Pre-registration teaching of radiotherapy planning in a non-clinical setting should allow students the opportunity to develop clinical decision-making skills. Students frequently struggle with their ability to prioritise and optimise multiple objectives when producing a clinically acceptable plan. Emerging software applications providing quantitative assessment of plan quality are designed for clinical use but may have value for teaching these skills. This project aimed to evaluate the potential value of automated feedback to second year BSc (Hons) Radiotherapy students.

All 26 students studying a pre-registration radiotherapy planning module were provided with automated prediction of relative feasibility for left lung tumour planning targets by planning metrics software. Students were also provided with interim quantitative reports during the development of their plan. Student perceptions of the software were gathered using an anonymous questionnaire. Independent blinded marking of plans was performed after module completion and analysed for correlation with software-assigned marks.

In total, 25 plans were utilised for marking comparison and 16 students submitted feedback relating to the software. Overall, student feedback was positive regarding the software. A ‘strong’ Spearman’s rank-order correlation (rs=0·7165) was evident between human and computer marks (p=0·000055).

Automated software is capable of providing useful feedback to students as a teaching aid, in particular with regard to relative feasibility of goals. The strong correlation between human and computer marks suggests a role in benchmarking or moderation; however, the narrow scope of assessment parameters suggests value as an adjunct and not a replacement to human marking.

In recent years, there has been a spectacular development in nanomedicine field with new nanoparticles for diagnosis and cancer therapy. Although most researchers have been always interested in gold nanoparticles (GNPs)

In the present work we present a comparison between the use of bio-nanomaterials in proton therapy.

Consequently, our results show that platinum nanoparticles (PtNPs) present an interesting advantages comparing with GNPs and silver nanoparticles. On the other hand, the use of PtNPs facilitates in a considerable way the proton therapy.

During radiotherapy of the prostate it is important to minimise interfraction prostate motion to allow dose escalation and reduce normal tissue damage. Rectal volume has been identified as playing a significant role in prostate motion with various methods used to reduce it. The aim was to systematically review published literature to allow evidence based recommendations to be made to current practice to reduce interfraction prostate motion.

A systematic search of CINAHL, Medline, PubMed, Science Direct, NHS Evidence and The Cochrane Library was performed. Limited searches of The Society of Radiographers website, OpenGrey and COPAC were undertaken, alongside manual searches of cross references of eligible articles. The quality of included papers was measured using a pre-existing tool. The causes, consequences and solutions to manage rectal volume and its effect on prostate position were extracted, compared and evaluated to extract solutions to be implemented into clinical practice.

Of the 2,339 unique articles systematically retrieved, 23 met the inclusion criteria, 15 of which discuss radiotherapy, five constipation and three flatulence.

A combined medicinal and dietary approach adaptable to departmental workflow is required to manage rectal volume, with special consideration to patients with pre-existing extrinsic factors.

In our study basic dosimetric properties of a flattening filter free 6 MV photon beam shaped by multileaf collimators (MLC) is examined using the Monte Carlo (MC) method.

BEAMnrc code was used to make a MC simulation model for 6 MV photon beam based on Varian Clinic 600 unique performance linac, operated with and without a flattening filter in beam line. Dosimetric features including central axis depth dose, beam profiles, photon and electron spectra were calculated and compared for flattened and unflattened cases.

Dosimetric field size and penumbra were found to be smaller for unflattened beam, and the decrease in field size was less for MLC shaped in comparison with jaw-shaped unflattened beam. Increase in dose rate of >2·4 times was observed for unflattened beam indicating a shorter beam delivery time for treatment. MLC leakage was found to decrease significantly when the flattening filter was removed from the beam line. The total scatter factor showed slower deviation with field sizes for unflattened beam indicating a reduced head scatter.

Our study demonstrated that improved accelerator characteristics can be achieved by removing flattening filter from beam line.

London South Bank University (LSBU) has successfully implemented Virtual Environment for Radiotherapy Training (VERT) across the therapeutic radiography training curricula and are now supporting the use of VERT for patient education in clinical departments. A number of publications have reported on the use of VERT in education and training; more recent literature has focused on the use of VERT for patient education.

