Pub Date : 2025-04-29DOI: 10.1016/j.tipsro.2025.100313
S. Boisbouvier , F. Hermant , A. Béasse
Radiation therapy (RT) is one of the main treatment modalities for cancer. In France, radiation therapists (RTTs) undergo a combined training program in radiography, nuclear medicine, and RT. In the context of rising cancer cases and greater utilisation of RT, RT departments face a workforce shortage. This study investigates the interest of final-year radiography students in working in RT and explores deterrents to their career choice.
A survey was conducted in January 2024 among French radiography students who had completed at least 3 weeks of RT clinical placement. The survey included closed and open-ended questions on career preferences and highlighted barriers to working in RT. Data analysis included absolute number, frequency of students wishing to work in RT according to the age range of the students. A Chi square test was used to assess the influence of the age range on the desire to work in RT field. A thematic analysis of free-text responses was also performed.
The results indicated a low interest in a career in RT among students, with the main reasons being psychological and educational barriers. Enhancing RT-specific education, improving clinical placements, addressing emotional resilience, and modernising training programmes are crucial to attract future RTTs and address workforce shortages in this critical field.
{"title":"Radiography students wishing to work in the field of radiation therapy: A French experience","authors":"S. Boisbouvier , F. Hermant , A. Béasse","doi":"10.1016/j.tipsro.2025.100313","DOIUrl":"10.1016/j.tipsro.2025.100313","url":null,"abstract":"<div><div>Radiation therapy (RT) is one of the main treatment modalities for cancer. In France, radiation therapists (RTTs) undergo a combined training program in radiography, nuclear medicine, and RT. In the context of rising cancer cases and greater utilisation of RT, RT departments face a workforce shortage. This study investigates the interest of final-year radiography students in working in RT and explores deterrents to their career choice.</div><div>A survey was conducted in January 2024 among French radiography students who had completed at least 3 weeks of RT clinical placement. The survey included closed and open-ended questions on career preferences and highlighted barriers to working in RT. Data analysis included absolute number, frequency of students wishing to work in RT according to the age range of the students. A Chi square test was used to assess the influence of the age range on the desire to work in RT field. A thematic analysis of free-text responses was also performed.</div><div>The results indicated a low interest in a career in RT among students, with the main reasons being psychological and educational barriers. Enhancing RT-specific education, improving clinical placements, addressing emotional resilience, and modernising training programmes are crucial to attract future RTTs and address workforce shortages in this critical field.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100313"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-23DOI: 10.1016/j.tipsro.2025.100310
Boris Mueller , Yulin Song , Xingchen Zhai , Yubei Liang , Paul Tamas , Simon Powell , David M Guttmann , Diana Roth O’Brien , Beryl McCormick , Atif Khan , Laura Cervino-Arriba , Bo Zhao , Linda Hong , Lior Z. Braunstein
<div><h3>Purpose/Objective</h3><div>Skin tattoos represent the standard for surface alignment and setup of breast cancer radiotherapy yet contribute to adverse cosmesis and patient dissatisfaction. With the advent of contemporary surface imaging technology, we evaluated setup accuracy, time, and dosimetric parameters between traditional tattoo-based setup techniques and a “tattoo-less” approach for lymph node positive and high-risk breast cancer patients requiring chest wall and regional nodal radiation.</div><div>Material/Methods</div><div>Patients receiving chest wall radiation for breast cancer underwent a traditional tattoo-based setup (TTB), alternating daily with a tattoo-less setup via surface imaging using AlignRT (ART) to serve as an internal control. Following initial setup (using tattoos or AlignRT), target position was verified by daily kV imaging, with matching on the chest wall bony anatomy representing ground truth. Translational (TS) and rotational shifts (RS) were ascertained, as were setup time and total in-room time. Delivered dosimetry was calculated using the reverse isocenter shift technique. Statistical analyses used the Wilcoxon Signed Rank test and Pitman-Morgan variance test.</div></div><div><h3>Results</h3><div>A total of 49 breast cancer patients receiving a total of 1118 fractions (n = 560 for ART and 558 for TTB) of chest wall radiation were analyzed. For tattoo-less setup via ART, the median absolute TS was 0.28 cm vertical (range: 0.14–––0.48), 0.24 cm lateral (0.10–––0.40), and 0.26 cm longitudinal (0.13––0.44). For TTB setup, the corresponding median TS were 0.34 cm (0.15–––0.52), 0.29 (0.13–––0.46), and 0.34 cm (0.14–––0.59), respectively. ART was significantly more accurate than TTB with regard to TS (p = 0.038, 0.007, <0.001, respectively). Variance testing also showed increased precision with ART in the vertical (p < 0.001) and longitudinal (p < 0.001) axes.