The nearing completion of the Australian Bragg Centre for Proton Therapy and Research marks a transformative leap in cancer care in Australia. Highlighting the precision and potential of particle therapy in reducing long-term side effects, particularly in paediatric and rare cancers, this editorial underscores Australia's commitment to integrating this innovative modality into national healthcare, despite challenges in accessibility and cost.
Health care and research are increasingly mandating consumer involvement in the planning, design and evaluation of services, quality projects and research. The editorial reviews the Australian progress with accreditation processes in research and provides practical direction in an area that is unfamiliar to many researchers and clinicians.
Intra-operative duplex ultrasound in renal transplantation was first described in 1998 and whilst reported in problematic cases, there are few reports of its routine use and no current published protocols. Since 2013, we have used intra-operative ultrasound in all renal transplants. The formal protocol used since August 2020 is presented as a reference document for other transplant centres. A Canon Aplio 800 ultrasound system with an i22LH8 hockey-stick transducer is used to image the renal cortex and major vessels, and an i8CX1 matrix transducer to image the graft during and after fascial closure. These transducers are fully sterilised with Sterrad and no sheathing of transducers is required. The transplant surgeon scans within the sterile field with the sonographer guiding imaging and adjusting machine settings. Ultrasound findings are discussed between team members including any requirement for interventions. Ultrasound is performed at three stages of the operation: Stage 1: after clamp release identifying issues of graft vascularity including otherwise unrecognised major vessel and anastomotic abnormalities. Stage 2: following ureteric implantation identifying compromised perfusion due to graft rotation or vessel kinking. Stage 3: after fascial closure identifying compromised perfusion due to external compression. Post-operative scanning, including assessment of the collecting system and bladder, is performed routinely on days 1, 3, 7 and 30. The intervention is effective with no early graft losses or peri-operative vascular thromboses. The requirements for service provision are significant including the availability of additional transducers, and sonographers with expertise in intra-operative scanning able to attend after-hours for extended periods.
Diagnostic radiography students experience challenges during clinical placements, which have the potential to impact students' emotional wellbeing. This study aimed to explore radiography students' perception of the newly developed podcast series as a wellbeing support tool.
A mixed methods study was conducted analysing data from listeners, including usage data from the podcast host site, surveys, and focus groups. Usage data was analysed descriptively. A bespoke survey, using a 5-point Likert scale and fixed-response questions was analysed descriptively. Two focus groups consisting of ten participants in total were conducted and data was analysed using thematic analysis.
There were 1201 downloads of the ‘Breathe-in Radiography Podcast’ series across 20 countries and 17 platforms during the study period. A total of 66 complete survey responses demonstrated an overall positive perception of the podcast series. Five main themes were identified from the focus groups: integrated with other activities, accessed when experiencing emotional challenges, relatability to peers, impact on behaviour and mindset, and future podcast content.
This study demonstrated students' positive perceptions of a podcast for support during clinical placement. Further studies are needed to maximise the benefits of podcasting to radiography students and to establish a direct effect of podcasts on student wellbeing.
Surface-guided radiation therapy (SGRT) has emerged as a powerful tool to improve patient setup accuracy in radiation therapy (RT). Combined with the goal of increasing RT accuracy is an ongoing effort to decrease RT side effects. The application of a prophylactic skin dressing to the treatment site is a well-documented method of reducing skin-related side effects from RT. This paper aims to investigate whether the application of Mepitel, a prophylactic skin dressing, has an impact on the accuracy of surface-guided patient setups in chest wall RT.
A retrospective analysis of daily image-guided Online Corrections (OLCs) from patients undergoing chest wall irradiation with SGRT was performed. Translational (superior–inferior, lateral, and anterior–posterior) OLC magnitude and direction were compared between patients treated with Mepitel applied and those treated without. Systematic and random errors were calculated and compared between groups.
OLCs from 275 fractions were analysed. Mean OLCs were larger for patients with Mepitel applied in the superior_inferior axis (0.34 vs. 0.22 cm, P = 0.049) and for the combined translational vector (0.54 vs. 0.43 cm, P = 0.043). Combined translational systematic error was slightly larger for patients with Mepitel applied (0.15 vs. 0.09 cm).
Mepitel can impact the accuracy of SGRT patient-positioning in chest wall RT. The variation however is small and unlikely to have any clinical impact if SGRT is coupled with image guidance and appropriate PTV margins. Further investigation is required to assess the effect of Mepitel on SGRT accuracy in other treatment sites, as well as any potential dosimetric impacts.
There are limited data on chest computed tomography (CT) findings in the assessment of lung nodules among adult Aboriginal Australians. In this retrospective study, we assessed lung nodules among a group of adult Aboriginal Australians in the Northern Territory of Australia.
