Delays in the diagnosis of cancer were found to be a worldwide matter, and the early cancer detection has been targeted as a way to improve survival. Quantitative studies from Saudi Arabia reported a high number of cancer cases presenting at cancer centres for the first time with more advanced stages of the disease progression compared to Western countries without exploring the reasons for this phenomenon. Worldwide research identified several factors that contribute to delay in the diagnosis and treatment of cancer which were attributed to both patient and healthcare system. However, it was argued that variation in the operation of health systems and the socio-cultural context across countries makes it difficult to generalise findings beyond individuals’ countries. This necessitates country specific research to investigate why patients in Saudi Arabia present to cancer centres with late/advanced stages of their diseases.

The aim of this study is to identify and explore the factors that contribute to late-stage presentation of common cancers in Saudi Arabia. The main objective of this study is to understand the help seeking journey taken by patients with cancer from the time they discovered or felt their symptoms until the time they have their treatment initiated.

Qualitative interviewing was used to collect data from 20 patients and 15 health professionals. The interviews were transcribed and then were subjected to the thematic analysis using a framework approach developed by Ritchie and Spencer (1994).

While some findings support what previous studies found as contributing factors responsible for delayed presentation of common cancers, this study identified several factors, which are believed to be country-specific. The ‘role of General Practitioner (GP)’, ‘challenges facing GPs’ and ‘ambiguity of the referral system’ were found to be factors that contribute to delay in the diagnosis and treatment of cancer in Saudi Arabia.

This research identified several factors that need to be investigated in the future using quantitative methods. There is a need to investigate the extent of using alternative medicine and its possible association with late presentation of cancer.

Service user involvement has been demonstrated as an important aspect of cancer professionals’ education. There is some understanding of service users’ incentive to be involved, but little insight into what motivates them. This study explores this concept more fully.

To explore the motivations and experience of service users’ involvement in radiotherapy and oncology education.

One-to-one interviews were conducted with service users who have been involved in education at the university. Thematic analysis was conducted. Five participants were asked about their motivations and experience of taking part in a variety of educational activities.

The experience of being involved gave the participants a sense of wellbeing and purpose. Three sub-themes were identified that related to service users’ motivation for being involved in educational activities with undergraduate students. These were to promote awareness by sharing their experiences of cancer; improve patient care through learning from negative experience; and personal reward skills for survivorship.

This study has highlighted the importance of hearing the voice of the service users; a two-way engagement for which there are benefits for both the students and service users. The involvement of service users in education becomes part of their personal journey.

Studies have investigated the prevalence of compassion satisfaction and compassion fatigue in various healthcare professions. However, the majority of evidence is linked to the nursing profession and little is known about paramedical professions such as radiography and even less is known about its prevalence in students. The purpose of this study was to describe the levels of compassion satisfaction and compassion fatigue in the student population and how they varied in time.

Students undertaking radiotherapy training at the researcher’s host sites were surveyed using the Professional Quality of Life questionnaire at the end of each final clinical block in each year of their training.

During the 3 years of training compassion satisfaction falls and burnout increases in the student population, although the change is not significant. Secondary traumatic stress increases significantly during the 3 years of training, F=5·725, p=0·005. Considerable variation also exists in the three scores dependent on the student’s clinical training site. Relationships are also observed between some personality traits, particularly conscientiousness and neuroticism and compassion scores.

Conjunctival squamous cell carcinoma (SCC) is a rare tumour of the ocular region and microscopic radical surgical is difficult. There are no single guidelines for therapeutic management and the role of radiation therapy is not clearly defined although conventionally photon or electron beams are used. Proton beam radiotherapy (PBRT) is a new option for a conservative approach and allows good sparing of the organs at risk.

After surgical resection, we collected 15 cases treated at our institution with PBRT. The dose delivered was between 48 and 60 Gy relative biological effectiveness (RBE), with fractions of 12–15 Gy RBE.

After an average period of 48 months, the patients achieved excellent disease control (overall survival and disease-free survival: 86·6%), with minimal acute and late toxicity.

In this work, we present our experience on the use of PBRT technique in SCC treatment. A larger sample of patients is needed to draw conclusions about the impact of this treatment on disease recurrence and overall survival.

To compare the contours and dose volume histograms (DVH) parameters of the high-risk clinical target volume (HRCTV) contoured on computed tomography (CT) using clinical findings at brachytherapy, clinical findings at brachytherapy with magnetic resonance imaging (MRI) at diagnosis and HRCTV defined on MRI at brachytherapy in cervical cancer patients.

Fifteen patients undergoing MRI-guided image-based brachytherapy underwent both CT and MRI after applicator insertion. Two sets of contours were defined on CT. In the first set, the HRCTV was defined with the help of clinical findings at brachytherapy (CT-HRCTV). In the second set, HRCTV was defined with MRI at diagnosis and clinical findings at brachytherapy (CT-HRCTVdmri). This was compared with the HRCTV defined on MRI at brachytherapy (MR-HRCTV). The doses to the organs at risk (OARs) were compared for CT and MRI.

