Understanding the Unique Roles of Oncology Teams in Biology-Guided RT

Biology-guided radiotherapy is "teamwork," according to Bianzon.

Biology-guided radiotherapy (BGRT) is an emerging technology that integrates real-time positron emission tomography (PET) imaging with radiation therapy to enhance tumor targeting. In clinical practice, BGRT requires the coordination of multiple health care professionals to ensure safe and effective treatment, according to Samantha Bianzo, BSN, RN.

In an interview with Oncology Nursing News, Bianzon, a radiation oncology nurse at Keck Medicine of the University of Southern California in Newport Beach, California, outlined how nurses, physicians, nuclear medicine technologists, and radiation therapists work together in this complex process.

What factors do physicians consider when determining if BGRT is appropriate for a patient?

Bianzon: The doctor evaluates patients to determine if BGRT is appropriate. The physician assesses the tumor characteristics, the tumor shape, the tumor size … patients with factors like … low PET contrast or who require special consideration, like those with pacemakers, may be excluded. We have a patient who was a candidate for BGRT. Unfortunately, he has a pacemaker and the tumor is close to the pacemaker. [Part of] patient selection criteria is the proximity the tumor is close to critical structures. It’s not only the vital organs, but also the pacemaker.

What role do physicians and nurses play in preparing patients for BGRT?

The physicians obtain the informed consent explaining the majority processes, risks, and alternatives, and the planned workflow approval on treatment management, and then we go back to nursing. One of the major responsibilities of the oncology nurse is patient preparation and education. The nurse introduces the patient to the BGRT process. I always explain to the patient the relationship of PET scan and BGRT.

What patient education is needed prior to BGRT?

Often during an education visit or simulation day, they review the pre-scan preparation instructions … for FDG PET this include fasting for 6 hours prior, avoiding strangers, exercising before scans, and managing blood glucose—especially if they’re a diabetic patient. The nurse ensures the patient understands dietary and medication restrictions and schedules them if they need lab work done, like glucose testing, but we do the glucose testing here, as well as pretreatment checks before the BGRT session.

What safety checks are oncology nurses responsible for before BGRT treatment?

The nurse performs critical safety checks. They should arrive about 1 hour and 30 minutes before treatment time, and the nurse confirms the treatment order. We obtain the patient’s weight and the vital signs, and we make sure that we are ready to start their IV. Then, [nurses coordinate] IV access and injection.

How do nurses contribute to the overall BGRT care team?

BGRT is teamwork. It doesn’t revolve around nursing, because it’s more on physicians, dosimetry doctors, radiation therapists. These are the major roles as a nurse: patient education, pretreatment checks on treatment visit, assessment, screening, and IV access or port access. … Some of the most important roles of the nurse are the IV and the patient education.

What other clinicians are heavily involved in the BGRT process?

The nuclear medicine technologist, or the PET technician, is the only one who can inject the radio tracer, or the radioactive glucose tracer. The radio tracer handling, or the PET technician, is responsible for the injection, and then we have the radiation therapist. They’re responsible for the room and equipment readiness.

Each day, radiation therapists prepare the treatment room and the reflection machine. Because BGRT involves PET, the therapist performs special daily system checks. On BGRT days, they confirm the PET detectors, imaging function, and Linac calibration. Those are the [main tasks], and then free fraction setup and checks, PET imaging verification, treatment delivery, monitoring and post-treatment task. The therapist assists the patient off the table and then perform required documentation.

This transcript has been edited for clarity and conciseness.