The radiation therapist (RTT) is a practitioner who must learn to take responsibility as an autonomous professional within a collaborative multi-professional team. A case study of international students on fellowship studies to a South African Higher Education Institution was used as the lens to explore the development of professional expertise in RTTs. Documents and semi-structured interviews generated textual data that was semantically analysed. The findings are presented as a discussion of the themes that emerged from the text data; (1) autonomy in a team, (2) collaboration facilitates learning, (3) the need for professional competence, (4) reflective practice and (5) participatory learning. The paper offers the interpretation of professional competence as a practitioner who has applicable knowledge, clinical and generic competence as well as appropriate behaviour and attitudes. It is proposed that a collaborative, integrated curriculum meets the need for the education of RTTs on the African continent. In such an environment optimised learning is facilitated by access to good clinical role models, the development of skills toward reflective practice and student participation in the learning environment.

Continuous professional development (CPD) is regarded as an essential component of working life for radiation therapists and is increasingly being used by professional associations to ’prove’ the competence of their members. In the past, CPD activities have primarily been viewed as an individual responsibility, and have focused on maintaining a professional knowledge base and, subsequently, hands-on competency through didactic learning. However, there are drawbacks associated with this model; and concentrating on only one facet of learning ignores other theoretical areas of knowledge acquisition. This article explores several areas of social and organisational theories of learning including social networks, communities of practice, learning organisations, knowledge management, knowledge translation and research utilisation. It is concluded that maintenance of competence after graduation is multilayered and should be viewed in a holistic manner to incorporate some of the relevant elements of the concepts discussed. This article also offers some suggestions for the individual wanting to maximise their educational opportunities beyond traditional models of CPD.

Reflection, reflective learning, reflective writing and reflective practice are used increasingly in higher education and professional development–but we do not work to one definition and there are considerable differences in the views of educationists on issues of definition. Such discrepancies can exist between the staff working with the same student group. The situation can lead to difficulties in indicating to students how to reflect, and what reflective writing ‘should look like’. Once students do manage to represent their reflection broadly in the required manner (usually writing), there is frequently observed to be a further problem because their reflection is superficial and descriptive. A consequence is that their learning from the reflective process is restricted.

This paper addresses the issue of definition of reflection initially through clarifying the different words used around the notion of reflection (e.g., reflection, reflective learning, reflective writing) and providing some suggested definitions. It then addresses the matters both of how we should help students to start with reflection, and with the problem of the superficiality of much of their work. The ‘depth’ of reflection is a concept that has not been much discussed in the literature of reflection and yet it seems to be closely related to the quality of reflective work. The paper discusses the concept of depth and then introduces a style of exercise in which a scenario is reproduced at progressively deeper levels of reflection. The exercise is related to a generic framework for reflective writing. The rationale and justification for the exercise and the framework are discussed and suggestions are made for its manner of use. The exercise and the generic framework for reflective writing are in Appendices 1 and 2.

The use of reflection to enhance formal learning has become increasingly common in the past 7 years. From the principle beginnings of its use in the professional development of nurses and teachers, its use has spread through other professions. Now, in the form of personal development planning (PDP), there is an expectation that all students in higher education will be deliberately engaging in reflection in the next 2 years.1 In addition, there are examples of the use of reflective learning journals and other reflective techniques in most, if not all, disciplines.2

Reflection is not, however, a clearly defined and enacted concept. People hold different views of its nature, which only become revealed at stages such as assessment. For example, what is it that differentiates reflective writing from simple description? There are difficulties not only with the definition itself but also in conveying to learners what it is that we require them to do in reflection and in encouraging reflection that is deeper than description. In this paper, we consider some issues of definition and then focus on the means of encouraging learners to produce a reflective output of good-enough quality for the task at hand. The latter is presented as an exercise for staff and learners (Appendix 1) with a framework that underpins it (Appendix 2).

Informed consent is a fundamental principle of health care ethics. All patients should have equal opportunities in accessing information to help them make informed decisions about their treatments.

