To compare the dosimetry and reproducibility of set-up with monoisocentric technique (MIT) and dual isocentric technique (DIT) in adjuvant breast radiotherapy (RT).

Breast cancer patients treated with MIT or DIT were retrospectively studied. The organ-at-risk dose was compared between two groups. All patients underwent set-up verification with an electronic portal imaging device, and set-up time was recorded for each fraction. Treatment reproducibility was assessed in terms of systematic and random error.

Twenty patients were included (11 right and 9 left-sided tumours) and ten received whole breast RT, while the rest received chest wall RT. Overall, the mean heart dose was less with MIT (0.40 versus 0.79, p = <0.001) as well as in left-sided tumours (0.37 versus 0.98, p = 0.003). The maximum dose at the field junction was significantly higher with DIT (43 Gy, 107%, p = 0.003). The maximum total error was 1 cm in lateral for supraclavicular field and 8 mm in superior–inferior in tangents for both techniques. There was no difference in set-up errors between the two techniques.

MIT resulted in better dose homogeneity at the field junctions and reduced mean heart dose as compared to DIT. MIT is safe for implementation in clinical practice for breast cancer treatment.

This study is one of the few studies comparing MIT with DIT in terms of the dosimetry and the first one to compare set-up errors between the two techniques. The ease of set-up and better dosimetry with MIT was achieved.

The aim of this study was to find the optimal radiotherapy (RT) method using three-dimensional (3D) conformal RT (CRT), physical wedge-based CRT (WB-CRT) and dynamic intensity-modulated RT (D-IMRT) techniques for stomach cancer.

Ten patients with gastric cancer were selected for this study. For each patient, three different treatment plans were generated. 3D-CRT, WB-CRT and IMRT plans were evaluated in terms of dosimetry. Treatment plans were compared with respect to the planning target volume and organs at risk (OARs) volumes including right and left kidney doses (V13, V20 and V28), heart mean and maximum doses, spinal cord maximum doses, dose homogeneity index, conformity index (CI), delivery time and the monitor unit counts for the treatment. Statistical analysis was performed using the SPSS (Statistical Package for the Social Sciences) v25.1 software (IBM Inc., Chicago, IL, USA).

In stomach plans, IMRT showed a significantly lower dose for the left and right kidneys than that of WB-CRT or 3D-CRT (p < 0·05). Compared with WB-CRT or 3D-CRT, IMRT reduced the V28, V20, V13 and mean dose to bilateral kidneys (p < 0·05). IMRT plans indicated better dosimetry for at the Dmean of the liver and heart. Concerning the calculated CI, values for IMRT plans gave significant results than other plans (p < 0·05).

IMRT plans provided better protection for the kidneys, liver, heart and spinal cord. For the treatment of stomach cancer, considering the dose to the OARs, IMRT appears to be the most superior technique.

To determine whether myocardial perfusion scintigraphy (MPS) changes in lung cancer patients treated with radiotherapy (RT) were detectable with late gadolinium enhancement cardiac magnetic resonance imaging (LGE CMR).

Twenty-one patients with lung cancer were evaluated pre-RT and at 2 and 6 months post-RT follow-up (FU) with MPS and LGE CMR. MPS changes in the left ventricle (LV) were analysed using the semi-quantitative summed rest score method (20 segments) and the Bull’s-eye-view technique. The LGE CMR studies were analysed for visual signs of myocardial damage (fibrosis), that is, focal LGE in the LV and cardiac function parameters.

MPS changes were detected in 7/20 patients at 2 months FU and in 8/13 patients at 6 months FU. Only one patient had a new irreversible defect judged to be caused by direct irradiation. MPS changes in two cases were deemed to be caused by attenuation. All new MPS defects were minor and no corresponding myocardial damage, or any functional changes, were evident on LGE CMR.

The extent of MPS changes at 6 months FU appeared less prominent than in previous reports. No visual signs or functional changes corresponding to myocardial damage were detected on LGE CMR. A risk for false-positive MPS changes caused by attenuation is evident.

