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Appendix 7 - IGRT Training Programme Framework

The IGRT training programme should cover 3 aspects

Acquisition process – this could be covered in a formal presentation either delivered face to face or electronically. This should be accompanied by appropriate written documents which could be followed when practicing using a phantom. Issues relating to imaging dose and quality should also be included

Analysis process – cover in presentation and written instructions. A database of patient images for all IGRT techniques and anatomical sites should be available for practice

Action - guidance for the timing and frequency of actions with explanation of the site specific protocols


Assessment can be a combination of self-assessment and peer assessment. For example workbooks could be used to explain each IGRT technology system and the applications with self-assessment of baseline skills and further reading to develop greater understanding. The workbooks, ideally to be developed by the core site specialist multi-professional group, could be general eg use of kV CBCT or site specific for complex cases eg adaptive bladder, stereotactic lung. Competency assessments using a database of images to match against a standard can then also be used with a predetermined threshold for acceptable clinical competence.

Suggested contents of a workbook:

Relevant journal articles for use of the technique for that anatomical site

CT Anatomy (and test).

The use of VERT should be considered and utilised as appropriate. Otherwise a treatment planning system may be used where the GTV, OAR would be pre-outlined for reference. The trainee could contour the structures with the reference contours turned off and then compare.

Detail of staging, epidemiology/aetiology, current management and treatment options

Relevant clinical trials for this anatomical site

Assessment of competency which could include:-

(i) Self-assessment of baseline skills with questions to verify learning

(ii) Record of image analysis registrations

(iii) Specific learning objectives

(iv) Portfolio of relevant experience

(v) Evidence of observation of registration/action

A competency assessment program should not only assess image analysis skills but also the decision making process for appropriate action. This may require additional training for example DVH interpretation, IMRT/VMAT implications for image guidance as well as individual cases where anatomy anomalies may affect the action.

Regular updates should be mandated, the frequency of which will depend on departmental rotation time, the number of IGRT capable linacs and sites treated on each linacs. Ideally annual updates are recommended together with re-assessment of competence after a period away from the specific technology.


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