The burden of lifestyle-associated disease is increasing with a preventative approach to health becoming more of a focus. Within the oncology setting, the importance of supporting patients with positive lifestyle changes post treatment is included within the recently developed recovery package and the contribution of therapeutic radiographers will be significant in the implementation of this.

A 23-question survey tool was distributed via the online platform Survey Monkey. The questionnaire was promoted online through the Society and College of Radiographers (SCoR). All members of the SCoR had access to the questionnaire to allow for assessment of health improvement provision nationally. Quantitative and qualitative data were acquired and analysed using the statistical package for the social sciences, descriptive statistics and thematic analysis.

Therapy radiographers recognise importance of health promotion. Highest levels of provision were observed with smoking cessation and lowest levels of provision observed on the topic of exercise. Key barriers identified were staff responsibility and lack of knowledge and training of therapy radiographers.

Health improvement is part of the role of the therapy radiographer and is delivered within UK radiotherapy departments; however, there is scope to increase delivery with the identification and overcoming of barriers to provision.

This study aims to compare conventional simultaneous integrated boost (SIB) planning technique with a hybrid SIB intensity-modulated radiation therapy (IMRT) technique with varying open tangent to IMRT field dose ratios. Furthermore, we investigated which of the dose ratios proves the most favourable as a class solution across a sample.

In total, 15 patients with conventional SIB treatment plans were re-planned with hybrid SIB IMRT technique using three differing open field:IMRT dose ratios, that is, 80:20, 70:30 and 60:40. Plans were compared using dosimetric comparison of organs at risk (OARs) and homogeneity and conformity indexes across target structures.

All hybrid plans reduced dose maximums and showed a reduction of high doses to both lungs but increased lower doses, that is, V5, with similar results discovered for the heart. Contralateral breast dose was shown to decrease V5 and V1 measures by hybrid arms, whereas increasing the V2. Left anterior descending artery dose and non-irradiated structures were reduced by all hybrid arms. The homogeneity and conformity increased across all hybrid arms. Qualitative assessment of all plans also favoured hybrid plans.

Hybrid plans produced superior dose conformity, homogeneity, reduced dose maximums and showed an improvement in most OAR parameters. The 70:30 hybrid technique exhibited greater benefits as a class solution to the sample than conventional plans due to superior dose conformity and homogeneity to target volumes.

The aim of this study was to consult patients about their experiences of comfort while wearing a thermoplastic mask during head and neck radiotherapy before designing a study to develop a comfort scale for radiotherapy.

A qualitative method using a focus group of patients receiving radiotherapy for head and neck cancer was deployed. Five patients were invited and agreed to participate. Semi-structured questions guided the focus group interview. Thematic analysis was used to identify themes.

Three patients participated in the focus group. Three main themes were identified: Physical comfort, Mental perception, Passivity. Physical comfort derived from feelings of pressure, unpleasantness, and generally being uncomfortable. Mental perception derived from how the physical comfort was perceived and derived from feelings of shock, anxiety, indifference and sensory systems. Passivity arose from feelings such as the ‘doctor knows best’, ‘putting up with it’, and ‘being taken for a ride’.

The insight of patient’s comfort and experiences are valuable for clinicians to provide patient-centred care. Findings of this study implicate further investigation of how the themes of patient comfort can be measured in radiotherapy to improve the patient experience.

Irish healthcare has seen radical reforms in recent years. Regulatory Body Registration was introduced to improve patient care and regulate professionals. Continuing Professional Development (CPD) is a requirement of registration. Professionals need to keep up-to-date with new techniques and technologies while maintaining their skills.

This research assessed the factors affecting CPD participation in Radiation Therapists and Diagnostic Radiographers and their knowledge and attitudes towards Regulatory Body Registration.

Online surveys were designed and made available on the Irish Institute of Radiography and Radiation Therapy (IIRRT) Website for IIRRT members. The responses were analysed using descriptive statistics and χ2 tests in a statistical computer programme.

Personal development, time, cost and staff shortages negatively affect CPD participation. Reflective practise is not a barrier to CPD. Knowledge and attitudes to Regulatory Body Registration varied.

CPD must be developed in Radiation Therapy and Diagnostic Radiography. Funding, time and increased staffing could result in effective implementation of CPD. Regulatory Body Registration has been communicated but more information regarding the process is required.

To compare intensity-modulated radiation therapy (IMRT) treatment planning between using positron emission tomography/computed tomography (PET/CT) and CT for target volume delineation in patients with non-small cell lung cancer (NSCLC).

