The rapid growth in web technologies illustrates how global attitudes to paper are changing. The world of radiotherapy is responding to this by steadily replacing paper-based systems with digital equivalents. In this time when the world is swapping thousands of years of dependence on ink and paper for pixels and screens, representing professional development in a large file of paper may soon seem incongruous.

This paper aims to introduce the concept of a “virtual portfolio” along with the rationale for using it. In the context of radiotherapy professional practice, the virtual portfolio's function mirrors that of a conventional portfolio, but uses electronic media to collate and present the evidence. Potential advantages and disadvantages of the virtual portfolio are presented, along with a brief overview of the software tools that can assist with the transition away from paper.

Since a portfolio is ultimately a very individual expression of personal and professional development, it is obvious that the virtual portfolio will not be suitable for everyone. It can be seen that electronic media offer some useful tools to the portfolio developer, but ultimately it is the content and use of the portfolio rather than the format that is of importance.

Reflective journals have been used as an assessment tool in clinical practice, in the fully integrated context directed learning (CDL) undergraduate program at the University of South Australia, over a period of five years. This paper reports the commonest issues evidenced within the year 2 and year 3 reflective journals. The results confirm that these are linked to the stage of development and experience of the students in both academic knowledge and clinical practice. Quotations from the journals give an insight into students' experiences of both emotional and practical skills development.

The Academic Clinical Oncology and Radiobiology Research Network (ACORRN) was launched in 2005 by the National Cancer Research Institute (NCRI) to revitalise radiotherapy (RTX) and radiobiology (RB) research in the UK [Price P. Clin Oncol 2005; 17:299–304]. The network was established in response to the sharp decline over the past 10 years in the number of clinical academics and radiation biologists. The decline had left the UK's radiotherapy and RB communities with insufficient infrastructure and capacity, despite radiotherapy experiencing one of the most rapid advances in technology and computerisation of any field in medicine.

The accuracy of a range of immobilisation systems for head and neck radiotherapy has been measured. Two types of vacuum-formed shells, and eight thermoplastic systems have been evaluated. For each system, a mask was made for the same volunteer. A non-invasive optical system, using a scanning laser digitiser, was used to measure the displacement of a fiducial marker. The volunteer was asked to move a maximum comfortable distance in each of the superior, inferior, left and right directions, and a scan was taken at each location. Standard deviations, calculated from the maximum range of movements, were in the range of 1.7–2.9mm in the right–left direction, and 0.9–3.0mm in the superior–inferior direction. The smallest movements were measured for the Medtec S-frame, with nine-point fixation. A laser-scanning camera can assess the movement potential for a subject inside an immobilisation device with good accuracy and precision. Because ionising radiation is not used as part of the imaging process, the same subject can be used for several mask systems to assess which is the best one.

In 2005, against a background of expanding radiotherapy services and increasing demands on therapy radiographers, the UK radiotherapy managers group were concerned about vacancies and low establishments impacting on service delivery, and lack of guidance on staffing establishments. They undertook a survey and work to develop a staffing framework, also to highlight the criticality of adequate radiographer staffing to radiotherapy, both in service delivery and treatment safety. The survey, of 2004 services and staffing, aimed to see if commonality existed in establishment size related to services delivered, and whether staffing levels correlated with activity levels.

Reasonable parity in the total number of funded WTE establishment for “core” services, per centre, per planned daily Linear Accelerator (linac) hour of service was shown. The resultant staffing formula for core services is 1.33 WTE per linac hour. This includes radiographers, assistants, helpers and others contributing to the core activities. The average linac day length was 8h. The average fraction time was 11min with a range of 1.7–5.7 fractions per hour, the variations in activity rate correlating with actual staffing levels. The formula was tested in three departments and example staffing models constructed to help in operationalising the four-tier career structure.

Introduction: Computed radiography (CR) is an imaging facility that does not require the use of hard copy film, digital images are obtained with a photostimulable phosphor plate, which replaces film, in a cassette. As the first UK radiotherapy site to trial CR, we are collecting data to assess the feasibility of using CR in radiotherapy treatment verification.

