As more and more patients are planned in 3D, the need to verify their position and treatment in 3D also becomes apparent. Megavoltage (MV) and kilovoltage (KV) cone beam computed tomography (CBCT) provide 3D verification of patient position. However, the soft tissue contrast and thus the accuracy of delineation is superior with KV CT imaging. CBCT in conjunction with energy fluence maps from electronic portal imaging devices (EPIDs) could theoretically be used to verify the dose delivered. In this instance, a cross calibration between the KV CBCT and the EPID would be required which would not be necessary with MV CBCT. Adaptive planning with CBCT poses similar challenges for both KV and MV CBCT. Although KV CBCT can produce images with Hounsfield units (HUs) comparable with conventional CT in homogenous phantoms there are large discrepancies in inhomogeneous mediums. If the cupping artefact is corrected for in MV CBCT, the HU values can compare well with KV CBCT for homogenous media. However, advances need to be made to achieve a lower patient dose with MV CBCT. At present, the lower dose required for KV CBCT allows for more frequent imaging and better image quality.

Glioblastoma multiforme (GBM) is the most commonly occurring adult brain tumour and has the worst prognosis. Radiobiologically, GBM exhibits radioresistant characteristics, which may contribute to its incurability. The use of a chemical radiosensitiser combined with radiotherapy may be an exploitable mechanism to improve therapeutic gain. Temozolomide (TMZ) is a promising new alkylating agent that has been introduced into clinical practice over the last decade and has shown modest activity against high-grade gliomas. This paper aims to evaluate the evidence base for the use of TMZ as a radiosensitiser in practice by reviewing published literature. Findings demonstrate promising improvements in progression-free and overall survival for patients with GBM receiving concomitant and adjuvant TMZ and radiotherapy compared with radiotherapy alone. These results are evaluated to put forth recommendations for further research.

Recognising one’s abilities and limits in clinical tasks is a valuable part of professionalism. This study investigated the self-ratings of problem-solving confidence of radiation therapists (RTs) in two domains: clinical scenarios and critical thinking items (CTIs). We divided the 60 participants into three groups based on post-qualification experience (PQE), and found that greater PQE was linked with higher self-rated confidence for clinical scenarios, but not for CTIs.

Purpose: To add six new cases to the literature and to determine whether women with pre-existing scleroderma have an increased incidence of complications after breast-conserving therapy.

Methods and Materials: From 1995 to 2005, nine patients with pre-existing scleroderma were treated for their breast cancer at the Institute Curie. Six of them underwent radiotherapy. The patients who underwent radiotherapy were irradiated using high-energy photons of a cobalt unit and/or linear accelerator, either before or after surgery, or were exclusively treated using radiation therapy. The early and late skin reactions have been evaluated using the Acute Radiation Morbidity Scoring Criteria (RTOG) and Late Radiation Morbidity Scoring Scheme (RTOG, EORTC).

Results: Median follow-up of the six irradiated patients was 34 months (range from 10 to 120 months). Early reactions were as follows: grade 1 in two cases, grade 2 in two cases, and grade 3 in two cases. Late toxicity was as follows: grade 0 in three patients, currently at 56, 48, and 12 months of follow-up; grade 1, slight atrophy, in two patients; grade 3 reaction with marked atrophy in one patient, followed up for 120 months now. There was no toxicity worse than grade 3 in these series.

Conclusions: This small study cannot provide evidence that scleroderma increases the risk of developing early and late toxicity. Patients with scleroderma must be discussed in multidisciplinary meetings to adapt their treatment to their rheumatologic history. When radiotherapy is considered, more attention must be paid to the protection of normal tissues. Careful follow-up during and after the radiation therapy remains of paramount importance in this specific population of patients.

The GliaSite radiation therapy system (RTS) is an implantable balloon brachytherapy applicator used to deliver iodine-125 in the treatment of recurrent high-grade gliomas. Patients generally tolerate the procedure well, with only rare reports of adverse events such as wound infection, meningitis, and symptomatic radiation necrosis. Hemorrhagic complications have not been reported. We present a case report describing intracranial hemorrhage during GliaSite manipulation in a patient receiving long-term anticoagulation for a previously diagnosed pulmonary embolism. The GliaSite RTS and the management of venous thromboembolism in patients with brain tumors are reviewed. These events suggest that normalizing coagulation status during GliaSite balloon inflation and deflation should be considered.

The research identifies and evaluates the content and readability of Websites of all radiotherapy departments that provide a Website. As more patients are being referred for radiotherapy treatment each year, the information needs of the public on this subject is growing. Fifty-two per cent of radiotherapy departments within the United Kingdom (UK) and Ireland were identified as providing a Website. These Websites were evaluated, over a period of 2 weeks, using an adapted Website evaluation tool. Five criteria – content, authority, navigation, design and technical aspects – were identified as important aspects of a Website. For each criterion a number of statements were listed and using a Likert scale were marked. Flesch–Kincaid readability tests were used to analyse the readability level of the Websites. Data analysis resulted in the ranking of the Websites. Evaluation scores varied greatly and the readability tests showed 92% of the Websites were written at a level too high for the public. This shows the varying quality of radiotherapy department Websites with scores ranging from 48 to 115, and the varying readability level of these Websites. The research makes suggestions for the improvement of radiotherapy department Websites including the provision of a dedicated Website team within the department, educated in Website design.

Introduction: Although tangential radiotherapy is one of the major treatments for breast cancer, little has been done to address the skin toxicity and general dose inhomogeneity experienced in patients with larger breasts that are treated with 6MV photons. From our understanding of radiation in tissue at depth, it is proposed that 10MV photons could have a clear role in such patients through improved dose distribution. However, a greater build up depth with 10MV could mean that this energy is unacceptable.

Aims: To quantify and characterise superficial build up dosimetry in tangential breast irradiation for 6MV and 10MV photons.

Methods: Using Thermoluminescent Dosimeters (TLD’S), a comparative study was carried out investigating dose at a range of superficial depths in a phantom irradiated by tangential fields. Each delivering 2Gy for 6MV and 10MV photons.

Results: There was a 0.10Gy difference in maximum dose over a depth of 10.8 mm between 6MV and 10MV photons, along with an average difference of dose at depth of 0.09Gy.

Conclusion: Evidence has been obtained that eliminates comprise to superficial tissue if 10MV photons are used. Furthermore, reinforcement towards a more homogenous dose distribution with 10MV photons has been established.