To compare the image-based three-dimensional treatment planning using AcurosTM BV and AAPM TG-43 algorithm for intracavitary brachytherapy of carcinoma cervix.

Twenty-seven patients with cancer cervix, stage IIB or IIIB with vaginal involvement limited to the upper third of the vagina was included into the study. Intracavitary treatments with the patient in this study done with computed tomography and magnetic resonance imaging compatible ring applicator. Groupe European de Curietherapie and European Society for Therapeutic Radiology and Oncology recommended doses to target volumes and organs at risk compared using dose volume histogram.

The mean value of Point ‘A’ dose was compared between AcurosTM BV and TG-43, which indicates 0·13% difference. The differences in the mean dose to gross tumour volume for various volumes are V100% 0·28%, V150% 1·22% and V200% 1·03%; all volumes showed small difference but statistical significant (p<0·05). The mean dose of high-risk clinical target volume (HRCTV) D90 using AcurosTM BV was 8·47 Gy, which was 1·63% less compared with TG-43. The mean point A dose using AcurosTM BV is 1·04 times the dose to D90 of mean HRCTV. The same difference was observed in comparison with TG43. D2cc and D0·1cc of the bladder, rectum and sigmoid showed a statistically significant difference (p<0·05) in comparison with TG-43.

The differences in dosimetric parameters between the AcurosTM BV and TG-43 proved to be statistically significant. The difference is very small, and they are clinically insignificant.

The success of radiation therapy for cancer patients is dependent on the ability to deliver a total tumouricidal radiation dose capable of eradicating all cancer cells within the clinical target volume, however, the radiation dose tolerance of the surrounding healthy tissues becomes the main dose-limiting factor. The normal tissue adverse effects following radiotherapy are common and significantly impact the quality of life of patients. The likelihood of developing these adverse effects following radiotherapy cannot be predicted based only on the radiation treatment parameters. However, there is evidence to suggest that some common genetic variants are associated with radiotherapy response and the risk of developing adverse effects. Radiation genomics is a field that has evolved in recent years investigating the association between patient genomic data and the response to radiation therapy. This field aims to identify genetic markers that are linked to individual radiosensitivity with the potential to predict the risk of developing adverse effects due to radiotherapy using patient genomic information. It also aims to determine the relative radioresponse of patients using their genetic information for the potential prediction of patient radiation treatment response.

This paper reports on a review of recent studies in the field of radiation genomics investigating the association between genomic data and patients response to radiation therapy, including the investigation of the role of genetic variants on an individual’s predisposition to enhanced radiotherapy radiosensitivity or radioresponse.

The potential for early prediction of treatment response and patient outcome is critical in cancer patients to make decisions regarding continuation, escalation, discontinuation, and/or change in treatment options to maximise patient survival while minimising adverse effects and maintaining patients’ quality of life.

Electronic portal imaging device (EPID) offers high-resolution digital image that can be compared with a predicted portal dose image. A very common method to quantitatively compare a measured and calculated dose distribution that is routinely used for quality assurance (QA) of volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy treatment plans is the evaluation of the gamma index. The purpose of this work was to evaluate the gamma passing rate (%GP), maximum gamma (γmax), average gamma (γave), maximum dose difference (DDmax) and the average dose difference (DDave) for various regions of interest using Varian’s implementation of three absolute dose gamma calculation techniques of improved, local, and combined improved and local.

We analyzed 232 portal dose images from 100 prostate cancer patients’ VMAT plans obtained using the Varian EPID on TrueBeam Linacs.

Our data show that the %GP, γmax and γave depend on the gamma calculation method and the acceptance criteria. Higher %GP values were obtained compared with both our current institutional action level and the American Association of Physicists in Medicine Task Group 119 recommendations.

The results of this study can be used to establish stricter action levels for pre-treatment QA of prostate VMAT plans. A stricter 3%/3 mm improved gamma criterion with a passing rate of 97% or the 2%/2 mm improved gamma criterion with a passing rate of 95% can be achieved without additional measurements or configurations.

Head and neck cancer patients face many demanding events, such as radiation therapy, which can cause anxiety and uncertainty. Studies report that relevant information decreases emotional distress and inadequate communication can lead to increased fear and anxiety. There is a lack of research that describes what radiographers do when they meet the patients. The aim is to explain what radiographers’ do that may lead to less anxiety and uncertainty for head and neck cancer patients.

