Purpose: Having previously reviewed the implementation of systematic in vivo dosimetry at the Norfolk and Norwich Hospital this paper examines the results of entrance dose measurements for specific sites/techniques and determines whether different action/alert protocols are required for these different categories.

Methods and materials: Entrance dose measurements using p-type diodes were analysed for the following treatment categories: Breast, head and neck in beam direction shell, abdomino-pelvic and intrathoracic. A 4% tolerance was applied.

Results: Mean deviations from expected dose and proportion of measurements exceeding tolerance were: Breast: +1.15%±3.04% (1SD), 238/1073≥4%; Head and neck: +0.35%±2.20% (1SD), 21/326≥4%; Abdomino-pelvic: +0.52%±2.75% (1SD), 93/712≥4%; Intrathoracic: −0.01%±2.75% (1SD), 22/119≥4%. Significant improvements in results for breast patients were noted following the introduction of a commercial breast board. The results for abdomino-pelvic patients confirmed a substantial variation in diode response under short FSD, wedged fields at 16MV (that had not been corrected for). The statistical uncertainty in dose measurement for each treatment category was calculated in order to assist determination of appropriate tolerance levels.

Conclusions: A blanket tolerance of 4% was generally too low given the extent of measurement uncertainty. The relatively high number of readings outside tolerance where identification of errors was difficult/impossible resulted in inconsistent application of the action protocol. Some widening of tolerances is likely to improve quality of procedure and treatment. Appropriate action levels are recommended for each treatment category.

roles for radiation therapists are currently in a period of rapid global change. technological advancement, increased entry-level education and the growing specialisation and professionalisation of many non-physician clinician groups are all significant drivers for change. there has been considerable interest in the province of ontario in “advanced practice” roles for therapists. this literature review identifies some of the background issues involved from a local and global perspective.

Spinal cord ependymomas are relatively rare tumours and their management is not well established. This retrospective analysis was performed to examine the outcome of patients treated for this malignancy at our institution between 1982 and 2004.

Hospital charts of 14 consecutive patients (10 men and four women) aged 8 to 58 years (median 32 years) were retrospectively analysed. This series included nine extramedullary and five intramedullary well differentiated (eight – G1, six – G2) ependymomas. All patients were treated with primary surgery. Postoperative radiotherapy was administered in 12 patients after subtotal excision. Total dose ranged from 35Gy in 17 fractions to 50.4Gy in 28 fractions. One patient experienced spinal axis failure despite complete resection of the primary tumour and was managed with salvage radiotherapy and chemotherapy following surgical excision of the relapse. There have been no radiotherapy-related serious side effects.

One patient was lost to follow-up. Of the remaining 13 patients, at a median follow-up of 5.5 years (3 months to 20 years), 12 were alive including 11 without progression.

Conclusion: In our group of patients radiotherapy following subtotal resection or used as a single modality was well tolerated and resulted in 92% long-term survival.

purpose: to identify factors determining the possibility of role development for therapeutic radiographers in hong kong public hospitals.

methods: questionnaires were sent to all ranks of radiographers, clinical oncologists, medical physicists and nurses in four clinical oncology departments in local public hospitals. information was sought on role development and the nature of extended role tasks that should be undertaken by therapeutic radiographers. both open and closed questions were used to ascertain views. individual, semi-structured interviews were used to explore further opinions of therapeutic radiographers. for open-ended questions, data were analysed thematically by grouping similar opinions, while for closed questions data were analysed by descriptive statistics and independent-samples t-test/levene's test for homogeneity of variances.

results and discussion: in total, 132 out of 285 questionnaires were returned (46.32%). subjects (77.10%) expressed views that role development in therapeutic radiography (rt) would have a positive impact on oncology services within the region. medical dominance was highlighted as the main barrier to role development (mean: 2.86; sd: 1.78). radiographers would tend not to extend their roles by taking up tasks that were performed by oncologists: for example, radiographers would not want to prescribe drugs to patients with radiation side-effects (57.58%), while 83.33% of oncologists also disagreed with this being performed by radiographers. other professionals (nurses and medical physicists) held a reserved view in delegating their tasks to radiographers, even after accredited clinical training.

conclusion: role development in rt should relieve the increasing workload of the entire clinical oncology department. it also increases the status of therapeutic radiographers within the health care setting, which is beneficial for the whole profession. however, efforts must be made by all health professionals within the department to ensure that the greatest effectiveness can be achieved from such developments.

