Preparing for the MR-Linac: Analyzing an Educational Curriculum

Abstract

Background Image guided radiotherapy (IGRT) has made multiple advances that allow for more precise delivery of dose. Incorporation of magnetic resonance imaging (MRI) into workflows has provided the next incremental step. MRI capable linear accelerators (MR-Linac) provides the ability for treatment adaptation and replanning, which requires significant alteration of clinical workflows. Treatment on MR-Linacs has proven cumbersome for this reason, with multiple feasibility studies failing on time constraints. Minimal data is available regarding departmental preparation for the MR-Linac, despite expansion to multiple institutions. This trial set out to create and apply an educational curriculum regarding the MR-Linac, addressing this gap for future expansion. Methods In this IRB approved study (NU STU00216145), intradepartmental radiation therapists (RTs) and resident physicians (RPs) were recruited to participate in the educational curriculum and subsequent contouring assessment. The course consists of lectures and demonstrations tailored to each cohort. Proficiency of the course will be assessed by volumetric analysis of contours delineated on multiple MRI series both before and after the course, with requested organs specific to each cohort. Collected data will be anonymized. Each volume will be compared to a gold standard multiple physician consensus for Dice coefficient analysis. A post-education questionnaire will be distributed for analysis of the quality of the course and assessments. Results A total of 5 RTs and 6 RPs were recruited. The full course consisted of 4 hours for each cohort. RTs were each given 5 cases for both pre- and post education analysis, while RPs were given 3 cases. Currently, all RTs have completed their pre- and post-education cases with 100% retention. RP education is still underway. The null hypothesis predicts no increase in either individual Dice scores or total cohort Dice scores from pre- to post-education MRI volumes. Surveys will be distributed after completion of the trial. Discussion This is a novel educational study performed during the implementation of an MR-Linac in an academic hospital. The objective of this study is to prepare personnel for treatment adaptation while assessing feasibility of an educational series. Feasible implementation will be signaled by significant improvement from pre- to post-education contours on MRI series when compared to a gold standard. Results of this study will show the extent of education required to adequately prepare both RTs and RPs to perform MRI-based contouring during adaptive radiotherapy. If proven to be feasible and well received on surveys, this course could be formalized and exported. Image guided radiotherapy (IGRT) has made multiple advances that allow for more precise delivery of dose. Incorporation of magnetic resonance imaging (MRI) into workflows has provided the next incremental step. MRI capable linear accelerators (MR-Linac) provides the ability for treatment adaptation and replanning, which requires significant alteration of clinical workflows. Treatment on MR-Linacs has proven cumbersome for this reason, with multiple feasibility studies failing on time constraints. Minimal data is available regarding departmental preparation for the MR-Linac, despite expansion to multiple institutions. This trial set out to create and apply an educational curriculum regarding the MR-Linac, addressing this gap for future expansion. In this IRB approved study (NU STU00216145), intradepartmental radiation therapists (RTs) and resident physicians (RPs) were recruited to participate in the educational curriculum and subsequent contouring assessment. The course consists of lectures and demonstrations tailored to each cohort. Proficiency of the course will be assessed by volumetric analysis of contours delineated on multiple MRI series both before and after the course, with requested organs specific to each cohort. Collected data will be anonymized. Each volume will be compared to a gold standard multiple physician consensus for Dice coefficient analysis. A post-education questionnaire will be distributed for analysis of the quality of the course and assessments. A total of 5 RTs and 6 RPs were recruited. The full course consisted of 4 hours for each cohort. RTs were each given 5 cases for both pre- and post education analysis, while RPs were given 3 cases. Currently, all RTs have completed their pre- and post-education cases with 100% retention. RP education is still underway. The null hypothesis predicts no increase in either individual Dice scores or total cohort Dice scores from pre- to post-education MRI volumes. Surveys will be distributed after completion of the trial. This is a novel educational study performed during the implementation of an MR-Linac in an academic hospital. The objective of this study is to prepare personnel for treatment adaptation while assessing feasibility of an educational series. Feasible implementation will be signaled by significant improvement from pre- to post-education contours on MRI series when compared to a gold standard. Results of this study will show the extent of education required to adequately prepare both RTs and RPs to perform MRI-based contouring during adaptive radiotherapy. If proven to be feasible and well received on surveys, this course could be formalized and exported.