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.

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.

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.

Aims: To compare and contrast how the law relating to medical negligence in England and Wales applies to conventional and complementary practice and to outline some of the legal issues which may arise. Methods: A thorough review of the literature was used to collect relevant information. This involved a comparative analysis of documentation, including Statutory Powers, Statutory Instruments, case law, books and journal publications. Results and discussion: Complementary therapists, regardless of whether they are private or NHS employees, are bound by the same duty of care for their patients as conventional practitioners and the same legal rules apply. If complementary therapists claim to possess special skills, then they are liable for actions arising out of clinical practice, in the same way as conventional practitioners. State registration, for the mainstream complementary therapies, is one way of improving the status of such professions as they become an integral part of the management of cancer patients. However, until they are fully integrated, a balance must be achieved so as to overcome any conflicts of interest between complementary and conventional healthcare practitioners and to facilitate acceptance of the former into the healthcare team. Conclusions: As complementary therapies are integrated into the care of cancer patients, controls and regulations must be implemented, possibly influenced by a legal framework, so as to establish a foundation for enhancing or adding authority to the ethical issues and guidelines which already exist.

Purpose: (1) To present data on I–125 seed calibration in a clinical setting so that reasonable tolerance levels can be set for the discrepancy in seed strength between manufacturer specified value and institution measured value; (2) To present data on measured exposure rates and estimate radiation exposure levels associated with I–125 prostate implants.

Methods and Materials: Ten percent of each batch for 50 batches of I–125 seeds were calibrated using an HDR 1000 PLUS well chamber with a single source holder. Exposure rates due to I–125 were measured by survey meters with a scintillation probe designed for low energy photon counting, as well as a survey meter of the ionization chamber type. Exposure rates of an unshielded I–125 seed, a needle loaded with three seeds, and 54 prostate implant patients immediately after the implant were obtained.

Results: Compared to the manufacturer stated midrange seed strength for a batch of seeds, the average seed strength of sampled seeds had maximum deviations of ±8%, however for 45 out of 50 batches the deviation was less than ±5%. Measured single seed strength deviated up to ±12% from the manufacturer stated midrange value, and between −11% to 7% from the mean of the sampled batch. The exposure rate of a 1.39×107 Bq (0.375 mCi) unshielded I–125 seed was about 1.548×10−8C/kgh (0.06 mR/h) at 1 m, and 1.29×10−6C/kgh (5 mR/h) at 10 cm. For a needle loaded with three seeds, the exposure rate was 1.29×10−8C/kgh (0.05 mR/h) at the handle, and 1.29×10−7C/kgh (0.5 mR/h) along the shaft. For patients implanted with I–125 seeds in the prostate, the average exposure rate was 3.61×10−8C/kgh (0.14 mR/h) at 1m, and 4.13×10−7C/kgh (1.6 mR/h) at the pelvis surface.

Conclusions: For the mean seed strength a first action level should be set at a deviation of at least 5% deviation from the manufacturer stated midrange value. For individual seeds, a first action level set at 10% deviation from the manufacturer stated midrange value seems reasonable. A person performing I–125 seed calibration or seed loading could receive up to 0.5 mSv (50 mR) per case to the hands. In the first year following an I–125 prostate implant, the spouse of the patient could receive slightly over 1mSv from the I–125 in the patient. A co-worker should not receive more than 0.5 mSv from the patient.

In the past 50 years, informed consent has become a fundamental principle of health care ethics. With the introduction of new technology and new techniques in radiotherapy practice, practitioners must be aware of the ethical dimensions of their work and be able to organize their understanding of the issues. Informed consent is based on the recognition of the patient as an autonomous agent. This paper commences by defining autonomy and its supposed opposite concept – paternalism, as well as discussing patient advocacy and illustrating these concepts in the context of informed consent in radiotherapy practice. Practitioners must mould themselves not only to be knowledgeable and skilled professionals but also to be respectful and caring human beings.