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

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.