A system to assist daily identification of radiotherapy patients and to prevent accidental exposures to mis-indentified patients was developed. The fingerprint-based biometric system was chosen because of its high sensitivity in identification and suitability for hospital use. In a 6-month survey, 85.7% of the daily treatment fractions were identified successfully; 5.5% of the unsuccessful identifications were overridden by the staff and the remaining 8.8% were due to poor-quality fingerprints. No false identifications occurred so that patient was identified as a different person. During the past 2.5 years and 47,000 treatment fractions, the system has been well accepted by the patients and radiation technologists and misidentified patients have not been treated since the installation.

Matching assessment strategies to learning outcomes in radiation therapy education is of the utmost importance. Assessing clinical competence requires that ‘competence’ be clearly defined prior to the start of any clinical programme. In this article, we report on our experience in using clinical oral examinations in assessing competence in second year undergraduate radiation therapy students. The shortcomings of clinical oral examinations such as ‘leaking’ of the agenda are addressed and more positive attributes, such as increased collaboration between academic and clinical radiation therapists are discussed.

Background: Virtual environments in medical education are becoming increasingly popular as a learning tool. However, there is a large amount of evidence linking these systems to adverse effects that mimic motion sickness. It is also proposed that the efficacy of such systems is affected by how well they engage the user, which is often referred to as presence.

Purpose: This primary purpose of this study was to look at the side effects experienced and presence in the Virtual Environment for Radiotherapy Training (VERT) system which has recently been introduced.

Method: A pre-VERT questionnaire was given to 84 subjects to ascertain general health of the subjects. The simulator sickness questionnaire was utilised to determine the side effects experienced, whereas the igroup presence questionnaire was used to measure presence. Both questionnaires were given immediately after use of the VERT system.

Results: The majority of symptoms were minor; the two most commonly reported symptoms relating to ocular issues. No relationship was seen between simulator sickness and presence although subjects with a higher susceptibility to travel sickness had reported higher levels of disorientation and nausea. There was also a decrease in involvement with the system in subjects with a higher susceptibility to travel sickness.

Radiotherapy is a critical component for many patients undergoing treatment for breast cancer. Most patients develop some degree of acute radiation skin reaction as a result of the treatment. Acute skin reactions range from faint erythema to moist desquamation and often peak within 1 month after completion of treatment.

The emphasis of radiotherapy skincare advice is often during treatment with less attention paid to post-radiotherapy skincare. This article highlights this gap in service provision at one radiotherapy centre and demonstrates the difficulties encountered when there is an inadequate support system. Possible options are discussed for the management of skin reactions after radiotherapy and the potential implications of adopting these strategies. The pragmatic solution introduced to Addenbrookes’ Hospital was to amend patient information providing a supplementary section for health-care professionals overseeing patient care after completion of treatment. This has gone some way to addressing this issue but still has limitations.

Provision of timely and consistent skincare advice and support is vital to provide high-quality patient care. This article emphasises the importance of standardisation of radiotherapy skincare and providing an effective support network for patients after completion of radiotherapy.

Do you have an enquiring mind and an enthusiasm or thirst for knowledge? Do you want to get involved in radiotherapy research or develop your research expertise? Research should underpin the clinical and educational activities undertaken by Radiation Therapists. For many, research can seem a daunting process that is beyond their expertise or capabilities. All health care practitioners can use research evidence and some may want to undertake their own research but may feel unsure where to start.

This article is aimed at novice researchers (or those with limited research experience) and those wanting to develop their research potential. The discussion should help practitioners identify the necessary skills required to undertake research, where to go for help, the research process (including where research ideas come from), and what to consider when putting together a project team or applying for research funding.

The discussion concludes on the importance of research training and support (or mentoring) for novice researchers or those at the start of their research careers. The national professional body for therapists can play an important role in helping researchers to network with likeminded individuals. Some professional bodies (such as the College of radiographers in the UK) may also provide small research grants to help build research activity, and as such can be a useful starting point when considering research funding.

Patients treated with palliative intent present a complex issue for radiotherapy departments in terms of their specific care needs, treatment times, and the productivity of orthovoltage resources. This study seeks to evaluate and quantify patient-related factors, treatment times, and to assess tools and data for future utilisation by radiotherapy departments. A modified Basic Treatment Equivalent (BTE) methodology was chosen, with stopwatch timings taken of treatments on orthovoltage units, over a 4-week period at two radiotherapy departments. Data collected included patient-related, treatment and equipment factors to assess their relative or specific effects on treatment times. Analysis considered the differences in data sets, significance and correlation. Forty-three fractions of treatment were recorded, across a range of treatment sites. The number of fields and delivery of first fractions/plan and treat episodes were found to result in significant differences in treatment time. The use of equipment, age and performance status were not found to be influential. Pain and skin viability symptoms had the greatest impact on treatment times–with these themselves being influenced by the impact of number of fields treated and first fractions. A full study should now be undertaken with a view to design a new equivalence model for the effective assessment of orthovoltage productivity.

