My Project Gallery Revolution

The Challenge

Well it has been a few years since I panned my iPad + Poster experiment back in the summer of 2014 at the COMP annual conference (See Part 1, Part 2, Part 3  and Part 4 for the series on "Why Posters Suck") .
It was an interesting experience and I learned a great deal on presenting science in a slightly less boring way.

After many years of attempting, I've finally found a way to attend the COMP Winter School meeting (see here for more details). It is a great meeting where Quality and Safety are general themes, focusing on patient care in a multi-disciplinary setting. I'm looking forward to connecting with colleagues, technologists, physicians, academics, and patients to discover how we, collectively, might be a bit better at what we do.

To justify my trip, I submitted an abstract to one of the 'Project Gallery' sessions. I really have no idea what this means. According to the organizers:


Project Gallery Presentations
During each 60-minute project gallery, a small number of conversational presentations will be held concurrently. Presenters will be assigned tables in a meeting room to display their materials (printed pages, laptop, or other media). Attendees will travel from station to station at intervals set by the session moderator. Winter School faculty will be present to facilitate these sessions. All media must be supplied by the presenter.

As you can see, there is a LOT of leeway here on how and what might be presented. The nice thing about this format is that it appears there appear to be flexible opportunities to meet and converse with attendees... at least the ones interested in your 'Project'. I see plenty of opportunities to have a "Project" which might be a bit more engaging.

My topic would seem a tad boring: it's essentially a 'Project Management' thing with some science speckled in. Below is my submitted abstract:

Title: Change Management of IGRT in Breast Radiation Therapy: Guidance on Image Guidance, please?

Introduction: Within a span of 2 years, our centre migrated all of our radiation treatment units -which lacked kV-imaging systems- to those with MV-, kV- and CBCT-imaging systems. The rapid introduction of this technology forced a re-evaluation of how image guided radiation therapy (IGRT) is used in all radiation treatment sites, including breast. Our objective was to safely introduce these new technologies while maintaining the same treatment appointment times.

Methods: A multi-disciplinary team was assembled to determine whether existing MV-IGRT action levels and processes remained valid, determine how kV imaging might modify current IGRT practices, determine the impacts of imaging dose, treatment time, and resources on possible changes in our IGRT practice, determine best practices for assessing volumetric changes in breast tissue, provide training and education during the transition, and, to implement continuous auditing and quality improvements of IGRT practices.

Our MV-IGRT practice was based on treatment DRRs, where action levels  for tangents, mono-isocentric breast, partial breast, and deep inspiration breath hold are compared with 3 day average shifts-data (5-10 mm) or a single day’s shift (7-15 mm). Prior to transition, 92 patients with MV-IGRT procedures were audited to evaluate the appropriateness of these action levels and their workflow. The need for daily SSD treatment field measurements, for assessing gross anatomical uncertainties or volumetric changes, was heatedly debated. We examined the dosimetric impact of 5-20 mm volume changes in 3 typical breast patients across the entire breast, medially or laterally.

Results:. The MV-IGRT audit revealed 8% patients breached historical action levels. Daily no-threshold shifts using kV-orthogonal pair isocentre matching was chosen as the preferred IGRT method for all breast treatment techniques. After introduction, an audit of 86 patients with kV-based IGRT procedures revealed 13% patients breached historical MV-based action levels. Images from outliers were analyzed to rule out poor image quality or matching. An engineering “control-systems” approach was used to re-estimate action levels. A global action level of 10 mm persistent for more than 1 day was adopted for all breast treatment techniques.

We found treatment field SSD checks were insensitive to breast volume changes; instead, anterior or lateral SSD measurements close to the seroma are more appropriate surrogates for assessing volumetric changes in the breast. The ability to intervene and correct dose to the breast tissue (ex: through MU scaling) is dependent on the number of fractions delivered. Since anatomical changes not detectable with SSD checks would be detected with CBCT, we implemented regular use of CBCT in breast IGRT (at a cost of 1-2 minutes additional treatment time), particularly when SSD discrepancies exceeding 15 mm are repeatedly breached.

Conclusions: Within the span of a year, we have dramatically changed our breast IGRT practice while maintaining treatment appointment times. This has not been without challenges, such as addressing dogmas and traditions that may no longer be relevant with new technologies. Future work includes adopting better IGRT strategies for correcting rotation, boost treatments and improving training, education, and documentation.

So, the Challenge: How might I make this topic more engaging given the boundary conditions of the project gallery?

Challenge accepted. Stay tuned. If you have ideas, comment away!