roles for radiation therapists are currently in a period of rapid global change. technological advancement, increased entry-level education and the growing specialisation and professionalisation of many non-physician clinician groups are all significant drivers for change. there has been considerable interest in the province of ontario in “advanced practice” roles for therapists. this literature review identifies some of the background issues involved from a local and global perspective.

purpose: to identify factors determining the possibility of role development for therapeutic radiographers in hong kong public hospitals.

methods: questionnaires were sent to all ranks of radiographers, clinical oncologists, medical physicists and nurses in four clinical oncology departments in local public hospitals. information was sought on role development and the nature of extended role tasks that should be undertaken by therapeutic radiographers. both open and closed questions were used to ascertain views. individual, semi-structured interviews were used to explore further opinions of therapeutic radiographers. for open-ended questions, data were analysed thematically by grouping similar opinions, while for closed questions data were analysed by descriptive statistics and independent-samples t-test/levene's test for homogeneity of variances.

results and discussion: in total, 132 out of 285 questionnaires were returned (46.32%). subjects (77.10%) expressed views that role development in therapeutic radiography (rt) would have a positive impact on oncology services within the region. medical dominance was highlighted as the main barrier to role development (mean: 2.86; sd: 1.78). radiographers would tend not to extend their roles by taking up tasks that were performed by oncologists: for example, radiographers would not want to prescribe drugs to patients with radiation side-effects (57.58%), while 83.33% of oncologists also disagreed with this being performed by radiographers. other professionals (nurses and medical physicists) held a reserved view in delegating their tasks to radiographers, even after accredited clinical training.

conclusion: role development in rt should relieve the increasing workload of the entire clinical oncology department. it also increases the status of therapeutic radiographers within the health care setting, which is beneficial for the whole profession. however, efforts must be made by all health professionals within the department to ensure that the greatest effectiveness can be achieved from such developments.

background: verification of radiation therapy treatment using electronic portal images (epi) involves the correlation between a reference image and a treatment epi. this paper investigates the accuracy and confidence in reference anatomy outlining and anatomy matching components of epi review, when performed by radiation therapists with varying experience in epi analysis.

methods: thirty radiation therapists performed reference anatomy contouring and anatomy matching of seven pairs of reference and treatment images belonging to five previous patients. accuracy was determined by the discrepancy (mm) between the anatomy contouring and matching of the subjects and the original parameters completed by an experienced senior radiation therapist, with formal training in epi analysis. confidence was recorded on a 10cm visual-analogue scale (vas).

results: no significant differences were found in the accuracy of anatomy contouring or anatomy matching between subjects with and without formal epi training nor between subjects with less than or greater than five or more years of radiation therapy experience (p > 0.18). significantly different confidence scores were found in subjects with formal training in epi (p < 0.00006)

conclusions: accuracy of anatomy contouring and matching was not significantly influenced by the years of radiation therapy experience and formal epi training, although these factors did affect subjects' confidence in performing epi review tasks. frequent exposure to portal image analysis may be as or more important to the technical skills required in epi review, than formal training or years of experience.

there is currently great interest in the treatment of prostate cancer due to its increasing profile in the older male population. in recent years brachytherapy has become a viable treatment option. low dose rate implants using permanently implanted radioactive seeds and high dose rate treatments using afterloading machines are two methods regularly used for the treatment of this disease. both techniques require close integration between imaging and the placement of the radioactive sources. future developments in imaging will lead to improved targeting of the radiation to diseased areas of the prostate and interactive treatment planning. this review paper describes the current status of the treatment of prostate cancer by brachytherapy, references current published results and examines radiation protection issues.

study objective: the study intended to investigate the possible relationship between physical activity and prostate cancer risk on a previously unexamined population set.

design: a population-based study was conducted on males entered on the irish cancer registry between the years 1994 to 1997 to investigate if physical activity affected the risk of prostate cancer. activity was coded for three levels of occupational activity and the odds ratios were calculated together with 95% confidence limits.

results: despite limitations in the data, an elevated risk (odds ratio 2.13, 95% confidence interval 1.29–3.52) was seen in working subjects with low levels of activity compared with the high activity group. in the retired group there was a slight elevation of risk, although it was not statistically significant.

