Valid and informed consent in healthcare is an ethical and legal requirement. This evaluation reports the practices within UK radiotherapy departments surrounding consent processes and therapeutic radiographer (TR) education. This article focuses on those patients who are considered to lack the capacity to consent.

This service evaluation adopted a qualitative research design. Seventy-six radiotherapy department managers were sent the online survey: containing a combination of open, closed and free text questions relating to consent practices. Descriptive analysis using Microsoft Excel was performed; additional correlation analysis was attempted with Fisher’s exact test using Statistical Package for the Social Sciences.

TRs from 39 radiotherapy departments (51%) completed the survey. Analysis of results demonstrated obtaining written consent before radiotherapy treatment was completed in all departments. Assessment methods used to determine capacity to consent varied across the departments. Responses identified 37 departments employ a different consent form for those considered to lack capacity. Thirty-eight departments have a policy surrounding consent; 16 departments reported no formal TR education in consent. Of the remaining 22 departments, 13 departments included lack of capacity within their education package.

To ensure best practice throughout the UK, is it recommended that radiotherapy departments review their consent processes to ensure they are in the best interests of the patient. It is recommended that TRs are familiar with their regulatory body standards and the ethical and legal issues surrounding consent; all departments should consider capacity and those considered to lack capacity within their education and training framework.

A 4D-dosimeter and quality assurance phantom prototype was developed to quantify the effects of respiratory motion.

The dose distributions were measured using two-dimensional detectors that were mounted on a mobile platform capable of sinusoidal motion in one direction with different patterns using adjustable motion amplitude and frequency. The dose distributions were obtained from various treatment plans including conformal and intensity-modulated beams for both photon and proton therapy. Dose delivery and measurement were conducted using this 4D-dosimeter with the mobile phantom for different motion amplitudes (0–35 mm) and frequencies (0.25–0.33 Hz).

The increase in motion amplitude increased the blurring of the dose distributions at the beam edges along the direction of motion and led to large dose discrepancies. This produced larger dose deficits inside the treatment planning volume (PTV) and increasing dose deposition in the surrounding normal tissue with increasing motion amplitudes. For both the IMRT and VMAT-treatment plans, the dose profile for each increased amplitude increment showed a reproducible flattening of the penumbra at the beam edge, all changing around the 40–60% isodose line.

The 4D-dosimeter developed in this work provides a noble clinical tool to quantify the deviations in the dose distributions induced by respiratory motion.

Cancer is a major health concern in Portugal, especially among older adults, who represent nearly half of new cases. Radiation therapy (RT) is crucial in their treatment, emphasizing the need for improved education in geriatric oncology for radiation oncologists (RO).

A pretested 22-item online survey on RO’s geriatric oncology knowledge was disseminated.

The analysis involved 52 respondents, including 13 residents (25%) and 39 consultants (75%); RO were asked to specify the age threshold they considered to define an older cancer patient. Their responses were as follows: 60 years (n = 2, 3·8%), 65 years (n = 7, 13·5%), 68 years (n = 1, 1·9%), 70 years (n = 29, 55·8%), 75 years (n = 10, 19·2%) and 80 years (n = 2, 3·8%). Forty-six respondents (88·5%) acknowledged an observed increase in the number of older cancer patients in RT departments. Twenty-nine participants (55·8%) reported that age was considered either most of the time or always in clinical decisions. Regarding frailty screening, it was performed by 15 participants (28·8%), while four participants (7·7%) stated that frailty was assessed during comprehensive geriatric assessment in another department. Of those implementing screening tools, nine (17·3%) utilized the G8 tool, and two respondents (3·8%) employed the Triage Risk Screening Tool. Most respondents reported a lack of awareness regarding specific guidelines for older cancer patients, and 98·1% expressed the need for enhanced training in geriatric oncology.

The study highlights a critical need for improved training in geriatric oncology among RO professionals. Furthermore, the findings underscore the imperative for treatment decisions to reflect an understanding beyond chronological age, emphasizing the necessity of addressing this knowledge gap in clinical practice.

The study seeks to evaluate the influence of planning target volume (PTV) margins on plan parameters during inverse planning of brain metastases with the Gamma Knife treatment unit, considering various prescription isodose levels (PIL).

