Impact/Outcomes: By naming the discomfort that is typically experienced when placed in a team setting, power is returned to the individual and an opportunity is created for them to recognize when it is lacking.This awareness acts as a precursor to fostering psychological safety and allows for action to be taken. Development of an Online Adaptive radiation therapy framework on an Ethos treatment unitDave McAloney, Kenny Zhan, Natasha Macmaster Nova Scotia Health Aim: To develop an efficient adaptive therapy workflow at our local cancer center.Currently, there is no protocol for adaptive therapy at our center.Due to the complexity and multi-disciplinary approach to adaptive therapy, a specific model should be in place to guide practice.Adaptive therapy requires input from radiation therapists, dosimetrists, physicists, and radiation oncologists at the time of treatment delivery.Process: Due to the multidisciplinary nature of adaptive therapy, there will be overlapping scopes of practice during the treatment process.Our center is proposing that a radiation therapist with specialty training could critically review the automated segmentation and make changes, if required, to normal and target structures.Once the plan is developed by the Ethos treatment planning system (TPS), the therapist could be the one to review the adaptive plan and determine if it should be chosen over the scheduled treatment plan.Once the desired treatment plan is chosen, final treatment approval would be done by a medical physicist prior to treatment delivery.Benefits/Challenges: Adopting the proposed workflow as outlined above would reduce the workload required to deliver adaptive therapy.It would be difficult to facilitate physician availability during clinical hours for each treatment session.A specially trained therapist would work to develop the knowledge and clinical reasoning skills to become autonomous in making the proposed treatment decisions required to deliver adaptive therapy.Adaptive therapy is only feasible if the process becomes more efficient and streamlined.Reducing the number of staff required to deliver adaptive therapy and increasing their scope of practice is one feasible way to achieve this result.Impact/Outcomes: The goal at our cancer center would be to complete the adaptive planning process and treat within a 30-minute appointment.Ethos potentially allows this due to shorter image acquisition times, improved image quality and automated contouring and treatment planning processes.Adaptive therapy could now be clinically feasible due to decreased workload and staffing requirements.A radiation therapist with specialty training would be required to achieve these goals.

address important healthcare challenges. The TAHSNp Health Professions Innovation Fellowship program ("Program") supports health professionals' leadership development by offering them an opportunity to lead a quality improvement project and participate in a curriculum focused on leading change. Objective: As part of an outcome evaluation of the program, our objective was to determine the program's impact on leadership activities and roles undertaken by alumni. Methods: A questionnaire was administered to participants who completed the program in 2019 and 2020 at 6 and 18 months post-program to assess their leadership activities, leadership roles and the program's impact. Prospectively, we conducted internal and LinkedIn searches to identify current roles and obtained personal statements from program alumni of medical imaging health professions as complementary data sources for our program evaluation. Results: At 6 and 18 months post-program, 47% - 59% of alumni respondents reported participation in hospital/organization committees, mentoring fellows or students, and presenting scholarly work inside or outside their organizations (6 months: N = 25, response rate = 39.1%; 18 months: N = 17, response rate = 26.6%). Additionally, at 18 months post program, 35% - 41% of alumni reported leading a new quality improvement initiative, pursuing formal education, and having a new leadership role. Most alumni reported their leadership activities were influenced by the program, with the largest impact occurring after 18 months post-program for leading a new quality improvement initiative (100%), career plans for the next five years (94%), mentoring fellowship staff (91%), presenting at their healthcare organization (91%) and a new leadership role (90%). Alumni reported the program helped build their confidence, create networking opportunities, leadership skill-building and interest in pursuing other roles beyond their clinical role. More specifically, alumni reported that leadership skills gained from the program were used in subsequent roles and responsibilities. Conclusion/Implications: The program evaluation demonstrates engaged alumni who undertake informal and formal leadership activities and roles. Our results are illustrative of the value-add as a result of healthcare organizations' investment in developing leadership among healthcare professionals. As continued engagement and career development are known to be important for staff retention and succession planning strategies, our findings are highly relevant given the current staffing challenges in healthcare.

Purpose: Cardiac toxicity is a major concern for left-sided breast cancer patients receiving radiation therapy (RT). Different breath-hold techniques may be used to reduce cardiac dose including voluntary deep inspiration breath hold (vDIBH), the Elekta Active Breathing Coordinator (ABC), and the AlignRT system from VisionRT. The purpose of this study is to evaluate the differences in heart position and mean heart dose for these three techniques during RT of left-sided breast cancer patients. Methods: In this prospective study, 55 left-sided breast cancer patients receiving post-operative RT were randomly assigned to vDIBH, ABC or AlignRT. Patients were set up daily to tattoos and cone-beam computed tomography (CBCT) imaging was performed weekly to verify patient position. During weekly CBCT, patients were matched to chestwall and all shifts were applied prior to treatment. Weekly CBCTs were retrospectively assessed in the Pinnacle Treatment Planning System. The delivered mean heart dose was calculated by adjusting the heart contour from the planning CT scan to match the heart position observed on each weekly CBCT. The mean cardiac dose was re-calculated using the planned treatment fields and the adjusted heart contours for patients receiving any of the three breath-hold techniques. Three-dimensional cardiac displacement between the planned (CT) and treated (CBCT) heart positions was obtained from the changes in coordinates of the heart centroids. Abstract Results: A total of 7 patients received a dose of 5000 cGy in 25 fractions, 45 patients received 4256 cGy in 16 fractions and 3 patients received 4005 cGy in 15 fractions. Sixteen of these patients received RT with VBH, 19 patients were treated with ABC and 20 patients were treated with AlignRT. The change in mean cardiac dose between planning CT and treatment CBCT was 2.9% (vDIBH), 2.0% (ABC) and 6.6% (AlignRT). The median standard deviations for change in interfractional heart dose on treatment were 11.0 cGy (vDIBH), 13.6 cGy (ABC) and 16.1 cGy (AlignRT). The mean cardiac displacement between planning CT and treatment CBCT were 0.37 cm (vDIBH), 0.35 cm (ABC), and 0.35 cm (AlignRT). All cardiac displacements were found to be statistically non-significant in comparing the three breath-hold techniques (p < 0.36). All differences in the dosimetric data were also found to be statistically non-significant in comparing the three breath-hold techniques (p < 1.35). Conclusion: This study demonstrates that the differences in heart position on treatment are negligible for vDIBH, ABC and AlignRT, and that the cardiac dose sparing is equivalent for these three breath-hold techniques.

