Radiation Therapists Perspectives on Motion Management in Definitive Prostate Cancer Radiotherapy: Insights from Indian Clinical Practice

Introduction: Prostate cancer is a leading malignancy among men, with radiotherapy (RT) serving as a cornerstone of curative treatment. The precision of external beam radiotherapy (EBRT) is challenged by prostate motion caused by bladder and rectal filling variations, leading to inter- and intra-fraction positional uncertainties. Advanced image-guided radiotherapy (IGRT) and motion management technologies can mitigate these uncertainties; however, their implementation in low- and middle-income countries (LMICs) such as India remains inconsistent due to infrastructure, training, and resource limitations. Radiation therapists (RTTs) play a critical role in accurate patient setup, imaging, and on-treatment verification, yet their perspectives on motion management in prostate radiotherapy are underrepresented in literature. This study aimed to evaluate current RTT practices, challenges, and training needs in India. Materials and Methods: A descriptive, cross-sectional, questionnaire-based survey was conducted over 60 days among RTTs treating prostate cancer with EBRT in India. The online survey, developed through literature review and expert consultation, included 15 mandatory questions across seven domains: demographics, institutional profiles, clinical load, techniques in use, workflow impact, technical challenges, and training preferences. Purposive sampling recruited participants via professional networks, email, and social media. Responses from 202 RTTs were analyzed using descriptive statistics in Microsoft Excel. Results: Daily cone-beam computed tomography (CBCT) was the most widely adopted motion management method (84.7%), followed by respiratory position management (15.8%), surface-guided radiotherapy (15.8%), and real-time tracking (9.4%). Notably, 40.6% reported no dedicated motion management technique. The most common challenges were inconsistent bladder/rectum filling (64.4%), time constraints (34.2%), patient discomfort (24.3%), and technology limitations (14.9%). Motion management increased setup times by 6-15 minutes in 49.5% of cases, with 16.3% of RTTs reporting reduced patient throughput. While 66.9% agreed that current strategies reduce setup uncertainties, responses revealed variability in practice and technology access. Training needs were substantial, with workshops (55.4%), SOP/guideline updates (46.5%), and online modules (34.2%) most preferred. Private institutions accounted for 81.2% of responses, reflecting disparities between urban and rural access to technology. Conclusions: This nationwide survey highlights widespread adoption of CBCT-based IGRT in Indian prostate cancer radiotherapy but also reveals significant gaps in advanced motion tracking, workflow optimization, and standardized patient preparation protocols. Addressing these limitations through national guidelines, equitable technology distribution, and RTT-focused education is essential for consistent, high-quality motion management. Investment in training, patient education, and infrastructure will be critical to bridging practice variability and improving treatment precision across diverse healthcare settings.