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Standardization and Division of Therapists’ Responsibilities in Treatment Delivery
Poster Viewing E547
Volume 96 Number 2S Supplement 2016 in the “standard” carepath (nZ450; 68.9%). Only 37 (5.7%), 38 (5.8%), and 37 (5.7%) cases were in the “urgent,” “non-emergent palliative,” and “emergent” carepaths, respectively. A total of 31 patients (4.7%) required major changes and were represented after the suggested modifications. 36 patients (5.5%) had minor recommendations that did not require repeat presentation. 82 (12.6%) cases had minor documentation-related recommendations that did not require any editing of the contours. Conclusion: The RVS system can be used to create carepaths to facilitate daily prospective contouring and planning rounds. Pretreatment, and most often, preplanning review of contours and directives allows for more detailed review and changes to be made early on in the treatment planning process. Author Disclosure: M. Surucu: Research Grant; Varian Medical Systems. W. Small: Research Grant; Varian Medical Systems. J.C. Roeske: Research Grant; Varian Medical Systems. J. Price: None. C. Perino: None. T.F. McCoo: None. A.A. Solanki: None.
3341 Standardization and Division of Therapists’ Responsibilities in Treatment Delivery J.O. Galle,1 T. Butte,2 J. Holliday,2 D. Long,2 T. Hunt,2 R. Shapiro,2 B.A. Lulu,3 and H. Fosmire2; 1Indiana University Radiation Oncology, Indianapolis, IN, 2Richard L. Roudebush VA Medical Center, Indianapolis, IN, 3Indiana University Radiation Oncology, Indianapolis, IN, United States Purpose/Objective(s): Misadministrations can occur as a result of errors made by radiation therapists when delivering therapeutic radiation by linear accelerators. In many practices, the responsibilities of the treatment team are not formally divided and standardized. This can lead to misunderstanding and confusion regarding which aspect of the treatment each therapist is responsible, which may increase the risk of the treatment plan being administered improperly. Materials/Methods: This potential patient safety issue was identified in our continuous daily improvement huddle, a comprehensive staff meeting attended by radiation oncologists, radiation therapists, dosimetrists, medical physicists, and nurses. A task group within the department with the help of a hospital systems redesign coordinator designed a process flow map focusing on the decision tree in radiation delivery. By analyzing the process flow map from a patient’s perspective, a model dividing and standardizing the therapist’s responsibilities was created. Results: A 3 therapist team on each linear accelerator was thought by the task group to be ideal. Each team is divided into three distinct roles: Navigator, Pilot, and Co-Pilot. After a first time out focusing on patient identification, each member helps position the patient on the treatment couch. Once the therapists leave the vault a second time out is called by the Co-Pilot which verifies the correct treatment plan is loaded. The Pilot assumes control of the treatment console and is primarily responsible for operating the on board imaging and the beam on/off function. The Navigator’s primary role is it to monitor the patient throughout the entire treatment course. After leading the time out, the Co-Pilot assures the multileaf collimators are moving appropriately and documents the fraction into the medical record at treatment completion. Conclusion: The treatment responsibilities of the radiation therapy team can be divided and standardized using the Navigator, Pilot, and Co-pilot model. This model helps reduce uncertainty regarding responsibility during treatment delivery, with the goal of reducing the incidence of misadministration. Author Disclosure: J.O. Galle: None. T. Butte: None. J. Holliday: None. D. Long: None. T. Hunt: None. R. Shapiro: None. B.A. Lulu: None. H. Fosmire: None.
