Purpose: Sexual dysfunction is a well-documented side effect of radical radiotherapy treatment for prostate cancer and the provision of information to patients is often a radiotherapist and assistant role. The study sought to measure the attitudes and beliefs of individuals before and after an educational intervention and establish current practice in providing sexual information.

Method: A quantitative approach with a minor qualitative element was used. A simple pre–post test questionnaire design using an adapted version of the Reynold and Magnan (2005) Sexual Attitudes and Beliefs’ Questionnaire was utilised. The educational intervention was a Reflective Learning Package (RLP).

Results: Fifty-six participants took part, a response rate of 87.5%. The data was analysed using SPSS, version 15. The RLP had a highly significant effect on improving the attitudes and beliefs of the participants (Wilcoxon test 0.000 p < 0.001). Qualitative data key themes showed lack of knowledge, confidence and embarrassment were the main barriers to giving sexuality information during the ‘first day chat’.

Conclusion: There may be a need to address the current methods of education and support of staff being prepared to perform this important role and to recognise that personal limitations may influence the individuals’ effectiveness in communicating sexuality information.

Objective: Freeform reflective writing is one way that radiation therapists can document their development. Barriers to this form of writing include the fact that some radiation therapists do not know what to write or how to begin this writing process. This paper outlines the development and validation of guided inventories called the Newcastle Reflective Inventories and the validation of the Newcastle Reflective Analysis Tool as an effective tool for assessing short-form guided reflective writing.

Method: The Newcastle Reflective Inventories consist of a series of questions that guides the user through the reflective writing process. Validation of the Newcastle Reflective Inventories involved comparing the evidence of reflection in 14 freeform journals to that of 14 inventories completed on the same topic. Validation of the Newcastle Reflective Analysis Tool included the assessment of 30 Newcastle Reflective Inventories.

Results: There was a highly statistically significant difference (p < 0.001) in the high levels of reflection evident in the inventories when compared to the lower levels of reflection in the freeform journals. Good levels of agreement were achieved between the coders.

Discussion: These results show that the Newcastle Reflective Inventories are effective tools in promoting reflective writing when compared with freeform journaling.

Purpose: To investigate the dosimetric consequences of rectal distension at the time of the planning computed tomography (CT) scan and any resultant prostate movement on the planned dose delivery for patients receiving three-dimensional conformal radiotherapy (3DCRT) to the prostate.

Methods and materials: 25 prostate cancer patients whose planning CT scan demonstrated a full rectum were rescanned after following a laxative protocol. Rectal dimensions on the two scans and 3DCRT treatment plans produced on each plan were compared. The dosimetric implications of changes in rectal size on the treatment plans and the delivered dose were determined. Statistical significance was evaluated with the Wilcoxon signed ranks test.

Results: Significant differences in rectal size were found between the initial CT scan and the rescan. The corresponding median change in prostate position was 4.7 mm. The use of planning scans with a full rectum, that is unrepresentative of the rectum, during treatment causes significant reductions in planning target volume (PTV) minimum dose (median reduction 33.7%) and coverage by the 95% isodose (median reduction 3.7% of the PTV).

Conclusion: Rectal distension on the initial planning scan can lead to significant PTV underdosage. Patients presenting with large initial rectal fillings must be rescanned in order to avoid a systematic underdosing of the PTV.

Carbon fibre couch inserts are widely used in external beam radiotherapy to provide rigid and lightweight patient support. Carbon fibre is often perceived to be essentially radiotranslucent implying that it does not interfere with the radiation beam. However, there is evidence in the literature which suggests that this perception may not be appropriate, particularly at oblique angles of incidence. Furthermore, there is evidence indicating that the use of carbon fibre significantly reduces the skin sparing effect. In this study, the radiation attenuation and surface dose enhancement characteristics of the carbon fibre insert for the Varian ExactTM couch have been investigated. It was found that attenuation increased significantly with increasing angle of incidence, resulting in in-phantom dose reductions of up to 6% at 6 MV and 4% at 15 MV. It has been shown that it is possible to model couch attenuation on a commercial treatment planning system (Elekta CMS XiO) by including the carbon fibre insert in the planning computed tomography (CT) dataset. Finally, the carbon fibre insert was found to significantly increase skin dose to the patient. The skin dose was approximately three times as large when the couch insert was added to 6 and 15 MV photon beams. However, even with this substantial increase it is highly unlikely that the skin tolerance dose will be exceeded.

