Investigating user perspective on training and clinical implementation of volumetric imaging

Purpose: Volumetric imaging (VI) is gaining momentum as a clinical tool for image guidance. The purpose of this study was to explore radiation therapists' (RTs) perception of VI training and clinical implementation. The results provide an evaluation of current training for continuous improvement, identify educational needs for the future, and chart a path for higher level evaluation of the learning activities. Methods: Sixty-five RTs who received initial training and subsequent front-end user experience with VI were contacted with an electronic posttraining questionnaire. Defined with assistance from a pilot group to encompass relevant aspects of training and VI, the survey consisted of 16 questions using a 4-point Likert scale and 1 open-ended comment box. The main sections of the survey were: demographics, current training satisfaction, user perception of competence with VI software manipulation, and assessment of future training needs for RTs. Results: Forty-five returned surveys (69%) were used for analysis. Results were examined for all participants, and then separated by subgroups for comparison with the Fisher exact test. The subgroups used were years of RT experience (<2 years, 2-5 years, 6-10 years, >10 years), and length of hands-on practice with VI (<3 months, 3-6 months, 7-9 months, >9 months). There was a consensus that training was organized (93%), comprehensive (89%), and adequate for VI clinical application (91%). Although 62% of respondents were confident with soft-tissue visualization, 95% agreed with the need for further training. Proposed cross-sectional anatomy review was seen as beneficial in 73%, though analysis with subgroups (experience with VI [P = .042], experience as an RT [P = .019]) showed that less experienced staff perceived a supplemental review session valuable. A total of 93% had confidence using VI for image matching; however, subgroup analysis revealed that the more experienced RTs are less confident (P = .016). Although only 58% agreed that workflow is improved with VI, 93% felt that volumetric imaging increased accuracy of radiotherapy. Common themes for improvement of future training sessions included conducting training closer to VI unit placement, and increased hands-on use of the software complemented case studies. Conclusions: RTs felt the initial VI image training assisted them in gaining confidence in interpreting and analyzing information obtained from VI. They found this training organized, comprehensive, and adequate for their needs. Continuous training for implementation of new technology is essential to the success of image guidance methods.