Caring is a fundamental tenet of healthcare. Caring ‘too much’ can result in compassion fatigue syndrome and is often linked to burnout and low morale. The objective of this study was to examine compassion fatigue, secondary traumatic stress (STS) and burnout by investigating the relationship between levels of compassion (compassion satisfaction) and STS and burnout. The study also aimed to identify radiation therapist (RTTs) groups who may be at risk for developing (STS) and burnout. Finally, we investigated the level of social support that RTTs receive.

RTTs practicing across Canada were invited to participate in an electronic questionnaire. The questionnaire consisted of: demographic information including health-related issues and occupational variables; the Professional Quality of Life Compassion Satisfaction and Fatigue Questionnaire (ProQOL-V) to assess the potential for compassion satisfaction and vulnerability for STS and burnout; and the Multidimensional Scale of Perceived Social Support (MSPSS) to examine the level and sources of social support. A two-way ANOVA was performed to test the statistical significance between varying groups within the study population. A linear regression analysis using potential co-factors was used to test correlations between compassion fatigue, compassion satisfaction and burnout and variables in age, education, years of experience and levels of caring to patients.

A total of 477 survey responses were received representing a 36% response rate. Results of the regression analyses generally indicate inverse correlations between the risks associated with compassion satisfaction, burnout and STS compared with the independent study variables of age, education, years of experience and levels of caring to patients. It was observed that responses were not linear within subgroups (age groups, education classifications, years of study).

RTTs practicing in Canada have a substantial social support network and demonstrate high levels of compassion satisfaction in their daily practice. The results of the study indicate that compassion levels are inversely correlated with burnout and compassion fatigue, although some groups may be at higher risk than others. A possible risk catalyst for compassion fatigue and burnout is associated with underdeveloped managerial workplace support programmes.

This study evaluated the impact of patient set-up errors on the probability of pulmonary and cardiac complications in the irradiation of left-sided breast cancer.

Using the CMS XiO Version 4·6 radiotherapy planning system's normal tissue complication probability (NTCP) algorithm and the Lyman–Kutcher–Burman model, we calculated the dose–volume histograms (DVH) indices for the ipsilateral lung and heart and the resultant NTCP for radiation-induced pneumonitis and excess cardiac mortality in 12 left-sided breast cancer patients.

Isocentric shifts in the posterior direction had the greatest effect on the lung V20, heart V25, and mean and maximum doses to the lung and the heart. DVH results show that the ipsilateral lung V20 tolerance was exceeded in 58% of the patients after 1 cm posterior shifts. Similarly, the heart V25 tolerance was exceeded after 1 cm antero-posterior and left–right isocentric shifts in 70% of the patients. The baseline NTCPs for radiation-induced pneumonitis ranged from 0·73% to 3·4%, with a mean value of 1·7%. The maximum reported NTCP for radiation-induced pneumonitis was 5·8% (mean 2·6%) after 1 cm posterior isocentric shift. The NTCP for excess cardiac mortality were 0% in 100% of the patients (n = 12) before and after set-up error simulations.

Set-up errors in left-sided breast cancer patients have a statistically significant impact on the Lung NTCPs and DVH indices. However, with a central lung distance of 3 cm or less (CLD < 3 cm), and a maximum heart distance of 1·5 cm or less (MHD < 1·5 cm), the treatment plans could tolerate set-up errors of up to 1 cm without any change in the NTCP to the heart.

To evaluate the efficacy of a Belly Board immobilisation device for rectal cancer patients.

A randomised trial in patients receiving neo-adjuvant chemoradiation for rectal carcinoma was established. Patients were treated, prone with control arm, according to standard departmental protocol and experimental arm with the use of a Belly Board. All treatments were planned using a three-field technique. The primary endpoints were reproducibility and irradiated small bowel volume. Questionnaires were used to assess secondary endpoints of patient comfort, ease of set-up and acute toxicities.

