Intensity-modulated radiootherapy (IMRT) is being rapidly embraced as a radiotherapy technique in many cancer centres across the world. This paper aims to highlight the reported problems associated with the use of IMRT for the treatment of head and neck cancer. Specific areas of concern that are mentioned are the identification of tumour volumes, reproducibility of treatment, issues of tumour resistance and tumour recurrence. Radiotherapy departments are advised to make haste slowly when considering the implementation of this technique.

In last few years, adjuvant post-operative radiotherapy and occasionally preoperative irradiation combined with chemotherapy are considered as effective practices to improve disease control and survival in gastric cancer. Yet, chemoradiotherapy result in severe toxicities and radiotherapy practice is a significant contributor. For a recommended median dose of 45 Gy to the treatment volume of stomach and surrounding lymphnode regions, considerable doses are likely to be delivered to liver, kidneys and spinal cord. Few literatures and texts state about the radiotherapy techniques, with recent emphasis on conformal (3-D CRT) or intensity-modulated radiotherapy (IMRT). However, these facilities are not uniformly available in most developing countries where stomach cancer is common. This is a report on practical aspects of radiotherapy techniques and planning which can be utilised as per available settings of a radiotherapy department.

Inter-observer variations in contouring and their impacts on dosimetric and radiobiological parameters in intensity-modulated radiotherapy (IMRT) treatment for localised prostate cancer patients were investigated. Four observers delineated the gross tumour volume (GTV) (prostate and seminal vesicles), bladder and rectum for nine patients. Contouring done by radiologist was considered as gold standard for comparison purposes and for IMRT plan optimisation. Maximum average variations in contoured prostate, bladder and rectum volumes were 3% (SD = 8.4), 2.5% (SD = 4.12) and 13.2% (SD = 6.77), respectively. The average conformity index for standard contouring set (observer A) was 0.85 (SD = 0.028) and statistically significant differences were observed for observers A–B (p = 0.008), A–C (p = 0.006) and A–D (p = 0.011). Average values of normal tissue complication probability for bladder and rectum for observer A were 0.361% (SD = 0.036) and 1.59% (SD = 0.14). Maximum average tumour control probability was 99.94% (SD = 0.035) and statistically significant difference was observed for observers A–B (p = 0.037) and observers A–C (p = 0.01). Inter-observer contouring variations have significant impact on dosimetric and radiobiological outcome in IMRT treatment planning. So accurate contouring of tumour and normal organs is a fundamental prerequisite to make good correlation between calculated and clinical observed results.

This research aims to establish the prevalence and aetiology of anxiety and depression in cancer patients within their first 2 weeks of a radical course of radiotherapy. Depression followed by anxiety is the two most frequent psychological disorders experienced by cancer patients. However, these two disorders are frequently undiagnosed and untreated in patients undergoing a course of radiotherapy possibly because the treatment side effects often simulate those of anxiety and depression; the consequences of this can be reduced patient prognosis and increased health care costs. A questionnaire was administered to a sample of 100 eligible cancer patients and this yielded a 68% response rate. The Hospital Anxiety and Depression (HAD) scale was integrated into the questionnaire to accurately establish levels of anxiety and depression in the respondents of the study. The study identified six respondents with clinically significant levels of anxiety (9%) and six with depression (9%); 21% (n = 14) of participants had higher than normal levels of anxiety and 21% for depression (n = 14). Correlations were then identified between levels of psychological distress and the four independent variables; age, diagnosis, adjuvant medication and pain. Four predisposing factors were established—breast cancer diagnosis, age range 40–50 years, the presence of pain and adjuvant chemotherapy regimes.

As radiation therapy practice evolves with advancing treatment and planning technologies, merging of imaging modalities, changing working models and the advancement to higher education, radiation therapists are frequently finding themselves on the frontline of translating new knowledge into practice. To a large degree, this growing involvement in self-directed original research, with associated dissemination of completed results, has led to an increasing number of therapists being encouraged to pursue an academic path in addition to a clinical career. In Canada, radiation therapists are being appointed as faculty to university departments for the first time. It is heartening that such opportunities are increasing; therapists are able to play a profound role in developing an evidence-based professional body of knowledge while at the same time being recognised for scholarly endeavours. However, despite these many positive steps, barriers and challenges to the development of a scholarly culture for radiation therapists still exist. Part one of this two-part series explores the history of the profession and the subsequent development of a scholarly culture.

Part two of this two-part series presents the results of a departmental initiative implemented in 2003 at a large urban cancer centre, Princess Margaret Hospital (PMH) in Toronto, Ontario, Canada. This new model for radiation therapists was called Advanced Integrated Practice (AIP) and was developed, in part, to encourage and promote scholarship within radiation therapy. The AIP model incorporated integrated clinical specialty roles designed to blend exemplary clinical practice with focused academic activities. This paper discusses an evaluation of the AIP model undertaken to obtain a formal measure of how the model had evolved, how the radiation therapists and other stakeholders were responding to the new model, whether the initial outcomes were realized and to create plans for further development of the design. The evaluation utilized a mixture of traditional qualitative research methodologies such as focus groups, quantitative surveys and a variety of other available measurable outcomes. Outcomes from the model included increased opportunities for diverse roles that incorporated an element of academic practice and augmented career choice and scope for radiation therapists. In addition, academic output and research work also increased within the department. Lessons learned from the implementation and evaluation of the model are shared, and the authors offer some suggestions to increase scholarly activity within the profession.