Method: From 30 patients undergoing radical radiotherapy, 10 were consecutively accrued to three sites: pelvis, thorax and head and neck. Treatment verification images were taken using current protocols, but substituting standard imaging for CR images on one fraction. Four independent observers were used: two clinical oncologists and two therapy radiographers. Observers rated CR, electronic portal imaging (EPI) and enhanced contrast (EC) films of the three sites for both landmark visibility and ease of verification decision, using a numerical scoring system.

Results: Ratings for visibility of landmarks and for verification decision were similar for CR and film/EPI images for most landmarks. However, CR images rated poorly compared to EC film in the head and neck region with landmarks such as thyroid cartilage and cricoid cartilage rating as ‘not clear’. CR images rated better than EPI images for both visibility and verification decision on the majority of landmarks in the pelvis region.

Conclusion: Results gathered from a relatively small sample size have provided the following conclusion. The visibility of landmarks in CR images is comparable to that in film and EPI. Verification of treatment images based on CR is comparable to that of the current imaging media in the department.

Vestibular Schwannomas (VS) are benign tumours arising from the neural sheath of the vestibular nerve, located near the auditory canal and cerebello-pontine angle adjacent to the brainstem making tumours “malignant by position”. With high complication rates following surgery for tumour resection it is essential that alternative yet comparable management options such as Stereotactic Radiosurgery (SRS) be more fully evaluated in order to attain its efficacy and provide patients with alternative treatment modalities.

The aim of this study was to critically evaluate the treatment outcomes of patients treated with SRS for Vestibular Schwannomas at the Cromwell Hospital's Gamma Knife Centre between 1998 and 2002. To facilitate this, information regarding patient's clinical history and SRS treatment parameters was collated and analysed via departmental on-line systems.

In total the study provided a representative sample size of 74 patients with follow up data ranging from 6 months to 4 years post SRS (with a median of 12 months).

At the maximum point of follow up attained by each patient 43% had an overall smaller tumour volume than at the time of treatment whilst 18% demonstrated a volume increase and 39% remained unchanged. In total 67% demonstrated evidence of decreased central tumour contrast enhancement (necrosis). 27% of patients suffered some form of immediate complication post SRS, all of which had resolved within 6 months. No correlation was found between the severity of the complication, prescription dose and tumour volume.

Results are comparable with those from other published series highlighting a positive response from the tumour (decrease in volume) with few immediate complications, largely unchanged severity of symptoms post SRS and no negative impact on the patients quality of life. Although a number of significant papers have been published regarding the role of SRS in the management of VS there remains no definitive answer as to the best management option. Tumour control rates are comparable in both options and whilst both have their limitations, complication rates are generally much lower in the SRS group. Even so it is yet to be widely accepted as the treatment of choice in suitable cases. Nonetheless broadening the knowledge base with more research and education regarding the benefits of SRS will allow it to be promoted as a primary, contemporary treatment option in the management of VS.

In this article the potential for use of electronic portfolios by healthcare practitioners and students is considered in the context of work currently being undertaken in the School of Health at the University of Wolverhampton. We write at a time when knowledge of, and interest in, eportfolios is expanding beyond a relatively small number of projects and into the consciousness of a wider audience of academics and institutions. In the last 2 years interest in eportfolios has grown rapidly, particularly within a Higher Education sector keen to meet the Higher Education Funding Council for England/Quality Assurance Agency progress file deadline in 2005, but also spurred by the reports of Burgess (Universities UK. Measuring and recording student achievement, 2004 [Online report] [Accessed: 01 March 2006]. Available from: http://bookshop.universitiesuk.ac.uk/downloads/ measuringachievement.pdf) and of Tomlinson (DfES. Harnessing Technology: Transforming learning and children's services, 2005. [Online Report]. Published 15 March 2005 [Accessed: 01 Mar 2006]. Available from: http://www.dfes.gov.uk/publications/e-strategy/index.shtml). Examples of the use of eportfolio as a means of recording achievement and, in particular, facilitating reflective practice are discussed. The potential of an eportfolio system incorporating asynchronous communication features to resolve the tensions between academic and clinical practitioner roles is explored.

