This is a prospective study to evaluate the dosimetric benefits of treatment plan adaptation for patients who had undergone repeat computed tomography (ReCT)and re-planning due to treatment-induced anatomical changes during radiotherapy.

This study involved five head and neck cancer patients who had their treatment plan modified, based on weekly thrice imaging protocol. Impact of mid-course imaging was assessed in patients using ReCT and cone beam computed tomography (CBCT)-based dose verification. Patients were imaged, apart from their initial CT, during the course of their radiation therapy with a ReCT and on board imager CBCT (Varian Medical Systems Inc., Palo Alto, CA, USA). Each CBCT/CT series was rigidly registered to the initial CT in the treatment planning system Eclipse (Varian Medical Systems Inc.) using bony landmarks. The structures were copied to the current CBCT/CT series and, where needed, manually edited slicewise. The dose distribution from the treatment plan was viewed as of the current anatomy by applying the treatment plan the CBCT/CT series, and studying the corresponding dose–volume histograms for organs at risk doses.

The reduction of parotid volumes due to weight loss was observed in all patients, which means an increase in predicted mean doses of parotid when initial CT plan was re-calculated on ReCT and CBCT (Table 1). This explains the necessity of adaptive planning. The predicted mean dose of parotid glands was increased and constraints to spinal cord and skin were exceeded, so re-planning was performed.

The CBCT is a useful tool to view anatomic changes in patients and get an estimate of their impact on dose distribution. Re-planning based on imaging in head and neck patients during the course of radiotherapy is mandatory to reduce side effects.

Dose distribution index (DDI) is a treatment planning evaluation parameter, reflecting dosimetric information of target coverage that can help to spare organs at risk (OARs) and remaining volume at risk (RVR). The index has been used to evaluate and compare prostate volumetric modulated arc therapy (VMAT) plans using two different plan optimisers, namely photon optimisation (PO) and its predecessor, progressive resolution optimisation (PRO).

Twenty prostate VMAT treatment plans were created using the PO and PRO in this retrospective study. The 6 MV photon beams and a dose prescription of 78 Gy/39 fractions were used in plans with the same dose–volume criteria for plan optimisation. Dose–volume histograms (DVHs) of the planning target volume (PTV), as well as of OARs such as the rectum, bladder, left and right femur were determined in each plan. DDIs were calculated and compared for plans created by the PO and PRO based on DVHs of the PTV and all OARs.

The mean DDI values were 0·784 and 0·810 for prostate VMAT plans created by the PO and PRO, respectively. It was found that the DDI of the PRO plan was about 3·3% larger than the PO plan, which means that the dose distribution of the target coverage and sparing of OARs in the PRO plan was slightly better. Changing the weighting factors in different OARs would vary the DDI value by ∼7%. However, for plan comparison based on the same set of dose–volume criteria, the effect of weighting factor can be neglected because they were the same in the PO and PRO.

Based on the very similar DDI values calculated from the PO and PRO plans, with the DDI value in the PRO plan slightly larger than that of the PO, it may be concluded that the PRO can create a prostate VMAT plan with slightly better dose distribution regarding the target coverage and sparing of OARs. Moreover, we found that the DDI is a simple and comprehensive dose–volume parameter for plan evaluation considering the target, OARs and RVR.

Lung tumours, especially those in the lower lobes, can move a lot during respiration; this motion needs to be accounted for during radiotherapy. In cases where 4D CT simulation scans are not performed, the current protocol at our centre is to apply a generic (internal motion + setup) margin of 0·70 cm in the axial plane and 1·20 cm in the longitudinal plane to all lung tumours, regardless of location. We analyse the tumour motions of a cohort of our local patients and categorise them into different locations in the lung. We seek to assess the adequacy of the current margins and to derive a more accurate set of standard margins which are specific for lung tumour locations.

All cases of lung tumours treated with stereotactic ablative radiotherapy between 2012 and 2016 were identified retrospectively and 4D CT scan data analysed. These tumours were grouped into the following locations: upper zone (UZ), middle zone (MZ) and lower zone (LZ). The treatment planning system was used to generate the displacements of the centre of mass of the tumours in the right–left, anterior–posterior and superior–inferior axes; these were compared with the current generic margins. Median displacements were calculated for each axis in each location. New planning target volume (PTV) margins were derived by summing the median displacement, median absolute deviation (MAD) and 0·5 cm (for setup error).

