In July
2014 the first Surface Guided Radiation Therapy (SGRT) system was installed in
the clinic for radiation-oncology USZ. Before using SGRT in a clinical setting,
a dedicated team of clinicians, physicists and RTT`s was formed to implement
the system. The team had the opportunity to see the SGRT system in a clinical
setting and receive vendor training. After site visits, a workflow was created
and clinical protocols were developed to safely implement the system in a
clinical routine.
First we
started with monitoring all our free breathing (FB) breast patients. The SGRT
core team trained the other staff members so they had a chance to get familiar with the system and
we had the opportunity to collect as much monitoring data as possible. After
being familiar with the system we started to use the SGRT system together with
the RPM system (Respiratory Gating for Scanners RGSC system (Varian Medical
Systems, Palo Alto (USA)), for our breast patients treated with deep
inspiration breath hold (DIBH). We used both systems simultaneously in order to
see if the CT scan, acquired with the RPM system, correlates with the SGRT
system on the treatment machine.
The next step in the implementation of the SGRT system was to ensure the safe treatment
of DIBH patients with the SGRT system only.
After establishing this workflow with the breast patients, we focused on
setting up and monitoring thorax and abdominal patients with the SGRT system.
The goal here was to go tattoo-less, creating a robust set up and to monitor
patient movements during treatment.
The SGRT
core team initiated all these projects and new implementations. In addition,
the core team set up new protocols, gave hands on training and ensured that all
workflows and clinical protocols were available for all staff members. New
projects and workflows were discussed in a team meeting before starting them
and for the first patient one person of the SGRT core team was present.
After being
familiar with the system, convinced about the safety and accuracy and having
well trained staff, we started in 2019 a new workflow for breast treatments,
the so called imageless treatment. If the set up is accurate for the first
three days of treatment, the next treatments were applied with SGRT only and kV/MV
imaging was done once weekly. If, for some reason, the SGRT set up failed,
imaging was done according to the shrinking action level protocol
(sal-protocol).
After
installing our third SGRT system in 2020 and a turnover of staff members, we
received and did more training. First, we started with a vendor training on site.
Online anonymous questionnaires were send out to all RTT`s before this
training. A member of the SGRT core team did then a second training session on
the treatment machine. Here the results of the questionnaires helped us to know
what the training sessions focus needed to be on. After the second session we
sent out the same questionnaire again, the results showed that these trainings
improved the self-assurance and understanding of the system for our staff
members a lot.
Currently
the SGRT is routinely used to setup and gate breast DIBH treatments, setup and
monitor SBRT treatments and its use will be extended to tattoo-less set up of
patients at multiple sites.
After
continuously training, with a SGRT core team and vendor support all staff
members are now able to use the system optimally. We try to use our SGRT
systems for as many setups as possible to optimize the patient comfort.
Patients with a difficult or complicated set up will be evaluated and all staff
members are able to make the decision if SGRT would be suitable. Continuously (re-)training
and a thorough preparation are the key to a successful implementation of SGRT
systems.