To investigate levels and sources of job stress, job satisfaction and burnout experienced by radiation therapists (RTs) in an Australian cancer hospital, and determine the factors of emotion-focussed patient care and communication that contribute to RTs’ stress and burnout.

One hundred and thirteen RTs working in a dedicated cancer hospital in Australia completed a self-report questionnaire.

Twelve percent of RTs reported job stress while 73·5% reported job satisfaction in their current work roles. Up to 19% of RTs experienced burnout as measured on the Maslach Burnout Inventory scales. Emotion-focussed care and communication with patients was found to have links with job stress and burnout, but also with job reward and satisfaction. A range of organisational, personal and support factors were associated with RTs’ experiences, including training and confidence in emotion-focussed patient communication.

Emotion-focussed care and patient communication contributes to both job stress and burnout, as well as job satisfaction. RTs’ experience of job stress, satisfaction or burnout are likely to vary according to a range of personal, demographic and organisational factors.

Service user involvement has been demonstrated as an important aspect of cancer professionals’ education. There is some understanding of service users’ incentive to be involved, but little insight into what motivates them. This study explores this concept more fully.

To explore the motivations and experience of service users’ involvement in radiotherapy and oncology education.

One-to-one interviews were conducted with service users who have been involved in education at the university. Thematic analysis was conducted. Five participants were asked about their motivations and experience of taking part in a variety of educational activities.

The experience of being involved gave the participants a sense of wellbeing and purpose. Three sub-themes were identified that related to service users’ motivation for being involved in educational activities with undergraduate students. These were to promote awareness by sharing their experiences of cancer; improve patient care through learning from negative experience; and personal reward skills for survivorship.

This study has highlighted the importance of hearing the voice of the service users; a two-way engagement for which there are benefits for both the students and service users. The involvement of service users in education becomes part of their personal journey.

Caring is a fundamental tenet of healthcare. Caring ‘too much’ can result in compassion fatigue syndrome and is often linked to burnout and low morale. The objective of this study was to examine compassion fatigue, secondary traumatic stress (STS) and burnout by investigating the relationship between levels of compassion (compassion satisfaction) and STS and burnout. The study also aimed to identify radiation therapist (RTTs) groups who may be at risk for developing (STS) and burnout. Finally, we investigated the level of social support that RTTs receive.

RTTs practicing across Canada were invited to participate in an electronic questionnaire. The questionnaire consisted of: demographic information including health-related issues and occupational variables; the Professional Quality of Life Compassion Satisfaction and Fatigue Questionnaire (ProQOL-V) to assess the potential for compassion satisfaction and vulnerability for STS and burnout; and the Multidimensional Scale of Perceived Social Support (MSPSS) to examine the level and sources of social support. A two-way ANOVA was performed to test the statistical significance between varying groups within the study population. A linear regression analysis using potential co-factors was used to test correlations between compassion fatigue, compassion satisfaction and burnout and variables in age, education, years of experience and levels of caring to patients.

A total of 477 survey responses were received representing a 36% response rate. Results of the regression analyses generally indicate inverse correlations between the risks associated with compassion satisfaction, burnout and STS compared with the independent study variables of age, education, years of experience and levels of caring to patients. It was observed that responses were not linear within subgroups (age groups, education classifications, years of study).

RTTs practicing in Canada have a substantial social support network and demonstrate high levels of compassion satisfaction in their daily practice. The results of the study indicate that compassion levels are inversely correlated with burnout and compassion fatigue, although some groups may be at higher risk than others. A possible risk catalyst for compassion fatigue and burnout is associated with underdeveloped managerial workplace support programmes.

Recent studies have suggested significant variations in radiotherapy schedules used to treat advanced non-small-cell lung cancer (NSCLC), both between different centers in one country as well as between countries. In this study, different treatment methodologies have been explored using management plans proposed by radiation oncologists regarding general questions and theoretical case histories for patients with advanced NSCLC.

The survey was conducted by sending a questionnaire to 24 radiotherapy centers in Europe. The questionnaire was composed of two sections. The first section concerned reasons for giving radiotherapy, parameters that influence the choice of total dose and fractionation for radiotherapy and kind of equipment used. The second section concerned the management of five theoretical patients (A–E) regarding the selection of the radiotherapy technique and the aim of treatment (radical or palliative). Furthermore, 19 trials comparing different regimens of palliative radiotherapy in patients with NSCLC were reviewed. There were marked differences in the doses of the investigated radiotherapy schemes, the patient characteristics and the assessed outcome measures.

