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A code orange for traffic-light-protocols as a communication mechanism in IGRT.

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  • 1Laboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium.

Technical Innovations & Patient Support in Radiation Oncology
|November 18, 2024
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Summary

Traffic-light protocols (TLPs) in image-guided radiation therapy (IGRT) aim to standardize reporting for locally advanced non-small-cell lung cancer (LA-NSCLC). However, this study found significant underreporting of flagged treatment fractions, indicating a communication gap despite protocol adoption.

Keywords:
LungRTT-led IGRTTLP

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Cancer Treatment

Background:

  • Traffic-light protocols (TLPs) standardize image registration and interdisciplinary communication in image-guided radiation therapy (IGRT).
  • TLPs use color codes (green, orange, red) to indicate anatomical changes during treatment.
  • Effective communication is crucial for managing locally advanced non-small-cell lung cancer (LA-NSCLC) during IGRT.

Purpose of the Study:

  • To evaluate the reporting accuracy of traffic-light protocols (TLPs) in locally advanced non-small-cell lung cancer (LA-NSCLC) treatment.
  • To identify barriers to accurate reporting within the IGRT workflow.
  • To assess the effectiveness of TLPs in facilitating interdisciplinary communication.

Main Methods:

  • Retrospective analysis of 1997 CBCTs from 74 LA-NSCLC patients treated with IGRT.
  • Independent blinded assessment of CBCTs using TLPs (TLP2023 and TLP2019) by radiation therapy technologists (RTTs).
  • Focus group discussions with RTTs to identify reporting barriers.

Main Results:

  • Significant underreporting of flagged LA-NSCLC fractions was observed, with only 40% of fractions coded orange and 13 coded red.
  • Inter-RTT agreement was 77% in a subset of reviewed fractions.
  • Barriers included lack of online reporting tools and divergent feedback expectations.

Conclusions:

  • While TLPs have promoted CBCT-based IGRT adoption, they have not effectively established interdisciplinary communication.
  • Multifactorial origins contribute to the underreporting of flagged LA-NSCLC fractions in clinical practice.
  • Improvements in reporting tools and feedback processes are needed to enhance communication in IGRT.