Background and Objectives: Building capacity for research and innovation among point-of-care health professionals can translate into positive outcomes from the organization, staff, and patient perspective. However, there is not a widely accepted framework in place across academic hospitals to guide this work and measure impact. This article outlines one Canadian hospital's approach and provides a blueprint with appropriate indicators as a starting point and guide for organizations looking to develop and implement a practice-based research and innovation strategy. Methods: An adapted framework was utilized to measure and track progress toward achievement of research and innovation strategic goals. The framework outlines key domains for research and capacity development and appropriate metrics. Data are reported from a 4-year period (2014-2018). Results: The evaluation of the practice-based research and innovation portfolio identified several important factors that contribute to the success of embedding this strategy across a large academic teaching institution. These include using a collaborative leadership model, leveraging linkages, partnerships, and collaborations, and recognizing the academic contributions of health professionals engaging in research and innovation. Conclusions: Engaging those who provide care directly to patients and families in research and innovation is critical to ensuring high-quality health outcomes and patient experience. Creative and innovative funding models, collaborative leadership, and partnerships with key stakeholders to support research and innovation are needed to ensure sustainability.

A diverse patient demographic at a cancer centre can present communication challenges due to language barriers in limited English proficiency (LEP) patients. Studies show that language barriers are linked to less health education, lower interpersonal care and lower patient satisfaction. The project's aim is to increase communication with available interpretation tools while incorporating staff and patient perspective.

Radiation therapy is often used as a primary treatment for head and neck cancers. Through advancements in technology, radiation therapy has improved at sculpting dose towards the tumour and reducing dose to surrounding normal tissues. However, even with these advancements, patients still experience a variety of side effects that can have an adverse impact on their quality of life both during and after treatment. Acute side effects tend to peak post-treatment, when there is minimal support available. At our centre, patients receive generic, non site-specific, post-treatment patient education. Providing head and neck patients with timely, site-specific education that would allow them to provide self-care at home for expected, non-severe side effects of radiation treatment could provide a cost- effective solution and improve the patient experience. The objective of this research is to determine areas of improvement for patient education in the current standard of care that will allow head and neck patients to better independently manage their care post-treatment.

Person centred care (PCC) is fundamental to the provision of quality care. Inherent in PCC is the need to embed the voice of the person in all aspects of care by sharing their voice with the healthcare team through clear and consistent documentation. Recognizing this importance, the Radiation Therapy Department sought to improve documentation by Radiation Therapists (MRT (T)) through the adoption of SBAR: a validated tool for structured communication in health care. While SBAR had been introduced to radiation therapists it was not widely used in practice. A novel training approach was developed to reintroduce SBAR, adhere to the principles of PCC and support patients in the role as educators. The documentation committee designed a training session to facilitate knowledge to practice transfer by providing MRT(T)s the opportunity to build confidence with and an appreciation of SBAR in a simulated environment. Central to the experiential learning design was the adoption of patient 'actors' into the training sessions. While providing relevant theoretical information on SBAR, the focus of the sessions was the interaction, including documentation, between the patient "actors" and the MRT(T)s. Through a series of simulated role plays, the MRT(T)s were provided with peer and patient 'actor' feedback on verbal and written documentation. Patient 'actors', as participants in the documentation process, provided feedback based on their perception of how the documentation represented their voice. Facilitators from the working group were present to guide the participants through each scenario, assist with utilizing the framework and promote reflection by participants. Evaluation was conducted through pre, post and six week post surveys. The pre- session survey was framed to gain insight into therapists' self-reported knowledge of SBAR and use in practice. Post session evaluations included questions directed at therapists' confidence to use the SBAR tool and their commitment to implement the tool into practice. Nineteen training sessions were conducted with 111 MRT(T)s, 14 facilitators and 13 patient volunteers. Scheduling challenges were overcome by the support of administration, peer MRT(T)s and volunteer services coordinators. Design of the sessions was purposeful to foster a supportive learning environment and addressed concerns of potential unease of MRT(T)s with the incorporation of patients as active participants in the training. Having patients as participants created an authentic simulation of patient/therapist interaction and offered MRT(T)s the opportunity to receive feedback on the effectiveness and style of their communication. Comparison of surveys resulted in a 50% increase in MRT (T) confidence with SBAR use. This increase in confidence in ability to use SBAR was maintained in the 6 week post mark. Commitment to use SBAR in practice post session was 90% with 85 % of respondents at 6 weeks stating they had applied SBAR in their documentation. The survey comments support for the interactive, collaborative and practical nature of the sessions with the majority valuing the contribution of the patient volunteers. By situating the training in a simulation environment, the MRT(T)s were provided with practice opportunities and received immediate feedback from multiple sources. Furthermore, by involving patient volunteers, the sessions provided the opportunity to embed patient voice into the training process.