</div><div>The median absolute RS for ART was 0.80° rotational (range:0.40–1.50), 0.60° roll (0.20–1.20), and 0.50° pitch (0.10–1.00). The corresponding median RS for TTB was 1.00° (0.40–1.70), 0.60° (0.20–1.20), and 0.50° (0.10–1.00). ART was significantly more accurate for RS than TTB (p = 0.023). ART setup was otherwise not statistically different from TTB regarding roll and pitch (p = 0.558, 0.929, respectively). ART showed no difference in precision versus TTB regarding RS, pitch, and roll (p = 0.181, p = 0.544, p = 0.858).</div><div>The median total in-room time for ART was 18.77 min (range: 16.04–20.77) and 18.70 min (17.58–20.67) for TTB (p = 0.38). The median setup time was 12.75 min (11.43–14.80) for ART and 13.78 min (12.42–15.09) for TTB (p = 0.054). There was no significant difference between the AlignRT and the tattoo-based methods for both setup and in-room time.</div></div><div><h3>Conclusion</h3><div>These findings indicate that utilizing the tattoo-less setup method with AlignRT provides sufficient accuracy and speed to potential
{"title":"Tattoo-less chest wall and regional nodal irradiation using surface imaging","authors":"Boris Mueller , Yulin Song , Xingchen Zhai , Yubei Liang , Paul Tamas , Simon Powell , David M Guttmann , Diana Roth O’Brien , Beryl McCormick , Atif Khan , Laura Cervino-Arriba , Bo Zhao , Linda Hong , Lior Z. Braunstein","doi":"10.1016/j.tipsro.2025.100310","DOIUrl":"10.1016/j.tipsro.2025.100310","url":null,"abstract":"<div><h3>Purpose/Objective</h3><div>Skin tattoos represent the standard for surface alignment and setup of breast cancer radiotherapy yet contribute to adverse cosmesis and patient dissatisfaction. With the advent of contemporary surface imaging technology, we evaluated setup accuracy, time, and dosimetric parameters between traditional tattoo-based setup techniques and a “tattoo-less” approach for lymph node positive and high-risk breast cancer patients requiring chest wall and regional nodal radiation.</div><div>Material/Methods</div><div>Patients receiving chest wall radiation for breast cancer underwent a traditional tattoo-based setup (TTB), alternating daily with a tattoo-less setup via surface imaging using AlignRT (ART) to serve as an internal control. Following initial setup (using tattoos or AlignRT), target position was verified by daily kV imaging, with matching on the chest wall bony anatomy representing ground truth. Translational (TS) and rotational shifts (RS) were ascertained, as were setup time and total in-room time. Delivered dosimetry was calculated using the reverse isocenter shift technique. Statistical analyses used the Wilcoxon Signed Rank test and Pitman-Morgan variance test.</div></div><div><h3>Results</h3><div>A total of 49 breast cancer patients receiving a total of 1118 fractions (n = 560 for ART and 558 for TTB) of chest wall radiation were analyzed. For tattoo-less setup via ART, the median absolute TS was 0.28 cm vertical (range: 0.14–––0.48), 0.24 cm lateral (0.10–––0.40), and 0.26 cm longitudinal (0.13––0.44). For TTB setup, the corresponding median TS were 0.34 cm (0.15–––0.52), 0.29 (0.13–––0.46), and 0.34 cm (0.14–––0.59), respectively. ART was significantly more accurate than TTB with regard to TS (p = 0.038, 0.007, <0.001, respectively). Variance testing also showed increased precision with ART in the vertical (p < 0.001) and longitudinal (p < 0.001) axes.</div><div>The median absolute RS for ART was 0.80° rotational (range:0.40–1.50), 0.60° roll (0.20–1.20), and 0.50° pitch (0.10–1.00). The corresponding median RS for TTB was 1.00° (0.40–1.70), 0.60° (0.20–1.20), and 0.50° (0.10–1.00). ART was significantly more accurate for RS than TTB (p = 0.023). ART setup was otherwise not statistically different from TTB regarding roll and pitch (p = 0.558, 0.929, respectively). ART showed no difference in precision versus TTB regarding RS, pitch, and roll (p = 0.181, p = 0.544, p = 0.858).</div><div>The median total in-room time for ART was 18.77 min (range: 16.04–20.77) and 18.70 min (17.58–20.67) for TTB (p = 0.38). The median setup time was 12.75 min (11.43–14.80) for ART and 13.78 min (12.42–15.09) for TTB (p = 0.054). There was no significant difference between the AlignRT and the tattoo-based methods for both setup and in-room time.</div></div><div><h3>Conclusion</h3><div>These findings indicate that utilizing the tattoo-less setup method with AlignRT provides sufficient accuracy and speed to potential","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100310"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-20DOI: 10.1016/j.tipsro.2025.100312
Siret Kivistik , Eija Metsälä , Heli Virtanen
Objective
This integrative review investigates perceptions, educational expectations, and knowledge gaps of patients with breast cancer (BC) regarding radiotherapy (RT).
