Victorian Medical Radiation Practitioners Education Trust

Virtual Reality (VR) coaching for the management of anxious patients undergoing radiation therapy (head and neck cancer)
- Daniel Sapkaroski

Patients undergoing medical imaging examinations (MIE) such as CT, MRI or PET scans have been found to have high levels of emotional distress, anxiety and claustrophobia. In particular, recent findings assessing cancer patients undergoing MIE indicate that 26% present with anxiety, 52% sub-clinical claustrophobia and 27% present with moderate to severe claustrophobia.

The prevalence of anxiety can especially be heightened in treatment of head and neck cancer (HNC) patients having radiation therapy where a tightly fitted thermoplastic mask is made to stabilise patients for their treatment.  A quarter of all HNC patients will experience mask anxiety relating to their treatment stating that lack of “experience and expectations” is a major confounding factor (Nixon et al. 2018).  Furthermore fear of mask anxiety has also been found to cause up to 24% of treatment related disruptions (Clover et al, 2011).  

How does statutory regulation influence practice? An exploration of the understanding and experiences of radiographers and sonographers in Australia.
- John McInerney

Health professional regulation internationally has changed dramatically in the last two decades. This has evolved as a consequence of damning reports of medical error and professional misconduct in healthcare. These have raised concern in the public eye about the management and regulation of health care professionals (Kohn et al., 2000, Wilson et al., 1995). Sentinel events such as the Harold Shipman case, the Bristol Infirmary in the UK and the Jayant Patel case in Bundaberg have undermined the public’s trust in traditional selfregulatory frameworks (Freckelton, 2010, Hamilton et al., 2014, Short et al., 2012). 

Radiation therapy student experiences using a cloud based planning system
- Dr Kellie Knight

Advances in technology and pedagogy have enabled major transitions in radiation therapy (RT) education. These include virtual environments used to facilitate the development of pre-clinical communication/patient care and technical skills.1, 2 To date, the only option for authentic treatment planning (TP) education has been through work-integrated learning or on-campus treatment planning labs. 

The advent of cloud-based workspaces has revolutionised education, where students can learn anywhere and on any device.3 There has been a growing imperative to reshape pedagogic and curricula practices for TP education in line with developments in the clinical environment.4 In 2018 Monash embarked on a novel interdisciplinary, cross institutional project to implement real-time mobile TP education into an online curriculum delivered to students Australia-wide. The introduction of cloud-based RT TP into the curricula assists to facilitate the gaining of RT TP knowledge and the building of TP skills to a geographically dispersed group of students, thus ensuring graduates have equal opportunities to develop TP skills regardless of their location. 

Optimal Breath-hold technique for Upper-abdominal & thoracic Radiotherapy
- Briana Welsh

The delivery of radiotherapy to cancers of the lung and upper abdomen, including the liver, pancreas, adrenal gland and kidneys, is technically challenging, as the tumour and surrounding organs move due to breathing.1 One method to overcome the effect of this motion is to deliver radiotherapy while the patient is holding their breath. A specialised machine called an Active Breathing Coordinator (ABC) is used to assist patients to hold their breath during radiation treatment. The intent of using this machine is to ensure the tumour and nearby healthy organs do not move during radiotherapy treatment. However, over multiple breath-holds, some small differences in tumour position can be observed. This small instability must be accounted for in the planning of the patient’s radiotherapy treatment, to ensure the tumour is treated with the correct dose.  Too large a volume will result in unnecessary normal tissue irradiation and increased risk of side effects. 

Better Preparing Prostate Cancer Patients for Radiotherapy: Incorporating Telehealth Consultations into Pre-treatment Patient Management
- Nigel Anderson

Modern technologies have enabled significant improvements in radiotherapy precision, providing an exciting opportunity to optimise patient outcomes. However, greater precision generates heightened sensitivities to deviations in planned radiotherapy due to dynamic patient changes throughout treatment.  Prostate radiotherapy demands precision, due to the close proximity of critical structures (i.e. bladder and bowel) to the targeted area (prostate or prostate bed). Pre-radiotherapy bladder and bowel filling protocol adherence ensures optimal avoidance of these structures, mitigating prostate/prostate bed displacement away from targeted radiation caused by dynamic patient changes. Such non-compliance often necessitates the need to repeat both the patient CT simulation (the preparatory CT scan that is required to enable radiotherapy planning) and radiotherapy treatment (multiple sessions to deliver the required dose of therapeutic radiation) appointments to ensure optimal treatment.

Patient protocol compliance is often challenging. Currently, up to 40% of patients presenting for prostate radiotherapy CT simulation at the Peter MacCallum Cancer Centre (Peter Mac) have not adequately prepared, despite receiving printed preparation instructions and a follow-up phone call. This dramatically impacts service delivery, due to the need for additional appointments to rectify patient non-compliance. Additionally, patients are also inconvenienced with this extra requirement.

Peter Mac now offers a telehealth video consultation platform organisation-wide. Application of telehealth in the provision of prostate cancer patient information provides an exciting opportunity to positively impact the persistent issue of bladder/bowel filling non-compliance, providing multifaceted benefits to both the patients and the organisation.

Overcoming radiation therapy language barriers with the use of an instant translation device for culturally and linguistically diverse (CALD) patients.
- Hunter, D., Schneider, M., Wright, C., Oates, R.