3342 Is Postsurgical Imaging Necessary for Heterotopic Ossification Prophylaxis? C.A. Lehocky, S.M. Glaser, and J.C. Flickinger, Sr; Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA Purpose/Objective(s): Heterotopic ossification (HO) following trauma at joints such as the hip can be prevented through prophylactic external beam radiotherapy (XRT). Treatment typically involves pre-operative imaging, surgery, pre-XRT imaging, and lastly XRT. We analyzed if XRT treatment planning for HO prophylaxis can be achieved through pre-operative imaging alone, without the need for independent XRT CT-simulation. Materials/Methods: We identified our most recent nine patients who received hip joint HO prophylaxis planned using post-op CT-simulation, who had available pre-op imaging. Using the pre-surgical CT scans, a new treatment plan was independently generated using field boundaries specific to each patient’s anatomy. Originally delivered doses (7-8 Gy) and beam energies (15-23 MV) were maintained. The clinical target volume (CTV) (region at high risk for HO formation) was contoured on the pre- and postsurgical CTs. The newly generated pre-operative plans were fused and transferred to the post-surgical CT, including the prescribed monitoring units (MU). We thus were able to gather data on how well the plans generated on pre-op imaging covered the post-op target and could compare attributes of the theoretical pre-op plan with what was actually delivered using the post-op CT-simulation imaging. Paired-sample Wilcoxon signed rank test was used to compare plans. Results: Median treatment field area was 133.9 cm2 on pre-surgical and 166.32 cm2on pre-XRT scans (P Z 0.66). Patient thickness (separation) was 21.7 cm on post- and 21.9 cm on pre-surgical CT (P Z 0.86). Median MU from the actual plan were 406.5 MU, compared to 391.5 MU on preop plans (P Z 0.024). In post-op planning, the median hot spot was 106.3% and the CTV receiving 95% of the prescribed dose (V95) was 99.0%, while pre-op plans produced a hot spot of 105.6% (P Z 0.56) and V95 of 98.7% (P Z 0.17). After the pre-op plan was transferred to the CTsim and recalculated, the median patient thickness 21.9 cm (P Z 0.89), maximum dose 7.67 Gy (P Z 0.77) and V95 99.2% (P Z 0.14) did not significantly differ from the actual XRT plans. Furthermore, all patients’ V95exceeded 95% when the theoretical pre-op plan was calculated on postop CT-simulation imaging. Conclusion: This preliminary study indicates that post-operative imaging solely for XRT planning may be unnecessary and that pre-operative imaging may suffice. Since many of these patients experience severe pain with movement eliminating this additional CT-simulation can reduce patient discomfort, as well as radiation exposure, operating costs and procedural turnaround time. Author Disclosure: C.A. Lehocky: None. S.M. Glaser: None. J.C. Flickinger: None.
3343 Clinical Outcome of Pencil Beam Scanning Proton Therapy for Children With Rhabdomyosarcoma D. Leiser,1,2 R.S. Malyapa,2 F. Albertini,3 U. Kliebsch,2 L. Mikroutsikos,2 P. Morach,2 B. Bojaxhiu,1,2 A. Bolsi,3 M. Walser,3 B. Timmermann,4 A.J. Lomax,3 R. Schneider,3 and D.C. Weber3,5; 1Department of Radiation Oncology. Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland, 2Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland, 3Paul Scherrer Institute, Villigen, Switzerland, 4 Clinic for Particle Therapy, University Hospital Essen, West German Proton Therapy Center Essen (WPE), Essen, Germany, 5Department of Radiation Oncology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland Purpose/Objective(s): To assess the clinical outcome of children with rhabdomyosarcoma (RMS) treated with pencil beam scanning (PBS) proton therapy (PT).
Volume 96 Number 2S Supplement 2016 in the “standard” carepath (nZ450; 68.9%). Only 37 (5.7%), 38 (5.8%), and 37 (5.7%) cases were in the “urgent,” “non-emergent palliative,” and “emergent” carepaths, respectively. A total of 31 patients (4.7%) required major changes and were represented after the suggested modifications. 36 patients (5.5%) had minor recommendations that did not require repeat presentation. 82 (12.6%) cases had minor documentation-related recommendations that did not require any editing of the contours. Conclusion: The RVS system can be used to create carepaths to facilitate daily prospective contouring and planning rounds. Pretreatment, and most often, preplanning review of contours and directives allows for more detailed review and changes to be made early on in the treatment planning process. Author Disclosure: M. Surucu: Research Grant; Varian Medical Systems. W. Small: Research Grant; Varian Medical Systems. J.C. Roeske: Research Grant; Varian Medical Systems. J. Price: None. C. Perino: None. T.F. McCoo: None. A.A. Solanki: None.
3341 Standardization and Division of Therapists’ Responsibilities in Treatment Delivery J.O. Galle,1 T. Butte,2 J. Holliday,2 D. Long,2 T. Hunt,2 R. Shapiro,2 B.A. Lulu,3 and H. Fosmire2; 1Indiana University Radiation Oncology, Indianapolis, IN, 2Richard L. Roudebush VA Medical Center, Indianapolis, IN, 3Indiana University Radiation Oncology, Indianapolis, IN, United States Purpose/Objective(s): Misadministrations can occur as a result of errors made by radiation therapists when delivering therapeutic radiation by linear accelerators. In many practices, the responsibilities of the treatment team are not formally divided and standardized. This can lead to misunderstanding and confusion regarding which aspect of the treatment each therapist is responsible, which may increase the risk of the treatment plan being administered improperly. Materials/Methods: This potential patient safety issue was identified in our continuous daily improvement huddle, a comprehensive staff meeting attended by radiation oncologists, radiation therapists, dosimetrists, medical physicists, and nurses. A task group within the department with the help of a hospital systems redesign coordinator designed a process flow map focusing on the decision tree in radiation delivery. By analyzing the process flow map from a patient’s perspective, a model dividing and standardizing the therapist’s responsibilities was created. Results: A 3 therapist team on each linear accelerator was thought by the task group to be ideal. Each team is divided into three distinct roles: Navigator, Pilot, and Co-Pilot. After a first time out focusing on patient identification, each member helps position the patient on the treatment couch. Once the therapists leave the vault a second time out is called by the Co-Pilot which verifies the correct treatment plan is loaded. The Pilot assumes control of the treatment console and is primarily responsible for operating the on board imaging and the beam on/off function. The Navigator’s primary role is it to monitor the patient throughout the entire treatment course. After leading the time out, the Co-Pilot assures the multileaf collimators are moving appropriately and documents the fraction into the medical record at treatment completion. Conclusion: The treatment responsibilities of the radiation therapy team can be divided and standardized using the Navigator, Pilot, and Co-pilot model. This model helps reduce uncertainty regarding responsibility during treatment delivery, with the goal of reducing the incidence of misadministration. Author Disclosure: J.O. Galle: None. T. Butte: None. J. Holliday: None. D. Long: None. T. Hunt: None. R. Shapiro: None. B.A. Lulu: None. H. Fosmire: None.
