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6. Focus group meeting

A focus group meeting for all of the IGRT Lead therapeutic radiographers and imaging physicists was hosted by the IGRT support team at the end of the support programme in May 2013. This presented an opportunity to feedback the outcomes of the IGRT clinical support programme. All 50 radiotherapy service providers from England were represented at the meeting by at least one member of their IGRT multi professional team. During the meeting, a facilitated workshop was held, the purpose of which was to enable the IGRT support team to gather feedback from the delegates’ perspective regarding the success of the support programme. One hundred and four delegates attended the focus group meeting and worked in groups of approximately eight to discuss their experiences under the four headings below.

6.1 Focus group feedback

The quotes below are the responses from the delegates who participated in the facilitated workshop.

6.1.1    Question 1: Did the NRIG IGRT report change IGRT practice within your centre? If so what change took place?

  • “Helped to focus what we need to do and how it should be done”
  • “Was utilised in developing documentation”
  • “Framed current strategy”
  • “Made IGRT a priority topic”
  • “Supported business cases for new staff roles”
  • “Confidence that underlying principles are sound and affirmed belief that more resources are needed”.

In summary, the report has identified IGRT as a priority focus within local implementation strategies.

6.1.2    Question 2: Do you think your IGRT service has changed as a result of the IGRT support programme? If so, how as it changed?

  • “Focal point for development within our department”
  • “Helped with development of training”
  • “Visit was a good audit of imaging practice”
  • “Pushed us into going to the next level”
  • “Streamlining of processes to increase efficiency”
  • “Motivation to reach the end point”
  • “Using recommendations to set-up IGRT programme”
  • “Initiated analysis of SSE data for local margins”
  • “Provided momentum for management to move forward”
  • “Good to know we are doing what we could with equipment we have”.

In summary, audit of local practice during the IGRT review visits has enabled centres to streamline their service and focus on areas for development.

6.1.3    Question 3: Thinking about both the IGRT report and support programme

  1. What did they do well to support IGRT implementation?
  • “Outlined a clear framework to follow”
  • “Gave the IGRT team a voice”
  • “Good representation of national programmes”
  • “1-1 information”
  • “Development of training packages”
  • “Feedback to management validated work done”
  • “ Support from team even when don’t have up to date equipment”
  • “Team willing to answer questions and share ideas laid out information for training very well”
  • “Helped to motivate and focus”.
  1. What could they have done better to support IGRT implementation?
  • “There is a need for national guidance/ standard”
  • “Should be more prescriptive, some departments still doing their own thing”
  • “Funding of a rolling programme”
  • “Library of protocols”
  • “Longer visits to provide training and support”.

In summary, feedback from delegates regarding positive support that they had received included developing training programmes, motivation and focus on IGRT development. An increase in continued support would help to build on the success of the programme.

6.1.4   Question 4: NRAG recommended the implementation of Adaptive Radiotherapy (ART).

  1. What are the challenges for your centre now?
  • “Resources for implementing new technology”
  • “Getting management to understand needs”.
  1. What are your plans locally to overcome these challenges?
  • “Prioritise limited resources”
  • “Appoint specialist in IGRT”
  • “Business case for equipment and additional staff”
  • “Educate patients to demand advanced techniques”.
  1. Is there any further national support which would help?
  • “Need penalties for not using imaging”
  • “Logs of national equipment and techniques”
  • “Library of datasets for training”
  • “National group to continue with current work and future development”
  • “IGRT sessions in national conferences”.

In summary, to enable ART to be successfully embedded into routine clinical practice, there needs to be more resources made available that include time, staffing and equipment.  The implementation of ART must be guided by a national support programme.

6.2 Feedback for radiotherapy equipment manufacturers

Delegates to the focus group were asked to comment on their experience of applications training and any desirable future developments. These are summarised and included within the recommendations in section 8.

Delegates were also asked to put forward a wish list for future IGRT equipment developments that included:

  • “Automatic recording of imaging dose, exposures, exposure  factors, modality for dose reporting units”
  • “Remote access for imaging, patient transfer, off-line  review, training, remote terminal access”
  • “Access to data for systematic error and population trend analysis, including statistical analysis tools within the oncology management system”
  • “Dose overlays, colour washes, change colour of  daily scans”
  • “Auto analysis of QA images”
  • “Secondary terminals for off-line work, training, image preparation”
  • “Reliable CT numbers, CT reconstruction algorithm for accurate Hounsfield Units”
  • “Database of calibration data to allow plots of change  with time”
  • “Post processing software on CBCT for ART”
  • “Increase in guidance on QA”
  • “AEC for Cone Beam CT optimisation”

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