A significant overestimation of the maximum width and width at point A was observed for CT-HRCTV (p −0·00; 0·00) and CT-HRCTVdmri (p −0·03; 0·01), respectively. The height was underestimated with CT-HRCTV in patients with intrauterine disease extension. For a single fraction, the mean difference in the D90 for the CT contours was <1 Gy. The doses to the OARs were comparable.

CT may be an alternative when facilities for MRI image-based brachytherapy are lacking, provided at least one MRI is available before brachytherapy.

Cancer of the vulva is rare, it is a disease commonly diagnosed in elderly women, however, the incidence in younger women is rising. Many patients diagnosed and treated for vulval cancer face physical, social, sexual and psychological challenges. It is essential that therapy radiographers and members of the wider multidisciplinary team understand such challenges in order to provide patient centred care.

This review aims to highlight the key psycho-social issues experienced by patients with cancer of the vulva, identifying implications for practice in order to improve the holistic care for this patient group.

A search of English literature was performed using Medline, Pubmed, CINAHL and PsycINFO. Search terms included, vulva or vulval cancer, psychosocial, psychosexual impact and quality of life. Articles were excluded if they focussed on cancers other than gynaecological and vulval cancers.

Although there are numerous reports on the psychological and psychosocial problems faced by gynaecological cancer patients; there was a paucity of literature pertaining to patients with cancer of the vulva, this is consistent with previous research. Studies show a significant negative, psychosocial impact experienced by these women. Common themes being isolation, loneliness, stigmatisation and lack of information for patients and their carers, themes spanning over three decades. Nevertheless, it is important to be aware of the findings from recent studies consistent with patient’s needs, highlighting that listening to women’s narratives on living with cancer of the vulva is essential if we are to help with the psychosocial issues experienced by these women. They underline a necessity to raise awareness among healthcare professionals and the general public, to improve holistic support for this particular group of women. This is particularly important in the radiotherapy setting as many of these women undergo lengthy courses of treatment and the appropriately trained therapeutic radiographer can play a vital role in addressing the physical and psychosocial problems.

Head and neck (HN) radiotherapy (RT) is complex, involving multiple target and organ at risk (OAR) structures delineated by the radiation oncologist. Site-agnostic peer review after RT plan completion is often inadequate for thorough review of these structures. In-depth review of RT contours is critical to maintain high-quality RT and optimal patient outcomes.

In August 2020, the HN RT Quality Assurance Conference, a weekly teleconference that included at least one radiation oncology HN specialist, was activated at our institution. Targets and OARs were reviewed in detail prior to RT plan creation. A parallel implementation study recorded patient factors and outcomes of these reviews. A major change was any modification to the high-dose planning target volume (PTV) or the prescription dose/fractionation; a minor change was modification to the intermediate-dose PTV, low-dose PTV, or any OAR. We analysed the results of consecutive RT contour review in the first 20 months since its initiation.

A total of 208 patients treated by 8 providers were reviewed: 86·5% from the primary tertiary care hospital and 13·5% from regional practices. A major change was recommended in 14·4% and implemented in 25 of 30 cases (83·3%). A minor change was recommended in 17·3% and implemented in 32 of 36 cases (88·9%). A survey of participants found that all (n = 11) strongly agreed or agreed that the conference was useful.

Dedicated review of RT targets/OARs with a HN subspecialist is associated with substantial rates of suggested and implemented modifications to the contours.

Cone beam computed tomography (CBCT) images contain more scatter than a conventional computed tomography (CT) image and therefore provide inaccurate Hounsfield units (HUs). Consequently, CBCT images cannot be used directly for dose calculation. The aim of this study is to enable dose calculations to be performed with the use of CBCT images taken during radiotherapy and potentially avoid the necessity of re-planning.

A phantom and prostate cancer patient with a metallic prosthetic hip replacement were imaged using both CT and CBCT. The multilevel threshold algorithm was used to categorise pixel values in the CBCT images into segments of homogeneous HU. The variation in HU with position in the CBCT images was taken into consideration and the benefit of using a larger number of materials than typically used in previous work has been explored. This segmentation method relies upon the operator dividing the CBCT data into a set of volumes where the variation in the relationship between pixel values and HUs is small. A field-in-field treatment plan was generated from the CT of the phantom. An intensity-modulated radiation therapy plan was generated from CT images of the patient. These plans were then copied to the segmented CBCT datasets with identical settings and the doses were recalculated and compared.

In the phantom study, γ evaluation showed that the percentage of points falling in planning target volume, rectum and bladder with γ<1 (3%/3 mm) was 100%. In the patient study, increasing the number of bins to define the material type from seven materials to eight materials required 50% more operator time to improve the accuracy by 0·01% using pencil beam and collapsed cone and 0·05% when using Monte Carlo algorithms.

