This paper aims to provide an overview of age related macular degeneration (ARMD) and its radiotherapy management.

ARMD is already the leading cause of adult blindness in the western world. The neovascular form of ARMD is responsible for some 85% of blindness caused by ARMD as a whole. Its aetiology is unknown. The natural course of the disease is rapid progression from onset to disciform scarring and accompanying loss of visual acuity. Laser photocoagulation is only suitable for 10% of patients with neovascular ARMD. Initial studies using low dose fractionated external beam radiotherapy have demonstrated stable visual acuity over the range of 40–93% at short term follow-up. Only transient acute side effects have been observed. No radiation-induced retinopathy or vasculopathy have been observed. Common radiotherapy macula techniques are reviewed, field sizes examined and criteria for a simple macula technique proposed. A subset of patients with rapidly progressing neovascular ARMD may be candidates for rapid treatment starts. Although follow up times have been short, radiotherapy is a promising option for those patients facing imminent blindness due to rapidly progressive neovascular ARMD.

This article reviews the development and potential impact of Digitally Reconstructed Radiographs (DRR's) in the planning and verification of radiotherapy treatments. It explores the requirements for the creation of usable DRR's their integration into current verification methods and it highlights some of the factors that may influence the routine use of DRR's. Continuing developments in radiotherapy techniques demand increasingly accurate verification methods. DRR's provide an efficient and effective representation of planned treatments for comparison with both simulator and portal images, encompassing the digital imaging technology which is the future of radiotherapy treatment verification.

Therapy radiographers may be empowered to contribute more freely to the multi-disciplinary professional team if they critically reflect on their inherent clinical knowledge and perspectives. Critical reflection may help radiographers articulate the rationale behind professional decisions and proposed evidence-based treatment planning and delivery protocols, and reveal knowledge embedded in practice. Documentation of professional reflection may yet become a cornerstone for continuing professional development. Despite a paucity of rigorous empirical investigation, ‘reflective practice’ has become focal in nursing education. Three concepts appear confused, ill defined or interchangeable in the literature: ‘reflective practice’, ‘reflection’ and the ‘reflective practitioner’. Debate continues into the value of ‘reflective practice’ as a system: it remains problematic, it is difficult to conceptualise, it appears to have no clear or universal definition and no certain framework or guidelines for its implementation. In reflecting on action there may be strong hindsight bias which may invalidate conclusions reached. There are doubts raised about the benefits of structured models to implement reflective practice. Belonging to such an empirically based profession, it may be that educators and clinical therapy radiographers incorporate only those elements of systematised ‘reflective practice’ that can be empirically demonstrated to be beneficial to the profession, and will result in improved patient outcomes. There is no compelling evidence yet that any systematised ‘reflective practice’ is inherently more beneficial to therapy radiographers than radiographers continuing to reflect as they do now, with or without documentation.

In this article several issues will be discussed. Firstly, the efficacy of using helical CT data to image the thorax, and delineate volumes (clinical target volumes (CTV) and planning target volumes (PTV). Secondly, the practicalities of using CT data sets for dose inhomogeneity corrections and planning in the thorax. And thirdly, the associated problems of organ motion and immobilisation in this region.

Although it has long been known that fatigue is one of the more common side-effects accompanying radiotherapy treatment, little research into the topic has been done until recently. The article reviews the recent literature highlighting our lack of understanding of what fatigue is, its aetiology, its relationship to radiotherapy treatment and how best to deal with what some patients consider to be a major problem. Finally the paper looks at the evidence of the possible benefit that can be obtained through the use of exercise, a recommendation that is currently at odds with what most radiographers within Britain are advocating to patients.

This review article aims to address the paucity of information regarding professional portfolio development for therapeutic radiographers. It will review briefly the current literature regarding continuous professional development (CPD) for therapeutic radiographers and add to the on going debate regarding the monitoring and enforcement of a mandatory CPD scheme. It will recapitulate the applications of professional development portfolios and equip therapeutic radiographers with the basic knowledge and skills to undertake the process of portfolio development, ultimately leading to a product that provides evidence of CPD.

The purpose of this paper is twofold; firstly, to present for wider consideration data collected about the role of information and support radiographers (ISRs) in the United Kingdom and secondly, to review critically issues of significance arising from the initial data collection and content analysis.

The empirical material is taken from a much larger survey of Oncology Centres1 whose aim was to analyse the extent and effectiveness of information and support services for cancer patients in order to evaluate service provision in a less developed country. A short, self completed postal questionnaire to identified information and support radiographers was employed. It sought to identify the main components of the ISR role, underpinning qualifications, limitations and potential for development. 64% of ISRs surveyed responded (n = 22) and the findings are presented for consideration in this paper.

