To quantify the effect of breathing motion on post-mastectomy radiotherapy with three-dimensional (3D) tangents and intensity-modulated radiotherapy (IMRT)

Patients trained for breath-hold underwent routine free breathing (FB) computed tomography (CT) simulation for radiotherapy as well as additional CT scans with breath held at the end of normal inspiration (NI scan) and expiration (NE scan) for study. The FB scan was used to develop both tangents and IMRT plans. To simulate breathing, each plan was copied and applied on NI and NE scans. The respiratory parameters of the patients as well as the dosimetric data with both the plans were analysed.

Breathing motion resulted in mean fall in target coverage (V95) with IMRT by more than 5% when compared with tangents, and this effect significantly correlated with higher tidal volume. There was also a decrease in the mean target minimal dose by 20–25% with IMRT when compared with 10–12% with tangents, attributable to breathing motion. However, the cardiac dose crossed the limit (V25<10%) with breathing in the 3D tangents plan.

Dosimetric coverage of the chest wall is sensitive to breathing motion for the IMRT technique when compared with standard tangents, especially in patients with large tidal volume.

In this work, dosimetric properties of the PTW Octavius detector in and out of the irradiation field have been evaluated. The 2D array of ion chambers has the potential to simplify the linear accelerator QA and pre-treatment verification.

The evaluation was performed using customised written codes in Matlab and SPSS software for statistical analysis.

Experiments indicate that the reproducibility and stability of the measurements were excellent; the detector showed the same signal with a maximum deviation of <0·5% in the short and long term. Comparisons of the ion chamber with the detector showed the same results with a maximum deviation of ~0·1%. As the detector response is linear with the dose, it can be used for the measurement at regions of high-dose gradient effectively. Logarithmic regression y=0·127 ln(x)+0·729 for detector signal and field size changes yielded a coefficient of determination of 0·997. The dose value decreases with increase in source-to-surface distance, which was modelled using a binomial regression with a coefficient of determination of 0·998 that agrees with the ionisation chamber measurement within 1%.

On the basis of the measurements and comparisons performed, this system is a reliable and accurate dosimeter for quality assurance in radiotherapy.

It is unclear whether body mass index (BMI) is a useful measurement for examining prostate motion. Patient’s subcutaneous adipose tissue thickness (SAT) and weight has been shown to correlate with prostate shifts in the left/right direction. We sought to analyse the relationship between BMI and interfraction prostate movement in order to determine planning target volume (PTV) margins based on patient BMI.

In all, 38 prostate cancer patients with three implanted gold fiducial markers in their prostate were recruited. Height, mass and SAT were measured, and the extent of interfraction prostate movement in the left/right, superior/inferior and anterior/posterior directions was recorded during each daily fiducial marker-based image-guided radiotherapy treatment. Mean corrective shift in each direction for each patient, along with BMI values, were calculated.

The median BMI value was 28·4 kg/m2 (range 21·4–44·7). Pearson’s product-moment correlation analysis showed no significant relationship between BMI, mass or SAT and the extent of prostate movement in any direction. Linear regression analysis also showed no relationship between any of the patient variables and the extent of prostate movement in any direction (BMI: R2=0·006 (ρ=0·65), 0·002 (ρ=0·80) and 0·001 (ρ=0·86); mass: R2=0·001 (ρ=0·87), 0·010 (ρ=0·54) and 0·000 (ρ=0·99); SAT: R2=0·012 (ρ=0·51), 0·013 (ρ=0·50) and 0·047 (ρ=0·19) for shifts in the X, Y and Z axis, respectively). Patients were grouped according to BMI, as BMI<30 (n=25, 65·8%) and BMI≥30 (n=13, 34·2%). A two-tailed t-test showed no significant difference between the mean prostate shifts for the two groups in any direction (ρ=0·320, 0·839 and 0·325 for shifts in the X, Y and Z axis, respectively).

BMI is not a useful parameter for determining individualised PTV margins. Gold fiducial marker insertion should be used as standard to improve treatment accuracy.

Therapeutic radiographers routinely offer advice to patients regarding treatment-related side effects. Cranberry has long been used as a natural remedy for several health complaints and has more recently been suggested as having a role in the treatment and prophylaxis of urinary tract infection (UTI) and symptoms.

The aim of this review was to investigate whether there is a place for cranberry as part of the management of radiation cystitis caused by radiotherapy treatment of pelvic cancers, in order to aid therapeutic radiographers in tailoring their advice regarding pelvic side effects.

A structured search was carried out using PubMed, CINAHL, Scopus and Cochrane Library databases. A total of 25 articles were selected for review.

