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A new CBCT-guided online adaptive radiotherapy (ART) capable linear accelerator (LINAC) will be delivered to Aberdeen Royal Infirmary in February 2022, with head and neck cancer (H&N) as the first ART tumour site. Upon acceptance focus will inevitably be on the new technology training and refining the ART workflow and as a result centres often experience a delay before moving to a fully RTT-led service. Therefore, an in-house training programme has been designed to enable the workforce to acquire the skills required to independently deliver ART in advance of the system being clinically available.

An in-house training programme has been developed to train RTTs to safely and effectively deliver ART. The training package consists of in-house video presentations on contouring, plan evaluation, and CBCT evaluation in the H&N delivered by a clinical oncologist and presentations on inverse planning and plan evaluation in the H&N from a treatment planning perspective. Practical experience and assessment has been achieved using the CBCTs and treatment plans of 12 previously treated H&N patients. Competency in contour evaluation is achieved by RTTs assessing and editing planning contours deformed onto CBCTs. These sessions are documented and evaluated by a clinical oncologist. Radiotherapy treatment plan comparison exercises have completed and documented with evaluation by a planning physicist. This training will be supplemented by vendor delivered application training after machine delivery. Practical training in the ART workflow will be delivered using deformable phantoms prior to the machine being available for clinical use.

A Multidisciplinary Group including RTTs, radiotherapy physicists and clinicians have been set to assess and monitor the training needs of RTTs in order to implement RTT-led ART. A training package consisting of video lectures, practical training exercises and documented assessment has been developed. Training started 8 months before the delivery of the equipment. Clinical hands-on training will be started after commissioning of the LINAC. A transition phase with physicist and clinician presence at the treatment unit is planned for the first 3 months post implementation.

Extensive training needs to take place before the clinical implementation of RTT-led CBCT-guided adaptive radiotherapy for the treatment of head and neck cancer. RTTs require training in new skills that can be undertaken before the delivery of the hardware to facilitate capacitation. A Multidisciplinary Team approach is necessary to address training needs and grant a safe and successful implementation.