Team huddles is a best practice tool that allows preemptive discussions between members of different treatment units to address staffing, workload, patient concerns and recognize team achievements. Given the complexity of care and workload within radiation therapy, our aim was to assess staff preparedness of implementing team huddles within a Radiation Therapy Department. A needs assessment was conducted and included a literature review of team huddles within healthcare, an environmental scan of team huddles in clinical practice, and a staff survey. The survey was adapted from the TeamSTEPPS® questionnaires and included questions on communication, team climate and atmosphere. The survey was used to establish a baseline on the perception of team communication and team morale and also asked for feedback to enable co-design of the huddle process. A recommended huddles checklist from the American Medical Association’s Steps Forward was modified to incorporate feedback from the staff. The huddle checklist was finalized and learning sessions were provided to ensure clarity and comfort with the huddle process before implementation into practice. Team huddles can improve the amount of meaningful communication and ensure the continuity of patient care among the treatment units, ultimately strengthening the intra-professional collaboration culture. It allows staff to review their workload, ensuring adequate time spent with each patient, while emphasizing the value of each team member. Consequently, team huddles can boost morale by serving as an opportunity to recognize and celebrate staff contributions and achievements. Team huddles can be implemented within any intra- or inter-professional team as patient safety is a shared responsibility and requires effective communication for the delivery of high quality care. Identified challenges included: concerns on how to prepare for the huddle and the level of time commitment needed. Our findings showed that only 23.9% (n=11) of staff felt there was sufficient opportunities to formally discuss patient workload between treatment units even though 58.7% (n=27) thought it was important to discuss these differences. In regards to team morale, 54.5% (n=25) of staff agreed that their team experienced high morale. While 65.2% (n=30) of staff felt that it was important to acknowledge and celebrate achievements, only 37% (n= 17) agreed that team members received recognition for individual performance. During the learning sessions, participants were provided the opportunity to seek clarification on the components of the checklist and practice performing a team huddle. After the session, all participants indicated that they felt ready to begin the huddle pilot.

BACKGROUND On a new dedicated radiosurgery unit enabling frameless treatments, a cone-beam computed tomography (CBCT) can be used for stereotactic definition. Since magnetic resonance imaging (MRI) is used to delineate target, reproducible MRI-to-CBCT coregistration is vital for accurate target localization. OBJECTIVE To evaluate reproducibility of image coregistration in patient images. METHODS Three types of coregistration (source-to-target) were analyzed: (1) MRI-to-CT; (2) MRI-to-CBCT; and (3) CT-to-CBCT. For each patient (n = 15), each coregistration type was independently performed 5 to 30 times (total: 465 coregistrations). Each coregistration yielded a transformation matrix, which was subsequently applied to transform every point in the source image to stereotactic coordinates. Two metrics were measured: (1) target registration error (TRE): mean distance between the registered position of each target point and the average registration position of that point; (2) compound registration error (CRE): mean spatial difference between stereotactic coordinates using (A) MRI-to-CT-to-CBCT and (B) MRI-to-CBCT. RESULTS The median (range) of TRE was 0.11 mm (0.06-0.22 mm), 0.17 mm (0.10-0.36 mm), and 0.12 mm (0.08-0.21 mm) for MRI-to-CT, MRI-to-CBCT, and CT-to-CBCT, respectively. The TRE for MRI-to-CBCT was statistically higher than the other 2 methods (P < .01). The median (range) of CRE was 0.44 mm (0.22-0.59 mm). The maximum point CRE between patients ranged from 0.37-1.15 mm when considering all MRI points, but reduced to 0.31-0.90 mm within the central 16 cm. The CRE varied across the image volume, and typically was minimized near the center. CONCLUSION The variation in image coregistration is within 0.2 mm, indicating a high degree of reproducibility. The CRE varies throughout the head but is submillimeter in the central 16 cm region.

Radiation review is a weekly clinic in the radiotherapy treatment (RT) care trajectory. It is an opportunity for patients undergoing RT to discuss emergent health issues with their care team. Recently, there was an opportunity to leverage technology to improve the arrival process of patients to this clinic and communication amongst the care team. Previously, Radiation Therapists escorted patients to the clinic and arrived patients on a paper list. This process was considered inefficient as these lists were found electronically, however not utilized. Lack of staffing and communication between review staff and treatment therapists generated unnecessary delays. An interdisciplinary group was assembled, with nursing, volunteer representative and radiation therapists. The primary focus was to utilize the electronic patient lists found in our record and verify system, MOSAIQ. Issues inherent to the manual process were discussed and solutions tested. Standard communication templates were created along with training materials. Training began prior to implementation in which both the paper process and the electronic process were done simultaneously. The change proved challenging as each group required different training needs with varying levels of comfort with technology. Every groups buy-in was essential to the success of the transition and to overcome the resistance to change. The utilization of electronic lists was accessible by all, allowing for real-time patient tracking. This streamlined the review process improving efficiency and communications between members of the healthcare team. The preliminary qualitative results varied by professional group. Radiation therapists found the electronic process more efficient. The volunteer group adjusted rapidly. Nursing's integral role in the review process, made their buy in essential to the success of the transition and took about 3 weeks for this to be accomplished. The next steps are to conduct a qualitative survey to further understand the impact.

Introduction Health care services use surveys to assess patient satisfaction and identify areas for improvement. While it is important to assess patient satisfaction to ensure their needs are met, lengthy questionnaires with closed-ended questions often focus on areas that may be considered important by institutions rather than patients. Recently, focus has shifted toward patient and caregiver experience, which institutions address via appreciative inquiry. The aim of this initiative was the development of a patient experience survey (PES) for radiation therapy patients and caregivers which would allow them to express their opinions and priorities. This patient feedback would then be addressed through quality improvement (QI) projects geared toward improving the overall patient and caregiver experience in radiation therapy. Methods A three-question minute survey was developed for use as a PES in the radiation therapy department of an academic oncology program located in a large metropolitan area. Feedback was obtained from patient education and person-centred care experts, as well as 10 radiation therapy patients. All feedback was incorporated to create the final PES; respondents rated their agreement on a five-point Likert scale with the statement "My overall experience in Radiation Therapy was great" and two open-ended questions allowed them to highlight departmental strengths and areas for improvement. An initial 3-month pilot was conducted where PESs were available on a self-serve basis to patients and caregivers in waiting areas and at radiation therapy treatment units. All responses were anonymous and completed surveys were returned via drop boxes. Descriptive statistics and thematic analysis were used to analyse responses. Results A total of 86 surveys were returned. Of those, 80 (93%) responded to the Likert scale question with 83% agreeing or strongly agreeing that their experience in radiation therapy was great. Several strengths were identified by respondents including teamwork, professionalism, and knowledge. Areas identified for improvement included management of appointment delays and communication of delays to patients, as well as environmental improvements. Conclusions Although most respondents reported a favourable experience, this pilot demonstrated the minute survey can identify areas for improvement that can be addressed through QI. Including the patient perspective in QI is evidenced to enhance its outcome and aligns with institutional, provincial, and national strategic goals of improving the quality of cancer care through patient engagement.

