ePosters

Abstracts for the ePoster exhibition.

The ePosters available to review on mobile screens throughout the conference. Many of the authors were available to discuss their work on the Friday evening.

Shalini Barnard – Radiographer Led Services in a Private Practice Setting.

Radiographer Led services have enabled flexibility modifying the service around the patient which has speeded up the pathway to gain quicker access to Radiotherapy treatment and meet the demands of the Clinical Oncologist, patient and department. This initiative has enabled staff to provide clinical leadership within palliative and breast radiotherapy planning, bringing strategic direction, innovation and influence through practice, research and education. Local policies promoting advanced roles identify the legal and ethical framework within which this practice operates.

Palliative patients require speedy access to radiotherapy by virtue of the nature of the disease. Pain is one of the most common problems associated with metastases, along with rapid tumour growth, and deterioration of the quality of the patient’s life. Traditionally Clinical Oncologists have led many of the radiotherapy processes therefore a timely input from them has always been a key bottleneck across the patient pathway. This poses a big impact when attempting to minimize the gap between planning and treatment in order to meet government targets.

To ensure these changes are not short lived or non-existent, as a department one must review annually these role development initiatives and ensure these are incorporated into the business planning cycle. There is also a requirement for on-going audit, regular reviews of practice and formal evaluation of incidents and errors to monitor and improve the service provided.

Helen Bayles – The introduction of enemas into routine clinical use – an evidence based approach.

The need to achieve a reproducible patient setup with increased accuracy, and high demand on CT planning appointments within the radiotherapy department highlighted the need to introduce a more effective bowel preparation regime for patients referred for prostate radiotherapy. That would reduce the CT rescan rate of 34.7%, and, that could be applied in a timely manner and be accepted by this patient group. A systematic review was undertaken to establish an evidence base.

This showed the effective use of enemas in both the radiotherapy and non oncology setting and highlighted a patient group who are at ‘high risk’ of constipation due to intrinsic and extrinsic factors. Discussion with the consultants followed and the use of enemas before CT planning for prostate radiotherapy was agreed and implemented, alongside the implementation of a constipation risk questionnaire to establish which patients would continue to use enemas throughout treatment.

Implementing the use of enemas at CT planning and the questionnaire to identify ‘higher risk’ patients reduced the CT rescan rate to 5.8%. Using 3DCBCT, consistency of rectal diameter and percentage of uninterrupted treatments was also assessed and were comparable to measurements undertaken before the introduction of enemas. Further developments include the application of this protocol to other patient groups such as those undergoing gynaecological and bladder radiotherapy.

Linda Bedford – Palliative Radiotherapy (Brain and Bone Metastases).

Introduction
Palliative patients account for 25% of the radiotherapy department’s workload, however many of these patients are not end of life and may live for years with a cancer diagnosis Historically, they have had a long wait to see consultant clinical oncologists and receive radiotherapy for their symptoms (the most common of which is pain) (Jones et al 2014).

Service Improvement
A service has been developed for rapid access to palliative radiotherapy for patients with bone and brain metastases, to improve the patient experience and access timely symptom control. This has been achieved by promoting a radiographer led service where patients can be seen by a consultant radiographer, assessed for radiotherapy and consent, treatment and radiation prescriptions all completed. This eliminates waiting times encountered when patients wait to be seen in clinics by Consultant Oncologists. This includes a consultant radiographer led outreach service within the trust which ensures all patients requiring palliative radiotherapy receive timely assessment and treatment.

Aims

To assess patients individually in terms of suitability for palliative radiotherapy.
Promote awareness of Palliative Radiotherapy as a treatment option in managing metastatic cancer as a complex long term condition
Reduction of Pill Burden (Farrell et al 2013)
Reducing length of stay and admissions.
Holistic pain management – liaising with palliative care teams in the community.

Results
A streamlined process has been developed demonstrating continuity of care whilst educating staff, patients, families and carers on the use of palliative radiotherapy in the treatment of metastatic cancer as a long term condition. Specialist nurses and physios now contact the Consultant Radiographer for advice and direct referrals. Pain is managed in a timely manner and optimised before any radiotherapy treatment allowing a reduction in pain flare side effects.

Conclusion
This work has highlighted the complex nature of palliative radiotherapy in the management of cancer as a long term condition enabling patients to access timely symptom control. Furthermore, development of palliative a MDT group including radiographers, dosimetrists and Clinical Oncologists is in place to assess the efficacy of the service.

