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. 2024 Sep 29:32:100279.
doi: 10.1016/j.tipsro.2024.100279. eCollection 2024 Dec.

From novice to Expert: Reducing Breast Imaging rejection rates through physician mentorship in Advanced Practice Radiation therapy

Clodagh Starrs  1 , Sima Rabinowitz  2 , Erin Moshier  3 , Sheryl Green  4
Affiliations

From novice to Expert: Reducing Breast Imaging rejection rates through physician mentorship in Advanced Practice Radiation therapy

Clodagh Starrs et al. Tech Innov Patient Support Radiat Oncol. .

Abstract

Purpose: The study's goal was to evaluate the impact of a Radiation Oncologist (RO)-Radiation Therapist (RTT) mentorship on image approval rates for a breast population undergoing radiation therapy in a high-volume practice. The mentorship was undertaken within a large health system in partial fulfillment of the Expert Practice Module for a Masters (MSc) in Advanced Practice Radiotherapy and Oncology.

Methods: Images were retrieved from the MOSAIQ EMR on breast diagnostic code. 1,295 images/115 patients were reviewed pre-mentorship (October 2019-March 2020) and compared with 1,047 images/91patients during/post-mentorship (April 2020-September 2020). The Anderson-Gill (AG) model was used to estimate the hazard ratio for image rejection. Rejected images were classified by reason and compared using Fisher's exact test. Concordance data (RO/RTT image rejection) were collected during Phase Three of the mentorship.

Results: Of 115 patients assessed pre-mentorship, 16 (14 %) had at least 1 image rejected at any session. Of 91 patients assessed post-mentorship, 8 (9 %) had at least 1 image rejected. Likelihood of image rejection decreased by 54 %, with a hazard ratio of 0.46 [95 % CI: 0.24, 0.88]; p = 0.0195. Reasons for image rejection differed pre- and post-mentorship. Poor imaging technique accounted for rejection of 9 of 24 images (37.5 %) before compared to 0 of 11 images (0 %) post-mentorship. Other reasons for image rejection: depth at isocenter (25 % pre-mentorship; 18 % post-mentorship), supraclavicular medial border position (12.5 % vs. 9.09 %), isocenter location (12.5 % vs. 0 %), arm position (4.17 % vs. 54.55 %); hip alignment (8.33 % vs. 18.18 %). Concordance rate was 100 %.

Conclusions: The mentorship proved successful in elevating the RTT's skills and image approval rates, while contributing to improvements in departmental imaging best practices.

Keywords: Advanced Practice; Best practices; Breast image review; Mentorship; Novice to Expert; Workflows.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A Comparison of Image rejection Reasoning Pre and Post mentorship
Fig. 2
Fig. 2
Intensity model comparing pre and postmentorship Breast Image rejection probability
See this image and copyright information in PMC

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