Sixty-three cases were eligible for analyses. Motion in the superior–inferior direction was the greatest for all tumour locations, ranging from a median of 0·17 cm (MAD 0·12 cm) in UZ to 0·77 cm (MAD 0·27 cm) in LZ. Median tumour displacements in the anterior–posterior and right–left axes were similar for all locations, <0·30 and 0·20 cm, respectively. The current generic margins were adequate for only one-third of the cases in this study. A new PTV margin of 2·10 cm in the superior–inferior axis may be required for LZ tumours, while an additional 1–2 mm should be added to the current radial margins.

The current generic margins are inadequate for the majority of cases. Tumour motion is the greatest in LZ in the superior–inferior axis. Motion mitigation strategies are essential for large LZ tumours.

Mastectomy is a treatment option for patients diagnosed with breast cancer. There is very limited research into the psychosocial impact of mastectomy on female breast cancer patients, especially in the sub-Saharan African setting which has unique cultural norms. The study aimed at assessing the psychosocial impact of mastectomy on female breast cancer patients attending a radiotherapy/oncology centre in Ghana.

A cross-sectional design was used to undertake this study. A total of 80 female mastectomy breast cancer patients participated in this study. A semi-structured questionnaire was used for data collection over a 5-month period, January to May 2018. The data collected were analysed with Statistical Package for Social Science (SPSS) version 22.

Most of the participants were adversely affected psychologically and emotionally by mastectomy. In particular, many (56·7%) agreed that they felt less feminine, and 71% reported they experienced psychological distress as a result of their mastectomy, while 63% of them reported loss of self-confidence. A large proportion of them (51, 63·8%) agreed that their lifestyles had changed following mastectomy, while 58% of them admitted that they felt treated as outcasts by society, and 75% resorted to the use of breast prostheses to reduce attention.

The study revealed that mastectomy for breast cancer patients had a negative impact on their psychological, emotional and social well-being. The availability of affordable breast prostheses, involvement of clinical psychologists in the care of post-mastectomy women, provision of emotional, psychological and even financial support could alleviate the psychosocial impact of affected women.

Radiation therapy (RT) remains a common and effective treatment modality for patients with locally advanced prostate cancer. Technological advancements over the past decade have resulted in the introduction of intensity-modulated radiation therapy (IMRT) planning and delivery techniques that maximise the dose of radiation delivered to the prostate while sparing organs at risk (OAR). A more recent and evolving IMRT technique, called volumetric-modulated arc therapy (VMAT), involves a continuous irradiation at a constant or variable dose rate when the gantry rotates around the prostate using one or more arcs.

This paper reports on a dosimetric evaluation of our implementation of VMAT technique for prostate cancer treatment. A retrospective analysis of VMAT plans was performed for 300 prostate cancer patients treated during the period of January 2013 to December 2014. Two prescription cohorts of patients treated to a dose of 78 Gy in 39 fractions as the primary radiation therapy treatment (XRT) and 66 Gy in 33 fractions as a post-op or salvage XRT were considered.

The mean and maximal doses, dose inhomogeneities and conformity indexes for the planning target volumes were evaluated for each prescription cohort of patients. Similarly, the doses to OAR such as rectum, bladder and femoral heads were also assessed for various dose levels.

This study shows that highly conformal radiation dose distribution for the treatment of prostate cancer is achievable with the VMAT technique. It provides evidence to support the adoption of such conformal technology in many disease sites such as the prostate. We believe that our experience reported here could help form the foundation for individual institutions to evaluate and develop the most suitable planning criteria tailored to their own needs and priority. This endeavour hopefully will provide further improvement in the planning process and, therefore, help achieve an effective and efficient delivery of radiotherapy for prostate cancer.

