Course report

10-14 November 2024, Budapest, Hungary

1. A radiation therapist’s perspective

My name is Platon Pappas. I have been a radiation therapist (RTT) at IASO Hospital in Athens, Greece, since 2011, and at Athens Medical Centre since 2020. Both hospitals are very well equipped and keep up with the latest techniques in radiotherapy.

This was the first course that I had attended at the ESTRO School. I wanted to choose a course that would be part of the daily routine of an RTT. Nowadays image-guided radiation therapy (IGRT) is used on a daily basis in all treatments, so I thought it would be a great opportunity to enrich my knowledge of this topic. Additionally, since ESTRO is a global centre for radiotherapy, I thought it would be a chance to talk with colleagues from other countries and learn about the ways in which they worked in their centres and the protocols they followed for the registration of IGRT.

I found the course well-balanced for all the participants. It was very interesting for doctors, physicists and RTTs in my opinion. I can’t be unbiased; as an RTT, I was more related to the presentations that were most RTT-centred. However, I can say that the rest of the presentations were just as interesting for me. Additionally, I was very excited that they were made in such a way that it was very easy for me to attend. Overall, I really enjoyed the break-out sessions, in which I had the opportunity to hear how other colleagues worked, what equipment they used and how they approached the breath-hold technique. Also, I was pleasantly surprised that I was given the opportunity to learn more things about the XVI breath-hold software. Although I have been using it for the past decade, I learnt some new tricks about it and also image registration (thank you very much Marcel).

I can say that I left the course wiser than I was when I arrived ‑ in all aspects, from the volume delineation to the selection of the margins and the perspectives of doctors, physicists and RTTS about the treatment. The examples of the correct ways to register the image and how the plan-of-the-day is selected through the differences in the daily anatomical changes really captivated me. I returned to my hospital with knowledge that I am now ready to share with my colleagues.

The course definitely met my expectations and surpassed them. It was very well structured for the participants and the teachers gave very interesting presentations. I really liked the fact that many of the presentations were interactive and that the teachers urged us to ask questions through them and not at the end. In my opinion, IGRT and adaptive radiotherapy were fully covered as a topic.

Many case examples were shown. Our teachers presented us with an adaptation with MRLinacs, and a selection of the plan-of-the-day with the use of normal linacs.

The three important “takeaways” following the course were:

• adaptive radiotherapy with hypofractionation is the future;
• following on from IGRT, I see great developments in the near future in terms of image quality in radiotherapy and the part that artificial intelligence (AI) has to play in our profession: and
• the role of RTTs has changed and will continue to change with more responsibilities and more active roles in the delivery of treatments.

In my clinic, we don’t use plan-of-the-day, and we perform adaptations only when we see a great change in the volume of the tumour or in an anatomical change of the patient due to weight loss. However, I can use a couple of tricks I learnt about the use of the XVI for the registration.

As I mentioned before, it is a great course, with many interesting presentations. It offers a great opportunity for others because there is always something new to learn and most importantly, it is a great chance to talk with colleagues from around the world and to find out first-hand how they work in their clinics.

Platon Pappas, radiation therapist,  IASO Clinic, Athens, Greece

platonpappas@yahoo.gr

2. A medical physicist’s perspective

My name is Anna Dinkla and I am a medical physicist at Amsterdam University Medical Centre (UMC) (The Netherlands). I have been working in the field of radiotherapy for more than 10 years, starting with a PhD study that was focused on prostate brachytherapy. I also worked as a postdoc on MR-only radiotherapy and synthetic CT generation, before I started my medical physics expert residency in Amsterdam. Now that I am a qualified medical physicist and specialist in IGRT, I felt it was a good time to attend the ESTRO course on IGRT.

In our department, RTTs who specialise in IGRT (the image-guided and adaptive radiotherapy, IGART team) also attend this course when they are new to the team, so it was very nice to be able to interact with my colleagues about our clinical practice and to reflect on things that perhaps could be evaluated or improved in our practice. Also, attendance at these kinds of courses gives the opportunity to step away for a couple of days from the daily clinic and reflect. The only downside of this was that there was less time to get to know the other (80?) participants.