This study compared the plan dosimetry between the intensity-modulated radiation therapy (IMRT) and field-in-field (FIF) technique for head-and-neck cancer using the Elekta Monaco treatment planning system (TPS).

A total of 20 head-and-neck cancer patients were selected in this study. IMRT and FIF plans for the patients were created on the Monaco TPS (ver. 5.11.02) using the 6-MV photon beam generated by the Elekta Synergy linear accelerator. The dose–volume histograms, maximum doses, minimum doses, mean doses of the target volumes and organs-at-risk (OARs), conformity index (CI), homogeneity index (HI) and monitor units (MUs) were determined for each IMRT and FIF plan. All IMRT plans passed the patient-specific quality assurance tests from the 2D diode array measurements (MatriXX Evolution System, IBA Dosimetry, Germany).

The results showed that the dose distribution to the target volumes of IMRT plans was better than FIF plans, while the dose (mean or max dose) to the OAR was significantly lower than FIF plan, respectively. IMRT and FIF resulted in planning target volume coverage with mean dose of 71·32 ± 0·76 and 73·12 ± 0·62 Gy, respectively, and HI values of 0·08 ± 0·01 (IMRT) and 0·19 ± 0·06 (FIF). The CI for IMRT was 0·98 ± 0·01 and FIF was 0·97 ± 0·01. For the spinal cord tolerance (maximum dose < 45 Gy), IMRT resulted in 39·85 ± 2·04 Gy compared to 41·37 ± 2·42 Gy for FIF. In addition, the mean doses to the parotid grand were 27·27 ± 7·48 and 48·68 ± 1·62 Gy for the IMRT and FIF plans, respectively. Significantly more MUs were required in IMRT plans than FIF plans (on average, 846 ± 100 MU in IMRT and 467 ± 41 MU in FIF).

It is concluded that the IMRT technique could provide a better plan dosimetry than the FIF technique for head-and-neck patients.

This study aims to compare the dosimetric parameters among four different external beam radiotherapy techniques used for the treatment of retinoblastoma.

Computed tomography (CT) sets of five retinoblastoma patients who required radiotherapy to one globe were included. Four different plans were generated for each patient using three dimensional conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and VMAT using flattening filter free (VMAT-FFF) beam techniques. Plans were compared for target coverage and organs at risk (OARs) sparing.

The target coverage of planning target volume (PTV) for all the four modalities were clinically acceptable with a V95 of 95 ± 0%, 97·6 ± 1·87%, 99·3 ± 0·5% and 99·17 ± 0·45% for 3DCRT, IMRT, VMAT and VMAT-FFF respectively. The VMAT and IMRT plans had better target coverage than the 3DCRT plans (p = 0·001 and p = 0·07 respectively). IMRT and VMAT plans were also found superior to 3DCRT plans in terms of OAR sparing like brainstem, optic chiasm, brain (p < 0·05). VMAT delivered significantly lower dose to the brainstem and contralateral optic nerve in comparison to IMRT. Use of VMAT-FFF beams did not show any benefit over VMAT in target coverage and OAR sparing.

VMAT should be preferred over 3DCRT and IMRT for treatment of retinoblastoma owing to better target coverage and less dose to most of the OARs. However, IMRT and VMAT should be used with caution because of the increased low dose volumes to the OARs like contralateral lens and eyeball.

CyberKnife is the most advanced form of stereotactic body radiotherapy (SBRT) system that uses a robotic arm to deliver highly focused beams of radiation; however, a limitation is that it only irradiates from ceiling to floor direction. In patients with posterior lungs tumour who are positioned supine, normal lung tissue may suffer undesirable radiation injuries. This study compares the treatment planning between the prone set-up and the supine set-up for lung cancer in CyberKnife SBRT to decrease normal lung dose to avoid radiation side effects.

A human phantom was used to generate 108 plans (54 for prone and 54 for supine) using the CyberKnife planning platform. The supine and prone plans were compared in terms of the dosimetric characteristics, delivery efficiency and plan efficiency.

