Valid and informed consent in healthcare is an ethical and legal requirement. This evaluation reports the practices within UK radiotherapy departments surrounding consent processes and therapeutic radiographer (TR) education. This article focuses on those patients who are considered to lack the capacity to consent.

This service evaluation adopted a qualitative research design. Seventy-six radiotherapy department managers were sent the online survey: containing a combination of open, closed and free text questions relating to consent practices. Descriptive analysis using Microsoft Excel was performed; additional correlation analysis was attempted with Fisher’s exact test using Statistical Package for the Social Sciences.

TRs from 39 radiotherapy departments (51%) completed the survey. Analysis of results demonstrated obtaining written consent before radiotherapy treatment was completed in all departments. Assessment methods used to determine capacity to consent varied across the departments. Responses identified 37 departments employ a different consent form for those considered to lack capacity. Thirty-eight departments have a policy surrounding consent; 16 departments reported no formal TR education in consent. Of the remaining 22 departments, 13 departments included lack of capacity within their education package.

To ensure best practice throughout the UK, is it recommended that radiotherapy departments review their consent processes to ensure they are in the best interests of the patient. It is recommended that TRs are familiar with their regulatory body standards and the ethical and legal issues surrounding consent; all departments should consider capacity and those considered to lack capacity within their education and training framework.

A 4D-dosimeter and quality assurance phantom prototype was developed to quantify the effects of respiratory motion.

The dose distributions were measured using two-dimensional detectors that were mounted on a mobile platform capable of sinusoidal motion in one direction with different patterns using adjustable motion amplitude and frequency. The dose distributions were obtained from various treatment plans including conformal and intensity-modulated beams for both photon and proton therapy. Dose delivery and measurement were conducted using this 4D-dosimeter with the mobile phantom for different motion amplitudes (0–35 mm) and frequencies (0.25–0.33 Hz).

The increase in motion amplitude increased the blurring of the dose distributions at the beam edges along the direction of motion and led to large dose discrepancies. This produced larger dose deficits inside the treatment planning volume (PTV) and increasing dose deposition in the surrounding normal tissue with increasing motion amplitudes. For both the IMRT and VMAT-treatment plans, the dose profile for each increased amplitude increment showed a reproducible flattening of the penumbra at the beam edge, all changing around the 40–60% isodose line.

The 4D-dosimeter developed in this work provides a noble clinical tool to quantify the deviations in the dose distributions induced by respiratory motion.

Cancer is a major health concern in Portugal, especially among older adults, who represent nearly half of new cases. Radiation therapy (RT) is crucial in their treatment, emphasizing the need for improved education in geriatric oncology for radiation oncologists (RO).

A pretested 22-item online survey on RO’s geriatric oncology knowledge was disseminated.

The analysis involved 52 respondents, including 13 residents (25%) and 39 consultants (75%); RO were asked to specify the age threshold they considered to define an older cancer patient. Their responses were as follows: 60 years (n = 2, 3·8%), 65 years (n = 7, 13·5%), 68 years (n = 1, 1·9%), 70 years (n = 29, 55·8%), 75 years (n = 10, 19·2%) and 80 years (n = 2, 3·8%). Forty-six respondents (88·5%) acknowledged an observed increase in the number of older cancer patients in RT departments. Twenty-nine participants (55·8%) reported that age was considered either most of the time or always in clinical decisions. Regarding frailty screening, it was performed by 15 participants (28·8%), while four participants (7·7%) stated that frailty was assessed during comprehensive geriatric assessment in another department. Of those implementing screening tools, nine (17·3%) utilized the G8 tool, and two respondents (3·8%) employed the Triage Risk Screening Tool. Most respondents reported a lack of awareness regarding specific guidelines for older cancer patients, and 98·1% expressed the need for enhanced training in geriatric oncology.

The study highlights a critical need for improved training in geriatric oncology among RO professionals. Furthermore, the findings underscore the imperative for treatment decisions to reflect an understanding beyond chronological age, emphasizing the necessity of addressing this knowledge gap in clinical practice.

The study seeks to evaluate the influence of planning target volume (PTV) margins on plan parameters during inverse planning of brain metastases with the Gamma Knife treatment unit, considering various prescription isodose levels (PIL).

CT scan images of a STEEV anthropomorphic phantom were transferred into the GAMMA PLAN Treatment Planning System. A target measuring a volume of 4·9cc was centrally contoured. Plans with a 0 mm volume margin at five prescription isodose levels from 50% to 70% at 5% increment were created. With 0.5 mm, 1 mm, 1.5 mm and 2 mm PTV margins, identical plans were regenerated. Adjustments were made to each plan when necessary to achieve same target coverage. One-way ANOVA test was used to analyse the influence of PTV margins on parameters including Selectivity[S], Gradient index [GI], V12, Paddick’s conformal index [PCI] and Treatment time [TI].