The successful introduction of VERT before students’ first clinical placements resulted in the development of a ‘Pre-Clinical week’ where students practice and improve their technical skills, using the hand controls without a patient present, leading to increased confidence in clinical practice. Other examples of VERT curriculum integration at LSBU focused on the use of VERT for anatomy teaching. The more recent innovation at LSBU relevant to VERT integration has been the design, development and implementation of collaborative research projects where the aims of the studies were to explore patients’ perceptions of VERT as an information giving resource before radiotherapy delivery.

The introduction of VERT as education tool has enabled academic staff to develop a range of teaching methods to embed virtual training into the traditional classroom setting, demonstrating innovation and collaboration.

Despite crossing at the isocentre, misaligned laser beams may cause significant positioning problems.

The jig proposed here is to be used in addition to the quality assurance procedures employed with linacs and deals with possible misalignments of transverse lasers.

It is an inverted T construction with a two-sided rectangular, slightly transparent mirror set vertical on a piece of glass serving as its base. The device is carried by a horizontally set spirit-level surface and placed on the couch-top so that the sagittal laser passes through the vertical mirror’s plane. Then the therapy couch is translated along the Y direction until a laser beam shines on the corresponding side of the semi-transparent mirror. This spot is marked and is normally the linac’s isocentre set through an independent procedure employing a rotating plate. If the laser had been set properly, then its beam should be reflecting back on its source. If not, the alignment can be corrected by rotating and/or translating the laser holder until it does that. At the same time, it should be ensured that the beam does not wander away from the isocentre spot on the mirror. When both are achieved, the beam ends up perpendicular to the linac’s axis of rotation, while passing through the isocentre. The procedure can be repeated for the opposite laser.

The jig was simple to construct and has been found quite useful in practice. The accuracy of patient positioning will be restricted only by the size of the laser beam’s cross-section.

Antioxidant therapies to control oxidative damage have already attracted worldwide attention in recent years. Extensive studies on phytochemicals in cell culture system and animal models have provided a wealth of information on the mechanism by which such nutraceuticals show their beneficial effect. Nutraceuticals include plant-derived factors (phytochemicals) and factors derived from animal sources as well as from microbial sources. The activities of nutraceuticals are broad and include antioxidation, modulation of enzyme activity and modification of natural hormonal activity (agonist or antagonist) to act as a precursor for one or more beneficial molecules. Antioxidants scavenge free radicals that cause cell damage. Antioxidant consumption during radiotherapy and its effects are still controversial. Some studies suggest that antioxidant supplementation during chemotherapy or radiotherapy may be beneficial and some, harmful. Wheat grass is rich in superoxide dismutase, an antioxidant enzyme. Radiotherapy causes tumour cell kill via activation of reactive oxygen species, specifically by the hydroxyl radical and needs the reactive species for effective tumour control. Wheat grass which is rich in free radical scavengers can interfere with reactive oxygen species generated by radiation for tumour cell kill and can be detrimental to the therapy per se.

To hypothesise if the antioxidant properties of wheat grass could influence tumour activity, the effects of radiation therapy on tumour cells can be nullified when wheat grass is taken during radiotherapy.

At The Radiation Medicine Program described, the entire radiation therapy (RT) workflow was previously conducted through the use of two electronic programs. It duplicated workflow and created a situation where it was difficult to measure the RT process. Recent enhancements to the electronic medical record facilitated the consolidation of RT planning and treatment workflows into one electronic system.

This report will describe the clinical implementation of electronic Radiation Oncology (RO) Care Plans at a Regional Cancer Centre, and how they can be applied as a foundation for RT process improvements.

A total of 51 Care Plans and 95 IQ Scripts were successfully implemented. The benefits of RO Care Plans include a more streamlined process, removed ambiguity, improved communication, standardised workflow and automation of tasks. In addition, multiple performance indicators can be obtained from the RO Care Plans, such as caseload reports, workflow reports and a ‘white board’.

The implementation of RO Care Plans serves as a foundation for data-driven process improvement at a local Regional Cancer Centre.

Patients treated with intensity-modulated radiation therapy (IMRT) for head-and-neck cancer are often positioned supine on a carbon fibre board to which a thermoplastic mask is attached to immobilise the head and shoulders. For patients unable to tolerate a supine position, we developed a tilting board that accommodates a full-scale head-and-shoulder mask.