Radiation therapy treatment presents a unique challenge for culturally and linguistically diverse (CALD) cancer patients. Evidence suggests that CALD patients are disadvantaged by poor cancer literacy, restricted access to optimal care and undisclosed psychosocial issues. This prospective intervention study aims to overcome communication barriers associated with non-English speaking patients presenting for daily radiation therapy treatment. It is hypothesised that an instant translation device will improve treatment compliance and address unmet patient needs. Study outcomes are expected to inform radiation therapy practice, and may provide a foundation to expand into other medical radiations professions, nursing and/or allied health domains.

Synchrotron radiation therapy: radiobiology studies to prepare for clinical trials
- Smyth, L

Synchrotron radiation therapy (SRT) is an experimental form of radiation therapy that has fundamentally different physical properties compared to conventional radiation therapy (CRT). The biological consequences of these physical parameters include reduced side effects for healthy organs, resulting in a better therapeutic index. An understanding of the biological effects of SRT, especially in regard to toxicity, is crucial to its translation to clinical use. The findings of this project will enhance our understanding of the differential biological effects of SRT and CRT at a molecular level and provide novel insight into the normal tissue sparing effects of SRT.

Professionalism in the medical radiation practice professions: understanding professional dilemmas through student narratives about workplace learning
- Dr Caroline Wright

This research will use focus groups/interviews to investigate the range and nature of professionalism dilemmas which final year radiation therapy and radiography students experience whilst on clinical placement. The findings from the qualitative narrative analysis will be used to inform further research, develop course materials for students and professional development materials for practitioners.

MRI Training Course
- Debono, P.

Magnetic Resonance Imaging is a valuable technology used in diagnostic radiography. Fortunately the availability of MRI in rural situations is increasing as radiographers are trained and MRI scanners installed. For the last 6 months I have been studying the physical principles of MRI and MRI scanning in preparation for the AIR MRI level 1 exam. Each year Catherine Westbrook and John Talbot present MRI in Practice - a four day course lecturing their award winning textbook. This course will be an excellent learning opportunity for me 1 month before the exam, and I hope to practice MRI in our rural Victorian department for years to come.

Advanced Practice for Nuclear Medicine Technologists - Intradermal Injections for Lymphoscintigraphy - Development of training and competency based assessment program
- Tempest, M.

The role of Nuclear Medicine Technologists has expanded to include tasks that were traditionally performed by Nuclear Medicine Specialists, such as intravenous cannulation and radiopharmaceutical administration. These tasks are now considered entry level technologist skills and are taught at undergraduate level.

A new and evolving role for technologists is the administration of radiopharmaceutical for sentinel node lymphoscintigraphy by intradermal injection. This VMRPET funded project will involve the development of a training and competency-based assessment program for technologists to perform this advanced skill, providing opportunities to expand scope of practice, while offering improved efficiency and access for patients.

Following development, a trial group will undertake the program to achieve competency in intradermal injections, with the potential for roll-out to other Victorian practices.

Virtual reality simulation in radiography undergraduate clinical training
- Sapkaroski, D.

Simulation opportunities are valued by students as providing unlimited opportunities to develop a range of skills within a safe and supportive environment.

As part of a post-graduate research study, this project aims to investigate and measure the effectiveness of a Virtual Reality Simulation Learning Environment (VR SLE) utilsing complete 3D stereoscopic immersion. This Clinical Education Training Solutions Clinic (CETSOL) enables users to develop transferable general radiographic skills in the procedural, technical and communication domains, thereby reducing the time spent in providing on-the-job training to student radiographers.

Virtual Reality Preparation for Children Undergoing Medical Imaging Procedures
- Cahoon, G.

Virtual environments have been used for training and preparation in many areas of medicine, in particular to reduce pain and improve the psychological wellbeing of paediatric patients undergoing hospital treatments. At the Royal Children’s Hospital (RCH), Melbourne, mock MRI and CT procedures have successfully prepared numerous patients for complex clinical and research studies. Recent advances in Virtual Reality (VR) technology offer a low cost and adaptable method for preparing children for a number of medical imaging procedures, without the need for dedicated rooms or resources. This innovative project aims to use VR technology to prepare children for complex medical imaging procedures and provide guidance for practitioners working in paediatric imaging.

Evaluation of the Implementation of Australian Radiation Therapy Advanced Practitioners
- Matthews, K.

Advanced practice for radiation therapists has been part of the international landscape for more than a decade and several papers have reported service enhancements in relation to patient access and timeliness of care. Australia has been somewhat slower to develop similar roles, and currently there is no national standard in relation to advanced practice education or performance expectations.

This VMRPET funded project forms part of a post-graduate research study to investigate the influencing factors around the implementation of radiation therapy advanced practice in Australia. A qualitative case-study approach will be used to develop an understanding of radiation therapy advanced practice implementation nationally, to better inform key stakeholders.

Radiation dose measurements using NanoDOT and DAP for two scoliosis imaging systems
- Shanahan, M., Geso, M., Dunstan-Potter, A., Lennie, G.

Children exposed to radiation face higher cancer risks. In situations where children are likely to have repeat examinations over time, such as scoliosis imaging, it is essential that radiation dose for such examinations is minimised. This research aims to investigate radiation dose for scoliosis imaging (phantom study) using a new slot-scanning system, EOSTM imaging and compare it to a currently used broad-beam digital imaging system.

This study will also investigate the reliability and validity of the Dose Area Product automatically provided by manufacturers of the imaging systems and entrance and exit skin doses measured by multiple radiation dosimeters (NanoDOTs).