Methods
The included studies were analysed using a thematic analysis approach. Each segment of data was coded with open coding. The codes were gathered into subthemes as they emerged and into overarching themes, after which the data was analysed again.
Results
22 studies were included: 11 qualitative, 10 cross-sectional, and 1 case study. Our findings indicate that breast cancer patients perceptions of radiation therapy (RT) are influenced by their understanding of RT, its side effects, the treatment burden, emotional state or feelings, effectiveness if RT, prognosis, and viewing RT as the end-of-care phase. They expect education on the treatment pathway, psychosocial support, personalised aspects of RT, planning, delivery, follow-up, and side effects. Additionally, women undergoing RT have knowledge gaps related to preparedness and support, unforeseen risks and side effects, as well as daily practical issues.
Conclusion
Tailored, culturally sensitive education is essential to bridge gaps in understanding, manage anxiety, and build trust. It requires individualized communication strategies and psychosocial support. By integrating personalized information and leveraging technological solutions, healthcare providers can empower patients, improve adherence, and enhance outcomes, particularly in resource-limited settings.
{"title":"Perceptions, educational expectations and knowledge gaps of patients with non-metastatic breast cancer regarding radiotherapy: Integrative review","authors":"Siret Kivistik , Eija Metsälä , Heli Virtanen","doi":"10.1016/j.tipsro.2025.100312","DOIUrl":"10.1016/j.tipsro.2025.100312","url":null,"abstract":"<div><h3>Objective</h3><div>This integrative review investigates perceptions, educational expectations, and knowledge gaps of patients with breast cancer (BC) regarding radiotherapy (RT).</div></div><div><h3>Methods</h3><div>The included studies were analysed using a thematic analysis approach. Each segment of data was coded with open coding. The codes were gathered into subthemes as they emerged and into overarching themes, after which the data was analysed again.</div></div><div><h3>Results</h3><div>22 studies were included: 11 qualitative, 10 cross-sectional, and 1 case study. Our findings indicate that breast cancer patients perceptions of radiation therapy (RT) are influenced by their understanding of RT, its side effects, the treatment burden, emotional state or feelings, effectiveness if RT, prognosis, and viewing RT as the end-of-care phase. They expect education on the treatment pathway, psychosocial support, personalised aspects of RT, planning, delivery, follow-up, and side effects. Additionally, women undergoing RT have knowledge gaps related to preparedness and support, unforeseen risks and side effects, as well as daily practical issues.</div></div><div><h3>Conclusion</h3><div>Tailored, culturally sensitive education is essential to bridge gaps in understanding, manage anxiety, and build trust. It requires individualized communication strategies and psychosocial support. By integrating personalized information and leveraging technological solutions, healthcare providers can empower patients, improve adherence, and enhance outcomes, particularly in resource-limited settings.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100312"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-04DOI: 10.1016/j.tipsro.2025.100309
Donna Caldwell , Aileen Duffton , Chloe Wilkinson
Background
The primary role of the Clinical Trials Radiographer (CTR) within the UK workforce is the set-up and initiation of new trials, and recruitment of patients. There is very little published evidence to indicate the impact and value of the CTR. The aim of this study is to describe the evolving role of the CTR and to quantify impact on set-up, and recruitment to Radiotherapy (RT) clinical trials.
Results
The number of trials approved and opened annually, number of open studies within the portfolio, and number of patients recruited have all increased alongside the number of CTR hours.
Conclusion
The data provides quantitative evidence to support the impact of the CTR role and its value in a RT department’s research infrastructure. This reinforces the need to consider the CTR position in long term funding and future workforce planning.
{"title":"The impact of Clinical Trials Radiographers on set-up and recruitment to radiotherapy trials","authors":"Donna Caldwell , Aileen Duffton , Chloe Wilkinson","doi":"10.1016/j.tipsro.2025.100309","DOIUrl":"10.1016/j.tipsro.2025.100309","url":null,"abstract":"<div><h3>Background</h3><div>The primary role of the Clinical Trials Radiographer (CTR) within the UK workforce is the set-up and initiation of new trials, and recruitment of patients. There is very little published evidence to indicate the impact and value of the CTR. The aim of this study is to describe the evolving role of the CTR and to quantify impact on set-up, and recruitment to Radiotherapy (RT) clinical trials.</div></div><div><h3>Results</h3><div>The number of trials approved and opened annually, number of open studies within the portfolio, and number of patients recruited have all increased alongside the number of CTR hours.</div></div><div><h3>Conclusion</h3><div>The data provides quantitative evidence to support the impact of the CTR role and its value in a RT department’s research infrastructure. This reinforces the need to consider the CTR position in long term funding and future workforce planning.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100309"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-26DOI: 10.1016/j.tipsro.2025.100305
Madison Bush , Scott Jones , Catriona Hargrave
Introduction
Hydrogel spacers (HS) are designed to minimise the radiation doses to the rectum in prostate cancer radiation therapy (RT) by creating a physical gap between the rectum and the target treatment volume inclusive of the prostate and seminal vesicles (SV). This study aims to determine the feasibility of incorporating diagnostic MRI (dMRI) information in statistical machine learning (SML) models developed with planning CT (pCT) anatomy for dose and rectal toxicity prediction. The SML models aim to support HS insertion decision-making prior to RT planning procedures.
