To examine patient satisfaction with a Clinical Specialist Radiation Therapist (CSRT) in a palliative radiotherapy clinical environment.

A one-point dissemination design captured satisfaction scores from patients who did (n=19) and did not (n=14) receive palliative care from the CSRT. The ‘Patient Satisfaction Questionnaire’ included six common questions and four additional questions for patients seen by a CSRT. T-tests compared results from common questions and mean values, standard deviations were also calculated.

For questions ‘I was told everything that I want to know about my condition’ and ‘I felt that the problem that I came with was sorted out properly’, those who received care from the CSRT scored significantly (p<0·05) higher than those that did not (p=0·033, 0·037). For CSRT-specific questions, 89% of participants felt the experience with the CSRT was excellent, 78% strongly agreed/agreed having a CSRT on the care team was important, and 89% of participants strongly agreed/agreed having a CSRT on the care team was important to patients’ understanding of treatment.

Patients receiving care from the CSRT had better understanding of treatment and an excellent experience with the CSRT. This interaction provided more opportunities to address patient questions/concerns, thus alleviating patient anxiety, increasing satisfaction with care, and demonstrating how new roles can develop new models of care within the current healthcare system.

In those receiving radiotherapy for pelvic cancers, up to 80% develop gastrointestinal symptoms, with dietary interventions recommended to reduce these symptoms. However, research outlining the current dietary support provided to patients undergoing radiotherapy for pelvic cancer is lacking.

To identify the gastrointestinal symptoms experienced by those undergoing pelvic radiotherapy and to identify the dietary support provided to these patients.

A service evaluation was undertaken in one NHS Trust hospital whereby patients undergoing radical pelvic radiotherapy during a 15-week recruitment period were invited to complete an anonymous questionnaire. Participants were recruited using purposive sampling and the data were analysed descriptively using SPSS.

In total, 31 patients responded achieving a response rate of 48%. The most frequent reported gastrointestinal symptoms were gas and flatulence followed by diarrhoea, nausea and abdominal pain. The main dietary changes implemented by the respondents and recommended by health care professionals included reducing fibre intake, reducing certain vegetables, reducing caffeine and increasing water.

The results illustrate the impact of gastrointestinal side effects on patients’ dietary intake. The results highlight that nutritional guidance need to be standardised, especially for the management of diarrhoea and gas and flatulence as these were the most common occurring side effects. With radiographers most frequently giving nutritional advice they must be provided with guidance to support those undergoing pelvic radiotherapy.

Compassion and compassionate care are central to radiographers’ professional policy and practice and are congruent with the core values of the National Health Service Constitution. The term compassion however is over-used, ambiguous and vague. This work sought to explore and provide contextual understanding to the term compassion in healthcare.

Walker and Avant’s eight-step model was used as the framework for the concept analysis. Data collection utilised a number of resources including online databases: Medline, CINAHL complete, Scopus, PubMed, PsycINFO, ScienceDirect, Cochrane and DARE; dictionaries, social media, Internet sources, books and doctoral theses. In all, 296 resources were included in the review.

The concept analysis distinguishes the defining characteristics of compassion within a healthcare context, allowing for associated meanings and behaviours to be outlined aiding understanding of compassion. Compassion in healthcare requires five defining attributes to be present: recognition, connection, altruistic desire, humanistic response and action.

The findings identify the complexity of the term and subjective nature in which it is displayed and in turn perceived. The concept analysis forms the basis of further research aiming to develop a healthcare explicit definition of compassion within healthcare, specifically cancer care and radiography practices. Lucidity will enhance understanding, facilitating active engagement and implementation into practice.

To evaluate and develop an image-guided radiotherapy (IGRT) protocol for the effective treatment of prostate and pelvic lymph nodes.

This study comprised of nine patients receiving radiotherapy for node negative prostate cancer, who had a pair of planar kV images taken for 37 treatment fractions. The positioning accuracy for both implanted fiducial markers and pelvic bony anatomy (surrogate for pelvic node position) was calculated using random and systematic errors. Appropriate margins were also determined. All patients followed a strict bladder and bowel protocol before computed tomography planning and treatment.

