This report examines the recommendations of The International Commission for Radiation Units and Measurements, ICRU 50 and a typical interpretation of them. It hypothesises that there is a small identifiable group of patients that may be at risk of long term damage due to current radiotherapy treatment to the breast.

The report emphasises the variation in dose obtained when the whole volume of the irradiated breast is considered. The dose distribution beyond the central contour and the effect of lung density is analysed. Even if three-dimensional planning and inhomogeneity correction factors are not available, consideration must be given to their significance.

This report acknowledges that the ICRU reference point is a much-needed method of comparing radiotherapy treatments between hospitals, but points out that it was not intended to be a means of determining dosimetry, despite the suggestion that it may be advantageous if its relative dose is 100%.

The report concludes that there should be greater awareness and attention paid to the recommendation that heterogeneity should be within +7 and −5% of the prescribed dose.

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.

The purpose of this Phase 2 Breast Skin Care Pilot Study was to compare the acute skin reaction in patients undergoing radiation therapy for early breast cancer who use Aloe vera gel on the irradiated skin, with the acute skin reaction in patients from our earlier study who followed a normal skin care routine. Two secondary objectives were to assess patient compliance with the use of Aloe vera gel and the ease of using two skin toxicity scoring tools.

A total of 109 patients undergoing radiotherapy following surgery for breast cancer between October 1997 and February 1998 consented to participate in this study. Each patient applied the Aloe vera gel three times daily to the irradiated area during radiation treatment. Skin reactions were assessed objectively on a weekly basis during radiation using the Radiation Therapy Oncology Group (RTOG) and the Acute Skin Reaction Index (ASRI) skin scoring tools and subjectively by patients. All patients were followed for up to 3 weeks following treatment.

The use of Aloe vera gel did not increase the acute skin reactions due to irradiation when compared with the two arms of the previous Phase 1 Breast Skin Care Study. This pilot study demonstrated that patients could safely use Aloe vera gel while undergoing radiation therapy treatments. All patients complied uniformly with the instructions of using the gel during the study. The ASRI skin scoring tool was easier to use and more sensitive in displaying differences in skin reactions in comparison to the RTOG scale.

A clear rationale exists for routine in vivo dosimetry as part of an overall quality assurance (QA) programme within a radiotherapy department. A survey was undertaken in order to identify the extent of diode dosimetry practice within the UK.

Questionnaires were distributed to 57 radiotherapy physics departments in the UK in order to determine the extent of central axis diode dosimetry and the protocols implemented, the range of other in vivo measurements performed using diodes and the type of equipment used. Fifty-four responses were received. Eighteen departments undertook some form of central axis entrance dosimetry. Fifteen departments could be considered to be doing this routinely. Seven departments indicated planned future use. Six centres routinely undertook exit dosimetry with a further 3 indicating planned future use. Varied protocols for use were reported by those centres undertaking central axis dosimetry. Thirty-two respondents used a diode system for other forms of in vivo measurements with critical organ and TBI dosimetry being the most common. The vast majority used Scanditronix equipment.

Despite the distinct benefits of central axis diode dosimetry, this continues to be infrequently adopted as part of a departmental QA programme. However, an indication of a number of departments planning to implement such an approach is reassuring.

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.

Radiotherapy departments are increasingly reliant on networked computers to co-ordinate all aspects of radiotherapy treatment such as treatment planning, verification or simulation. This paper suggests three relatively inexpensive strategies that can be applied to file servers within such networks. If they are implemented, the additional resilience of the network will increase the number of clinically available hours as most common hardware problems can be scheduled for repair outside routine clinical use.

Health care ethics is a term that has come very much to the fore in the National Health Service during the past few years due to greater awareness of the subject and issues involved and challenging attitudes on the part of both health care professionals and patients. With advances in technology conflict of ethics has arisen, further increasing this subject's profile. This paper commences by defining some of the terms associated with health care ethics, followed by an explanation of two of the main underlying philosophical theories of medical ethics in modern health care practice.

Background: Radiotherapy skin reactions have been well documented in the past. Until recently, washing of the treated area and the use of perfumed products that contain metals has not been advocated during treatment. The aims of this study were to assess the skin reactions of patients using a non-metallic deodorant and to see whether there were any psychological benefits from being able to use the deodorant.

Method: 41 women attending for radiotherapy to either the breast or breast and axilla were recruited into the trial. They were randomised into one of two groups. Complete data was obtained for 36 patients. 20 patients used the deodorant and 16 did not. Any skin reactions noted were recorded on a weekly basis. Patients were also asked to complete a questionnaire relating to feelings and activities and to comment on the deodorant if they had used it.

Results: Skin reactions did seem to be slightly worse in the patients using deodorant, and it was only in this group of patients that axillary reactions were noted. However, neither of these results were statistically significant. The use of the deodorant did not have any impact on the psychological well being of the patients, but patients using it had found it pleasant to use and the majority said that they would use it again.

Conclusion: Further study is indicated to look at skin reactions using the deodorant with a larger sample of patients.

Patients who receive radiotherapy need to be informed about its effects. Available evidence is inadequate because it has focused on selected symptoms and has emphasized the objective characteristics of symptoms rather than the patients' own experience of them. This study therefore examined women's own accounts of physical side-effects during the first 12 months after treatment for early breast cancer. Semi-structured audiotaped interviews with 15 patients 1 week to 12 months after treatment were analysed qualitatively. The women described some symptoms that were consistent with what is already known, in particular fatigue and skin changes, but also others that have been previously neglected. The women's explanations for symptoms were an inextricable component of their experience of them. Surprisingly, many women blamed themselves for having caused their symptoms. These findings contribute to the evidence that is necessary to inform health care professionals' advice to patients. They can also guide future quantitative research into symptoms associated with treatment and ensure that this is grounded in patients' experience of symptoms rather than clinicians' assumptions about patients' experience.

Therapy radiographers require the ability to perceive three-dimensional relationships, in order to position patients correctly for treatment. A test predicting this would therefore be useful during undergraduate selection. This study examines whether therapy radiographers have a greater spatial ability than the general population, and secondly the relationship between spatial and clinical ability.

A correlation design utilised 54 therapy radiographers. Each subject undertook 3 tests: 2 spatial ability tests; WAIS block test (WBT) and Lego block test (LBT), and a clinical set-up (CS). Results indicate that therapy radiographers have a significant higher level of spatial ability, p <0.001, than the general population in the 25–34 year age group. Pearsons correlation of WBT with LBT (r = 0.56, p < 0.0005) demonstrated concurrent validity of the new LBT.

The results suggest therapy radiographers have a higher degree of spatial ability than the general population. A test of spatial ability would therefore be of use to determine potential clinical competency during undergraduate selection. Whilst a potential useful instrument has been identified further research needs to be undertaken in this area as spatial ability is just one factor needed for clinical competence.

This technical note describes a hinged lead alloy shielding block that could be used, in certain circumstances, for shaping a megavoltage X-ray field. The construction of the shield is described and the results of transmission and penumbra measurements are given.

The issue of patients' rights has become an important part of modern health care practice due to patients being much more aware of what they can expect from health care professionals when they enter the health care environment. This paper commences by explaining what rights are, followed by a discussion of two fundamental rights issues considered important in the relationship between patients and health care professionals in order to ensure good health care practice.

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.