Radiotherapy is a common treatment modality for cancer patients. Unfortunately, the treatment can result in skin reactions that may affect their quality of life and clinical outcomes. PILs can provide guidance on managing early symptoms and reduce unscheduled treatment breaks. Evaluating PILs is not frequently evidence-based, and research into evaluating PILs’ inclusiveness for radiotherapy skin reactions does not exist. This study aims to contribute to the knowledge base to better serve the whole radiotherapy population.

A constructivist methodology was developed to evaluate skin-tone inclusivity in the author’s local PILs, and a literature review was conducted to assess the knowledge base and facilitate providing recommendations for improvement.

Publication, diagnostic, language and educational bias were identified in the literature. The content analysis found the author’s departmental PILs were not inclusive of medium and dark-skinned patients.

Further research into radiotherapy PILs inclusivity is warranted. The creation or amendments to existing radiotherapy skin reaction diagnostic tools are needed to cater for the whole population. Diverse educational resources are needed to contribute to the reduction of health inequalities faced by radiotherapy patients.

Head and neck squamous cell carcinomas (HNSCCs) are aggressive tumours lacking a standardised timeline for treatment initiation post-diagnosis. Delays beyond 60 days are linked to poorer outcomes and higher recurrence risk.

A retrospective review was conducted on patients over 18 with HNSCC treated with (chemo)radiation at a rural tertiary care centre (September 2020–2022). Data on patient demographics, oncologic characteristics, treatment details and delay causes were analysed using SPSS.

Out of 93 patients, 35.5% experienced treatment initiation delays (TTIs) over 60 days. Median TTI was 73 days for delayed cases, compared to 41.5 days otherwise. No significant differences in demographics or cancer characteristics were observed between groups. The primary reasons for the delay were care coordination (69.7%) and patient factors (18.2%). AJCC cancer stage showed a trend towards longer delays in advanced stages.

One-third of patients faced delayed TTI, primarily due to care coordination and lack of social support. These findings highlight the need for improved multidisciplinary communication and patient support mechanisms, suggesting potential areas for quality improvement in HNSCC treatment management.

This study compares tumor control probability (TCP) and normal tissue complication probability (NTCP) across different hypo-fractionated (HypoRT) and conventional breast radiotherapy regimens using radiobiological models.

Computed tomography data from 30 patients with left breast-conserving surgery were used to evaluate three HypoRT regimens (39 Gy and 41·6 Gy in 13 fractions, and 40 Gy in 15 fractions) and a conventional regimen (50 Gy in 25 fractions). Dose-volume histograms (DVHs) were extracted for radiobiological calculations using Equivalent Uniform Dose (EUD) and Poisson models for TCP, and EUD and LKB (Lyman-Kutcher-Burman) models for NTCP.

Conventional treatment achieved significantly higher TCP (95%) than all HypoRT regimens (p < 0·001), with no significant differences between HypoRT regimens (p > 0·05. The 39 Gy/13 fraction regimen showed the lowest lung NTCP (p < 0·05). HypoRT regimens had significantly lower NTCP for the lungs and heart compared to the conventional regimen (p < 0·01). TCP and NTCP values from Poisson and LKB models were higher than those from the EUD model (p < 0·01).

HypoRT regimens reduced NTCP, with the lowest values in the regime of 39 Gy/13 fractions regimen, though the conventional regimen had higher TCP.

Brachytherapy is a widely used cancer treatment technique requiring precise dose delivery for optimal outcomes. This study evaluates the dosimetric properties of the ${{\rm{\;}}^{192}}$Ir Flexisource using Gafchromic EBT3 film, adhering to American Association of Physicists in Medicine guidelines.

The EBT3 film was calibrated with a linear accelerator to establish the relationship between optical density and absorbed dose. Measurements were conducted in a water-equivalent solid phantom to simulate human tissue. The dosimetric properties measured included the dose rate constant, radial dose function and anisotropy function.

The results showed a close alignment with reference data: a maximum deviation of 3·1% for the dose rate constant, 2·3% for the radial dose function and 5·67% for the anisotropy function. These deviations are within acceptable limits, indicating high accuracy.

