Dataset Information

Radiation therapy staffing model 2014.

ABSTRACT:

Introduction

In 2001, the Radiation Therapy Advisory Panel (RTAP) of the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) (formerly known as Australian Institute of Radiography) published a model for radiation therapist staffing in Australian radiation oncology departments. Between 2012-2013, the model was reviewed to ensure it reflected current radiation therapy practice, technology, and to facilitate forward planning of the radiation therapy workforce.

Method

Twenty-four sites from all states participated and provided data on megavoltage simulation, planning and treatment delivery. For simulation and planning activity, the length of time to complete was collected against relevant Medicare Benefits Schedule (MBS) items. For treatment delivery, time to complete activities was collected against a common set of activities. Modelling assumptions are clearly identified in the methodology.

Results

A new model was developed retaining the essential model parameter of full-time equivalent (FTE) radiation therapists (RTs) per linear accelerator operating hour as in the 2001 model but based on contemporary practice and data. The model also includes significant refinements that improve the model's overall utility and flexibility for both workforce planning purposes and for individual services to use the model according to their own organisational needs and service delivery profiles.

Conclusion

The ASMIRT believes that the 2014 RT staffing model provides the utility and flexibility for radiation oncology services to best plan RT staffing establishments according to their needs and reflecting the diversity between services and within the sector. It should also provide a robust and valid basis for governments and service planners to use as a guide in workforce planning into the future.

SUBMITTER: Smith LJ

PROVIDER: S-EPMC5167329 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Publications

Radiation therapy staffing model 2014.

Smith Leigh J LJ Kearvell Rachel R Arnold Anthony J AJ Choma Kevina K Cooper Aniko A Young Michael R MR Matthews Donna L DL Hilder Bronwyn B Howson Debbie D Fox Katherine K Churcher Katheryn K

Journal of medical radiation sciences 20161201 4

<h4>Introduction</h4>In 2001, the Radiation Therapy Advisory Panel (RTAP) of the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) (formerly known as Australian Institute of Radiography) published a model for radiation therapist staffing in Australian radiation oncology departments. Between 2012-2013, the model was reviewed to ensure it reflected current radiation therapy practice, technology, and to facilitate forward planning of the radiation therapy workforce.<h4>Method</h4 ...[more]

PMID: 27910290

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Project description:This paper reports the key findings of the Faculty of Radiation Oncology 2014 workforce census and compares the results with earlier surveys.The census was conducted in mid-2014 with distribution to all radiation oncologists, educational affiliates and trainees listed on the college database. There were six email reminders and responses were anonymous. The overall response rate was 76.1%.The age range of fellows was 32-96 (mean?=?49 years, median?=?47 years). The majority of the radiation oncologists were male (n?=?263, 63%). The minority of radiation oncologists were of Asian descent (n?=?43, 13.4%). Radiation oncologists graduated from medical school on average 23 years ago (median?=?22 years). A minority of fellows (n?=?66, 20%) held another postgraduate qualification. Most radiation oncologists worked, on average, at two practices (median?=?2, range 1-7). Practising radiation oncologists worked predominantly in the public sector (n?=?131, 49%), but many worked in both the public and private sectors (n?=?94, 37%), and a minority worked in the private sector only (n?=?38, 14%). The largest proportion of the workforce was from New South Wales accounting for 29% of radiation oncologists. Radiation oncologists worked an average of 43?h/week (median?=?43?h, range 6-80). Radiation oncologists who worked in the private sector worked less hours than their public sector or public/private sector colleagues. (38.3 vs. 42.9 vs. 44.3?h, P?=?0.042). Victorians worked the fewest average hours per week at 38?h and West Australians the most at 46?h/week. Radiation oncologists averaged 48?min for each new case, 17?min per follow up and 11?min for a treatment review. Radiation oncologists averaged 246 new patients per year (median?=?250, range?=?20-600) with men (average?=?268), Western Australians (average?=?354) and those in private practice seeing more (average?=?275). Most radiation oncologists considered themselves as specialists (n?=?151, 60%), but nearly all those from South Australia were generalists (n?=?15, 94%) as were three-quarters of those from private practice. A minority of radiation oncologist respondents (10%) intended to retire within 5 years with a further 16% within 10 years.There was a stabilisation of trainee numbers in Australia and New Zealand with no increase compared with 2010 (142 in 2014 vs. 143 in 2010). The most common age bracket for trainees remained 31-35 years. One-third of trainees were of Asian descent and nearly half held other degrees. The majority of trainees were satisfied with their career, but 30% were not entirely satisfied. Nearly half of trainee respondents would have reconsidered their choice of specialty had they known about the possible oversupply in the workforce with 12.4% undecided about continuing their career in radiation oncology. There were still 16% of trainees with no protected time during the working week, and a further 21% with only 1?h. Only one trainee respondent preferred to work in private practice, and job availability remained a concern for 89% of respondents.The radiation oncologist workforce numbers have increased at a much slower rate, and unemployment remained low. Many parameters remained similar to the 2010 survey. However, there has been a decrease in the average number of new patients seen per year, working hours and also a slight decrease in the time spent per new patient. The trainee numbers have stabilised, but job availability remained a concern. A significant proportion of trainees were not satisfied with their career.

