The overall aim of this study was to evaluate the use of Virtual Environment for Radiotherapy Training Image-Guided Radiotherapy (VERT™IGRT) as a teaching and assessment tool for 3D image matching competency within the radiotherapy clinical setting and explore radiographer perceptions, experiences and integration of VERT™IGRT as an imaging tool.

A mixed-methods study was utilised to measure clinical image matching competencies in the first quantitative phase through means of a workbook and imaging assessment. Phase II used qualitative semi-structured interviews to explore radiographer perceptions.

Workbooks enabled participants to prepare for image assessments. Interview findings were highlighted in three distinctive themes: (1) The need for supervision, guidance and feedback; (2) Experience and practice leads to confidence and competence and (3) Technology supports process but not evaluation.

VERT™IGRT provides a sound platform for training therapeutic radiographer image matching skills, but needs to be delivered with continuous feedback to develop individual decision-making skills. The technology provides opportunities for staff to increase confidence in utilsing image matching technology, but analytical and evaluation skills require supervision and continuous feedback which should be embedded in any educational training programme.

To determine which concomitant boost technique is dosimetrically superior in the treatment of breast cancer; volumetric-modulated arc therapy (VMAT) or fixed field intensity-modulated radiotherapy (ff-IMRT).

In total, 30 breast patients were re-planned with both VMAT and fixed field concomitant boost intensity-modulated radiotherapy techniques. A hybrid technique was used delivering 80% of the dose through tangential beams and 20% through an integrated boost. A two-tailed t-test sample for means was used to compare the dosimetric differences between the techniques.

Maximum dose was statistically lower for VMAT; 103·2 versus 103·7% for ff-IMRT along with statistically lower V2 Gy doses to the contralateral lung (0·7 versus 1·6%) and heart for both left- (19·0%/22·6%), and right- (5·5%/8·8%) sided patients, respectively. ff-IMRT boasted significantly lower ipsilateral lung V20, V18 and V10 Gy (7·9/8·6/13·1 versus 8·1/8·8/13·4%) than VMAT, respectively. No differences were found with minimum coverage, mean dose and V5 Gy to all organs at risk (OARs).

VMAT and ff-IMRT techniques demonstrate excellent target coverage and OAR sparing facilitated by the hybrid planning technique and deep inspiration breath hold. There is no obvious dosimetrically superior option between the two techniques. Reduced treatment times with VMAT make it more desirable to implement clinically.

To study the feasibility of constant dose rate volumetric modulated arc therapy (CDR-VMAT) in radiotherapy for gallbladder cancer by comparing dosimetric parameter suggested by International Commission on Radiation Units and Measurements-83 (ICRU-83) with step and shoot intensity-modulated radiation therapy (SS IMRT).

For this study, we selected 21 post-operative gallbladder cancer patients, which were treated with the IMRT technique from 2016 to 2019. For each patient, we generated SS IMRT plan and CDR-VMAT plan and were dosimetrically compared by parameters suggested by ICRU-83 for PTV. Homogeneity Index (HI) and Conformity Index (CI) were also calculated. For evaluation of Organ at Risk (OAR), we compared the mean doses, volume doses to the right kidney, left kidney, both kidneys combined, liver and max dose to the spinal cord. Monitor units (MUs) and treatment delivery time were also compared.

On comparing, we found that CDR-VMAT plans were highly conformed as CI and PCI (CI define by Paddick) were found more (0·98 ± 0·01 vs. 0·97 ± 0·03 and 0·86 ± 0·05 vs. 0·85 ± 0·05) than IMRT plans but not statistically significant. Better dose HI was found for IMRT plans with statistical significant difference (p < 0·001). The tumour coverage was found similar 98·24% and 97·83% for SS IMRT and CDR-VMAT, respectively. For D2%, the maximum dose to PTV was significantly lower in IMRT (p = 0·001). D50% and mean dose to PTV were also comparable to IMRT with no statistically significant difference. The OAR parameters were comparable in both the techniques. The mean doses and volume doses V10, V20 and V30 to the right kidney, left kidney and liver were also comparable with no significant difference (p > 0·05) was noted among them. However, the maximum dose to the spinal cord was significantly less in CDR-VMAT (21·1 Gy vs. 25·1Gy) than SS IMRT with p = 0·006. More MUs were associated with the CDR-VMAT technique, but shorter treatment delivery time than the IMRT technique.