There are still many challenges to overcome and this is very much work in progress. Poster

References

Farrell, B., Merkley, V. and Ingar, N. (2013). Reducing pill burden and helping with medication awareness to improve adherence. Canadian Pharmacists Journal, 146 (5). 262-269
Jones, J., Lutz, S., Chow, E. and Johnstone, P. 2014. Palliative radiotherapy at end of life: A critical review. Cancer Clinical Journal 64. 295-310

Aileen Considine – The role of the IGRT specialist in radiotherapy planning and the impact of the role on our adaptive radiotherapy service.

The NRIG report for Image guided radiotherapy (IGRT) reported that 4D-adaptive IGRT is the future standard of care for radical radiotherapy using IGRT information to establish the dose to the tumour and organs at risk (OARs) on a regular basis during the treatment course with the aim of adapting the plan by re-optimisation or re-planning.

4a and 4b adaptive radiotherapy is currently standard practice within the author’s department. The use of daily volumetric imaging has highlighted on-treatment changes in target volumes, OARs and the anatomy surrounding target volumes. As this IGRT service has evolved, the IGRT specialist radiographer role in treatment planning has developed, to implement adaptive planning to account for on-treatment changes. The on-treatment changes are escalated by the radiographers to the planning IGRT specialist for assessment.

Effective assessment of the on-treatment changes requires image registration and interpretation skills, knowledge of the imaging protocols but also knowledge and skills of plan dosimetry. The IGRT specialist in radiotherapy planning can efficiently assess the on-treatment changes and the impact of these changes on the plan and where necessary, following a decision by the oncologist, adapt the patient’s treatment plan. The treatment planning IGRT specialist also provides individualised image matching guidance for patients using knowledge of the plan and image assessment skills to develop this guidance.

The treatment planning IGRT specialist works with the IGRT team and uses knowledge of treatment planning and image matching to assess images, assess the impact of on-treatment changes, develops image matching guidance and implements adaptive radiotherapy. Poster

Ruth Easton – Physiotherapists and emergency nurse practitioners satisfaction of plain image radiological reports; comparison between radiologists and reporting radiographers.

Professional bodies within radiology recommend that all imaging procedures have a written report attached to them [1][2]. Greive et al [3] carried out a study on general practitioners preferences and perceptions of a radiological report. A recommendation from the study was further investigation into the preferences of other referrers such as extend scope physiotherapists [3]. However, there appears to be a gap in the literature for studies of physiotherapists and emergency nurse practitioner (ENP) preferences. With the expanding roles of allied health professionals (AHPs) and nurses there is an increase of inter-professional working. Part of the NHS Scotland AHPs national delivery plan is the development of integrated teams across health and social care services to support continuous improvement [4]. The national delivery plan also focuses on maximising workforce engagement and development [4]. As part of an MSc thesis, this work analyses the degree of satisfaction of physiotherapists and ENPs for report content and style of plain film MSK images received from the reporting radiographers and radiologists.

Three reporting radiographers and three radiologists interpreted a number of images (10 each of knees, hands and shoulders) from emergency and outpatient referral sources. Reports were produced in 3 different styles (written paragraph, bullet points and normal/abnormal). The physiotherapy and ENP participants evaluated the image for content and preference of style by use of a questionnaire whilst reviewing the images on a clinical workstation normally employed in their everyday surroundings in an attempt to reproduce their normal viewing conditions. As this is a work in progress, data will be analysed to establish preferred style, who delivers it and what learning can be taken from these results for future practice, particularly in light of what might have been included in the referral details and how this influences the report that is generated. It is also envisaged that this will support enhanced interdisciplinary team work and also improve the reporting radiographers role in the patient pathway. Poster

References

Robinson P. Radiology’s Achilles’ heel: error and variation in the interpretation of the Rontgen image. The British Journal of Radiology 1997; 70: 1085-1098
Robinson P, Wilson D, Coral A, Murphy A, Verow P. Variation between experienced observers in the interpretation of accident and emergency radiographs. The British Journal of Radiology 1999; 72: 323-330
Grieve F, Plumb A, Khan S. Radiology Reporting: a general practitioner’s perspective. The British Journal of Radiology 2010; 83: 17-22
The Scottish Government. AHPs as agents of change in health and social care. The National Delivery Plan for the Allied Health Professional 2012-2015. The Scottish Government; 2012

Kirsteen Graham – Advanced practice radiographer reporting corrects poor referral practices from emergency and minor injury departments.

