Introduction: The College of Radiographers recommends preceptorship for newly qualified radiographers. Personal experience highlighted concerns regarding the lack of understanding of preceptorship, but where a preceptorship program had been implemented, the program was beneficial, and could potentially alleviate some of the recruitment and retention issues faced within radiotherapy. This study explored the perceived usefulness of preceptorship between a department that had implemented a successful preceptorship programme, and a department that hadn't implemented preceptorship.

Method: An exploratory, qualitative study was undertaken within the constructivist paradigm to explore the views of preceptorship amongst two groups of radiographers. A focus group interview method was employed that was transcribed and analysed using Burnard's 14-stage analysis.

Findings: Time, definition and understanding, professionalism and implementation were the major themes that occurred from the interviews.

Conclusions: Preceptorship can be a useful tool for newly qualified radiographers, helping to alleviate the stress and anxiety faced when entering the profession. Careful consideration needs to be given to disseminating a definition and a framework for its implementation. Having a member of staff who is responsible for coordinating a preceptorship programme adds to the success of implementation which in turn can improve the recruitment and retention of radiographers within the profession.

Recently, radiotherapy breast gowns have been introduced into some Radiotherapy Departments across the country. The idea of using the breast gowns came from issues highlighted regarding privacy and dignity from patient satisfaction surveys. The introduction of the breast gowns was not evidence based, however they have become popular as they were considered a good aid for patients' comfort. This study aimed to investigate patients' perceptions of the breast gowns using a qualitative, phenomenological approach. The methodology was designed to explore patient's feelings about their experiences throughout their cancer journey. The data was collected through semi-structured interviews, which were transcribed and analysed, via content analysis. The key themes that emerged from the study were related to: patients' emotions; dignity and privacy issues; exposure; patient choice and an unexpected result were their views relating to the notion of “possession”. The results of this study cannot be generalised due to the methodology chosen, however the findings can aid the development of a multi-centred study to investigate this topic further. In addition, this study has highlighted an important recommendation for radiotherapy practice: the development of a “modesty gown” for most treatment sites.

Prostate cancer is a common male cancer, and arguably the form of cancer with least certainties about most appropriate form of treatment, leading to a greater freedom of choice among patients as to which treatment they wish to undertake.

Department of Health guidelines state that to be valid, consent to treatment must be fully informed, and professional bodies demand that consent should be ongoing throughout a course of treatment. It is recognised that in spite of the wealth of information available, prostate cancer patients generally feel less well informed about their disease and treatment than those with any other form of cancer.

Information about treatment efficacy and outcome is available from a wide variety of sources, of varying reliability, and patients can as easily receive too much information as they can too little. Bias from those imparting information cannot be excluded, and patient choices could be made on the basis of inaccurate or misleading information.

Practitioners have a duty of care to ensure that patients receive a level of information appropriate to their level of understanding and ability to absorb knowledge, and longstanding legal precedents are established to ensure that risks as well as benefits of treatment are discussed with patients.

Purpose: To identify subgroups in glioblastoma multiforme (GBM) with different susceptibilities to radio-chemotherapy by p53 protein and Ki-67 expression.

Patients and Methods: Thirty-one patients with primary GBM underwent a combined radio-chemotherapy with topotecan. Percentage of cells expressing p53 protein and Ki-67 antigen was determined immunohistochemically. Additionally, the cell density within the tumour tissue was measured.

Results: Median percentages of p53 and Ki-67 expressing cells were 4.3% (range = 0–28%) and 12.0% (range = 0–28%), respectively. Dividing the cases into two groups by high or low p53 protein 1-year disease-free survival rates were 13.3% and 23.6%. High or low Ki-67 expression showed one-year disease-free survival rates of 18.8% and 17.1%. Neither p53 nor Ki-67 expression showed a significant correlation with disease-free survival or overall survival. Median cell density was 252 cells/field (range = 42–595). 1-year disease-free survival rates were 14.5% and 21.7% in high and low cell density group, respectively. A significant correlation with progression-free survival was observed, whereas the stratification into two groups revealed no significance. Cell density showed a significant inverse correlation with p53 and Ki-67 immunopositivity.

Conclusion:p53 protein and Ki-67 expression seem to be inappropriate for the estimation of prognosis in patients receiving a combined radio-chemotherapy with topotecan.

Prostate cancer has been treated with low-dose rate (LDR) brachytherapy for early localised disease in the form of permanent seed implants, with all its inherent problems in terms of dosimetry and seed migration. High-dose rate (HDR) brachytherapy has mainly been utilised as a boost to external beam radiotherapy (EBRT) in patients with locally advanced disease. However, limited studies investigating HDR as a monotherapy for early local disease are yielding promising results in terms of biochemical control and reduced toxicity. With the ability to optimise the plan and conform the dose, dose escalation can be achieved whilst sparing normal tissue. Recent studies to assess the α/β ratio of prostate cancer have shown this to be low, making this tumour sensitive to large fractions or hypofractionation. The HDR delivery and large fraction sizes may be advantageous in tumours sensitive to radiation fraction size making HDR brachytherapy the treatment of choice over LDR brachytherapy and EBRT.

