Callens Dylan, De Haes Rob, Verstraete Jan, Berkovic Patrick, Nulens An, Reynders Truus, Lambrecht Maarten, Crijns Wouter
Laboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium.
Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium.
Tech Innov Patient Support Radiat Oncol. 2024 Oct 28;32:100286. doi: 10.1016/j.tipsro.2024.100286. eCollection 2024 Dec.
Traffic-light protocols (TLPs) use color codes to standardize image registration and improve interdisciplinary communication in IGRT. Generally, green indicates no relevant anatomical changes, orange signals changes requiring follow-up but does not compromise the current fraction, and red flags unacceptable changes. This study examines the communication aspect, specifically the reporting accuracy for locally advanced non-small-cell lung cancer (LA-NSCLC), and identifies barriers to reporting.
MATERIALS & METHODS: We conducted a retrospective study on 1997 CBCTs from 74 LA-NSCLC patients. Each scan was in retrospect assessed blinded using the tailored TLP by an IGRT-RTT and subsequently by a second RTT for a subset of fractions. The assessment included both CBCTs from current clinical practice (TLP) and from the TLP implementation period (TLP). Accuracy of image registration was not evaluated. Reporting barriers were identified through focus group discussions with RTTs.
During TLP, 22 of the 63 (35%) patients received at least one code orange during therapy, with 2 of them having a systematic code orange, totaling 43 (2%) fractions with at least one code orange. The IGRT-RTT assigned code orange or red in 59 (94%) patients, 38 (60%) of which had systematic codes orange. In total, the IGRT-RTT reported 684 (40%) fractions with code orange and 13 with code red. During TLP, similar numbers are observed. In the subset reviewed by two IGRT-RTTs, reports matched in 77% of cases. Various factors contribute to a low reporting rate, originating both during the decision-making process such as lack of online reporting tools and within offline processes such as divergent feedback expectations.
While our TLP has successfully promoted the widespread adoption of CBCT-based RTT-led IGRT, it has not succeeded in establishing interdisciplinary communication. Our study reveals significant underreporting of flagged LA-NSCLC fractions in clinical practice using a TLP. This underreporting stems from multifactorial origins.
交通灯协议（TLP）使用颜色代码来规范图像配准并改善IGRT中的跨学科沟通。一般来说，绿色表示无相关解剖结构变化，橙色表示需要随访但不影响当前分次治疗的变化，红色表示不可接受的变化。本研究考察沟通方面，特别是局部晚期非小细胞肺癌（LA-NSCLC）的报告准确性，并识别报告障碍。
我们对74例LA-NSCLC患者的1997次CBCT进行了回顾性研究。每次扫描均由一名IGRT-RTT使用定制的TLP进行回顾性盲法评估，随后由第二名RTT对部分分次进行评估。评估包括来自当前临床实践（TLP）和TLP实施期间（TLP）的CBCT。未评估图像配准的准确性。通过与RTT进行焦点小组讨论来识别报告障碍。
在TLP期间，63例患者中有22例（35%）在治疗期间至少收到一次橙色代码，其中2例有系统性橙色代码，共有43次（2%）分次至少有一次橙色代码。IGRT-RTT在59例（94%）患者中分配了橙色或红色代码，其中38例（60%）有系统性橙色代码。总体而言，IGRT-RTT报告了684次（40%）分次为橙色代码和13次为红色代码。在TLP期间，观察到类似的数字。在由两名IGRT-RTT审查的子集中，77%的病例报告相符。各种因素导致报告率较低，既有决策过程中的因素，如缺乏在线报告工具，也有线下过程中的因素，如不同的反馈期望。
虽然我们的TLP成功促进了基于CBCT的RTT主导的IGRT的广泛采用，但它未能成功建立跨学科沟通。我们的研究揭示了在临床实践中使用TLP时，LA-NSCLC分次标记的报告严重不足。这种报告不足源于多方面原因。
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