Radiographers are undertaking roles that are a development and extension of what has traditionally been seen as their remit. As with any development, it is important that such changes in practise have a positive rather than negative effect on patient care and patient experience. This article examines patient perception and level of patient satisfaction of an ‘on-treatment review’ conducted by a site-specific advanced practitioner radiographer instead of an oncology doctor. Overall, the results were positive suggesting that such reviews, when conducted by an appropriately trained individual, can enhance patient care and provide a satisfactory level of support during treatment.

Objective: To systematically review and critically appraise all evidence on skin care advice and products tailored for patients receiving radical radiotherapy for breast cancer and to determine an evidence-based conclusion regarding the most effective products.

Data Resources and Review Methods: Major healthcare databases were searched with additional efforts made to hand-search current journals. All relevant literature fulfilling the inclusion and exclusion criteria was subjected to quality assurance checks. Those that passed underwent a more rigorous appraisal and were included in the review.

Results: Ten studies were identified as fulfilling the review criteria with regards to aims and quality. All were randomised controlled trials; three were double-blinded, three were single-blinded, the remaining were not blinded. Two addressed washing regimes, two addressed deodorant use, whilst the six remaining studies investigated creams, gels or dressings.

Conclusions: The results suggest that there is a place for creams in the management and delay of radiation-induced skin toxicities; however, research fails to highlight one product which has a demonstrable benefit over others whilst still being cost effective and free from adverse effects. Patients should not be discouraged from washing with water or mild soaps and results suggest that the restriction of aluminium-free deodorant during treatment is unnecessary; however, more research in this area is needed with larger sample sizes.

As more and more patients are planned in 3D, the need to verify their position and treatment in 3D also becomes apparent. Megavoltage (MV) and kilovoltage (KV) cone beam computed tomography (CBCT) provide 3D verification of patient position. However, the soft tissue contrast and thus the accuracy of delineation is superior with KV CT imaging. CBCT in conjunction with energy fluence maps from electronic portal imaging devices (EPIDs) could theoretically be used to verify the dose delivered. In this instance, a cross calibration between the KV CBCT and the EPID would be required which would not be necessary with MV CBCT. Adaptive planning with CBCT poses similar challenges for both KV and MV CBCT. Although KV CBCT can produce images with Hounsfield units (HUs) comparable with conventional CT in homogenous phantoms there are large discrepancies in inhomogeneous mediums. If the cupping artefact is corrected for in MV CBCT, the HU values can compare well with KV CBCT for homogenous media. However, advances need to be made to achieve a lower patient dose with MV CBCT. At present, the lower dose required for KV CBCT allows for more frequent imaging and better image quality.

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.

In recent years the role of the radiation therapist (RT) has increasingly evolved. In Australia, one of the major developments has been the transition from practice which was rarely based on scientific evidence, to the profession today which engages in and incorporates research into everyday practice. The aim of this article is to provide an insight into the current status of Australian radiation therapy research. In order to present a national overview, a survey relating to research activity was e-mailed to all (48) clinical centres in Australia. Thirty-six out of the 48 centres responded, representing 13 private and 23 public centres. The results demonstrated that a research culture is beginning to be established and that there are challenges associated with implementing research. The role of universities in facilitating the development of research skills was considered important with an increasing number of practitioners undertaking higher research degrees. Overall, research activity in the Australian radiation therapy community is becoming more prevalent. If the profession is to continue to strengthen its research profile the professional body and universities need to continue providing academic and funding support. Greater focus on multidisciplinary collaboration is needed with direct involvement of RTs in multi-centre studies.

This research aims to establish the prevalence and aetiology of anxiety and depression in cancer patients within their first 2 weeks of a radical course of radiotherapy. Depression followed by anxiety is the two most frequent psychological disorders experienced by cancer patients. However, these two disorders are frequently undiagnosed and untreated in patients undergoing a course of radiotherapy possibly because the treatment side effects often simulate those of anxiety and depression; the consequences of this can be reduced patient prognosis and increased health care costs. A questionnaire was administered to a sample of 100 eligible cancer patients and this yielded a 68% response rate. The Hospital Anxiety and Depression (HAD) scale was integrated into the questionnaire to accurately establish levels of anxiety and depression in the respondents of the study. The study identified six respondents with clinically significant levels of anxiety (9%) and six with depression (9%); 21% (n = 14) of participants had higher than normal levels of anxiety and 21% for depression (n = 14). Correlations were then identified between levels of psychological distress and the four independent variables; age, diagnosis, adjuvant medication and pain. Four predisposing factors were established—breast cancer diagnosis, age range 40–50 years, the presence of pain and adjuvant chemotherapy regimes.

