Future of Multidisciplinary Team in the Context of Adaptive Therapy

Training for tomorrow: Establishing a worldwide curriculum in online adaptive radiation therapy

This commentary discusses the implementation of online adaptive radiation therapy (oART) in cancer treatment within the context of current challenges faced by radiation therapy professionals. oART enables modifications to treatment plans based on daily imaging, enhancing target accuracy while minimising harm to surrounding organs. Despite its potential to improve patient outcomes, the application of oART is hindered by notable barriers, particularly in human resources. A global shortage of skilled radiation professionals such as radiation therapists or therapeutic radiographers (RTTs), medical physicists and radiation oncologists, along with training challenges in online adaptive techniques, hinders oART implementation and sustainability. Moreover, geographical disparities limit access to advanced training programs, leaving RTTs and their patients in underserved regions at a disadvantage. There is growing global evidence that RTTs are being successfully trained to lead adaptive fractions in both cone-beam computed tomography and magnetic resonance imaging guided oART. This commentary proposes the notion of standards for a global training curriculum to address barriers and expand RTT capabilities in delivering oART. By leveraging artificial intelligence and fostering interdisciplinary collaboration, the radiation therapy field can enhance efficiency and accuracy in oART. Successful training models from leading institutions illustrate the importance of hands-on experience and ongoing mentorship. A coordinated effort among stakeholders is essential to establish a comprehensive global training framework, ultimately improving patient access to oART and elevating standards of care worldwide.

Pan-Canadian assessment of image guided adaptive radiation therapy and the role of the radiation therapist

Purpose

Adaptive radiation therapy (ART) is a close-looped process where anatomic changes observed during treatment are identified, leading to plan modification prior to treatment delivery. The aim of this study was to explore the status of ART across Canada and review the impact of adaptive technologies on the roles and responsibilities of Radiation Therapists (RTTs).

Materials and Methods

Study information and a link to a 30-question survey was sent via email to the RTT manager of all cancer centres across Canada (n = 48). The survey questions included centre demographics, presence of offline and/or online ART activities as standard of care, corresponding roles and responsibilities of the multidisciplinary team, and training activities. The survey was administered electronically and closed after a 3-week accrual period. Responses were analyzed using descriptive statistics.

Results

Thirty-two out of 48 centres responded across all ten provinces (67 % response rate). Twenty-five centres (78 %) currently perform ART, all of which practiced offline ART while 5 practiced online ART. Most common responses for lack of ART were 'technical limitations' and 'lack of resources'. RTTs are responsible for 50 % (offline) versus 58 % (online) ART respectively, with the most notable change being the addition of target delineation to their daily practice.

Conclusions

The status of ART varies across Canada. Offline ART is commonly practiced, but online ART remains an infrequent process due to technical limitations and lack of resources. As centres move towards implementing online ART, the role of the RTT will need to be redefined with corresponding upskilling to support the emergent treatment paradigm.