For posterior targets, the area of low-dose exposure to normal lungs was smaller in the prone set-up than in the supine set-up. V10 of the lungs was 7·53% and 10·47% (p < 0·001) in the anterior region, and 10·78% and 8·03% (p < 0·001) in the posterior region in the supine and prone set-up plans, respectively.

The comparison between the prone set-up and the supine set-up was investigated with regard to target coverage and dose to organs at risk. Our results may be deployed in CyberKnife treatment planning to monitor normal tissue dose by considering patient positioning. This may assist in the design of better treatment plans and prevention of symptomatic radiation pneumonitis in lung cancer patients.

Intraoperative radiotherapy (IORT) has gained popularity over recent years due to its impact on shortening the radiotherapy treatment time for early breast cancer. It has certainly proven effective as an exclusive treatment or when combined with whole breast irradiation (WBIR). Seroma is a common non-life-threatening complication that may delay treatment and impose challenges on radiological diagnostic follow-up.

To review and compare the occurrence of seroma in patients who received exclusive IORT or when combined with WBIR and to outline the diagnostic challenges encountered during radiological follow-up.

Based on strict selection criteria, all eligible patients who received IORT ± WBIR treatment between 2012 and 2019 in a university hospital setting were included. Demographic data, histological diagnosis, tumour size, tumour grade, lymphovascular invasion, nodal status, receptor status, treatment with neoadjuvant hormonal chemotherapy, applicator size, dose used, duration of radiotherapy treatment, timing of seroma development and duration of seroma were documented. Both clinical and radiological follow-up were exercised in all patients.

The total number of patients treated with breast conserving surgery (BCS) and IORT was 86. Age ranged between 31 and 75 years with the median age of 51 years. Patients treated exclusively with IORT were 39 (45%) while those who received the IORT as a boost were 47 (55%). Seroma was observed in 39(45%) of both IORT and IORT\WBIR patients. Those included 15(38%) of the exclusive IORT treated patients and 24 (62%) of those treated as a boost. Duration of asymptomatic seroma ranged from 6 months to 6 years. Repeated aspiration was performed in 2 (5%) patients. Postoperative seroma occurred independent of age histological diagnosis, tumour size, tumour grade, lymphovascular invasion, nodal status, receptor status, treatment with neoadjuvant hormonal\chemotherapy, applicator size, dose used or duration of radiotherapy treatment. All reviewed patients have shown increased risk of developing seroma; however, an increased incidence of seroma in the IORT + WBIR treated patients was higher than those who received exclusive IORT treatment.

Postoperative seroma is a common non-life-threatening entity that occasionally may lead to delay in the subsequent treatment plan. IORT is a safe modality with many benefits; however, it may increase the risk of seroma formation independent of the clinical parameters. Promoting the expertise in post IORT breast imaging aids in overcoming diagnostic challenges.

Radiation-induced nausea and vomiting (RINV) is a common side effect of single fraction palliative radiotherapy. Patients experiencing RINV have significantly reduced quality of life and a prescription of prophylactic antiemetics, principally 5-HT3 antagonists, is recommended. There is a growing body of evidence relating to indications for this, but as yet there are no national guidelines.

A retrospective audit aimed to determine the extent to which patients at high and moderate emetogenic risk receiving single fraction radiotherapy were prescribed prophylactic emetic medication in line with the current evidence base.

A total of 60 patients were included in the audit; of these patients, 50 were consented for the risk of nausea and/or vomiting. Prophylactic antiemetics were only prescribed to 28 (46·7%) of all audited patients. Out of the 50 patients who provided informed consent, only 24 (48%) were prescribed an antiemetic prior to their treatment.

Antiemetic prescribing for single fraction patients at moderate to high emetogenic risk at a large regional centre is underutilised in relation to published evidence. Amended guidance and further audits are recommended to ensure that this patient group is best supported.

The impact of loco-regional treatment (LRT) with radiotherapy (RT) in patients presenting with metastatic breast cancer (MBC) has not been widely studied. The aim of this study was to review the treatment outcomes of LRT including RT in patients with MBC.