Aims: Monitoring and reviewing patients during adjuvant radiotherapy for breast cancer is an integral component of care and was until recently a predominantly medical domain. Patients were often reviewed in busy routine breast clinics, for short consultations with a variety of medical staff and with little time to address questions or concerns. Non-medical treatment review clinics, staffed by senior nursing and senior therapy radiographers have been introduced to provide a dedicated, consistent treatment review. This survey was conducted to assess the effectiveness of the non-medical review of these patients.

Materials and methods: This was a prospective survey of all patients attending for breast or chest wall radiotherapy, between 1st July 2003 and 30th June 2004. Patients were invited to complete and return a postal questionnaire related to their treatment and treatment review. Review staff collected data on demographic information, clinical history and treatment intent for these patients at first visit. At subsequent weekly review visits, data were recorded relating to patient assessment, interventions and referrals initiated. Skin reactions were graded using Radiation Therapy Oncology Group scoring tool.

Results: One thousand and ninety-five patient questionnaires were distributed and 865 (79%) were returned. There were high satisfaction scores with the time spent with review staff (99.7%) and the ability to discuss all aspects of treatment and concerns (99.1%). One hundred and ninety-three patients were referred to non-medical staff for additional support. Five hundred and forty-four were referred to medical staff. The majority (437) were planned referrals to their clinical oncologist to prescribe a ‘boost’ or review endocrine treatment and 107 to their general practitioner for routine visits and employment certificates. Review staff data of 1,067 patients showed 342 referrals for treatment and non-treatment related physical problems, 80 referrals for additional information and emotional support. Majority of skin reactions were grade 1 or 2a.

Conclusion: The successful identification of patients’ supportive needs and high patient satisfaction with this service supports the use of this approach.

Purpose: The aims of this study were to describe the scope of practice of the radiotherapy ’on treatment’ review radiographer. This included trying to gain an insight in to what knowledge, skills and characteristics are needed to operate in this role extension and to establish whether the role requires skills in areas of patient care and support which are beyond the generic training of a treatment floor therapy radiographer.

Method: A qualitative grounded theory methodology was employed using semi-structured interviews with ’on treatment’ review radiographers from three different departments. The departments were selected to maximise the amount of data collected, consequently they were chosen due to the differences in the way their review service was set up. This ranged from full time, to team led, to part time review. Using coding and constant comparative analysis based on grounded theory, categories were developed describing attributes of the role.

Results: The scope of practice and challenges of the role varied slightly between the departments. The core categories needed to operate in the role were identified as knowledge, listening skills and characteristics with sub categories of self-reflection, interpersonal skills and attitudes.

Conclusions: To be a review radiographer requires advanced knowledge at Masters level, with well developed listening and interpersonal skills and enjoyment of the people side of the profession. These skills need to be regularly practised, updated and reflected upon. The requirements for further training needs are noted and recommendations for further research are identified along with the limitations of this research. The role appears to require knowledge and skills in areas of patient care and support, which are above the level of practice of a treatment floor therapy radiographer.

According to the World Health Organization (WHO 2006), cancer is one of the leading causes of death worldwide. Deaths from cancer are projected to continue rising, with an estimated 9 million people dying from cancer in 2015 and 11.4 million dying in 2030 (WHO 2006). Delayed presentation or late diagnosis of cancer is associated with low survival. The aim of this review is to identify factors associated with delayed presentation of cancer that were reported by previous studies. Published studies which identified the most common factors attributed to the late presentation of cancer were reviewed. Publications were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), the Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and EMBASE (Excerpta Medica Database) databases. A Critical Appraisal Skills Programme (CASP) was used to assess the methodological quality of the studies. A total of 24 studies met the inclusion criteria. A data extraction sheet was used to systematically record relevant factors. Twenty-four studies met the inclusion criteria which identified factors associated with patients’ delay including patients’ knowledge, stress and fear, and nature of the disease. Other factors were attributed to health providers such as general practitioner (GP) experience, referral delay, and a younger age group being considered as low risk, so symptoms were missed.

In this article the potential for use of electronic portfolios by healthcare practitioners and students is considered in the context of work currently being undertaken in the School of Health at the University of Wolverhampton. We write at a time when knowledge of, and interest in, eportfolios is expanding beyond a relatively small number of projects and into the consciousness of a wider audience of academics and institutions. In the last 2 years interest in eportfolios has grown rapidly, particularly within a Higher Education sector keen to meet the Higher Education Funding Council for England/Quality Assurance Agency progress file deadline in 2005, but also spurred by the reports of Burgess (Universities UK. Measuring and recording student achievement, 2004 [Online report] [Accessed: 01 March 2006]. Available from: http://bookshop.universitiesuk.ac.uk/downloads/ measuringachievement.pdf) and of Tomlinson (DfES. Harnessing Technology: Transforming learning and children's services, 2005. [Online Report]. Published 15 March 2005 [Accessed: 01 Mar 2006]. Available from: http://www.dfes.gov.uk/publications/e-strategy/index.shtml). Examples of the use of eportfolio as a means of recording achievement and, in particular, facilitating reflective practice are discussed. The potential of an eportfolio system incorporating asynchronous communication features to resolve the tensions between academic and clinical practitioner roles is explored.