The waiting room experience can drive patient satisfaction and affect outlook on encounters with healthcare professionals and quality of care. Patient education initiatives in waiting areas can improve overall patient experience in the primary care setting. A recent survey conducted in the radiation therapy department of a large metropolitan cancer centre revealed patients and their families were dissatisfied with the waiting room experience. Patients reported a lack of distraction and a desire for more information on available resources. The aim of this initiative was to evaluate the impact of a patient information monitor on the experience of patients and families visiting the radiation therapy department at our centre. This initiative was executed by a pre-existing patient experience working group with representation from different areas within the department including administration, treatment delivery, specialty areas, research and education. A brainstorming session was held and five categories of content were identified: 1) Organizational Information (e.g. parking services), 2) Resources Available (e.g. family and supportive services), 3) Trivia and Random Facts, 4) Brain Teasers, and 5) Scenic Photos. Categories were assigned to group members for content development. Template pages were created using Microsoft PowerPoint™ to ensure consistency and uniformity of content presentation. Where possible, information from existing patient education and information materials was used verbatim. To avoid repetition during a patient visit, a minimum of one hour of content was required, with each page of content displayed for 30 seconds for a total of 120 pages. Sample pages were sent to various stakeholders for review, including patient education experts, patient representatives and interprofessional groups. Once the monitor was on display, 50 patients and caregivers were approached for their reaction and feedback on the content. Development and upload of content is labour intensive. This is compounded by the volume of content required to reduce repetition. Additionally, content needs to be reviewed periodically to ensure information is accurate and up-to-date. Currently, there is a single monitor positioned in the middle of the radiation therapy waiting area. Only 21 of the 50 individuals approached for feedback had noticed the monitor. However, 29% (6/21) of patients that noticed the monitor found the Organizational and Resource content informative and helpful while 48% (10/21) enjoyed the distraction provided by the Scenic Photos, Trivia and Brain Teasers. The experience of patients and families in the radiation therapy waiting room is an important component of overall patient experience in our department. In the radiation therapy department, the patient information monitor serves as an easily accessible source of information and distraction for our patients and families. In the future, additional monitors in different locations could increase the number of individuals that benefit from this initiative.

“I was born intelligent but Facebook ruined me” [[1]Facebook Unknown AuthorI was born intelligent facebook ruined me.2017https://www.facebook.com/I-Was-Born-Intelligent-Facebook-Ruined-me-110868915624302/Google Scholar]. Social media serves as one of the major public health engines of the 21st century, granting health care practitioners and the public alike unprecedented access to information on procedures, interventions, research, and survival [[2]Klapper S. Social media and oncology: creating unprecedented opportunities for connecting and learning.2015https://connection.asco.org/magazine/features/social-media-oncology-creating-unprecedented-opportunities-connecting-learningGoogle Scholar]. But, as with all great power comes great responsibility. In Canada, over 88% of our population has access to the Internet, with more than two-thirds of the country possessing a social media network profile. More than half of these Internet users have multiple profiles; among those, Facebook, YouTube, Twitter, and Pinterest rate the highest in popularity [[3]UFCWBy the numbers: social media in Canada.2017http://www.ufcw.ca/index.php?option=com_content&view=article&id=31389:by-the-numbers-social-media-in-canada&catid=9820&Itemid=6&lang=enGoogle Scholar]. Ease of accessibility through web-based and/or mobile-based applications with free or minimal financial burden facilitates this uptake of social media among the public [[4]Lewis M.A. Dicker A.P. Social media and oncology: the past, present, and future of electronic communication between physician and patient.Semin Oncol. 2015; 42: 764-771Crossref PubMed Scopus (38) Google Scholar] (Figure 1). Social media, also known as Web 2.0, can be defined as a collection of web-based technologies that share a user-focussed approach to design and functionality, in which users can actively participate in content creation and editing through open collaboration between members of communities of practice [[5]Tunnecliff J. Ilic D. Morgan P. et al.The acceptability among health researchers and clinicians of social media to translate research evidence to clinical practice: mixed-methods survey and interview study.J Med Internet Res. 2015; 17: e119Crossref PubMed Scopus (46) Google Scholar]. This includes social networking, web logs (blogs), and media sharing [[6]Ventola C.L. Social media and health care professionals: benefits, risks, and best practices.Pharm Ther. 2014; 39: 491-520Google Scholar]. Pervading our private and public personas, social media drives to document and share snippets of our lives through communications to our various networks, for example, in tweets of 140 characters or less. Social media presents a non-conventional tool for medical radiation technologists (MRTs), whose uses include, but are not limited to: rapid dissemination of information and knowledge translation, building professional networks, and professional development [[7]Adilman R. Rajmohan Y. Brooks E. et al.ReCAP: Social media use among physicians and trainees: results of a national medical oncology physician survey.J Oncol Pract. 2016; 12: 79-80Crossref PubMed Scopus (55) Google Scholar]. Social media has the potential to impact the practices of MRTs and the way they share and access current information. Previous research has identified reluctance to engage with online media, especially social media, despite 80% of MRTs accessing their professional development online [[8]Matthews K, Lawson C. (2016). Blurring boundaries: radiation therapist perception of social media as a professional development tool, poster presentation. Paper presented at: Australian and New Zealand Association for Health Professional Educators conference; 19-23 March; Perth, Western Australia.Google Scholar]. Similarly, patients use social media when researching health information, when seeking a platform for support, and to express themselves in a positive space [[9]Antheunis M.L. Tates K. Nieboer T.E. Patients' and health professionals' use of social media in health care: motives, barriers and expectations.Patient Educ Couns. 