The discussion comprises a critical review by the first author of some issues raised by the findings in the context of the national service framework for integrated provision2 and current developments in the practice and processes of therapeutic radiography. Specifically, the relative contribution of different aspects of the role of the ISR are evaluated, examining the benefits to patients and professionals alike. The difficulties of trailblazing a new role in a traditional, hierarchical service are explored. The necessity of a profession specific base for information and support provision in clinical oncology is questioned and it is suggested that, professionally, there are both advantages and disadvantages to this role development, but there is support for a less predatory, more interprofessional approach.

The research attempts to gain a greater understanding of the experience of radiotherapy from the viewpoint of the female patient with breast cancer. A qualitative, phenomenological approach was employed using semistructured interviews undertaken in the patient's home approximately two weeks after completion of their treatment course. Data analysis resulted in the description of five important categories of experience for the women. Discussion concludes that it is paramount for all health care professionals and therapy radiographers in particular to undertake and promote this type of research in order for them to establish and maintain a true sense of empathy and understanding with their patients. It also helps health care professionals maintain a sense of the importance of the ‘whole experience’ for those in their care. This type of enquiry provides a valuable and yet all too rare insight into aspects of attending for radiotherapy which would otherwise remain buried beneath the bustle of a busy radiotherapy department.

This article is an edited version of a Master's dissertation and as such can only convey the essence of the original work.

Aim: To define the role of spiral CT in evolving an evidence-based 3D Conformal Radiotherapy (CRT) prostate protocol at Lincoln, UK.

Discussion: Tumour doses traditionally prescribed at this centre to the prostate planning target volume (PTV) (64 Gy in 32 fractions) cannot be further escalated without modification of existing technique and may currently be inadequate to obtain the highest probability of local control. Prostate CRT has been demonstrated to be well tolerated with both conventional and escalated doses, however as 3D CRT PTV margins are tightened, prostate position has to be reliably predicted to avoid geographic misses or unacceptable normal tissue toxicity. The question of prostate position variability might be addressed by sequential on-treatment spiral CT scans at this centre. Spiral CT offers specific advantages of speed, small detail conspicuity, and arbitrary axial reconstruction compared to conventional CT with no attached dose penalty. Spiral CT coupled to the next generation of radiotherapy treatment planning systems (RTPs) may soon replace the CT virtual-simulator. There are significant hardware discrepancies between some present generation CT couch tops and linac couch tops. Recently published CT studies that consider prostate position variability may be fundamentally and significantly flawed due to these couch top differences. Due to a paucity of reported evidence regarding immobilisation methods, a spiral CT study is warranted to assess efficacy of immobilization method for an evidence-based prostate protocol. Confirmative spiral CT research at this centre into prostate position variability is required to select adequate margins to form the PTV for an evidence-based 3D CRT prostate protocol. Such a spiral CT study could be integrated with the immobilisation study and may separate or define the correlation (which at present is both unclear and unreported) between pelvic immobilization and prostate position variability. Initial PTV margins defined by expanding the CTV in three dimensions using an ellipsoid with major axes 1.65 times one standard deviation of prostatic displacement reported in initial studies to obtain margins of 0.7 cm laterally, 0.7 cm cranio-caudally and 1.1 cm in the AP direction are presently indicated for this centre's evidence-based prostate protocol.

Conclusion: Spiral CT will provide the essential data set for 3D CRT planning for an evidence-based prostate protocol at Lincoln. Confirmative research using spiral CT is also warranted to assess daily prostate position variability and help define the prostate PTV for an evidence based prostate protocol at this centre.

Purpose: In 1995, a post of quality control (QC) officer was established in the Radiotherapy Department of the University Hospital Gent (R-UZG). We report here the evolution of error detection in the domain of information transfer during the different steps of the treatment chain, in our department, since the creation of this job.

Material and Methods: From January 1995 to December 1997 (1995 n = 831; 1996: n = 1095; 1997: n = 1091), data on errors were recorded. At the start, an inventory was made of the existing situation and a Quality Assurance (QA) program was outlined for process control. According to the site of origin of errors in the treatment preparation chain, errors were separated into five levels: medical treatment prescription, simulation, treatment planning, treatment data transfer and daily set-up.