During the course, it was nice to watch the experienced faculty. It is clear that they know each other well, so small jokes during and between the lectures gave the course an informal touch, with plenty of room for questions. With such a large group of participants, there was no shortage of questions!

One reason for attending this course was that many of the presentations covered the basics, which I think is important for attendees also to understand the current needs. Some of the lectures covered the history, basic principles and clinical practice. Others covered more modern techniques such as MR-guided and cone-beam CT-guided online adaptive radiotherapy. There were also lectures on technical issues and innovations that showed (im)possibilities and areas in which innovations were needed. As for the lectures on modern techniques, it was good to see that we as a department are already pretty up-to-date. The excellent presentations by, for instance, Drs Parag Parikh and Gitte Persson provided the attendees with a good current perspective from physicians, to remind us of the importance and relevance of (the adoption of) evolving technology. Finally, even big data (for instance, heart dose vs. long-term clinical outcome) and AI (for instance image enhancement, autocontouring and automatic planning) were covered.

For me, and this I am sure holds for many (future) colleagues, as I started my (external beam) radiotherapy career in departments with modern equipment and practices such as online adaptive therapy, it was very helpful to revisit the history and basics of IGRT. The presence on this course of some really experienced teachers who were present almost at the very beginning of IGRT is a reason in itself to subscribe to it. I think I can use the improvements it brought to my knowledge and skills in the field of IGRT immediately in my practice, but also to design or implement new practices such as online (or offline) adaptive therapy for specific indications, and to think about future directions.

In general, participation in courses helps you to take the time to evaluate your own clinical practice (preferably in a multidisciplinary setting!) and to see whether they are still up-to-date or could use some revision.

I would also advise people who have been in the field for longer than I have to participate in an ESTRO course like this one if they have the chance, because it gives them the possibility to look from a broader / different perspective, to learn different approaches, and to interact with colleagues inside and outside their department. I believe we learn a lot from these kinds of conversations and we get to meet (in this case IGRT-minded) people from across Europe (or even the world!).

Dr Anna Dinkla, Medical physicist

Amsterdam UMC, Amsterdam, The Netherlands

a.dinkla@amsterdamumc.nl

 

 

 

 

3. A radiation oncologist’s perspective

I am a radiation oncologist based two hours south of Sydney, Australia. Mainly I treat patients with genitourinary, thoracic or gynaecological cancers. I attended the ESTRO IGART course to update my knowledge of the techniques and to learn how they are implemented internationally. I have found previous tumour site-based ESTRO courses to be practical and educational, and I was drawn to the interdisciplinary nature of this course on which I could hear the perspectives of RTTs and medical physicists.

There was a good mixture of theoretical and practical talks over two half days and three full days, along with two pre-recorded webinars. It was interesting to hear about the historical development of IGART techniques and to understand margin calculation with practical examples. Tumour site-based lectures were helpful; they included RTTs explaining their decision-making with case scenarios. 

Break-out sessions for radiation oncologists, medical physicists and RTTs allowed attendees to ask questions and discuss differences in practice. The entry and exit exams prompted attendees to consider their knowledge prior to, and improved by, the course. By attending the course, I feel more confident in decision-making regarding IGRT and it was great to hear about the developments in both MR- and CT-guided adaptive radiotherapy over the last few years, as well as novel and recent topics such as the use of AI in IGRT and cardiac ablation. Budapest was a fantastic venue and the course was well-run, with the rapport among the course faculty contributing to a cohesive experience.

The course alternates online and in-person formats, which allows attendance for those who find the travel challenging. I think the ESTRO IGART course is relevant for radiation oncologists, medical physicists and RTTs, whether they be trainees, juniors or seniors. 

Dr Stephen Chin, Radiation oncologist

 Shoalhaven Cancer Care Centre, Nowra, NSW, Australia

schin@ihug.com.au