Purpose: Sexual dysfunction is a well-documented side effect of radical radiotherapy treatment for prostate cancer and the provision of information to patients is often a radiotherapist and assistant role. The study sought to measure the attitudes and beliefs of individuals before and after an educational intervention and establish current practice in providing sexual information.

Method: A quantitative approach with a minor qualitative element was used. A simple pre–post test questionnaire design using an adapted version of the Reynold and Magnan (2005) Sexual Attitudes and Beliefs’ Questionnaire was utilised. The educational intervention was a Reflective Learning Package (RLP).

Results: Fifty-six participants took part, a response rate of 87.5%. The data was analysed using SPSS, version 15. The RLP had a highly significant effect on improving the attitudes and beliefs of the participants (Wilcoxon test 0.000 p < 0.001). Qualitative data key themes showed lack of knowledge, confidence and embarrassment were the main barriers to giving sexuality information during the ‘first day chat’.

Conclusion: There may be a need to address the current methods of education and support of staff being prepared to perform this important role and to recognise that personal limitations may influence the individuals’ effectiveness in communicating sexuality information.

Background and purpose: Research is increasingly important in radiation therapy, but radiation therapists (or therapy radiographers) (RTs) are relatively new to research and may have difficulty defining research topics. Our aim was to identify the group interests and focus research priorities of Australian RTs. Although not measured, an additional aim was to make RTs more aware of the relevance of RT research.

Materials and methods: An Australia-wide Delphi process was used, examining the problems related to patient care, working with colleagues, and radiotherapy in general, that RTs experienced in their daily work. In an initial study, 374 problems were identified. These were translated into 53 research areas which were prioritised in the second stage of the study. Agreement between groups was analysed using a hierarchical cluster procedure and post hoc Scheffe multiple comparisons.

Results: There were three groups of responders with varying degrees of research interest. There was agreed high importance (p > 0.01) for the technical aspects of radiation therapy, such as image guidance, intensity-modulated radiation therapy (IMRT) and patient positioning. There was significant disagreement (p < 0.001 to p = 0.023) between groups on the importance of patient care research.

Conclusions: The strong interest in technical research is consistent with the rapid influx of technology, particularly in imaging. The disagreement on patient-related research may be of concern. The list of potential research areas specific to radiation therapy will be useful for new RT researchers to consider.

Background and purpose: Repeat imaging protocols, specifying imaging frequency and action levels for movement correction, can be used to achieve more accurate targeting of the prostate gland during radiotherapy. We have carried out a study comparing the accuracies of online versus off-line correction strategies which use implanted marker seeds to localize the prostate.

Material and methods: Data have been analysed for 60 prostate patients, verified using an online imaging technique. Systematic and random errors have been calculated for a daily imaging protocol and for other common imaging schedules. Resource requirements have been assessed for the daily imaging technique by analysing the in-room timings performed on 10 patients.

Results: Daily imaging is beneficial for the majority of patients, an online imaging schedule with a 2 mm action level significantly reducing systematic and random errors. The online imaging can be performed with a 2-minute increase in the standard treatment slot.

Conclusions: Online imaging tracking techniques can facilitate margin reduction, which may help to reduce rectal toxicities. The impact on departmental time and resource requirements is modest for the online daily tracking technique with marker seeds and kilovoltage planar imaging.

Background: A randomised study to investigate whether bilateral arm abduction is superior to unilateral abduction with respect to stability using shifts on treatment as the main outcome measure.

Material and Methods: 50 consecutive female patients were randomised to ipsilateral or bilateral arm abduction. Central lung depth (CLD) and cranial caudal depth (CCD) on the simulator image was compared with that featured on three Electronic Portal Images (EPI) captured during treatment for each patient. Systematic and random errors were analysed with respect to the average translational displacement and standard deviation per patient and per population between the planning image and the EPI.