In total, 292 sets of images were used for fiducial marker and pelvic bone registration. A discrepancy of >5 mm between the fiducial markers and the anatomical pelvic bone was seen in 4% of treatment sessions. The maximum displacement observed between the fiducial match and the bone match was 7, 10 and 4 mm in the A/P (anterior/posterior), S/I (superior/inferior) and R/L (right/left) directions, respectively.

The margins used in combination with an online IGRT strategy ensure both the fiducial match and the bone match correlate within 5 mm thus allows good coverage of both prostate and nodal target volumes. It is essential that this is combined with a strict bladder and rectal preparation protocol to ensure accuracy and reproducibility.

The aims of this project were to identify the national range of breast boost radiotherapy doses and variations in treatment practice; determine the factors that potentially cause variations; and examine whether differences between regions are based on clinical evidence or access to technical and financial resources by surveying Therapeutic Radiographers across the United Kingdom to determine current radiotherapy boost practice.

A cross-sectional study design was selected. An electronic questionnaire using the website Survey Monkey® tool was utilised to collect categorical data from practicing Therapeutic Radiographers within the United Kingdom.

Participants were invited to participate from radiotherapy departments across the four countries of the United Kingdom (England, Scotland, Wales and Northern Ireland). There are 52 radiotherapy departments across 12 regions of the United Kingdom.

In total, 34 Therapeutic Radiographers participated. Their responses were grouped according to their region of practice. Results indicated that there are ten different dose schedules offered to patients nationally for the treatment of breast boost, with 77% of respondents using electrons to deliver boost radiotherapy.

There is no general consensus among Therapeutic Radiographers about whether factors such as age, tumour size, tumour grade or the presence of negative or positive margins, influence the therapeutic doses prescribed for different patients. This may be attributed to the absence of clinical research evidence to support evidence-based practice.

The primary outcome of this study is to establish whether fatigue management education impacts on radiographers’ perceived competence and confidence in supporting patients undergoing radiotherapy.

A single-centre mixed method study was conducted. Participants completed a questionnaire determining baseline fatigue support practice, undertook an education package, then repeated the questionnaire to determine any change in their competence and confidence. Semi-structured interviews were used to gain insight into practice and perceived barriers.

In all, 17 radiographers (100%) participated. Some areas of practice were affected significantly by the education package, namely highlighting the need for training, perceived competence and confidence in providing support, knowledge of effective treatment options and risk factors, the effect of fatigue on the patient and greater agreement that their professional qualification means they are qualified to support patients with fatigue.

Fatigue management education impacts on radiographers’ perceived competence and confidence in supporting patients during their radiotherapy. Interviews highlighted that knowledge of cancer-related fatigue is built up through day-to-day practice. Although there is greater awareness and support of fatigue, barriers exist, including patient compliance, lack of practical training, provision to monitor patients and unclear referral pathways.

To investigate the dosimetric advantage of quasi-continuous couch motion-enabled trajectory modulated arc radiotherapy therapy (TMAT) over the coplanar tangential partial arcs volumetric modulated arc radiotherapy (VMAT) for treating left breast and chest wall patients.

Treatment plans of 43 patients who received radiotherapy for left breast (17) or for left chest wall (26) using coplanar partial tangential arcs VMAT (reference plan) were considered for this study. For each patient, in addition to the treatment plan, a TMAT plan was also generated using quasi-continuous couch rotation. The TMAT plan consisted of original two 30° tangential arc beams and two supplementary beams having a couch rotation of ±10°, ±20° and ±30°, respectively. The difference in PTV volume coverage (PTV V95%) between TMAT plan and VMAT plan was calculated for all the cases and normalised to the plan’s prescription dose. Similarly, differences in PTV_V105% and several dose-volume parameters related to organs at risk (OAR) were also computed and tabulated.