Stereotactic-fractionated radiotherapy and radiosurgery (RS) for benign and malignant intracranial lesions relies on a very high degree of accuracy in dose alignment due to the ablative dose delivered, and therefore requires a high-precision image guidance modality. The aim of this review is to investigate the localisation and verification accuracy performance of ExacTrac (ET) and Novalis Tx System.

A systematic review of the database Science Direct was carried out using search terms ‘stereotactic radiotherapy (SRT)’ and ‘ET’. All articles before 2000 were excluded. Only articles that involved intracranial lesions, with the exception of one article, were included in the final review.

Results from gold standard Hidden Target Tests and patient data show that patient position can be reproduced within 1·0 mm with the use of ET imaging. In addition, the 6 degrees of freedom algorithm function of ET allows for better translational accuracy as well optimal positioning when rotations are corrected for. Studies showed excellent correlation (p<0·01) between bony ET images and cone beam computed tomography (CBCT) soft tissue registration, evidencing the safe reliance of bony anatomy for image guidance via ET. Shifts were found to be comparable between CBCT and ET.

There is the need for regular calibration to prevent systematic errors and potential geographic miss. However, due to ET’s additional benefits, including reduced concomitant dose and faster imaging time, ET is the superior image guidance modality for RS/SRT in the treatment of intracranial lesions.

In this article, our goal is to compare the TMR10 and convolution dose calculation algorithm in GammaPlan used in stereotactic radiosurgery (SRS) treatments with Gamma Knife and to assess if the algorithms produce clinically significant differences.

Treatment plans were analysed from ten patients who have undergone Gamma Knife SRS treatments. Patient plans were retrospectively recalculated using Lesksell GammaPlan 10 treatment software utilising the TMR10 and convolution dose calculation algorithms in order to create a paired dataset for comparison. Evaluation was based on the dose volume histogram (parameters of minimum, mean, maximum and integral doses.

The ratios of average integral doses calculated by the convolution dose calculation algorithm to the average integral doses calculated by the TMR10 algorithm are 0·997 for the target (p=0·028), 1·048 (p=0·48) for the skull and 1·005 (p=0·68) for the brainstem.

Although doses calculated with the convolution algorithm resulted in slightly higher mean integral doses for the brainstem and skull critical structures when compared to that of TMR10 doses, these results were not statistically or clinically significant. Thus we continue to use the TMR10 algorithm at our clinic.

Palliative cancer care is by definition multi-professional in nature. An interdisciplinary approach to disease management emphasising continuity of care results in increased quality of life for patients and families. Complex disease management demands the provision of a full spectrum of high-quality care; requiring both specialist and generalist services. Appointed keyworkers are knowledgeable about patient preferences enabling effective coordination of care and promotes collaborative team-working. The need for diversity in the provision of palliative care is recommended but can challenge effective interdisciplinary collaboration by creating tension and limiting the interdisciplinary team (IDT) from reaching its full potential resulting in adverse outcomes.

The purpose of this paper is to review the literature available regarding how IDTs and keyworkers influence high-quality palliative care; evaluate how professional culture barriers can influence team collaboration; discuss the keyworker role in minimising these barriers and clinical implications.

A review of the English literature from 2003 to 2013 was performed using the databases PubMed (NML), OVID Medline and Google Scholar.

Keyworkers can help overcome professional culture barriers that result from ineffective team communication. Facilitating improved communication regarding professional roles fosters mutual understanding among team members. The dissemination of relevant and timely information minimises fragmentation, prompting team decision-making and promotes continuity of high-quality palliative care.

Cancer during pregnancy has an incidence of 1/1,000, and when diagnosed, the most common ones are breast cancer (1/10,000), Hodgkin’s lymphoma (1/6,000), and head and neck cancer (1/10,000). If a diagnosis is made during pregnancy, the treatment cannot wait until delivery, and there is concern about the effects that radiotherapy may have on the foetus. The multidisciplinary group has to assess and ethically make decisions with regard to the mother and foetus.

