Best RTT Paper Award

ESTRO 2025 Congress Report I: Interdisciplinary track

Online adaptive radiotherapy is used to tailor treatment plans to daily changes in patient anatomy, but delivery of such care is a time- and resource-intensive process. In 2022, Washington University School of Medicine, known as WashU Medicine, in St Louis, Missouri, USA, recruited the first advanced practice radiation therapist (APRT) in the USA to specialise in online adaptive contouring. A two-year analysis was conducted on our high-volume adaptive stereotactic body radiation therapy (SBRT) programme to evaluate the effect that the APRT had on contouring times compared with a team of radiation oncologists (ROs) across a large SBRT patient cohort. A time-driven activity-based costing (TD-ABC) analysis was also conducted to evaluate the financial impact of contouring an adaptive SBRT programme for various hypothesised adapter models per fraction and per year. This analysis was calculated using both the APRT contouring times (individual cost) and the RO contouring times (team cost) for all providers.

A total of 117 individual SBRT patients were evaluated, with 530 adaptive SBRT fractions being reviewed. Of these, 339 fractions were contoured by the APRT, while 191 were contoured by a team of seven physicians. The results showed that the APRT significantly reduced contouring times by 10 minutes on average, compared to RO fractions (p<0.001). For the TD-ABC analysis, we created varying coverage models to provide insight into the costs related to contouring for online adaptive radiotherapy using actual clinical timing data. Models were created for ROs, physicists, dosimetrists, and APRTs using both individual and team approaches. Staff salaries were from the most recent staff surveys based on national organisations, such as the American Society of Radiologic Technologists and the American Association of Physicists in Medicine, and the cost rate was calculated down to the minute in order to find the per-fraction cost.This was then projected over our previous year, during which we had supplied treatment in the form of 692 adaptive SBRT fractions to 139 adaptive SBRT patients to find the yearly estimated costs. We found that contouring costs (per individual or team) for ROs ranged from $23,224 to $50,855 per year, whereas APRTs doing the same work cost between $5,605 and $12,276 per year. All costs can be found in the figure below.

 

We are providing evidence that specially trained therapists, in elevated positions, can alleviate the additional time burden of online adaptive radiotherapy for ROs in a high-volume online adaptive SBRT clinic. Additionally, our TD-ABC analysis demonstrated a cost reduction by utilising an APRT-based adaptor model. By redefining the roles within the adaptive radiotherapy team, substantial improvements can be made to workflow and cost-effectiveness, potentially promoting a sustainable approach to the delivery of personalised cancer treatments. Our findings show that the incorporation of a dedicated APRT not only enhances operational efficiency but also offers new career advancement pathways for radiation therapists, potentially addressing critical issues such as job satisfaction and staff retention.

 

 

Robbie Beckert

Advanced practice radiation therapist

Department of Radiation Oncology | WashU Medicine
 

Email: Robbie@wustl.edu

LinkedIn: www.linkedin.com/in/robbiebeckert