TipsRO Young Researcher Award

 

ESTRO 2025 Congress report

 

Over the last decade, proton therapy (PT) has become increasingly available in Europe. However, variations in practices are observed both nationally and internationally. A recently conducted scoping review (currently under review) revealed gaps in existing guidelines in workflows where radiation therapists* (RTTs) play a leading role. This review highlighted the need for the development of standardised practices. Our study aimed to identify best practices in workflows in PT that are handled by RTTs. The ultimate goal? To harmonise and improve the quality of practices in PT.

We used a Delphi consensus methodology to identify best practices. To identify the problem area, we relied on the findings of the scoping review and organised a 2-day RTT workshop to explore where best practices could potentially be established. This resulted in creating 26 statements regarding possible best practices in workflows involving RTTs. These statements were grouped into seven predefined workflow areas, and expert feedback was collected using a 5-point Likert scale, ranging from “strongly disagree” to “strongly agree.”

Using a set of criteria for proton therapy centres (PTCs), we contacted experts working in the field via our contact list, PTC websites, and encouraged others to share the invitation. Final participants registered online and provided additional information, such as working experience and field of expertise. Our goal was to include as many PTCs across Europe as possible, with an equal number of experts per centre.

Prior to the study, we agreed on a fixed number of survey rounds and defined criteria for consensus: 66% agreement or disagreement counted as consensus, and anything above 80% was considered strong consensus.

We conducted three online survey rounds in which experts reviewed and rated the 26 statements. After each round, we analysed the responses and revised statements that had not reached consensus, taking expert feedback into account.

In total, 40 experts from 15 different PTCs in Europe participated in the study. Consensus was reached on the need for specific knowledge in understanding the impact of uncertainties, working with paediatric patients, and working with artificial intelligence. Regarding patient positioning, consensus was reached that a dry run is not needed for all patients to achieve optimal patient preparation and cooperation. However, no agreement was reached on performing a dry run without a patient present.

RTTs should take an active role in sharing knowledge within their institute and organising peer reviews of treatment plans within their own country. However, no consensus was reached regarding this practice at the European level.

Several statements highlighted the need for clear protocols, especially for RTTs to independently make decisions, such as repeating a planning CT or cone beam computed tomography (CBCT). Furthermore, protocols with defined action levels are needed for an efficient workflow and to execute and evaluate a recalculation on a repeat CT. Expert feedback emphasised that multidisciplinary involvement is essential when creating protocols.

In conclusion, this study identified 24 best practices for RTTs working in PT across Europe. The next step? Translating these best practices into practical guidelines to harmonise workflows and improve the quality of PT practices across Europe.

*The term RTT refers to professionals involved in preparing and delivering proton therapy, including dosimetrists and oncology nurses.

Jenneke Jacobs

Holland Proton Therapy Centre, Delft, The Netherlands

j.jacobs@hollandptc.nl

https://www.linkedin.com/in/jenneke-jacobs-6a9b8649/

www.tasernet.eu