Project description:PURPOSE:To develop and validate a technique for radiation therapy gating using slow (?1 frame per second) magnetic resonance imaging (MRI) and a motion model. Proposed uses of the technique include radiation therapy gating using T2-weighted images and conducting additional imaging studies during gated treatments. METHODS AND MATERIALS:The technique uses a physiologically guided breathing motion model to interpolate deformed target position between 2-dimensional (2D) MRI images acquired every 1 to 3 seconds. The model is parameterized by a 1-dimensional respiratory bellows surrogate and is continuously updated with the most recently acquired 2D images. A phantom and 8 volunteers were imaged with a 0.35T MRI-guided radiation therapy system. A balanced steady-state free precession sequence with a 2D frame rate of 3 frames per second was used to evaluate the technique. The accuracy and beam-on positive predictive value (PPV) of the model-based gating decisions were evaluated using the gating decisions derived from imaging as a ground truth. A T2-weighted gating offline proof-of-concept study using a half-Fourier, single-shot, turbo-spin echo sequence is reported. RESULTS:Model-interpolated gating accuracy, beam-on PPV, and median absolute distances between model and image-tracked target centroids were, on average, 98.3%, 98.4%, and 0.33 mm, respectively, in the balanced steady-state free precession phantom studies and 93.7%, 92.1%, and 0.86 mm, respectively, in the volunteer studies. T2 model-interpolated gating in 6 volunteers yielded an average accuracy and PPV of 94.3% and 92.5%, respectively, and the mean absolute median distance between modeled and imaged target centroids was 0.86 mm. CONCLUSIONS:This work demonstrates the concept of model-interpolated gating for MRI-guided radiation therapy. The technique was found to be potentially sufficiently accurate for clinical use. Further development is needed to accommodate out-of-plane motion and the use of an internal MR-based respiratory surrogate.

Project description:Aim:Radiation therapy has been proven “safe and effective” in the management of colorectal cancer liver metastases, especially for oligometastases. However, to date, there is no consensus on optimal prescribed doses or dose fraction schemes. The current study was conducted to investigate the effectiveness and safety of 2 different radiation therapy methods, conventional conformal radiation therapy and stereotactic body radiation therapy, in the treatment of limited colorectal cancer liver metastases.Methods:From December 2011 to December 2016, twenty-six patients with colorectal cancer having postoperative liver metastases (?3) who were being treated with radiation therapy, either conventional conformal radiation therapy (50 Gy in 25 fractions) or stereotactic body radiation therapy (50 Gy in 10 fractions), were selected for this study. Overall survival and local control survival were analyzed by log-rank and Cox regression methods.Results:Radiation therapy delivered to each of the 26 patients with a total of 50 liver lesions. Conformal radiation therapy was delivered to 32 lesions in a total of 15 patients. Stereotactic body radiation therapy was delivered to 18 lesions in a total of 11 patients. Median follow-up was 13 months. Three-year overall survival and local control survival were 0% and 38.5%, 20.5%, and 53.0%, respectively, for the conformal radiation therapy and stereotactic body radiation therapy groups. The slightly better overall survival and local control survival in the stereotactic body radiation therapy group in comparison to the conformal radiation therapy group (P = .323 and .297) is insignificant. There were no differences in grade 3 hepatic toxicity between the 2 groups. Eastern Cooperative Oncology Group performance status and the number of liver lesions were significant prognostic factors in both univariate and multivariate analyses.Conclusions:Noninvasive radiation therapy provides satisfactory survival benefit for limited colorectal cancer liver metastases without intolerable toxicity and is therefore especially suitable for those elderly patients with poor performance status. Furthermore, stereotactic body radiation therapy with a higher biological equivalent dose and an abbreviated course of treatment has been shown to provide a better outcome than conventional conformal radiation therapy.