Patients who presented with MBC were included in this retrospective study. Analysis was undertaken to determine the difference in local disease control, overall survival (OS) and progression-free survival (PFS) with systemic treatment alone, surgery alone, surgery plus RT and RT alone with long-rank test. Multivariate analysis was done, using the cox regression for factors affecting PFS and OS.

From 2007 to 2014, data of 257 patients with MBC were collected. Totally, 185 patients received LRT and 72 did not. LRT was surgery plus RT, surgery only and RT only in 113, 47 and 25 patients, respectively. Cytotoxic chemotherapy and hormone therapy were received by 205 and 166 patients, respectively. Median follow-up was 36 months (6–120 months). PFS and OS at 3 years with and without LRT were 31% versus 6% (p < 0·001) and 41% versus 17% (p < 0·001), respectively. PFS at 3 years with surgery plus RT, RT alone and surgery was 40, 33 and 6%, respectively. OS at 3 years with surgery plus RT, RT alone and surgery was 50, 38 and 17%, respectively. Patients without LRT had worse PFS and OS, 6 and 17%, respectively. RT had significant impact on PFS and OS along with chemotherapy and hormone treatment.

In patients with MBC, improved local control, PFS and OS were achieved with loco-regional RT. Loco-regional RT along with chemotherapy and hormones were significant factors for PFS and OS irrespective of surgery.

Incidence rates of Human Papillomavirus (HPV) positive head and neck cancer (HNC) are increasing. The aim of this study was to explore the availability of information and the knowledge and confidence of healthcare professionals (HCPs) involved in the cancer pathway to provide information on HPV to patients.

An online questionnaire was designed using closed and open questions to investigate the availability of patient information for patients diagnosed with HPV-associated HNC; health professional’s knowledge of the information available; and their confidence in discussing the topic. The questionnaire was advertised to health professionals through the British Association of Head and Neck Oncologists website. Twenty-five health professionals from six professions across five UK Cancer Alliances completed the questionnaire between November and December 2018.

Nearly half of the participants did not know whether patients were routinely provided with information on HPV following an HPV-positive (HPV+) cancer diagnosis; 52% indicated that specific information was available within their hospital trust, however, there were inconsistencies with participants’ knowledge of the content of the information leaflets currently available. On a scale of 1–100, the mean confidence in providing HPV-related information was 58.

Inconsistencies appear to exist with respect to information about HPV available to patients presenting with HNC. A need has been identified for the education of health professionals involved in the patient care to support information provision.

To determine the feasibility of non-daily image-guided radiotherapy (RT) with volumetric-modulated arc therapy for pelvic cancer.

Daily cone beam computed tomography (CBCT) images data of 21 patients (542 fractions) with pelvic cancer were used to simulate 5 non-daily imaging (DL) protocols (Alternate day: AD, First 5 + Weekly: FF+WL, Weekly: WL, First 5 fractions: FF and Alternate week: AW protocol). The residual errors in the lateral (X), longitudinal (Y), and vertical (Z) directions and 3D vector shifts of each non-DL protocol were explored. The planning target volume (PTV) margins were calculated using the van Herk’s formula according to population systematic and random error. Finally, the average time of each process from the start to stop of the treatment was used to calculate the number of patients treated per day to assess the treatment delivery capacity for different imaging protocols.

The 3D vector shift for the FF+WL protocol produced the greatest proportion of residual error ≤ 0·5 cm and showed the smallest random error in all three directions. However, the FF protocol produced the greatest proportion of residual error > 0·5 cm and revealed the largest magnitudes of systematic error in all three directions. Only the AD protocol can explore the PTV margin of less than 0·5 cm in all three directions. The AW protocol showed the maximum capacity of the treatment delivery, showed the highest number of patients treated per day. In contrast, the AW protocol also affects the treatment accuracy, showed the large residual error and PTV margin.

