: 0.18 +/‐ 0.17 cm).

Discussion/Conclusion: Clinically negligible and correctable deviations suggest that the CDR solution is comparable with previous RTIDs. The uniformity of the CDR solution across all campuses provides improved organisational efficiency.

Analyses of patient mask anxiety during radiotherapy and the implementation of VR patient coaching

Daniel Sapkaroski,^1,2,3 Lachlan McDowell,¹ Karla Gough,¹ Nigel Anderson^1,2,3

¹ Peter MacCallum Cancer Centre, Melbourne, Australia ² Sir Peter MacCallum Department of Radiation Oncology (Melbourne University), Melbourne, Australia ³ Monash University School of Medicine and Allied Health, Clayton, Australia

Introduction: Recent findings assessing cancer patients undergoing imaging procedures indicate that 26% present with anxiety, 52% sub‐clinical claustrophobia, and 27% with moderate to severe claustrophobia.¹ However, a validated state anxiety assessment tool for head and neck cancer (HNC) patients undergoing radiation therapy with a thermoplastic mask is still lacking, furthermore the main method of dealing with anxiety alleviation currently relies heavily on medication. This aim of this research project was to develop a specific state mask anxiety tool, assess the levels of mask and treatment anxiety in HNC patients and to implement an interactive virtual reality patient experience using the Oculus Quest 2 to alleviate anxiety levels.

Methods: State anxiety for n = 39 patients was measured using a short STAI questionnaire.² Results were converted to pro‐rated scores with a lower and higher anxiety cut of score of 41 and 55, respectively. Descriptive statistics and joint frequency distributions for the discrete variables were derived with 95% confidence intervals calculated using Ward's method. The CETSOL VR patient experience was created using the Unity game engine.³

Results: Our results showed that 43.6% (cut off score of 41) and 20.5% (cut off score 55) of HNC had high and very high levels of anxiety respectively before treatment and mask making procedure.

Conclusion: HNC patients appear to have high levels of mask anxiety which should warrant some form of anxiety alleviation. Correspondingly, patients with low and high levels of mask anxiety reported a desire for a simulated virtual reality mask‐making experience.

References

1. Pelland ME, et al. PO‐0608: Depression, anxiety and claustrophobia in patients undergoing radiotherapy for head and neck cancer. Radiother Oncol 2017;123:S317‐S318.

2. Marteau TM, Bekker H. The development of a six‐item short‐form of the state scale of the Spielberger State‐Trait Anxiety Inventory (STAI). Br J Clin Psychol 1992;31(3):301–6.

3. Sapkaroski D, et al. The implementation of a haptic feedback virtual reality simulation clinic with dynamic patient interaction and communication for medical imaging students. J Med Radiat Sci 2018;65(3):218–25.

Looking toward 2031 across medical radiation sciences education, research and practice

Jonathan McNulty¹

¹ University College Dublin, Dublin, Ireland

This presentation will share some recent work undertaken by the European Federation of Radiographer Societies (EFRS) together with some personal reflections on our profession; where we have come from, where we are today, and what may lie ahead. Radiographic practice underpinned by education and informed by research is vital to the delivery of effective and timely medical imaging, nuclear medicine and radiotherapy services and this importance can only grow as the shift from population to personal health care takes effect.

The EFRS Radiographer Education, Research and Practice project was established to produce a white paper based on considered expectations of and ambitions for radiographers over the next decade.

Through a Delphi methodology, the EFRS invited a group of leading radiographers from across the globe to draft statements that described expectations and ambitions related to radiographers’ education, research and practice. This resulted in 216 statements which were then entered into an online survey tool. An invitation to complete the survey was then sent to 448 radiography educators, practitioners and researchers, and to the international expert group. Survey participants were asked to consider each statement and indicate their level of agreement. Responses were received from 157 respondents. Detailed analysis enabled the 216 statements to be stratified into three levels of importance under the headings: education, research, and practice. Subsequently stakeholder organisations, including patients and other professions, were invited to share their views of the future of the radiographer profession and all 114 EFRS member organisations were invited to review and comment.

Our profession has come a long way, but it is essential that all medical radiation science professionals around the world consider the direction of the profession in their country across medical imaging, nuclear medicine and radiotherapy. Our profession’s ambitions and expectations for the future must consider issues such as artificial intelligence, advanced practice, new roles, setting standards, building evidence, promoting our profession, and it is hoped that the EFRS white paper will support activity linked to building a strong professional future.