Literature on informed consent, translators in health care, non-English-speaking patients and the importance of communication and information, most specifically in radiotherapy, were reviewed. Western studies published between 1995 and 2005 were accessed and filtered though two eligibility screens and a critique framework to assess quality.

The evidence suggested that many non-English-speaking patients are not in a position to give true informed consent due to lack of interpreters. This may lead to health care professionals giving treatment without full consent. Written information for radiotherapy patients was often only available in English, apart from inner city areas.

There appears to be a scarcity of professional interpreters used in the health care setting; the most common practice is to use family members and friends to interpret. This practice results in breach of patient confidentiality, extra pressure on family members and filtration of information.

This patient group is often excluded from certain treatment opportunities such as clinical trials. Ideally, a fully accessible professional interpreting service should be available to allow non-English patients equal rights in accessing appropriate health care options and treatments.

The goals of this study were (1) to compare, in a single institute, the clinical results of patients with newly diagnosed glioblastoma multiforme (GBM) treated with stereotactic radiosurgery (SRS), which has been incorporated into the initial management approach, with those in-patients treated with intra-operative radiotherapy (IORT) and (2) to assess whether these local irradiation boost therapies are prognostic factors on survival analysis. One hundred and twenty adult patients with supratentorial GBM had undergone tumour resection or biopsy and had received external beam radiotherapy (EBRT). Of them, 31 underwent IORT, 29 underwent SRS, and the remaining 60 had no local high-dose irradiation boost. The local irradiation boost led to clearly better results on survival of GBM patients. Furthermore, SRS is less invasive and allows for meticulous target planning of the irradiation boost, and was superior to IORT in terms of survival prolongation as well as suppression of local tumour recurrence/progression at the primary site in this series. In addition, SRS was a significant, positive prognostic factor for survival as well as gross-total resection of the tumour, and could be an alternative therapeutic modality to IORT for GBM.

Combined-modality treatment using chemotherapy and radiotherapy, particularly concurrently, has now become the standard of care for many solid tumour sites on the basis of improvements in locoregional disease control and in some cases survival. The rationale for combined-modality treatment, potential mechanisms of interaction, the therapeutic ratio and the current place of sequential and concurrent chemoradiotherapy are discussed.

Purpose: Quantification of set-up errors is necessary to assess the accuracy of patient positioning and define set-up margins. In this article, we describe the analysis of two different set-up verification and correction procedures in pelvic irradiation for rectal cancer patients treated on a belly-board device.

Methods: First, we conducted a retrospective study in ten patients. Skin marks were used for set-up and the position was verified and corrected at the start of treatment by portal imaging. Second, we analysed the implementation of a more rigorous verification and correction procedure in ten patients. The same set-up procedure was used, but verification was performed during the first three sessions and on a weekly basis thereafter. In both studies, systematic and random errors were linked with possible patient-related, treatment-unit-related and time-related factors.

Results: The pooled data showed a significant reduction in systematic and random error in favour of the second verification procedure (p < 0.05). This resulted in a reduction in the size of the safety margin of more than 3 mm in all directions. Time trends were significant in four patients in the first analysis and in three patients in the second analysis. In six patients in the first and seven patients in the second study, a significant correlation was found between the vertical couch movement and the antero-posterior set-up error. Analysis of patient-related factors demonstrated a relationship between the abdominal contour and rotational errors in both studies.

Conclusion: The results of these set-up analyses show that patient positioning on a belly-board device by laser alignment to skin marks is accurate and reproducible. However, in some patients we recommend the implementation of a fixed vertical couch position. The systematic error should be identified and corrected during the first fractions of treatment. Thereafter, verification should be performed at regular intervals to correct for possible time trends. Positioning of obese patients was found to be more prone to set-up errors and requires online position verification.

Background and purpose: Currently, optimal use of virtual simulation for all treatment sites is not entirely clear. This study presents data to identify specific patient groups for whom conventional simulation may be completely eliminated and replaced by virtual simulation.

