Information is key to patient informed choice and the internet is currently a major source of health information for adults in the UK. In order for the users to make use of the information it must be presented in a way that the user can understand. This depends on a number of factors one being that the document is written at the right level to be understood by the reader, readability.

The aim of this study was to assess the readability of radiotherapy-related documents on the internet and compare their levels to published norms.

An internet search was undertaken using Google, to identify UK-based literature. Once identified documents were downloaded into Word and cleaned of punctuation other than that at the end of the sentence, documents were then analysed by the software package Readability Studio.

Documents tended to be written at too high a reading level, but the reading level had improved from a similar study conducted in 2006. The level of readability appears to show a relationship to the use of passive voice, which was very variable in the sample collected and reduction in the use of passive voice could help with the readability of the information.

Current literature suggests the information and support needs of oncology patients undergoing radical radiotherapy to the prostate often remain unmet and can impact quality of life. We aimed to explore the effectiveness of delivery and opportunities for service improvement, including a group-based treatment review.

A total of 60 prostate patients completing radical radiotherapy (mean age 70, range 47–79) in a UK cancer-centre completed a self-designed questionnaire assessing information and support. To explore views on a group-based treatment review, 11% took part in a semi-structured interview. Descriptive data were computed and interviews transcribed and analysed thematically.

In all, 87% were satisfied with information and support when delivered by radiographers. However, 26% were only ‘sometimes’ able to complete bladder-filling, suggesting information regarding treatment delays would improve this. In total, 49% preferred both Doctor and Urology nurse reviews whereas 26% preferred nurse only; 70% stated their ‘concerns were always addressed’ by a nurse and 49% by a Doctor. Interviews revealed that a group review was generally acceptable with peer support an influencing factor.

Overall patients felt their needs were being met. Suggestions for improvement (more information on preparation, side effects and delays) will be implemented locally. Future work will explore the feasibility of group reviews in patients undergoing radical radiotherapy to the prostate.

Varying the calculation grid size can change the results of dose-volume and radiobiological parameters in a treatment plan, and therefore has an impact on the treatment planning quality assurance.

This study investigated the dosimetric influence of the calculation grid size variation in the prostate volumetric modulated arc therapy (VMAT) plan.

Dose distributions of 10 prostate VMAT plans were acquired using calculation grid sizes of 1–5 mm. Dose-volume histogram (DVH) analysis was carried out to determine the dose-volume variation corresponding to the grid size change using the Gaussian error function (GEF). At the same time, dose-volume points, dose-volume parameters and radiobiological parameters were calculated based on DVHs of targets and organs at risk (OARs) for each grid size.

Comparing percentage variations of GEF parameters between the planning target volume (PTV) and clinical target volume (CTV), GEF parameters of the PTV were found varied more significantly than the CTV. This resulted in larger variations of dose-volume (%ΔCI=40·02 versus 13·55%, %ΔHI=12·45 versus 2·93% and %ΔGI=0·22 versus 0·06%) and radiobiological parameters (%ΔTCP=0·61 versus 0·25% and %ΔEUD=2·11 versus 0·26%) of the PTV compared with CTV. For OARs, the rectal wall showed a larger dose-volume variation than the rectum. However, similar dose-volume variation due to grid size change was not found in the bladder, bladder wall and femur.

Knowing the dosimetric variation in this study is important to the radiotherapy staff in the quality assurance for the prostate VMAT planning.

To evaluate the Klarity® Mask with respect to skin doses and toxicity secondary to head and neck cancer radiation treatment.

This prospective study included five nasopharyngeal cancer patients who underwent intensity-modulated radiation therapy and monitored for skin toxicity. An anatomical Perspex head and neck phantom was designed and used. All patients’ treatment plans were separately transferred to the phantom. Dosimetric measurements were performed using chip-shaped thermoluminescent dosimeters (LiF:Mg,Ti TLDs) which were distributed at certain target points on the phantom. Phantom was irradiated twicely with and without a Klarity® Mask. Three fractions for each patient plan were obtained and compared with treatment planning system (TPS) doses as guided by computed tomography.

The Klarity mask used for patient immobilisation increased the surface dose by 10·83% more than that without the mask. The average variations between skin dose measurements with and without the Klarity mask for all patients’ plans ranged from 10·26 to 11·83%. TPS overestimated the surface dose by 19·13% when compared with thermoluminescent dosimeters that measured the direct skin dose.

Klarity immobilisation mask increases skin doses, as a consequence, surface dose measurements should be monitored and must be taken into account.