2013; 92: 426-431Crossref PubMed Scopus (400) Google Scholar]. Driven by different factors, these subpopulations exist in parallel settings while using the same communication tool, creating a divide between patient and practitioner. In the right hands, the potential exists for this platform to bridge the gap and mitigate potential pitfalls between patients and practitioners. It offers an effective tool to open the lines of communication between these two groups, not only for interprofessional knowledge translation and patient education, but also knowledge sharing between patients and at the patient-caregiver interface. Social media has the power to connect people from across the globe. It now allows both patients and practitioners alike accessibility to a compendium of information, essentially in the palm of their hands. The benefits and risks of social media and its impact will be further examined in the following discussion between @ru_bee13 and @Brianakin. Social media offers a new-age platform that influences the practice of MRTs. A variety of social media platforms help to promote interprofessional collaboration and knowledge translation in the virtual environment [[6]Ventola C.L. Social media and health care professionals: benefits, risks, and best practices.Pharm Ther. 2014; 39: 491-520Google Scholar]. This rapid dissemination of knowledge also promotes professional development, because MRTs have access to the most current information and ground-breaking research developments. We now live in an age where a single tweet can circumnavigate the globe in less than a minute [[10]Twitter Marketing (2017). Available at: https://marketing.twitter.com/na/en/insights/twitter-transforms-conversations-between-companies-and-customers.html?utm_source=twitter&utm_campaign=MTC_Marketeers_CustoService&utm_medium=linkGoogle Scholar]. As fiscal concerns within the health care system increase, unconventional forums, such as Twitter and Facebook, afford opportunities for MRTs to connect using unconventional means. These online forums are replacing traditional conferences and live journal clubs, and facilitating the increase of professional networks. “Tweeting the Meeting” is a forum for conference attendees to tag posts using conference hashtags (ie, #RTi3Conference) linked to key messages that allow followers to learn from the meeting without physically attending (Figure 2). A simple retweet of a message can exponentially expand the reach of information, research, and developments. Livestreaming and Twitter journal clubs can connect MRTs across the globe. It can also allow programs of different practice orientation (rural, remote, non-academic) opportunities for real-time questions and answers with specialists in the field, fostering a two-way discussion in real-time that ultimately leads to an increase in access to resources [[6]Ventola C.L. Social media and health care professionals: benefits, risks, and best practices.Pharm Ther. 2014; 39: 491-520Google Scholar]. An excellent example of this innovative forum is the Twitter group, @MedRadJclub, the first online journal club engaging MRTs from a variety of specialisations across the world [[11]Currie G. Woznitza N. Bolderston A. et al.Twitter journal club in medical radiation science.J Med Imag Radiat Sci. 2016; 48: 83-89Abstract Full Text Full Text PDF Scopus (17) Google Scholar]. @MedRadJclub links their discussions to monthly blogs and allows engaging tweets to drive the exchange of ideas [[11]Currie G. Woznitza N. Bolderston A. et al.Twitter journal club in medical radiation science.J Med Imag Radiat Sci. 2016; 48: 83-89Abstract Full Text Full Text PDF Scopus (17) Google Scholar]. Participation in online journal clubs and online case-based tumour boards offers an opportunity to discover collaborators outside your traditional, in-person network [[12]Markham M.J. Gentile D. Graham D.L. Social media for networking, professional development, and patient engagement.Am Soc Clin Oncol Educ Book. 2017; 37: 782-787Crossref PubMed Scopus (58) Google Scholar]. Knowledge translation and information sharing via social media crosses the globe in a matter of minutes; even more impressive is the fact that users are not required to always generate their own content, but rather can facilitate discussions by sharing the content of others. Social media forums allow MRTs to not only share expert knowledge, but to collaboratively discuss relevant issues regarding patient and/or workflow. This open dialogue enables direct learning from the experiences of other clinicians and institutions [[6]Ventola C.L. Social media and health care professionals: benefits, risks, and best practices.Pharm Ther. 2014; 39: 491-520Google Scholar]. Research indicates that 86% of relevant evidence fails to be adopted into clinical practice because of the large lag time in distributing information. Sharing information via social media may assist in decreasing that lag time; and with this more rapid dissemination, MRTs have the opportunity to stay current with advances in practice, creating a driving force for professional development [[5]Tunnecliff J. Ilic D. Morgan P. et al.The acceptability among health researchers and clinicians of social media to translate research evidence to clinical practice: mixed-methods survey and interview study.J Med Internet Res. 2015; 17: e119Crossref PubMed Scopus (46) Google Scholar]. The act of building a professional network through social media presents many benefits, such as finding mentors, sharing experiences, and building confidence. Through this collegiality, MRTs can learn new skills by seeking out industry leaders willing to teach and share. Professional learning can take place in the form of renewed competence in clinical skills, the building of inquiry and quality improvement into practice, or evaluating current practices to ensure maximum effectiveness. Social media creates an environment of informal learning that can further advance academic practice in conjunction with professional development. Although social media increases the velocity and breadth of reach among practitioners, it is limited to both the context and interpretation of the practitioner communicating the message [[4]Lewis M.A. Dicker A.P. Social media and oncology: the past, present, and future of electronic communication between physician and patient.Semin Oncol. 2015; 42: 764-771Crossref PubMed Scopus (38) Google Scholar]. Case in point, attending a conference, one may tweet a 140-character message regarding a study identifying an increased incident rate is correlated at a time when the most staff is on a unit. This tweet lacks context. Did the study illustrate an increase in incidents because more incidents were linked to confusion in transfer of accountability? Was the increase due to the opportunity for staff to report incidents? The onus falls onto practitioners to follow-up on the information they receive to its source, understand its rigour, and make one's own conclusions rather than take the interpretations of others at face value. Of greater concern is the larger community to which social communications are available. The line between private and professional networks with respect to social media often blurs [[4]Lewis M.A. Dicker A.P. Social media and oncology: the past, present, and future of electronic communication between physician and patient.Semin Oncol. 2015; 42: 764-771Crossref PubMed Scopus (38) Google Scholar]. Facebook interactions require “friending” to establish a connection between social networks. This connection by the very definition of the term implies the dissolution of the professional boundary of the patient-professional caregiver boundary [[4]Lewis M.A. Dicker A.P. Social media and oncology: the past, present, and future of electronic communication between physician and patient.Semin Oncol. 