Research in radiation therapy is developing as radiation therapists recognise the need for improved evidence-based practice and patient care. However, many radiation therapists have a limited background in the area of research practices and the methodology that may be utilised to answer specific research questions. The purpose of this paper is to describe the development of a research question and the steps involved in determining an appropriate methodology that can be used to answer that research question. To demonstrate application of the approaches and methodologies that are described, an example research question that focuses on the experience of treatment decision-making for early stage breast cancer is considered and referred to throughout the paper. Initially, quantitative and qualitative research paradigms are considered and described to demonstrate the approaches that can be used, the type of data that can be collected and the results that can be analysed and utilised to answer the research question. As a phenomenological approach was found to be appropriate to investigate the question, this approach is explored in greater detail.

It is believed that health care workers are particularly susceptible to developing stress-related illness because of the nature of their work. The purpose of this research was to identify occupational stresses that may or may not be unique to therapy radiographers, identify the coping mechanisms that are used to combat work-related stress and gain insight into the lived experiences of this group of therapy radiographers. A phenomenological (qualitative) approach was used to identify the radiographers' perception of occupational stresses and coping mechanisms. Data collection was through in-depth interviews that were transcribed and analysed using Colaizzi methodology. The results identified stresses within the following categories: personal performance, patient contact, working environment, communication, management, professional behaviour and departmental working. These results support the stresses identified through other research studies on health care workers. Coping mechanisms identified include Social Support, Confrontive Coping, Escape-Avoidance, Self-Controlling, Distancing and Positive Reappraisal. The most frequently used coping mechanisms were social support, confrontive coping and escape-avoidance. This research has also identified a new stress; the stress associated with the ‘potential to make errors’ i.e. the acute awareness of the damaging effects of high energy X-rays if a mistake is made.

This research has attempted to provide insight into the working world of the therapy radiographer and to discover the meaning and information specific to their ‘lived experience’. It is hoped that this research provides the reader with a deeper understanding of the nature and meaning of the experience.

background: verification of radiation therapy treatment using electronic portal images (epi) involves the correlation between a reference image and a treatment epi. this paper investigates the accuracy and confidence in reference anatomy outlining and anatomy matching components of epi review, when performed by radiation therapists with varying experience in epi analysis.

methods: thirty radiation therapists performed reference anatomy contouring and anatomy matching of seven pairs of reference and treatment images belonging to five previous patients. accuracy was determined by the discrepancy (mm) between the anatomy contouring and matching of the subjects and the original parameters completed by an experienced senior radiation therapist, with formal training in epi analysis. confidence was recorded on a 10cm visual-analogue scale (vas).

results: no significant differences were found in the accuracy of anatomy contouring or anatomy matching between subjects with and without formal epi training nor between subjects with less than or greater than five or more years of radiation therapy experience (p > 0.18). significantly different confidence scores were found in subjects with formal training in epi (p < 0.00006)

conclusions: accuracy of anatomy contouring and matching was not significantly influenced by the years of radiation therapy experience and formal epi training, although these factors did affect subjects' confidence in performing epi review tasks. frequent exposure to portal image analysis may be as or more important to the technical skills required in epi review, than formal training or years of experience.

Melanoma patients can be split into two main categories that have different aims for treatment; localised disease with either intermediate or high-risk of recurrence after surgery, and metastatic disease. Over the past decade, there have been many clinical trials looking at improving the success rates for localised and metastatic melanoma with alternative systemic treatments, namely immunotherapy, biochemotherapy and vaccines. This literature review summarises the clinical trials for each form of systemic treatment in localised and metastatic melanoma and assesses the effectiveness of each by an evaluation and comparison of relevant clinical trials for each systemic modality. The main objective was to assess whether alternative forms of systemic therapy have improved the disease free and overall survival rates achieved with chemotherapy.

there is currently great interest in the treatment of prostate cancer due to its increasing profile in the older male population. in recent years brachytherapy has become a viable treatment option. low dose rate implants using permanently implanted radioactive seeds and high dose rate treatments using afterloading machines are two methods regularly used for the treatment of this disease. both techniques require close integration between imaging and the placement of the radioactive sources. future developments in imaging will lead to improved targeting of the radiation to diseased areas of the prostate and interactive treatment planning. this review paper describes the current status of the treatment of prostate cancer by brachytherapy, references current published results and examines radiation protection issues.