CT scan images of a STEEV anthropomorphic phantom were transferred into the GAMMA PLAN Treatment Planning System. A target measuring a volume of 4·9cc was centrally contoured. Plans with a 0 mm volume margin at five prescription isodose levels from 50% to 70% at 5% increment were created. With 0.5 mm, 1 mm, 1.5 mm and 2 mm PTV margins, identical plans were regenerated. Adjustments were made to each plan when necessary to achieve same target coverage. One-way ANOVA test was used to analyse the influence of PTV margins on parameters including Selectivity[S], Gradient index [GI], V12, Paddick’s conformal index [PCI] and Treatment time [TI].

Margin addition resulted in PTV volume increase. The findings indicated that the PTV margin of 2.0 mm exhibited the highest mean selectivity of (0.93 ± 0.00), PCI (0.92 ± 0.01), GI (2.50 ± 0.04), V12 (16.17 ± 0.38) and treatment time (118.32 ± 2.91 min). The 0.0 mm PTV margin had the lowest mean value for all the parameters except for the treatment time (105.58 ± 3.48 min) which was slightly higher compared to the 0.5 mm PTV margin (M = 86.36 ± 4.13 min).

Incremental increases in PTV margins for Gamma knife radiosurgery though a relatively controversial concept influence all dosimetric parameters, which may pose potential detrimental effects and thus need to be carefully evaluated for brain metastasis treatment.

In vivo diode dosimetry proved its efficacy as a patient-specific quality assurance tool for 3DCRT. Its usefulness in IMRT is not sufficiently investigated.

Four step-and-shoot IMRT plans were generated for different treatment sites using an Alderson Rando anthropomorphic phantom. Two in vivo semiconductor diodes were used to perform 33 entrance radiation dose measurements at central axis and max beam point dose on a water-equivalent slabs based on the anthropomorphic plans. Measured values were compared to planned ones, and detailed analysis per segment of each IMRT field was made to infer the reason behind the discrepancies of measurements from expectations.

Point dose measurements were performed on a beam and a segment basis. Agreement within ±5% action level with planned dose was 27% of beams at central axis versus 45% at max point dose and 10% of segments at central axis versus 25% at max point dose. For ±10% action level, 70% of beams at central axis versus 73% at max point dose, and 15% of segments at central axis versus 41% at max point dose. Classification of segments resulted in a significance of .021 for measuring at positions unaffected by the MLC partial and total blockage.

Diode measurements are recommended at maximum dose coordinates for open beams/segments for more accurate patient dose verification results as part of in vivo dosimetry. This is important for limited resources centres treating with sMLC IMRT.

This study introduces the prostate cancer linear energy transfer sensitivity index (PCLSI) as a novel method to predict relative biological effectiveness (RBE) in prostate cancer using linear energy transfer (LET) in proton therapy based on screening for DNA repair mutations.

Five prostate cancer cell lines with DNA repair mutations known to cause sensitivity to LET and DNA repair inhibitors were examined using published data. Relative Du145 LET sensitivity data were leveraged to deduce the LET equivalent of olaparib doses. The PCLSI model was built using three of the prostate cancer cell lines (LNCaP, 22Rv1 and Du145) with DNA mutation frequency from patient cohorts. The PCLSI model was compared against two established RBE models, McNamara and McMahon, for LET-optimized prostate cancer treatment plans.

The PCLSI model relies on the presence of eight DNA repair mutations: AR, ATM, BRCA1, BRCA2, CDH1, ETV1, PTEN and TP53, which are most likely to predict increased LET sensitivity and RBE in proton therapy. In the LET-optimized plan, the PCLSI model indicates that prostate cancer cells with these DNA repair mutations are more sensitive to increased LET than the McNamara and McMahon RBE models, with expected RBE increases ranging from 11%–33% at 2keV/µm.

The PCLSI model predicts increasing RBE as a function of LET in the presence of certain genetic mutations. The integration of LET-optimized proton therapy and genetic mutation profiling could be a significant step toward the use of individualized medicine to improve outcomes using RBE escalation without the potential toxicity of physical dose escalation.