Reducing the frequency of image-guided RT results in a high residual error. Non-daily image-guided RT strategies for pelvic irradiation should be applied for margins more than 0·5 cm. The number of patients treated per day, residual error and PTV margin are information to determine non-daily protocol applications that balance treatment delivery capacity and treatment accuracy.

Head and neck cancer (HNC) is the most common malignancy in the Indian males. Most of the cases of HNC present in locally advanced stage and requires a multidisciplinary management approach. Radical or adjuvant external beam radiotherapy (EBRT) is one of the important integral components of the management of HNC.

To find the incidence of hypothyroidism (HT) in patients of HNC treated with radiotherapy with or without concurrent chemotherapy.

A prospective, single institutional longitudinal observational study conducted at the department of radiotherapy, Institute of Post Graduate Medical Education and Research, Kolkata.

In this study, data of 118 patients were analysed. The median age at presentation was 56 years. The most common primary site of malignancy was oral cavity (39%). The patients were stage I, stage II and stage III as 11, 37·3 and 51·7% respectively. The median dose of EBRT was 66 Gy. HT statistically significantly correlated with primary site of malignancy (p = 0·001), dose of EBRT (p = 0·005). At the end of follow-up of 6 months, 39·8% developed HT.

The thyroid gland is an important organ at risk while considering EBRT to neck region. The inclusion of thyroid function test in routine follow-up is mandated.

Studying the use of Aperture Shape Controller (ASC) and Convergence Mode (CM) in Eclipse (Varian Medical System) in terms of plan quality and complexity of volumetric modulated arc therapy (VMAT).

Forty VMAT plans were re-optimised for the prostate, prostate + lymph nodes, breast and head & neck patients retrospectively, changing the ASC settings (off, moderate, very high) and CM settings (off, on and extended).

Using ‘on’ or ‘extended’ CM increased plan quality in terms of planning target volume homogeneity and low-dose spread to the organs at risk (OAR). ‘Extended’ CM increased the optimisation time 4·3-fold compared to ‘on’, and deteriorated the plan quality in several simple planning cases. ‘Moderate’ ASC decreased plan complexity with minor effect on plan quality compared to ‘off’, but ‘very high’ ASC had larger adverse dosimetric effects. However, the ASC decreased the plan complexity only if the CM was turned ‘on’.

Using ‘on’ CM increases the plan quality but using ‘extended’ CM is not recommended. The ‘moderate’ ASC decreased complexity without significant adverse effects on plan quality, and even ‘very high’ ASC may be used when plan simplicity is prioritised. However, if CM is not used, the ASC should also be turned off.

To compare dose to target and organs at risk (OARs) in conventional plan (2D) versus computed tomography (CT)-based three-dimensional (3D) plan in vaginal cuff brachytherapy (VBT) and to compare the effect of bladder distension on target and OARs dosimetry.

Post-hysterectomy patients with an indication for VBT were included in the study. All patients underwent planning CT scans with a full bladder and an empty bladder protocol. For each CT, two plans were generated—one library-based 2D plan and another CT-based 3D plan. Dosimetric parameters were recorded for clinical target volume (CTV) and OARs.

A total of 92 observations were made from data collected from 46 patients. Difference between CTV dose in terms of 2D and 3D plans were not statistically significant for CTV (p = 0·11). Significant reduction in D0·1cc, D1cc and D2cc dose parameters were observed in bladder, rectum, sigmoid and bowel doses with the 3D plan (p < 0·001). Bladder distension showed a 20% reduction in dose for bowel (p < 0·001). Bladder distension also showed a 6·12% (p = 0·047) increase in D2cc, but there was a significant reduction in the mean dose to the bladder.

Our study demonstrates the dosimetric benefits with 3D CT-based planning for VBT over 2D-based conventional planning and benefit of bladder distension in the reduction of bowel dose without compromising dose to the target volume.

Small-cell lung cancer (SCLC) has poor prognosis owing to the high risk of distant metastasis.

To identify the prognosticators of brain metastasis from SCLC treated by whole-brain radiotherapy.

