Functional Magnetic Resonance Imaging (fMRI) permits the non-invasive mapping of brain activation during some specific stimulation. This paper demonstrates the application of fMRI for including cortical activation into a treatment plan produced on our commercial treatment planning system (CMS XiO™). A patient with an intracranial tumour near the motor cortex was studied on a 1.5 Tesla GE Signa scanner. Images from conventional MRI, used to define the planning target volume (PTV), and from fMRI, used to define the organ at risk (OAR), were transferred to the treatment planning system. Three plans were generated with similar treatment intent and compared to assess the dose given to the OAR. These were: 1. a conventional plan; 2. an IMRT plan optimised to cover the PTV and; 3. an IMRT plan optimised to additionally spare the OAR. Results show that 21% of the motor cortex (OAR) receives 90% of the prescription dose when planned conventionally. This is reduced to 9% when IMRT is used, and to 2% when fMRI data is included. This novel approach can be extended to other functional areas of the brain, giving rise to a more conformal avoidance radiotherapy technique, which may help to preserve patient's quality of life.

The development of intensity modulated radiotherapy (IMRT) has allowed the delivery of concave dose distributions. Planning studies have demonstrated the potential clinical benefit of IMRT in the treatment of the prostate and pelvic nodes in patients with advanced prostate cancer. As a consequence, IMRT was clinically implemented in the Royal Marsden NHS Trust in September 2000, using Elekta Sli series linear accelerators and NOMOS Corvus v3.0 planning system. As a relatively new treatment procedure in the United Kingdom, the clinical implementation involved developing appropriate quality assurance and verification procedures as well as training staff. This paper describes the practicalities of implementing IMRT into the routine workload of the radiotherapy department.

Several instruments have been used to measure absorbed radiation dose under non-electronic equilibrium conditions, such as in the build-up region or near the interface between two different media, including the surface. Many of these detectors are discussed in this paper. A common method of measuring the absorbed dose distribution and electron contamination in the build-up region of high-energy beams for radiation therapy is by means of parallel-plate ionisation chambers. Thermoluminescent dosimeters (TLDs), diodes and radiographic film have also been used to obtain surface dose measurements. The diamond detector was used recently by the author in an investigation on the effects of beam-modifying devices on skin dose and it is also described in this report.

The benefits of employing computed tomography (CT) into the planning process of radiotherapy has been well established over the last 20 years. The cross sectional images provide invaluable information that enable clinicians to plan patients treatment with confidence. More recently there has been the development of the CT-simulator (CT-sim), however its place in the clinical setting has still to be established.

One of the most anticipated questions is “will the CT-simulator replace the present conventional treatment simulator as a tool for simulation?” There appear to be tremendous reasons why it should, but there are also many issues that need to be addressed.

This discussions aims to critically assess the practical and technical aspects of the new technology, by means of reviewing published literature. The aim is to decipher whether its introduction into the planning process is realistic and appropriate for all radiotherapy patients, and whether it has the possibility to replace the treatment simulator.

Issues concerned with image production, simulation (virtual), planning, cost, quality assurance (QA) and patient criteria (i.e. radical and palliative patients) have been reviewed. The Study concludes that the CT-sim has the realistic possibility to dramatically improve the treatment intent of all radiotherapy patients. Although there are situations where the treatment simulator appears to supersede the CT-sim, there still appears to be a place for it within the planning process.

The Clinical Oncology Patient Liaison Group (COPLG) was established by the Faculty of Clinical Oncology of The Royal College of Radiologists in 1997. One of the early issues to be addressed by the COPLG was the “patient-friendliness” of radiotherapy departments in the United Kingdom. A questionnaire relating to several aspects of patient care was formulated substantially by the lay members of the Group and circulated to all departments. There was a 63% response rate. The results demonstrated considerable variation in departmental practice and they were used as the basis for writing a booklet entitled “Making your Radiotherapy Service more patient-friendly”, which was circulated to all departments. This was intended to give practical suggestions on improving services, recommending only what had been shown to be feasible. A year later another questionnaire was circulated, designed to measure the effect of the booklet. There was a 53% response rate. In the great majority of responding departments the booklet had influenced staff and had led to changes in practice and improved care. The service areas most influenced were the provision of facilities for waiting patients, the provision of information about treatment, the maintenance of privacy and dignity and surveying the views of patients.

This article reviews portal imaging undertaken for prostate cancer with the intention of developing an imaging protocol for this category of patient. It explores the online and offline approaches of electronic portal imaging, when intervention for field placement errors (FPE) should take place and who actually makes this decision. The choice of reference image is discussed and the questions the use of re-simulation. This paper concludes that it is necessary to image for three fractions in the first week in order to highlight systematic errors, that an electronic portal imager is cost effective in time and money, and that radiographers should review images and make the decisions upon intervention strategies. Images will be reviewed via a quantitative template method rather than via a qualitative “eyeball” method.

A 71-year-old man with Stage II gastric cancer developed rapid onset radiation induced liver disease after ceasing adjuvant chemotherapy and radiotherapy. Autopsy revealed moderate hepatocellular iron overload. Posthumously, he was found to be a compound heterozygote for hereditary haemochromatosis. Since both radiation and iron overload may induce liver damage through the activation of hepatic stellate cells, it is possible that hepatocellular iron overload may potentiate the effects of irradiation and predispose the patient to radiation induced liver disease.

This technical note describes a port film graticule that can be used to determine the central axis of a portal image when used with megavoltage film or on-line electronic portal imaging. The construction and quality control of the portal film graticule are highlighted.