Purpose: Radiation techniques employed for breast cancer must be efficient as well as effective in order to minimise waiting lists. Protocol restrictions, or the technical application of treatment, may influence planning and treatment times as radiographers follow departmental policies. A national survey of UK radiotherapy centres was undertaken to establish trends in waiting times for breast cancer irradiation; and to investigate relationships of waiting times with the deployment of equipment and personnel and technical procedures adopted.

Method: A questionnaire was posted to the Head of Radiotherapy Services and a Clinical Oncologist with an interest in breast cancer in the radiotherapy centres in the UK. Survey questions investigated a number of issues, including the number of breast patients planned per week; protocols chosen; average treatment and planning times; levels of personnel and equipment; and the population served.

Results: A total of 53 centres were contacted, of which 51 centres responded to some aspect of the survey (96%). Average waiting times for treatment fluctuated from 1 to 7 weeks and maximum waiting times of 11 weeks were reported. Variation in clinical practice was found, including procedure times and the number of radiographers employed per linear accelerator. A multiple regression analysis indicated that a combination of equipment levels, simulation times, and the number of breast contours taken best predicted the average waiting time for breast treatment.

Conclusion: Waiting times reported were influenced by a combination of levels of equipment available and protocols adopted.

This work describes the feasibility of using a polymer-based tissue equivalent gel for measuring radiation doses in situ. The gel is based on the MAGIC formulation thereby enabling it to be manufactured under normal atmospheric conditions. Its composition has been altered to achieve a similar sensitivity to the more widely used, but technically more difficult to produce, PAG gels. Irradiation of the gel material causes polymerisation of the molecular structure resulting in a shortening of transverse relaxation time (T2), which can be imaged using Magnetic Resonance Imaging (MRI). This work calibrates the radiation response in terms of transverse relaxation rate (R2) and uses this information to provide absolute dose verification in a separate gel, which has been previously irradiated to a known configuration. Results demonstrate that this technique is able to verify radiation doses to within a few percent of delivered intent in three dimensions and with high spatial resolution. This work may be followed by anyone with an interest in the quality assurance of advanced conformal radiotherapy delivery methods.

In recent years therapy radiographers, as one of the Allied Health Professions, have been subject to many initiatives, recommendations and professional and technical developments which have driven or encouraged them to increase their uptake of post-registration continuing education and professional development activities. These initiatives and drivers for change are diverse both in their source and in their degrees of influence and range from government legislation at a national level down to local initiatives. This paper identifies the main drivers affecting therapy radiographers with regard to these issues, evaluates their impact on the profession and discusses some of the barriers and limitations to the uptake of educational and CPD activities.

The Board of Faculty of Clinical Oncologists and The Royal College of Radiologists published the first edition of explicit guidelines in 1996 for “the management of the unscheduled interruption or prolongation of a radical course of radiotherapy”.

The recommendations highlighted the significant detrimental effects on local tumour relapse rates in some cancer types, when the time taken to deliver a radical radiotherapy prescription is increased.

A national audit was carried out in February 2001, to establish compliance and trace ability of radiotherapy prescription delivery. The audit aimed to establish if local protocols are in place and if regular audit process took place to promote continuous improvement to treatment delivery compliance.

Sixty-four radiotherapy managers were invited to participate in the study, by completing a short questionnaire. A response rate of 74% was achieved.

The findings from the study indicated that the majority of radiotherapy centres within the United Kingdom have a protocol for the management of radiotherapy prescription compliance, where causes in non-compliance are documented. In contrast, a statistically significant number of radiotherapy department fail to monitor or evaluate causes of radiotherapy prolongation.

The author recommends, that, in order to reduce local tumour relapse rates, the use of a strategic, robust local and national audit system must be in place.

The second edition of recommendations for managing radiotherapy prolongation was published in 2002. The theme of strategic auditing remains high on the agenda.

Staffing and equipment levels in the UK are impacting heavily on waiting times for radiotherapy. This paper presents the results of financial and organisational interventions on the radiotherapy waiting list at the Derbyshire Royal Infirmary. Efficacy of these interventions was assessed using audits before and after their application. The interventions included working extended days and weekends, employment of agency staff and “out-of-hours” machine servicing and maintenance. A Waiting List and Data Quality radiotherapist was appointed to streamline the radiotherapy referral system. A waiting list database application was developed to book patients in the correct order of priority and within target waiting times. The resulting increase in radiotherapy workload was achieved over a 3-month period at an approximate cost of £30,000, albeit with several implications. Staff felt that the pace of work was unsustainable, although sickness rates did not increase. After the interventions were removed, and waiting times increased, staff morale dropped. Extended working hours impacted on the reliability of the machines, causing more unscheduled interruptions than normal. This indicated the need for additional maintenance or servicing sessions.

This paper shows that full compliance with RCR guidelines for waiting times is achievable, given sufficient financial and organisational assistance.