Practices of Radiation Therapists in Motion Management Techniques for Definitive Prostate Cancer Radiotherapy

Radiation therapists play a vital role in ensuring precision and accuracy during definitive prostate cancer radiotherapy. Their practices in motion management focus on minimizing prostate movement caused by bladder and rectal filling, respiration, and patient setup variations. Techniques such as daily image-guided radiotherapy (IGRT), fiducial marker alignment, cone-beam CT verification, and the use of rectal balloons or spacers are routinely employed. Radiation therapists ensure patient preparation protocols such as consistent bladder filling and rectal emptying are strictly followed. Their expertise in adaptive planning, real-time imaging, and interpretation of motion patterns contributes significantly to maintaining target coverage while minimizing dose to organs at risk, ultimately improving treatment accuracy and patient outcomes.

1. Practices of Radiation Therapists in Motion Management Techniques for Definitive Prostate Cancer Radiotherapy   Subrata Roy Senior Radiation Therapist Radiation Oncology Department Nanavati Max Superspeacility Hospital,Mumbai

2. Background & Rationale Prostate motion during EBRT causes geometric & dosimetric uncertainties. Common causes: bladder/rectal filling, intra-fraction motion. IGRT techniques (CBCT, fiducials, SGRT) essential for accuracy. Practice variations exist in India due to resource gaps. The main objective of this national survey is to identify the common workflow challenges faced by radiation therapists in India when implementing prostate cancer motion management techniques.

3. Study Design Type:  Cross-sectional descriptive survey Tool:  Structured online questionnaire (15 questions) Population:  202 RTTs treating prostate cancer in India Data collection:  60 days via professional networks Analysis:  Descriptive statistics using Excel Sections covered

4. Demographics and Institutional Profiles Q1- How many years of experience do you have in radiation therapy as a Radiation Therapist?   Q2- What type of healthcare facility do you work in?   Q3- If Selected Any Other Specify here   Q4- In which city/state is your hospital located?

5. Experience level:  34% >10 years; 30% 2–5 years; others well-distributed. Workplace type:  81% private, 12% government, 7% others. Geographic spread:  40+ cities, both metros and regional centers. Demographics and Institutional Profiles

6. Clinical Load and Techniques in Use Q5- What is the average number of prostate cancer patients earned monthly at your centre?   Q6- Which motion management techniques are commonly used for prostate cancer patients at your center?   Q7-If Selected Any Other Specify here  

7. Clinical Load and Techniques in Use Key findings: 51% centers treat >15 prostate pts/month Real Time intrafraction monitoring (9.4%), RPM/SGRT ~15% each, Daily CBCT most common (30.7%) 40.6% with no specific motion management technique.

8. Time Impact and Workflow Efficiency Q8- How frequently is Positional Verification (2D or 3D imaging) done before treatment?   Q9- What is the average time added to your workflow per patient due to prostate motion management techniques?   Q10- How frequently do you encounter setup or equipment-related issues while managing prostate motion?  

9. Time Impact and Workflow Efficiency Key findings: 84.7% reported the use of daily CBCT for setup verification. A minority practicing alternate-day (8%) or thrice-weekly imaging (6%). A small subset indicated no imaging  before treatment, raising concerns regarding motion uncertainty. 15.8 % estimated 0-5 minutes, 27.7% estimated 6–10 minutes, 21.8% reported 11–15 minutes, 12.4 % estimated more than 15minutes. Notably, 22.3% marked this question as not applicable, In total, 65.3% of respondents acknowledged increased treatment time, underscoring the need for workflow optimization. suggesting non-implementation or minimal workflow impact. Regarding operational challenges, 41.1% reported equipment or setup-related issues rarely, while 28.7% encountered them occasionally, and 9.4% frequently. Only 4% reported such issues consistently. Indicating general stability with room for technical refinement.

10. Common Technical Challenges Q11- What are the key workflow challenges you face with prostate motion management?   Q12- Do you feel the motion management techniques in use effectively reduce prostate motion uncertainties?

11. Common Technical Challenges The most frequently reported challenge was inconsistent bladder/rectum filling (64.4%). Time constraints (34.2%). patient discomfort (24.3%), and technology limitations (14.9%). Less frequently cited issues included complex setup (13.4%).  lack of training (6.9%), and communication barriers (4%). These findings emphasize the need for robust patient preparation protocols and streamlined workflows. Regarding perceived effectiveness- 43.6% of RTTs agreed 23.3% strongly agreed that current motion management techniques reduce prostate motion uncertainties. Only a small fraction disagreed (1.5%) or strongly disagreed (0.5%). Approximately 19.8% remained neutral. 10.9% marked “not applicable,” Indicating varying degrees of exposure and confidence.

12. Setup and Imaging Issues & Perception of Motion Management Effectiveness Q13- How often are repeat setups or imaging required due to patient preparation issues (e.g., bladder/rectum status)? Q14- How does prostate motion management affect daily patient throughput at your center?      

13. Setup and Imaging Issues & Perception of Motion Management Effectiveness A significant portion (63.9%) reported that such occurrences happen “sometimes” while 18.3% indicated “rarely”. Alarmingly, 17.8% of respondents reported frequent or constant repeat setups, Highlighting the need for enhanced patient education and standardized bladder/bowel protocols. The impact of motion management on daily treatment throughput. While 23.8%marked this as “Not Applicable” 22.3% indicated a slight reduction, and 10.9% reported a significant reduction. Interestingly, 12.4% believed it increased workflow efficiency, while 14.4% saw no impact. The diversity in responses likely reflects heterogeneity in institutional resources, staff training, and workflow design.

14. Training and Support Needs Q15- What kind of training or support would enhance your role in prostate motion management?

15. Training and Support Needs The most preferred mode of support was workshops (55.4%). SOP/guideline updates (46.5%), online modules (34.2%). Peer-learning sessions (33.7%), and manufacturer-led demonstrations (23.8%). 14.9% of RTTs found these options not applicable, indicating widespread interest in structured training. These findings underline a significant demand for continuous professional development, hands-on learning, and regular updates to institutional protocols to support effective prostate motion management.  

16. Conclusions “Empowering RTTs through structured education and equitable technology access is key to high-quality prostate motion management.” Indian RTTs demonstrate strong adoption of IGRT practices, but face critical gaps in motion management standardization, training, and access to advanced technology. Progress:  Daily CBCT widely adopted, improving setup accuracy. Challenges:  Workflow delays, inconsistent bladder/rectal prep, limited real-time tracking. Action:  National guidelines, structured RTT training, and infrastructure upgrades needed.

17. [email protected] [phone] Subrata Roy R.T.(T) @iamSubrata_ Thank you for your Kind Attention