Phantom measurements were obtained to confirm the dosimetric accuracy of our treatment planning system when using this board. A patient was simulated in the flat and tilted positions on the board. The two corresponding treatment plans were evaluated by comparing the target coverage and doses with organs at risk. The patient’s intra-fraction motion was quantified during his tilted treatments.

Phantom measurements confirmed the accuracy of the dosimetric calculations. The tilted plan met dosimetric standards for clinical acceptability. The intra-fraction motion of the patient in the tilted position was >3 mm in any direction.

The tilting board met clinical requirements for IMRT planning and delivery. Full-scale head-and-shoulder immobilisation was achieved in a more tolerable tilted position.

Jugulotympanic glomus tumours (JTGT) are highly vascular neoplasms composed of paraganglionic tissue of neural crest origin. Because of the neoplasm’s slow growth potential, any claimed efficacy associated with applied treatment must be supported by long-term effects observed in patients.

This report presents a case of advanced stage JTGT in a 66-year-old woman treated by γ knife radiosurgery (GKRS).

Sustained tumour control with preservation of lower cranial nerve function was observed for more than 10 years after completion of treatment.

GKRS even with large intracranial extension of JTGT in patients may help to achieve long-term disease control with minimal morbidity.

Deep inspiratory breath hold (DIBH) during left-breast irradiation helps to minimise cardiac irradiation by physically separating the heart from the left breast. The dose to organs-at-risk in intensity-modulated radiotherapy (IMRT) and opposed tangent three-dimensional conformal radiotherapy (3DCRT) during DIBH in patients with left-sided breast cancer was compared.

A total of 20 consecutive patients with left-sided breast cancer had a computed tomography scan utilising DIBH. Mean volumes of the heart, left anterior descending coronary artery, total lung and right breast receiving 5–95% of the prescription dose were calculated.

Target volume homogeneity was improved with IMRT and average mean dose to target was higher for 3DCRT (51·03 Gy) compared with IMRT (50·47 Gy, p<0·01). The average mean dose to the heart was lower with 3DCRT (87 versus 77 cGy, p<0·01). The average mean dose to the contralateral breast was also lower with 3DCRT (19 versus 17 cGy, p<0·01). Less monitor units (MUs) were required with 3DCRT with an average difference of 225 MU/fraction (p<0·01).

Under DIBH, absolute differences between 3DCRT and IMRT were minimal. 3DCRT under DIBH provided excellent dosimetric results in most patients with left-sided breast cancer without the need for IMRT.

Success with acupuncture-like transcutaneous nerve stimulation (ALTENS) in the treatment of radiation-induced xerostomia has not been reported after an extended time.

We report a case of successful ALTENS therapy 5 years after radiation treatment.

The patient discontinued treatments in a second course due to complete resolution of symptoms.

This case report demonstrates a potential for offering ALTENS to those long suffering from radiation-induced xerostomia.

We report a unique presentation of a late side effect associated with stereotactic body radiation therapy (SBRT) of the lung.

The case of a 65-year-old male who developed left-sided vocal cord paralysis after two courses of SBRT for squamous cell lung carcinoma is presented. The patient developed this late toxicity 15 months after his second treatment, which was to address a recurrence in the perihilar region of the left upper lobe.

An astroblastoma is a rare primary glial tumour occurring preferentially in young adults. It is characterised by a perivascular arrangement of tumour cells forming perivascular pseudorosettes mimicking ependymomas. The histogenesis of astroblastoma is unclear.

We present the history of a 13-year-old girl with chief complaints of headache associated with vomiting, blurring of vision on the left eye and a history of diplopia on the right eye. She underwent left parietal parasagittal craniotomy and near-total excision of tumour. She was planned for postoperative radiotherapy 5,940 cGy in 28 fractions along with concurrent temozolamide100 mg. She had no neurological deficit or complaints during her last visit.

Astroblastomas are a distinct clinic pathologic entity, with well-described radiologic, pathologic and cytogenetic features. Its recurrence is high, and efforts must be made to elucidate the role and usefulness of radiotherapy and chemotherapy in these tumours.