There are several clinically useful techniques for delivering radical radiotherapy to the prostate. One such beam arrangement is a conformal four-field box technique. Patients who have undergone a total hip replacement have in place a metallic prosthesis, which presents challenges in achieving a homogenous dose distribution. This is due to the increased density of the metal in comparison to bone and soft tissue. The resultant effect is additional attenuation of the X-ray beam as it passes through the prosthesis. The interaction of the photons with the metal also causes increased scatter. Thus, the dose delivered to the tumour is reduced if it is not corrected for. Due to the uncertainty in the amount of attenuation, it is recommended to avoid irradiating through the hip concerned. This means that the four-field box technique cannot be used. Instead, different field arrangements are used such as three or four oblique fields. This is a retrospective investigation into which field arrangement would be the most appropriate for early stage prostate cancer patients. Ten previously treated prostate patients were planned with different beam arrangements avoiding the prosthesis. The results were analysed and are presented with reference to the doses to the organs at risk and the planning target volume. The results indicate that the beam arrangement of choice should be three fields (anterior, posterior and lateral) or a three-field oblique beam arrangement. It has been proved that these plans are acceptable as a solution in this scenario.

During a 20-year period, we treated 26 patients with radiation after total laryngectomy because of laryngeal cancer with subglottic extension (LCSE). The paratracheal lymph nodes superior (and inferior in two cases) to the suprasternal notch were irradiated in addition to the primary tumour bed. With a follow-up period ranging from 5 to 185 months, the occurrence of neoplastic disease in the upper mediastinum was not observed in a single case. The rates of recurrent tumour in the neck and distant metastasis were both 8%. The 6-year survival rate was 67%. The observed results lead us to the conclusion that even with non-irradiation of the superior mediastinal paratracheal lymph nodes, postoperative radiotherapy can achieve reasonable long-term disease-free survival in patients with LCSE.

A number of Radiotherapy Departments have extended the working day on linear accelerators, as a method of increasing treatment capacity. However, reports from the Royal College of Radiologists predict a rate of increase in requirements for radiotherapy, significantly in excess of the rate at which radiographers will become available to run the necessary equipment.

Based on the premise that radiographers are the most difficult staff group to recruit, a number of different patterns of radiotherapy linear accelerator use has been investigated, with an aim of seeing which delivers the greatest return on radiographer time. The requirement for radiographers per linac-hour has been examined for a number of lengths of day and utilising various staffing assumptions.

Given current patterns of work, the greatest manpower efficiency in use of trained radiographers is achieved if machines are run for a 7-h-day or for an 8-h-day if part-time radiographers are available. This working pattern relies on all ancillary tasks being removed from the treatment unit, many of which can be performed by other appropriately trained, non-radiographer, staff groups.

With linac-hour demand projected to rise faster than the rate at which new trained radiographers become available, extended working days are not sustainable without significant change to current work patterns.

Intraoperative radiotherapy (IORT) using a miniature X-ray source has the potential to impart the same clinical benefit as external beam radiotherapy (EBRT), in a single fraction. The patient benefits are significant, since IORT could replace several weeks of fractionated EBRT. We present our initial experiences of IORT using the Zeiss Intrabeam™ system for treating early stage breast cancer and intracranial malignancies. Implementing this treatment modality requires a multidisciplinary approach drawing on the expertise of surgeons, oncologists, medical physicists, anaesthesiologists, nursing staff and pathologists. Team coherence is facilitated by a nurse co-ordinator. We have treated 66 patients in 24 months. For breast tumours, the mean treatment time was 28.54 min and the applicator sizes ranged from 3.0 to 5.0cm (mode = 4.5cm). A dose of 5Gy is prescribed to spherical volume of 1cm from the applicator surface. For brain tumours, the mean treatment time was 19.70 min and the applicator sizes ranged from 1.5 to 3.5cm (mode = 2.5cm). Mean dose was 11.1Gy prescribed to a spherical volume of 0.5cm from the applicator surface.