A 35-year-old female, a carrier of Behcet’s disease, underwent 5 years of treatment with hydroxychloroquine, prednisone and low-molecular-weight heparin (the patient being a carrier of Behcet’s disease, there is a high risk for cancer of the oral cavity and oropharynx with an HR of 2·11, so the cancer could be related to the tonsil). The patient’s oncological situation started on December 2017 with a volume increase in preauricular, parotid and right mandibular angle, with a progressive growth. At this time, the foetus was of 17·5 weeks of gestation. An oral cavity tumour that invaded the right retromolar triangle was observed, and upon biopsy, a basaloid squamous cell carcinoma was diagnosed.

Radiotherapy treatment was started at 22 weeks of gestation; intensity-modulated radiation therapy (IMRT) was planned with a dose of 69·96 Gy to the primary tumour and 59·4 Gy to ganglion levels II, III and IV, bilaterally in 33 fractions. At fraction 27 a significant decrease in tumour volume was noted, so adaptive radiotherapy was performed to complete the treatment. Currently the patient has no clinical evidence of tumour pathology.

The risk of radiation exposure in pregnant women (after 20 weeks of gestation), being treated for cancers of the tonsil, reaching the foetus is minimal, with a reduced risk of a few or no effects.

Radiotherapy in tonsil cancer has been shown to be effective in combination with chemotherapy for local control of the disease. In the case of this pregnant patient, radiotherapy, as the only modality, provided local control and little exposure of radiation to the foetus.

The aim of this study was to investigate the extent to which lung stereotactic body radiotherapy (SBRT) treatment plans can be improved by replacing conventional flattening filter (FF) beams with flattening filter-free (FFF) beams.

We selected 15 patients who had received SBRT with conventional 6-MV photon beams for early-stage lung cancer. We imported the patients’ treatment plans into the Eclipse 13·6 treatment planning system, in which we configured the AAA dose calculation model using representative beam data for a TrueBeam accelerator operated in 6-MV FFF mode. We then created new treatment plans by replacing the conventional FF beams in the original plans with FFF beams.

The FFF plans had better target coverage than the original FF plans did. For the planning target volume, FFF plans significantly improved the D98, D95, D90, homogeneity index and uncomplicated tumour control probability. In most cases, the doses to organs at risk were lower in FFF plans. FFF plans significantly reduced the mean lung dose, V10, V20, V30, and normal tissue complication probability for the total lung and improved the dosimetric indices for the ipsilateral lung. For most patients, FFF beams achieved lower maximum doses to the oesophagus, heart and the spinal cord, and a lower chest wall V30.

Compared with FF beams, FFF beams achieved lower doses to organs at risk, especially the lung, without compromising tumour coverage; in fact, FFF beams improved coverage in most cases. Thus, replacing FF beams with FFF beams can achieve a better therapeutic ratio.

Radiation oncology information systems (OIS) play a crucial role in radiation therapy by ensuring accurate and safe delivery of treatment. A MOSAIQ OIS system is currently used to support undergraduate radiation therapist training at Queensland University of Technology. This review addresses the rationale for implementation and integration in teaching environments and explores the pedagogical benefits supported by educational theory.

A review of MOSAIQ functionality shows potential to transform learning through the development of authentic and engaging learning tasks. It provides students with an opportunity to learn two-dimensional image matching through the use of digitally reconstructed radiographs and electronic portal images as well as three-dimensional image matching using computed tomography (CBCT) data in a safe learning environment without clinical time pressures. In addition, this provides the students with knowledge of quality assurance (QA) checks through the verification of treatment parameters and the transfer of information from the planning system to the treatment units. However, there are several potential challenges and practical considerations that need to be overcome.

The application of MOSAIQ OIS could potentially transform teaching and learning strategies for student radiation therapists. Increased knowledge and hands-on skills at undergraduate levels in areas such as image matching and QA can be powerful tools to drive the standards of practice a step further.

One of the stereotactic radiosurgery techniques is Gamma Knife radiosurgery, in which intracranial lesions that are inaccessible or inappropriate for surgery are treated using 201 cobalt-60 sources in one treatment session. In this conformal technique, the penumbra width, which results in out-of-field dose in tumour-adjacent normal tissues should be determined accurately. The aim of this study is to calculate the penumbra widths of single and 201 beams for different collimator sizes of Gamma Knife machine model 4C using EGSnrc/BEAMnrc Monte Carlo simulation code and comparison the results with EBT3 film dosimetry data.