We evaluated patients diagnosed with primary brain metastasis from SCLC between 1 January 2010 and 30 September 2019. Age, sex, disease stage at the first examination, time to the diagnosis of brain metastasis, state of other lesions at the diagnosis of brain metastasis, haematological parameters, neurologic symptoms, whole-brain radiotherapy dose, imaging findings of the brain metastasis (single or multiple), and chemotherapy and radiotherapy status were investigated for correlations with survival from the diagnosis of brain metastasis.

A total of 24 participants were evaluated. After radiotherapy, the median survival period was 118·5 (22–998) days, and 21 patients died during the follow-up period. Multivariate stepwise analysis of the four parameters of lactate dehydrogenase (LDH) level (within vs. above the reference value), platelet level (continuous variable), neurologic symptoms (with versus. without), and NSE (neuron-specific enolase) level (continuous variable) identified the following significant differences: neurologic symptoms were 3·81 (95% CI 1·07–13·5, p = 0·04), and NSE was 1·01 (95% CI 1·00–1·01, p = 0·04).

NSE and neurologic symptoms are prognosticators of brain metastasis from SCLC treated by whole-brain radiotherapy.

Delineating the proximal urethra can be critical for radiotherapy planning but is challenging on computerised tomography (CT) imaging.

We trialed a novel non-invasive technique to allow visualisation of the proximal urethra using a rapid sequence magnetic resonance imaging (MRI) protocol to visualise the urinary flow in patients voiding during the simulation scan.

Of the seven patients enrolled, four were able to void during the MRI scan. For these four patients, direct visualisation of urinary flow through the proximal urethra was achieved. The average volume of the proximal urethra contoured on voiding MRI was significantly higher than the proximal urethra contoured on CT, 4·07 and 1·60 cc, respectively (p = 0·02). The proximal urethra location also differed; the Dice coefficient average was 0·28 (range 0–0·62).

In this small, proof-of-concept prospective clinical trial, the volume and location of the proximal urethra differed significantly when contoured on a voiding MRI scan compared to that determined by a conventional CT simulation. The shape of the proximal urethra on voiding MRI may be more anatomically correct compared to the proximal urethra shape determined with a semi-rigid catheter in place.

Lung cancer is the most commonly diagnosed cancer in Canada and the leading cause of cancer-related mortality in both men and women in North America. Surgery is usually the primary treatment option for early-stage non-small cell lung cancer (NSCLC). However, for patients who may not be suitable candidates for surgery, stereotactic body radiation therapy (SBRT) is an alternative method of treatment. SBRT has proven to be an effective technique for treating NSCLC patients by focally administering high radiation dose to the tumour with acceptable risk of toxicity to surrounding healthy tissues. The goal of this comprehensive retrospective dosimetric study is to compare the dosimetric parameters between three-dimensional conformal radiation therapy (3DCRT) and volumetric-modulated arc therapy (VMAT) lung SBRT treatment plans for two prescription doses.

We retrospectively analysed and compared lung SBRT treatment plans of 263 patients treated with either a 3DCRT non-coplanar or with 2–3 VMAT arcs technique at 48 Gy in 4 fractions (48 Gy/4) or 50 Gy in 5 fractions (50 Gy/5) prescribed to the planning target volume (PTV), typically encompassing the 80% isodose volume. All patients were treated on either a Varian 21EX or TrueBeam linear accelerator using 6-MV or 10-MV photon beams.

The mean PTV V95% and V100% for treatment plans at 48 Gy/4 are 99·4 ± 0·6% and 96·0 ± 1·0%, respectively, for 3DCRT and 99·7 ± 0·4% and 96·4 ± 3·4%, respectively, for VMAT. The corresponding mean PTV V95% and V100% at 50 Gy/5 are 99·0 ± 1·4% and 95·5 ± 2·5% for 3DCRT and 99·5 ± 0·8% and 96·1 ± 1·6% for VMAT. The CIRI and HI5/95 for the PTV at 48 Gy/4 are 1·1 ± 0·1 and 1·2 ± 0·0 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The corresponding CIRI and HI5/95 at 50 Gy/5 are 1·1 ± 0·1 and 1·3 ± 0·1 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The mean R50% and D2cm at 48 Gy/4 are 5·0 ± 0·8 and 61·2 ± 7·0% for 3DCRT and 4·9 ± 0·8 and 57·8 ± 7·9% for VMAT. The corresponding R50% and D2cm at 50 Gy/5 are 4·7 ± 0·5 and 65·5 ± 9·4% for 3DCRT and 4·7 ± 0·7 and 60·0 ± 7·2% for VMAT.