Background and purpose: Research is increasingly important in radiation therapy, but radiation therapists (or therapy radiographers) (RTs) are relatively new to research and may have difficulty defining research topics. Our aim was to identify the group interests and focus research priorities of Australian RTs. Although not measured, an additional aim was to make RTs more aware of the relevance of RT research.

Materials and methods: An Australia-wide Delphi process was used, examining the problems related to patient care, working with colleagues, and radiotherapy in general, that RTs experienced in their daily work. In an initial study, 374 problems were identified. These were translated into 53 research areas which were prioritised in the second stage of the study. Agreement between groups was analysed using a hierarchical cluster procedure and post hoc Scheffe multiple comparisons.

Results: There were three groups of responders with varying degrees of research interest. There was agreed high importance (p > 0.01) for the technical aspects of radiation therapy, such as image guidance, intensity-modulated radiation therapy (IMRT) and patient positioning. There was significant disagreement (p < 0.001 to p = 0.023) between groups on the importance of patient care research.

Conclusions: The strong interest in technical research is consistent with the rapid influx of technology, particularly in imaging. The disagreement on patient-related research may be of concern. The list of potential research areas specific to radiation therapy will be useful for new RT researchers to consider.

Background: In July 2005 the national forum of gynaecological oncology nurses published the first UK best practice guidelines for the use of vaginal dilators after pelvic radiotherapy. It was written following a Cochrane review by Denton and Maher suggesting that vaginal dilators minimised vaginal stenosis and improved sexual function. Women within the author’s large cancer centre are advised to use vaginal dilators in accordance with the national recommendations.

Primary outcome measure: To evaluate compliance with the use of vaginal dilators in women who have received radiotherapy for either cervix or endometrial cancer. Compliance was defined as the use of vaginal dilators two or more times a week, at 6 months.

Design: One hundred and sixty-four women were posted questionnaires. Potential participants had received pelvic radiotherapy for cancer of the cervix or endometrium, were 6 months to 5 years post-treatment and disease free. The 18-point questionnaire consisted of 11 points assessing demographics and dilator use, while points 12–18 related to vaginal symptoms. Simple descriptive statistics were used to describe demographics. Mann–Whitney U and Fisher’s exact tests were used for one-at-a-time analysis of compliance against age, vaginal symptoms, treatment modality and cancer type.

Results: Seventy-five completed questionnaires were returned (response rate 45.7%). Seventy-four out of the 75 respondents had been offered vaginal dilators during treatment. 89.2% (66/74) were compliant with vaginal dilation (95% confidence interval 80.1% to 94.4%).

Conclusion: The compliance rate in this study was greater than seen in previously published studies. This could be due to the intervention by practitioners within the author’s cancer centre. Further prospective evaluation studies are required to explore the potential benefits of intervention at 6 months post-treatment to improve long-term compliance.

Timely administration of palliative radiation therapy (PRT) to manage symptoms derived from advanced prostate cancer is necessary to help alleviate discomfort and improve quality of life. Despite PRT being an effective treatment, analyzing utilization rates in British Columbia (BC), Canada for palliative purposes implies it is an under-utilized medical resource. Access to and utilization of radiation therapy (RT) is lower in remote geographical regions and higher in urban regions where a cancer care facility is close in proximity suggesting the presence of geographical barrier affecting access to health care and services. Equitable access to PRT can be achieved by reducing barriers such as geographical distance. This retrospective cohort study describes accessibility of PRT in the management of prostate cancer and the impact of an additional facility on improving access to PRT.

Objective: To examine the outcomes of patients with adenoid cystic carcinoma (ACC) treated with post-operative accelerated hypofractionated radiotherapy (AHRT).

Methods: Patients treated with AHRT (50–55 Gy in 20 fractions over 25 days) between 1997 and 2008 were identified and retrospectively analysed. Data collection included site of primary and surgical excision margin. Primary outcomes were overall survival (OS) and local control (LC) calculated using the Kaplan–Meier method.

Results: A total of 37 patients meeting the above criteria were identified with a median age of 55 years (range 31–79). Distribution by anatomical site was as follows: parotid 9 patients; submandibular gland 8 patients; other salivary gland tissue 20 patients. Surgical excision margins were as follows: non-involved 25 patients; microscopic involvement 7 patients; macroscopic involvement 4 patients; unknown 1 patient. Median follow-up was 59 (range 14–126) months. Five patients had local recurrence, 4 distant recurrences, and 1 both local and distant recurrence. The 5-year LC and OS rates were 81.8% (95% confidence intervals (CIs) 60.9–92.2) and 78.5% (95% CI 58.0–89.8%), respectively.

