ESTRO 2020 Abstract book

S1133 ESTRO 2020

in the same manner and the purpose of this study is to describe our first experience finding and training future “adapters”. Material and Methods As the first clinic in the world we have implemented a new commercial CBCT based oART solution. The first patient treatments with oART were carried out by one physicist and one physician. After the initial experience, 6 RTTs with different background (2/3 are nurses with add-on radiotherapy training and 1/3 are radiographers) received 2-day general introduction to the system by the vendor. Additionally, the RTTs received more specific training to be able to cover the work carried out by the physicist in the daily practice. The specific training started with the RTTs observing treatments carried out by the physicist and physician for one week. The following week the RTTs got trained on an emulator, simulating the entire workflow for the patients currently undergoing oART, with the focus on speed when propagating the target and OAR on the anatomy of the day. Thereafter, a test was performed to see if the RTTs were able to carry out this part of the adaptation with high speed and accuracy. The RTTs passing the test were certified to treat the specific patients trained on and additional training was carried out for RTTs not passing the test. During the training period it was also identified any additional in-depth gaps in knowledge and this training was later covered by letting the RTTs participate in e.g. delineation and treatment planning. Results RTTs were able to carry out fast and accurate propagation of structures to drive the oART workflow, and thereby pass the test. This was important as it helped bring oART into clinical routine, which would not have been possible if having physicists and physicians online full time for all patients and all fractions. However, some RTTs required additional training before passing the test. In particular, it was necessary to conduct more in-depth training in treatment plan evaluation. Conclusion It has been demonstrated, using a specially designed training program, that RTTs can gain knowledge to cover an important role in oART. Continued hands-on training on a regular basis is important to maintain the quality and speed in the adaptive process and early experience from clinical routine is therefore essential. The training program helped identify the different needs for different RTTs and will be used to train and maintain knowledge of “adapters” in the future. PO-1940 Education and Training of RTTs of the Radiation Oncology Departments in Russia V. Glebovskaya 1 , S. Tkachev 1 , A. Nazarenko 1 , P. Bulychkin 1 , E. Timoshkina 1 , B. Dolgushin 1 , V. Kuprieva 1 , M. Kislyakova 1 1 National Medical Research Center of Oncology named by N.N. Blokhin, Radiation Oncology Department, Moscow, Russian Federation Purpose or Objective In Russia the profession of Radiation Therapy Technologist (RTT) was not officially recognized and there was no education program specified for this profession. The responsibilities of the RTTs were performed by nurses who received on-the-job training, which was done by the senior staff in radiation oncology departments. The on-the-job training period lasted from 6 to 18 months depending on the complexity of equipment. It is quite evident that the increased complexity of equipment and technologies requires the proper education and training of RTTs in Russia. Material and Methods The participation in the IAEA/ESTRO Training Course on Best Practice in Radiation Oncology - Train the RTT in 2013 encouraged us to develop a national education program for RTTs based on the core competences that enabled them to

PO-1938 Implementation of Stereotactic Radiosurgery (SRS) for brain metastases. A. Nielsen 1 , M.B. Andersen 1 1 University Hospital Herlev, Radiotherapy department, Herlev, Denmark Purpose or Objective Stereotactic Radiosurgery (SRS) workflow optimization for the treatment of brain metastases. Material and Methods A multidisciplinary working group consisting of physicians, physicists and Radiotherapy technicians (RTT's) was in September 2018 introduced to HyperArc from Varian and ExacTrac from Brainlab. Prior to implementation of SRS, ExacTrac was already installed in the department, but not yet in clinical use. The physicist group found, that ExacTrac could be used as an independent system for patient positioning and verification before and during treatment. Therefore, the starting point was to combine Cone beam computed tomography (CBCT) and MV-images with ExacTrac. The group was ready to receive the first patient for SRS treatment October 11. 2018 on a Varian Truebeam accelerator equipped with a Millennium 120 multileaf collimator (MLC). The first workflow consisted of CBCT, MV-images and ExacTrac, with a tolerance for treatment of ≤1 mm. in VRT, LNG and LAT as well as ≤1 degree for pitch, roll and rotation. The treatment time was approx. 60-90 min. During this period, physicians, physicists and RTTs were present to approve and give the treatment. After three months and 30-35 patients, the treatment was moved to a Varian Truebeam with a high-definition HD 120 MLC. During this transition, the workflow was changed to include only CBCT and ExacTrac. Tolerances were optimized to ≤0.5 mm in VRT, LNG and LAT and ≤0.5 degrees for pitch, roll and rotation. The treatment time was reduced to approx. 25-45 min. Physicists were responsible for approving the treatment in collaboration with RTTs. Results The combination of CBCT and ExacTrac, makes it possible to correct and to verify the current patient position. In couch positions where the couch angle is 45 or 90 degrees, it is not possible to acquire CBCT. To acquire a CBCT, the couch has first to be moved to 0 degrees and subsequently returned to the treatment position. Any changes to the couch positions are however both time consuming and associated with uncertainty. The changes in procedures reduced the overall treatment time from 60-90 min. to 25- 45 min. and optimized the workflow. Conclusion One year after implementation, 120 patients have been treated. The multidisciplinary working group has gained considerable experience in handling both patients and in the use of HyperArc combined with ExacTrac. The time for treatment has been reduced to approx. 50%. By combining the HyperArc SRS treatment with ExacTrac, it is possible to offer a high-performance treatment with an effective workflow for the benefit of the patient. PO-1939 Training of RTT on CBCT online adaptive radiotherapy - first step finding the future “adapters” L. Andersson 1 , I.L. Gullander 1 , K. Hansen 1 , K. Lundgaard 1 , A. Nielsen 1 , K. Søltoft 1 , A.K. Jacobsen 1 , L. Calmels 1 , R. Leikersfeldt 1 , P. Geertsen 1 , P. Sibolt 1 , D. Sjöström 1 1 University Hospital Herlev, Oncology department, Herlev, Denmark Purpose or Objective Today the RTTs at our institution are trained to evaluate geometrical and anatomical changes on CBCT. Physicists and physicians are only involved in the process when the RTTs see changes that they suspect will have an impact on the patient treatment. Our goal is that the RTTs also will be able to carry out online adaptive radiotherapy (oART)