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5. Summary of Review Visit Findings

5.1 Compliance with Key Standards for IGRT

Figure 5 illustrates compliance with the 16 criteria selected to measure IGRT implementation across the 50 providers by the end of the programme. Local planning margin (n=31) and risk assessment (n=31) have the lowest compliance.  MPT working is seen across all sites however not all define their roles and responsibilities clearly.

 A number of support themes emerged during visits, among them the need to define roles and responsibilities within imaging for all professional groups including a vision and strategy for implementing all aspects of imaging developments.

A number of centres did not meet the guidelines laid out within the NRIG IGRT report1 and ‘On target’ 6and needed support in developing appropriate site specific protocols. These included the clarification of systematic set-up error  (SSE) correction terminology; the correct application of the No Action Level (NAL) protocol was frequently misinterpreted and those centres claiming to be using this protocol were, in fact, employing an action level threshold related to their local site-specific patient set up tolerances.

There is limited evidence in the community of recording individual patient imaging doses with some centres using manufacturer pre-set values without local confirmation. Reg 7 3(b) of IRMER requires that an “assessment of patient dose” is undertaken as well as ensuring that dose optimisation takes place.  A number of centres requested advice from the physics support teams and the radiographer leads as to where and how imaging dose should be recorded. Further work is required to reach a consensus on this and to rationalise dose recording across pre-treatment and treatment imaging.

Developing local IGRT training programmes is a major priority with some centres sharing their programmes to support development; those creating the required documentation are encouraged to refer to the framework within the guidelines (Appendix 7) and utilise the e-LfH IGRT module.4 Centres need to pay particular attention to the image optimisation training provided to radiographers, so that images can be optimised for image analysis purposes. This skill was not widely evident during the IGRT review visits and recommendations were provided to individual centres where this was seen to be an issue. Centres have been encouraged to consider whether the environment in which image review is conducted is optimal.

The findings indicate that there is evidence of good practice and the majority of radiotherapy centres in England are progressing with the adoption and application of IGRT. The collection and analysis of data needs to improve and routine risk assessments should be undertaken.

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