Conclusion: Outcomes with post-operative AHRT appear comparable to those in the literature. However, until more is known about the radiobiology of this rare disease, a biological equivalent of 60 Gy in 2 gray fractions without correction for accelerated repopulation should be used.

Background and purpose: Repeat imaging protocols, specifying imaging frequency and action levels for movement correction, can be used to achieve more accurate targeting of the prostate gland during radiotherapy. We have carried out a study comparing the accuracies of online versus off-line correction strategies which use implanted marker seeds to localize the prostate.

Material and methods: Data have been analysed for 60 prostate patients, verified using an online imaging technique. Systematic and random errors have been calculated for a daily imaging protocol and for other common imaging schedules. Resource requirements have been assessed for the daily imaging technique by analysing the in-room timings performed on 10 patients.

Results: Daily imaging is beneficial for the majority of patients, an online imaging schedule with a 2 mm action level significantly reducing systematic and random errors. The online imaging can be performed with a 2-minute increase in the standard treatment slot.

Conclusions: Online imaging tracking techniques can facilitate margin reduction, which may help to reduce rectal toxicities. The impact on departmental time and resource requirements is modest for the online daily tracking technique with marker seeds and kilovoltage planar imaging.

The present study was carried out to evaluate the levels of plasma fibronectin (Fn) in cancer patients undergoing radiation therapy (RT) in correlation with outcomes in terms of radiation toxicity. A total of 26 patients with lung and gastrointestinal (GI) cancer, treated with RT were enrolled in this study. Plasma Fn levels were determined before and following a course of RT. The Radiation Therapy Oncology Group (RTOG) criteria were used to determine the grade of RT toxicity. Statistical analysis utilised the nonparametric Mann–Whitney U-test as well as bivariate linear regression. Pre-RT Fn levels were significantly higher in cancer patients without toxicity (median ± SE) (485.0 ± 87 μg/ml) as compared with the levels of plasma Fn in patients with grade I–II RTOG acute toxicity (354.0 ± 74 μg/ml, p = 0.01). No significant difference in Fn levels was found in patients with grade I toxicity compared with patients with grade II toxicity. In addition, low baseline Fn levels (148 and 299 μg/ml) were observed in two lung cancer patients who developed symptomatic pneumonitis during the first 2 months after RT. These preliminary results suggest that low baseline Fn may have potential as a predictive marker for development of RT-induced toxicity.

Purpose: High-dose-rate brachytherapy (HDR) boost is an effective method for dose escalation when treating prostate cancer. Optimal number and location of catheters play key role in radiation dose delivery. We studied the impact of catheters and associated trauma on the dose uncertainties and urethral toxicity.

Methods and Materials: Between July 2008 to August 2009, 50 patients with prostate cancer were treated with 46 Gy of external irradiation of whole pelvis (2 Gy per fraction) and two HDR brachytherapy fractions (each 14 Gy) at the end of 10 fractions of external beam. All brachytherapy implants were planned using real-time, ultrasound-based planning system. Variables were prostate and urethral volumes, number of catheters and their mean distance from base of bladder and dose volume histogram parameters. All data were collected during first implant only. The toxicities were graded according to Radiation Therapy Oncology Group Toxicity Criteria. Statistical analysis was done on SPSS version 17.0.

Results: The mean number of catheters implanted was 12.38 (8–19), and number of attempts per needle to achieve desired position was 1.6 (range = 0–5). Mean distance between the catheters tips to contrast filled bladder was 3.2 mm (1–8 mm) after the adjustment. Distances >5 mm showed lower doses to prostate and lower predicted tumour control probability (TCP) (p < 0.01). No correlation was found between numbers of catheters implanted, attempts per catheter and severity of acute genitourinary (GU) toxicity. Significant correlation was found between severity of acute GU toxicity and urethral V130, V150 (p < 0.001).

Conclusion: Dose decline and subsequently lower TCP were seen for the greater distances between the needles and bladder. Acute GU toxicity increased with higher urethral, but severity of acute GU toxicity does not increase with increase in prostate/urethral volumes, number of catheters needles and attempts.

Purpose: To evaluate composite coplanar and non-coplanar three-dimensional conformal techniques (3D-CRT) for external-beam prostate radiotherapy using a low-energy (6 MV) photon beam.