Gafchromic EBT3 film demonstrates reliable dosimetric measurement in high-dose rate brachytherapy. The film’s accuracy in evaluating the ${{\rm{\;}}^{192}}$Ir Flexisource ensures precise treatment delivery and enhances patient safety, supporting its continued use in clinical practice.

To study the simplified sphericity index (SSI) of planning target volume (PTV) and correlate it with the gradient index (GI) for stereotactic radiosurgery (SRS)/stereotactic radiotherapy (SRT) treatment of brain metastasis.

A collection of fifteen brain metastasis cases previously treated with SRS/SRT by volumetric-modulated arc therapy (VMAT) technique was included in the analysis. All the previous plan data from Monaco 6.2.1.0 TPS were used for re-planning and computation of SSI and GI. Pearson’s correlation analysis was performed by using OriginPro 8.5 software, and the outcomes were tabulated.

The statistical analysis and linear fitting of data show a negative linear correlation between SSI and GI, taking SSI as the independent variable and GI as the dependent variable. Pearson’s correlation coefficient (r) was found to be -0.91563 with a p-value of 0.0000124 showing strong statistical significance.

It is observed that the GI of the PTV improves as the SSI increases, that is, when the target volume approaches a perfect sphere. Calculating the SSI of the target before planning may help in predicting the GI which may guide making crucial decisions regarding PTV dose prescription and acceptance criteria for organs-at-risk dose tolerance.

Lung cancer ranks high among the causes of mortality in cancer patients, as per the most recent World Health Organization report. Proton therapy offers a precise approach to treating lung cancer by delivering protons with high accuracy to the targeted site. However, inaccuracies in proton delivery can lead to increased toxicity in healthy tissues. This study aims to investigate the correlation between proton beam dose profiles in lung tumours and the scattered gamma particles.

The study utilised the Gate simulation software to simulate proton beam radiation and an imaging system for prompt gamma imaging during proton therapy. An anthropomorphic Non-uniform rational B-spline (NURBS) cardiac and torso (NCAT) phantom was employed to replicate lung tumours of various sizes. The imaging system comprised a multi-slit collimation system, CsI(Tl) scintillator arrays and a multichannel data acquisition system. Simulations were conducted to explore the relationship between prompt gamma detection and proton range for different tumour sizes.

Following 60 MeV proton irradiation of the NCAT phantom, the study examined the gamma energy spectrum, identifying peak intensities at energies of 2.31, 3.8, 4.44, 5.27 and 6.13 MeV. Adjustments to the proton beam source tailored to tumour sizes achieved a coverage rate of 98%. Optimal energies ranging from 77 to 91.5 MeV were determined for varying tumour volumes, supported by dose distribution profiles and prompt gamma distribution illustrations.

The study evaluated the viability of utilising 2D gamma imaging with a multi-slit collimator scintillation camera for real-time monitoring of dose delivery during proton therapy for lung cancer. The findings indicated that this method is most suitable for small lung tumours (radius ≤ 12 mm) due to reduced gamma emission from larger tumours.

While the study demonstrates promising results in range estimation using prompt gamma particles, challenges were encountered in accurately estimating large tumours using this method.

To compare the dosimetric characteristics and treatment delivery efficiency of trigeminal neuralgia (TN) stereotactic radiosurgery (SRS) patients previously treated with a 6 MV-FFF (flattening filter-free; radiation beam obtained by removing the flattening filter) beam versus those re-planned with a 10 MV-FFF beam using a conical collimator on the TrueBeam Novalis STx linear accelerator.

Eleven patients with TN previously treated with a 6 MV-FFF beam following the SRS protocol of 90 Gy in a single fraction were selected. Plans were recalculated using 10 MV-FFF beam, maintaining the same dose prescription and beam angle configuration used with 6 MV-FFF beam. The dose gradient, volumes receiving 20 and 10 Gy, maximum dose and dose to 10% of the brainstem were recorded for both the energies. Efficiency was assessed by the average monitor unit (MU) and time per arc. The 10 MV-FFF machine was configured in the treatment planning system (TPS) to measure the tissue phantom ratio (TPR), dose profiles and scatter factors using RAZOR, PTW-60012 diodes and EBT3 radiochromic films.