conclusion: the study suggests that physical activity offers a small but significant reduction in prostate cancer risk for those people in work.

the trial required field placement to within 3mm. radiographers from participating centres related set-up methods to accuracy to establish best practice and inform recommendations. all centres made changes to methods as a result of the trial to improve accuracy, identified in categories, including patient positioning, iso-centre setting, couch top, imaging methods, and bladder and rectal filling. up to 80% of centres made changes in any one category.

in three centres accuracy was inferior in one axis, related to the set-up methods used.

recommendations included:

1. for reproducibility –

1. achieving a comfortable bladder status

2. using a standardised firm head support (not pillow)

3. using the hands on chest position to avoid the weight of the arms on the trunk

4. aligning lateral tattoos in both the longitudinal and vertical directions

5. using leg or ankle supports

evidence-based methods of controlling rectal filling are still required

1. for iso-centre setting –

1. using the anterior tattoo for lateral direction and the lateral tattoos for the superior/inferior direction

2. using a solid/carbon couch top throughout, using the height above couch as the reference measurement, not the anterior source to skin distance

3. develop an alternative to using the couch height readout alone

this paper aims to evaluate the range of techniques available to minimise both interfraction and intrafraction errors. the main interfraction errors are due to changes in volume of the rectum and bladder. intrafraction errors are mainly due to respiration and to a lesser extent cardiac motion. there are various methods of minimising internal organ motion that attempt to permit reduction of the internal margin around the clinical target volume (ctv).

techniques such as rectal balloon insertion and breathing control are evaluated to determine their role in reduction of margins for improved conformal radiotherapy. the paper concludes that rectal balloons have been shown to permit limited reduction of internal margins and morbidity levels. breathing control has not increased reproducibility, but has allowed for reduction in lung morbidity. reduction of margins can only be recommended when using breathing control in conjunction with daily ctv relocalisation.

although these techniques do have a role to play at the moment, it appears that attempting to maintain a static environment within the highly mobile patient is fraught with difficulties and we must accept that there is always going to be motion. rather than attempting to control the position of the tumour, future developments such as adaptive radiotherapy and tomotherapy may account for the movement.

radiotherapy skin care is a contentious issue surrounded by myth, damaging and frightening stories and unfounded guidance. this is compounded by the fact that, when seeking information, patients, relatives and staff are faced with a barrage of conflicting, poorly researched data. each of the five scottish cancer centres worked together to produce guidance for all health professionals who are involved in the care of patients with radiotherapy skin reactions. as a result, a “best practice statement” has been produced to give an overall view of radiotherapy skin reactions and their recommended care. this will guide best practice and dispel the many myths of care, which are still in existence, thus ensuring that equity of best practice care is available to all patients.

an investigation of human resource issues in radiotherapy physics services in the nhs, including an evaluation of the extent to which the management of human resources was strategic, was undertaken as part of mba level research by a radiotherapy clinical scientist. the research incorporated a telephone census of heads, or acting heads, of radiotherapy physics services. this census looked at the establishment and scale of radiotherapy physics services, issues around recruitment and flexibility, business management, strategy and strategy formation and human resource management practices.

a 96% response rate was obtained with 55 out of a potential population of 57 subjects participating in the survey. it was found that at the time of the survey, 11.0% of all radiotherapy physicist posts were vacant. this was due predominantly to recruitment difficulties. furthermore, 42% of radiotherapy physicists in post were relatively inexperienced, having spent less than 6 years in the discipline. eighty-seven per cent of services had re-graded radiotherapy physicist posts in order to recruit. additionally, 53% of services had changed their skill mix by increasing the ratio of technologists to physicists. fifty-nine per cent of those services did so because of difficulties in recruiting radiotherapy physicists.

whereas 38 respondents (69% of total) said they had a human resource strategy linked to the service's business strategy, only 12 respondents (22% of total) claimed to undertake appraisal and training needs analyses coupled with personal development plans and continuing professional development. relatively little succession planning was undertaken, and only 14 services (26% of total) had well-developed succession plans.

recommendations are made as to how human resource management in nhs radiotherapy physics services could be more strategic.