From a perspective of Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) inappropriate referral practices are frequently encountered. These are generated by all medical practitioner levels, emergency nurse practitioners and triage nurses in a range of environments from major trauma centres to minor injury units. This investigation identified the degree of failure to meet IR(ME)R governance expectations across the most heavily populated health board in Scotland during a period of one rotation of junior medical staff when data was gathered at the start of their placement and in their final month of education. This presentation describes work in progress that identifies where omissions in content are made and by whom, and potential, impact on the report.

Without the appropriate background knowledge and experience available to advanced practice reporting radiographers, it is opined that inappropriate interpretation is likely through the principles of satisfaction of search. This is avoided through an enhanced capability of the radiographer trained to report and as such prevents treatment errors or missed initial trauma/disease identification that may be communicated through an alert system or interaction with the referring department. Poster

Emma Hallam – The Nottingham Radiotherapy Late Effect Clinic.

This poster will cover the development of a radiographer led unique self referral/other AHP and GP service for any patient that is experiencing a side effects from radiotherapy treatment.
The service is a result of 2 years of primary care education, innovative networking and pathway design to streamline help and support for these patients.
Case studies will also be illustrated along with the skills developed by the lead radiographers. Poster 1 Poster 2

Sally Hodkins – Advanced practice in urology – Life outside radiology.

The eposter will explore how this role is different from the more obvious advanced practitioner sonographer roles within radiology. I work as part of clinical team of urologists, radiologists, nurses and HCAs managing and treating patients with renal calculi. We treat patients using ESWL and manage their course of treatment. We run a practitioner led clinic which sees patients for follow up and provides stone recurrence checks and advice.

The role was implemented 3 years ago when a new machine was installed. At first it was just treating patients but this has now evolved into the service we have today. In addition to treatments we also discharge patients and refer them on for further tests into their stone disease. We can refer for CT and metabolic stone screening tests. This improves our patient pathways and enables consultant clinic slots to be used more effectively. In the future the role would be enhanced if I was able to prescribe the analgesics and antibiotics required for the treatment.

It is different working outside radiology as we get the chance to make a real difference to patients progress from referral to discharge which is outside of traditional advanced practice radiographer roles.

Sections planned for the e-poster are,

Development of the role
Role description
Multidisiplinary teamworking
The future of the role

Poster

Claire Huntley – The use of compression in the treatment of lower lobe lung tumours for Stereotactic ablative radiotherapy (SABR) a case study.

Objectives
Describing the localisation techniques and effective use of abdominal compression for lower lobe tumours, without the use of fluoroscopy.

Background
The conventional simulator was decommissioned during the recent redevelopment of the department and left us with no means to carry out motion assessment for lower lobe tumours. A new work flow was implemented to decide if compression is required and if it is effective enough to reduce tumour motion to meet the criteria for SABR treatment.

Case Description
The patient presented is a female aged 78 with a diagnosis confirmed as Non-small cell carcinoma of the right Lower lung lobe with a stage/grade of T2N0M0.
Patients PET CT showed a small positive lesion close to the diaphragm with movement greater than 1.5cm.

Conclusion
Carrying out the necessary assessments before planning is possible using the linear accelerators 4D Cone beam CT on-board imaging capabilities. The use of effective compression can reduce the motion of the tumour enough to enable the patient to receive the SABR treatment technique.

Ricardo Khine – The professional and organisational impact of the consultant therapy radiographer: a case study.

The NHS has been experiencing significant changes in order to improve the services offered to patients (DOH, Cancer Reform Strategy 2007) For instance in therapeutic radiography there has been a drive for improving the “patient’s experience of care” on the cancer pathway (College of Radiographers, 2006). One significant example is the creation of the consultant therapeutic radiographer to not only improve patient care, but also to improve working systems, and provide role development/expansion amongst therapeutic radiographers. (Howes, 2009) (Ford, 2010).

The research will explore the development of the consultant therapeutic role and consider the professional and organisational impact (Gerrish et al, 2011)
To examine the consultant therapeutic radiographer role, through the perspectives of medical and healthcare staff by means of a qualitative inquiry.
The core issues to address include; gaining an insight into the issues related/relevant to the creation of the role. Assessing the experiences of the consultant therapeutic radiographers. Examining the experiences of the medical and healthcare staff, who work alongside the consultant therapeutic radiographers. Analysing and evaluating the impact of consultant practice in therapeutic radiography.