Pre-planned interim analysis was performed after recruiting 30 patients. In all, 348 portal images were analysed retrospectively. Around 8 out of 12 parameters measuring set-up reproducibility were in favour of the Belly Board arm. Random error in the anterior–posterior direction was improved and statistically significant in the experimental arm (95% CI; p≤0·05). Small bowel V15 was significantly lower in the Belly Board position (mean V15=14·5%) compared with the standard position (mean V15=21·4%), paired t-test 95% CI; p=0·035. Also, patients’ comfort satisfaction was greater in the Belly Board arm.

Set-up reproducibility, small bowel V15, patient comfort and satisfaction were all significantly improved by the use of the Belly Board.

To investigate possible optimisation of the image guidance procedure for the prostate cancer patients with respect to imaging frequency and patient body mass index (BMI).

The 6,085 setup correction shifts and BMI for 216 prostate cancer patients treated on tomotherapy units in two centres were analysed. Margins needed to account for inter-fraction target motion with daily only automatic correction and with automatic and manual corrections during one, three or five first fractions as a reference for further treatment without imaging were calculated.

The planning target volume margin calculated for the daily automatic correction only scheme was significantly lower than the margins calculated for the image guidance limited to a few initial fractions. Manual corrections after automatic fusion were more important for patients with higher BMI. On average, the patients with normal BMI had manual correction shift of 0·7 mm in anterioposterior direction, while overweight and obese patients required, correspondingly, the shifts of 1·3 and 1·4 mm.

Overweight and obese patients require daily imaging with time saving available by performing automatic kV/MV computed tomography registration only. The patients with normal BMI may be treated with imaging guidance during a few initial treatment fractions.

The aim of this study was to assess the efficacy of IMRT with concomitant boost simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) compared with conventional radiation in the setting of sequential chemoradiotherapy (induction chemoradiotherapy(ICRT)) for patients with advanced oropharynx cancer (OPC).

A single-institutional retrospective review was conducted on 84 patients (conventional radiation, n = 36; SIB-IMRT, n = 48) with stage III and IV OPC, who underwent definitive ICRT from 2002 to 2012. The study endpoints included overall survival (OS) and locoregional control (LRC).

The median follow-up of the matched cohorts resulted similar (30 months for 3D-radiation technique versus 37 months for IMRT), and baseline characteristics were generally balanced between the two groups. However, patients managed with conventional radiation were less likely to have positron emission tomography-computed tomography (PET-CT) for staging and to receive induction chemotherapy with TPF. A multivariate Cox proportional hazard model showed that OS and LRC were associated with several known prognostic factors, along with radiation modality (SIB-IMRT versus conventional radiation, hazard ratio 0·27, p = 0·004; hazard ratio 0·31, p = 0·006; for OS and LRC, respectively).

The adoption of SIB-IMRT versus conventional radiation may produce a clinical benefit in OS and LRC among patients receiving ICRT for advanced OPC.

To compare the outcome among patients with invasive bladder cancer treated with cystectomy alone with outcome among those treated with combined-modality treatment in a randomised phase III trial.

Patients with histologically confirmed invasive non-metastatic bladder cancer T2-3, N0 and M0 were randomly assigned to two arms: Arm 1: of which all patients underwent radical cystectomy (RC) alone; and Arm 2, of which all patients were subjected to maximal transurethral resection of bladder tumour, followed 2 weeks later by combined chemoradiotherapy. The whole pelvis received 46 Gy in 23 fractions over 4·5 weeks. Chemotherapy was administered concomitantly with radiotherapy with: cisplatin 70 mg/m2 q. 3 weeks and Gemcitabine 300 mg/m2 D 1, 8 and 15 q. 3 weeks for two cycles. Patients who had complete response were shifted to phase II treatment: 20 Gy/10 fractions/2 weeks to the bladder. Patients with residual tumour underwent RC.