On dosimetric comparison of two treatment techniques, we conclude that CDR-VMAT can be a valid option in radiotherapy as it achieved highly conformed dose distribution, comparable tumour coverage and OAR sparing as IMRT technique for gallbladder cancer.

The treatment planning system (TPS) plays a key role in radiotherapy treatments; it is responsible for the accurate determination of the monitor unit (MU) needed to be delivered to treat a patient with cancer. The main goal of radiotherapy is to sterilise the tumour; however, any imprecise dose delivered could lead to deadly consequences. The TPS has a quality assurance tool, an independent program to double check the MU, evaluate patient plan correctness and search for any potential error.

In this work, a comparison was carried out between a MU calculated by TPS and an independent in-house-developed monitor unit calculation program (MUCP). The program, written in Cplusplus (C++ Object-Oriented), requires a database of several measured quantities and uses a recently developed physically based method for field equivalence calculation. The ROOT CERN data analysis library has been used to establish fit functions, to extend MUCP use to a variety of photon beams. This study presents a new approach to checking MU correctness calculated by the TPS for a water-like tissue equivalent medium, using our MUCP, as the majority of previous studies on the MU independent checks were based on the Clarkson method. To evaluate each irradiated region, four calculation points corresponding to relative depths under the water phantom were tested for several symmetric, asymmetric, irregular symmetric and asymmetric field cases. A comparison of MU for each radiation fields from readings of the TPS and the MUCP was undertaken.

A satisfactory agreement has been obtained and within the required standards (3%). Additional experimental measurements of dose deposited in a water phantom showed a deviation of <1·6%.

The MUCP is a useful tool for basic and complex MU verification for 3D conformal radiation therapy plans.

Intensity-modulated radiation therapy (IMRT) is one of the most reported techniques for head and neck cancer treatment, as it allows a good coverage of the planning target volume (PTV) while sparing the surrounding organs at risk (OAR) better than conventional conformal radiotherapy. The objective of this work is to optimise an IMRT technique for the simultaneously integrated boost (SIB) treatment of larynx cancer delivering a total dose of 69·96 Gy to the boost volume and 54·45 Gy to the elective volume in 33 fractions.

Three IMRT techniques, each using seven equally spaced beams, were planned for a sample of 10 patients. The first two techniques (IMRT-0 and IMRT-26) differ only for the starting angle of the seven beams, whereas the third (IMRT-CT) combines both these techniques by delivering IMRT-0 in the first half of treatment, and IMRT-26 in the second half, thus taking advantage of using 14 beams in total while using seven at a time only. The planning results were compared according to the dose coverage, homogeneity and conformity of the two PTVs, as well as to the dose to OARs, that is, spinal cord, parotids, mandible, brainstem and healthy tissue (defined as the body volume minus the sum of PTVs).

Basically the PTV coverage resulted acceptable and comparable with all the three techniques. Concerning OARs, statistically better results are obtained in IMRT-CT when compared with IMRT-26 and IMRT-0.

The IMRT-CT technique, combining two different seven-beam setups, delivered in two treatment phases, improves dose distribution without increasing delivery time.

Jugulotympanic glomus tumours (JTGT) are highly vascular neoplasms composed of paraganglionic tissue of neural crest origin. Because of the neoplasm’s slow growth potential, any claimed efficacy associated with applied treatment must be supported by long-term effects observed in patients.

This report presents a case of advanced stage JTGT in a 66-year-old woman treated by γ knife radiosurgery (GKRS).

Sustained tumour control with preservation of lower cranial nerve function was observed for more than 10 years after completion of treatment.

GKRS even with large intracranial extension of JTGT in patients may help to achieve long-term disease control with minimal morbidity.

Salivary duct carcinoma (SDC) is an extremely rare and aggressive subtype of salivary gland cancer with high morbidity and mortality and poor response to treatment. The current options of treatment include radical surgery followed by radiotherapy (RT) with or without chemotherapy. The aim of this study was to analyse the patterns of recurrences, possible predictors of outcome and role of RT in a cohort of patients with non-metastatic SDC.

A retrospective review of patients treated between 2010 and 2019 with histologically proven non-metastatic SDC was conducted.

Sixteen patients were included in the series. Median follow-up was 25 months. Progression-free survival (PFS) and overall survival (OS) at 12 months were 61% and 80%, respectively. Seven out of the 16 patients had disease progression, distant metastases being most frequent. Four patients died due to disease progression. PFS was significantly worse for patients with pathological neck node positivity (p = 0·036) and peri-parotid nodes (p = 0·007). Local control was significantly associated with RT (p = 0·011). Addition of any chemotherapy, regardless of either concurrent or adjuvant, had no impact on the PFS or OS. Pathological neck node positivity with nodal stage of N2 or higher correlated significantly with worse OS (p = 0·031).