An exploratory case study approach (Yin 2009) is used to represent the thoughts, opinions and views of the consultant therapeutic radiographers, medical and healthcare staff regarding the role. The research is conducted over three phases consisting of a focus group with the consultant therapeutic radiographers (phase one), interviews with each individual consultant therapeutic radiographer and with a range of medical and healthcare staff, inaddition document review of consultant therapeutic radiographer job descriptions (phase two) and interviews with key stakeholders (SCoR and DoH) (phase three).

The presentation will focus and discuss some of the findings from the data collected to indicate if there is evidence of impact of the role. Poster

References

College of Radiographers (CoR). Positioning therapeutic radiographers within cancer services: Delivering patient centred care; 2006
Department of Health. Cancer Reform Strategy, Department of Health; 2007
Ford, P. (2010) ‘The role of the consultant radiographer – experience of appointees’, Radiography 16, 189 – 197
Gerrish K, McDonnell A, Kennedy F (2011) Capturing impact: A practical toolkit for nurse consultants. Sheffield Hallam University, Sheffield
Howes, N. (2009) ‘Demystifying the role of the consultant therapy radiographer’ Imaging & Oncology 6-1
Yin, R (2009) ‘Case Study Research: Design & Methods’ (4th Ed) Sage Publications

Li Hoon Lim -Therapists And Oncologists Perceptions On Site-specific Advanced Practice Roles For Therapists In Radiation Oncology Practice.

Purpose
The impact of AP has been widely published but the development in Singapore is still nascent. This study assessed the perception of the radiation oncologists (RO) and RT on site-specific advanced practice (SSAP) roles for RT and the potential of SSAP establishment in radiotherapy and the possible implication on current services.

Materials and Methods
A cross-sectional survey design and purposive sampling method was adopted using a mixed-method semi-structured questionnaire. All ROs and RTs working in National Cancer Centre (NCC), were invited to participate in the study.

Results
88 RO and RT were approached and the response rates were 65% and 94% respectively. The major findings included the RO’ strong support for SSAP development, the RT’ requisition for fair opportunities for role development and clear role delineation to minimise overlapping of roles and to avoid medico-legal issues.

Conclusions
There was strong support for SSAP with potential benefits in RT’s career advancement, job satisfaction, recruitment and retention. Inter-professional relationship would improve with greater communication and collaboration to provide a holistic treatment pathway. Service quality and patient satisfaction would also be enhanced with the prompt personalised service envisaged. Poster

Alex Martin – Evolution of the advanced radiographer for lung cancer radiotherapy at the Norfolk and Norwich University Hospital Foundation Trust.

Abstract

Overview
In 2011 the position of advanced radiographer for lung cancer radiotherapy was introduced to the Norfolk and Norwich University Hospital Foundation Trust. It was anticipated that the applicant would evolve the role to fit the department’s needs.

Aim
To improve the pathway for lung cancer patients receiving radiotherapy.
Service improvements implemented

4DCT scanning implemented. This is now in routine clinical use for all radical lung patients.
IMRT had not been used for lung patients. IMRT is now used for lung patients when conventional radiotherapy does not produce an acceptable plan or when significant improvement can be achieved with IMRT.
CBCT had not been used for lung cancer patients. CBCT is now used for selected radical lung cancer patients and routinely for SABR patients.
SABR had not been introduced to the department. A high proportion of lung cancer patients in this region tend to be elderly. The logistics of referring patients elsewhere for treatment is difficult. SABR is now in routine use for peripheral early stage NSCLC patients who are medically inoperable or who decline surgery.

Discussion
This role has evolved around the need to introduce technique advancements. Whilst on-going projects are more ‘patient-centered’ such as the delegation of obtaining informed consent and radiotherapist-led lung tumour delineation, there has been little change to the patient pathway from a ‘patient-centred’ perspective. Potential projects for future development such as on-treatment review, telephone follow-up post SABR treatment and radiographer-led palliative lung planning, could alter the scope of this role leading to a more even distribution of expertise and advancing practice. Poster

Robert Milner – UK reporting radiographers: Limitations on practice.