Oral mucositis (OM) emerged in the late 1980s to describe the adverse effects of radiation therapy (RT) on the oral mucosa. OM is the most common and clinically significant acute adverse effect of radiotherapy for head and neck cancer. Symptoms of OM vary from pain and discomfort to an inability to tolerate food or fluids, and it may affect the quality of life, breaks in treatment, hospitalisation, and therefore cancer treatment and outcome. This study aimed to evaluate the pomegranate flower’s efficacy in preventing and treating radiation-induced mucositis due to antioxidant, anti-inflammatory and anti-cancer effects.

This phase II clinical trial was conducted on 50 patients (case and control) with head and neck malignancy. Patients in the case groups were instructed to rinse their mouths with 5 mg Pomegranate powder with 15 cc of sterile water three times a day. The patients in the control group rinsed their mouths with normal saline mouthwash, which is the most relatively accepted preventive and supportive care in this setting. The onset and degree of radiation-induced mucositis were graded during treatment, with ‘WHO mucositis grading’ and the ‘quality of life questionnaire’ (QLQ-OES18).

Forty-eight patients were analysed. There was a significant difference between the two groups on onset and severity of mucositis in the two groups. There were longer intervals for the incidence of different grades of mucositis in the case group, in comparison with the control groups (P value < 0·05). Also, Complaints of dysphagia in the case groups were lower than in the control.

Pomegranate flower seems to be effective at the time of onset, and the severity of oral mucositis during head and neck radiation. It could be a simple, potent, and inexpensive agent, which is easily available.

Dental management is critical prior to radiotherapy (RT) for head and neck cancer (HNC) but cumbersome and time intensive. This qualitative study investigates dentists’ evaluative processes to identify areas for improvement.

Semi-structured interviews were conducted with dentists involved in the care of HNC patients. The interviews were guided by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to identify factors influencing pre-RT dental management.

Five dentists were participated in the interviews. Key themes were identified through qualitative and quantitative evaluation and are as follows: Coordination among care providers, knowledge of the RT plan, visual depictions of dose distribution and understanding of the patient’s dental history.

This study demonstrates the complexity of pre-RT management and identifies key elements. Knowledge of the RT plan and improved interdisciplinary coordination represents opportunities for improvement. Visual dose prediction methods may expedite and improve pre-RT management.

Cervical cancer remains a significant public health concern in sub-Saharan Africa, with treatment modalities such as chemoradiotherapy impacting patients’ quality of life (QoL). This study assessed the QoL of cervical cancer patients undergoing definitive chemoradiotherapy.

This cross-sectional study was conducted at the National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle-Bu Teaching Hospital, Accra, between February and May 2023. A total of 120 adult female cervical cancer patients, treated with definitive chemoradiotherapy, were purposively recruited. Data were collected using the FACT-Cx questionnaire, which assessed physical, social, emotional and functional well-being as well as additional concerns. Statistical analysis included descriptive and inferential methods with Spearman Rho used to examine correlations.

The mean age of participants was 53·5 years (SD 15·6), with most (77%) employed and half (50%) married. QoL scores were highest in social well-being (mean = 17·3/24·0) and emotional well-being (mean = 16·8/24·0), but lower in physical (mean = 15·4/28·0) and functional well-being (mean = 12·3/24·0). Most participants (66·7%) reported a good QoL, while 6·7% reported poor QoL. Key challenges included fatigue, pain and dissatisfaction with sex life, although participants received strong emotional support from their families. Correlations between age and QoL domains were statistically insignificant (p > 0·05).

The findings suggest that despite the physical and functional challenges faced during chemoradiotherapy, most participants reported good overall QoL, largely attributed to strong family and social support. Future studies should incorporate longitudinal designs with baseline data collection to better understand treatment-related changes in QoL.

Radiotherapy with androgen deprivation therapy (ADT) is the standard of care for locally advanced prostate cancer but causes erectile dysfunction (ED). Vacuum erectile devices (VED)s are a first-line treatment for ED along with phosphodiesterase-5 inhibitors (PDE5-Is), yet all evidence supporting their use arises from post-surgical ED. This study aimed to assess effectiveness of VEDs for patients with ED resulting from radiotherapy and ADT.

