Development and Implementation of an Electronic Education Tool for Volumetric Image Guided Radiation Therapy

TOP RANKED ABSTRACTS Abstract 1 Communicating with Emotional Patients: Thoughts, Skills and Influencing Factors for Ontario Radiation Therapists Presenting author: L. Hulley Radiation Therapist, Princess Margaret Cancer Centre, Canada E-mail address: [email protected] Other authors: A. Cashell and T. Rosewall Purpose: Patients receiving radiation therapy are subject to very high anxiety levels. Therapists are uniquely positioned to support patients as they progress through treatment, but little is known about therapists’ ability to perform this important task. Therefore, this research was designed to describe radiation therapists’ ability to communicate with cancer patients during emotional interactions and to determine what intrinsic and extrinsic factors influence that ability. Methods: A two-phase consecutive mixed methods design was used. Single centre focus groups were used to develop themes for a questionnaire. That questionnaire was then distributed throughout 13 Ontario cancer centres. Themes evaluated included intrinsic factors (demographics, value, support education etc) and extrinsic factors (work environment and resources etc). A validated clinical vignette evaluated actual respondent communication ability. Inferential statistics were used to identify factors that influenced a respondent’s ability to correctly answer the vignette, and their overall satisfaction with provision of support to emotional patients. Results: 199 responses were received from 13 large and small cancer centres, distributed broadly across Ontario. Response rate was low (31%) but wave analysis indicated a lack of non-response bias. Therapists showed a high degree of ability to effectively engage with emotional patients, with minimal use of blocking or controlling behaviors. 84% became radiation therapists to provide care and emotional support, and felt that this should be the focus of the profession. 63% of respondents felt satisfied with the quality of support they provide for emotional patients. Factors shown to significantly influence ability to communicate with emotional patients include personal sociability and experience, organizational provision of time, private space and support (p<0.05). Conclusions: This study demonstrates that radiation therapists are effective at communicating with emotional patients. That ability is significantly influenced by both personal and organizational factors. Most importantly these are experience and time. These findings are congruent with the literature for other professions and are likely generalisable throughout Canada and similar international practice environments. Abstract 2 Development and Implementation of an Electronic Education Tool for Volumetric Image Guided Radiation Therapy Presenting author: W. Li Research Radiation Therapist, Princess Margaret Cancer Centre, Canada E-mail address: [email protected] Other authors: D. Moseley, A. Cashell, S. Foxcroft and J. Wenz Purpose: Image-guided radiation therapy (IGRT) through daily cone-beam computed tomography (CBCT) has significantly impacted the role of the Radiation Therapist at our institution; continuing education is crucial to ensure safe practice of technology in the clinical environment. The purpose of this work was to develop an electronic refresher module for CBCT-practicing Radiation Therapists, with an aim to equip staff with the critical thinking skills and clinical judgment required to operate in a CBCT-IGRT environment. Technique/Process Used: To provide an innovative interface to engage the learner’s interest, a module themed ‘‘Myths in Cone Beam Computed Tomography Practice’’ was developed. The electronic module focused on the technical aspects and fundamental theory of CBCT acquisition, with an

aim to refresh the user’s knowledge and confidence in image fusion and assessment. Specific module objectives were: to ensure accurate use of current IGRT software; to understand the limitations of IGRT software; to appreciate matching strategies and surrogate use; and to support continuing education for staff in the CBCT–IGRT environment. Ten myths were identified in the module, and evidence-based content was referenced within each myth to support theory. Evaluation of the learner was performed through a 12-question quiz at the end of the module. The tool and quiz questions were reviewed and validated by radiation therapy and physics experts in CBCT-IGRT prior to departmental implementation at our institution. Benefits & Challenges: The benefits associated with an electronic learning tool include: delivery of consistent information; reduction in instruction time; convenience and increased accessibility; and no time constraints on the learner as staff can complete the module at their pace. A challenge of the online tool is the need for yearly review to ensure the information provided is current and relevant. Future Work: Future work is planned to evaluate the module and assess its applicability to Radiation Therapists outside our institution. Abstract 3 Surface Mold Brachytherapy for Mycosis Fungoides of the Foot Presenting author: M. Westerland Radiation Therapist - Brachytherapy, Queens University, Cancer Centre of Southeastern Ontario, Canada E-mail address: [email protected] Other authors: C. Jenkins, J. Gooding, C. Gaddess, L. Tomasich, M. Freedman and J. Rose Purpose behind Practice Innovation: The purpose of our innovation was to develop a method of conformal irradiation to the skin of the ankle and foot which, in the past, has proven challenging to treat with external beam radiotherapy. Technique / Process Used: A 51-year-old male with previous history of mycosis fungoides presented with a patch of mycosis fungoides in a previously irradiated region of his left ankle and foot. We elected to treat this lesion with HDR surface mold brachytherapy. On examination, there was an erythematous patch on the left ankle and foot involving the dorsum, lateral aspect, Achilles region and medial malleolar fossa, sparing the sole. The CTV was identified and a thermoplastic mold of the foot was created. 14 flexible brachytherapy catheters were affixed to the mold and a planning CT was performed. The prescription was 2500 cGy in 10 daily fractions to the skin surface. Benefits / Challenges: The total skin target volume to be treated was 50.23 cm3. CTV D90 was 97.2% demonstrating excellent target coverage. The plan also displayed good homogeneity, with mean, maximum and minimum skin doses of 102.6%, 115.2% and 93.6% and a heterogeneity index of 0.97. The surface mold performed well during treatments and was sufficiently durable. Future Work / Implications: In this case report, we have applied surface mold brachytherapy to region of the body that in the past has proven challenging to treat with external beam radiotherapy. We have demonstrated that surface mold brachytherapy is a versatile method of radiotherapy that can achieve excellent target coverage and homogeneity while maximizing normal tissue sparing. ABSTRACTS FOR PROFERRED PAPERS Abstract 4 It’s A Kind Of Magic! The Unexpected Impact of a Systematic In-Patient Controlled Clinical Trial on Patient Well-Being Presenting author: N.C. Bennett Clinical Charge Radiation Therapist and Professional Director, Department of Radiation Therapy, University of Otago, Southern Blood and Cancer Centre, Dunedin Hospital, New Zealand E-mail address: [email protected]

Proceedings from RTi3 2013: Inquire, Inspire, Innovate/Journal of Medical Imaging and Radiation Sciences 44 (2013) 44-58

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