TMAT shows an increment in the PTV dose coverage V95% with respect to reference plan by 4·7±2·5% when averaged overall prescription dose levels. Mean PTV dose (averaged overall prescription levels) for reference and TMAT plan was 4638·6±423·8 and 4793·5±447·2 cGy, respectively, and statistically insignificant (p=0·06). However mean PTV_V105% values for TMAT and for reference plans were 6·7±4·8 and 7·2±5·2%, respectively, and were not statistically different (p=0·85). Mean heart dose in TMAT was less than in VMAT plans, but not significantly. As regarding D1% to heart, TMAT plan was again found to be better with a mean difference of 137·1 cGy over VMAT plan. Other parameters evaluated were: mean dose and D1% to contralateral breast, and V20 Gy and V5 Gy for lung.

TMAT plans were found to be better than VMAT plans in terms of PTV coverage and D1% for heart. For evaluated dose parameters apart from PTV coverage and D1% to the heart, no significant differences were observed. Thus, TMAT plans yielded better dose distribution in terms of PTV dose coverage, hot spots and OAR doses.

Achieving daily consistent bladder volume is acknowledged as challenging for patients undergoing radiotherapy to the cervix or endometrium. We investigated if use of an ultrasound bladder volume scanner (BioCon-700) improves bladder reproducibility when used during an active volume correction protocol.

During our method-comparison study, prospectively recruited patients (n=20) followed a fluid-loading protocol to achieve acceptable bladder volume. Bladder ultrasound was performed daily to verify planned volume, with patients actively correcting volumes outside a planned range up to a maximum of three times. Using the Bland–Altman method, we compared mean ultrasound readings (USMean) with mean cone-beam computed tomography (CBCT) volumes (CBCTMean). We also conducted staff focus groups exploring issues encountered during implementation of bladder scanning.

Comparing USMean with CBCTMean produced a mean of the differences −10±49·92 mL (1 SD), demonstrating that bladder volume scanning is equivalent to our standard measure for the stated confidence levels. The cohort mean bladder volume decrease from week 1 to 5 was only 8·4%. Mean USMean was 323 mL, mean CBCTMean was 313 mL. Staff experience with the scanner overall was positive.

The BioCon-700 is suitable for the purpose of daily pre-treatment volume verification, facilitating daily assessment and modification of bladder volume, resulting in reproducible treatment volumes.

The Virtual Environment for Radiotherapy Training (VERT) is a high-fidelity simulation hardware and software resource that replicates the expensive and high-pressure clinical environment of a radiotherapy treatment machine. The simulation allows students to gain confidence with clinical techniques in a safe and unpressured academic environment before clinical placement. The aim of this study was to establish the current and future role of VERT and explore the potential for collaborative resource development and research.

An anonymous online survey was made available to all users of the software internationally (n=52). A mixture of fixed and open response questions gathered usage data and user feedback.

The study had a 90% response rate (n=47). Most participants (78·5%) used the resource 1 day/week or less; around 8,000 hours worldwide. It was clear that most participants used the simulation resource to help student to either gain understanding of concepts and techniques or to gain practice with techniques and practical skills. There was good support for collaborative resource development, deployment and evaluation to help VERT users to fully exploit its range of pedagogical uses.

This audit demonstrated high levels of engagement and enthusiasm for collaborative resource development and ongoing research among the radiotherapy simulation community. Adoption of an international Academic Community of Practice for collaborative simulation resource deployment and support may be of significant value and is worthy of further discussion and consideration.

This retrospective study aimed to report clinical outcomes of high-dose rate brachytherapy (HDR-BT) and whole pelvic radiation therapy (WPRT) in intermediate- to high-risk localised prostate cancer and to gain a better understanding of how behavioural variability of patients from various ethnic origins affects clinical practice.

In total, 116 localised intermediate- to high-risk prostate cancer patients who were treated during 2004–12 were enroled into the study. WPRT was delivered to the full pelvis (50 Gy per conventional fractionation) and two fractions (15 Gy per fraction) of high-dose rate brachytherapy were designed for all patients to the peripheral zone of McNeal. The reported results were biochemical control rate, toxicity profiles and behavioural variations of patients.