This service evaluation utilised a longitudinal survey method to gather ED scores at baseline, after commencing ADT and after receiving a VED. Patients who were undergoing ADT for prostate cancer either before or alongside radical radiotherapy and who had been referred to receive a VED were invited to participate. Data including how patients used the VED, psychosexual counselling and PDE5-Is were also collected. Thematic analysis was used to identify men’s perceptions of the VEDs.

Data from the 15 participants demonstrated statistically significant treatment-related ED but failed to determine impact of VED on this. Qualitative data identified that participants found the VEDs to be unhelpful, too clinical, unappealing, emasculating and frustrating to use. Limited data suggested that VEDs are more effective at treating ED when used in combination with PDE5-Is.

Patients in this small sample generally reported dissatisfaction with VED usage. Limited engagement with the study frustrated attempts to draw conclusions regarding the effectiveness of VEDs for radiotherapy patients suffering from ED during ADT and a larger national study should be conducted to establish this. Improvements to the care pathway and access to psychosexual counselling are recommended.

Radiotherapy departments need to allocate appropriate treatment appointment times to maintain quality of care. Lung cancer patients typically exceed their appointment time due to their increased co-morbidities. Modern radiotherapy methods have reduced treatment time; however, different complexity factors cannot be predicted, indicating that time allocation for treatment appointments requires regular monitoring.

Quantitative data were collected for 4 weeks, including treatment time allocated, actual treatment time required, and different complexity factors of radical lung cancer patients. Descriptive statistics were employed to analyse the treatment times recorded. The Wilcoxon signed-rank test was deployed to determine statistical significance.

Nineteen cancer patients were included in data collection, and 76 treatment times were recorded. Over 70% of patients’ treatment appointments exceeded the allocated 15 minutes. 11 out of the 15 complexity factors recorded were statistically significant. The overall treatment appointment time was statistically significant and showed that on average, patients required 3 minutes longer than allocated.

Most treatments recorded exceeded their allocated appointment time. Patient complexity factors significantly influenced time, indicating that appointment allocation needs to be considered on a patient-to-patient basis. This evaluation determined that appointment allocation needs to be investigated for all cancer patients in individual departments, to ensure high-quality care.

Sarcomas occurring during pregnancy are rare and they present significant challenges in clinical management, to optimise, investigations and treatment choices to ensure both maternal and foetal well-being.

A 32-year-old G1P0 female presented with a rapidly growing swelling in her right axilla. Ultrasound-guided core needle biopsy revealed a high-grade pleomorphic malignant tumour. The dilemmas and choices weighing the risks of staging studies, risks of contrast-enhanced scans, surgery during pregnancy and pre- and post-operative radiotherapy to both the mother and foetus are discussed in this case report

Decision of unenhanced whole-body MRI was chosen for staging studies to mitigate radiation and contrast risks to the foetus and mother. Imaging studies revealed a 10 cm tumour in the right axilla, displacing the subclavian neurovascular structures but without evidence of metastatic disease. Concerns about pre-operative radiotherapy including proton beam radiotherapy, given risk of tumour progression and surgical challenges post-radiation therapy, a consensus decision was reached to proceed with surgical resection followed by delivery of the baby and post-operative radiotherapy. Successful limb-preserving sarcoma surgery was performed at 26 weeks of gestation. She gave birth to a healthy female child at 38 weeks of gestation, and she is receiving post-operative radiotherapy.

Sarcomas diagnosed during pregnancy are rare and delicate balance is required for optimising oncologic outcomes and minimising risks to the mother and the foetus. Decision-making involving multiple specialties and multidisciplinary teams, a treatment plan was formulated that prioritised the safety of the patient and her baby.

Adaptive radiotherapy (ART) is commonly used to mitigate effects of anatomical change during head and neck (H&N) radiotherapy. The process of identifying patients for ART can be subjective and resource-intensive. This feasibility project aims to design and validate a pipeline to automate the process and use it to assess the current clinical pathway for H&N treatments.

