Identifying best practices for RTTs and dosimetrists: a Delphi consensus study on standardizing workflows in proton therapy
Technical Innovations & Patient Support in Radiation Oncology, vol. 38, pp. 100411
Abstract
Background and purpose: A recent scoping review identified gaps in proton therapy (PT) guidelines, especially in fields of expertise of radiation therapists (RTTs) and dosimetrists. This study aimed to reach consensus on best practices within seven workflows performed by RTTs working in European proton therapy centers (PTCs). Material and method: Delphi consensus methodology was used and applied to 26 statements based on results of an RTT workshop. The process included three rounds, with responses scored using a 5-point Likert scale. Consensus was defined as >66% agreement or disagreement, strong consensus at ≥80%. Predefined criteria were used to select PTCs, and experts were invited to participate via registration. Results: Forty experts from 15 European PTCs participated. Consensus highlighted the need for specialized training for RTTs working in PT, covering knowledge of uncertainties, working with children, and artificial intelligence. An active role is needed in monitoring the overall treatment course and in knowledge sharing at institutional and national level. Furthermore, consensus was reached on RTT-only workflows based on protocols. In treatment planning, individual beam setups should be used, and additional plan checks are required for quality assurance compared to photon therapy. It was agreed that not all patients need a dry run before treatment. In image-guided PT, manual adjustment to automatic matches should be performed if needed. Conclusion: Consensus was reached on 24 statements covering seven workflows. This Delphi study provides a foundation for developing practical guidelines for RTTs working in PTCs across Europe. Although consensus was reached, multidisciplinary collaboration is needed.
Authors 15
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Jenneke Jacobs corresponding
Holland Particle Therapy Center
Affiliation as printed
HollandPTC, Huismansingel 4, 2629 JH Delft, the Netherlands
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E. van Weerd corresponding
Holland Particle Therapy Center
Affiliation as printed
HollandPTC, Huismansingel 4, 2629 JH Delft, the Netherlands
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A. M. Moerman corresponding
Holland Particle Therapy Center
Affiliation as printed
HollandPTC, Huismansingel 4, 2629 JH Delft, the Netherlands
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Leiden University · Leiden University Medical Center · Holland Particle Therapy Center
Affiliation as printed
HollandPTC, Huismansingel 4, 2629 JH Delft, the Netherlands
Leiden University Medical Centre, Department of Radiation Oncology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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C. Xavier corresponding
Holland Particle Therapy Center
Affiliation as printed
HollandPTC, Huismansingel 4, 2629 JH Delft, the Netherlands
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M. Høyer corresponding
Affiliation as printed
Danish Centre for Particle Therapy, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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E.G.C. Troost corresponding
German Cancer Research Center · Helmholtz-Zentrum Dresden-Rossendorf · National Center for Tumor Diseases · OncoRay · University Hospital Carl Gustav Carus · Nationales Centrum für Tumorerkrankungen Dresden · German Cancer Research Center (DKFZ) Dresden · German Cancer Consortium (DKTK) Dresden · Technische Universität Dresden
Affiliation as printed
Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307 Dresden, Germany
Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
Im Neuenheimer Feld 280, 69192 Heidelberg, Germany
Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328 Dresden, Germany
National Center for Tumor Diseases (NCT), Partner Site Dresden, German Cancer Research Center (DKFZ), Heidelberg, Germany
OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, 01307 Dresden, Germany
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V. Nguyen corresponding
University College London Hospitals NHS Foundation Trust · University College London
Affiliation as printed
University College London Hospital NHS Foundation Trust, Grafton Way Building, 1 Grafton Way, London WC1E 6AS, United Kingdom
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L. Jorgensen corresponding
Affiliation as printed
Danish Centre for Particle Therapy, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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M. Zorneth corresponding
Affiliation as printed
Paul Scherrer Institute, Forschungsstrasse 111, 5232 Villigen PSI, Switzerland
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S. Kelly corresponding
The Christie NHS Foundation Trust
Affiliation as printed
The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom
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J. Thiele corresponding
Helmholtz-Zentrum Dresden-Rossendorf · OncoRay
Affiliation as printed
Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328 Dresden, Germany
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Affiliation as printed
Paul Scherrer Institute, Forschungsstrasse 111, 5232 Villigen PSI, Switzerland
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H Bijwaard corresponding
National Institute for Public Health and the Environment · Inholland University of Applied Sciences
Affiliation as printed
Inholland University of Applied Sciences, Bijdorplaan 15, 2015 CE Haarlem, the Netherlands
National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands
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M.S. Hoogeman corresponding
Erasmus MC · Erasmus MC Cancer Institute · Holland Particle Therapy Center
Affiliation as printed
Erasmus MC Cancer Institute, Department of Radiation Oncology, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
HollandPTC, Huismansingel 4, 2629 JH Delft, the Netherlands
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