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EFRS/EORTC - Radiographers: at the heart of cancer treatment and research
Evidence-Based Imaging Oncologic Imaging Professional Issues Radiographers Research
Thursday, February 28, 16:00 - 17:30
Room: Y
Type of session: Joint Session of the EFRS and EORTC
Topic: Evidence-Based Imaging, Oncologic Imaging, Professional Issues, Radiographers, Research
Moderators: C. Beardmore (London/GB), M. Smits (Rotterdam/NL)

An overview of the roles of radiographers in research
J. McNulty; Dublin/IE
Learning Objectives

1. To understand how professional development is supporting the development of radiographer research roles.
2. To consider the opportunities for radiographer research.
3. To gain an insight into the impact of radiographer research in improving patient outcomes.


Research and evidence-based practice (EBP) underpin modern healthcare and can lead to enhanced patient safety, improved patient outcomes, and efficiencies in service delivery. The contribution of radiographers, academic and clinical, to this evidence through undertaking quality research, and subsequent dissemination is essential and will also serve to raise the profile and standing of radiographers beyond our profession. This applies equally to all three recognised branches of the profession: medical imaging, nuclear medicine, and radiotherapy. Radiographers are much more than facilitators, or data providers, in medical imaging research and some of the leading radiography researchers in the world can be found in Europe. These individuals lead large research groups, successfully compete for national and international research funding, collaborate beyond their profession, and publish in high-impact journals. In 2016, the European Federation of Radiographer Societies (EFRS) published a Statement on Radiography Research which clearly sets out the EFRS position on encouraging, supporting and developing high-quality radiographer-led research in order to strengthen our professional knowledge base. This statement, together with the 2015 Statement on Evidence-Based Practice in the Undergraduate Curriculum, and the European Qualifications Framework (EQF) Level 6(Bachelors) and Level 7(Masters) Benchmarking documents for radiographers, clearly set-out the importance of clear research focus in educational programmes. Radiographers can add value at all stages of the research process and for medical imaging or radiation oncology research to have a true impact and to benefit our patients it must be inclusive and multidisciplinary and span the academic-clinical divide.

Establishing the scientific and clinical value of advanced imaging
M. Smits; Rotterdam/NL
Learning Objectives

1. To understand the importance of imaging in supporting oncology research.
2. To learn about the range of trials evaluating imaging techniques.
3. To appreciate the importance of team working in enabling effective research.


In this presentation, glioma is used to exemplify the current challenges on oncological imaging. Gliomas constitute a group of tumours with heterogeneous clinical behaviour, with many therapeutic agents under investigation for their effectiveness. The assessment of treatment effect is not without difficulty. It is on the one hand hampered by therapy-related changes which can be indistinguishable from tumour progressions, such as pseudoprogression or radiation necrosis; and on the other hand by a phenomenon called pseudoresponse, occurring in the context of anti-angiogenic treatment, in which contrast enhancement diminishes unrelated to an actual anti-tumoural effect. New, preferably quantitative, markers of response are desperately needed to assess treatment response as accurately and early as possible within the context of a clinical trial. Furthermore, recent insights indicate that the clinical heterogeneity of glioma behaviour can - at least in part - be attributed to the tumour genotype. In the context of clinical trials, it is adamant that patients are correctly stratified according to their tumour genotype, which at this point in time can only be determined from tumour tissue acquired through biopsy/surgery. To avoid such invasive procedures, as well as to obtain a full overview of the tumour and its heterogeneity, and to be able to follow changes over time, advanced imaging can play an important role using a radiogenomic approach. In this presentation, I will discuss the current and potential imaging markers of glioma biological behaviour and response to treatment, and the challenges for implementation in clinical, multicentre trials.

Fostering excellence in radiation oncology research through a clinical research culture
H. McNair; London/GB
Learning Objectives

1. To understand the barriers and enablers which impact upon delivering effective research.
2. To learn how clinical departments can utilise the resources already available with the goal of developing a more confident and competent clinician-researcher culture.
3. To appreciate the importance of patient and professional input into trial design.


Research provides the evidence base for good clinical practice and is an essential component of any health care delivery service. However, conducting research in the clinic by radiography and radiotherapy staff can be difficult. Few research mentors may be available because of the lack of clinical academic positions. Clinical service takes priority when there are staff and time pressure. To create a research culture within these constraints is often difficult but not unachievable.
Clinical staff are best placed to pose and answer research questions around the patient pathway and patient technology interface. The first step is to define a research question, consider what needs to be measured and the tools required to measure. The research method may be an audit, service evaluation or trial. Audits are extremely useful tools and are easily accessible to clinical staff. BSc(Hons) educated radiographers, having developed their research skills in training should be ready to engage in research on qualification. Postgraduate courses can also be a driver. Patient and public input (PPI) from idea conception to the dissemination of results is essential. PPI gives insight into the research question from the patient perspective and is essential when developing patient information sheets. To apply for funding output is critical, posters, presentations and papers. Finally, examine the academic pathways of doctors, physicists and other allied health professionals to determine if a similar academic career path can be created for radiography. Radiographers are an essential part of research activity.

Radiation therapy quality assurance (RTQA) in clinical trials: the role of the radiographer/radiation therapy technologist
M. van Os; Rotterdam/NL
Learning Objectives

1. To understand the essential role of the radiographer/radiation therapy technologist in RTQA.
2. To appreciate the potential impact of poor RTQA practices on clinical trials.
3. To consider best practice in multi-centre RTQA for clinical trials.


The European Organisation for Research and Treatment of Cancer (EORTC) is involved in many multicentre trials in Radiotherapy. It is mandatory that included patients are treated similarly in all internationally participating institutes, and that outcome of the treatment is consistent for analysis. Therefore quality assurance per trial is required checking the equipment and procedures per participating institute. Within the Radiation Oncology Group, this task is assigned to the multidisciplinary RTQA-team consisting of radiation oncologists, physicists and radiotherapy technologists (RTTs). While overall survival or progression free survival are common endpoints to many trials, secondary endpoints often include toxicity. Since radiation induced toxicity is related to delineated volumes, it is of importance that the outlining of the organs at risk (OAR) is performed consistently enabling to ascribe differences in outcome to treatment and discrepancies in OAR delineation. It is also important to be able to disentangle radiation-induced from drug-induced toxicities. However, delineation has proven to show large interobserver variability and especially in delineation of OAR there often is no consensus on clear guidelines. While increasingly more RTTs are involved in the process of treatment planning and volume delineation, the RTT subcommittee initiated the RTQA Delineation Project aiming to develop clear guidelines for OAR delineation in EORTC trials. In this presentation, I will describe the role of RTTs within the EORTC RTQA-group initiating a delineation study on OAR in the male pelvic area and consequently analysing and improving volume definition during two EORTC trials by means of questionnaires and delineation workshops.

Panel discussion: Preparing our departments for high quality clinical trials
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