A multidisciplinary team is essential for the successful implementation of IORT. This paper describes how, through reliance on an oncology nurse specialist to co-ordinate the programme, we have successfully set-up an IORT service.

The purpose of this pilot study was to explore with the breast care nurse specialist (BCNS) their perspectives on the information and support offered to male patients with breast cancer. The BCNS role is to provide the patient with both verbal and written information, and they are viewed as a key resource for the patients during their cancer journey.

A qualitative method was adopted that utilised semi-structured interviews with the BCNS. The questions were derived from reviewing the literature and the written information available for the male patients; identifying key areas to explore and then utilising open ended questions to collect the data in the interviews. After each interview the transcripts were analysed and coded and further questions were formulated.

The findings illustrate that although there is some gender specific information given, this is limited and often directs the patient to literature designed specifically for women. It is therefore recommended that a more comprehensive gender specific booklet be designed for men with breast cancer.

This article is an edited version of an undergraduate dissertation and as such can only convey the essence of the work.

Background: The literature on the evaluation of the management of radiation-induced dermatitis demonstrates the methodological difficulties of studying this subject. Therefore, the feasibility of a methodology whereby the patient acted as their own control was used to study acute cutaneous side effects for head and neck radiotherapy patients using 1% hydrocortisone cream (HC).

Methods: Twenty patients were asked to apply Hyderm (1% hydrocortisone) cream twice daily to one side of the treatment area (either right or left) beginning on day one of radiation therapy and ending 2 weeks post-radiation therapy. The centres standard skin care protocol using mild soap and water and no creams was used on the other side of the neck. Once weekly the patients were assessed and scored using the Radiation-Induced Skin Reaction Scale and Radiotherapy and Oncology Group assessment scales and the patient completed a symptom scoring scale each week was a baseline assessment undertaken before they started treatment. To document compliance with study instructions, patients were asked to keep a calendar indicating when they applied the cream and to which side, and this was collected by clinical staff.

Results: At the conclusion of the study, 12 patients were enrolled. During the course of the study it became increasingly obvious that the side to which patients were applying the Hyderm scored higher on the assessment scale, indicating an increased skin reaction than the control side. This was confirmed with the photographs and patient symptom scale. As a result of these increased reactions, the study ceased accrual earlier than anticipated and all patients were advised to discontinue Hyderm use.

Conclusion: The increase in skin toxicity was unexpected, particularly as the institutional standard of care recommended the use of HC as treatment for radiation dermatitis. The number of patients in the study was too small to make conclusive statements about the efficacy of HC. We were able to confirm the feasibility of using an internal control methodology in these patients. Compliance results indicate the skin care instructions were clearly written and patients were able to follow them.

A patient arriving for their first Radiotherapy appointment can exhibit an array of behaviours, such as anxiety or aggression, which are generated by intense emotions. Each patient will have their own individual concerns and their needs should be addressed, to make their first experience in the Radiotherapy Department as smooth and stress free as possible.

The radiographer's role at this point is undoubtedly to provide patients with information, whilst demonstrating a compassionate and genuine nature. This can make all the difference to the way a patient reacts and copes with the entire course of radiotherapy.

The skills that will allow a radiographer to handle these situations are, in the first instance; good communication skills, but in addition to this the development of some basic counselling skills could further enhance patient care.

The aim of this article is to discuss the benefits of utilising basic counselling skills to create the best environment possible for the patient, and possibly answer some questions about their legitimate nature.

In recent years there has been a push to move away from traditional clinician led on treatment review of radiotherapy patients. Despite this impetus there has been little published work relating to how the new system can be implemented. This article describes how one department implemented a change in direction from the conventional and moved forward with radiographer-led review clinics. The Plan–Do–Check–Act cycle is used as a basis for evaluation with results of a small-scale patient audit and a comparison with other departments in the UK being presented. This method of implementation and evaluation proved successful and may serve as an early model for radiotherapy departments elsewhere.