Salivary ductal carcinoma is an aggressive malignancy with high metastatic potential. Inferior prognosis was observed among patients who had metastatic deposits in either cervical nodes or peri-parotid nodes on histopathology. As systemic failures are more predominant among these patients, larger prospective trials are needed to formulate an optimum strategy for choice and sequencing of first-line systemic therapy.

Re-planning mid-treatment, with the adjustment of target volumes, has been performed as part of the normal workflow at our institution. We sought to quantify the benefit of this approach and identify factors to optimise plan adaptive strategies.

Patients with locally advanced oropharyngeal cancer treated to 70 Gy with concurrent chemoradiation (CCRT) on TomoTherapy® who underwent re-planning during the treatment were eligible. Survival and prognostic factors were evaluated with Kaplan–Meier and Cox proportional hazards, two-side p-value <0·05 significant.

Forty-two patients were identified with Stage III (n = 5), IVA (n = 34) and IVB (n = 3) [AJCC 7th] disease. Median re-planning dose was 40 Gy (14–60 Gy). Median change in mean total parotid dose was reduction of 1 Gy (range –7·5 Gy to +13·9 Gy). The volume of PTV70 and PTV60 receiving 99% of the prescribed (V99) dose was increased by 2·2% (–3·3 to +16·6%) and 1·9% (–11·5 to +12·6%) by re-planning. As a continuous variable, increasing per cent nodal regression was associated with the improved disease control in a multivariate model including stage, pack years smoking and human papilloma viral (HPV) status (HR: 0·85, 0·71–0·99, p = 0·05).

Adaptive planning generates a superior plan for the majority of patients, but there is modest overall parotid gland sparing.

Stereotactic radiosurgery (SRS) has proven itself as an effective tool in the treatment of intracranial lesions. Image-guided high dose single fraction treatments have the potential to deliver ablative doses to tumours; however, treatment times can be long. Flattening filter free (FFF) beams are available on most modern linacs and offer a higher dose rate compared to conventional flattened beams which should reduce treatment times. This study aimed to compare 6 MV FFF and 10 MV FFF to a 6 MV flattened beam for single fraction dynamic conformal arc SRS for a Varian Truebeam linac.

In total, 21 individual clinical treatment plans for 21 brain metastases treated with 6 MV were retrospectively replanned using both 6 MV FFF and 10 MV FFF. Plan quality and efficiency metrics were evaluated by analysing dose coverage, dose conformity, dose gradients, dose to normal brain, beam-on-time (BOT), treatment time and monitor units.

FFF resulted in a significant reduction in median BOT for both 6 MV FFF (57·9%; p < 0·001) and 10 MV FFF (76·3%; p < 0·001) which led to reductions in treatment times of 16·8 and 21·5% respectively. However, 6 MV FFF showed superior normal brain dose sparing (p < 0·001) and dose gradient (p < 0·001) compared to 10 MV FFF. No differences were observed for conformity.

6 MV FFF offers a significant reduction in average treatment time compared to 6 MV (3·7 minutes; p = 0·002) while maintaining plan quality.

The role of the Consultant Radiographer (CR) is crossing traditional boundaries to encompass duties and responsibilities normally performed by the medical profession. Changes and streamlining of radiotherapy (RT) services result as therapeutic radiographers are taking on the responsibility of informed consent.

This article discusses and evaluates the legal, ethical and practical aspects of informed consent within the trust and how they have implemented the introduction of CR-led consent. It reports on the impact on the waiting times for treatment and user experience for myeloma patients receiving RT for pain relief from bone metastases.

A literature search was conducted using PubMed, CINAHL, Medline and Cochrane library using the term ‘informed consent’. The legal, ethical and practical aspects were compared to the current system and then was used to inform the development of a new pathway. Data were analysed from the department’s statistics for waiting times and the number of treatment courses.

CR-led informed consent has streamlined the patient pathway and has improved patient care and experience.

To study 2D and 3D dosimetric values for bladder and rectum, and the influence of bladder volume on bladder dose in high dose rate (HDR) intracavitary brachytherapy (ICBT). The large patient data incorporated in this study would better represent the inherent variations in many parameters affecting dosimetry in HDR-ICBT.

