S2878
RTT - RTT education, training, and advanced practice
ESTRO 2026
escalation pathways.
1. McNeice, J.M. et al. (2023) 'Prostate stereotactic body radiotherapy: Quantifying intra-fraction motion and calculating margins using the new BIR geometric uncertainties in daily online IGRT recommendations', BJR, 96(1146). doing 10.1259/bjr.202208522. Ng, M et al (2014) 'Fiducial markers and Spacers in prostate
radiotherapy: Current applications'. BJU International, 113 (S2),pp. 13-20. doing:
10.111/bju.126243. Van As, N. et al. (2023) '5-Year Outcomes from PACE B: An International Phase III RCT Comparing Stereotactic Body Radiotherapy vs. Conventionally Fractionated or Moderately Hypo Fractionated External Beam Radiotherapy For Localised Prostate Cancer,' International Journal of Radiation Oncology*Biology*Physics, 117(4) pp. e2-e3.
A repeat audit was scheduled after a bedding-in period for the updated procedure to assess the impact of the implemented framework. Results: Initial audit showed that CBCT use exceeded the expected number; implementation of the HIPO/LIPO framework reduced unnecessary CBCTs and workflow escalations without compromising safety (Table 1).
Proffered Paper 3255 RTT-led framework for justification of unscheduled CBCTs in gynaecological EBRT Miriam Kerr, Gavin Kennedy, Serena O'Keeffe, Rachel Harwood, Ciaran Malone, Dean Harper Radiation Oncology, St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland Purpose/Objective: Routine online CBCT is a mainstay of verification to ensure safe EBRT treatment delivery that appropriately ensures target coverage and ensure protection of OARs. A lack of clarity in site-specific IGRT procedures can result in unnecessary repeat imaging, avoidable dose, and workflow delays, particularly when organ-at-risk (OAR) variations are not clinically significant. This study aims to quantify CBCT use during gynaecological EBRT, implement a decision framework to rationalise online image guidance, and evaluate its safety, feasibility, and impact on workflow, patient experience, and imaging dose. Material/Methods: A retrospective audit of 50 radical and palliative gynaecology EBRT patients established baseline IGRT practice. Key metrics included the number of CBCTs per course compared with prescription and expected schedule, patient dose from CBCTs, and frequency of escalations to RTT, physics, and radiation oncologists (ROs).A multidisciplinary quality improvement programme followed, including a literature review, leading to an updated IGRT procedure that introduced a novel “HIPO/LIPO” (Higher vs Lower IGRT Priority OAR) framework, with accompanying RTT education, and MDT agreement on exception criteria and
Preliminary data indicate reductions in CBCT frequency relative to expected schedule, lower associated imaging dose, improved workflow efficiency at unit and MDT levels, fewer patient delays, and enhanced documentation of HIPO/LIPO status. No adverse clinical events or compromises to target coverage were identified. Conclusion: The RTT-led HIPO/LIPO IGRT framework safely reduced unnecessary CBCT imaging, improved workflow efficiency, and standardised MDT communication. Embedding clear documentation of responsibilities enhanced coordination among RTTs, physicists, and ROs.All CBCTs continue to be reviewed online, and cyclical repeat audit will further monitor compliance. The HIPO/LIPO designation has been
applied in our institution to a range of non- gynaecological pelvic treatment sites and is
generalisable to other radiotherapy centres seeking to apply a framework for justification of unscheduled radiotherapy imaging. Keywords: IGRT, Gynaecological, OAR
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