Of the 80 patients assigned Arm 2, a visibly completed transurethral resection of the bladder tumour was possible in 48 patients (60%). Phase I of combined chemoradiotherapy (CCRT) was accomplished in 74 patients. Post-induction urologic evaluation revealed no evidence of disease in 62 patients (83·8%) and residual disease in 12 patients (16·2%). Phase II of CCRT was completed in 58 of the 62 patients. The median follow-up for all patients is 27 months (range: 4–49). The 3-year overall survival (OS) for the combined-modality group and for the surgery group were 61 and 63%, respectively (p = 0·425), whereas the disease-specific survival (DSS) for each group was 69 and 73%, respectively (p = 0·714). The 3-year OS with bladder preservation for Arm 2 patients was 50%.

Multivariate analysis for the whole series showed that tumour stage and performance status (PS) were the only factors independently associated with DSS, although PS was the only factor independently associated with OS. In addition, residual disease after transurethral resection of the bladder tumour in Arm 2 patients was independently associated with both DSS and OS.

Acute toxicity was moderate and most of the late toxicities were grade 2 with no grade 4 toxicity and no treatment-related deaths, none required cystectomy for bladder contraction.

This study demonstrates that trimodality bladder-preserving approach represents a valid alternative for suitable patients. The OS and DSS rates of patients treated with trimodality bladder-preserving protocol are comparable to the results reported on patients treated with immediate radical cystectomy.

To compare the contours and dose volume histograms (DVH) parameters of the high-risk clinical target volume (HRCTV) contoured on computed tomography (CT) using clinical findings at brachytherapy, clinical findings at brachytherapy with magnetic resonance imaging (MRI) at diagnosis and HRCTV defined on MRI at brachytherapy in cervical cancer patients.

Fifteen patients undergoing MRI-guided image-based brachytherapy underwent both CT and MRI after applicator insertion. Two sets of contours were defined on CT. In the first set, the HRCTV was defined with the help of clinical findings at brachytherapy (CT-HRCTV). In the second set, HRCTV was defined with MRI at diagnosis and clinical findings at brachytherapy (CT-HRCTVdmri). This was compared with the HRCTV defined on MRI at brachytherapy (MR-HRCTV). The doses to the organs at risk (OARs) were compared for CT and MRI.

A significant overestimation of the maximum width and width at point A was observed for CT-HRCTV (p −0·00; 0·00) and CT-HRCTVdmri (p −0·03; 0·01), respectively. The height was underestimated with CT-HRCTV in patients with intrauterine disease extension. For a single fraction, the mean difference in the D90 for the CT contours was <1 Gy. The doses to the OARs were comparable.

CT may be an alternative when facilities for MRI image-based brachytherapy are lacking, provided at least one MRI is available before brachytherapy.

To verify the accuracy of two common absorbed dose calculation algorithms in comparison to Monte Carlo (MC) simulation for the planning of the pituitary adenoma radiation treatment.

After validation of Linac's head modelling by MC in water phantom, it was verified in Rando phantom as a heterogeneous medium for pituitary gland irradiation. Then, equivalent tissue-air ratio (ETAR) and collapsed cone convolution (CCC) algorithms were compared for a conventional three small non-coplanar field technique. This technique uses 30 degree physical wedge and 18 MV photon beams.

Dose distribution findings showed significant difference between ETAR and CCC of delivered dose in pituitary irradiation. The differences between MC and dose calculation algorithms were 6.40 ± 3.44% for CCC and 10.36 ± 4.37% for ETAR. None of the algorithms could predict actual dose in air cavity areas in comparison to the MC method.

Difference between calculation and true dose value affects radiation treatment outcome and normal tissue complication probability. It is of prime concern to select appropriate treatment planning system according to our clinical situation. It is further emphasised that MC can be the method of choice for clinical dose calculation algorithms verification.

In radiation therapy, to spare normal surrounding tissues, either Multileaf Collimators or Cerrobend blocks are used.

The current study focuses on the relative dose distribution under the areas protected by Cerrobend blocks.

A dual-energy linear accelerator and a Cobalt-60 machine were utilised as radiation sources. Several blocks were designed using commercially available materials to shield radiation fields. The relative dose distribution was then evaluated using extended dose range 2 films.