Themes of mechanism of action of cranberry, composition of cranberry products, cranberry and UTI, use of cranberry in radiotherapy and further issues to consider were identified and explored.

A lack of high-quality data was identified in the literature reviewed and no firm evidence was found to support the continued recommendation of cranberry as part of management of radiation induced urinary tract side effects. Well-designed randomised controlled trials are required before further recommendations regarding the use of cranberry in radiotherapy are made.

Meta-analyses demonstrate single-fraction radiotherapy to be as effective as multi-fraction treatment in palliating painful bone metastases, although surveys suggest reluctance in prescribing single fractions.

Assess the factors influencing the choice of dose-fractionation regimen in an unselected population; examine retreatment rates and subsequent skeletal events.

Data were extracted from case notes for 120 patients treated in 2000 and 2006 in a single centre serving a defined population; analysis used χ2 and Fisher's exact statistical tests.

An 8 Gy fraction was the commonest regimen prescribed (single-fraction delivery rate 53·6%). Tumour site was a significant factor in choice of dose-fractionation schedule. Patients with metastatic breast carcinoma were significantly less likely to receive single-fraction treatment compared with those with metastatic lung carcinoma (year 2000: p = 0·038, 2006: p = 0·001). There was a significantly higher retreatment rate following single-fraction compared with multi-fraction treatment (11% versus 3%). There were two subsequent neural axis compressions and four pathological fractures.

Single-fraction treatment is the commonest regimen but multiple fractions are still frequently delivered. Better prognosis groups appear more likely to receive multi-fraction treatment, possibly to avoid the need for retreatment. Subsequent skeletal events are rare but carry high morbidity when they occur.

To calculate and compare planning target volume (PTV) margins for an offline 3 mm tolerance, daily bony anatomy verification, tattoo alignment and online prostate marker matching with those currently used at our institution.

Seventy patients had offline bony anatomy megavoltage verification. 23 different patients underwent fiducial marker matching using daily online kilovoltage verification. Systematic and random errors were measured in the right–left (RL), superior–inferior (SI) and anterior–posterior (AP) directions. Geometric uncertainties from literature were used to help calculate the margins.

PTV margins (mm) were 7 RL, 12 SI and AP (3 mm tolerance offline bony), 6 RL, 11 SI and AP (daily online bony), 8 RL, 12 SI and AP (tattoo alignment) and 5 RL, 8 SI and 6 AP (online daily prostate marker correction).

Our current margins for conformal radiotherapy patients are too small for phase 2 in the SI and AP directions. Implementing online daily bony anatomy matching would not reduce the PTV margin significantly. Online daily marker correction showed current PTV71 Gy margins as excessive by (mm) 5 RL, 2 SI and 4 anterior.

This work aims to evaluate the effect of Hitachi 16-slice scanner reconstruction filters on Hounsfield unit (HU) variations. In the literature, there is a lack of information from a wide variety of scanners in this regard. In addition, not all studies have investigated the effect of reconstruction filters on HU in an exhaustive way.

The computerised imaging reference system electron density phantom (model 062M) was scanned with different substitute materials of different density from Hitachi 16-slice computed tomography. The raw images were obtained with four tube voltage settings: 80 kVp, 100 kVp, 120 kVp and 140 kVp. The raw images for each energy level were then reconstructed using different reconstruction filters.

The HU values of dense bone were significantly different when changing the reconstruction filters without beam hardening correction (BHC). Nevertheless, when selecting the BHC, this variation decreases heavily for 80 kVp and decreases slightly for 140 kVp, but it remains outside the tolerance of ±50 HU. However, for 100 kVp and 120 kVp, the differences in HU values become within the tolerances indicated for dense bone.

Changing image reconstruction filters during a dosimetric scan had a significant effect on HU in dense bone. Therefore, it is recommended to evaluate this effect during the commissioning phase. As a result, this study provides a methodology to comprehensively investigate the effect of reconstruction filters on HU.

The COVID-19 pandemic has required a rapid and evolving response in order to enable the continued delivery of radiotherapy, whilst effectively managing the risk of infection to patients and staff. In early March 2020, we were presented with the challenge of achieving safe delivery of care in clinical practice for a group of patients that are already at higher risk of morbidity from COVID-19 with only limited guidance.

This article outlines the adjustments made at The Christie at Oldham satellite centre in order to promote optimal care to our patients receiving radiotherapy, and to mitigate infection risk at the department for both patients and staff.

We share insight into some of the evolving processes that our team have developed since March 2020 in promoting optimal care to patients receiving radiotherapy at The Christie at Oldham satellite centre. These include changes to the department floor, paper flow, supportive care and staffing.

