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Throughout the COVID-19 pandemic, our Australian-based network of cancer centres launched five radiation oncology departments within Mainland China. With limitations on international and domestic travel, a remote training and supervision program was established to support local staff during the preparation and commencement of clinical services. Here we report the design of the IGRT program component and subsequent outcomes from program evaluation and clinical auditing.

Online surveys and semi-structured interviews were used to establish baseline clinical experience and education of recruited RTTs in China as well as evaluating subsequent training experience within the developed program. The design of the IGRT training program was aligned with RTT baseline experience and required competencies to perform online CBCT matching for all treatment sites. The program was also required to be deliverable by trainers based in Australia and New Zealand. Online, bilingual teaching resources were developed and complemented by asynchronous methods of remote competency assessment. Wearable video headsets were used to provide remote support at the treatment console for go-live, with a structured audit program implemented thereafter to track IGRT procedural compliance and identify areas for ongoing professional development.

16 RTTs completed the survey and participated in semi-structured interviews. All had either bachelor- or diploma-level qualifications, the majority (69%) relating to medical imaging. 25% of RTTs had no prior radiation therapy experience. 69% and 75% of RTTs had no experience with CBCT and daily imaging, respectively. The IGRT training program was the most positively rated component of the overarching onboarding course, whilst simultaneously described as one of the largest practice changes from prior RTT experience.

Weekly IGRT audit data from December 2021 to July 2022 was analysed, which comprised 1607 randomly selected treatment fractions across all departments. Using a standardised assessment rubric, procedural compliance was 98.4% across the reporting period. 41 minor deviations and 6 major deviations were identified. These most commonly related to incorrect prioritisation of matching, followed by the application of couch corrections exceeding standard action thresholds.

Amidst the unanticipated disruption caused by COVID-19, our network has successfully developed and delivered internationally led, remote IGRT training. Despite significant disparities in clinical education and experience, our program has upskilled RTTs in Mainland China as evidenced by consistently high compliance with defined practice standards. Intentionally designed and validated remote training and support programs offer significant opportunities to improve the quality of care across geographic barriers.