This study aimed to investigate tolerance dose to organs at risk (OARs) as well as degree of conformity and homogeneity for head and neck cancer patients by using simultaneous integrated boost intensity-modulated radiotherapy technique (SIB IMRT).

This study analysed 15 head and neck cancer patients receiving treatment using inverse planned SIB IMRT technique. Using a beam energy of 6 MV, two dose levels of 70 and 55·4 Gy were used to treat the tumour. Doses of 2 Gy in 35 fractions and 1·68 Gy in 33 fractions were simultaneously delivered for effective planning target volume (PTV1) and boost planning target volume (PTV2), respectively.

Dose distribution in PTV and critical organs lies within tolerance dose guidelines protecting spinal cord, brain stem, optic chiasm, optic nerve, thus reducing the risk of damage to normal tissues. Minor deviation from tolerance limit was observed for parotid glands. This technique provided highly conformal and homogenous dose distribution as well as better sparing of OARs, hence verifying quality assurance results to be satisfactory.

SIB IMRT technique offers best solution for preserving organ function by keeping dose below tolerance level. Treatment of head and neck carcinoma using SIB IMRT is feasible, more efficient, and dose escalation is achieved in a single plan.

For palliative radiotherapy treatments, two types of simulation are available at our Centre: conventional (or 2D) and virtual. Each has its advantages: conventional simulation requires less preparation time whereas virtual simulation allows accurate visualisation and identification of target volumes in 3D. We propose a new approach where treatment field parameters are determined on diagnostic CT scans, and then reproduced with reference to a patient’s bony landmarks using conventional simulation. This combines the benefits of both methods. We argue that the slight differences in set-up between diagnostic and simulation CT scans will have little impact on the determination of the target volume in palliative treatment settings.

In total, 12 patients who had diagnostic scans done within a month before their virtual simulation were randomly selected. Both scans were retrieved retrospectively for the study. An independent radiation oncologist contoured the target volumes on both scans and their relative positions were compared by fusing the digitally reconstructed radiographs generated from the respective scans. A 2D Conformity Index (2DCI) was then calculated and tabulated for 0, 0.5, 1.0, 1.5 and 2 cm margins to evaluate the accuracy of this approach and determine the margins required to account for the inherent variability of this method. In addition, the deviation or offset of the centre of field (COF) was also measured and analysed.

The median 2DCI (0 margin) was 0.85. For margins of 0.5, 1.0, 1.5 and 2.0 cm, the median 2DCIs were 0.97, 1, 1 and 1, respectively. The median displacement of the COF in the superior–inferior direction was 0.7 cm and that in the right–left direction was 0.2 cm.

Our pilot study suggests that our approach is feasible. We recommend adding an additional margin of up to 0.5 cm (to the usual treatment margins) to ensure good coverage of the target volume when using this method.

The aim of the current study was to (i) to calculate organ equivalent dose (OED) and (ii) to estimate excess absolute risks (EARs), lifetime attributable risks (LARs) and relative risks (RRs) from stereotactic ablative radiotherapy (SABR) for lung cancer to in-field, close to field, and out of field structures.

A total of five patients with T1, T2 (≤4 cm), N0, M0 medically inoperable non-small cell lung cancer were selected for treatment planning. Patient selection criteria were based on RTOG 0236. Five treatment deliveries were investigated: (i) three-dimensional conformal radiotherapy (3DCRT), (ii) intensity-modulated radiotherapy (IMRT), (iii) intensity-modulated radiotherapy with flattening filter free beam (IMRTF), (iv) volumetric modulated arc therapy (VMAT) and (v) volumetric modulated arc therapy with flattening filter free arcs (VMATF). Delineated normal structures included chest wall, left and right lung, trachea, small and large airways, spinal cord, oesophagus and involved ribs. All plans were prescribed to 60 Gy in five fractions to primary planning target volume (PTV) volume so that ≥98% of the PTV received ≥98% of the prescription dose and internal tumour volume received 100% of the prescription dose. The OED for all delineated normal structures was calculated using differential dose volume histograms. Using risk models, the age-dependent LAR’s and RR were calculated. Additionally, the secondary cancer risk for organs inside primary radiation was analysed using sarcoma and carcinoma risk models.

