It is already well-understood that patients requiring multiple hospital visits deal with several barriers. This paper considers a new methodology for determining the barrier that travel can cause, applying it to the mixed rural-city population of South-West Wales, calculating the travel burden for patients accessing radiotherapy. Travel burden could factor into conversations around optimisation of appointments and the impact of changes to treatment pathways.

Patient-specific travel data were calculated using Google Maps, for 1516 patients attending South-West Wales Cancer Centre for radiotherapy, modelled for 5-fraction and 15-fraction regimes.

28% of patients travelled for longer than 60 minutes. Moving to a 5-fraction treatment regime saves 20 one-way trips to the hospital, resulting in an average time saving of 15.9 hours for those travelling by car and 39.3 hours for those travelling by public transport. On average, this reduces carbon dioxide emissions by 91 kg per patient.

Implementation of a 5-fraction treatment regime has significantly reduced the travel burden for some patients receiving radiotherapy, as well as emissions related to travel. However, access to radiotherapy services in South-West Wales varies, with certain regions facing substantial travel burdens. Further research exploring other potential options to reduce travel burden is needed.

This investigation quantifies the dose enhancement effect and dose distribution modifications due to the presence of high-z nanospheres in a proton beam.

Various proton pencil beams of therapeutic energies (60–226 MeV) and spatial distribution of 2·7 mm spot size diameter were simulated onto a water phantom utilising the TOPAS Monte Carlo toolkit version 3.6.1. The simulation modelled either water or nanospheres of high-z materials (gold, silver or platinum) at the location of the Bragg Peak (BP) to compare the differences of the resulting dose distributions.

The introduction of the nanospheres increases the maximum dose, narrows the BP and shifts the BP location upstream compared to the water phantom with no nanospheres.

This work shows that the local dose can be enhanced with the use of high-z nanoparticles in proton therapy, thereby increasing patient safety and decreasing side effects with the same amount of delivered radiation.

To analyse the dosimetric benefit of the hybrid inverse planning optimisation (HIPO) planning method over the graphical optimisation (GrO) planning method for 3D volume-based intravaginal brachytherapy (IVBT) in a mono-centre patient cohort.

Twenty-five patients surgically staged with endometrial cancer were considered for the study. All the patients had received adjuvant IVBT for three fractions with one-time computed tomography image-based planning. The data on the patient, tumour, plan, and treatment characteristics were retrieved from the database. All the plans were re-optimised with GrO and HIPO techniques for this comparison study. The different dosimetric parameters were compared between the two methods, and the collected data were tabulated and shown graphically. The statistical evaluation was performed with IBM SPSS version 26, and Origin Pro 8.5 was employed for plots.

HIPO plans show similar target coverage in terms of D 90(%), V 95(%) and conformity index with no significant statistical difference from the GrO plans with an acceptable increase in homogeneity index (0·087 ± 0·062%). It succeeds in achieving a statistically significant reduction of dose to organs at risk such as D0·1 cc, D1·0 cc and D2·0 cc for the bladder (11·59%, 4·8% and 3·99%), rectum (41·33%, 16·9% and 16·05%) and sigmoid (20·97%, 13·53% and 11·21%), respectively, in comparison with GrO optimisation.

Considering the dosimetric outcome of 3D-based IVBT, it is suggested to adopt inverse optimisation techniques like HIPO over GrO to achieve higher quality treatment plan in terms of adequate target dose and lesser dose to OARs.

The aim of this service review was to review whether implementing a formal training package increased therapeutic radiographer confidence and competence in recognising neutropenic sepsis in radiotherapy patients. In addition, authors also investigated whether the introduction of a weekly National Early Warning Score (NEWS) protocol had been successful in identifying cases of neutropenic sepsis.

Therapeutic radiographer (n = 13) views on the new protocol were collected through an online questionnaire. A review of the clinical observation sheets of patients who received chemo-radiotherapy (n = 49) between 18 April 2019 and 31 October 2019 was undertaken. Information on disease site, NEWS scores, number of patients who had become neutropenic and action taken by therapeutic radiographers was collected.

The majority of respondents to the questionnaire found that training benefitted both professionals and patients. Some challenges were highlighted relating to increased workload. For patients receiving regular observations, NEWS scores ranged from 0 to 4. When a patient scored on NEWS, the most common score was 1 across all treatment sites except cervix.

Implementing a neutropenic sepsis protocol appears to be beneficial to therapeutic radiographers as professionals, increasing their confidence in patient assessment and monitoring. Regular observations may help to identify deteriorating patients alongside clinical judgement and symptom reviews.

This study investigates the dose escalation to dominant intra-prostatic lesions (DILs) that is achievable using single-source-strength (SSS) and dual-source-strength (DSS) low-dose-rate (LDR) prostate brachytherapy and a sector-based plan approach.