Compared to the 6 MV-FFF, the 10 MV-FFF plans exhibit average increments in dose gradient, volume of 20 Gy and volume of 10 Gy of 3.8, 17.1 and 17.8%, respectively. Average increases of 6.5 and 18.1% were obtained for maximum dose and dose to 10% of the brainstem, respectively. An average increase of 31 MU/arc was observed for the 10 MV-FFF plans, with a 40% reduction in treatment time per arc. The TPR for the 10 MV-FFF beams increased by 10%, and a penumbra width of 0.3 mm was observed. Scatter factor increments of 15, 13.5, 12.7 and 10.3% were observed for the 6 MV-FFF over the 10 MV-FFF for cones of 4, 5, 6 and 7 mm, respectively.

In TN SRS, the utilisation of 10 MV-FFF beams reduces treatment duration but results in an increased brainstem radiation dose. To mitigate this increase in brainstem dose, it is necessary to adjust the isocentre position.

This project developed and validated an automated pipeline for prostate treatments to accurately determine which patients could benefit from adaptive radiotherapy (ART) using synthetic CTs (sCTs) generated from on-treatment cone-beam CT (CBCT) images.

The automated pipeline converted CBCTs to sCTs utilising deep-learning, for accurate dose recalculation. Deformable image registration mapped contours from the planning CT to the sCT, with the treatment plan recalculated. A pass/fail assessment used relevant clinical goals. A fail threshold indicated ART was required. All acquired CBCTs (230 sCTs) for 31 patients (6 who had ART) were assessed for pipeline accuracy and clinical viability, comparing clinical outcomes to pipeline outcomes.

The pipeline distinguished patients requiring ART; 74·4% of sCTs for ART patients were red (failure) results, compared to 6·4% of non-ART sCTs. The receiver operator characteristic area under curve was 0·98, demonstrating high performance. The automated pipeline was statistically significantly (p < 0·05) quicker than the current clinical assessment methods (182·5s and 556·4s, respectively), and deformed contour accuracy was acceptable, with 96·6% of deformed clinical target volumes (CTVs) clinically acceptable.

The automated pipeline identified patients who required ART with high accuracy while reducing time and resource requirements. This could reduce departmental workload and increase efficiency and personalisation of patient treatments. Further work aims to apply the pipeline to other treatment sites and investigate its potential for taking into account dose accumulation.

Mycetoma is a chronic infection of the skin and the subcutaneous tissue caused by both bacteria and fungi. Eumycetoma, caused by fungus, requires prolonged use of antifungals and/or surgery.

In this scenario it has been attempted to treat a case of eumycetoma with an aim to improve the symptoms and to give an antifungal drug free period. Radiotherapy was delivered in two sittings. In the first sitting, 20 Gy in five fractions was given. Because of the excellent response to the radiotherapy, after 9 months, another 15 Gy was delivered in five fractions.

The symptom-free period extended for another 11 months, making a cumulative effect of 21 months.

The use of radiotherapy in the salvage of refractory eumycetoma cases should be further explored.

Second primary breast cancers are among the most common risks to female patients who have received radiotherapy for mediastinal lymphoma.

This study aims to audit breast dose in women who received mediastinal radiotherapy for lymphoma and compare the combined dose parameter values measured to those in the literature.

Twenty-three patient datasets from 2017 to 2021 were obtained. Inclusion criteria, such as female gender and 30Gy prescription dose, were applied. Target volumes were delineated using involved site radiotherapy and planned on Eclipse (Varian, Palo Alto, CA) using either fixed field or VMAT. Breast contours were retrospectively outlined according to RTOG/EORTC guidance and descriptive statistics were used to compare findings to those from the literature.

Differences were found in V4gy, V5Gy and mean dose compared to the literature with mean dose being 2Gy in the literature and 4Gy in this audit.

Breast dose parameter values between patients in this study vary due to multiple factors. These include the treatment delivery method used and the position of the treatment field in relation to the location of breast tissue. Mean dose and V4% and V5% to breast tissue found in this study differ from that found in the literature. This study highlights the importance of accurate contouring and optimising breast tissue when possible.