# Practice development perspective of RTT contouring in online adaptive radiotherapy for prostate cancer: A single-centre cost-consequence analysis

## TL;DR

Expanding the role of therapeutic radiographers in online adaptive prostate cancer radiotherapy can save costs and improve efficiency.

## Contribution

This study provides a cost-consequence analysis of delegating online contouring to RTTs in prostate cancer oART.

## Key findings

- RTT online contouring leads to cost savings in prostate cancer online adaptive radiotherapy.
- RTT involvement increases patient throughput compared to radiation oncologists.
- RTT role expansion reduces pressure on healthcare resources.

## Abstract

•RTT online contouring provides cost savings in online adaptive prostate radiotherapy.•Increasing RTT scope of practice results in time saving efficiencies for radiation oncologists.•RTT availability increases patient throughput compared to radiation oncologists.•RTT role expansion eases pressure on healthcare resources in online adaptive radiotherapy.

RTT online contouring provides cost savings in online adaptive prostate radiotherapy.

Increasing RTT scope of practice results in time saving efficiencies for radiation oncologists.

RTT availability increases patient throughput compared to radiation oncologists.

RTT role expansion eases pressure on healthcare resources in online adaptive radiotherapy.

Technological advances in online adaptive radiotherapy (oART) are set to revolutionise the treatment of prostate cancer (PCa). Yet, the need for a multi-disciplinary team oversight at every fraction remains a significant resource barrier to wider implementation. This practice-development paper explores the cost-consequence analysis and the operational implications of delegating online contouring responsibilities to therapeutic radiographers (RTTs) within an established MRI-guided online adaptive radiotherapy (oART) PCa service. Using a discrete-event simulation model informed by single-centre workflow data, the implications of RTT- and radiation oncologist (RO)-contoured workflows are discussed in terms of personnel costs, RO time, and patient throughput. With RTT online contouring generating substantial cost savings, demonstrating how reallocation of tasks can improve service efficiency and support sustainable oART. Highlighting the importance of workforce development and economic evidence to help to inform policy decisions, with the aim to broaden access to adaptive radiotherapy worldwide.