Methods and Materials: For treatment-planning purposes, three different planning target volumes (PTV) were defined for ten patients with prostate cancer and as follows: PTV1 (pelvis), PTV2 (prostate + seminal vesicles + 1 cm margin) and PTV3 (prostate + 1 cm margin). Conformal techniques of 2, 3, 4, 5 (coplanar) and 6 (non-coplanar) field techniques have been considered and combined to produce five different plan combinations (i.e. techniques A, B, C, D and E). Treatment plans were generated with a prescription dose of 75 Gy to PTV3, 65 Gy to PTV2 and 45 Gy to PTV1 and were assessed on the basis of 3D dose distributions and dose-volume histograms (DVHs). Normal tissue-dose constraints for the relevant organs at risk (OARs), that is, rectum, bladder and femoral heads, were also considered.

Results: Findings show that all five treatment-plan combinations result in adequate PTV coverage and acceptable OAR irradiated volumes. The greatest rectal spacing in the high-dose region is achieved by technique C; all techniques achieve this, except for technique A, and give approximately the same fraction of volume (of rectum) that receives a dose of 50 Gy (V50) and 60 Gy (V60). When considering the bladder, techniques B, D and E give the best bladder sparing with small absolute differences, whereas technique A results in the lowest dose for femoral heads. Technique E appears to give the best compromise for all three considered OARs, provided the PTV is adequately covered.

Conclusions: Even though the optimum photon-beam energy for conformal prostate radiotherapy is greater than 10 MV, our study shows that a good sparing of OAR can be achieved even with a lower-energy beam (6 MV) and the appropriate plan combination and that the dose to prostate can be as high as 75 Gy.

Purpose: This study evaluated the difference in verification performance and organ doses between megavoltage computed tomography (MVCT) and kilovoltage cone-beam computed tomography (kV CBCT).

Methods: Anthropomorphic phantoms of head-and-neck (H&N) and pelvic regions were scanned by the computed tomography–simulator. A common reference standard setup position for each phantom was determined. Markings of known deviations from the standard position in the lateral, longitudinal and yaw displacements were made on the phantoms. The verifications by kV CBCT and MVCT were conducted in the linear accelerator and helical tomotherapy treatment unit respectively. The phantoms were then shifted in steps according to the assigned different degree of positional deviations. The discrepancy between the detected data and the known data (δD) indicated the detection error of the verification system. Thermoluminescent dosimeters were used for dose measurements of kV CBCT and MVCT.

Results: δD of the lateral translations and yaw rotation in kV CBCT of the H&N region were lower than MVCT. There were no differences in the error detection along longitudinal direction between the two verification methods. For H&N, the mean doses of the various organs were significantly lower in kV CBCT except the skin. For the pelvis, MVCT delivered significantly higher mean dose to the prostate and femoral heads.

Background: A randomised study to investigate whether bilateral arm abduction is superior to unilateral abduction with respect to stability using shifts on treatment as the main outcome measure.

Material and Methods: 50 consecutive female patients were randomised to ipsilateral or bilateral arm abduction. Central lung depth (CLD) and cranial caudal depth (CCD) on the simulator image was compared with that featured on three Electronic Portal Images (EPI) captured during treatment for each patient. Systematic and random errors were analysed with respect to the average translational displacement and standard deviation per patient and per population between the planning image and the EPI.

Results: The CLD average translational displacement in the test group was −1.7 mm (95% CI = −5 to 1.6 mm) Σ pop = 2.3 mm, σ pop = 1.6 mm, and in the control group −1.9 mm (95% CI = −6 to 3 mm) Σ pop = 4 mm, σ pop = 2.1 mm. The average translational displacement of CCD in test group was 0 mm (95% CI = − 5.3 to 5.1 mm) Σ pop = 2.2 mm, σ pop = 2.6 mm. CCD translational displacement was greater in the unilateral arm abduction group at − 1.6 mm (95% CI = −6.7 to 3.4 mm) Σ pop = 3.6 mm, σ pop = 2.4mm.

Conclusion: The reduction in systematic error and inter-patient variability observed in the test group is evidence that bilateral arm abduction is a more stable and reproducible position than unilateral arm abduction. The CCD translational data indicates that patients treated with unilateral arm abduction were moving inferiorly on the breast board. These results support the adoption of bilateral arm abduction as a standard technique.