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ESTRO 36 2017
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techniques for online tumour tracking will be presented
and a discussion on the required quality assurance for
application in patient treatments. Many motion
monitoring techniques may be utilised for online tumour
tracking including various internal and external tracking
techniques or combinations of the two. Online tumour
tracking includes simple adaptation methods such as
gating and breathhold techniques which minimise the
motion present during the time that the treatment beam
is on. However, the main focus in this talk will be on
techniques leveraging treatment units specifically
designed for intrafraction motion compensation. These
include online tumour tracking with robotic (CyberKnife)
and gimballed (Vero) linacs, as well as with standard linacs
utilising a multi-leaf collimator (MLC) or a robotic couch.
The talk will conclude with a discussion of important
factors to be considered in the design of quality assurance
programmes for online tumour tracking.
Symposium: Particle theraphy: how to start up and
carry out daily clinical practice
SP-0215 RTTs skills for proton therapy – how and what
to include in a learning programme
A. Boejen
1
, T. Trans
1
, M. Madsen
1
, D. Mortensen
2
1
Aarhus University Hospital, Department of Oncology,
8000 Aarhus C, Denmark
2
Aarhus University Hospital, The Danish Centre for
Particel Therapy, 8000 Aarhus C, Denmark
Treatments with particle therapy (PT) will be common
daily practice in more clinics and countries in Europe in
the coming years. At Aarhus University Hospital, the
Danish Centre for Particle Therapy is currently under
construction, and installing and monitoring of equipment
for dose delivery will start June 2017. All clinical
procedures, such as CT-scanning, dose planning and
immobilisation, must be ready for practice, as well as
guidelines e.g. for patient pathway, correct dose delivery,
image guidance, patient care and management.
Interdisciplinary groups are starting to build up a new
field. All professions must be qualified in their field to
secure patients receive a correct treatment, and all
centres are organising education and learning
programmes.
This presentation will share our experiences concerning
development of skills, learning objects and educations
programmes for experienced radiation therapists (RTTs) at
a centre under establishment, which is expected to be in
operation autumn 2018. The presentation will also cover
experiences on establishing learning programmes in an
interdisciplinary group with no clinical experience in
proton therapy and no available online education
programmes or documentation of the competencies for
RTTs on PT.
To secure an international perspective ESTROs Core
Curriculums[1] were used as inspiration to build up
learning levels and expected outcomes concerning
knowledge, skills and attitudes using Bloom's taxonomy[2].
The taxonomy should be used in the field of clinicians,
physicists and RTTs, while harmonisation was expected to
be useful in the development of interdisciplinary
programmes. Hiring of RTTs will start in spring 2018 and is
estimated to be expanded with opening of additional
gantries every six to twelve months until full employment
in 2023. The final learning programme has to consider the
progressive increase in employed RTTs and ensure the
right competencies for RTTs within treatment
preparation, dose delivery and patient care.
The preliminary tasks for RTTs were described first and
followed by a long list defining specific competencies
regarding e.g. management of positioning, fixation,
ProBeam, IGRT and side effects. There has to be a
constant focus on the differences between conventional
radiotherapy and PT. The systematic plan with learning
levels in all contexts has helped to visualize learning
methods in each competence. A 3D virtual ProBeam
(VERTUAL Ltd, UK) is being developed and will be
integrated together with an IT- laboratory (Varian VMS) as
part of the learning features. Interdisciplinary education,
supervision and collaboration with physicists and clinicians
are important. Observer ships at experienced particle
centres and weekly conferences with evaluation of proton
plans aimed at learning have contributed to the learning
process.
[1] The updated ESTRO core curricula 2011 for clinicians,
medical physicists and RTTs in radiotherapy/radiation
oncology. Eriksen JG et al, Radiother Oncol. 2012
Apr;103(1):103-8. doi: 10.1016/j.radonc.2012.02.007.
[2] D.R. Krathwohl, A revision of Bloom’s taxonomy: an
overview, Theory Pract, 41 (2002), pp. 212–218
SP-0216 How to start up a proton therapy department
– the point of view of a RTT
M. Furberg
1
1
Skandionkliniken, Uppsala, Sweden
Short history, organization and distributed
competence
.
The Swedish proton project started in 2003 with a
formation of SPTC (Swedish proton therapy center), which
consisted of members of the medical profession. They
advocated for a national proton clinic in Sweden, and in
2005 all 21 county politicians agreed that we should have
a proton therapy clinic in Sweden. In 2006 the seven
counties that have university hospitals formed a municipal
federation for advanced radiotherapy and decided that
they would build a proton clinic that would be located in
Uppsala, in the middle of Sweden. They also decided that
the clinic would be based on a distributed competence
concept, which means that all expertise available in the
country at university clinics will be used and that all
preparation for the patient fixation, CT scanning, target
delineation and treatment planning would be conducted
at university clinics, while the treatment will be delivered
at the proton facility. In practice, this means that the
university hospitals would make a photon and a proton
plan for each of the patients to see whether there is an
advantage for protons for the diagnoses that had clinical
proton protocols. These plans are presented on a national
multidisciplinary video conference where the plans are
compared and the clinicians jointly take the decision
whether the patient should receive proton therapy. In this
case the patient is called to the clinic while fixation
devices and the proton plans are sent to the facility. The
clinic uses permanent staff, including all RTT/nurses, two
permanent physicians and three permanent medical
physicists, as well as rotating radiation oncologists and
medical physicists from the university hospitals.
Process description and risk analysis
.
The first RTT/nurse was hired a year and a half before the
start of treatments, who along with a national multi-
disciplinary working group devised a process description
and a risk analysis based on the proposed patient course
from the university clinics to the Skandion Clinic and back.
Two RTT/nurses employed one year before the start of
treatments worked together in various national working
groups to develop procedures, workflows, train in and
configure the systems to be used in the process such as
the Mosaiq OIS (oncology information system), patient
information system and fixation procedures. Three
RTT/nurses joined six months before the start of
treatments with responsibility to work up procedures and
guidelines for the coordinator, the procedures and
guidelines for pediatric treatments and for nursing care at
the facility. An important part was dedicated to writing
all the required documents for new processes that has to
be developed from scratch, so a group of RTT/nurses and