This paper explores the views of men who have experienced external beam radiotherapy as part of their treatment for prostate cancer. Using three focus groups, the study aimed to explore men's experience of radiotherapy. However it soon became clear that it is not possible to disentangle the experience of radiotherapy from that of the whole cancer journey. Four themes emerged from qualitative analysis of the data, namely, making decisions (feeling prepared and informed), the experience of radiotherapy, side effects of treatment and sources of support.

The findings indicate that health care professionals involved in radiotherapy treatment delivery need to understand and maintain sensitivity to the physical and emotional impact of the men's experience prior to radiotherapy in addition to those experienced during radiotherapy. In order to raise awareness and understanding of whole experience from the men's perspective, it is suggested that feedback of patient experience should become an integral part of radiotherapy department activity.

This paper is an extract from a wider study that explores the experience of men undergoing brachytherapy and external beam radiotherapy.

The concept of intensity-modulated radiotherapy is now familiar to everyone working in radiotherapy in the UK. To date however, the majority of UK radiotherapy departments have yet to offer this technique clinically. Implementation of IMRT represents a significant change in practice from the delivery of conventional or conformal treatment, requiring careful planning and a full understanding of the issues and new technology involved.

This paper provides a review of the stages involved in the IMRT process; from localisation and immobilisation through inverse treatment planning and quality control to delivery and verification, highlighting those aspects that represent a significant change in practice or approach.

Current and future developments that are expected to enhance or provide alternatives to IMRT, such as developments in radiobiological modelling, functional imaging, tomotherapy and proton therapy are discussed.

UK Radiotherapy Departments have been surveyed to establish the current level of provision of intensity-modulated radiotherapy (IMRT) and its expected growth in the next 2 to 5 years. At the time of writing, nine UK Departments have implemented IMRT, providing a national capacity of approximately 20 new patients per month. By 2005, a further nine Departments expect to have implemented IMRT. As confidence and experience of IMRT grows, streamlining of quality control (QC) and the development of class solutions for inverse treatment planning are expected to significantly reduce the preparation time required for each patient and so increase patient capacity in all Departments.

Staff training requirements, extra workloads in treatment planning and QC, identification of inverse planning parameters and current limitations of inverse treatment planning systems were identified as the key learning points for Departments that have been through the implementation process. Obstacles identified as preventing early implementation include equipment availability, staff shortages and heavy clinical workloads limiting the amount of time available for implementation.

Purpose: This paper describes our experiences of implementing systematic in vivo dosimetry at the Norfolk and Norwich Hospital and reviews the results of 2,254 entrance dose measurements made over a 17-month period.

Methods and materials: Entrance dose measurements using p-type diodes were performed on all new planned patients. The calibration procedure and correction factors applied are described. A 4% tolerance was applied.

Results: The results of all measurements indicated a small mean deviation from expected entrance dose of 10.77% and a standard deviation of 2.85%. 16.7% of all measurements exceeded the 4% tolerance with 9.2% exceeding a 5% level. The estimated overall errors for 578 treatments were calculated using the weighted averages of all beams. A narrower SD of 1.96% combined with only 4.8% of all treatments exceeding a 4% tolerance show that large deviations from a single field do not always translate into significant overall errors.

Conclusions: Global dosimetric accuracy was within clinically acceptable limits and variations between measured and expected doses were mainly attributable to factors affecting diode reading. A number of errors in calculating deviations and the inconsistent application of the protocol suggest the need for interfacing the diode system with software control.

Persistent nausea remains one of the most distressing side effects of radiotherapy treatment despite advances in anti-emetic medication.

Stimulation of the Nei-Guan (P6) acupoint on the wrist has been used in Chinese medicine to treat nausea for over 4,500 years. Studies have demonstrated that acupressure wristbands can reduce postoperative nausea, motion sickness, morning sickness and chemotherapy-induced nausea. This pilot study aimed to determine if they could also help reduce radiotherapy-induced nausea. There are no published reports of their use in this setting, thus this preliminary pilot was conducted before engaging in a major study.

A prospective, paired, cross-over study investigated the impact adding acupressure wristbands to the usual anti-emetic care had on radiotherapy-induced nausea. Over the trial period, 30 patients were recruited when they reported radiotherapy-induced nausea to radiotherapists. Their daily nausea levels were assessed for a fortnight using a simple questionnaire and an anti-emetic tablet count. Comparing the 2 weeks data for these patients showed that there was a dramatic drop in their scores when the acupressure wristbands were used. There was a mean score drop of 61% for the combined nausea and vomiting frequency and severity, i.e. a 61% improvement in quality of life.

This study suggested that acupressure wristbands might have a role to play in the treatment of radiotherapy-induced nausea. It is recommended that further studies be conducted to determine their exact role. They potentially offer several benefits when compared to anti-emetic medication. They are easy to use, have no side effects and are more economical since they are reusable. Furthermore, acupressure wristbands place the patient in control of their nausea to some degree. This in turn will make the patients feel less anxious, less depressed and reduce the common feelings of helplessness that often accompanies cancer patients.

Introduction: Conformal radiotherapy demands an accurate and reproducible treatment set up technique therefore the purpose of this study was to determine whether the current techniques were suitable for use with conformal treatment plans and to establish whether the current verification procedure was adequate.

Method: 30 patients undergoing radical radiotherapy were recruited to each technique to be studied. Megavoltage images (MVI's) were taken twice during week one and then at weekly intervals. All study images were assessed after the patient had completed the treatment course using Masthead PIPS software. Field placement errors were recorded in x, y and z directions where appropriate. Patient characteristics were recorded to establish whether there was any relationship between reproducibility and patient size.

Results: Head and neck: 26.6% patients had one or more errors >5 mm, 3.3% had consistent errors >5 mm throughout treatment. Poor fit of the beam direction shell was associated with errors >5 mm. Chest and abdomen: The technique was modified after 20 patients due to the large number of errors exceeding 10 mm. A significant (p < 0.01) reduction in the number of errors was in the modified technique group, this group also had a significantly (p < 0.01) reduced range of errors in the y direction. Pelvis: Significantly more errors were seen in the y and z directions using the sinmed kneeblock. A link between field placement errors and patient size was found.

Conclusion: Imaging on the first fraction is not sufficient to determine whether a set up error is likely to occur consistently during treatment, at least two sets of images are required. The study has shown that technique development is necessary for the chest, abdomen and pelvis prior to the introduction of conformal radiotherapy.