Hadron therapy uses sub-atomic particles to deliver radiotherapy and has the capability of delivering to an increased depth compared to photons. This offers the potential of conformal therapy without the increased integral dose associated with intensity-modulated radiotherapy (IMRT). In addition, there is the possibility of hadron therapy having increased relative biological effectiveness (RBE) when compared to photons. There is increasing interest in this topic currently with the possibility of a second UK hadron therapy facility being under discussion.

This paper introduces the concept of hadron therapy and presents an evaluation of the potential benefits associated with it. Planning studies and clinical trials are reviewed in order to assess the impact that hadron therapy would have on patient management. Costs and other factors affecting the implementation of a hadron therapy facility are presented.

The proven benefits of hadron therapy are easily demonstrated by the planning studies with increased conformity and reduced integral dose over a range of tumour sites. Simple hadron plans consistently out-perform complicated IMRT plans. The costs associated with hadron facilities are higher than for photons, but they offer simplified planning due to the inherent conformality achievable with simple hadron beams. As costs decrease and technology improves, the benefits of hadron therapy may result in the replacement of the photon for radiotherapy.

study objective: the study intended to investigate the possible relationship between physical activity and prostate cancer risk on a previously unexamined population set.

design: a population-based study was conducted on males entered on the irish cancer registry between the years 1994 to 1997 to investigate if physical activity affected the risk of prostate cancer. activity was coded for three levels of occupational activity and the odds ratios were calculated together with 95% confidence limits.

results: despite limitations in the data, an elevated risk (odds ratio 2.13, 95% confidence interval 1.29–3.52) was seen in working subjects with low levels of activity compared with the high activity group. in the retired group there was a slight elevation of risk, although it was not statistically significant.

conclusion: the study suggests that physical activity offers a small but significant reduction in prostate cancer risk for those people in work.

Acute skin reactions are expected in patients receiving radical radiotherapy to the breast. Side effects of other adjuvant treatments such as chemotherapy and hormonal therapy can further impact upon patients' well being. As a result these patients are routinely monitored throughout their radiotherapy treatment at a review clinic. Previously the domain of doctors, radiographers are expanding their existing role and becoming more involved in review clinics.

This paper highlights the key side effects reported by actual patients from their adjuvant treatment and strategies to alleviate these side effects. It also reflects upon the experience, both positive and negative, of undertaking clinical review and role expansion in general.

the trial required field placement to within 3mm. radiographers from participating centres related set-up methods to accuracy to establish best practice and inform recommendations. all centres made changes to methods as a result of the trial to improve accuracy, identified in categories, including patient positioning, iso-centre setting, couch top, imaging methods, and bladder and rectal filling. up to 80% of centres made changes in any one category.

in three centres accuracy was inferior in one axis, related to the set-up methods used.

recommendations included:

1. for reproducibility –

1. achieving a comfortable bladder status

2. using a standardised firm head support (not pillow)

3. using the hands on chest position to avoid the weight of the arms on the trunk

4. aligning lateral tattoos in both the longitudinal and vertical directions

5. using leg or ankle supports

evidence-based methods of controlling rectal filling are still required

1. for iso-centre setting –

1. using the anterior tattoo for lateral direction and the lateral tattoos for the superior/inferior direction

2. using a solid/carbon couch top throughout, using the height above couch as the reference measurement, not the anterior source to skin distance

3. develop an alternative to using the couch height readout alone

The management of intracerebral tumours has always provided us with a challenge when deciding upon the best treatment approach. However, when such tumours are benign and located in close proximity to critical structures, tumour management becomes all the more challenging.

The treatment of vestibular schwannomas has always posed such problems because of their anatomical proximity to critical structures such as the brainstem and several cranial nerves. Through a comprehensive literature appraisal, this article evaluates the problems associated with conventional treatment options and discusses how technical advances over the past decades have affected disease management and therefore impacted on the range and type of treatment modalities employed. In addition, it highlights the role of alternative contemporary approaches in the management of vestibular schwannomas.