Nine NSCLC patients with PET/CT images were enrolled into this study. Gross tumour volumes (GTVs) were delineated by the PET visual assessment (PETvis), the automated PET (PETauto), standardised uptake value (SUV)>2·5 (PET2·5) and threshold 40% SUVmax (PET40), and CT-based method. For each patient, two IMRT treatment plans based on CT and PET/CT delineation were performed. The target coverage and the dose–volume parameters for organs at risk were analysed.

The PETauto referred to PET40 when SUVmax<7 and PET2·5 when SUVmax≥7. The mean GTVs were 15·04, 15·7 and 15·14 cc for PETauto, PETvis and CT based, respectively. The GTV of PETauto was not different from PETvis (p=0·441) and CT based (p=0·594). Based on CT delineation in IMRT planning, only 34% of the cases had sufficient PET/CT planning target volumes coverage, whereas the organs at risk dose parameters were not statistically significant (p>0·05).

PET/CT enables more accurate assessment of tumour delineation for NSCLC, therefore improve target coverage in IMRT plan.

Cone beam computed tomography (CBCT) images contain more scatter than a conventional computed tomography (CT) image and therefore provide inaccurate Hounsfield units (HUs). Consequently, CBCT images cannot be used directly for dose calculation. The aim of this study is to enable dose calculations to be performed with the use of CBCT images taken during radiotherapy and potentially avoid the necessity of re-planning.

A phantom and prostate cancer patient with a metallic prosthetic hip replacement were imaged using both CT and CBCT. The multilevel threshold algorithm was used to categorise pixel values in the CBCT images into segments of homogeneous HU. The variation in HU with position in the CBCT images was taken into consideration and the benefit of using a larger number of materials than typically used in previous work has been explored. This segmentation method relies upon the operator dividing the CBCT data into a set of volumes where the variation in the relationship between pixel values and HUs is small. A field-in-field treatment plan was generated from the CT of the phantom. An intensity-modulated radiation therapy plan was generated from CT images of the patient. These plans were then copied to the segmented CBCT datasets with identical settings and the doses were recalculated and compared.

In the phantom study, γ evaluation showed that the percentage of points falling in planning target volume, rectum and bladder with γ<1 (3%/3 mm) was 100%. In the patient study, increasing the number of bins to define the material type from seven materials to eight materials required 50% more operator time to improve the accuracy by 0·01% using pencil beam and collapsed cone and 0·05% when using Monte Carlo algorithms.

The segmentation of CBCT images using the method in this study can be used for dose calculation. For a simple phantom, 2 values of HU were needed to improve dose calculation accuracy. In challenging circumstances such as that of a prostate patient with hip prosthesis, 5 values of HU were found to be needed, giving a reasonable balance between dose accuracy and operator time.

To explore the impact of breast size on mean lung dose (MLD) for patients receiving breast radiotherapy.

Chest wall separation (CWS), volume of tissue receiving 95% isodose and MLD were measured on 80 radiotherapy treatment plans of patients receiving tangential radiotherapy treatment to the whole breast. Breast size was categorised as small (CWS<25 cm and planned target volume (PTV)<1,500 cm3) and large (CWS>25 cm and PTV>1500 cm3). Pearson’s correlation and independent sample t-test were used to analyse data.

MLD was not affected by CWS (r=−0·13, p=0·24) nor volume of tissue receiving 95% isodose (r=−0·08, p=0·49). Significant variation between small and large breasts was noted for CWS (t=8·24, p=0·00) and volume of tissue receiving 95% isodose (t=5·68, p=0·00). No significant variation was noted between small and large breast for MLD (t=−0·26, p=0·80) and between left and right breasts for CWS (t=1·42, p=0·16) and volume of tissue receiving 95% isodose (t=−1·08, p=0·28). Significant difference between left (18–808 cGy) and right breast (325–365 cGy) was demonstrated for MLD (t=3·03, p=0·00).

This study demonstrated lack of correlation between breast size and MLD. Further research is recommended for justification of alternative techniques for this subgroup of patients to provide optimised radiotherapy delivery.