Methods
Regions of interest (ROIs) were retrospectively contoured on the pCT and registered dMRI scans for 20 patients. ROI Dice and Hausdorff distance (HD) comparison metrics were calculated. The ROI and patient clinical risk factors (CRFs) variables were inputted into three SML models and then pCT and dMRI-based dose and toxicity model performance compared through confusion matrices, AUC curves, accuracy performance metric results and observed patient outcomes.
Results
Average Dice values comparing dMRI and pCT ROIs were 0.81, 0.47 and 0.71 for the prostate, SV, and rectum respectively. Average Hausdorff distances were 2.15, 2.75 and 2.75 mm for the prostate, SV, and rectum respectively. The average accuracy metric across all models was 0.83 when using dMRI ROIs and 0.85 when using pCT ROIs.
Conclusion
Differences between pCT and dMRI anatomical ROI variables did not impact SML model performance in this study, demonstrating the feasibility of using dMRI images. Due to the limited sample size further training of the predictive models including dMRI anatomy is recommended.
{"title":"Evaluation of MRI anatomy in machine learning predictive models to assess hydrogel spacer benefit for prostate cancer patients","authors":"Madison Bush , Scott Jones , Catriona Hargrave","doi":"10.1016/j.tipsro.2025.100305","DOIUrl":"10.1016/j.tipsro.2025.100305","url":null,"abstract":"<div><h3>Introduction</h3><div>Hydrogel spacers (HS) are designed to minimise the radiation doses to the rectum in prostate cancer radiation therapy (RT) by creating a physical gap between the rectum and the target treatment volume inclusive of the prostate and seminal vesicles (SV). This study aims to determine the feasibility of incorporating diagnostic MRI (dMRI) information in statistical machine learning (SML) models developed with planning CT (pCT) anatomy for dose and rectal toxicity prediction. The SML models aim to support HS insertion decision-making prior to RT planning procedures.</div></div><div><h3>Methods</h3><div>Regions of interest (ROIs) were retrospectively contoured on the pCT and registered dMRI scans for 20 patients. ROI Dice and Hausdorff distance (HD) comparison metrics were calculated. The ROI and patient clinical risk factors (CRFs) variables were inputted into three SML models and then pCT and dMRI-based dose and toxicity model performance compared through confusion matrices, AUC curves, accuracy performance metric results and observed patient outcomes.</div></div><div><h3>Results</h3><div>Average Dice values comparing dMRI and pCT ROIs were 0.81, 0.47 and 0.71 for the prostate, SV, and rectum respectively. Average Hausdorff distances were 2.15, 2.75 and 2.75 mm for the prostate, SV, and rectum respectively. The average accuracy metric across all models was 0.83 when using dMRI ROIs and 0.85 when using pCT ROIs.</div></div><div><h3>Conclusion</h3><div>Differences between pCT and dMRI anatomical ROI variables did not impact SML model performance in this study, demonstrating the feasibility of using dMRI images. Due to the limited sample size further training of the predictive models including dMRI anatomy is recommended.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.tipsro.2025.100307
Milad Mirzaei , Suki Gill , Mahsheed Sabet , Martin A. Ebert , Pejman Rowshanfarzad , Jake Kendrick , Angela Jacques , Clare Herbert , Jeremy Croker , Sean Bydder , Joshua Dass , Edward Bailey , Rohen White , Catherine Moffat , Colin Tang , Adriano Polpo , Nicholas Bucknell
Purpose
Daily image-guided radiotherapy (IGRT) for prostate cancer reduces treatment-related toxicity. However, positional and anatomical variations can result in patient re-setup, increased treatment time, and additional imaging dose. A simple technique of two distinct imaging modalities was investigated: initially, an anteroposterior kilovoltage (AP-kV) planar image was acquired, followed by cone beam computed tomography (CBCT). To determine whether this dual imaging modality (DIM) can reduce repeat CBCTs with an AP-kV screening image compared to CBCT alone, i.e. a single imaging modality (SIM).