The segmentation of CBCT images using the method in this study can be used for dose calculation. For a simple phantom, 2 values of HU were needed to improve dose calculation accuracy. In challenging circumstances such as that of a prostate patient with hip prosthesis, 5 values of HU were found to be needed, giving a reasonable balance between dose accuracy and operator time.

Varian RapidArc is a volumetric modulated arc therapy (VMAT) that obtains a conformal dose around the desired structure by employing variable gantry speed, dose rate and dynamic multileaf collimator (DMLC) speed as the gantry rotates about machine isocenter. This study is meant to build upon previous research by Ling et al. by completing the tests with an in vivo dosimetric device attached to the linac gantry and a 2D ionisation chamber array with an isocentric gantry mount.

Two PTW detectors, seven29 array with gantry mount and DAVID, were attached to the linear accelerator gantry, allowing each device to remain perpendicular to the beam at all gantry angles. Three tests for RapidArc evaluation were performed on these devices including: dose rate and gantry speed variation, DMLC speed and dose rate variation and DMLC position accuracy. The reproducibility of the arc data was also reported.

A picket fence plan varying dose rates (111 to 600 MU/minute) and gantry speeds (5·5 to 4·3°/second) was delivered consisting of seven sections of different combinations. These measurements were compared with static gantry, open field measurements and found to be within 2·39% for the DAVID device and 0·84% for the seven29. A four-section picket fence of varying DMLC speeds (0·46, 0·92, 1·84 and 2·76 cm/second) was similarly evaluated and found to be within 1·99% and 3·66% for the DAVID and seven29, respectively. For DMLC position accuracy, a picket fence arc plan was compared with a static picket fence and found to agree within 0.38% and 2.91%. Reproducibility for these three RapidArc plans was found to be within 0·30% and 2·70% for the DAVID and seven29.

The DAVID and seven29 detectors were able to perform the RapidArc quality assurance tests efficiently and accurately and the results were reproducible. Periodic verification of DMLC movement, dose rate variation and gantry speed variation relating to RapidArc delivery can be completed in a timelier manner using this equipment.

The aim of this study was to explore the experiences of radiotherapy students on clinical placement, specifically focussing on the provision of well-being support from clinical supervisors.

Twenty-five students from the University of the West of England and City University of London completed an online evaluation survey relating to their experiences of placement, involving Likert scales and open-ended questions.

The quantitative results were generally positive; however, the qualitative findings were mixed. Three themes emerged: (1) provision of information and advice; (2) an open, inclusive and supportive working environment; and (3) a lack of communication, understanding, and consistency.

Students’ experiences on placement differed greatly and appeared to relate to their specific interactions with different members of staff. It is suggested that additional training around providing well-being support to students may be of benefit to clinical supervisors.

This study aimed to examine the dosimetric properties of Gafchromic® EBT3 film and intensity-modulated radiation therapy quality assurance (IMRT QA).

Beams characteristics dosimetric properties and 20 IMRT plans were created and irradiated on Varian dual-energy DHX-S Linac for 6 and 15 MV energies. EBT3 films were analysed using ‘film Pro QA 2014’ software.

The dosimetric comparison of EBT3 film (for red channel dosimetry) and ionisation ion chamber measurement showed that average deviations of symmetry, flatness, central axis, penumbra (left) and penumbra (right) of dose profile were 0·18, 1·34, 0·49%, 3·68 and 3·61 mm for 6 MV and 0·10, 1·3, 0·45, 2·65 and 2·71 mm for 15 MV, respectively. The blue and green channels dosimetry showed greater dose deviation as compared with red channel. IMRT QA verification plan complied about 95% at all different criteria. Reproducibility, stability and face orientation of film were within 1·4% for red channel.

The results advocate that the film can be used not only for dosimetric assessment but also as a reliable IMRT QA tool.

Research in the applications of the principles of quantum physics in oncology has progressed significantly over the past decades; and several research groups with professionals from diverse scientific background, including electrical engineers, mathematicians, biologists, atomic physicists, computer programmers, and biochemists, are working collaboratively in an unprecedented and pioneering economic, organisational and human effort searching for a wider and more effective, potentially definitive, understanding of the cancers. It is hypothesised that the principles of quantum physics could open new and broader understanding of the cancers and the development of new effective, targeted, accurate, personalised and possibly definitive cancer treatment.

This paper reports on a review of recent studies in the field of the applications of the principles of quantum physics in biology, chemistry, biochemistry and quantum physics in cancer research, including quantum physics principles and cancer, quantum modelling techniques, quantum dots and its applications in oncology, quantum cascade laser histopathology and quantum computing applications.

The applications of the principles of quantum physics in oncology, chemistry and biology are providing new perspectives and greater insights into a long-studied disease, which could result in a greater understanding of the cancers and the potential for personalised and definitive treatment methods.