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2. Programme Methodology

2.1 Setting the standards

Key standards for measuring an IGRT service, derived from ‘On target: ensuring geometric accuracy in radiotherapy’ 6 and the NRIG IGRT report 1 were developed by members of the NRIG IGRT sub-group and the National IGRT leads (Appendix 1). By evaluating compliance with these standards, it was deemed possible to tailor support to the needs of individual centres and evaluate the implementation and uptake of IGRT in England at this time. IGRT is defined in terms of levels of complexity; levels achievable by each provider are dependent on equipment available (Appendix 2). Protocol development was to be a key component in advancing IGRT use, especially in support of local equipment and abilities including measuring, recording and justifying imaging doses. Manufacturer support was targeted to facilitate the acquisition of local data for margin calculations.

2.2 The Programme Support Strategy

Each of the 50 radiotherapy providers in NHS England was asked to invite the IGRT Leads to undertake a review visit. Contact was made with each to agree dates and obtain existing documentation for IGRT related protocols and work instructions, and training documentation. A visit pro-forma was provided if needed (Appendix 3), the majority being one day visits. Initially the IGRT leads conducted five visits together in order to ensure consistency in the support provided during subsequent visits that the IGRT leads performed independently. The structure of the visits was flexible to support the needs of the centre and fit in with the requirements of the clinical practice. 

2.3 IGRT Lead support

Each visit began with an initial meeting with the IGRT MPT to outline the IGRT support programme and to clarify the focus of the support visit. Following a tour of the department, time was spent observing image review within the treatment control rooms before discussion with key staff regarding protocol and IGRT training development. During the visit, the IGRT leads offered time to meet with the medical physics teams to discuss the NRIG IGRT guidance and general implementation issues, specifically the measurement and recording of imaging dose was discussed and also ways in which the medical physics team could support the treatment radiographers’ IGRT training. At the end of each site visit, headline feedback was provided to the IGRT MPT, followed by an official IGRT review visit report within three weeks (Appendix 4). Each report was independently reviewed by the other IGRT Lead prior to submitting to each centre.

Arrangements for continuing support throughout and beyond the programme were also put in place. These included the setting up of the radiotherapy imaging SIG in October 2012 and an IGRT focus group in May 2013, hosted by the support team.

2.4 Physics IGRT support

Support was to be provided remotely via telephone or e-mail to those departments that had requested support. This was to include advice on implementation of quality assurance (QA) programmes for new IGRT equipment and optimisation of existing IGRT related protocols and work instructions. The physics support roles were awarded to radiotherapy physics teams from Addenbrookes, Clatterbridge and Nottingham hospitals.

2.5 Clinical oncologist IGRT support

IGRT support for clinical oncologists was facilitated as part of the support provided to the MPT at each centre. Should specific clinical support have been required, arrangements were in place for the NRIG IGRT report co-chair to facilitate this; however no requests were received.

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