Methods
Patients were enrolled sequentially before and after the new departmental protocol for IGRT. Initially, all patients had a CBCT prior to treatment (SIM group) as usual. For the DIM group, AP-kV imaging was added to the first three fractions, and subsequent AP-kV imaging (on demand) for patients unable to maintain adequate bladder and bowel compliance. Sixty intact prostate or post-prostatectomy patients were included: 30 before the change in protocol (SIM group) and 30 after (DIM group). Bladder volume, rectal filling, and positioning errors were evaluated.
Results
In the SIM group, 30 patients underwent a total of 1116 CBCTs. In the DIM group, 30 patients had 156 AP-kV images and 1077 CBCTs. In the SIM group, 166 were repeat CBCTs with a median of 4 repeat CBCTs per patient. In DIM group, 132 were repeat CBCTs with a median of 3 repeat CBCTs per patient. We found a significant difference in incidence of repeat CBCTs due to suboptimal bladder filling (p = 0.028) and rectal gas (p = 0.045), indicating the number of repeat CBCTs was significantly lower in patients imaged with DIM.
Conclusion
The DIM technique was found to be superior to the SIM technique, as it allowed the desired bladder volume, rectal condition, and patient positioning to be achieved prior to CBCT, reducing the need for repeat CBCTs.
{"title":"Treatment efficiency and quality improvement via double imaging modality (DIM) versus single imaging modality (SIM) image-guided radiotherapy for prostate cancer","authors":"Milad Mirzaei , Suki Gill , Mahsheed Sabet , Martin A. Ebert , Pejman Rowshanfarzad , Jake Kendrick , Angela Jacques , Clare Herbert , Jeremy Croker , Sean Bydder , Joshua Dass , Edward Bailey , Rohen White , Catherine Moffat , Colin Tang , Adriano Polpo , Nicholas Bucknell","doi":"10.1016/j.tipsro.2025.100307","DOIUrl":"10.1016/j.tipsro.2025.100307","url":null,"abstract":"<div><h3>Purpose</h3><div>Daily image-guided radiotherapy (IGRT) for prostate cancer reduces treatment-related toxicity. However, positional and anatomical variations can result in patient re-setup, increased treatment time, and additional imaging dose. A simple technique of two distinct imaging modalities was investigated: initially, an anteroposterior kilovoltage (AP-kV) planar image was acquired, followed by cone beam computed tomography (CBCT). To determine whether this dual imaging modality (DIM) can reduce repeat CBCTs with an AP-kV screening image compared to CBCT alone, <em>i.e.</em> a single imaging modality (SIM).</div></div><div><h3>Methods</h3><div>Patients were enrolled sequentially before and after the new departmental protocol for IGRT. Initially, all patients had a CBCT prior to treatment (SIM group) as usual. For the DIM group, AP-kV imaging was added to the first three fractions, and subsequent AP-kV imaging (on demand) for patients unable to maintain adequate bladder and bowel compliance. Sixty intact prostate or post-prostatectomy patients were included: 30 before the change in protocol (SIM group) and 30 after (DIM group). Bladder volume, rectal filling, and positioning errors were evaluated.</div></div><div><h3>Results</h3><div>In the SIM group, 30 patients underwent a total of 1116 CBCTs. In the DIM group, 30 patients had 156 AP-kV images and 1077 CBCTs. In the SIM group, 166 were repeat CBCTs with a median of 4 repeat CBCTs per patient. In DIM group, 132 were repeat CBCTs with a median of 3 repeat CBCTs per patient. We found a significant difference in incidence of repeat CBCTs due to suboptimal bladder filling (p = 0.028) and rectal gas (p = 0.045), indicating the number of repeat CBCTs was significantly lower in patients imaged with DIM.</div></div><div><h3>Conclusion</h3><div>The DIM technique was found to be superior to the SIM technique, as it allowed the desired bladder volume, rectal condition, and patient positioning to be achieved prior to CBCT, reducing the need for repeat CBCTs.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100307"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-17DOI: 10.1016/j.tipsro.2025.100306
S.E. Alexander , J. Selous-Hodges , A. Araujo , L. Booth , L. Delacroix , E. Garrad , A. Gordon , C. Graham , A. Guerra , C. Gulyaeva , C. Ockwell , S. Shire , U. Oelfke , H.A. McNair , A.C. Tree
Introduction
Bladder and rectal preparation regimes for prostate cancer (PCa) radiotherapy (RT) can heighten anxiety before and during RT. Patient’s perception of RT preparation is under-represented in the literature. To address this gap, patient’s experience of preparation with respect to understanding, comfort, anxiety, effectiveness and impact on daily life was examined.
Materials and methods
A novel patient preparation survey was created and validated, it contained 12 original questions related to general, bladder and rectal preparation. Plus, the Patient Health Questionnaire 4 (PHQ4) and question 15 of the Expanded Prostate Cancer Index Composite (EPIC).
