[en] Volumetric-modulated arc therapy (VMAT) is a relatively new treatment technique in radiation therapy. A comparison study of conformal, intensity-modulated radiation therapy (IMRT) and single- and double-arc VMAT plans was undertaken to evaluate the dosimetric impact of this new technology in prostate cases. The research questions were as follows: how does VMAT dosimetry compare with IMRT and conformal plans?; does VMAT increase the volume of bowel receiving lower doses?; are one or two VMAT arcs required for standard prostate cases? Eight prostate cancer and post-prostatectomy patients were randomly selected for this study. Conformal, IMRT and single and double Arc VMAT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 75.6 Gy over a course of 42 fractions to the planning target volume (PTV). The Healthy Tissue Conformity Index and the conformation number results revealed the IMRT and two VMAT techniques to have superior dosimetry to the PTV compared with the conformal plans. The maximum dose delivered to the PTV was significantly higher with the single-arc VMAT technique compared with the conformal or double-arc VMAT plans. There were no significant differences between the planning techniques for the bladder and small bowel dosimetry. However, IMRT and VMAT plans delivered less radiation to the rectum and femoral heads, and a single-arc VMAT plan was optimal for the right femoral head and the two VMAT techniques were optimal to the IMRT plans for the left femoral head. Single- and double-arc VMAT consistently resulted in favourable or slightly superior dosimetry when compared with static gantry IMRT for prostate cases. Both the VMAT techniques and static gantry IMRT resulted in superior critical tissue sparing when compared with conformal plans.

[en] Patients with anal canal carcinoma treated with standard conformal radiotherapy frequently experience severe acute and late toxicity reactions to the treatment area. Roohipour et al. (Dis Colon Rectum 2008; 51: 147–53) stated a patient's tolerance of chemoradiation to be an important prediction of treatment success. A new intensity modulated radiation therapy (IMRT) technique for anal carcinoma cases has been developed at the Andrew Love Cancer Centre aimed at reducing radiation to surrounding healthy tissue. A same-subject repeated measures design was used for this study, where five anal carcinoma cases at the Andrew Love Cancer Centre were selected. Conformal and IMRT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 54 Gray (Gy) over a course of 30 fractions to the primary site. The IMRT plans resulted in improved dosimetry to the planning target volume (PTV) and reduction in radiation to the critical structures (bladder, external genitalia and femoral heads). Statistically there was no difference between the IMRT and conformal plans in the dose to the small and large bowel; however, the bowel IMRT dose–volume histogram (DVH) doses were consistently lower. The IMRT plans were superior to the conformal plans with improved dose conformity and reduced radiation to the surrounding healthy tissue. Anecdotally it was found that patients tolerated the IMRT treatment better than the three-dimensional (3D) conformal radiation therapy. This study describes and compares the planning techniques

[en] That three dimensional (3D) planning for radiation therapy (RT) of carcinoma of the prostate (CaP) improves radiation dosimetry to the tumour and reduces dose to the rectum and bladder compared with 2D planning, has not been properly evaluated. We addressed this by downloading the CT data files of twenty-two patients who had completed 2D planned RT for CaP onto a 3D planning system and re-planning RT using the same four field technique and dose prescription as the 2D technique. The radiation dose at 100%, 90%, 50% and 0% volumes (D100, D90, D50 and D0) of the Dose Volume Histograms (DVH's) of the GTV, PTV, rectum and bladder, the area under the curves of each DVH and the field sizes were evaluated and compared between the two sets of plans. Repeated measured t-tests were used to compare the means of the different measurements. The D100, D90 and D50 of the GTV, PTV and rectum were increased for the 3D versus the 2D plans (p<0.05 for each parameter). The area under the rectal DVH was also greater for the 3D plans (p<0.05). These changes are attributable to the larger field sizes, particularly the length in the 3D compared with the 2D plans

[en] Introduction: Documentation on the history of Australian radiotherapy is limited. This study provides radiation therapists' (RTs) perspectives of the people, workplace, and work practices in Australian radiotherapy centres from 1960 onwards. It provides a follow-up to our previous study: Australian radiation therapy: An overview – Part one, which outlines the history and development of radiotherapy from conception until present day. Methods: Four focus groups were conducted on separate occasions in 2010, one in South Australia and three in Victoria, Australia. Participants who worked in radiotherapy were purposively selected to ensure a range of experience, age, and years of work. Results: From a RT perspective, radiotherapy has evolved from a physically demanding ‘hands-on’ work environment, often with unpleasant sights and smells of disease, to a more technology-driven workplace. Conclusion: Understanding these changes and their subsequent effects on the role of Australian RTs will assist future directions in advanced role development

[en] Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities

[en] The main aims of this research was to employ alanine doped with gold-nanoparticles “AuNPs” to determine the levels of dose enhancement caused by these particles when irradiated with proton beams, low and high energy X-rays and electrons. DL-alanine was impregnated with 5 nm gold-nanoparticles (3% by weight) and added as a uniform layer within a wax pellet of dimensions 10 × 5 × 5 mm. Control pellets, containing DL-Alanine were also produced, and placed within a phantom, and exposed to various types of radiations: low energy (kV ranges) X-rays were obtained from a superficial machine, high energy (MV) X-rays and electrons derived from a linear accelerator, and protons were produced by the Hyogo Ion Beam Centre in Japan. Nominal doses received ranged from 2 to 20 Gy (within clinical range). The Electron Paramagnetic Resonance (EPR) spectra of the irradiated samples were recorded on a BRUKER Elexsys 9.5 MHz. The dose enhancement caused by gold nanoparticles for 80 kV x-rays was found to be more than 60% at about 5 Gy. Smaller dose enhancements (under the same measurement conditions) were observed for megavoltage x-ray beams (up to 10%). Dose enhancement caused by charged particles indicated minimal values for 6 MeV electrons (approximately 5%) whilst less than that is obtained with protons of 150 MeV. The proton results validate the latest simulation results based on Monte Carlo calculations but the dose enhancement is significantly less than that reported in cell and animal model systems, (about 20%). We attribute this difference to the fact that alanine only measures the levels of free radicals generated by the inclusion of nanoparticles and not the redox type radicals (such as reactive oxygen species) generated from aqueous media in cells. Dose enhancement caused by 5 nm gold-nanoparticles with radiotherapy type proton beams has been found to be less than 5% as determined when using alanine/wax as both a phantom and dosimeter. This agrees well with the latest Monte Carlo simulation results for similar sized gold-nanoparticles. Furthermore, our results for both low and high energy x-rays are validated against published data for in vitro studies. - Highlights: • Dose enhancement by 5 nm AuNPs (3% within alanine) determined for various beam types • Alanine/3% AuNPs composites show potential as low dose radiotherapy dosimeters (kV) • Alanine doped with AuNPs gave ∼60% dose enhancement for kV and ∼10% for MV X-rays • Alanine doped with AuNPs gave ≤5% dose enhancement for electron and proton beams • Good agreement with results for dose enhancement in cell and simulation studies