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

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 preand 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.