A new model of care for rapid lung SABR treatment planning: Evaluation of the advanced RTT role.
Rachael Wooder,
United Kingdom
OC-0464
Abstract
A new model of care for rapid lung SABR treatment planning: Evaluation of the advanced RTT role.
Authors: Rachael Wooder1, Neil Bayman2, Clara Chan2, Joanna Coote2, Corinne Faivre-Finn2, Rhiannon Goldstraw3, Margaret Harris2, Laura Pemberton2, Ahmed Salem2, Hamid Sheikh2, Philip Whitehurst4, David Woolf2
1The Christie NHS Foundation Trust, Christie medical physics and engineering , Manchester, United Kingdom; 2The Christie NHS Foundation Trust, Networked services, clinical oncology, Manchester, United Kingdom; 3The Christie NHS Foundation Trust, Christie medical physics and engineering, Manchester, United Kingdom; 4The Christie NHS Foundation Trust,, Christie medical physics and engineering, Manchester, United Kingdom
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Purpose or Objective
Lung SABR
treatment is managed by a multidisciplinary team to ensure optimal delivery of
care. The incorporation of a lung SABR advanced practitioner (specialist RTT)
role to delineate target volumes and organs at risk (OAR) aims to improve
service efficiency. This study evaluated inter-observer variability as well as target
volume and OAR delineation acceptance.
Material and Methods
An initial
pilot study assessed if there was a statistically significant difference in OAR
delineation between advanced practitioners and radiation oncologists. Following
a training session and the provision of a supporting OAR atlas 2 advanced
practitioners and 5 radiation oncologists delineated the heart, oesophagus,
trachea, proximal bronchial tree and brachial plexus on 8 lung SABR patient CT scans.
These structure sets were analysed in ADMIRE (Advanced Medical Imaging
Registration Engine, Elekta AB, Stockholm, Sweden). The advanced practitioners
OAR were compared against a STAPLE (Simultaneous Truth and Performance Level
Estimation) volume generated from the radiation oncologist’s volumes. Inter-observer
variability was measured using distance to agreement metrics.
PTV and OAR delineation
competency was assessed separately by the completion of 10 Supervised Learning
Event for Radiotherapy Planning Skills (SLERPS). All clinical lung SABR plans
delineated by the advanced practitioner were then subject to peer review. After
6 months the advanced practitioner peer review acceptance rate (proportion of
cases accepted without changes during peer review) was compared against that of
the radiation oncologists.
Results
The pilot study showed there was no significant difference
in OAR delineation between the advanced practitioners and radiation oncologists,
except for the brachial plexus (p = 0.014), highlighting this as an area for training
development (Table 1).
A review of complex lung SABR plans (n=29) found the advanced
practitioner peer review acceptance rate (68%) was comparable with the radiation
oncologists (69%).
Over a 6 month period the advance practitioner delineated
168 patients; this was 79.6% of the SABR patient workload.
Table 1. The median of
the max distance to agreement and range for each OAR across all patients is
shown. Results are compared with an independent t-test.
| Median
mDTA (mm) Consultant Oncologist
| Median
mDTA (mm) Advanced Practitioner
| p
|
Brachial
Plexus
| 3.6
(2.5 – 4.2)
| 5.0
(3.4 – 17.1)
| 0.014
|
Oesophagus
| 1.0
(0.8 – 1.5)
| 1.0
(0.8 – 1.4)
| 0.82 |
Heart
| 1.3
(1 – 1.5)
| 1.5
(0.8 – 2.4)
| 0.49
|
PBT
| 1.2
(0.6 – 1.7)
| 1.3
(0.9 – 1.7)
| 0.8
|
Trachea
| 1.2
(0.8 – 1.6)
| 1.2
(0.6 – 1.8)
| 0.78 |
Conclusion
With
appropriate training the advanced practitioner is competent delineating OAR and
planning target volumes for lung SABR. The lung SABR advanced practitioner role
has successfully reduced clinician workload.