Margin addition resulted in PTV volume increase. The findings indicated that the PTV margin of 2.0 mm exhibited the highest mean selectivity of (0.93 ± 0.00), PCI (0.92 ± 0.01), GI (2.50 ± 0.04), V12 (16.17 ± 0.38) and treatment time (118.32 ± 2.91 min). The 0.0 mm PTV margin had the lowest mean value for all the parameters except for the treatment time (105.58 ± 3.48 min) which was slightly higher compared to the 0.5 mm PTV margin (M = 86.36 ± 4.13 min).

Incremental increases in PTV margins for Gamma knife radiosurgery though a relatively controversial concept influence all dosimetric parameters, which may pose potential detrimental effects and thus need to be carefully evaluated for brain metastasis treatment.

In vivo diode dosimetry proved its efficacy as a patient-specific quality assurance tool for 3DCRT. Its usefulness in IMRT is not sufficiently investigated.

Four step-and-shoot IMRT plans were generated for different treatment sites using an Alderson Rando anthropomorphic phantom. Two in vivo semiconductor diodes were used to perform 33 entrance radiation dose measurements at central axis and max beam point dose on a water-equivalent slabs based on the anthropomorphic plans. Measured values were compared to planned ones, and detailed analysis per segment of each IMRT field was made to infer the reason behind the discrepancies of measurements from expectations.

Point dose measurements were performed on a beam and a segment basis. Agreement within ±5% action level with planned dose was 27% of beams at central axis versus 45% at max point dose and 10% of segments at central axis versus 25% at max point dose. For ±10% action level, 70% of beams at central axis versus 73% at max point dose, and 15% of segments at central axis versus 41% at max point dose. Classification of segments resulted in a significance of .021 for measuring at positions unaffected by the MLC partial and total blockage.

Diode measurements are recommended at maximum dose coordinates for open beams/segments for more accurate patient dose verification results as part of in vivo dosimetry. This is important for limited resources centres treating with sMLC IMRT.

This study introduces the prostate cancer linear energy transfer sensitivity index (PCLSI) as a novel method to predict relative biological effectiveness (RBE) in prostate cancer using linear energy transfer (LET) in proton therapy based on screening for DNA repair mutations.

Five prostate cancer cell lines with DNA repair mutations known to cause sensitivity to LET and DNA repair inhibitors were examined using published data. Relative Du145 LET sensitivity data were leveraged to deduce the LET equivalent of olaparib doses. The PCLSI model was built using three of the prostate cancer cell lines (LNCaP, 22Rv1 and Du145) with DNA mutation frequency from patient cohorts. The PCLSI model was compared against two established RBE models, McNamara and McMahon, for LET-optimized prostate cancer treatment plans.

The PCLSI model relies on the presence of eight DNA repair mutations: AR, ATM, BRCA1, BRCA2, CDH1, ETV1, PTEN and TP53, which are most likely to predict increased LET sensitivity and RBE in proton therapy. In the LET-optimized plan, the PCLSI model indicates that prostate cancer cells with these DNA repair mutations are more sensitive to increased LET than the McNamara and McMahon RBE models, with expected RBE increases ranging from 11%–33% at 2keV/µm.

The PCLSI model predicts increasing RBE as a function of LET in the presence of certain genetic mutations. The integration of LET-optimized proton therapy and genetic mutation profiling could be a significant step toward the use of individualized medicine to improve outcomes using RBE escalation without the potential toxicity of physical dose escalation.

Oral mucositis (OM) emerged in the late 1980s to describe the adverse effects of radiation therapy (RT) on the oral mucosa. OM is the most common and clinically significant acute adverse effect of radiotherapy for head and neck cancer. Symptoms of OM vary from pain and discomfort to an inability to tolerate food or fluids, and it may affect the quality of life, breaks in treatment, hospitalisation, and therefore cancer treatment and outcome. This study aimed to evaluate the pomegranate flower’s efficacy in preventing and treating radiation-induced mucositis due to antioxidant, anti-inflammatory and anti-cancer effects.

This phase II clinical trial was conducted on 50 patients (case and control) with head and neck malignancy. Patients in the case groups were instructed to rinse their mouths with 5 mg Pomegranate powder with 15 cc of sterile water three times a day. The patients in the control group rinsed their mouths with normal saline mouthwash, which is the most relatively accepted preventive and supportive care in this setting. The onset and degree of radiation-induced mucositis were graded during treatment, with ‘WHO mucositis grading’ and the ‘quality of life questionnaire’ (QLQ-OES18).

Forty-eight patients were analysed. There was a significant difference between the two groups on onset and severity of mucositis in the two groups. There were longer intervals for the incidence of different grades of mucositis in the case group, in comparison with the control groups (P value < 0·05). Also, Complaints of dysphagia in the case groups were lower than in the control.

Pomegranate flower seems to be effective at the time of onset, and the severity of oral mucositis during head and neck radiation. It could be a simple, potent, and inexpensive agent, which is easily available.