Background
The implementation of reporting by radiographers was adopted early by a large number of UK NHS Trusts. Multiple subsequent studies have demonstrated inconsistencies in implementation, particularly in relation to the scope of practice which varied between organisations.

Method
Radiographers employed to provide a definitive written report on general radiographic examinations were invited to complete an online survey. Information was sought regarding demographics, geographical location, and anatomical and referral scope of practice.

Results
259 responses were received; representing approximately 35% of the population of UK based reporting radiographers. The majority of reporting radiographers have limitations on their practice. Most are limited by patient age, although the age at which reporting is restricted varies significantly. Others had limitations based on clinical history; reporting only if there was a history of trauma. Some reporting radiographers’ double report certain examinations whist others have counter-intuitive protocols, such as only reporting ‘normal’ studies. Some of the findings correlate with limitations applied to other allied health professionals’ practice.

Conclusion
There is a lack of consistency in reporting practice across the UK, with a postcode lottery of roles and patient pathways. Most reporting radiographers have limitations on their practice, and these do not appear to be based on latest evidence. Poster

Alison Ormerod – An Evaluation of support of patients with prostate cancer living with or beyond cancer treatment. A local perspective on future provision.

Abstract

Purpose
This study was designed to evaluate whether radiographer-led on-treatment review clinics are meeting the needs of prostate patients receiving radiotherapy.

Methods
Semi-structured interviews were used to elicit patient and staff perspectives. Seven patient and two staff interviews were audio-taped and the dialogue was manually transcribed. Interviews have been used extensively in qualitative research to produce breadth and depth of insight into participants’ experiences and opinions. A thematic analysis of the data was carried out to identify key aspects of the review service for both patients and staff.

Results
Four main categories of questions were used to elicit patient and staff views. Several themes emerged from both patient and staff perspectives. All staff and patients expressed satisfaction with the service. Strengths include staff communication, relaxed environment, individualised support and consistency in identifying and managing side-effects. Weaknesses include information and communication gaps at the beginning and end of treatment, liaison with other staff groups, and staff unable to prescribe medication.

Conclusion
Interviews produced an in-depth view of patient and staff experiences. Staff and patients identified core strengths and some areas for improvement within the local service.

Key Words
Prostate cancer; interviews; review clinic; patient information; living beyond cancer. Poster

Hayley Seenan – Standardising anti-emetics for palliative radiotherapy patients.

Overview
Radiation-induced nausea and vomiting (RNIV) can effect between 50- 80% of radiotherapy patients (Feyer et al 2010). This can have a negative impact on quality of life and also could discourage patients from agreeing to further radiotherapy. A prophylactic dose of ondansetron prior to radiotherapy can help prevent RNIV.

After working alongside oncologists for a number of years the advanced practitioner (AP) in palliative planning identified inconsistencies in their approach to prescribing anti-emetics. The switch in planning from conventional to virtual (CT) simulation highlighted a training issue for CT staff; they were unable to consistently identify those palliative patients vulnerable to RNIV.

Aim
To ensure that all palliative patients at risk of RNIV consistently receive anti emetics prior to the radiotherapy.

Service Implementation.

Patient group directive (PGD) training was completed by the AP so anti-emetic could be dispensed.
Guidance documents were produced, including diagrams and lists of body sites vulnerable to RINV, for the radiographers to refer to.
Document was sent to the oncologists for consultation and agreement.
Ensured relevant staff groups were aware of the change.
Anti-emetics were provided to the patient at their CT planning appointment by AP via the PGD.

Discussion
Providing informal presentations to radiographers prior to implementing this process, particularly challenging dated opinions on RNIV, would have been useful. Looking ahead it would be beneficial to follow up the patients who received ondansetron via telephone to discuss the effectiveness of the anti-emetics and advice given.

Long term telephone follow ups would provide valuable data to ensure we are not excluding any body sites which could be prone to RINV. PGD needs revising to increase the number of staff members who can dispense ondansetron. Recommend departments conduct an audit of RINV patient experience to highlight the body sites which may be vulnerable to this side effect. Poster

Reference

Feyey, P.C., Maranzano, E., Molassiotis, A., Roila, F., Clark-Snow, R., Jordan, K. (2009). Radiotherapy-induced nausea and vomiting (RINV): MASCC/ESMO guideline for antiemetics in radiotherapy: update 2009. Supportive Care in Cancer. 19 (1), 5-14.