The median follow-up time was 51 months. The 4-year biochemical control rates, according to the American Society for Therapeutic Radiology and Oncology was 93·1%. T stage was the prognostic factor for biochemical control. No significant differences in biochemical control could be identified across ethnic groups (p>0·05). Five patients developed grade 3–4 gastrointestinal toxicity. Prior knowledge was commonly found among Caucasian patients and urinary functions seemed to be more concerned among Caucasian and Middle East patients than those from other ethnic origins.

Clinical outcomes of intermediate- to high-risk prostate cancer patients from various ethnic origins were comparable with that of the Caucasian-only population reported previously. A number of detected ethnic-related factors might be beneficial for treatment decision-making for patients with different cultural background and could be utilised to better personalise/optimise cancer care and aftercare.

We evaluated water-equivalent slabs as an alternative to a bolus to reduce radiation dose to the underlying lungs during electron scar boost irradiation in breast cancer patients with a thin chest wall undergoing post-mastectomy radiation therapy.

Percent depth doses (PDDs) and attenuation factors were obtained for 6 MeV (the lowest electron energy in most clinics) with solid water slabs (1–10 mm by 1 mm increments) placed on top of electron cones. Scatter dose to contralateral breast caused by the solid water slabs was measured on a human-like phantom using two selective scar boost patient setups.

The PDD plots showed that the solid water slabs had similar dosimetric effects to the bolus with lower skin dose to ipsilateral breast for the same thickness. Slab attenuation and scatter dose to the contralateral breast were increased by ~220% and by a factor of 3 with a 5 mm slab, respectively.

Our results demonstrate the feasibility of using water-equivalent slabs to reduce lung dose for electron scar boost treatment in mastectomy patients with a thin chest wall. However, the increases in treatment time and scatter dose to the contralateral breast are the disadvantages of this approach.

Craniospinal irradiation (CSI) has become an important and challenging radiation technique for radiation oncologists. Helical tomotherapy (HT) seems to have dosimetric advantage for CSI compared with other radiation modalities. The purpose of this study was to compare dosimetric data between two different HT plans; simultaneous integrated boost (SIB) and sequential boost (Sq).

Twelve previously treated CSI contoured datasets by SIB technique were replanned. Dosimetric comparative parameters of targets were conformity index (CI) and homogeneity index (HI). For organ at risk (OARs), the mean dose of parallel organs, D2% of serial organs and whole body integral dose (ID) were also investigated.

SIB plan significantly provided more conformed dose to CSI and tumour boost while resulting in a similar CI in spinal boost region compared with Sq plan. The HI showed no differences between two plans. Radiation exposure to serial organs and ID were also significantly lower in SIB plan.

CSI treatment using HT, SIB technique was feasible and had more target coverage while minimising the radiation dose to healthy tissues.

To develop a software program to convert physical dose distribution into biological effective dose (BED).

The MATLAB-based BED distribution software program was designed to import the radiotherapy treatment plan from the computer treatment planning system and to convert the physical dose distribution into the BED distribution. The BED calculation was based on the linear-quadratic-linear model (LQ-L model). Besides radiobiological parameters, other specific data could be fed in through the panel. The accuracy of the program was verified by comparing the BED distribution with manual calculation.

This software program was able to import the radiotherapy treatment plans and pull out pixel-wised physical dose for BED calculation, and display the isoBED lines on the computed tomographic (CT) image. The verification of BED dose distribution was performed in both phantom and clinical cases. It revealed that there were no differences between the program and manual BED calculations.

It is feasible and practical to use this in-house BED distribution software program in clinical practices and research work. However, it should be used with caution as the validity of the program depends on the accuracy of the published biological parameters.

Stereotactic body radiation therapy (SBRT) is a treatment option for patients with early-stage non-small cell lung cancer who are medically inoperable or decline surgery. Here we compare the outcome of patients with centrally located lung tumours who underwent either single fraction (SF)- or five-fraction (FF-) SBRT at a single institution over 5 years.