Accurate patient positioning is vitally important in intensity modulated radiation therapy (IMRT) for head and neck (H&N) cancer. The introduction of kilovoltage (kV) on-board imaging (OBI) at our centre was anticipated to improve the accuracy and efficiency of H&N IMRT patient position verification over traditional megavoltage (MV) electronic portal imaging (EPI). This study compares these imaging systems with a phantom accuracy study and retrospective analysis of imaging workload in H&N IMRT at our centre. Six therapists performed online evaluation of phantom images, and residual positional errors for each system were recorded. The largest residual error was 1 mm for OBI and 3 mm for EPI. The estimated improvement in residual error in OBI over EPI was 0.57 mm (95% confidence interval 0.33–0.81 mm), suggesting treatment staff would be better able to detect set-up deviations with OBI. Electronic treatment records of 20 H&N IMRT patients (10 verified daily with MV EPI and 10 with kV OBI) were analysed. Mean imaging session duration was 9.51 min for EPI and 9.76 min for OBI. Analysis found no evidence of an effect on duration due to the imaging system used for this subset of patients (p = 0.664).

In recent years the role of the radiation therapist (RT) has increasingly evolved. In Australia, one of the major developments has been the transition from practice which was rarely based on scientific evidence, to the profession today which engages in and incorporates research into everyday practice. The aim of this article is to provide an insight into the current status of Australian radiation therapy research. In order to present a national overview, a survey relating to research activity was e-mailed to all (48) clinical centres in Australia. Thirty-six out of the 48 centres responded, representing 13 private and 23 public centres. The results demonstrated that a research culture is beginning to be established and that there are challenges associated with implementing research. The role of universities in facilitating the development of research skills was considered important with an increasing number of practitioners undertaking higher research degrees. Overall, research activity in the Australian radiation therapy community is becoming more prevalent. If the profession is to continue to strengthen its research profile the professional body and universities need to continue providing academic and funding support. Greater focus on multidisciplinary collaboration is needed with direct involvement of RTs in multi-centre studies.

Introduction: Many patients in the United Kingdom having radiotherapy for breast cancer are recommended not to use a deodorant during treatment. The advice is not evidence based, it is solely thought as deodorants contained metals, which would react with radiation and cause an increased skin reaction. Hence this research was undertaken to establish whether patients having a course of radiotherapy for breast cancer could use a deodorant as part of their daily routine.

Method: The research took place between May 2004 and February 2005. A total of 192 breast cancer patients were recruited. This included breast or chest-wall patients with or without axilla involvement. The study was designed with two groups. Group 1 used no deodorant and Group 2 a specific deodorant. The researcher reviewed patients weekly, assessing skin reactions and recording the researcher and patient's observations.

Results: Most patients experienced no reaction or mild erythema and dry desquamation in the axilla. This was observed in both groups. Therefore, findings of this study indicate that future breast cancer patients should be given the choice of using this deodorant.

Further recommendations: Test the reliability of the skin assessment form, extend the research to include other patient groups who have their axilla treated, test different deodorants.

A brief general and personal history of research conducted in partnership with patients is outlined in order to substantiate the beneficial effect of this method in improving the quality of research and to illustrate the importance to patients of testing treatments in a manner that takes account of the outcomes they seek. Examples of two early initiatives, Radiotherapy Action Group Exposure (RAGE) and the Consumers' Advisory Group for Clinical Trials (CAG-CT), are used to demonstrate what can be accomplished by committed groups of patients working with policy makers and practitioners to improve the quality and provision of treatments for breast cancer.

Background: The rapid changes in practice of radiotherapy have taken place over the past 5 years in Pakistan. With advent of computed tomography simulator, and multileaf collimators–assisted linear accelerators and electronic portal imaging system, few centres in Pakistan have switched from conventional radiotherapy to modern computer-based technology. Our hospital is first centre in Pakistan which is using virtual simulation since March 2006. We present our experience with list of merits and demerits.

Design: Retrospective study.

Patient collection: Medical records of all patients who received radiotherapy in our centre were reviewed. Parameters included were type of malignancy, type radiotherapy (curative/palliative), simulation and planning process time and the displacement of the beam-axis from the planning isocentre in clinical situations during three-dimensional conformal radiotherapy using electronic portal imaging device (EPID). Data were collected on written proforma. Percentages, frequencies, measures of central tendency and dispersion were calculated using SPSS version 17.0.

Results: A total of 289 patients were treated from March 2006 to November 2008. Transitional cell carcinoma of urinary bladder was most common malignancy seen (42.4%) followed by prostate (28.62%) and renal cell carcinoma (14.14%). Of these 34.26% patients were treated on curative basis. The virtual simulation process could be completed in an average time of 5 min (SD 3.5). Under many cases, the treatment portals could be designed and the patient marked in one session. The displacements were recorded for 43 portals for early prostate cancer using an EPID system. The mean displacement was found 2.44 ± 0.8 mm in x (transverse), y (craniocaudal), and z (anteroposterior) directions during treatment. Standard deviation (SD) was 0.87 (90% CI 2.21–2.66). Average number of portals taken was 10 (6–27) per treatment session.

Conclusion: Computer-based simulation and treatment over conventional methods is appropriate for curative patients, achieving more accurate tumour localisation, sparing normal organs at risk, reduced field sizes and a film free environment; however efforts are required to achieve maximum immobilisation during treatment.

