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3. IGRT support survey

In the summer of 2012 all NHS radiotherapy centres in England were surveyed using Survey Monkey™ to obtain base line data about IGRT capability and to determine the level of support they were likely to require.  Invitations were sent to heads of service for both therapeutic radiography and radiotherapy medical physics with the request that the survey was completed collaboratively as a single response to ensure accuracy of the data provided. Forty-seven out of 50 centres provided data (Appendix 5). However, three centres completed more than one response, suggesting that the proposed collaboration had not occurred. Each had answered questions on behalf of the other with different responses as to the current position and support requirements for their centre.

Centres were asked to name equipment with IGRT capability, detail its use, the roles and responsibilities of key staff, whether there was an IGRT MPT in place and specifically what support they felt they required.

Additionally, the survey introduction encouraged each centre to identify an IGRT specialist to act as a co-ordinating voice in correspondence with the IGRT support team and also enabled the support team to prioritise visits according to needs indicated in the survey.

3.1 Survey findings (n = 47)

3.1.1 IGRT Equipment Capability

The data provided by respondents made it difficult to establish a clear picture of IGRT capability. Three centres did report that they had had Cone Beam Computed Tomography (CBCT) equipment for up to two years and that it had still not been fully commissioned but there was little detail to support why this was the case.

3.1.2 IGRT MPT, Training and Responsibilities

Forty-two centres reported that they had an IGRT MPT in place. Fourteen centres reported that they did not have clearly defined roles and responsibilities for IGRT within their departmental protocols. The absence of an IGRT MPT would seem to explain the absence of clearly defined roles and responsibilities within these centres. Further discussion around this issue following site visits can be found in section 4 of this report. 

Forty-three centres had staff that had attended accredited IGRT courses either nationally or internationally, recognising that such training is essential for those that are responsible for both developing and delivering IGRT training in the workplace and implementing IGRT working practices. In some centres these individuals were the IGRT lead radiographer and/or physicist, with others reporting that several staff had attended such courses.

Fifteen centres reported that they did not have a specific IGRT training package in place, six of these being centres that did not have volumetric imaging equipment. It is unclear from this figure whether centres felt that they literally did not have any IGRT training or whether they felt that what they had was not adequate. Ten centres in total responded as having no volumetric imaging capability at the time of the survey with four of these centres expecting to have CBCT systems commissioned and in clinical use by the end of 2012. The relationship between access to volumetric imaging and the absence of an IGRT training package is highlighted by Figure 1. The larger segment (35) indicates those centres that reported having IGRT training programmes in place; the smaller segment (15) indicates those centres that reported having no IGRT training programme.

Figure 1: Access to volumetric imaging and training programmes

Thirty-six centres responded that they were satisfied with the level of physics applications training and 42 centres were satisfied with the radiographer applications training provided by the manufacturer.

3.1.3 Support

Twenty-one centres responded to say they would like IGRT support from the NCAT IGRT physics team (Appendix 6). Five specific areas of support were requested: commissioning equipment (n=4), developing QA protocols for maintenance of IGRT equipment (n=8), developing QA protocols for measurement of imaging dose (n=12), optimisation of imaging protocols (n=18) and specification of test equipment (n=6). Some centres requested support for each of these areas (Figure 2).

Further analysis of the survey responses indicated that some of these centres were merely seeking an independent review of their practice and felt comfortable with their current IGRT QA programme.

Figure 2: Areas highlighted for physics IGRT support

Specific support requests included IGRT protocol and training documentation review, advice regarding the implementation of IGRT for stereotactic ablative radiotherapy (SABR) and imaging with implanted fiducial markers for prostate radiotherapy.

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