For all patients, the mean V20 volumes from the SABR plans were 4·1% (3DRT), 11·8% (IMRT), and 12·7% (VMAT), respectively. The EAR (combining all organs EAR) for all the organs studied, ranged from 8·5 to 10·6/10,000 persons/year for VMATF and 3DCRT, respectively. The EAR (combining all organs EAR) for all the organs studied, ranged from 8·5 to 10·6/10,000 persons/year for VMATF and 3DCRT, respectively. The absolute EAR difference between IMRT and IMRTF was low ranging from 0·2 to 0·4/10,000 persons-year, whereas delivery difference (IMRT and VMAT) had a significant impact on EAR with absolute difference ranging from 0·5 to 1·0/10,000 persons-year for IMRT and VMAT and 1·1–1·5/10,000 persons-year for IMRTF, VMATF, respectively. The LAR data showed a strong dependence on age at exposure and the LAR decreased as a function of age at exposure. The absolute attributable risk of bone sarcoma was lower with the VMAT plan and was significantly higher with the 3DCRT plan.

From a clinical perspective, it should be concluded that all five solutions investigated in the study can offer high quality of patient treatments and only estimates of radiation-induced malignancies can truly differentiate among them. The results suggested it would be reasonable to use the cumulative LAR difference when needed to select between treatment techniques. In conclusion, the LAR of radiation-induced secondary cancer was significantly lower when using VMATF than when using IMRT for SABR lung patients. VMATF would be the right choice for the treatment of SABR lung patients in terms of LAR. However, more work is required for the specific estimation and long-term validation and updating of the models behind LAR estimation.

To create practical lookup tables containing percent depth dose (PDD) and profile parameters of electron beams and to demonstrate clinical application of the lookup tables to skin cancer treatment to ensure target coverage in a clinical setup.

For 6 and 9 MeV electron energies, PDDs and profiles at clinically relevant depths [i.e., R95 (distal depth of 95% maximum dose), R90, R85 and R80] were measured in water at 100 cm source-to-surface distance for an 10×10 cm2 open field and circular cutouts with diameters of 4, 5, 6, 7 and 8 cm. Then PDD parameters along with profile parameters such as width of isodose lines and penumbra at the clinically relevant depths were determined. Output factors for the cutouts were measured at dmax in water and solid water.

With PDD and profile parameters, dosimetry lookup tables were generated. Based upon the lookup tables, target coverage at prescribed depths was retrospectively reviewed for three skin cancer cases. The lookup tables suggested larger cutouts for adequate target coverage.

Dosimetry lookup tables for electron beam therapy should include profile parameters at clinically relevant depths and be provided to clinicians to ensure target coverage in a clinical setup.

Safety is a mandatory issue during the operation of a nuclear power plant. A nuclear reactor can have some atmospheric dispersion due to any errors in the safety system.

The aim of this study is to estimate the cancer risk incidence for different body organs due to accidentally released radionuclides from Bushehr Nuclear Power Plant (BNPP).

The assumed hypothesis was atmospheric dispersion of radionuclide into the environment due to the safety failure of BNPP. Total effective dose equivalent (TEDE) from radionuclide diffusion in the medium was calculated using HOTSPOT code at two different wind speeds. Finally, the risk of cancer incidence for different organs of male and female sex has been estimated by Biologic Effects of Ionizing Radiation (BEIR) VII model.

The results showed that with increasing the exposure age and attained age, the risk of cancer incidence for different organs is decreased. The value of TEDE was increased at lower wind speed. The most probable organ for cancer incidence at different levels of TEDE in male and female sex was colon and bladder, respectively. On the other hand, prostate and uterus had the lowest radiation sensitivity and cancer risk incidence in male and female sex, respectively. Increasing the wind speed reduces the risk of cancer incidence for all of organs understudy.

Based on the obtained results, it can be concluded that the younger persons are more subject to the cancer risk incidence because of both the intrinsically greater radio-sensitivity of their organs and their longer remaining life expectancy during which a cancer may develop. The overall risk of cancer incidence as well as the site specific solid cancer incidence were highly dependent to the sex of exposed person, so that the female sex was more exposed to the cancer risk incidence at all of the irradiation levels understudy.

To investigate discrepancies in dose calculation algorithms used for lung stereotactic body radiotherapy (SBRT) plans.

In total, 30 patients lung SBRT treatment plans, initially generated using BrainLab Pencil Beam (BL_PB) algorithm for 10 Gy×5 Fractions to the planning target volume (PTV) were included in the study. These plans were recalculated using BrainLab Monte Carlo (BL_MC), Eclipse AAA (EC_AAA), Eclipse Acuros XB (EC_AXB) and ADAC Pinnacle CCC (AP_CCC) algorithms. Dose volume histograms of PTV were used to calculate dosimetric and radiobiological quality indices, and equivalent dose to 2 Gy per fraction using linear-quadratic-linear model. The BL_MC algorithm is considered gold standard tool to compare PTV parameters and quality indices to investigate dose calculation discrepancies of abovementioned plans.