Twenty patients were retrospectively analysed. Image registration and planning were undertaken using VariSeed v9·0. SSS and DSS boost plans were produced and compared to clinical plans. Dosimetric robustness to seed displacement for SSS and DSS plans was compared to clinical plans using Monte Carlo simulations.

Fourteen out of 20 patients had DIL identifiable on magnetic resonance imaging. Median increase in sector D90 of 27% (p < 0·0001) and sector V150 of 31% (p < 0·0001) was achieved with SSS planning without exceeding local rectum and urethra dose constraints. DSS plans achieved dose distributions not statistically significantly different from the SSS plans with a median of eight fewer seeds and two fewer needles. SSS and DSS plan sensitivity to random seed displacement was similar to the clinical plans.

Treatment planning using VariSeed to produce SSS and DSS focal boost plans is feasible for LDR prostate brachytherapy to achieve a median escalation in sector D90 of 27% without exceeding local urethral and rectal constraints. SSS and DSS plan dosimetric robustness was similar to clinical plan dosimetric robustness.

To assess the accuracy of the Varian PerfectPitch six-degree-of-freedom (6DOF) robotic couch by using a Varian SRS QA phantom.

The stereotactic radiosurgery (SRS) phantom has five tungsten carbide BBs each with 7·5 mm in diameter arranged with the known geometry. Optical surface images and cone beam CT (CBCT) images of the phantom were taken at different pitch, roll and rotation angles. The pitch, roll, and rotation angles were varied from −3 to 3 degrees by inputs from the linac console. A total of 39 Vision RT images with different rotation angle combinations were collected, and the Vision RT software was used to determine the rotation angles and translational shifts from those images. Eight CBCT images at most allowed rotational angles were analysed by in-house software. The software took the coordinates of the voxel of the maximum CT number inside a 7·5-mm sphere surrounding one BB to be the measured position of this BB. Expected BB positions at different rotation angles were determined by multiplying measured BB positions at zero pitch and roll values by a rotation matrix. Applying the rotation matrix to 5 BB positions yielded 15 equations. A linear least square method was used for regression analysis to approximate the solutions of those equations.

Of the eight calculations from CBCT images, the maximum rotation angle differences (degree) were 0·10 for pitch, 0·15 for roll and 0·09 for yaw. The maximum translation differences were 0·3 mm in the left–right direction, 0·5 mm in the anterior–posterior direction and 0·4 mm in the superior–inferior direction.

The uncertainties of the 6-DOF couch were examined with the methods of optical surface imaging and CBCT imaging of the SRS QA phantom. The rotational errors were less than 0·2 degree, and the isocentre shifts were less than 0·8 mm.

The purpose of this study was to determine the dose enhancement factor (DEF) of gold nanoparticles in a dosimeter gel and construct percentage depth dose curves, using the Optical CT system and the Monte Carlo simulation model, to determine the effect of increasing the dose caused by increasing the concentration of gold nanoparticles at depths in the gel.

The Magic-f Gel was made based on the relevant protocol in the physics lab. To determine the amount of the increase in the absorbed dose, the gold nanoparticles were added to the gel and irradiated. An increase in the dose after adding nanoparticles to the gel vials was estimated both with the Optical CT system and by the Monte Carlo simulation method.

Dose enhancement curves for doses of 2, 4 and 6 Gy were prepared for gel vials without adding nanoparticles, and nanoparticle gels at concentrations 0·17, 3 and 6 mM. Also, the DEF was estimated. For the 0·17 mM molar gel, the DEF for 2, 4 and 6 Gy was 0·7, 0·743 and 0·801, respectively. For the 3 mM gel, it was 1·98, 2·5 and 2·2, and for the 6 mM gel, it was 37·4, 4·24 and 4·71, respectively.

The enhancement of the dose after adding gold nanoparticles was confirmed both by experimental data and by simulation data.

The purpose of this study is to investigate the feasibility of proton arc therapy (PAT) using the double-scattering MEVION-S250 proton system. The treatment planning and dose delivery parameters from PAT were compared with conventional treatment planning techniques.

PAT was simulated with multiple conformal and fixed-aperture beams (5–15) using the MEVION-S250-double-scattering proton system. Conformal apertures were simulated with the Eclipse-treatment-planning system: (a) using a static single aperture that provides the best average conformal circular or rectangular apertures to cover the tumour from different angular views (SPAT), and (b) dynamic conformal apertures of the tumour shape at each irradiation angle that can be obtained from a multi-leaf-collimator system (DPAT).