The pipeline analysed patients’ on-set cone-beam CT (CBCT) scans to identify inter-fractional anatomical changes. CBCTs were converted into synthetic CTs, contours were automatically generated, and the original plan was recomputed. Each synthetic CT was evaluated against a set of dosimetric goals, with failed goals causing an ART recommendation.

To validate pipeline performance, a ‘gold standard’ was synthesised by recomputing patients’ original plans on a rescan-CT acquired during treatment and identifying failed clinical goals. The pipeline sensitivity and specificity compared to this ‘gold standard’ were calculated for 12 ART patients. The pipeline was then run on a cohort of 12 ART and 14 non-ART patients, and its sensitivity and specificity were instead calculated against the clinical decision made.

The pipeline showed good agreement with the synthesised ‘gold standard’ with an optimum sensitivity of 0·83 and specificity of 0·67. When run over a cohort containing both ART and non-ART patients and assessed against the subjective clinical decision made, the pipeline showed no predictive power (sensitivity: 0·58, specificity: 0·47).

Good agreement with the ‘gold standard’ gives confidence in pipeline performance and disagreement with clinical decisions implies implementation could help standardise the current clinical pathway.

Accurate delivery of radiotherapy to head, neck and brain cancer relies on the use of sophisticated immobilisation devices, usually using a restrictive thermoplastic mask. These masks can cause anxiety and can make treatment difficult for many patients. Open-face or maskless techniques are alternatives which can improve the patient experience. This systematic review aimed to compare the effectiveness of open-face (OF) masks and maskless surface guided radiotherapy (SGRT) with conventional masks.

Primary research papers from the last 10 years were gathered from Scopus, PUBMED, Web of Science and OVID databases. Quantitative data reporting interfractional set-up errors and intrafractional patient motion were extracted from included studies and subjected to descriptive statistical analysis. Additional qualitative data relating to patient tolerance were also extracted to inform discussion.

Ten studies were identified for inclusion. The data identified that OF masks can reproduce patient set-up with an accuracy of <2 mm and <1° and can restrict movement to <1 mm and 0·4°, while maskless SGRT can achieve accuracy to within 0·05 mm and 0·1°.

This review indicates comparable reduction of intrafractional motion between conventional masks, Open-Face masks and maskless SGRT techniques. More research is needed into the impact of maskless SGRT techniques on translational and rotational motions compared to traditional masks.

Intracavitary brachytherapy (IBT) is the standard boost treatment for patients with locally advanced cervical cancer. Volumetric modulated arc therapy (VMAT) boost serves as an alternative to IBT boost, but it has inferior target tumour coverage and organ at risk (OAR) sparing. In this study, a pear-shaped dose distribution was generated in the applicator-guided (AG)-VMAT boost on the existing IBT boost patient by an intercomparison with the existing VMAT boost practice.

The treatment plan of eight patients treated with the VMAT boost and ten patients treated with the IBT boost was analysed. Then, the IBT boost CT images were exported from the OnCentra Brachytherapy treatment planning system (TPS) to Eclipse TPS to plan AG-VMAT boost to reproduce the pear-shaped dose distribution.

AG-VMAT boost successfully reproduced the pear-shaped outline using the 100% isodose line from the IBT boost. The IBT boost treatment planning had the best dosimetry coverage for tumours by D90 23·33 Gy and CI 1·00. The D2cc of the bladder, rectum and femoral heads in the VMAT boost were in significantly higher doses than IBT and AG-VMAT boosts (p ≤ 0·05). The cumulative EQD2 for the D90 in the IBT boost only fell within the tolerance limit. Meanwhile, the D2cc of all the OAR doses in these three techniques was within the dose constraint set by the American Brachytherapy Society (ABS).

24 Gy/3 fractions AG-VMAT boost successfully reproduced the pear-shaped dose distribution for D90 of the target, with D2cc of the OAR remaining within the ABS limit.

Before COVID-19, breast cancer patients in the UK typically received 15 radiotherapy (RT) fractions over three weeks. During the pandemic, adoption of a 5-fraction treatment prescription and more advanced treatment techniques like surface-guided RT, meant a change in the duration and number of hospital visits for patients accessing treatment. This work sought to understand how breast cancer patients’ time in the RT department has changed, between 2018 and 2023.