Eligible patients were individuals referred for prostate or prostate bed +/− pelvic lymph node RT from March-May 2024. Surveys were issued immediately after the patient’s planning scan, those completing the survey at this timepoint were asked to repeat it in their first and final weeks of RT.
Results
The survey was completed by 103/125 eligible patients at their planning scan, 47/103 in the first and 52/103 in the final week of RT. Perception of preparation was largely positive. For general and bladder preparation positive question response rate ranged from 55 to 98 % and negative from 0 to 26 %. Rectal preparation response rate was 59–100 % positive and 0–35 % negative. Difficulty maintaining a full bladder and using enemas was greatest at the end of RT.
No significant difference in experience was found for participants using or not using enemas for preparation. Anxiety and depression (PHQ4) affected 12–13 % of respondents, and significantly more patients reported bowel toxicity (EPIC), in the last week of RT compared to earlier timepoints.
Conclusion
The authors conclude that the preparation needs of their patients are well met. However, a considerable number did find preparation difficult, disruptive and ineffective, more so at the end of treatment. Further qualitative analysis of patient’s experience is needed to better understand why individuals experience varies.
{"title":"Patient experience preparing for prostate cancer radiotherapy","authors":"S.E. Alexander , J. Selous-Hodges , A. Araujo , L. Booth , L. Delacroix , E. Garrad , A. Gordon , C. Graham , A. Guerra , C. Gulyaeva , C. Ockwell , S. Shire , U. Oelfke , H.A. McNair , A.C. Tree","doi":"10.1016/j.tipsro.2025.100306","DOIUrl":"10.1016/j.tipsro.2025.100306","url":null,"abstract":"<div><h3>Introduction</h3><div>Bladder and rectal preparation regimes for prostate cancer (PCa) radiotherapy (RT) can heighten anxiety before and during RT. Patient’s perception of RT preparation is under-represented in the literature. To address this gap, patient’s experience of preparation with respect to understanding, comfort, anxiety, effectiveness and impact on daily life was examined.</div></div><div><h3>Materials and methods</h3><div>A novel patient preparation survey was created and validated, it contained 12 original questions related to general, bladder and rectal preparation. Plus, the Patient Health Questionnaire 4 (PHQ4) and question 15 of the Expanded Prostate Cancer Index Composite (EPIC).</div><div>Eligible patients were individuals referred for prostate or prostate bed +/− pelvic lymph node RT from March-May 2024. Surveys were issued immediately after the patient’s planning scan, those completing the survey at this timepoint were asked to repeat it in their first and final weeks of RT.</div></div><div><h3>Results</h3><div>The survey was completed by 103/125 eligible patients at their planning scan, 47/103 in the first and 52/103 in the final week of RT. Perception of preparation was largely positive. For general and bladder preparation positive question response rate ranged from 55 to 98 % and negative from 0 to 26 %. Rectal preparation response rate was 59–100 % positive and 0–35 % negative. Difficulty maintaining a full bladder and using enemas was greatest at the end of RT.</div><div>No significant difference in experience was found for participants using or not using enemas for preparation. Anxiety and depression (PHQ4) affected 12–13 % of respondents, and significantly more patients reported bowel toxicity (EPIC), in the last week of RT compared to earlier timepoints.</div></div><div><h3>Conclusion</h3><div>The authors conclude that the preparation needs of their patients are well met. However, a considerable number did find preparation difficult, disruptive and ineffective, more so at the end of treatment. Further qualitative analysis of patient’s experience is needed to better understand why individuals experience varies.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100306"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-05DOI: 10.1016/j.tipsro.2025.100304
Meegan Shepherd , Elizabeth Joyce , Bethany Williams , Siobhan Graham , Winnie Li , Jeremy Booth , Helen A. McNair
This commentary discusses the implementation of online adaptive radiation therapy (oART) in cancer treatment within the context of current challenges faced by radiation therapy professionals. oART enables modifications to treatment plans based on daily imaging, enhancing target accuracy while minimising harm to surrounding organs. Despite its potential to improve patient outcomes, the application of oART is hindered by notable barriers, particularly in human resources. A global shortage of skilled radiation professionals such as radiation therapists or therapeutic radiographers (RTTs), medical physicists and radiation oncologists, along with training challenges in online adaptive techniques, hinders oART implementation and sustainability. Moreover, geographical disparities limit access to advanced training programs, leaving RTTs and their patients in underserved regions at a disadvantage. There is growing global evidence that RTTs are being successfully trained to lead adaptive fractions in both cone-beam computed tomography and magnetic resonance imaging guided oART. This commentary proposes the notion of standards for a global training curriculum to address barriers and expand RTT capabilities in delivering oART. By leveraging artificial intelligence and fostering interdisciplinary collaboration, the radiation therapy field can enhance efficiency and accuracy in oART. Successful training models from leading institutions illustrate the importance of hands-on experience and ongoing mentorship. A coordinated effort among stakeholders is essential to establish a comprehensive global training framework, ultimately improving patient access to oART and elevating standards of care worldwide.