Project description:Skull base tumors are challenging lesions for neurosurgeons, but these cannot always be removed via surgical resection. Helical tomotherapy (HT) delivers small beamlets of photons in continuous rotational treatment arcs and has an advantage of soft-tissue verification using computed tomography. We present our experience with HT for skull base tumors when the tumors were not accessible via surgery or recurred after surgery. From December 2005 to October 2010, 60 patients underwent HT for brain tumors. Among them, 13 patients had skull base tumors; four patients had petroclival meningiomas; two patients had cerebellopontine angle (CPA) meningiomas; two patients had acoustic schwannomas; one patient had foramen magnum meningioma; one patient had sphenoid meningioma; one patient had cavernous meningioma; one patient had jugular foramen meningioma; and one patient had clival meninigioma. Eight patients (62%) underwent surgery before HT. The target size ranged from 0.55 to 141.86 cm3 (median 3.85 cm3), and the target dose ranged from 9 to 57 Gy in 1-31 fractions (median 25 Gy in 5 fractions). The median follow-up period was 11 months. The results of HT for skull base tumors are described in Table 1. Twelve patients (92%) had favorable radiologic response. Six patients (46%) had partial response, and another six patients (46%) had stable disease after HT. One patient with CPA meningioma (case 11) had disease progression and underwent a second surgery. One patient with acoustic schwannoma (case 8) had transient radiation-induced changes on the cerebellum, but other patients did not have radiation-induced complications. HT is a useful treatment modality for skull base tumors when surgical access is not possible, and HT is well tolerated by patients with skull base tumors. PURPOSE: A breast cancer-specific graded prognostic assessment (GPA) was developed to better estimate prognosis for breast cancer patients with brain metastases. This GPA was further refined by adding genetic subtype on the basis of a retrospective, multi-institutional analysis. We sought to externally validate this breast-cancer GPA via an independent, large, multi-institutional data set. MATERIALS AND METHODS: Between 1993 and 2012, 275 women from two institutions who had breast cancer metastases to the brain and complete information available to assign breast-GPA (age, Karnofsky Performance Score, and genetic subtype of luminal A or B, HER2, or basal) were evaluated. Median overall survival (OS) with 95% confidence interval (95% CI) was calculated for each breast-GPA group. Differences between groups were tested using the log-rank test. RESULTS: Of the 275 women, 208 (76%) are deceased. The median OS was 11.5 months (95% CI 8.4, 12.9). The median OS by GPA scores of 0-1.0, 1.5-2.0, 2.5-3.0, 3.5-4.0 were 3.9 (n = 46), 8.0 (n = 88), 13.8 (n = 95), and 17.6 (n = 46) months, respectively (p < 0.0001). These results compared favorably with those of Sperduto et al.: median OS of 3.4 (n = 23), 7.7 (n = 104), 15.1 (n = 140), and 25.3 (n = 133) months, respectively. Genetic subtype was associated with OS, with luminal A and B, HER2, and basal subtypes having a median OS of 12.5 (n = 81), 16.2 (n = 66), 14.9 (n = 34), and 5.8 months (n = 94), respectively (p < 0.0001). CONCLUSIONS: In this cohort of women, the breast-GPA incorporating genetic subtype demonstrated wide variation in prognosis according to GPA score and tumor subtype, in a manner similar to the original report. This analysis validates the prognostic value of including genetic subtype in the breast-GPA, which has been shown to have superior predictive power compared with tumor subtype alone.

Dataset Information

Radiation therapy staffing model 2014.

Introduction

Method

Results

Conclusion

Publications

Radiation therapy staffing model 2014.

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