70% of the responders answered that the most important factors for deciding what dose and fractionation scheme to use were: metastases, performance status (PS) of the patient, lung function and size of the primary tumour. The most common reasons for giving the treatment were symptom relief, prolongation of life and, in some cases, possibly cure. More than 95% of the responders stated that they would give radiotherapy in each of these cases. The total doses proposed where 20 Gy in five fractions or 30 Gy in ten fractions in 2 weeks for the cases A and D. If the previous two schemes were converted to a fractionation scheme delivering 2 Gy per fraction, the equivalent doses would be 23 and 33 Gy, respectively. For the cases B, C and E, the proposed fractionation schemes were 2 Gy daily to 60–68 Gy in 6 weeks or 2 Gy daily to 68 Gy in 7 weeks. For the case E, 20% of the responders suggested Stereotactic Body Radiotherapy (SBRT) giving 21 Gy three times a week with a day apart to 63 Gy. The total dose and number of fractions of radiotherapy are related to the perceived aims and expectations of treatment. Those aiming at extending life would give significantly higher total doses in a larger number of fractions, whereas those aiming at relieving symptoms would give significantly lower total doses. There is evidence for an increase in survival, in patients who are given higher radiotherapy doses, especially in those patients with better PS.

This survey demonstrates a range of treatment strategies for advanced and inoperable NSCLC within Europe. There are a number of factors that influence the perceived aims of treatment and treatment planning. These factors should be taken into account when evaluating the effectiveness of different irradiation techniques, especially in the determination of radiobiological parameters and dose–response relations. The majority of patients should be treated with short courses of palliative radiotherapy, of one or two fractions. The use of high-dose palliative regimens using many fractions or SBRT should be considered for selected patients with good PS.

This study evaluated the impact of patient set-up errors on the probability of pulmonary and cardiac complications in the irradiation of left-sided breast cancer.

Using the CMS XiO Version 4·6 radiotherapy planning system's normal tissue complication probability (NTCP) algorithm and the Lyman–Kutcher–Burman model, we calculated the dose–volume histograms (DVH) indices for the ipsilateral lung and heart and the resultant NTCP for radiation-induced pneumonitis and excess cardiac mortality in 12 left-sided breast cancer patients.

Isocentric shifts in the posterior direction had the greatest effect on the lung V20, heart V25, and mean and maximum doses to the lung and the heart. DVH results show that the ipsilateral lung V20 tolerance was exceeded in 58% of the patients after 1 cm posterior shifts. Similarly, the heart V25 tolerance was exceeded after 1 cm antero-posterior and left–right isocentric shifts in 70% of the patients. The baseline NTCPs for radiation-induced pneumonitis ranged from 0·73% to 3·4%, with a mean value of 1·7%. The maximum reported NTCP for radiation-induced pneumonitis was 5·8% (mean 2·6%) after 1 cm posterior isocentric shift. The NTCP for excess cardiac mortality were 0% in 100% of the patients (n = 12) before and after set-up error simulations.

Set-up errors in left-sided breast cancer patients have a statistically significant impact on the Lung NTCPs and DVH indices. However, with a central lung distance of 3 cm or less (CLD < 3 cm), and a maximum heart distance of 1·5 cm or less (MHD < 1·5 cm), the treatment plans could tolerate set-up errors of up to 1 cm without any change in the NTCP to the heart.

Student experience on clinical placement is not well captured with traditional program evaluation tools. This study aims to complete a qualitative analysis of the reflective clinical journals completed during professional placement by radiation therapy (RT) students in order to uncover the issues that affect students on placement and how these change as the student's progress through the program.

A qualitative descriptive analysis (QDA) was undertaken on the descriptive content of student journals completed by 97 students over 3 consecutive years while undertaking professional placement in Radiation Oncology Treatment Centres within Australia. Two coders used a QDA sourcebook specifically designed for the research to independently analyse the descriptive content of the reflective journals for four main categories and 18 subcategories.

The result revealed a statistically significant increased tendency to discuss clinical environment and a decreased tendency to discuss the patient, 92·9–12·5% (coder 1) and 85·7–18·8% (coder 2), as they progressed through the program.

The results of this study showed some similarities with studies completed in other health professions; however, the breadth of issues explored within the content of these RT student journals demonstrates the true diversity of the RT student experience on professional placement.

Although the notion of advanced practice (AP) has been widely accepted and implemented in some countries, for example, the United Kingdom, in Canada it is has yet to be widely tested as a model of working. Currently it has been implemented and evaluated in Ontario, but this approach is not widespread across the country. To date in British Columbia (BC), there are no advanced practitioners and no research has been conducted regarding the opinions and attitudes of radiation therapists (RTs) in BC towards the implementation of AP. Understanding RTs attitudes and perceptions towards AP may be important when considering the acceptance and implementation of new roles. The research objectives were to explore the attitudes and opinions of RTs and establish what the term AP means to BC RTs, and also to discover what they consider to be benefits, and barriers to implementing AP.