Results: The CLD average translational displacement in the test group was −1.7 mm (95% CI = −5 to 1.6 mm) Σ pop = 2.3 mm, σ pop = 1.6 mm, and in the control group −1.9 mm (95% CI = −6 to 3 mm) Σ pop = 4 mm, σ pop = 2.1 mm. The average translational displacement of CCD in test group was 0 mm (95% CI = − 5.3 to 5.1 mm) Σ pop = 2.2 mm, σ pop = 2.6 mm. CCD translational displacement was greater in the unilateral arm abduction group at − 1.6 mm (95% CI = −6.7 to 3.4 mm) Σ pop = 3.6 mm, σ pop = 2.4mm.

Conclusion: The reduction in systematic error and inter-patient variability observed in the test group is evidence that bilateral arm abduction is a more stable and reproducible position than unilateral arm abduction. The CCD translational data indicates that patients treated with unilateral arm abduction were moving inferiorly on the breast board. These results support the adoption of bilateral arm abduction as a standard technique.

We study how mucosal dose in the oral or nasal cavity depends on the irradiated small segmental photon fields varying with beam energy, beam angle and mucosa thickness. Dose ratio (mucosal dose with bone underneath to dose at the same point without bone) reflecting the dose enhancement due to the bone backscatter was determined by Monte Carlo simulation (EGSnrc-based code), validated by measurements. Phase space files based on the 6 and 18 MV photon beams with small field size of 1 × 1 cm2, produced by a Varian 21 EX linear accelerator, were generated using the BEAMnrc Monte Carlo code. Mucosa phantoms (mucosa thickness = 1, 2 and 3 mm) with and without a bone under the mucosa were irradiated by photon beams with gantry angles varying from 0 to 30°. Doses along the central beam axis in the mucosa and the dose ratio were calculated with different mucosa thicknesses. For the 6 MV photon beams, the dose at the mucosa-bone interface increased by 44.9–41.7%, when the mucosa thickness increased from 1 to 3 mm for the beam angle ranging from 0 to 30°. These values were lower than those (58.8–53.6%) for the 18 MV photon beams with the same beam angle range. For both the 6 and 18 MV photon beams, depth doses in the mucosa were found to increase with an increase of the beam angle. Moreover, the dose gradient in the mucosa was greater for the 18 MV photon beams compared to the 6 MV. For the dose ratio, it was found that the dose enhancement due to the bone backscatter increased with a decrease of mucosa thickness, and was more significant at both the air-mucosa and mucosa-bone interface. Mucosal dose with bone was investigated by Monte Carlo simulations with different experimental configurations, and was found vary with the beam energy, beam angle and mucosa thickness for a small segmental photon field. The dosimetric information in this study should be considered when searching for an optimized treatment strategy to minimize the mucosal complications in the head-and-neck intensity-modulated radiation therapy.

The effectiveness of PET-CT (positron emission tomography–computed tomography) was investigated for staging target delineation compared with CT-MR (computed tomography–magnetic resonance) and early response of intensity-modulated radiotherapy (IMRT). Gross tumour volume–clinical target volume (GTV-CTV) differences between PET-CT and CT-MR for 14 nasopharyngeal carcinoma (NPC) patients were compared. Evaluation of doses of organs at risk (OARs) was done by IMRT plans. Responses of IMRT were evaluated with both sets. PET-CT changed MR-based TNM (Tumour Lymph Nodes Metastasis) in 11 of 14 patients. The median GTVNP (nasopharyx gross tumour volume) was 49.25 and 18.8 cm3 for CT-MR and PET-CT, respectively. In eight cases, GTVNP in the PET-CT was smaller than the CT-MR. The PET-CT presented a larger GTVNP than the CT-MR for six cases. Mean doses for the parotid glands were found to be higher than in CT-MR-based plan in one patient although he had smaller GTVNP at the PET-CT. The median follow-up was 16 months. Only one patient experienced recurrence in the CTVNP (nasopharyx clinical target volume). MR showed a decrease in the size-number of lymph nodes in four patients whereas PET-CT showed no uptake. All patients had positive responses to IMRT in their second control MR and PET-CT. PET-CT could improve tumour delineation. This enables an increase in dose inside the CTV. PET-CT provided significant information on the control scans for most of our patients whose MR imaging showed residual or recurrence.