Patients who underwent at least two chest CT scans between 2012 and 2020 among those referred to undergo lung function testing (spirometry) were included. Chest CT scans were assessed for the number, location, size and morphological characteristics of lung nodules.
Of the 402 chest CTs assessed, 75 patients (18.7%) had lung nodules, and 57 patients were included in the final analysis with at least two CT scans available for assessment over a median follow-up of 87 weeks. Most patients (68%) were women, with a median age of 58 years and smoking history in 83%. The majority recorded only a single nodule 43 (74%). Six patients (10%) were diagnosed with malignancy, five with primary lung cancer and one with metastatic thyroid cancer. Of the 51 (90%) patients assessed to be benign, 64 nodules were identified, of which 25 (39%) resolved, 38 (59%) remained stable and one (1.8%) enlarged on follow-up. Nodules among patients with malignancy were typically initially larger and enlarged over time, had spiculated margins and were solid, showing no specific lobar predilection.
Most lung nodules in Aboriginal Australians are likely to be benign. However, a proportion could be malignant. Further prospective studies are required for prognostication and monitoring of lung nodules in this population.
Proton beam therapy (PBT) is increasingly used to treat cancers, especially in the paediatric and adolescent and young adult (AYA) population. As PBT becomes more accessible, determining when PBT should be used instead of photon irradiation can be difficult. There is a need to balance patient, tumour and treatment factors when making this decision. Comparing the dosimetry between these two modalities plays an important role in this process. PBT can reduce low to intermediate doses to organs at risk (OAR), but photon irradiation has its dosimetric advantages. We present two cases with brain tumours, one paediatric and one AYA, in which treatment plan comparison between photons and protons showed dosimetric advantages of photon irradiation. The first case was an 18-month-old child diagnosed with posterior fossa ependymoma requiring adjuvant radiotherapy. Photon irradiation using volumetric modulated arc therapy (VMAT) had lower doses to the hippocampi but higher doses to the pituitary gland. The second case was a 21-year-old with an optic pathway glioma. There was better sparing of the critical optic structures and pituitary gland using fractionated stereotactic radiation therapy over PBT. The dosimetric advantages of photon irradiation over PBT have been demonstrated in these cases. This highlights the role of proton-to-photon comparative treatment planning to better understand which patients might benefit from photon irradiation versus PBT.
With the anticipated launch of the Australian Bragg Centre for Proton Therapy and Research (ABCPTR) in Adelaide, Australia, proton therapy will become a significant addition to existing cancer treatment options for Australians. The anticipated benefits will be particularly evident in rare cancers such as clival chordomas, a challenging tumour entity due to the anatomical relationship with critical structures, and proven radio-resistance to conventional radiation therapy. The article synthesises key findings from major studies and evaluates the current evidence supporting various management strategies for clival chordomas. It also considers the influence of institutional volume and multidisciplinary team management on patient outcomes and outlines how high-quality care can be effectively delivered within the Australian healthcare system, emphasising the potential impact of proton therapy on the treatment paradigm of clival chordomas in Australia.
The textbook ‘Particle Therapy Technology for Safe Treatment’ provides readers with a comprehensive overview of the complex technology that makes up particle therapy. Authored by world-renowned particle accelerator and particle beam physicist Dr Jay Flanz, the book explains key particle therapy parameters and underlying physics concepts, alongside useful practical examples of how to ensure the safest clinical implementation of particle therapy.
This retrospective planning study aimed to evaluate the role of bolus in achieving dose uniformity in the ankles and feet in paediatric patients undergoing Modulated Arc Total Body Irradiation (MATBI) treatment and to identify patient factors that may negate or warrant its use.
The clinically treated plans of 20 paediatric patients who received MATBI treatment utilising ankle and foot bolus (Bolus plan) were compared with two retrospectively generated plans; a plan with bolus removed and no re-optimisation (No Bolus plan), and a re-optimised plan without bolus attempting to achieve equal dosimetry to the clinical plan via monitor unit adjustment (MU plan). Descriptive statistics were used to evaluate the dose uniformity criteria of ±10% coverage of the reference dose (RD) for each subregion of the ankle and foot for the three plans. The impact of patient height, weight, and age at the time of treatment was evaluated using Spearman's correlation.
Variation in doses >10% RD was minimal across the three plans, with an average D1cc difference < 0.4Gy. For the ankle and foot regions in the Bolus plans, the volume receiving at least 90% of the RD (V90) was on average > 92%. In No Bolus and MU plans, there was an average reduction of 24.5% and 23.2% V90 coverage respectively in the toes. Spearman's correlation suggests height has the strongest relationship to D1cc.
This study validated the continued use of ankle and foot bolus to achieve dosimetric goals for paediatric MATBI treatments, particularly V90 coverage across all heights.
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