In this study, simulation of Gamma Knife machine model 4C was performed based on the Monte Carlo codes of EGSnrc/BEAMnrc. To investigate the physical penumbra width (80−20%), the single beam and 201 beams profiles were obtained using EGSnrc/DOSXYZnrc code and EBT3 films located at isocentre point in a spherical Plexiglas head phantom.

Based on the results, the single beam penumbra widths obtained from simulation data for 4, 8, 14 and 18 mm collimator sizes along X axis were 0·75, 0·77, 0·90 and 0·92 mm, respectively. The data for 201 beams obtained from simulation were 2·61, 4·80, 7·92 and 9·81 mm along X axis and 1·31, 1·60, 1·91 and 2·14 mm along Z axis and from film dosimetry were 3·21, 4·90, 8·00 and 10·61 mm along X axis and 1·22, 1·69, 2·01 and 2·25 mm along Z axis, respectively.

The differences between measured and simulated penumbra widths are in an acceptable range. However, for more precise measurement in the penumbra region in which dose gradient is high, Monte Carlo simulation is recommended.

Tumour vasculature plays an important role in the development, maintenance and sustainability of a tumour. Endothelial cells which are recruited into the tumour stroma facilitate the formation of essential blood vessels that deliver nutrients and oxygen to tumour cells. A growing body of research is showing that there are synergistic anti-tumour effects when anti-vascular agents are combined with radiation. More recent reports have described favourable radiation response as a function of vascular targeting and blood vessel breakdown, primarily through interactions of radiation with vascular endothelial cells. Vascular disrupting agents are being utilised in several forms that include molecular targeting, biophysical assault and biological interference.

In the present review, we examine current advances in anti-vascular agents to enhance tumour response when combined with radiation therapy.

A comprehensive literature search was conducted on the US National Library of Medicine, National Institutes of Health (PubMed) using the following search keywords: vascular disrupting agents, radiation sensitisation, anti-angiogenic therapy, anti-vascular therapy, radiation therapy.

Current research suggests the applicability of vascular disrupting agents as an effective radiation sensitisation agent. Pre-clinical and clinical trials have been well developed to form the theoretical framework to apply this powerful modality to the treatment of cancer.

The aim of this study was to produce a low-cost anatomical model of adult male including lower limbs to evaluate the three-dimensional dose distribution for dosimetry measurements, especially in total body irradiation (TBI) and total skin electron therapy (TSET).

Computed tomography (CT) scan images of the atomic energy organisation RANDO phantom and lower limb CT scan images of 20 healthy persons were averaged. Selections of different body tissues substitute materials and phantom validation were performed according to previous studies worked on construction of radiation therapy phantoms.

The dosimetry aspect of the selected substitute materials from all considered methods showed that they were in good agreement with real human tissue, especially bone, with a percentage error of 0·5%. The results show that the electron densities obtained from the linear attenuation coefficient (reDLAC) for the tissue equivalent material used in the phantom is a better option for validation.

This validated phantom has numerous advantages over the origin type of RANDO phantom. Therefore, using it in TBI and TSET dosimetry is recommendable.

The aim of this study was to ascertain prostate cancer patients’ perceptions of the quality of physical and emotional support they receive as standard during their course of radiotherapy treatment.

Semi-structured interviews were conducted on 13 patients undergoing radical radiotherapy treatment for prostate cancer. Interviews were conducted between fractions 32 and 37 and data were analysed using the Giorgi method.

A number of themes emerged from the data including, interestingly, the value of patients’ place on the ‘waiting room support’ with 46% finding this to be a positive aspect of their experience. On the whole, patients felt well supported during their treatment by both radiographers and fellow patients. However, the results highlighted areas for further improvements, particularly around bowel and bladder preparation.

This small single-centre study has highlighted the importance of good quality, timely information provision. Although patients were, for the most part very happy with the services they were being provided with, areas in need of development where also highlighted. If a more structured review process is to be further investigated then the role of the ‘review radiographer’ should be considered as part of this. The potential benefits of patient peer support is also worthy of further exploration.