Sampling and method: Two hundred and sixty patients were recruited from four treatment sites (head and neck, breast, pelvis, and thorax). Patients were randomly assigned to be treated using the usual treatment process involving conventional simulation, or a treatment process differing only in the replacement of conventional plan verification with virtual verification. Data were collected on set-up accuracy at verification, and the number of unsatisfactory verifications requiring a return to the conventional simulator. A micro-economic costing analysis was also undertaken, whereby data for each treatment process episode were also collected: number and grade of staff present, and the time for each treatment episode.

Results: The study shows no statistically significant difference in the number of returns to the conventional simulator for each site and study arm. Image registration data show similar quality of verification for each study arm. The micro-costing data show no statistical difference between the virtual and conventional simulation processes.

Conclusions: At our institution, virtual simulation including virtual verification for the sites investigated presents no disadvantage compared to conventional simulation.

High therapist vacancy rates and an unsatisfied workforce reduce the opportunity to meet waiting time targets or maintain high standards of care. Current vacancy rates may conceal true staff shortages because of financial pressures. Levels of job satisfaction among the therapy radiographer workforce are presently unknown. A multi-phase study to investigate job satisfaction of therapy radiographers in the United Kingdom is under way. Phase I was an interpretive grounded theory study and, as interviews progressed, a review of the literature on job satisfaction was warranted (in line with the principles of grounded theory). The purpose of this article is to evaluate the literature on job satisfaction as a way to inform the development of retention strategies within the radiotherapy profession. The discussion is focused under the following three themes identified from our phase I study: job design, leadership and organisational governance, stress and burnout. A number of models within the wider literature can inform retention strategies for radiotherapy managers. In particular, the job characteristics model and the model for job-specific well-being adequately identify factors that are relevant to the work of a therapy radiographer. Ensuring mental challenge through job design and continuing professional development opportunities is vital to retaining staff. Support from immediate managers is also a crucial aspect of workers development of intentions to leave. Manager support can moderate experiences of job stress, limiting job dissatisfaction and reducing leaving intentions. Stress and burnout have been cited as significant in reducing job satisfaction in health workers. In the United States, high levels of emotional exhaustion among radiation therapists highlight the potential for the development of burnout within the UK therapy workforce. The discussion looks at the importance of these characteristics within a general retention strategy and recommends future areas of study.

Over the past two decades The Department of Health has made the consent process one of its main focus and has issued numerous guidelines on how the process must be conducted in order to make it valid. This mandate has been in accordance with the new patient-centred health service, which has patient autonomy as its fundamental standard. This paper will critically appraise the consent process in a radiotherapy department against the Department of Health’s recommendations. The ethical and legal principles governing the process will also be discussed using guidance from medical professional bodies and reference to English case law. Additionally, the function of written consent and consent forms will be assessed in order to establish whether implied or oral consent has any role in radiotherapy. The paper found that to a large extent the Department of Health’s recommendations are followed in the radiotherapy department evaluated. One key outcome arising from this paper is that written consent is the most appropriate form of consent in radiotherapy; however the record of consent should not be solely confined to a consent form. Rather it is critical that adequate notes of all areas of the dialogue that took place during the consent process with the patient should be written in the patient’s medical notes.

This paper reports on the commissioning tests performed on a new GE Lightspeed RT wide-bore computed tomography (CT) scanner with GE Advantage Sim software. This paper focuses on the laser marking system, CT hardware and the interfaces between each component of the system, and generalises the findings to most CT simulation systems currently available. A discussion on the commissioning of the virtual simulator software will follow in a separate paper. Three phantoms were used (two constructed in-house) to assist with a range of tests covering aspects such as the laser patient marking system, CT hardware, and connections between the CT scanner, virtual simulator system and the treatment planning system (TPS) and VARiS. Tests performed showed the CT simulation system to be working within acceptable tolerances suggested in the literature, and baseline data have been obtained against which future comparisons of system performance have been made. Where no tolerances were available, we have suggested suitable values. While considering tolerances on Hounsfield number variation that may lead to a dose error in excess of 2%, we found that in the case of low-kV CT scanning the range of Hounsfield numbers for dense bone was outside the acceptable limits for potential dose errors and so users were advised not to perform radiotherapy planning CT scans with kV below 100 kV.

