Daily CBCT for prostate

[napoleondynamite]

For those that do daily CBCT for prostate cancer - do you approve each CBCT prior to beam on, or are you comfortable approving at the end of the day once your therapists are up to speed on monitoring the bladder/rectum?

I have always been approving before each treatment based on how I was trained...but do I need to? The CMS guidelines are vague, I have seen many radoncs who do it at the end of the day..is there some official policy someone is aware of?

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[Gfunk6]

End of day. The idea is to prevent a mistake from being treated twice. In busy clinics, reviewing prior to beam on is disruptive.

Good RTTs who appropriately alert the MD when something is off are also helpful.

 

[medgator]

All CBCTs get approved by me first. It sucks at times, but that's how we roll.

I still implant fiducials often for pt and clinic convenience for that reason but occasionally I see the pt with a strong contraindication to come off anticoagulation so they get daily CTs. One advantage I see to it is better monitoring of bladder filling pre-tx

I think gfunk is still correct, igrt images have to be approved before the next fraction but per Medicare supervision guidelines, you need to be in the clinic to furnish "immediate" assistance if there is a question from the rtts

 

[Palex80]

We let our therapists match and treat if they feel comfortable with it.
We get called if the rectum looks totally different than in the planning CT and we review CBCTs once per week for all patients (NOT every day).

 

[Burt Radnolds]

End of the day. This is totally reasonable and done in many clinics. Reviewing a CBCT is not rocket science. If you have a competent therapist, I would hope they would have the mental faculties to basically look at 2 pictures and see if they match. I mean honestly a smart child could do it, maybe even a highly trained monkey.

If you catch a mistake, immediately notify your therapist and provide proper training and feedback, maybe review the next few prior to beam on if you are worried. If its a continuous pattern that you feel is impacting care, fire your therapist.