Adaptive radiation therapy is a promising concept that allows individualised, dynamic treatment planning based on feedback of measurements. The TomoTherapy Planned Adaptive application, integrated to the helical TomoTherapy planning system, enables calculation of actual dose delivered to the patient for each treatment fraction according to the pretreatment megavoltage computed tomography (MVCT) scan and image registration. As a result, new fractionation treatment plans are available if correction is necessary. In order to evaluate the real clinical effect, biological dose is preferred to physical dose. A biological parameter, biologically effective uniform dose (), has the advantages of not only reporting delivered dose but also facilitating the analysis of dose–response relations, which link radiation dose to the clinical effect. Therefore, in this study, four lung patients’ adaptive plans were evaluated using the in addition to physical doses estimated from the TomoTherapy Planned Adaptive module. Higher complication-free tumour control probability (P+) (of about 8%) was observed in patients treated with larger dose-per-fraction by using the in addition to the physical dose. Moreover, a significant increase of 13.2% in the P+ for the adaptive TomoTherapy plan in one of the lung cancer patients was also observed, which indicates the clinical benefit of adaptive TomoTherapy.

ACORRN was established in response to the sharp decline in the number of clinical academics and radiation biologists over the past ten years. The network was launched in 2005 to help revitalise radiotherapy and radiobiology research in the UK by networking and supporting individuals and groups. ACORRN is governed by a Steering Committee, comprising members of the UK research community and receives advice from an International Scientific Advisory Committee. Since its inception ACORRN has established a national office to support researchers, providing practical advice and assistance on funding streams, grant applications, ethics legislation and approval as well as facilitating collaborative research meetings. ACORRN has also developed several working parties, research interest groups and an interactive website (www.acorrn.org) which is actively used within the research community. The website serves as a hub of information allowing researchers to locate and contact each other and search for information on projects, institutions and opportunities, quickly and easily.

Purpose: A questionnaire was developed to explore variations among radiation oncologists in managing early-stage breast cancer, specifically radiation-induced skin reaction (RISK).

Materials and methods: A survey was designed to target a database of 962 radiation oncologists, self-identified as ‘interested in treatment of breast cancer’. This database was obtained from the American Society of Therapeutic Radiology & Oncology (ASTRO). Participants submitted the survey online or by mail. Overall response to the survey was 282 out of 962 (29.3%). Data were handled as rates.

Results: Out of 282 respondents, 275 (97.5%) agreed on delivering 4500–5040 cGy. The most frequently employed dose was 5040/180 cGy. Three-dimensional-conformal (3DCRT) treatment was used by 55.4%, intensity-modulated radiotherapy (IMRT) by 24.5%, and conventional by 20.1%. Almost all (92.5%) agreed on using boost in ductal carcinoma in situ (DCIS). Image-guided boost placement (IGBP) was used by 87.3%. Boost dose included variations: 50.2, 7.3, and 18% used 1000, 1200, and 1400 cGy, respectively; the remaining used higher doses. In management of RISK, Aquaphor was the most popular agent (72.1%). Other agents were utilized either alone or in combination. Almost all (99%) agreed that large breast size increases RISK.

Conclusion: This survey offers a glimpse of management practices in early-stage breast cancer amongst a cross-section of radiation oncologists in the United States. Although there appears to be an overall congruence on the doses and techniques of radiation delivery, the management of RISK is varied. Additional efforts are warranted to standardize practices in order to practice evidence based medicine in a cost-effective manner.

The Internet is an important information source for health practitioners; yet little is known of how radiation therapists (RTs) are currently using this vast information resource for their professional learning. In 2007, a four-page postal survey was sent to a random sample of 1,142 Medical Radiation Science practitioners with a response rate of 32.8%, which included 76 RTs. This paper reports and analyses the questionnaire responses from RTs on the use of the Internet to update their professional knowledge and issues affecting accessibility to the Internet in the workplace. This research provides an initial data set on the professional use of Internet-based tools and resources by Australian RTs. It has been shown that the Internet is an important information source widely used by RTs as they search the Internet (89%), access specific web pages (85%), use e-mail (84%) and listservs (49%) to update their professional knowledge. Although all RTs reported Internet access within their workplace, a number of factors have been identified which at present limit accessibility of current quality health and medical information through the Internet to RTs. A large number of RTs were unaware of Internet-based resources, such as Cochrane Library (48%) and GoogleScholar (42%), which support evidence-based practice (EBP) and research. RTs in teaching environments had greater access to computers with Internet access than their colleagues in non-teaching environments (p = 0.044). More RTs in the private sector (22%) reported they had ‘no’ access to the Internet in their workplace than their public sector colleagues (4%, p = 0.037). In addition, RTs in metropolitan workplaces had greater access to protected time during work hours for professional reading or study than their non-metropolitan colleagues (p = 0.000). These issues of non-uniformity of resources across workplaces and knowledge gaps within the profession must be addressed so that all RTs can avail themselves of high quality resources available through the Internet that support them in implementing EBP and meeting the mandatory requirement of updating their professional knowledge.