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.

Introduction: Benchmarking can be used to improve hospital performance. It is however not easy to develop a concise and meaningful set of indicators on aspects related to operations management. We developed an indicator set for managers and evaluated its use in an international benchmark of radiotherapy centres. The indicator set assessed the efficiency, patient-centeredness and timeliness of the services delivered.

Methods: We identified possible indicators from literature and professionals. Stakeholders’ feedback helped to produce a shortlist of indicators. For this indicator set, data were obtained in a pilot that included four European radiotherapy centres. With these data, the indicators were evaluated on definition clarity, data availability, reliability and discriminative value.

Results: Literature produced a gross list of 81 indicators. Based on stakeholder feedback, 33 indicators were selected and evaluated in the benchmark. Six negatively evaluated indicators were adapted, together with eight positively evaluated indicators 14 indicators seemed feasible. Examples of indicators concerned utilisation, waiting times, patient satisfaction and risk analysis.

Conclusions: This study provides a pragmatic indicator development process for international benchmarks on operations management. The presented indicators showed to be feasible for use in international benchmarking of radiotherapy centres. The pilot identified attainable performance levels and provided leads for improvements.

Part two of this two-part series presents the results of a departmental initiative implemented in 2003 at a large urban cancer centre, Princess Margaret Hospital (PMH) in Toronto, Ontario, Canada. This new model for radiation therapists was called Advanced Integrated Practice (AIP) and was developed, in part, to encourage and promote scholarship within radiation therapy. The AIP model incorporated integrated clinical specialty roles designed to blend exemplary clinical practice with focused academic activities. This paper discusses an evaluation of the AIP model undertaken to obtain a formal measure of how the model had evolved, how the radiation therapists and other stakeholders were responding to the new model, whether the initial outcomes were realized and to create plans for further development of the design. The evaluation utilized a mixture of traditional qualitative research methodologies such as focus groups, quantitative surveys and a variety of other available measurable outcomes. Outcomes from the model included increased opportunities for diverse roles that incorporated an element of academic practice and augmented career choice and scope for radiation therapists. In addition, academic output and research work also increased within the department. Lessons learned from the implementation and evaluation of the model are shared, and the authors offer some suggestions to increase scholarly activity within the profession.

Purpose: With the advent of multi-disciplinary team working in Oncology practice, this audit was designed to assess patient satisfaction with this approach within an on-treatment review clinic for breast cancer patients. It also aimed to look at conformity of reporting of treatment side effects between different staff groups.

Patients and methods: A questionnaire was distributed to 230 radical breast cancer patients once a week after each review clinic. An oncologist and a radiographer or nurse reviewed the patients during weeks 1–4 of treatment. A review form was completed at each visit specifying any side effects noted.

Results: Patients appeared satisfied with their clinic visits to both the radiographer and nurse with 84 and 85% confidence and trust in the members of staff compared to 73% with the doctor. There was disparity in the recording of side effects between non-medical and medical staff groups.

Conclusion: This audit has provided good evidence to support the continuation of multi-disciplinary review clinics. A key benefit is the reduction in clinic waiting times for patients and a substantial time saving for the medics. It also supports role development for the radiographer and nurse involved.

Purpose: To identify the challenges and opportunities that prevent Radiation Therapist (RT) led research at our clinic. Insight gained from this process may lead to strategies which can encourage and support RT research. In this way we can ensure evidence-based practises are promoted by RTs as well as enhancing the professional profile of RTs in the research domain.

Methods: A qualitative approach was chosen for this study. Five focus group sessions were conducted to discuss issues related to research participation within our department. Sessions were audio-recorded and transcribed. Thematic analysis occurred whereby overarching themes were identified, content categories were developed, and summaries were written from these categories. Pre-dominant themes were later presented to the entire radiation therapy department for member checking. Answers to a series of questions were obtained anonymously through the use of iClickersTM (MacMillan MPS, Gordonsville, VA). Further, an open group discussion followed focusing on three key areas (departmental, personal and professional). Initiatives or opportunities that could be implemented to increase research activities were discussed and recorded by a designated note-taker.

Results: Nineteen RTs participated in five focus group sessions. The over-arching themes identified were definition of research, involvement in research and the barriers to conducting research. Member checking confirmed these major themes.

Conclusion: We identified the challenges faced by RTs in the areas of research and development at our centre. This information has given us a greater understanding of the culture of our department and the attitudes to research activities from all groups within it. We aim to use these insights to set-up a framework of support to facilitate increased initiatives. Alongside this support RTs will have a clear understanding of their responsibilities to the organisation that facilitates their research. We anticipate these developments will lead to greater job satisfaction for RTs, increased staff morale and most importantly, the improvement of the overall quality of services we deliver to our patients.