A code orange for traffic-light-protocols as a communication mechanism in IGRT
Introduction: 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...
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Elsevier
2024-12-01
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| Series: | Technical Innovations & Patient Support in Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405632424000532 |
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| author | Dylan Callens Rob De Haes Jan Verstraete Patrick Berkovic An Nulens Truus Reynders Maarten Lambrecht Wouter Crijns |
| author_facet | Dylan Callens Rob De Haes Jan Verstraete Patrick Berkovic An Nulens Truus Reynders Maarten Lambrecht Wouter Crijns |
| author_sort | Dylan Callens |
| collection | DOAJ |
| description | Introduction: 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 (TLP2023) and from the TLP implementation period (TLP2019). Accuracy of image registration was not evaluated. Reporting barriers were identified through focus group discussions with RTTs. Results: During TLP2023, 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 TLP2019, 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. Conclusion: 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. |
| format | Article |
| id | doaj-art-49b07cd58ab74b74b7ec1451a0453fbd |
| institution | DOAJ |
| issn | 2405-6324 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Technical Innovations & Patient Support in Radiation Oncology |
| spelling | doaj-art-49b07cd58ab74b74b7ec1451a0453fbd2025-08-20T02:49:04ZengElsevierTechnical Innovations & Patient Support in Radiation Oncology2405-63242024-12-013210028610.1016/j.tipsro.2024.100286A code orange for traffic-light-protocols as a communication mechanism in IGRTDylan Callens0Rob De Haes1Jan Verstraete2Patrick Berkovic3An Nulens4Truus Reynders5Maarten Lambrecht6Wouter Crijns7Laboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium; Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium; Corresponding author at: Laboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium.Department of Radiation Oncology, University Hospitals of Leuven, Leuven, BelgiumDepartment of Radiation Oncology, University Hospitals of Leuven, Leuven, BelgiumLaboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium; Department of Radiation Oncology, University Hospitals of Leuven, Leuven, BelgiumDepartment of Radiation Oncology, University Hospitals of Leuven, Leuven, BelgiumDepartment of Radiation Oncology, University Hospitals of Leuven, Leuven, BelgiumLaboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium; Department of Radiation Oncology, University Hospitals of Leuven, Leuven, BelgiumLaboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium; Department of Radiation Oncology, University Hospitals of Leuven, Leuven, BelgiumIntroduction: 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 (TLP2023) and from the TLP implementation period (TLP2019). Accuracy of image registration was not evaluated. Reporting barriers were identified through focus group discussions with RTTs. Results: During TLP2023, 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 TLP2019, 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. Conclusion: 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.http://www.sciencedirect.com/science/article/pii/S2405632424000532RTT-led IGRTTLPLung |
| spellingShingle | Dylan Callens Rob De Haes Jan Verstraete Patrick Berkovic An Nulens Truus Reynders Maarten Lambrecht Wouter Crijns A code orange for traffic-light-protocols as a communication mechanism in IGRT Technical Innovations & Patient Support in Radiation Oncology RTT-led IGRT TLP Lung |
| title | A code orange for traffic-light-protocols as a communication mechanism in IGRT |
| title_full | A code orange for traffic-light-protocols as a communication mechanism in IGRT |
| title_fullStr | A code orange for traffic-light-protocols as a communication mechanism in IGRT |
| title_full_unstemmed | A code orange for traffic-light-protocols as a communication mechanism in IGRT |
| title_short | A code orange for traffic-light-protocols as a communication mechanism in IGRT |
| title_sort | code orange for traffic light protocols as a communication mechanism in igrt |
| topic | RTT-led IGRT TLP Lung |
| url | http://www.sciencedirect.com/science/article/pii/S2405632424000532 |
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