Purpose: The organ at risk in prostate radiotherapy is the anterior rectal wall . This pilot study was conducted to quantify the inter-observer variability of rectal contouring in conformal prostate radiotherapy planning using four contouring methods and to determine a standard rectal contouring definition.

Methods and materials: Ten patients with T1/T2 disease and six clinical oncologists were recruited. Two cross-sectional and two length limits generated four rectal volumes. Each clinician contoured the four volumes for each patient and the dose–volume histograms (DVHs) were analysed. The percentage rectal volume receiving 20%, 50%, 80%, 90% and 95% of the total delivered dose and the mean and median rectal doses were calculated. Data were presented as mean ± 2 standard deviations.

Results: The Sh Rec method (contouring the rectum including its contents extending from 2 cm above the upper limit of the prostate to 2 cm below the prostatic apex) was the least variable in the 80%, 90% and 95% percentage ranges. The mean difference in Sh Rec-contoured volume was 18.7 cm3 (± 22.3 cm3).

Conclusions: The Sh Rec-contouring method showed the least inter-observer variability. The results are informative and will help define a standard rectal contouring method.

Part two of this two-part series presents the results of a departmental initiative implemented in 2003 at a large urban cancer centre, Princess Margaret Hospital (PMH) in Toronto, Ontario, Canada. This new model for radiation therapists was called Advanced Integrated Practice (AIP) and was developed, in part, to encourage and promote scholarship within radiation therapy. The AIP model incorporated integrated clinical specialty roles designed to blend exemplary clinical practice with focused academic activities. This paper discusses an evaluation of the AIP model undertaken to obtain a formal measure of how the model had evolved, how the radiation therapists and other stakeholders were responding to the new model, whether the initial outcomes were realized and to create plans for further development of the design. The evaluation utilized a mixture of traditional qualitative research methodologies such as focus groups, quantitative surveys and a variety of other available measurable outcomes. Outcomes from the model included increased opportunities for diverse roles that incorporated an element of academic practice and augmented career choice and scope for radiation therapists. In addition, academic output and research work also increased within the department. Lessons learned from the implementation and evaluation of the model are shared, and the authors offer some suggestions to increase scholarly activity within the profession.

Purpose: With the advent of multi-disciplinary team working in Oncology practice, this audit was designed to assess patient satisfaction with this approach within an on-treatment review clinic for breast cancer patients. It also aimed to look at conformity of reporting of treatment side effects between different staff groups.

Patients and methods: A questionnaire was distributed to 230 radical breast cancer patients once a week after each review clinic. An oncologist and a radiographer or nurse reviewed the patients during weeks 1–4 of treatment. A review form was completed at each visit specifying any side effects noted.

Results: Patients appeared satisfied with their clinic visits to both the radiographer and nurse with 84 and 85% confidence and trust in the members of staff compared to 73% with the doctor. There was disparity in the recording of side effects between non-medical and medical staff groups.

Conclusion: This audit has provided good evidence to support the continuation of multi-disciplinary review clinics. A key benefit is the reduction in clinic waiting times for patients and a substantial time saving for the medics. It also supports role development for the radiographer and nurse involved.

Purpose: The purpose of this case study is to discuss factors that have an influence on the process of role development in radiotherapy breast planning.

Key themes: This article describes the process of development as experienced by the author and discusses factors that hindered the process of role development. These factors include development of a career plan, professional issues, resources, organisational structures, support from consultants, managers, multi-disciplinary, and professional colleagues and peer resistance.

Conclusion: The author makes recommendations that may contribute to improving the role development strategy in the profession and aid successful implementation of advanced practitioner and consultant roles for those radiographers who aspire to the consultant radiographer role in future. The article concludes that there is a need to identify, standardise and coordinate role development for therapy radiographers nationally to increase the appointment of more consultant radiographers.