The aim of this study is to document a case of Extra Mammary Paget's Disease (EMPD), which was treated with radiotherapy at the Suffolk Oncology Centre. We have shown evidence, both in the reviewed literature and in this study, that radiotherapy can be used successfully as a primary form of treatment for this disease.

The patient discussed in this paper had EMPD in the perianal region. 40 Gy in 10# using a parallel-opposed pair field arrangement was prescribed. However due to mental and physical frailty only 90% of the dose could be delivered. The patient suffered only minor side effects and three years post-radiotherapy was still disease free. We can therefore say that radiotherapy was successful in this instance.

We concluded that there is a definite role for radiotherapy in the management of EMPD and that it can be effective as a primary treatment, where the only other option could be mutilating surgery.

The recent advent of highly conformal three-dimensional radiotherapy techniques and Intensity Modulated Radiotherapy now allows higher radiation doses to be delivered. It is well-documented that the prostate is susceptible to both interfraction and intrafraction movements due to various physiological processes. Therefore there has been a recent general consensus that good immobilisation and electronic portal imaging is no longer sufficient to ensure accurate treatment verification. This idea has led to the concept of image-guided radiotherapy, which includes modalities such as cone-beam computed tomography and ultrasound to localise the prostate prior to treatment.

There has been considerable research undertaken to determine the effectiveness of each of the image guided modalities and these studies have identified the benefit and limitations of each modality. Ultrasound is a non-invasive technique using a suprapubic ultrasound probe, which seems to be quite promising in terms of cost and time. However until large scales studies are performed which demonstrate the value of using ultrasound localisation, as an alternative to electronic portal imaging, it is likely that current practice will remain unchanged.

The proximity of abdominal tumors to non-target organs has motivated exploration of intensity modulated radiation therapy (IMRT), with its demonstrated capability to create conformal dose gradients, in abdominal tumors. However, substantial extra-target dose may be observed to radiosensitive organs remote from the treatment field.

We present dosimetric data from two patients receiving abdominal IMRT using a sequential tomotherapy technique, demonstrating substantial dose to extra-target organs.

There is evidence that a conservative approach with chemoradiotherapy can achieve long-term local control in patients with anal adenocarcinoma. Identification of suitable patients for this approach remains a problem. We describe a patient with a clinically staged T2N0 tumour, who achieved a complete clinical response on magnetic resonance imaging and positron emission tomography after chemoradiotherapy, but was noted to have residual disease with evidence of lymph node metastasis on pathological examination in the abdominoperineal resection specimen. A complete clinical response does not necessarily equate to pathological response.

Purpose: To evaluate the role of retrograde urethrography in treatment planning for salvage external beam radiotherapy in patients with increasing prostate-specific antigen levels after radical prostatectomy.

Methods and Materials: From July 1988 to December 2002, 173 consecutive patients received external beam radiotherapy for increasing prostate-specific antigen levels after radical prostatectomy. All 173 simulation films were reviewed, and retrograde urethrography was performed in 148 patients (86%). The distance between the line connecting the lower poles of the ischial tuberosities and site of abrupt narrowing of contrast material was measured in all 148 patients. This distance was compared with that measured in 148 consecutive patients with intact prostates who had retrograde urethrography while undergoing treatment planning for definitive radiotherapy.

Results: The mean (median) distance from the line connecting the lower poles of the ischial tuberosities to the abrupt narrowing seen in the urethrogram in patients with increasing prostate-specific antigen levels was 1.54cm (1.50cm) compared with 1.73cm (1.80cm) in those with intact prostates (p = 0.0145).

Conclusion: Retrograde urethrography is important in treatment planning for salvage radiotherapy of the prostate bed after radical prostatectomy to adequately treat the apex of the prostate bed.

A recently released Pinnacle treatment planning system software, v7.4f includes some new physics features such as modeling of the rounded multi-leaf collimator (MLC) leaf ends and the tongue-and-groove structure between leaves. In this study, the above physics modeling improvements were verified by comparing the peripheral dose profiles for the small MLC fields calculated by the new Pinnacle v7.4f and the old Pinnacle v6.2b with those obtained from measurements experimentally. Three test MLC fields with different jaw sizes were prepared, and specific dose profiles (along cross-line, in-line and diagonal axis) at different depths were measured using a Varian 21 EX linear accelerator with 120-leaf Millennium MLC, big scanning water tank and photon diode. Estimated dose profiles for the test fields were calculated using Pinnacle v6.2b and v7.4f. By comparing the measured and calculated results, it was found that both v6.2b and v7.4f performed well in calculating the cross-line (along the gap between the longitudinal lengths of two leaves) and diagonal axis dose profiles at different depths. However, v7.4f gave calculated dose values closer to the measured field for in-line (gap between junctions of two rounded leaf ends) axis dose profiles at different depths. For the shape of the profile along the in-line axis, v7.4f calculated a flat “platform” dose profile of about 34.3% (inter-bank leakage) at depth dmax> beyond the MLC field edge using a clinical dose grid size of 0.4×0.4×0.4cm3, compared to the “zigzag” dose profile varying between 35.4% and 42.1% measured using the water tank and diode. However, both Pinnacle v6.2b and v7.4f calculated the percentage depth dose for the test fields well compared to the measurements.