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 53-year-old female presented with a large (945 cc) unresectable leiomyosarcoma of the uterus, with metastasis in the lungs, significant abdominal/pelvic pain and evidence of hydronephrosis secondary to obstruction caused by the mass. In an effort to palliate symptoms, radiation was recommended.

Given the size of the lesion, the patient was treated with crossfire GRID, a type of spatially fractionated radiotherapy (18 Gy × 1), followed four weeks later by a short course of external beam radiation (4 Gy × 5).

The patient experienced significant symptom relief. Her abdominal/pelvic pain resolved, and a stent was placed to relieve her hydronephrosis. The tumour volume had decreased significantly (5·5 months post-treatment 276 cc, 8·5 months post-treatment 17 cc). Unfortunately, at 9 months post-treatment, the patient died from progression of her metastatic disease in the lungs.

The use of GRID radiotherapy resulted in effective and sustained palliation of a large uterine leiomyosarcoma in this patient’s case.

This study aimed to assess the perception of radiographers on the difficulties encountered during the delineation of organs at risk (OARs) for radiotherapy planning and the methods that could be used to facilitate this process.

A self-designed questionnaire was distributed to all radiographers (n = 29) employed at the radiotherapy department in Malta. The survey assessed the challenges faced by the radiographers during the delineation of various OARs and inquired about the perceived effectiveness of specific measures that could be used to facilitate the delineation process using a Likert scale ranging from 1 (not difficult/effective) to 5 (very difficult/effective).

The response rate was 79%. Overall, the delineation of OARs was rated as slightly difficult (mean score 1.95 ± 0.33). Nevertheless, some OARs, such as the parotid, stomach and brain stem, were deemed more difficult to contour with a mean score of 3 or higher. The implementation of peer review was perceived as the most influential factor in reducing delineation difficulty (mean score 4.59 ± 0.58), followed by contouring training (mean score 4.48 ± 0.58) and training on artificial intelligence (AI) (mean score 4.35 ± 0.48).

The introduction of peer review, training and AI could facilitate the delineation of OARs.