As we continue to progress through this pandemic, we accept that there will be an ongoing journey of learning with adjustments to practice and evolving ‘new norm’, thereby ensuring we keep our patients and team safe and well. We also hoped that our experience would support radiotherapy-related practices in surges of the pandemic in other parts of the world or in case of the second wave.

During left-sided breast radiotherapy, the heart is often exposed to radiation dose. Shielding can be utilised to reduce heart exposure, but compromises the dose delivered to the breast tissue and, in a proportion of patients, to the tumour bed. Deep inspiration breath hold (DIBH) can be used as a technique to move the heart away from the treatment area and thus reduce heart dose. This study examines the efficacy of the Elekta Active Breathing Coordinator (ABC), a DIBH method, in reducing heart dose.

In total, 12 patients receiving radiotherapy to the left breast were planned for treatment with both a free-breathing (FB) and an ABC scan. The dose volume histogram data for the plans was analysed with respect to heart V13, V5 Gy, mean heart dose and ipsilateral lung V18 Gy. Tumour bed D98%, threshold lung volume in breath hold (BH) and the maximum BH time for each patient was also measured. Patients then received their radiotherapy treatment using the ABC plan and the systematic error in the craniocaudal, lateral and vertical axes was assessed using orthogonal imaging.

The median heart V13 Gy for FB and DIBH patients was 3% (range, 0·85–11·28) and 0% (range, 0–1·56), respectively, with a mean heart dose of 2·62 Gy (range, 1·21–4·93) in FB and 1·51 Gy (range, 1·17–2·22) in ABC. The median lung V18 Gy was 8·7% (3·08–14·87) in FB plans and 9% (4·88–12·82) in ABC plans. The mean systematic set-up errors in all three planes were within the departmental set-up tolerance of 5 mm for both techniques. Median FB tumour bed D98% was 97·4% (92·8–99·5) and 97·5% (97·3–98·5) for ABC.

ABC represents a good method of reducing radiation dose to the heart while not compromising on dose to the tumour bed, and it has a clear advantage over FB radiotherapy in reducing the risk of cardiac toxicity. It is tolerated well by patients and does not produce any difficulties in patient positioning.

This article describes a collaborative project that aimed to develop a patient-centred curriculum in radiotherapy. In the wake of the Francis report in 2013 and a call for compassion to be a central tenet of health programmes, the project was a timely opportunity to enhance the radiotherapy curriculum.

Collaboration between university staff and patients and carers using the service improvement model Plan-Do-Study-Act was the method employed for the curriculum project. Two key discussion forums helped shape the curriculum plan, with module and course evaluation continuing to inform developments.

The key outcome of the project is that it has shaped the 'care' theme evident in the current undergraduate programme. Co-production methods resulted in the development of a range of shared classroom activities that focus on experiences, care values and communication strategies. The new curriculum has evaluated positively and the impact of learning is demonstrated both in the classroom and clinical setting. The project team have also influenced recruitment processes and patient and carer involvement in programme approval is embedded.

Working together, with patients and carers is an ideal method to enhance the curriculum and reflect the requirements in practice of current health and social care professions. Further developments in student assessment are planned.

While treating brain metastasis with whole-brain radiotherapy incorporating a simultaneous integrated boost (WBRT-SIB), the risk of hippocampus injury is high. The aim of this study is to compare dosimetrically between intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in sparing of hippocampus and organs at risk (OARs) and planning target volume (PTV) coverage.

In total, 16 patients presenting with more than one brain metastases were previously treated and then retrospectively planned using VMAT and IMRT techniques. For each patient, a dual-arc VMAT and another IMRT (five beams) plans were created. For both techniques, 30 Gy in 10 fractions was prescribed to the whole brain (WB) minus the hippocampi and 45 Gy in 10 fractions to the tumour with 0·5 cm margin. Dose–volume histogram (DVH), conformity index (CI) and homogeneity index (HI) of PTV, hippocampus mean and maximum dose and other OARs for both techniques were calculated and compared.

A statistically significant advantage was found in WB-PTV CI and HI with VMAT, compared to IMRT. There were lower hippocampus mean and maximum doses in VMAT than IMRT. The maximum hippocampus dose ranged between 15·5 and 19·2 Gy and between 18·4 and 20·6 Gy in VMAT and IMRT, respectively. The mean dose of the hippocampus ranged between 11·5 and 17·7 Gy and between 13·2 and 18·3 Gy in VMAT and IMRT, respectively.

Using WBRT-SIB technique, VMAT showed better PTV coverage with less mean and maximum doses to the hippocampus than IMRT. Clinical randomised studies are needed to confirm safety and clinical benefit of WBRT-SIB.