In this article the potential for use of electronic portfolios by healthcare practitioners and students is considered in the context of work currently being undertaken in the School of Health at the University of Wolverhampton. We write at a time when knowledge of, and interest in, eportfolios is expanding beyond a relatively small number of projects and into the consciousness of a wider audience of academics and institutions. In the last 2 years interest in eportfolios has grown rapidly, particularly within a Higher Education sector keen to meet the Higher Education Funding Council for England/Quality Assurance Agency progress file deadline in 2005, but also spurred by the reports of Burgess (Universities UK. Measuring and recording student achievement, 2004 [Online report] [Accessed: 01 March 2006]. Available from: http://bookshop.universitiesuk.ac.uk/downloads/ measuringachievement.pdf) and of Tomlinson (DfES. Harnessing Technology: Transforming learning and children's services, 2005. [Online Report]. Published 15 March 2005 [Accessed: 01 Mar 2006]. Available from: http://www.dfes.gov.uk/publications/e-strategy/index.shtml). Examples of the use of eportfolio as a means of recording achievement and, in particular, facilitating reflective practice are discussed. The potential of an eportfolio system incorporating asynchronous communication features to resolve the tensions between academic and clinical practitioner roles is explored.

A number of Radiotherapy Departments have extended the working day on linear accelerators, as a method of increasing treatment capacity. However, reports from the Royal College of Radiologists predict a rate of increase in requirements for radiotherapy, significantly in excess of the rate at which radiographers will become available to run the necessary equipment.

Based on the premise that radiographers are the most difficult staff group to recruit, a number of different patterns of radiotherapy linear accelerator use has been investigated, with an aim of seeing which delivers the greatest return on radiographer time. The requirement for radiographers per linac-hour has been examined for a number of lengths of day and utilising various staffing assumptions.

Given current patterns of work, the greatest manpower efficiency in use of trained radiographers is achieved if machines are run for a 7-h-day or for an 8-h-day if part-time radiographers are available. This working pattern relies on all ancillary tasks being removed from the treatment unit, many of which can be performed by other appropriately trained, non-radiographer, staff groups.

With linac-hour demand projected to rise faster than the rate at which new trained radiographers become available, extended working days are not sustainable without significant change to current work patterns.

In recent years there has been a push to move away from traditional clinician led on treatment review of radiotherapy patients. Despite this impetus there has been little published work relating to how the new system can be implemented. This article describes how one department implemented a change in direction from the conventional and moved forward with radiographer-led review clinics. The Plan–Do–Check–Act cycle is used as a basis for evaluation with results of a small-scale patient audit and a comparison with other departments in the UK being presented. This method of implementation and evaluation proved successful and may serve as an early model for radiotherapy departments elsewhere.

Recently, radiotherapy breast gowns have been introduced into some Radiotherapy Departments across the country. The idea of using the breast gowns came from issues highlighted regarding privacy and dignity from patient satisfaction surveys. The introduction of the breast gowns was not evidence based, however they have become popular as they were considered a good aid for patients' comfort. This study aimed to investigate patients' perceptions of the breast gowns using a qualitative, phenomenological approach. The methodology was designed to explore patient's feelings about their experiences throughout their cancer journey. The data was collected through semi-structured interviews, which were transcribed and analysed, via content analysis. The key themes that emerged from the study were related to: patients' emotions; dignity and privacy issues; exposure; patient choice and an unexpected result were their views relating to the notion of “possession”. The results of this study cannot be generalised due to the methodology chosen, however the findings can aid the development of a multi-centred study to investigate this topic further. In addition, this study has highlighted an important recommendation for radiotherapy practice: the development of a “modesty gown” for most treatment sites.

The recent advent of highly conformal three-dimensional radiotherapy techniques and Intensity Modulated Radiotherapy now allows higher radiation doses to be delivered. It is well-documented that the prostate is susceptible to both interfraction and intrafraction movements due to various physiological processes. Therefore there has been a recent general consensus that good immobilisation and electronic portal imaging is no longer sufficient to ensure accurate treatment verification. This idea has led to the concept of image-guided radiotherapy, which includes modalities such as cone-beam computed tomography and ultrasound to localise the prostate prior to treatment.

There has been considerable research undertaken to determine the effectiveness of each of the image guided modalities and these studies have identified the benefit and limitations of each modality. Ultrasound is a non-invasive technique using a suprapubic ultrasound probe, which seems to be quite promising in terms of cost and time. However until large scales studies are performed which demonstrate the value of using ultrasound localisation, as an alternative to electronic portal imaging, it is likely that current practice will remain unchanged.

Purpose: To evaluate the role of retrograde urethrography in treatment planning for salvage external beam radiotherapy in patients with increasing prostate-specific antigen levels after radical prostatectomy.

Methods and Materials: From July 1988 to December 2002, 173 consecutive patients received external beam radiotherapy for increasing prostate-specific antigen levels after radical prostatectomy. All 173 simulation films were reviewed, and retrograde urethrography was performed in 148 patients (86%). The distance between the line connecting the lower poles of the ischial tuberosities and site of abrupt narrowing of contrast material was measured in all 148 patients. This distance was compared with that measured in 148 consecutive patients with intact prostates who had retrograde urethrography while undergoing treatment planning for definitive radiotherapy.

Results: The mean (median) distance from the line connecting the lower poles of the ischial tuberosities to the abrupt narrowing seen in the urethrogram in patients with increasing prostate-specific antigen levels was 1.54cm (1.50cm) compared with 1.73cm (1.80cm) in those with intact prostates (p = 0.0145).

Conclusion: Retrograde urethrography is important in treatment planning for salvage radiotherapy of the prostate bed after radical prostatectomy to adequately treat the apex of the prostate bed.

A recently released Pinnacle treatment planning system software, v7.4f includes some new physics features such as modeling of the rounded multi-leaf collimator (MLC) leaf ends and the tongue-and-groove structure between leaves. In this study, the above physics modeling improvements were verified by comparing the peripheral dose profiles for the small MLC fields calculated by the new Pinnacle v7.4f and the old Pinnacle v6.2b with those obtained from measurements experimentally. Three test MLC fields with different jaw sizes were prepared, and specific dose profiles (along cross-line, in-line and diagonal axis) at different depths were measured using a Varian 21 EX linear accelerator with 120-leaf Millennium MLC, big scanning water tank and photon diode. Estimated dose profiles for the test fields were calculated using Pinnacle v6.2b and v7.4f. By comparing the measured and calculated results, it was found that both v6.2b and v7.4f performed well in calculating the cross-line (along the gap between the longitudinal lengths of two leaves) and diagonal axis dose profiles at different depths. However, v7.4f gave calculated dose values closer to the measured field for in-line (gap between junctions of two rounded leaf ends) axis dose profiles at different depths. For the shape of the profile along the in-line axis, v7.4f calculated a flat “platform” dose profile of about 34.3% (inter-bank leakage) at depth dmax> beyond the MLC field edge using a clinical dose grid size of 0.4×0.4×0.4cm3, compared to the “zigzag” dose profile varying between 35.4% and 42.1% measured using the water tank and diode. However, both Pinnacle v6.2b and v7.4f calculated the percentage depth dose for the test fields well compared to the measurements.