A quantitative approach was utilised and an on-line questionnaire was sent to 266 RTs that currently practice in BC. Likert and demographic questions were used to explore the definition of AP and ascertain opinions about the barriers and benefits of implementing AP in BC.

A total of 183 questionnaires were completed for a response rate of 69%. The majority of respondents agreed with the Canadian Association of Medical Radiation Technologies (CAMRT) and the literature's definition of AP. Cost, time, lack of support and training and issues of medical dominance were cited as barriers. Job satisfaction, autonomy, and increased recruitment and retention of staff were considered benefits.

Although RTs believe there are obstacles to be overcome regarding the adoption and implementation of AP, these are outweighed by the potential benefits such as enhanced patient care due to increased levels of professional knowledge and development that can lead to increased levels of job satisfaction. These are seen as important drivers for creating the AP role in BC.

To evaluate the efficacy of a Belly Board immobilisation device for rectal cancer patients.

A randomised trial in patients receiving neo-adjuvant chemoradiation for rectal carcinoma was established. Patients were treated, prone with control arm, according to standard departmental protocol and experimental arm with the use of a Belly Board. All treatments were planned using a three-field technique. The primary endpoints were reproducibility and irradiated small bowel volume. Questionnaires were used to assess secondary endpoints of patient comfort, ease of set-up and acute toxicities.

Pre-planned interim analysis was performed after recruiting 30 patients. In all, 348 portal images were analysed retrospectively. Around 8 out of 12 parameters measuring set-up reproducibility were in favour of the Belly Board arm. Random error in the anterior–posterior direction was improved and statistically significant in the experimental arm (95% CI; p≤0·05). Small bowel V15 was significantly lower in the Belly Board position (mean V15=14·5%) compared with the standard position (mean V15=21·4%), paired t-test 95% CI; p=0·035. Also, patients’ comfort satisfaction was greater in the Belly Board arm.

Set-up reproducibility, small bowel V15, patient comfort and satisfaction were all significantly improved by the use of the Belly Board.

The incidence of venous air embolism (VAE) during and following diagnostic and interventional radiographic procedures utilizing contrast media has been well documented in the literature. However to date a case report of a venous air embolism occurring within an outpatient healthcare facility during a contrast enhanced computer tomography radiation therapy planning procedure remains under reported.

Healthcare professionals must remain alerted to the fact that iatrogenic VAE may occur unexpectedly during and following diagnostic and interventional radiographic procedures utilizing the injection of contrast media. The action by all healthcare professionals to implement rapid and clear acute care guidelines will increase the probability of the patient recovering from the event.

A review of the aetiology and associated pathophysiology of VAE is provided. This is followed by a detailed case report of the occurrence of a non-fatal VAE event (patient consent was obtained and the consent form template was reviewed by a Research Ethics Board).

We conclude with a discussion of quality assurance recommendations that should be considered for implementation in an outpatient facility setting that is performing contrast enhanced computer tomography diagnostic, interventional or radiation therapy planning radiographic procedures.

The clinical specialist radiation therapist (CSRT) is a radiation therapist with advanced site-specific clinical skills and knowledge that can be utilised to enhance the education of radiation therapy (RT) students within an academic setting. The aim of this study is to assess the students’ perception of the teaching provided by a CSRT within a case-based learning workshop tailored for breast cancer.

A workshop that followed the patient's RT treatment pathway (consultation, CT simulation, treatment planning and delivery) was led by a breast-site CSRT to 16 third-year students. Following completion of the workshop, a 4-point Likert-scale survey was distributed to explore the students’ didactic and clinical experiences and their general perceptions of the CSRT's contribution to their breast-site module education.

The median didactic experience reported by the students were ‘a lot’ in patient care and ‘some’ in treatment unit and treatment planning. In contrast, the students reported less clinical experience; the median response for patient care and treatment unit experience was ‘a little’ and ‘none’ for treatment planning. All 13 students who responded to the survey agreed that the CSRT enhanced their understanding of the material. The students felt engaged in the CSRT-lecture and perceived it as value added. The majority of the students (92%) indicated the CSRT to be a useful learning resource in their training and education. Additional comments provided by the students noted the utility of the CSRT-led lecture in consolidating their knowledge of the breast cancer treatment planning and delivery and suggest further expansion of this learning format to other disease sites.

Third-year RT students commencing their clinical practicum will have had a greater proportion of their learning from didactic teaching as opposed to clinical experience. In transitioning to their final year, the focus of the curriculum shifts to the application of theory into the clinical environment. The students perceived the CSRT to be a useful resource to enhance their understanding of the breast-site module and their feedback supports the instructional quality and effectiveness of the CSRT in this clinical teaching role.

At Queensland University of Technology, student radiation therapists receive regular feedback from clinical staff relating to clinical interpersonal skills. Although this is of great value, there is anecdotal evidence that students communicate differently with patients when under observation.