This study was conducted via qualitative interviews and took on a phenomenological, hermeneutic approach. Eleven head and neck cancer patients were interviewed 1-month post radiation therapy.

Successful meetings are characterised by the radiographer smiling, being pleasant, referring to the patient by their name, informing the patient thoroughly, asking open questions and answering questions.

Head and neck cancer patients feel vulnerable and need the radiographer to create a safe atmosphere when they undergo treatment. Then radiographers reduce uncertainty, provide emotional support, reduce loneliness, provide information and create alliances.

To review the incidence of clinically significant pulmonary toxicity following total body irradiation (TBI) as a part of the conditioning regimen for acute lymphoblastic leukaemia (ALL) patients undergoing bone marrow transplantation (BMT) at The Ottawa Hospital Cancer Centre.

This is a retrospective review of ALL patients who received TBI in The Ottawa Hospital Bone Marrow Transplant Program (TOH-BMT) as part of their conditioning regimen from 1991 to 2011 inclusive. The patients were treated using a locally developed translating-couch irradiation technique. We have analysed all available data for the first 100 days following TBI to determine the incidence of radiation-induced pulmonary toxicities.

Of the total 622 patients undergoing TBI during the specified period, 88 had ALL. Median age at BMT was 30 years and the conditioning regimens varied. A total of 74 (84%) patients received 12 Gy/6 F/BID of TBI. A total of 55 (63%) patients have died, 32 (36%) within the 1st year after BMT. In the 1st year, pulmonary events were reported for 24 (27%) patients, and the follow-up notes were unavailable for seven (8%). Pulmonary toxicities were reported as the cause of death for six patients, five (6%) within the 1st year. It is estimated that the total number of deaths in the 1st year possibly attributed to radiation-induced lung injury was four (4·5%). Eight (9%) patients had symptoms suggestive of non-lethal grade 2–3 radiation-induced pneumonitis.

TBI continues to be an important component of the conditioning regimen for ALL patients undergoing BMT, and the incidence of radiation-induced pulmonary injury, using our technique and lung dose, is comparable to the published literature.

Accupuncture-like transcutaneous electrical nerve stimulation (ALTENS) therapy has been shown in prospective studies to be effective in the treatment of radiation-induced xerostomia. Those studies treated patients within 27 months from end of radiation with ALTENS delivered in the clinic using a Codetron unit. However, that unit is no longer produced and there is limited data on success of ALTENS when delivered at home.

A 50-year old man with xerostomia, 8 years post-radiation for T4N1 squamous cell carcinoma of the tonsillar fossa, was given ALTENS with a currently commercially available unit from Girish Surgical. He used the unit at home, 20 minutes daily for 8 weeks.

After 8 weeks of ALTENS therapy the patient saw a reduction in the Self-Reported University of Michigan Xerostomia-Related Quality of Life Scale from 20 to 1.

This case report demonstrates (1) the Girish Surgical unit is effective, (2) self-administration of ALTENS in patients who cannot come to clinic regularly may be practical and (3) ALTENS can still offer durable benefit to patients even 8 years after chemoradiation therapy.

To investigate possible optimisation of the image guidance procedure for the prostate cancer patients with respect to imaging frequency and patient body mass index (BMI).

The 6,085 setup correction shifts and BMI for 216 prostate cancer patients treated on tomotherapy units in two centres were analysed. Margins needed to account for inter-fraction target motion with daily only automatic correction and with automatic and manual corrections during one, three or five first fractions as a reference for further treatment without imaging were calculated.

The planning target volume margin calculated for the daily automatic correction only scheme was significantly lower than the margins calculated for the image guidance limited to a few initial fractions. Manual corrections after automatic fusion were more important for patients with higher BMI. On average, the patients with normal BMI had manual correction shift of 0·7 mm in anterioposterior direction, while overweight and obese patients required, correspondingly, the shifts of 1·3 and 1·4 mm.

Overweight and obese patients require daily imaging with time saving available by performing automatic kV/MV computed tomography registration only. The patients with normal BMI may be treated with imaging guidance during a few initial treatment fractions.