{"title":"Training for tomorrow: Establishing a worldwide curriculum in online adaptive radiation therapy","authors":"Meegan Shepherd , Elizabeth Joyce , Bethany Williams , Siobhan Graham , Winnie Li , Jeremy Booth , Helen A. McNair","doi":"10.1016/j.tipsro.2025.100304","DOIUrl":"10.1016/j.tipsro.2025.100304","url":null,"abstract":"<div><div>This commentary discusses the implementation of online adaptive radiation therapy (oART) in cancer treatment within the context of current challenges faced by radiation therapy professionals. oART enables modifications to treatment plans based on daily imaging, enhancing target accuracy while minimising harm to surrounding organs. Despite its potential to improve patient outcomes, the application of oART is hindered by notable barriers, particularly in human resources. A global shortage of skilled radiation professionals such as radiation therapists or therapeutic radiographers (RTTs), medical physicists and radiation oncologists, along with training challenges in online adaptive techniques, hinders oART implementation and sustainability. Moreover, geographical disparities limit access to advanced training programs, leaving RTTs and their patients in underserved regions at a disadvantage. There is growing global evidence that RTTs are being successfully trained to lead adaptive fractions in both cone-beam computed tomography and magnetic resonance imaging guided oART. This commentary proposes the notion of standards for a global training curriculum to address barriers and expand RTT capabilities in delivering oART. By leveraging artificial intelligence and fostering interdisciplinary collaboration, the radiation therapy field can enhance efficiency and accuracy in oART. Successful training models from leading institutions illustrate the importance of hands-on experience and ongoing mentorship. A coordinated effort among stakeholders is essential to establish a comprehensive global training framework, ultimately improving patient access to oART and elevating standards of care worldwide.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100304"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1016/j.tipsro.2025.100303
Amanda Moreira , Tara Rosewall , Yat Tsang , Patricia Lindsay , Peter Chung , Winnie Li
Purpose
Adaptive radiation therapy (ART) is a close-looped process where anatomic changes observed during treatment are identified, leading to plan modification prior to treatment delivery. The aim of this study was to explore the status of ART across Canada and review the impact of adaptive technologies on the roles and responsibilities of Radiation Therapists (RTTs).
Materials and Methods
Study information and a link to a 30-question survey was sent via email to the RTT manager of all cancer centres across Canada (n = 48). The survey questions included centre demographics, presence of offline and/or online ART activities as standard of care, corresponding roles and responsibilities of the multidisciplinary team, and training activities. The survey was administered electronically and closed after a 3-week accrual period. Responses were analyzed using descriptive statistics.
Results
Thirty-two out of 48 centres responded across all ten provinces (67 % response rate). Twenty-five centres (78 %) currently perform ART, all of which practiced offline ART while 5 practiced online ART. Most common responses for lack of ART were ‘technical limitations’ and ‘lack of resources’. RTTs are responsible for 50 % (offline) versus 58 % (online) ART respectively, with the most notable change being the addition of target delineation to their daily practice.
Conclusions
The status of ART varies across Canada. Offline ART is commonly practiced, but online ART remains an infrequent process due to technical limitations and lack of resources. As centres move towards implementing online ART, the role of the RTT will need to be redefined with corresponding upskilling to support the emergent treatment paradigm.