2015; 42: 764-771Crossref PubMed Scopus (38) Google Scholar]. Consequently, communications intended for a professional audience are available to the public as well. Naïve to the context of a post, quote, or finding, the possibility of misinterpretation of information is a very real danger in the hands of the public. Referring to the above case, the potential perception by the public may be an associated risk when receiving treatment during peak hours. Lacking context of incident reporting could undermine the public's trust in the health care system. Compounding this effect is the potential for laypeople to share these communications among their social media networks. Twitter allows members to passively retweet content in an ever-expanding “broken telephone” network of misinformation [[12]Markham M.J. Gentile D. Graham D.L. Social media for networking, professional development, and patient engagement.Am Soc Clin Oncol Educ Book. 2017; 37: 782-787Crossref PubMed Scopus (58) Google Scholar]. Finally, the blurring of professional and personal networks is complicated by the presence of both professional and unprofessional content within a practitioner's social media presence. In a content review of 5,156 physician tweets, 38 privacy violations, 33 profane comments, 14 sexually explicit, and 4 discriminatory comments were identified. In addition, 12 conflicts of interest and 10 contradictions to practice were also noted [[13]Chretien K.C. Azar J. Kind T. Physicians on Twitter.JAMA. 2011; 305: 566Crossref PubMed Scopus (183) Google Scholar]. The virtual interactions within the realm of social media can foster a false sense of security. Casual posts and communications can have unintended ramifications with a ripple effect as they spread through retweets within the “Twitterverse”. It is evident that accessing health information through social media is easy and convenient for all. The ease of use does present risks due to the lack of guidance and watchdog organizations monitoring the quality of content. A social media account grants direct public access to your thoughts, good or bad. Many will exhibit the right to restrict their settings or be selective in approving new requests. Those that do not can be held accountable for the content they share. Social media conveys information about a person's personality and values, which can be used to address an MRTs professionalism [[6]Ventola C.L. Social media and health care professionals: benefits, risks, and best practices.Pharm Ther. 2014; 39: 491-520Google Scholar]. As such, MRTs have a social responsibility to represent their professions and institutions in these public domains. Similar to those in the public eye (political figures, athletes, and celebrities), MRTs can also be scrutinised for their actions. The American Society of Oncology (@ASCO) is the world's leading professional organisation for physicians and oncology professionals caring for people with cancer. @ASCO urges (oncologists) to “take advantage of the greatest opportunity to disseminate credible information and influence both our peers and our patients” [[4]Lewis M.A. Dicker A.P. Social media and oncology: the past, present, and future of electronic communication between physician and patient.Semin Oncol. 2015; 42: 764-771Crossref PubMed Scopus (38) Google Scholar]. @ASCO has put forth recommendations and tips for cancer health care providers when using social media platforms, including specifically defining who you represent and adding a disclaimer to note that the opinions expressed are your own (ASCO Social media 101, https://www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/documents/2015-social-media-tips-for-healthcare-providers.pdf). Similarly, other institutions will have their own recommendations that can be implemented to help protect the image of MRTs and the level of professionalism. The large reach of public profiles presents an opportunity to direct patients, caregivers, and other health care providers to credible resources. Statuses or tweets can include referrals to direct websites, links to other social media profiles, and uniform resource locators (URLs) to relevant articles. These redirects can serve as educational resources providing additional information on treatments and management strategies, ultimately allowing others to take control of their own health by providing them with the knowledge they need to make important decisions in their own care. Information delivered online is widely available and typically free to access, making it an excellent resource for all regardless of socioeconomic status [[14]Mairs K. McNeil H. McLeod J. Prorok J.C. Stolee P. Online strategies to facilitate health-related knowledge transfer: a systematic search and review.Health Inf Libraries J. 2013; 30: 261-277Crossref PubMed Scopus (49) Google Scholar]. Lastly, online communities of practice provide protected forums for MRTs to connect and share information. Communities of practice such as the Canadian Association of Medical Radiation Technologists' (@CAMRT_ACRTM) “Slack Platform” provide MRTs a space to communicate, share information, and develop ideas on national level [[15]CAMRTCommunities of practice.2017http://www.camrt.ca/mrt-profession/professional-resources/cop/Google Scholar]. This not only creates learning opportunities and disseminates knowledge, but also facilitates virtual connections, building your professional network and creating a pool of individuals with whom to collaborate. The communities of practice provide a safe environment without the concern of posts being misconstrued or misinterpreted, ultimately eliminating the fear of misrepresenting oneself as a professional (Figure 3). Similarly, the World Wide Radiation Therapist group on Facebook allows RTs to connect and discuss a multitude of clinical queries, ranging from process concerns to staffing models to career changes, with open dialogue building camaraderie. The learning can then be adapted to individual clinical settings. Through these posts, likes, and shares, networks can stay connected and share information while being geographically separated. Social media platforms offer a flexible and comfortable environment that promotes collaboration, enabling all personality types to engage in a benign environment. Virtual communities do not only exist for practitioners; many patients have come together in niches and created communities of their own, sharing commonalities in experiences and diagnoses. The learning from these groups has been indirectly integrated into clinical practice because patients use this knowledge when making decisions regarding their care [[16]West, H. J. (n.d.). Practicing in partnership with Dr. Google: the growing effect of social media in oncology practice and research. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23814045. Accessed June 9, 2017.Google Scholar]. Patients are filtering through numerous sites that give extensive information on where and from whom to get treatment, when to seek a second opinion, and information on clinical trials that may have otherwise been unknown [[16]West, H. J. (n.d.). Practicing in partnership with Dr. Google: the growing effect of social media in oncology practice and research. