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Decision-making processes in image guided radiotherapy: A think aloud study.

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  • 1College of Health Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield S10 2BP, UK.

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|October 18, 2023
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Summary

Radiation therapists (RTTs) use varied decision-making processes during 3D Image Guided Radiotherapy (IGRT) image interpretation. Encouraging a confirmation phase after intuitive decision-making can reduce errors and enhance expertise in IGRT.

Keywords:
CBCTClinical reasoningDecision-makingEducationIGRTRadiotherapyTraining

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Area of Science:

  • Medical Imaging
  • Radiotherapy Physics
  • Clinical Decision-Making

Background:

  • 3D Image Guided Radiotherapy (IGRT) using Cone Beam Computer Tomography (CBCT) is widely used in UK radiotherapy centers.
  • Limited research exists on how radiation therapists (RTTs) interpret images and make clinical decisions during IGRT.

Purpose of the Study:

  • To investigate the decision-making processes employed by RTTs during the image interpretation phase of IGRT.

Main Methods:

  • A case study methodology was used, involving think-aloud observations and interviews with 12 RTTs across three UK centers.
  • Simulated clinical scenarios were utilized, with data analyzed using protocol and thematic analysis.

Main Results:

  • RTT decision-making varied in length and approach, with six themes identified: Set Sequence, Site Specific Clinical Priorities, Initial Gross Review, Decision to treat, Compromise, and experience.
  • Three cognitive decision-making processes were observed: Simple linear, Linear repeating, and Intuitive.
  • Expertise in IGRT is enhanced by experience within a specific scope of practice.

Conclusions:

  • Three decision-making models (Simple linear, Linear repeating, Intuitive) were identified for RTTs in IGRT.
  • Intuitive decision-making, while potentially error-prone, can be improved with a subsequent confirmation phase.
  • Understanding these decision-making processes is crucial for developing RTT expertise and reducing errors in IGRT training and practice.