The use of 3DCRT or VMAT technique for lung SBRT is an efficient and reliable method for achieving dose conformity, rapid dose fall-off and minimising doses to the organs at risk. The VMAT technique resulted in improved dose conformity, rapid dose fall-off from the PTV compared to 3DCRT, although the magnitude may not be clinically significant.

Stereotactic ablative body radiotherapy (SABR) for spine metastases is associated with a risk of vertebral compression fracture (VCF). The aim of this study was to determine the rate of VCF at one UK institution and evaluate the use of the Spinal Instability Neoplastic Score (SINS) to predict these.

A retrospective analysis of all patients who underwent SABR for spinal metastases between 2014 and 2018 at one UK institution was performed. Basic demographic data were collected, and SINS prior to SABR was calculated. The primary outcome was VCF rate. Secondary outcomes included time to VCF and need for surgical intervention following VCF.

A total of 48 oligometastases were treated with a median follow-up of 20·5 months. A maximum of two vertebral bodies were treated. The median baseline SINS was calculated as 3. The median dose was 26 Gy in three fractions. Two patients were reported to have VCF and both were successfully conservatively managed.

SABR for spine oligometastases is being performed safely with low VCF rates which are comparable with those in international publications. This may be as a result of strict adherence to criteria for delivery of SABR with low pre-treatment SINS.

Stereotactic radiosurgery (SRS) has proven itself as an effective tool in the treatment of intracranial lesions. Image-guided high dose single fraction treatments have the potential to deliver ablative doses to tumours; however, treatment times can be long. Flattening filter free (FFF) beams are available on most modern linacs and offer a higher dose rate compared to conventional flattened beams which should reduce treatment times. This study aimed to compare 6 MV FFF and 10 MV FFF to a 6 MV flattened beam for single fraction dynamic conformal arc SRS for a Varian Truebeam linac.

In total, 21 individual clinical treatment plans for 21 brain metastases treated with 6 MV were retrospectively replanned using both 6 MV FFF and 10 MV FFF. Plan quality and efficiency metrics were evaluated by analysing dose coverage, dose conformity, dose gradients, dose to normal brain, beam-on-time (BOT), treatment time and monitor units.

FFF resulted in a significant reduction in median BOT for both 6 MV FFF (57·9%; p < 0·001) and 10 MV FFF (76·3%; p < 0·001) which led to reductions in treatment times of 16·8 and 21·5% respectively. However, 6 MV FFF showed superior normal brain dose sparing (p < 0·001) and dose gradient (p < 0·001) compared to 10 MV FFF. No differences were observed for conformity.

6 MV FFF offers a significant reduction in average treatment time compared to 6 MV (3·7 minutes; p = 0·002) while maintaining plan quality.

Harnessing available knowledge and learning from our errors are prerequisites of delivering on the challenge of improving patient safety. Towards Safer Radiotherapy, published in 2008, was a response from the UK’s (UK) radiotherapy community to concerns arising from high profile errors. The report was a driver for the development of a national reporting and learning system for radiotherapy.

A literature review was conducted covering the years from 2009 to 2020. Search terms used were radiotherapy errors, patient safety, incident learning, human factors and trend analysis. A total of 10 papers reported recommendations or implementation of changes to service delivery models following systematic error analysis. None of these were from UK service providers.

Twelve years on from the publication of Towards Safer Radiotherapy, there is little evidence of impact on safety culture within the UK radiotherapy community. Although the UK has a large radiotherapy error dataset, there remain unanswered questions about the impact on the safety culture in radiotherapy.