BL_PB overestimates doses that may be due to inability of the algorithm to properly account for electron scattering and transport in inhomogeneous medium. Compared with BL_MCNO plans, the EC_AAA and EC_AXB yield lower homogeneity indices and overestimate the dose in the penumbra region, whereas AP_CCC plans were comparable for small PTV (≈8 cc) and had significant difference for large PTV.

BL_PB algorithm overestimates PTV doses than BL_MC calculated doses. The EC_AAA, EC_AXB and AP_CCC algorithms calculate doses within acceptable limits of radiotherapy dose delivery recommendations.

To evaluate the impact of couch translational shifts on dose–volume histogram (DVH) and radiobiological parameters [tumour control probability (TCP), equivalent uniform dose (EUD) and normal tissue complication probability (NTCP)] of volumetric modulated arc therapy (VMAT) plans and to develop a simple and swift method to predict the same online, on a daily basis.

In total, ten prostate patients treated with VMAT technology were selected for this study. The plans were generated using Eclipse TPS and delivered using Clinac ix LINAC equipped with a Millennium 120 multileaf collimator. In order to find the effect of systematic translational couch shifts on the DVH and radiobiological parameters, errors were introduced in the clinically accepted base plan with an increment of 1 mm and up to 5 mm from the iso-centre in both positive and negative directions of each of the three axis, x [right–left (R-L)], y [superior–inferior (S-I)] and z [anterior–posterior (A-P)]. The percentages of difference in these parameters (∆D, ∆TCP, ∆EUD and ∆NTCP) were analyzed between the base plan and the error introduced plans. DVHs of the base plan and the error plans were imported into the MATLAB software (R2013a) and an in-house MATLAB code was generated to find the best curve fitted polynomial functions for each point on the DVH, there by generating predicted DVH for planning target volume (PTV), clinical target volume (CTV) and organs at risks (OARs). Functions f(x, vj), f(y, vj) and f(z, vj) were found to represent the variation in the dose when there are couch translation shifts in R-L, S-I and A-P directions, respectively. The validation of this method was done by introducing daily couch shifts and comparing the treatment planning system (TPS) generated DVHs and radiobiological parameters with MATLAB code predicted parameters.

It was noted that the variations in the dose to the CTV, due to both systematic and random shifts, were very small. For CTV and PTV, the maximum variations in both DVH and radiobiological parameters were observed in the S-I direction than in the A-P or R-L directions. ∆V70 Gy and ∆V60 Gy of the bladder varied more due to S-I shift whereas, ∆V40 Gy, ∆EUD and ∆NTCP varied due to A-P shifts. All the parameters in rectum were most affected by the A-P shifts than the shifts in other two directions. The maximum percentage of deviation between the TPS calculated and MATLAB predicted DVHs of plans were calculated for targets and OARs and were found to be less than 0·5%.

The variations in the parameters depend upon the direction and magnitude of the shift. The DVH curves generated by the TPS and predicted by the MATLAB showed good correlation.

The purpose of this study was to investigate whether significant difference exists on radiation dose delivered to organs at risks in megavoltage computed tomography (MVCT) verification using three predefined scanning modes, namely fine (2 mm), normal (4 mm) and coarse (6 mm). This will provide information for the imaging protocol of tomotherapy for the left breast.

Organ doses were measured using thermoluminescent dosimeters (TLD-100) placed within a female Rando phantom for MVCT imaging. Kruskal–Wallis test was conducted with p<0·05 to evaluate the significant difference between the three MVCT scanning modes.

Statistically significant difference existed in organ absorbed dose between different scan mode selections (p<0·001). Relative to the normal scan selection (4 mm), the absorbed dose to the organs of interests can be scaled down by 0·7 and scaled up by 2·1 for coarse (6 mm) and fine scans (2 mm) respectively.

Optimisation of imaging protocols is of paramount importance to keep the radiation exposure ‘as low as reasonably achievable’. The recommendation of undergoing daily coarse mode for MVCT verification in breast tomotherapy not only mitigates the radiation exposure to normal tissues, but also trims the scan-acquisition time.

Imaging protocols are implemented to identify and minimise set-up errors. A crucial component to the success of these protocols is staff compliance.

This is case report describing a retrospective review of radiation therapists’ compliance to a palliative imaging protocol in a single large institution in one calendar year.

The review showed a non-compliance to protocol for 8% of treatments. The most frequent protocol deviation was a failure to calculate the mean set-up displacement after 2/3 days of consecutive imaging.

Despite the presence of institutional evidence-based palliative imaging protocol unwanted deviations in practice can occur.