The DPAT and SPAT plans provided superior dose coverage and sparing of normal tissues in comparison with conventional plans (CPT). The entrance normal tissue and skin doses (<40%) were lowered significantly by delivering dose from different directions over a wider angular view compared to conventional plans that have large entrance dose from only two fields. While the mean and minimum doses from PAT and CPT were comparable, the maximum doses from arc plans were lower than the maximum doses in conventional plans. The SPAT and DPAT plans had comparable dose parameters for regularly shaped targets. The heterogeneity index (HI) was superior in PAT plans which improved with increasing number of beams in arc plans for the different treatment sites. The conformality index (CI) depends on the treatment site and complexity of the shape of the planning target volume where for brain, pancreatic and lung tumours, PAT plans conformality was comparable and sometimes superior to CPT; and HI and CI were generally better in DPAT compared to SPAT.

PAT plans have superior dose coverage and sparing of normal tissues compared to CPT plans using the MEVION double-scattering system as shown in this simulation study. Ideally, conformal proton arcs require beam shaping and dose delivery with the gantry moving; however, the MEVION double-scattering system lacks a multi-leaf collimator system and cannot deliver dose during gantry rotation. The single aperture conformal proton therapy technique is more time and cost effective compared with conventional techniques that are used currently with the MEVION proton therapy system because of the elimination of the need for patient-specific compensators. In present study, PAT was simulated with the MEVION double-scattering proton therapy system; however, it can be performed also with other proton therapy systems.

The aim of this study was to evaluate clinical efficacy and radiobiological outcome of intensity-modulated radiation therapy (IMRT) modalities using various collimator angles and non-coplanar fields for nasopharyngeal cancer (NPC).

A 70-Gy planning target volume dose was administered for 30 NPC patients referred for IMRT. Standard IMRT plans were constructed based on the target and organs at risk (OARs) volume; and dose constraints recommended by Radiation Therapy Oncology Group (RTOG). Using various collimator angles and non-coplanar fields, 11 different additional IMRT protocols were investigated. Homogeneity indexes (HIs) and conformation numbers (CNs) were calculated. Poisson and relative seriality models were utilised for estimating tumour control probability (TCP) and normal tissue complication probabilities (NTCPs), respectively.

Various collimator angles and non-coplanar fields had no significant effect on HI, CN and TCP, while significant effects were noted for some OARs, with a maximum mean dose (Dmax). No significant differences were observed among the calculated NTCPs of all the IMRT protocols. However, the protocol with 10° collimator angle (for five fields out of seven) and 8° couch angle had the lowest NTCP. Furthermore, the standard and some of non-coplanar IMRT protocols led to the reduction in OARs Dmax.

Using appropriate standard/non-coplanar IMRT protocols for NPC treatment could potentially reduce the dose to the OARs and the probability of inducing secondary cancer in patients.

Treatment of metachronous second primary non-small cell lung cancer (NSCLC) in patients already treated with definitive radiotherapy is a matter of debate, since most patients are excluded from surgical treatment, which remains a therapeutic standard for patients with isolated lung masses. Salvage chemotherapy or immunotherapy alone offers a low probability of disease control. The option of re-irradiation often remains the only viable, but the risks of severe acute or late toxicities affecting the surrounding normal tissues make this a real clinical challenge.

From January 2015 to April 2018, five patients (male/female: 4/1; age 54–81 years, median 68) with previously irradiated NSCLC presented with a second primary lung tumour.

A partial response was seen in four patients, one complete responses in the fifth. The toxicity was low: two patients experienced a grade 2 asymptomatic radiation pneumonitis after 6 and 12 months from the end of stereotactic body radiation therapy, resolved with cortisone therapy. No acute or late oesophageal or cardiac toxicity was found.

In this work, we present our initial experience about the use of stereotactic radiotherapy technique in already irradiated patients. We reported a local disease control in all cases with an acceptable toxicity.

The aim of this study is to investigate the impact of anatomical changes in prostate cancer patients on the target coverage when using 6 MV beams-VMAT therapy and to propose strategies that allow us to evaluate the dose or correct it by normalization without having to perform a new simulation.

Ten patients of high-risk prostate cancer were chosen for the study. All test plans were delivered using the same isocenter and monitor units as the original plan and compared against the original unedited plan. The expansion and contraction of body contours due to size changes was mimicked by increasing and decreasing the body contour with depths of −2, −1·5, …, 1·5, 2 cm, in the anterior, and both lateral directions of the patient. A total of 90 plans were evaluated, 9 for each patient. Dose-volume histogram statistics were extracted from each plan and normalized to prescription dose.

Weight changes resulted in considerable dose modifications to the target and critical structures. Plans were found to be varied with 2·9% ± 0·3% per cm SSD change for VMAT treatment with a correlation index close to one. Therefore, doses variations were linear to the changes of depth. Gamma index evaluation was performed for the 10 renormalized plans. All of them passed criteria of 3%/3 mm in at least 98.2% of points. Eight of them passed criteria in 99% points. Gamma index 4%/4 mm passed 100% points in all patients for the chosen region of interest.

