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1. Purpose

The purpose of this report is to provide the radiotherapy community in England with feedback from the findings and outcomes of the NCAT IGRT clinical support programme. It describes and analyses what has been achieved to date and makes recommendations for English radiotherapy services in relation to rapid implementation of the National Radiotherapy Implementation Group (NRIG) report ‘IGRT: Guidance for Implementation and Use’.1

1.1 Introduction

The NRIG IGRT Report1 was published in August 2012. It reaffirms the principles and updates ‘On target: ensuring geometric accuracy’.6The report is a guide for radiotherapy services to choose and implement appropriate IGRT techniques in different clinical situations to ensure the best standard of care. It was written to ‘support the wider adoption and application of IGRT to enable the future implementation of 4D adaptive radiotherapy (4D-ART) throughout England’ .

The report specified that radiotherapy service providers in England should have ‘plans in place to move to routine IGRT over the next 12 months’. A whole pathway approach is recommended for all patients, from treatment planning to delivery. Site-specific IGRT protocols should be in place, customised from the generic protocols in the report. It also recommends having a MPT approach and appointing an IGRT Lead for each professional group to coordinate its use.

NCAT subsequently developed a programme of support to be offered to services to permit rapid implementation. The programme was delivered by an MPT of clinical experts. The MPT comprised two 0.6 WTE radiographer IGRT Leads, whose appointment followed a rigorous selection process. Their role was to provide on-site support for centres in reviewing current practices and developing protocols and work instructions. Medical physics teams from NHS radiotherapy centres in England were invited to tender to provide remote technical support alongside the IGRT Lead radiographers. Following the tender process physics support was provided by three English NHS radiotherapy centres as an outreach service via e-mail or telephone. Specialist oncologist support was directed as appropriate by the co-chair of the NRIG IGRT sub-group.

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