{"title":"Pan-Canadian assessment of image guided adaptive radiation therapy and the role of the radiation therapist","authors":"Amanda Moreira , Tara Rosewall , Yat Tsang , Patricia Lindsay , Peter Chung , Winnie Li","doi":"10.1016/j.tipsro.2025.100303","DOIUrl":"10.1016/j.tipsro.2025.100303","url":null,"abstract":"<div><h3>Purpose</h3><div>Adaptive radiation therapy (ART) is a close-looped process where anatomic changes observed during treatment are identified, leading to plan modification prior to treatment delivery. The aim of this study was to explore the status of ART across Canada and review the impact of adaptive technologies on the roles and responsibilities of Radiation Therapists (RTTs).</div></div><div><h3>Materials and Methods</h3><div>Study information and a link to a 30-question survey was sent via email to the RTT manager of all cancer centres across Canada (n = 48). The survey questions included centre demographics, presence of offline and/or online ART activities as standard of care, corresponding roles and responsibilities of the multidisciplinary team, and training activities. The survey was administered electronically and closed after a 3-week accrual period. Responses were analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>Thirty-two out of 48 centres responded across all ten provinces (67 % response rate). Twenty-five centres (78 %) currently perform ART, all of which practiced offline ART while 5 practiced online ART. Most common responses for lack of ART were ‘technical limitations’ and ‘lack of resources’. RTTs are responsible for 50 % (offline) versus 58 % (online) ART respectively, with the most notable change being the addition of target delineation to their daily practice.</div></div><div><h3>Conclusions</h3><div>The status of ART varies across Canada. Offline ART is commonly practiced, but online ART remains an infrequent process due to technical limitations and lack of resources. As centres move towards implementing online ART, the role of the RTT will need to be redefined with corresponding upskilling to support the emergent treatment paradigm.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100303"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-13DOI: 10.1016/j.tipsro.2025.100302
Boaz Kalkhoven , Marjolein N. Hilberts , Melissa A.L. Verdonk , An-Sofie E. Verrijssen , Peter-Paul G. van der Toorn , Tom C.G. Budiharto , Patricia F.C. Bronius , Diana Geerts , Coen W. Hurkmans , Shyama U. Tetar , Rob H.N. Tijssen
Background & purpose
Magnetic resonance guided adaptive radiotherapy (MRgART) enables hypofractionated prostate radiotherapy by daily contour adaptation. The MRgART workflow, however, is labour intensive and in many institutes still requires the presence of the radiation oncologist (RO). Transferring the online contour adaptation task to the radiation therapist (RTT) will release the clinician from attending each treatment fraction making MRgRT more efficient and cost effective. In this study we investigate the viability of RTT-led prostate MRgART on a low-field MR-linac, by assessing the interobserver variations of RTT- and RO-generated CTV contour adaptations as well as the resulting dosimetric effects.
Materials & methods
Four RTTs and four ROs performed CTV contour adaptations on first fraction data in ten patients. Delineations were compared against a gold standard contour using target volume, Dice similarity coefficient (DSC), and 95th percentile Hausdorff distance. In addition, a dosimetric evaluation was performed on all first fractions by performing plan adaptations based on all RTT contour adaptation and comparing these to the clinically delivered plan. Finally, a full-treatment simulation was performed in four patients to investigate the dosimetric effects of the RTTs’ contour adaptations throughout an entire treatment.
Results
RTTs with no experience in prostate delineation prior to this study spent more time on CTV contour adaptations. The geometric and dosimetric analyses, however, showed no statistically significant differences between both groups.
Conclusions
This study confirmed that RTTs perform similarly to ROs in carrying out online contour adaptations. These results indicate the feasibility of initiating a transition in contour adaptation tasks from ROs to RTTs.
{"title":"Geometric and dosimetric evaluation of CTV contour adaptations by radiation therapists for adaptive prostate radiotherapy on a 0.35 T MR-Linac","authors":"Boaz Kalkhoven , Marjolein N. Hilberts , Melissa A.L. Verdonk , An-Sofie E. Verrijssen , Peter-Paul G. van der Toorn , Tom C.G. Budiharto , Patricia F.C. Bronius , Diana Geerts , Coen W. Hurkmans , Shyama U. Tetar , Rob H.N. Tijssen","doi":"10.1016/j.tipsro.2025.100302","DOIUrl":"10.1016/j.tipsro.2025.100302","url":null,"abstract":"<div><h3>Background & purpose</h3><div>Magnetic resonance guided adaptive radiotherapy (MRgART) enables hypofractionated prostate radiotherapy by daily contour adaptation. The MRgART workflow, however, is labour intensive and in many institutes still requires the presence of the radiation oncologist (RO). Transferring the online contour adaptation task to the radiation therapist (RTT) will release the clinician from attending each treatment fraction making MRgRT more efficient and cost effective. In this study we investigate the viability of RTT-led prostate MRgART on a low-field MR-linac, by assessing the interobserver variations of RTT- and RO-generated CTV contour adaptations as well as the resulting dosimetric effects.</div></div><div><h3>Materials & methods</h3><div>Four RTTs and four ROs performed CTV contour adaptations on first fraction data in ten patients. Delineations were compared against a gold standard contour using target volume, Dice similarity coefficient (DSC), and 95th percentile Hausdorff distance. In addition, a dosimetric evaluation was performed on all first fractions by performing plan adaptations based on all RTT contour adaptation and comparing these to the clinically delivered plan. Finally, a full-treatment simulation was performed in four patients to investigate the dosimetric effects of the RTTs’ contour adaptations throughout an entire treatment.</div></div><div><h3>Results</h3><div>RTTs with no experience in prostate delineation prior to this study spent more time on CTV contour adaptations. The geometric and dosimetric analyses, however, showed no statistically significant differences between both groups.</div></div><div><h3>Conclusions</h3><div>This study confirmed that RTTs perform similarly to ROs in carrying out online contour adaptations. These results indicate the feasibility of initiating a transition in contour adaptation tasks from ROs to RTTs.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"33 ","pages":"Article 100302"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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