Merkel cell carcinoma is a rare and aggressive primary cutaneous neuroendocrine carcinoma with a high risk of loco-regional and distant metastasis. It is predominantly seen in the elderly, on the head and neck or extremities. Although treated primarily with surgery, some patients are too frail. A World Health Organization performance status of two or more with co-existing medical co-morbidities, or the site of the disease adjacent to a critical structure, can prevent surgical management. In this cohort of patients, primary palliative radiotherapy has been found to achieve excellent tumour regression and improve quality of life. A new palliative split-course hypofractionated regime has been used in North Middlesex University Hospital in this cohort of patients. The purpose of this case series was to provide supporting evidence on the efficacy of this dose and fractionation regime and review the literature for the palliative management of Merkel cell carcinoma.

In total, four patients were treated with the palliative split-course hypofractionated regime. The regime consisted of an initial 20 Gray in 5 fractions over 1 week, a 2-week gap and then a further 20 Gray in 5 fractions over 1 week. Tolerability and response to treatment were evaluated by history and clinical examination.

The split-course hypofractionated regime was well tolerated, achieved excellent tumour regression and improved quality of life in all four patients. Since then, a further three patients have been successfully treated with the above regime. This case series demonstrates the efficacy of this dose and fractionation in a select group of patients too frail for radical management and adds to the evidence base for the optimal palliative management of Merkel cell carcinoma.

Craniospinal irradiation is a technique indicated when a patient has a malignancy that has either disseminated, or is at risk of disseminating, throughout the subarachnoid space. While the craniospinal axis is treatable with conventional radiotherapy, the high doses to organs at risk carry an increased risk of acute and late side effects. Proton craniospinal irradiation is an expensive technique that shows great theoretical promise arising from reduced exit doses. The purpose of this systematic review is to determine the potential role of proton therapy as a standard modality for craniospinal irradiation.

A literature review was performed to determine the efficacy and cost of proton craniospinal irradiation. The Cochrane Library and the Inspec, Medline (via Pubmed) and Scopus databases were searched. After exclusion criteria were applied, the remaining papers were systematically appraised utilising the Scottish Intercollegiate Guidelines Network critical appraisal checklists.

A total of 14 articles remained following the application of the screening and critical appraisal processes. In total, five of the articles concluded that the risk of secondary malignancy was lower with proton therapy, while ten of the articles included data showing that toxicity rates and organs at risk doses were lower with proton therapy. Doses to most thoracic and abdominal organs at risk analysed in the literature were reduced when proton therapy was used, with the sole exception of the oesophagus, the dose to which depended on whether or not the entire vertebral body was treated. Proton therapy also delivered optimal doses to organs at risk in the head and neck compared with conformal radiation therapy. However, in one study that compared tomotherapy to proton therapy, tomotherapy outperformed proton therapy by delivering lower doses to organs at risk in the head and neck, as well as the kidneys. The two cost-effectiveness studies did not indicate proton therapy as an optimal modality for all treatment sites; however, one of the studies found that for medulloblastoma, protons were more cost effective than conventional radiation therapy.

Proton therapy is a superior treatment option for craniospinal irradiation. The reduction in risk of toxicity and radiocarcinogenesis offered by proton craniospinal irradiation appear to outweigh the increased costs.

Despite crossing at the isocentre, misaligned laser beams may cause significant positioning problems.

The jig proposed here is to be used in addition to the quality assurance procedures employed with linacs and deals with possible misalignments of transverse lasers.

It is an inverted T construction with a two-sided rectangular, slightly transparent mirror set vertical on a piece of glass serving as its base. The device is carried by a horizontally set spirit-level surface and placed on the couch-top so that the sagittal laser passes through the vertical mirror’s plane. Then the therapy couch is translated along the Y direction until a laser beam shines on the corresponding side of the semi-transparent mirror. This spot is marked and is normally the linac’s isocentre set through an independent procedure employing a rotating plate. If the laser had been set properly, then its beam should be reflecting back on its source. If not, the alignment can be corrected by rotating and/or translating the laser holder until it does that. At the same time, it should be ensured that the beam does not wander away from the isocentre spot on the mirror. When both are achieved, the beam ends up perpendicular to the linac’s axis of rotation, while passing through the isocentre. The procedure can be repeated for the opposite laser.

The jig was simple to construct and has been found quite useful in practice. The accuracy of patient positioning will be restricted only by the size of the laser beam’s cross-section.

Success with acupuncture-like transcutaneous nerve stimulation (ALTENS) in the treatment of radiation-induced xerostomia has not been reported after an extended time.

We report a case of successful ALTENS therapy 5 years after radiation treatment.

The patient discontinued treatments in a second course due to complete resolution of symptoms.

This case report demonstrates a potential for offering ALTENS to those long suffering from radiation-induced xerostomia.