Appointments for CT simulation, mould room, and RT, from January 2018 to December 2023, were extracted from the Mosaiq® Oncology Management System. Appointments lasting between 5 minutes and 5 hours were analysed. Total visit time was calculated from check-in to completion on the quality checklist.

In total, 29,523 attendances were analysed over 6 years. Average time spent in the department decreased during the pandemic but has since increased 12·4% above pre-COVID-19 levels. Early morning and late afternoon appointments resulted in the shortest visits, with early afternoon appointments leading to the longest visits. On average, patients spend the longest in the department on a Monday, and the least amount of time on a Friday. Friday was the least common day to start a 15-fraction treatment, whereas Tuesday and Friday were equally uncommon for the 5-fraction regime.

During the COVID-19 pandemic, the number of visits a patient makes for breast cancer RT and related services dropped, and remained lower post-COVID-19, due to fewer treatment fractions being prescribed. Average time spent in the department initially decreased but has since increased beyond pre-COVID-19 levels.

This report discusses a 28-year-old male patient diagnosed with an intermediate-grade vascular neoplasm in the distal diaphysis of the right femur. The tumour was excised, irradiated extracorporeally and re-implanted, demonstrating the procedure’s feasibility and effectiveness of this approach.

A 28-year-old male patient presented with complaints of claudication. Magnetic resonance imaging revealed a lytic lesion measuring 65 × 40 × 91 mm in the distal diaphysis of the right femur. Positron emission tomography-computed tomography evaluation identified a malignant lytic lesion in the right femur without evidence of distant metastasis. Preoperative imaging suggested malignancy. The bone segment was excised, irradiated with 50 Gy in a single fraction and re-implanted. The patient underwent open reduction, internal fixation and deep soft tissue tumour excision. Histopathology confirmed intermediate-grade vascular neoplasm without angio invasion or perineural invasion. Immunohistochemistry was positive for Pansitokeratin, Vimentin, Cytokeratin-7, D2-40 and CD31 and negative for CD34.

Postoperatively, the bone segment was successfully re-implanted and fixed with metal hardware. Follow-up imaging over thirty months showed successful integration with no local recurrence or metastasis. The patient recovered well without significant complications.

Extracorporeal radiotherapy is a viable technique for treating intermediate-grade vascular bone neoplasms, providing effective tumour control and preserving limb function. This approach could be considered for broader clinical application.

To find the optimal dose weighting for a combination of three-dimensional conformal radiotherapy (3DCRT) and hybrid volumetric modulated arc therapy (hVMAT) plans for thoracic oesophageal cancer radiation therapy.

This retrospective study involved fourteen patients diagnosed with carcinoma of the oesophagus previously treated with VMAT radiotherapy techniques. Four hVMAT plans were developed for each patient, with a prescribed dose of 50.4 Gy delivered over 28 fractions. The plans incorporated varying ratios of 3DCRT and VMAT techniques: hVMAT-1(33% 2F 3DCRT/67% VMAT), hVMAT-2 (33% 3F 3DCRT/67% VMAT), hVMAT-3 (67% 2F 3DCRT/33% VMAT), and hVMAT-4 (67% 3F 3DCRT/33% VMAT). Dose volume histograms were used to assess the coverage of the planning target volume (PTV) and to analyse dosimetric parameters, including the doses received by organs at risk.

In the four hVMAT techniques, statistically insignificant differences were observed in PTV doses, conformity index and homogeneity index. Notably, monitor unit values differed significantly in three techniques, except for hVMAT-1(p = 0.358). hVMAT-3 demonstrated lower lung mean dose and lung V20Gy values (14.5±3.97, 21.09 ± 9.02) compared to other techniques. There were statistically significant differences in heart mean doses between hVMAT-1 and hVMAT-2, or hVMAT-3 and hVMAT-4 plans (p = 0.462, p = 0.542). However, a significant difference in spinal cord Dmax was found only in hVMAT-1(p = 0.024).

The hVMAT -1 and hVMAT-2 techniques (33% 2F 3DCRT/67% Arc) appear to be the most suitable weighting for the hybrid VMAT technique, offering optimal sparing of the lungs and heart while ensuring adequate coverage of the planning target volume.