Results: The total number of errors found was 459 in 1995; 809 in 1996 and 1046 in 1997. During 1995 and 1996 the medical prescription protocols were adapted to the increasing need of the radiation technologists for more information. This explains an increased number of errors (from 80/459 to 276/809) in 1996. After a period of adaptation, the number of errors decreased in 1997 (257/1046). The second level, where many errors were found, is at the transfer phase (1995: 181/459 1996: 210/809; 1997: 336/1046). Most of these errors were made during the transfer of data from the prescription chart to the computer. These errors were due to lack of attention, human mistakes and calculation errors. The number of errors during simulation increased due to rotation of personnel in 1996. The increase persisted in 1997 for the same reason. Transfer errors due to the automatic transfer of leaf settings decreased (1995:18/29; 1996:15/17; 1997:7/31) Thanks to the start of QC management, errors were detected and corrected in the entire treatment process at R-UZG. Once changes were accepted, new challenges were initiated. After each evaluation, initiatives were taken to try to decrease specific errors. Changing attitudes was a difficult and slow process, but progress was made. The most important change in attitude certainly was the acceptation of the concept of QC.

Background: Non-Hodgkin's Lymphomas (NHL) are considered to be a highly radiosensitive group of diseases with radiotherapy playing a major role in their treatment. It is recognised that the different grades and stages of NHL require different treatment approaches with current recommendations including combined chemotherapy and radiotherapy, chemotherapy alone or radiotherapy alone. Despite these recommendations there still remains a variation in the radiotherapy dose and fractionation regimens prescribed for NHL and this could be attributed to a lack of written treatment protocols for these patients. This paper gives an overview of the literature and reports on a small local study.

Method: A retrospective study recorded the treatment details of 35 patients treated with radiotherapy for NHL between April and September 1996 in a major radiotherapy centre. An analysis of the various radiotherapy dose and fractionation regimens identified was carried out and an attempt to identify the rationale behind the variations was made by correlating them to the grade of disease, the age of the patients, the prescribing consultants and whether chemotherapy was part of the treatment regimen.

Results: Thirteen consultants were identified as prescribing treatment for NHL. Forty-nine percent of patients presented as low, 11% intermediate and 31% high grade NHL. Of the 60% of patients who underwent chemotherapy the majority (62%) were prescribed Cyclophosphamide, Hydroxydaunorubicin, Oncovin (Vincristine) and Prednisolone (the CHOP regimen). Nineteen different radiotherapy dose and fractionation regimens were identified, 20 Gy in 5 fractions being the most common. No correlation was found between the age of the patients and the radiotherapy dose delivered. A strong positive relationship (r = 0.95) was identified between the radiotherapy dose and the number of fractions. There was no effect on the radiotherapy dose delivered between the different grades of disease or whether chemotherapy was administered.

Conclusions: It is considered that the implementation of a NHL treatment protocol is important and in an attempt to initiate this, specific NHL teams should be formed.

Objective: The objective of this study was to directly compare the cost of conformal radiotherapy used with the RTo1 trial with that of non-conformal radiotherapy of the prostate.

Method: Two methods were employed to establish the cost, a simplistic top-down method and the more complicated bottom-up method that involved breaking down the cost elements of the respective treatments and undertaking a non-participative timing study on 37 patients undergoing radiotherapy. Costs were then ascribed based on the time the staff and equipment were utilised.

Results: The total cost of radiotherapy using the top-down method for both non-conformal radiotherapy and 32 fraction conformal radiotherapy was £2890.88, compared with £3342.58 for conformal radiotherapy using 37 fractions. The costs of the bottom-up method were £2485.67 for non-conformal radiotherapy, £2717.67 for 32 fraction conformal radiotherapy and £3110.52 for conformal radiotherapy using a 37 fraction regime.

Conclusions: Conformal radiotherapy of the prostate costs significantly more than non-conformal radiotherapy which reflects the increase in complexity of the technique. Cost differences arose due to increased time in the planning stage and in the actual treatment because of an increase in equipment and staffing costs during treatment.

This paper explores some of the characteristics associated with learning about the care and management of people with cancer in an interprofessional setting. Most cancer patients have contact with a variety of health care professionals on their cancer journey. This journey is explored for a woman with breast cancer who experiences, reports and receives advice for the chronic fatigue that many such patients have during and after treatments. Recent literature, especially that informed by patients’ viewpoints, indicates that some patients perceive their care as fragmented and can be given conflicting advice from different professionals within the team. This paper demonstrates that working in an interprofessional way is full of complexities for the practitioners involved and argues for interprofessional education as a way towards more effective team work when two or more health care professionals are members of that team.

The paper discusses theoretical aspects of interprofessional education, with a focus on knowledge development through shared learning and how this may be achieved for students studying cancer care. Barriers to the effective development of interprofessional knowledge are elaborated upon.