Inter-Professional Education (IPE) Facilitated by Advanced Practice Radiation Therapist: A Crucial Step to Implement Real-Time Mr-guided Brachytherapy for Cervical Cancer

Abstract

Magnetic resonance (MR) is considered the gold-standard imaging modality to guide cervical cancer brachytherapy (BT). In most centres, MR-guided BT (MRgBT) for cervical cancer involves multiple patient transfers: from the operating room, to the MR simulation room then to the BT treatment room. The development of an integrated MRgBT suite has presented a unique opportunity to perform real-time MRgBT, where the patient remains in one location and the remote afterloader and MR system mounted on ceiling rails move in and out of the interventional suite as needed. Hence, general anesthesia, applicator insertion, MR-image acquisition and high-dose-rate BT delivery can take place in the same room. However, one of the challenges of implementing real-time MRgBT is training and creating the proper intra-operative culture for staff in the integrated Suite. A key consideration is ensuring that all non-MR safe instruments and devices required for applicator insertion are removed from the room prior to MR imaging. The inter-professional education (IPE) needed to be delivered to the peri-operative team (anesthesia and nursing) are the interdisciplinary team (radiation oncologists, radiation therapists and MR technologists) to ensure all team members are trained to the procedure in the integrated suite. The aim of this work is to describe our experience designing the IPE necessary for implementing the real-time MRgBT process for cervical cancer in an integrated MRgBT interventional suite. This unique process required coordination at the hospital-wide level, with engagement of the peri-operative and the brachytherapy team. To design the content of IPE, the CSRT led a team consisting of radiation oncologists (ROs), radiation and MR safety officers, medical physicists (MPs), MR technologists (MRTMR) and brachytherapists (MRTTs) to establish the necessary radiation and MR safety considerations of the procedure. Process mapping was then completed. IPE was delivered in structured walk-throughs with anaesthetists, nurses, ROs, MRTMRs and MRTTs. The CSRT completed the process mapping defining tasks for each discipline. The team designed four safety time-outs: pre-anesthesia, pre-applicator insertion, pre-MRI imaging and pre-HDR treatment. Two safety checklists (pre-drape & pre-MR scan), one surgical instrument and one anesthesia equipment/supplies checklist were developed to ensure that the patient, room and equipment were appropriately set-up and configured and that all non-MR safe objects were removed prior to MR image acquisition. Finally the IPE was delivered as a form of structured walk-throughs, the procedure was further refined based on feedback from the team prior to scheduling the first patient. Our initial experience demonstrated that real-time MRgBT treatment for cervical cancer is feasible in an integrated MRgBT interventional suite but required a well-planned IPE to ensure successful implementation of the procedure.