We prospectively collected data for 103 consecutive cervical cancer patients (over 310 HDR fractions) undergoing CT-based HDR-ICBT at our centre. Correlation among bladder and rectum maximum volume doses and corresponding International Commission on Radiation Units and Measurement (ICRU) point doses were estimated and analysed. Impact of bladder volume on bladder maximum dose was assessed.

The ICRU point doses to bladder and rectum varied from the volumetric doses to these organs. Further, bladder volume poorly correlated with bladder maximum dose for volume variations encountered in the clinical practice at our centre.

ICRU point doses to bladder and rectum are less likely to correlate with long-term toxicities to these organs. Further, in clinical practice where inter-fraction bladder volume does not vary widely there is no correlation between bladder volume and bladder dose.

In recent years, there has been a spectacular development in nanomedicine field with new nanoparticles for diagnosis and cancer therapy. Although most researchers have been always interested in gold nanoparticles (GNPs)

In the present work we present a comparison between the use of bio-nanomaterials in proton therapy.

Consequently, our results show that platinum nanoparticles (PtNPs) present an interesting advantages comparing with GNPs and silver nanoparticles. On the other hand, the use of PtNPs facilitates in a considerable way the proton therapy.

Accurate localisation of target position is crucial when using techniques with sharp dose fall off such as volumetric modulated arc therapy (VMAT). Gold seed fiducial markers have been used for target localisation in image-guided radiation therapy for various tumors including intact prostate cancers. However, their role for target localisation in post-prostatectomy radiotherapy is unclear. This study was undertaken to determine the feasibility and effectiveness of gold seed fiducial markers in patients undergoing prostate bed VMAT.

The institutional radiation oncology database was used to analyse the treatment data of 18 post-prostatectomy patients with implanted gold seed fiducial markers. The shifts of the fiducial markers were reviewed, tabulated and statistically analysed.

Three hundred and eighty-six orthogonal pair images for 18 patients were reviewed. Specifically, the average gold seed fiducial shifts were 0·34 cm in the superior–inferior (S/I) axis (0·31 SD), 0·31 cm (0·29 SD) in the anterior–posterior (A/P) axis and 0·28 cm (0·25 SD) in the lateral axis (R/L). As a result, the 95% probability of fiducial marker displacement was 0·96 cm in the S/I, 0·89 cm in the A/P and 0·78 cm in the R/L axes. The most frequent shifts occurred in the inferior, left and posterior directions. The percentage of shifts more than 0·5 cm were 19·74, 21·56 and 12·47% for the S/I, A/P and R/L axes, respectively.

In the absence of fiducial markers, non-uniform planning target volume (PTV) margins of 1 cm for S/I, 9 mm for A/P and 8 mm for the lateral direction are necessary for target localisation in post-prostatectomy radiotherapy. By improving prostate bed localisation, gold seed fiducial markers can decrease PTV margins, reduce normal tissue radiation exposure and allow for dose-escalated and/or hypofractionated radiotherapy to be considered in appropriate clinical scenarios.

To investigate the central electrode artefact effect of different ion chambers in the verification phantom using the dose calculation algorithms Analytical Anisotropic Algorithm (AAA) and Acuros XB.

The dosimetric study was conducted using an in-house fabricated polymethyl methacrylate head phantom. The treatment planning system (TPS)-calculated doses in the phantom with detectors were compared against the dummy detector fillets using AAA and Acuros XB algorithm. The planned and measured doses were compared for the study.

The mean percentage variation in volumetric-modulated arc therapy plans using Acuros XB and the measurement in the head phantom are statistically significant (p-value = 0.001) for FC65 and CC13 chambers. In small volume chambers (A14SL and CC01), the measured and TPS-calculated dose shows a good agreement.

The study confirmed the CT set of the phantom with detectors (FC65 and CC13) give more artefacts/heterogeneity caused a significant variation in dose calculation using Acuros XB. Therefore, the study suggests a method of using phantom CT set with the dummy detector for mean dose calculation for the Acuros XB algorithm.

Use of molecular information to guide clinical management of thoracic liposarcoma following resection.

We present a case of a large liposarcoma of the left hemithorax. Initial biopsy consistent with lipoma however following resection pathology showed well-differentiated liposarcoma. Clinical data and molecular information including MDM2 from the tumour were employed in decision making regarding subsequent adjuvant radiation therapy versus close observation.

Improved molecular characterisation has increased the precision of histological diagnoses and prediction of outcomes for many cancers. These may continue to help guide and strengthen clinical decision making and recommendations as they pertain to adjuvant therapy versus observation in the case of this patient.