Between January 2009 and October 2014, patients with centrally located lung tumours who underwent SBRT were included in this study. Data were retrospectively collected using an institutional review board-approved database. For analysis, the Kaplan–Meier method and competing risks method were used.

In total, 11 patients received 26–30 Gy in 1 fraction, whereas 31 patients received 50–60 Gy (median 55 Gy) in 5 fractions. After a median follow-up of 12 months for SF-SBRT and 17 months for FF-SBRT groups (p=0·64), 1-year overall survival rates were 82 and 87%, respectively. SF- and FF-SBRT groups showed no significant difference in grade 3+ toxicity (p=0·28). The only grade 4 toxicity (n=1) was reported in the SF-SBRT group. All toxicities occurred >12 months after the SBRT.

SF- and FF-SBRT have comparable overall survival. SF-SBRT may have some utility for patients unable to have multi-fraction SBRT.

The effective source to surface distance (SSDeff) for different combinations of energy/applicator size of the electron beam produced by the light intraoperative accelerator, a mobile dedicated intraoperative radiotherapy accelerator, has been calculated in this study.

Both ionometric dosimetry and Monte Carlo (MC) simulation were followed to obtain the SSDeff for different combinations of electron energy/applicator size. Simulations were performed using Monte Carlo Nuclear Particles (MCNP) MC code. Measurements were performed by Advance Markus chamber and inside a polymethyl methacrylate slab phantom. Inverse square law method was employed to determine the SSDeff from acquired dosimetry data.

With increasing the applicator diameter at a given energy, SSDeff is also increased. The same result is obtained with increasing the electron beam energy for a given applicator size. The results of MC-based SSDeff for 10 cm diameter reference applicator at different energies were in a good accordance with those obtained by ionometric dosimetry. The maximum and mean differences between the results were 1·1 and 0·6%, respectively.

The results of this study showed that SSDeff of intraoperative electron beam is highly dependent on the applicator size and is a mild function of electron beam energy. These facts are in accordance with those reported for conventional electron beam. The good agreement between the results of MC simulation and ionometric dosimetry confirms the application of MCNP code in modelling of intraoperative electron beam and obtaining the intended parameters.

During left-sided breast radiotherapy, the heart is often exposed to radiation dose. Shielding can be utilised to reduce heart exposure, but compromises the dose delivered to the breast tissue and, in a proportion of patients, to the tumour bed. Deep inspiration breath hold (DIBH) can be used as a technique to move the heart away from the treatment area and thus reduce heart dose. This study examines the efficacy of the Elekta Active Breathing Coordinator (ABC), a DIBH method, in reducing heart dose.

In total, 12 patients receiving radiotherapy to the left breast were planned for treatment with both a free-breathing (FB) and an ABC scan. The dose volume histogram data for the plans was analysed with respect to heart V13, V5 Gy, mean heart dose and ipsilateral lung V18 Gy. Tumour bed D98%, threshold lung volume in breath hold (BH) and the maximum BH time for each patient was also measured. Patients then received their radiotherapy treatment using the ABC plan and the systematic error in the craniocaudal, lateral and vertical axes was assessed using orthogonal imaging.

The median heart V13 Gy for FB and DIBH patients was 3% (range, 0·85–11·28) and 0% (range, 0–1·56), respectively, with a mean heart dose of 2·62 Gy (range, 1·21–4·93) in FB and 1·51 Gy (range, 1·17–2·22) in ABC. The median lung V18 Gy was 8·7% (3·08–14·87) in FB plans and 9% (4·88–12·82) in ABC plans. The mean systematic set-up errors in all three planes were within the departmental set-up tolerance of 5 mm for both techniques. Median FB tumour bed D98% was 97·4% (92·8–99·5) and 97·5% (97·3–98·5) for ABC.

ABC represents a good method of reducing radiation dose to the heart while not compromising on dose to the tumour bed, and it has a clear advantage over FB radiotherapy in reducing the risk of cardiac toxicity. It is tolerated well by patients and does not produce any difficulties in patient positioning.