The dosimetry estimation presented in this study shows important data for the radiation oncology staff to justify whether a CT rescan is necessary or not when a patient experiences weight changes during treatment. Based on the results of our study, discrepancies between real dose and planned dose were >5% for 1·7 cm of difference in external contour in the anterior and both lateral directions of the patient.

To investigate the dosimetric advantage of quasi-continuous couch motion-enabled trajectory modulated arc radiotherapy therapy (TMAT) over the coplanar tangential partial arcs volumetric modulated arc radiotherapy (VMAT) for treating left breast and chest wall patients.

Treatment plans of 43 patients who received radiotherapy for left breast (17) or for left chest wall (26) using coplanar partial tangential arcs VMAT (reference plan) were considered for this study. For each patient, in addition to the treatment plan, a TMAT plan was also generated using quasi-continuous couch rotation. The TMAT plan consisted of original two 30° tangential arc beams and two supplementary beams having a couch rotation of ±10°, ±20° and ±30°, respectively. The difference in PTV volume coverage (PTV V95%) between TMAT plan and VMAT plan was calculated for all the cases and normalised to the plan’s prescription dose. Similarly, differences in PTV_V105% and several dose-volume parameters related to organs at risk (OAR) were also computed and tabulated.

TMAT shows an increment in the PTV dose coverage V95% with respect to reference plan by 4·7±2·5% when averaged overall prescription dose levels. Mean PTV dose (averaged overall prescription levels) for reference and TMAT plan was 4638·6±423·8 and 4793·5±447·2 cGy, respectively, and statistically insignificant (p=0·06). However mean PTV_V105% values for TMAT and for reference plans were 6·7±4·8 and 7·2±5·2%, respectively, and were not statistically different (p=0·85). Mean heart dose in TMAT was less than in VMAT plans, but not significantly. As regarding D1% to heart, TMAT plan was again found to be better with a mean difference of 137·1 cGy over VMAT plan. Other parameters evaluated were: mean dose and D1% to contralateral breast, and V20 Gy and V5 Gy for lung.

TMAT plans were found to be better than VMAT plans in terms of PTV coverage and D1% for heart. For evaluated dose parameters apart from PTV coverage and D1% to the heart, no significant differences were observed. Thus, TMAT plans yielded better dose distribution in terms of PTV dose coverage, hot spots and OAR doses.

To explore student therapeutic radiographers’ understanding of obesity and cancer and to identify if student therapeutic radiographers believe that radiographers should have a role within weight management.

This study used a self-completed online questionnaire (google forms) to collect data from Radiotherapy and Oncology students, studying at one Higher Education Institution, to gain an understanding of their current knowledge of weight management. A retrospective margin of error calculation was carried out, showing a 9% margin of error with a 90% confidence level.

In total 57 responses were received, n = 50 BSc students and n = 7 pre-registration MSc students. Three key barriers to openly discussing weight loss management with service users emerged from the questionnaire data; these were a lack of time, lack of clear guidelines and lack of confidence. These barriers could potentially be addressed by improving education and training, making it easier for therapeutic radiographers to openly discuss weight management with service users.

Awareness of guidelines was suboptimal, with 82% (n = 47) of respondents unaware of any guidelines. In addition to this, the majority of students identified a lack of confidence as a barrier to them providing weight management advice. Despite this, 54·4% of respondents agreed that radiographers should have a role in providing weight management advice, with 22·2% of respondents being unsure. Findings suggest that behaviour change is required amounts both students and staff members, so that healthcare professionals are more inclined to have healthy weight management discussions. Perhaps more specialist roles need to be developed, so that healthy weight management discussions can become a norm.

The combination of radiation therapy and chemotherapy is rooted in its ability to help achieve locoregional and systemic control, therefore increasing the overall disease-free survival of patients. Understanding the mechanistic actions of cytotoxic agents and their targets on the cell cycle, as well as the governing pharmacokinetic principles can improve treatment delivery. The adjuvant treatment setting can overcome barriers such as hypoxia and genetically driven treatment resistance.

The purpose of this review is to present theoretical frameworks behind the chemoradiation paradigm and to describe current chemoradiation practices in radiation oncology.

A review was conducted using the US National Library of Medicine, National Institutes of Health database (PubMed) using the following search keywords: chemoradiation, spatial cooperation, chemotherapeutic agents, pharmacokinetics, anti-vascular agents, tumour vasculature and tumour hypoxia.

Current research has reported several rationales for the beneficial combination of radiation and chemotherapy to eradicate oncological diseases. Mechanisms of action and biological approaches are showing that concurrent treatments, as well as novel agents such as anti-vascular and anti-angiogenic agents may benefit improved treatment outcomes by reducing micro hypoxic environments in tumours. In addition, chemotherapy administered in tandem with radiation enhances cell-killing effects by targeting the cell cycle.