3342 Is Postsurgical Imaging Necessary for Heterotopic Ossification Prophylaxis? C.A. Lehocky, S.M. Glaser, and J.C. Flickinger, Sr; Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA Purpose/Objective(s): Heterotopic ossification (HO) following trauma at joints such as the hip can be prevented through prophylactic external beam radiotherapy (XRT). Treatment typically involves pre-operative imaging, surgery, pre-XRT imaging, and lastly XRT. We analyzed if XRT treatment planning for HO prophylaxis can be achieved through pre-operative imaging alone, without the need for independent XRT CT-simulation. Materials/Methods: We identified our most recent nine patients who received hip joint HO prophylaxis planned using post-op CT-simulation, who had available pre-op imaging. Using the pre-surgical CT scans, a new treatment plan was independently generated using field boundaries specific to each patient’s anatomy. Originally delivered doses (7-8 Gy) and beam energies (15-23 MV) were maintained. The clinical target volume (CTV) (region at high risk for HO formation) was contoured on the pre- and postsurgical CTs. The newly generated pre-operative plans were fused and transferred to the post-surgical CT, including the prescribed monitoring units (MU). We thus were able to gather data on how well the plans generated on pre-op imaging covered the post-op target and could compare attributes of the theoretical pre-op plan with what was actually delivered using the post-op CT-simulation imaging. Paired-sample Wilcoxon signed rank test was used to compare plans. Results: Median treatment field area was 133.9 cm2 on pre-surgical and 166.32 cm2on pre-XRT scans (P Z 0.66). Patient thickness (separation) was 21.7 cm on post- and 21.9 cm on pre-surgical CT (P Z 0.86). Median MU from the actual plan were 406.5 MU, compared to 391.5 MU on preop plans (P Z 0.024). In post-op planning, the median hot spot was 106.3% and the CTV receiving 95% of the prescribed dose (V95) was 99.0%, while pre-op plans produced a hot spot of 105.6% (P Z 0.56) and V95 of 98.7% (P Z 0.17). After the pre-op plan was transferred to the CTsim and recalculated, the median patient thickness 21.9 cm (P Z 0.89), maximum dose 7.67 Gy (P Z 0.77) and V95 99.2% (P Z 0.14) did not significantly differ from the actual XRT plans. Furthermore, all patients’ V95exceeded 95% when the theoretical pre-op plan was calculated on postop CT-simulation imaging. Conclusion: This preliminary study indicates that post-operative imaging solely for XRT planning may be unnecessary and that pre-operative imaging may suffice. Since many of these patients experience severe pain with movement eliminating this additional CT-simulation can reduce patient discomfort, as well as radiation exposure, operating costs and procedural turnaround time. Author Disclosure: C.A. Lehocky: None. S.M. Glaser: None. J.C. Flickinger: None.
3343 Clinical Outcome of Pencil Beam Scanning Proton Therapy for Children With Rhabdomyosarcoma D. Leiser,1,2 R.S. Malyapa,2 F. Albertini,3 U. Kliebsch,2 L. Mikroutsikos,2 P. Morach,2 B. Bojaxhiu,1,2 A. Bolsi,3 M. Walser,3 B. Timmermann,4 A.J. Lomax,3 R. Schneider,3 and D.C. Weber3,5; 1Department of Radiation Oncology. Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland, 2Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland, 3Paul Scherrer Institute, Villigen, Switzerland, 4 Clinic for Particle Therapy, University Hospital Essen, West German Proton Therapy Center Essen (WPE), Essen, Germany, 5Department of Radiation Oncology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland Purpose/Objective(s): To assess the clinical outcome of children with rhabdomyosarcoma (RMS) treated with pencil beam scanning (PBS) proton therapy (PT).