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23814045. Accessed June 9, 2017.Google Scholar]. @PatientsLikeMe [[17]PatientslikemeWe've partnered with 500,000+ people living with 2700+ conditions on 1 mission: to put patients first.2017https://www.patientslikeme.com/aboutGoogle Scholar] is the world's largest personalised health network that connects patients to each other to improve their health outcomes. @PatientsLikeMe [[17]PatientslikemeWe've partnered with 500,000+ people living with 2700+ conditions on 1 mission: to put patients first.2017https://www.patientslikeme.com/aboutGoogle Scholar] works with the health care system as they analyse the data submitted by patients to create evidence to feed back to the health care system to identify gaps in care. In a recent tweet, @patientslikeme shared that 15% of its members have started or stopped a treatment because of their service, clearly depicting the impact and influence niche communities can have when making important health-related decisions. When there exists this division of appropriate and directed conversations among practitioners, patients are omitted from this discussion. According to the Canadian Partnership for Quality Radiotherapy (@CPQR_PCQR) patient engagement guidelines, patient and family engagement is defined as the patient and family's shared involvement and participation in processes through which they integrate information and professional advice with their own needs, preferences, and abilities to optimise health. To achieve appropriate patient engagement, patients should be encouraged to achieve self-realisation through education and discussions related to their individual care, and to participate in programmatic decisions, including the development of useful educational resources (through the appropriate management of patient feedback and via the establishment of processes that allow for the evaluation of services resulting from said feedback). Excluding the patient voice in conversations of MRT practice eliminates valuable input and is a detriment to the practice [[18]CPQRCPQR patient engagement.2013http://www.cpqr.ca/about-us/Google Scholar]. A study conducted by Fox [[19]Fox S. Cancer 2.0: a summary of recent research. Available at: www.pewinternet.org/files/old-media/Files/Reports/…/PIP_Cancer_20_Dec2010.pdf. Accessed April 6, 2017.Google Scholar] identified that patients seek online information, but use this information to complement, rather than substitute for, good communication from their caregiver. Online communities, however, are increasing the influence on patients' decisions regarding their care plans, whom they should seek treatment from, and how [[16]West, H. J. (n.d.). Practicing in partnership with Dr. Google: the growing effect of social media in oncology practice and research. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23814045. Accessed June 9, 2017.Google Scholar]. Nature abhors a vacuum and this analogy can be applied to social media. The lack of credible resources available from responsible caregivers is inevitably filled with potentially misleading content. Frequently advertised on Facebook, “The Truth About Cancer: A Global Quest” is billed as the documentary series the mainstream media refused to air. The documentary consists of 11 episodes produced by Ty Bollinger, a supporter of natural treatments for cancer. Building his case on false facts and interviews with experts using non-scientific methodology, the documentary provides incomplete and misleading information to the public [[20]Hall H. “The truth about cancer” series is untruthful about cancer.2017https://sciencebasedmedicine.org/the-truth-about-cancer-series-is-untruthful-about-cancer/Google Scholar]. Siloing our communication among intra- and inter-professional social media discussions exclude the most important member of the health care team: the patient. This exclusion confounds the impact on the patient who, in a vulnerable state, may fall victim to misinformation and/or individuals seeking to profit from the lack of reliable sources. Patient engagement in the medical radiation sciences comes in many forms. To provide complete and appropriate information regarding care, we must ensure that our delivery is person-centred. In a study conducted by Thackeray et al [[21]Thackeray R. Crookston B.T. West J.H. Correlates of health-related social media use among adults.J Med Internet Res. 2013; 15: e21Crossref PubMed Scopus (191) Google Scholar], it was reported that nearly 75% of patients will begin to look for health care information online and 33% will include social media sites by the time their search is completed. Recent work presented at the UK Radiological and Radiation Oncology Congress analysed international tweets over randomly selected days that contained the word “radiotherapy.” The findings of this work indicated minimal two-way communication between patient and practitioner, identifying an unmet patient need [[22]Meeking, K. (2017). The radiotherapy conversation in the digital age. Poster presented at: UK Radiological and Radiation Oncology Congress.Google Scholar]. Each of these needs assessments point to a virtual community that facilitates dialogue between the parallel groups. Initiatives such as Choose Wisely Canada (@ChoosingWiselyCA) and @CPQR_PCQR are frontrunners in opening the dialogue that is needed to encompass patients, caregivers, and practitioners—including MRTs—through their various patient engagement initiatives [[23]Choosing Wisely CanadaWhat is CWC?.2017http://www.choosingwiselycanada.org/about/what-is-cwc/Google Scholar]. Although these are examples of innovations within the medical radiation sciences, these resources are still passive communications with patients. Using social media as a vehicle to deliver content, share stories, educate, and join in conversations with our patients engages them in a manner of their choosing. When MRTs and patients collaborate in online communities it breaks down practice siloes, increasing the accessibility of information to everyone. The challenge before us is bridging the gap between patient and practitioner, which can be achieved by establishing a virtual community in which both can participate in a two-way exchange, facilitating rapid dissemination of information and providing the supportive care our patients seek. Creating a virtual space in an existing social media platform that promotes collaboration among patients and MRTs builds on an existing resource that both parties participate in as part of their daily routine. Individually, we are using Facebook, Twitter, and Slack to fulfil a need for wanting more—more knowledge, more answers, and more connections. Working together, MRTs can promote knowledge translation while disseminating information not only to their colleagues, but also to our patients, who have shown a need for the delivery of pertinent information through a social media approach. It is our responsibility as MRTs to ensure that the needs of our patients are met. Tackling concerns and queries of patients in this manner allows MRTs to deliver person-centred care in a platform of the patient's choosing, stimulating two-way dialogue in real time, alleviating concerns they may have. Social media, the once unconventional tool, will now become standard, used to deliver high quality, person-centred care.

