Staffing and equipment levels in the UK are impacting heavily on waiting times for radiotherapy. This paper presents the results of financial and organisational interventions on the radiotherapy waiting list at the Derbyshire Royal Infirmary. Efficacy of these interventions was assessed using audits before and after their application. The interventions included working extended days and weekends, employment of agency staff and “out-of-hours” machine servicing and maintenance. A Waiting List and Data Quality radiotherapist was appointed to streamline the radiotherapy referral system. A waiting list database application was developed to book patients in the correct order of priority and within target waiting times. The resulting increase in radiotherapy workload was achieved over a 3-month period at an approximate cost of £30,000, albeit with several implications. Staff felt that the pace of work was unsustainable, although sickness rates did not increase. After the interventions were removed, and waiting times increased, staff morale dropped. Extended working hours impacted on the reliability of the machines, causing more unscheduled interruptions than normal. This indicated the need for additional maintenance or servicing sessions.

This paper shows that full compliance with RCR guidelines for waiting times is achievable, given sufficient financial and organisational assistance.

Background and purpose: Due to the increased complexity of the radiotherapy process in recent years, many QA procedures have been introduced to improve the quality of the treatment preparation and the treatment delivery. Most of these procedures give no direct information on the efficiency of the overall process in the radiotherapy department. It is quite evident that the frequency of errors will affect the efficiency of the process (for instance manpower to solve the detected problems), but also affect more generally the patients' experience.

Material and methods: To make some objective assessment of the erroneous entries in the process of radiotherapy, a pilot study was initiated to report all problems during a period of 2 months on a dedicated QA form. By registration of these errors, the QA group could trace the main sources of the decrease in efficiency and increased waiting time for patients.

Results and conclusions: For 46% of the patients during the two months at least one QA forms was filled in. With these QA forms 198 erroneous entries including 33 erroneous treatments were reported. Regarding the origin of the problems, the majority (60%) were generated in the planning process, while 56% of the errors were detected at the treatment unit before or during delivery of the first fraction. In total 461 actions were undertaken to recover all the reported errors. This generated time delay for 145 patients. Extrapolating these results to a year, a 0.7 full time equivalent person is spent to recover these errors, while the total patient population waits for about 140 hours. Corrective actions have been undertaken to optimise the overall process.

The Clinical Oncology Patient Liaison Group (COPLG) was established by the Faculty of Clinical Oncology of The Royal College of Radiologists in 1997. One of the early issues to be addressed by the COPLG was the “patient-friendliness” of radiotherapy departments in the United Kingdom. A questionnaire relating to several aspects of patient care was formulated substantially by the lay members of the Group and circulated to all departments. There was a 63% response rate. The results demonstrated considerable variation in departmental practice and they were used as the basis for writing a booklet entitled “Making your Radiotherapy Service more patient-friendly”, which was circulated to all departments. This was intended to give practical suggestions on improving services, recommending only what had been shown to be feasible. A year later another questionnaire was circulated, designed to measure the effect of the booklet. There was a 53% response rate. In the great majority of responding departments the booklet had influenced staff and had led to changes in practice and improved care. The service areas most influenced were the provision of facilities for waiting patients, the provision of information about treatment, the maintenance of privacy and dignity and surveying the views of patients.

Persistent nausea remains one of the most distressing side effects of radiotherapy treatment despite advances in anti-emetic medication.

Stimulation of the Nei-Guan (P6) acupoint on the wrist has been used in Chinese medicine to treat nausea for over 4,500 years. Studies have demonstrated that acupressure wristbands can reduce postoperative nausea, motion sickness, morning sickness and chemotherapy-induced nausea. This pilot study aimed to determine if they could also help reduce radiotherapy-induced nausea. There are no published reports of their use in this setting, thus this preliminary pilot was conducted before engaging in a major study.

A prospective, paired, cross-over study investigated the impact adding acupressure wristbands to the usual anti-emetic care had on radiotherapy-induced nausea. Over the trial period, 30 patients were recruited when they reported radiotherapy-induced nausea to radiotherapists. Their daily nausea levels were assessed for a fortnight using a simple questionnaire and an anti-emetic tablet count. Comparing the 2 weeks data for these patients showed that there was a dramatic drop in their scores when the acupressure wristbands were used. There was a mean score drop of 61% for the combined nausea and vomiting frequency and severity, i.e. a 61% improvement in quality of life.

This study suggested that acupressure wristbands might have a role to play in the treatment of radiotherapy-induced nausea. It is recommended that further studies be conducted to determine their exact role. They potentially offer several benefits when compared to anti-emetic medication. They are easy to use, have no side effects and are more economical since they are reusable. Furthermore, acupressure wristbands place the patient in control of their nausea to some degree. This in turn will make the patients feel less anxious, less depressed and reduce the common feelings of helplessness that often accompanies cancer patients.

This article reviews portal imaging undertaken for prostate cancer with the intention of developing an imaging protocol for this category of patient. It explores the online and offline approaches of electronic portal imaging, when intervention for field placement errors (FPE) should take place and who actually makes this decision. The choice of reference image is discussed and the questions the use of re-simulation. This paper concludes that it is necessary to image for three fractions in the first week in order to highlight systematic errors, that an electronic portal imager is cost effective in time and money, and that radiographers should review images and make the decisions upon intervention strategies. Images will be reviewed via a quantitative template method rather than via a qualitative “eyeball” method.

A 71-year-old man with Stage II gastric cancer developed rapid onset radiation induced liver disease after ceasing adjuvant chemotherapy and radiotherapy. Autopsy revealed moderate hepatocellular iron overload. Posthumously, he was found to be a compound heterozygote for hereditary haemochromatosis. Since both radiation and iron overload may induce liver damage through the activation of hepatic stellate cells, it is possible that hepatocellular iron overload may potentiate the effects of irradiation and predispose the patient to radiation induced liver disease.

Introduction: Conformal radiotherapy demands an accurate and reproducible treatment set up technique therefore the purpose of this study was to determine whether the current techniques were suitable for use with conformal treatment plans and to establish whether the current verification procedure was adequate.

Method: 30 patients undergoing radical radiotherapy were recruited to each technique to be studied. Megavoltage images (MVI's) were taken twice during week one and then at weekly intervals. All study images were assessed after the patient had completed the treatment course using Masthead PIPS software. Field placement errors were recorded in x, y and z directions where appropriate. Patient characteristics were recorded to establish whether there was any relationship between reproducibility and patient size.

Results: Head and neck: 26.6% patients had one or more errors >5 mm, 3.3% had consistent errors >5 mm throughout treatment. Poor fit of the beam direction shell was associated with errors >5 mm. Chest and abdomen: The technique was modified after 20 patients due to the large number of errors exceeding 10 mm. A significant (p < 0.01) reduction in the number of errors was in the modified technique group, this group also had a significantly (p < 0.01) reduced range of errors in the y direction. Pelvis: Significantly more errors were seen in the y and z directions using the sinmed kneeblock. A link between field placement errors and patient size was found.

Conclusion: Imaging on the first fraction is not sufficient to determine whether a set up error is likely to occur consistently during treatment, at least two sets of images are required. The study has shown that technique development is necessary for the chest, abdomen and pelvis prior to the introduction of conformal radiotherapy.

This technical note describes a port film graticule that can be used to determine the central axis of a portal image when used with megavoltage film or on-line electronic portal imaging. The construction and quality control of the portal film graticule are highlighted.