Results showed that the dose distribution under protected areas depends on several parameters including the width and height of protecting blocks, incident photon beam energy, radiation field size and source to surface distance. An increase in Cerrobend block height from 80 to 95 mm significantly decreases the dose at the protected areas.

An increase in the block width and photon energy decreases the relative dose deposition at the protected area. However, electron and neutron contaminations should also be taken into consideration.

Palliative cancer care is by definition multi-professional in nature. An interdisciplinary approach to disease management emphasising continuity of care results in increased quality of life for patients and families. Complex disease management demands the provision of a full spectrum of high-quality care; requiring both specialist and generalist services. Appointed keyworkers are knowledgeable about patient preferences enabling effective coordination of care and promotes collaborative team-working. The need for diversity in the provision of palliative care is recommended but can challenge effective interdisciplinary collaboration by creating tension and limiting the interdisciplinary team (IDT) from reaching its full potential resulting in adverse outcomes.

The purpose of this paper is to review the literature available regarding how IDTs and keyworkers influence high-quality palliative care; evaluate how professional culture barriers can influence team collaboration; discuss the keyworker role in minimising these barriers and clinical implications.

A review of the English literature from 2003 to 2013 was performed using the databases PubMed (NML), OVID Medline and Google Scholar.

Keyworkers can help overcome professional culture barriers that result from ineffective team communication. Facilitating improved communication regarding professional roles fosters mutual understanding among team members. The dissemination of relevant and timely information minimises fragmentation, prompting team decision-making and promotes continuity of high-quality palliative care.

Calypso® 4D Localization System is a system based on electromagnetic transponders detection enabling precise 3D localisation and continuous tracking of tumour target. This review intended to provide information in order to (1) show how Calypso® 4D Localization System works, (2) to present advantages and disadvantages of this system, (3) to gather information from several clinical studies and, finally, (4) to refer Calypso® System as a tool in dynamic multileaf collimator studies for target motion compensation.

A structured search was carried out on B-On platform. The key words used in this research were ‘Calypso’, ‘Transponder’, ‘Electromagnetic Localization’, ‘Electromagnetic Tracking’, ‘Target Localization’, ‘Intrafraction Motion’ and ‘DMLC’.

Treatment the implanted transponders are excited by an electromagnetic field and resonate back. These frequencies are detected and Calypso® software calculates the position of the transponders. If the movement detected is larger than the limits previously defined, irradiation can be stopped. The system has been proven to be submillimetre accurate.

Calypso® System has been presented as an accurate tool in prostate radiotherapy treatments. The application of this system to other clinical sites is being developed.

The Calypso® System allows real-time localisation and monitoring of the target, without additional ionising radiation administration. It has been a very useful tool in prostate cancer treatment.

An emerging developmental tool to help radiation therapists achieve better outcomes is ‘peer review’. This review of the current literature summarises the challenges and benefits of peer review in both individual and departmental practice.

There is compelling evidence supporting peer review implementation at both individual and department level in many professions. Implementing peer review requires that radiation therapists and other radiation oncology professionals embrace a culture that supports safety. Peer review can identify trends and barriers associated with quality radiotherapy and share best practice or recommend changes accordingly. Support for peer review must come from pre-registration educational systems as well as clinical managers. Continuing professional development in the workplace is nurtured by peer review of radiotherapy practice and an aptitude for this should be viewed as important to the profession as technical and clinical skills.

It is clear that peer review has the potential to facilitate reflective practice, improve staff motivation and help foster a culture of quality and safety in radiation oncology. To drive the issues of quality and safety a step further radiation therapists need to accept the challenge of adopting peer review methods in day-to-day practice.

Papillary thyroid carcinoma combined with thyroid mucosa-associated lymphoid tissue (MALT) lymphoma is exceedingly rare and there is no standard management.

We report a rare association of MALT lymphoma of thyroid in a 60-year-old woman with Hashimoto's thyroiditis along with an incidental focus of papillary carcinoma.

Patients with Hashimoto's thyroiditis are prone to develop other thyroid pathology, including rare tumours such as MALT lymphoma. The differential diagnosis for a neoplasm in such patients should be wide.