Case report: A novel model for educating radiation therapists in small countries: Case study of the "Train the Trainer" initiative in Israel

Introduction

Israel, as a small country faces many challenges to deliver quality RTT education. As technologies evolve, the need for RTT education becomes acute. This resulted in the Ministry of Health, IAEA and ESTRO running the train the trainers (TTT) program in a unique format.

Method

An expanded TTT program was run in Israel. This resulted in the establishment of the National Center for Radiotherapy Education (NCRE). Key elements of the NCRE include national leadership, high-tech teaching environment, simulation based teaching methodologies, and evidence based education.

Educational outcomes of the RTT course run in the NCRE were measured and statistically analysed.

Results

The measurement of educational outcome was highly significant (p < 0.00001). The feedback from the course was very positive, with a high aggregate data mean score for all questions pertaining to the effect the course has on work, and efficient use of time.

Discussion

The success of the RTT course of the NCRE is evident from the results. The impact of the TTT program went beyond RTT education, as the NRCE is a national radiotherapy education resource, utilized by all radiotherapy professionals.

Conclusion

More knowledgeable RTTs may be able to work in advanced roles, taking on tasks from other sectors in the department; this could improve the efficiency of patient care and improve the safety of radiotherapy delivery.

A study to establish international diagnostic reference levels for paediatric computed tomography

The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.

IAEA survey of paediatric computed tomography practice in 40 countries in Asia, Europe, Latin America and Africa: procedures and protocols

OBJECTIVE

To survey procedures and protocols in paediatric computed tomography (CT) in 40 less resourced countries.

METHODS

Under a project of the International Atomic Energy Agency, 146 CT facilities in 40 countries of Africa, Asia, Europe and Latin America responded to an electronic survey of CT technology, exposure parameters, CT protocols and doses.

RESULTS

Modern MDCT systems are available in 77 % of the facilities surveyed with dedicated paediatric CT protocols available in 94 %. However, protocols for some age groups were unavailable in around 50 % of the facilities surveyed. Indication-based protocols were used in 57 % of facilities. Estimates of radiation dose using CTDI or DLP from standard CT protocols demonstrated wide variation up to a factor of 100. CTDI(vol) values for the head and chest were between two and five times those for an adult at some sites. Sedation and use of shielding were frequently reported; immobilisation was not. Records of exposure factors were kept at 49 % of sites.

CONCLUSION

There is significant potential for improvement in CT practice and protocol use for children in less resourced countries. Dose estimates for young children varied widely. This survey provides critical baseline data for ongoing quality improvement efforts by the IAEA.