The aim of this pilot was to counter this perceived observer effect by allowing patients to provide students with additional feedback.

Radiotherapy patients from two departments were provided with anonymous feedback forms relating to aspects of student interpersonal skills. Clinical assessors, mentors and students were also provided with feedback forms, including questions about the role of patient feedback. Patient perceptions of student performance were correlated with staff feedback and assessment scores.

Results indicated that the feedback was valued by both students and patients. Students reported that the additional dimension focused them on communication, set goals for development and increased motivation. These changes derived from both feedback and study participation, suggesting that the questionnaires could be a useful teaching tool. Patients scored more generously than mentors, although there was agreement in relative grading.

The anonymous questionnaire is a convenient and valuable method of gathering patient feedback on students. Future iterations will determine the optimum timing for this method of feedback.

In radiotherapy (RT), there are high requirements for quality assurance (QA) in all the steps of the process. Development of QA systems are demanding in terms of financial and human resources. A national QA programme (KVIST) has been established in Norway to facilitate implementation of QA activity on hospital level.

The KVIST organisation comprises the KVIST team, the reference group (RG) and the working groups (WGs). The KVIST team is multidisciplinary and are employed in permanent positions. The RG acts as an advisory body for the KVIST team in defining and ranking the priority of projects. Relevant national QA projects are identified in collaboration with the RG, and WGs are established to carry out the various projects.

Several national consensus documents have been prepared by the various WGs. Systems for incident handling and activity reporting have been established and clinical audits have been implemented in Norwegian RT. Guidelines for RT of various diagnoses have also been prepared in collaboration with National Cancer groups.

The KVIST programme has been very well acknowledged in the Norwegian RT community. It has succeeded in creating a positive attitude towards QA and improved the communication between centres and the various professions.

To investigate possible optimisation of the image guidance procedure for the prostate cancer patients with respect to imaging frequency and patient body mass index (BMI).

The 6,085 setup correction shifts and BMI for 216 prostate cancer patients treated on tomotherapy units in two centres were analysed. Margins needed to account for inter-fraction target motion with daily only automatic correction and with automatic and manual corrections during one, three or five first fractions as a reference for further treatment without imaging were calculated.

The planning target volume margin calculated for the daily automatic correction only scheme was significantly lower than the margins calculated for the image guidance limited to a few initial fractions. Manual corrections after automatic fusion were more important for patients with higher BMI. On average, the patients with normal BMI had manual correction shift of 0·7 mm in anterioposterior direction, while overweight and obese patients required, correspondingly, the shifts of 1·3 and 1·4 mm.

Overweight and obese patients require daily imaging with time saving available by performing automatic kV/MV computed tomography registration only. The patients with normal BMI may be treated with imaging guidance during a few initial treatment fractions.

To calculate and compare planning target volume (PTV) margins for an offline 3 mm tolerance, daily bony anatomy verification, tattoo alignment and online prostate marker matching with those currently used at our institution.

Seventy patients had offline bony anatomy megavoltage verification. 23 different patients underwent fiducial marker matching using daily online kilovoltage verification. Systematic and random errors were measured in the right–left (RL), superior–inferior (SI) and anterior–posterior (AP) directions. Geometric uncertainties from literature were used to help calculate the margins.

PTV margins (mm) were 7 RL, 12 SI and AP (3 mm tolerance offline bony), 6 RL, 11 SI and AP (daily online bony), 8 RL, 12 SI and AP (tattoo alignment) and 5 RL, 8 SI and 6 AP (online daily prostate marker correction).

Our current margins for conformal radiotherapy patients are too small for phase 2 in the SI and AP directions. Implementing online daily bony anatomy matching would not reduce the PTV margin significantly. Online daily marker correction showed current PTV71 Gy margins as excessive by (mm) 5 RL, 2 SI and 4 anterior.

Printed patient education material enhances verbal patient teaching. ‘Starting radiation therapy: helpful tips for patients with head and neck cancer’ is a booklet that facilitates head and neck (H&N) cancer patients’ orientation to the study hospital. This study examined and compared patients’ and staff's opinion on the distribution and usefulness of this booklet.

Patients starting radiotherapy treatment to their H&N cancer, and staff involved in their care, were recruited. A survey was designed to collect responses from both cohorts.

Of the patients, 94% received the booklet before their first radiotherapy treatment. Of the staff, 67% referred to this booklet during patient education. Most patients (98%) found that the booklet increased their awareness of hospital and community services. Both groups indicated list of services and telephone number to be the most useful chapter. The staff suggested having this booklet available in different languages.

This booklet was useful as an orientation tool for the patients to navigate the hospital system. Patients and staff have similar opinion regarding the most useful sections in the booklet. Further studies needs to be conducted to validate the need of having this booklet available in other languages.