This paper explores some of the issues around implementing a consent policy within the radiotherapy department. Consent can be defined as a patient’s agreement for a health care professional to provide care. The NHS Plan1 highlighted the need for quality care centred around the patient and for changes in the way patients are asked to give their consent to treatment. This led to the Department of Health (DoH) publishing a Good Practice in Consent Implementation Guide (2001)2 for use within all NHS Trusts from 1 April 2002, which aimed to provide consistency across the NHS and provides a policy model and generic consent forms.

The policy recommends that the health professional carrying out the procedure is ultimately responsible for ensuring that the patient is genuinely consenting to what is being done, as it is they who would be held responsible in law should a case be made by a patient against a health professional. In radiotherapy, it is the Clinical Oncologist who obtains consent as they are responsible for prescribing courses of treatment; however, it is the Radiographer’s role to deliver this treatment. This paper discusses some of the issues around implementing a consent policy in terms of who can give and confirm consent, and what are the requirements for training if the patient is to receive the appropriate information before making the decision to consent to treatment.

Background: The clinical practicum provides an opportunity for students to apply and integrate classroom theory and clinical practice and competence effectively. In a teaching hospital, it is the responsibility of all staff to participate in clinical teaching and every interaction with a student constitutes a learning experience. The clinical teaching characteristics that are important to students and facilitate learning are not clearly defined in radiation therapy practice.

Objective: To determine and compare the perceptions of the most and the least important clinical teaching characteristics as identified by radiation therapy staff and students.

Methods: A self-administered, online questionnaire was used. The questionnaire was developed using clinical teaching characteristics identified in the literature and from Knox and Mogan’s Nursing Clinical Teaching Effectiveness Inventory. Participants were asked to rate on a 4-point, Likert-type scale the importance of the teaching characteristics with 1 being ‘not at all important’ and 4 being ‘very important’. Of the 150 questionnaires distributed, 49 radiation therapists and 10 students responded to the survey, constituting a 39% response rate.

Results: There was generally a greater agreement between staff and students in terms of rating the least important teaching characteristics, being in the categories of interpersonal relationships and personality traits. Staff ranked characteristics in the category of Clinical Competence as most important, whereas the most important clinical teaching characteristics for students were dispersed amongst all categories.

Conclusion: Radiation therapy staff and students place great emphasis on the demonstration of clinical competence in the teaching–learning process; clinical teachers should be made aware of and develop these characteristics, which ultimately assist in the student’s success.

This paper continues the discussion on the commissioning tests performed on a new GE Lightspeed RT wide-bore computed tomography (CT) scanner, focusing on the GE Advantage Sim software (version 6.0).

The tests performed and phantoms used to assess the virtual simulator functionality, including the 3D image display, contouring, treatment unit beam parameters, digitally reconstructed radiograph generation and image quality, isocentre generation and multi-modality image registration, are described.

The series of tests performed showed the virtual simulation software to be working within acceptance tolerances suggested in the literature and baseline data have been obtained against which future comparisons of system performance have been made. Where no tolerances were available, we have suggested suitable values.

Purpose: It is now six years since the publication of the NHS Cancer Plan. During this time, there has been considerable investment and research within UK cancer services. Some progress has been made towards improving treatment outcomes, but obstacles persist. This article explores some recent advances in cancer treatment and considers whether UK cancer treatment outcomes will best improve through the clinical advances being made in cancer research or whether improvement now needs to be more explicitly driven via a strategic approach. Methodology: The article explores this question from two differing perspectives. First, from a research perspective, it reviews briefly the evidence for a selection of clinical advancements in cancer therapy that have all been cited as providing breakthroughs in treatment outcomes. Second, it considers the investment in cancer research within a more strategic context, focusing on the reality of managing an improvement programme in UK cancer services. Here, some of the practical obstacles to improving treatment outcomes are highlighted. Findings: Significant progress has been made over the past six years towards improving UK treatment outcomes. Much of this is a direct result of international advances in clinical research. Further progress, however, is required. This article argues that progress will best be achieved by focusing resources and research investment on tackling some of the endemic strategic obstacles, highlighted in this article, that are the present reality within UK cancer services.