There is a large evidence base around prostate cancer. Most of this concentrates on which stages of the disease to treat with which modality. The purpose of this study is to try and determine from the literature an evidence based radiotherapy treatment technique. The evidence is examined on prostate and patient motion, the effect of bladder and rectum filling, patient positioning and error detection with portal imaging. The technique derived is patient supine or prone with empty bladder and bowel. A simple leg immobilisation device is recommended, with set-up to couch height. The required margins are 13.2 mm laterally, 18 mm anterior-posteriorly and 21.3 mm cranio-caudally using a three-dimensional margin recipe. It is shown that an intensive portal imaging routine is required to demonstrate that systematic set-up errors are below 5 mm.

Purpose: A randomized study to investigate the routine use of a simulator-based CT (Sim-CT) for planning purposes.

Materials and methods: 24 patients accepted for pelvic radiotherapy were randomized to receive either a Sim-CT or a DCT planning CT scan. The execution time was measured for different steps in both procedures. A questionnaire was developed to gain information about the psychological status and physical comfort.

Results: The set-up (of hardware, software and patient) took significantly longer for the Sim-CT procedure (p<0.05). An average of 5.7 min was found in comparison with 3.2 min for the DCT group. A similar result (p<0.0005) was observed for the scan time (resp. 15.9 versus 5.1 min). However the total time of the procedure (including patient preparation) was significantly lower (p<0.005) for the Sim-CT group (resp. 21.6 versus 31.7 min). Physical comfort score showed that some patients experienced more discomfort during the Sim-CT procedure than during DCT.

Conclusions: The scan acquisition time and set-up time of Sim-CT procedure was significantly higher than DCT however the total time was less for Sim-CT group. The overall reduction in time with Sim-CT is counterbalanced by increased patient discomfort.

In 1995, a meeting was arranged by the Radiation Oncology Committee of the British Institute of Radiology and the Royal College of Radiologists to look at the evidence of the impact of unscheduled gaps in radiotherapy on local tumour control, and to try to address some of the concerns that this raised. Following the meeting, guidelines were drawn up by a sub-committee of the Royal College of Radiologists to advise departments how to manage unscheduled interruptions or prolongation of radical courses of radiotherapy. One of their recommendations was that there should be regular audit of the outcome of the measures taken to avoid gaps in treatment. This paper presents how the guidelines were addressed in a department with one linac, together with the results of a 5-year audit.

Background and Purpose: The aim of this study was to determine set-up accuracy when comparing an Orfit® thermoplastic shell to a traditional acetate shell for the treatment of patients with age related macular degeneration.

Method and Materials: 20 patients with age related macular degeneration were sequentially allocated to be positioned in either an Orfit® shell or a traditional acetate shell (ten patients in each group). On each day of treatment, radiographic portal imaging was used to ascertain accuracy by comparison with the CT image and verification radiograph.

Results: 140 portal images were assessed by three independent readers. Pearson Correlation and ANOVA statistics were performed on the data to assess differences between the two types of shell. Inter- and intraobserver variations were also analysed. Results, for both Orfit® and Acetate, revealed that over 95% of error movements were 2 mm or less.

Conclusions: The study indicates that both devices are of comparable accuracy and that the Orfit® shell is an acceptable method of immobilisation for the treatment of age related macular degeneration.

Technological improvements in imaging and increased sophistication in radiotherapy techniques are causing the necessity for the reassessment of treatments. In particular tumours of the brain and head and neck region are benefiting from improved localisation, planning and treatment. This paper presents an overview of these developments.

This study aims to examine two related contemporary issues in cancer care; why people with cancer use complementary therapies [CM] and what lessons there may be in this for Cancer Centre Services. The report will be presented in two parts. Part 1 is in the current issue and Part 2 will follow in the next. In Part 1 the main questions are identified and contextualised with the current literature on complementary therapy use. In Part 2 the method, results and analysis the survey and interviews will be explored. 148 patients attending the Leicestershire Cancer Centre returned questionnaires of whom 14 were interviewed in three separate focus groups. Patients from a cancer patient self help group were also interviewed as a fourth focus group. The qualitative data enabled a deeper analysis and evaluation of the quantitative data to be made. The discussion of the data places the main questions asked by the study into a wider context, including the Calman Hine Report and patient-centred care. The conclusions are that although a significant minority of patients [13%] were using CM at the time of the survey a significant majority of respondents [73%] identified a role for CM alongside conventional cancer treatment and 78% responded that staff at the Cancer Centre should be trained to advise them on the use of CM. The respondents acknowledged the resource and educational implications for Cancer Centres but stated that equal status should be given to care and cure in managing malignant disease. This in line with the Calman–Hine Report. Far greater numbers of patients may use CM if appropriate levels of resources and information were available. The findings indicate that integration of CM could assist in promoting future improvements in quality of survival and patient-centred care as identified by Calman–Hine and other recent health policy initiatives.

This study aims to examine two related contemporary issues in cancer care; why people with cancer use complementary therapies (CM) and what lessons there may be in this for Cancer Centre Services. The report is presented in two parts. Part 2 is in the current issue and Part 1 was published in the previous issue (Journal of Radiotherapy in Practice 2000; 2(1): 45–51). In Part 1, the main questions for the study were identified and contextualised within the current literature on complementary therapy use. In Part 2 the method, results and analysis the survey and interviews are explored. Of the patients attending the Leicestershire Cancer Centre, 148 returned questionnaires of whom 14 were interviewed in three separate focus groups. Patients from a cancer patient self help group were also interviewed as a fourth focus group. The qualitative data enabled a deeper analysis and evaluation of the quantitative data to be made. The discussion of the data places the main questions asked by the study into a wider context, including the Calman-Hine Report and patient-centred care. The conclusions are that although a significant minority of patients (13%) were using CM at the time of the survey a significant majority of respondents (73%) identified a role for CM alongside conventional cancer treatment and 78% responded that staff at the Cancer Centre should be trained to advise them on the use of CM. The respondents acknowledged the resource and educational implications for Cancer Centres but stated that equal status should be given to care and cure in managing malignant disease. This in line with the Calman-Hine Report. Far greater numbers of patients may use CM if appropriate levels of resources and information were available. The findings indicate that integration of CM could assist in promoting future improvements in quality of survival and patient-centred care as identified by Caiman-Hine and other recent health policy initiatives.

From April 1997 until September 1998 an observational study was performed with respect to the quality of the “informed consent procedure concerning patients who were candidates to participate in the EORTC-trial 10925/22922. This phase-III trial deals with the question of whether irradiation of the internal mammary chain together with the ipsilateral supraclavicular chain leads to a better survival in patients with operable breast cancer. Patients with either medially located primary tumours or with (ipsilateral) axillary lymph node metastases were eligible for participation. Patients were, in our study, considered eligible if they were candidates for participation in the above mentioned EORTC-trial. After they had agreed to participate in the informed consent study, 2 radiological technologists interviewed 51 patients. It appeared that patients were well aware of it) the important characteristics of their disease; ii) the purpose of the treatment; iii) the fact that they were candidates for participation in a phase-III trial; iv) the fact that randomisation had taken place (for the participants). According to the answers of the patients it appeared that the quality of the information, as given by their physician, was good. Further attention needs to be given to the time allocated to the patients to consider their participation in the trial. The quality of the informed consent procedure could be measured adequately. Preferably this type of analysis should be performed at the start of a (large) trial. By doing so, the quality of the informed consent procedure can be evaluated and eventually the quality of the procedure can be improved.