Stereotactic radiosurgery (SRS) patients are a unique subset of the cancer population that does not fall into the conventional daily treatment schedule. As a result, they do not undergo weekly reviews with their Radiation Oncologist (RO), nor are they given the opportunity to fill out the Edmonton Symptom Assessment Screening (ESAS). SRS patients’ first opportunity to address concerns with their RO is typically six to eight weeks post-treatment. During this transition, patients may seek medical attention from a community practitioner, who may be unaware of the patient’s specific course of treatment, as well as the complexities of SRS and brain metastases. Our aim is to bridge the gap between active treatment and follow-up care for SRS patients by implementing an individualized Treatment Information Patient Summart or TIPS Sheet by assessing the current state.

Purpose/AimPeer review is the evaluation of the creative work or performance by other people in the same field to enhance the quality of work, or performance. In an effort to improve quality and standardization, a number of initiatives have been put in place at the national and provincial levels, such as physician planning a widely documented significant source of variation in the Radiation Oncology. In 2011 and updated in 2013, the Canadian Partnership for Quality Radiotherapy (CPQR) published Quality Assurance Guidelines for Canadian Radiation Treatment Programs. This document recommends that all radiation treatment plans administered with adjuvant or curative intent, and others plans where there is a significant potential for adverse patient outcome, undergo Radiation Oncologist peer review. Our aim was to identify and mitigate the barriers to an effective peer review program, to achieve the recommendations set forth in the CPQR guidance document.Method/ProcessA large urban comprehensive cancer centre performed peer review employing a site group model. 12 site groups are represented meeting on a weekly or bi-monthly. A three month retrospective analysis was performed identifying all cases treated within the time period. Each case was characterized by: site; month; referral to review; and review status. Cases not referred for review and or did not undergo peer review were examined for barriers to successful peer review.Results/Benefits/ChallengesThe average peer review rate for the three month time period was 85.07%. 15.34% of patients did not receive a referral to peer review. 3.38% of patients were referred for review, however did not undergo peer review. Identified barriers to successful peer review included; human error; workload; resource limitations; and culture change.Conclusion/Impact/OutcomesPeer review; has the potential to identify errors; serves as a forum for continuing education; and catalyzes standardization. By mitigating the barriers to peer review including; human error; workload; resource limitations; and adopting a culture promoting the initiative an increasing number of cases can be successfully reviewed, resulting in a high fidelity system to increase patient safety. Purpose/AimPeer review is the evaluation of the creative work or performance by other people in the same field to enhance the quality of work, or performance. In an effort to improve quality and standardization, a number of initiatives have been put in place at the national and provincial levels, such as physician planning a widely documented significant source of variation in the Radiation Oncology. In 2011 and updated in 2013, the Canadian Partnership for Quality Radiotherapy (CPQR) published Quality Assurance Guidelines for Canadian Radiation Treatment Programs. This document recommends that all radiation treatment plans administered with adjuvant or curative intent, and others plans where there is a significant potential for adverse patient outcome, undergo Radiation Oncologist peer review. Our aim was to identify and mitigate the barriers to an effective peer review program, to achieve the recommendations set forth in the CPQR guidance document. Peer review is the evaluation of the creative work or performance by other people in the same field to enhance the quality of work, or performance. In an effort to improve quality and standardization, a number of initiatives have been put in place at the national and provincial levels, such as physician planning a widely documented significant source of variation in the Radiation Oncology. In 2011 and updated in 2013, the Canadian Partnership for Quality Radiotherapy (CPQR) published Quality Assurance Guidelines for Canadian Radiation Treatment Programs. This document recommends that all radiation treatment plans administered with adjuvant or curative intent, and others plans where there is a significant potential for adverse patient outcome, undergo Radiation Oncologist peer review. Our aim was to identify and mitigate the barriers to an effective peer review program, to achieve the recommendations set forth in the CPQR guidance document. Method/ProcessA large urban comprehensive cancer centre performed peer review employing a site group model. 12 site groups are represented meeting on a weekly or bi-monthly. A three month retrospective analysis was performed identifying all cases treated within the time period. Each case was characterized by: site; month; referral to review; and review status. Cases not referred for review and or did not undergo peer review were examined for barriers to successful peer review. A large urban comprehensive cancer centre performed peer review employing a site group model. 12 site groups are represented meeting on a weekly or bi-monthly. A three month retrospective analysis was performed identifying all cases treated within the time period. Each case was characterized by: site; month; referral to review; and review status. Cases not referred for review and or did not undergo peer review were examined for barriers to successful peer review. Results/Benefits/ChallengesThe average peer review rate for the three month time period was 85.07%. 15.34% of patients did not receive a referral to peer review. 3.38% of patients were referred for review, however did not undergo peer review. Identified barriers to successful peer review included; human error; workload; resource limitations; and culture change. The average peer review rate for the three month time period was 85.07%. 15.34% of patients did not receive a referral to peer review. 3.38% of patients were referred for review, however did not undergo peer review. Identified barriers to successful peer review included; human error; workload; resource limitations; and culture change. Conclusion/Impact/OutcomesPeer review; has the potential to identify errors; serves as a forum for continuing education; and catalyzes standardization. By mitigating the barriers to peer review including; human error; workload; resource limitations; and adopting a culture promoting the initiative an increasing number of cases can be successfully reviewed, resulting in a high fidelity system to increase patient safety. Peer review; has the potential to identify errors; serves as a forum for continuing education; and catalyzes standardization. By mitigating the barriers to peer review including; human error; workload; resource limitations; and adopting a culture promoting the initiative an increasing number of cases can be successfully reviewed, resulting in a high fidelity system to increase patient safety.