This study evaluated the impact of a daily and weekly image-guided radiotherapy protocols in reducing setup errors and setting of appropriate margins in head and neck cancer patients.

Interfraction and systematic shifts for the hypothetical day 1–3 plus weekly imaging were extrapolated from daily imaging data from 31 patients (964 cone beam computed tomography (CBCT) scans). In addition, residual setup errors were calculated by taking the average shifts in each direction for each patient based on the first three shifts and were presumed to represent systematic setup error. The clinical target volume (CTV) to planning target volume (PTV) margins were calculated using van Herk formula and analysed for each protocol.

The mean interfraction shifts for daily imaging were 0·8, 0·3 and 0·5 mm in the S-I (superior-inferior), L-R (left-right) and A-P (anterior-posterior) direction, respectively. On the other hand the mean shifts for day 1–3 plus weekly imaging were 0·9, 1·8 and 0·5 mm in the S-I, L-R and A-P direction, respectively. The mean day 1–3 residual shifts were 1·5, 2·1 and 0·7 mm in the S-I, L-R and A-P direction, respectively. No significant difference was found in the mean setup error for the daily and hypothetical day 1–3 plus weekly protocol. However, the calculated CTV to PTV margins for the daily interfraction imaging data were 1·6, 3·8 and 1·4 mm in the S-I, L-R and A-P directions, respectively. Hypothetical day 1–3 plus weekly resulted in CTV–PTV margins of 5, 4·2 and 5 mm in the S-I, L-R and A-P direction.

The results of this study show that a daily CBCT protocol reduces setup errors and allows setup margin reduction in head and neck radiotherapy compared to a weekly imaging protocol.

We report a unique presentation of a late side effect associated with stereotactic body radiation therapy (SBRT) of the lung.

The case of a 65-year-old male who developed left-sided vocal cord paralysis after two courses of SBRT for squamous cell lung carcinoma is presented. The patient developed this late toxicity 15 months after his second treatment, which was to address a recurrence in the perihilar region of the left upper lobe.

Tobacco is a known addictive consumer product and its use has been reported to be associated with several health problems as well as the leading cause of premature, preventable mortality worldwide. For patients undergoing cancer treatment, tobacco smoking can potentially compromise treatment effectiveness; however, there is sufficient evidence suggesting numerous health benefits of smoking cessation interventions for cancer patients.

The Grand River Regional Cancer Centre (GRRCC) smoking cessation program began in October 2013 to provide evidence-based intensive tobacco intervention to patients. All new patients are screened for tobacco use and those identified as active smokers are advised of the benefits of cessation and offered referral to the program where a cessation nurse offers counseling. Patients’ disease site, initial cessation goal, quit date, number of quit attempts and mode of contact are collected by the cessation nurse. This study reports on the initial evaluation of the smoking cessation program activities at GRRCC.

There are 1,210 patients who were screened, accepted a referral and counseled in the program. The referral pattern shows a modest increase every year and most of the patients (58%) indicated readiness to quit smoking. Overall, 29 and 26% of patients either quit or cut-back smoking, respectively. Among 348 patients who quit smoking, 300 (86%) were able to quit at the first attempt. The data indicated that 309 (44%) out of the 698 patients who indicated their initial intent to quit smoking were able to quit, whereas about 242 (35%) were able to cutback. A total of 15 patients out of 32 who indicated initial readiness to ‘cutback’ smoking were able to reduce tobacco use and three patients actually ended up quitting, although their initial goal was ‘ready-to-cut-back’.

GRRCC smoking cessation program started in October 2013 to provide evidence-based intensive smoking cessation interventions for patients with cancer. Most patients referred to the program indicated a readiness to quit smoking affirming that if patients become aware of the various risks associated with continual smoking or if they are informed of the benefits associated with cessation with regard to their treatment, they will be more likely to decide to quit. Therefore, it is essential that patients, their partners and families are counseled on the health and treatment benefits of smoking cessation and sustainable programs should be available to support them to quit smoking. It is imperative then, that oncology programs should consistently identify and document the smoking status of cancer patients and support those who use tobacco at the time of diagnosis to quit. Evidence-based smoking cessation intervention should be sustainably integrated into the cancer care continuum in all oncology programs from prevention of cancer through diagnosis, treatment, survivorship and palliative care.

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.