Motion Capture Pillow (MCP): A novel method to improve comfort and accuracy in radiotherapy

The delivery of radiotherapy has changed signi?cantly over the last few decades. Recent advances in radiotherapy practice may increase patient discomfort. A key challenge to improve patient comfort is the common use of a thermoplastic mask for patients with head and neck cancers. Patients suffer from discomfort and the claustrophobic effect of the mask, or as they lose soft tissue due to treatment and gain undesirable movement in the mask. A prototype system using a robotic motion capture pillow (MCP) is investigated for proof-of-concept and is pictorially presented for the potential replacement of thermoplastic masks

A prospective study comparing radiographer and clinician based localisation for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer led service.

OBJECTIVES: To investigate if there was parity between treatment fields localised by radiographers and clinicians, by comparing geographical variations and hence determining the feasibility of a radiographer led service. METHODS: 23 patients with metastatic spinal cord compression (MSCC) were prospectively sampled. 4 radiographers not involved in the original planning performed a localisation on each patient. The 92 localisations were compared to the clinicians approved field. Agreement was defined as ≤0.5cm between field length, width and 3 isocentre coordinates. To be feasible agreement was required in a minimum of 97% of the cases. The potential time saved with a radiographer led approach was also recorded. RESULTS: Agreement between clinicians and radiographers was 97.8%. For all field parameters, the average differences were <0.3cm and was significantly different from the 0.5cm median (p<0.0001) that would establish no agreement using wilcoxon signed rank test. The average (range) delay waiting for clinician approval was 54 minutes (4 minutes to 141 minutes). CONCLUSIONS: Strong agreement between radiographers and clinicians localisation was established. It was also highlighted that time could be saved in the patient's pathway by removing the need to wait for clinician approval. We believe this supports a radiographer led service. Advances in Knowledge: This article is novel as it is the first known comparison between clinicians and radiographers in the localisation of MSCC radiotherapy. This data shows the feasibility of introducing radiographer led practice and a methodology that could be potentially transferred to investigate the localisation parity for other treatment sites

Assisted Probe Positioning for Ultrasound Guided Radiotherapy Using Image Sequence Classification

Effective transperineal ultrasound image guidance in prostate external beam radiotherapy requires consistent alignment between probe and prostate at each session during patient set-up. Probe placement and ultrasound image inter-pretation are manual tasks contingent upon operator skill, leading to interoperator uncertainties that degrade radiotherapy precision. We demonstrate a method for ensuring accurate probe placement through joint classification of images and probe position data. Using a multi-input multi-task algorithm, spatial coordinate data from an optically tracked ultrasound probe is combined with an image clas-sifier using a recurrent neural network to generate two sets of predictions in real-time. The first set identifies relevant prostate anatomy visible in the field of view using the classes: outside prostate, prostate periphery, prostate centre. The second set recommends a probe angular adjustment to achieve alignment between the probe and prostate centre with the classes: move left, move right, stop. The algo-rithm was trained and tested on 9,743 clinical images from 61 treatment sessions across 32 patients. We evaluated classification accuracy against class labels de-rived from three experienced observers at 2/3 and 3/3 agreement thresholds. For images with unanimous consensus between observers, anatomical classification accuracy was 97.2% and probe adjustment accuracy was 94.9%. The algorithm identified optimal probe alignment within a mean (standard deviation) range of 3.7$^{\circ}$ (1.2$^{\circ}$) from angle labels with full observer consensus, comparable to the 2.8$^{\circ}$ (2.6$^{\circ}$) mean interobserver range. We propose such an algorithm could assist ra-diotherapy practitioners with limited experience of ultrasound image interpreta-tion by providing effective real-time feedback during patient set-up.Comment: Accepted to MICCAI 202

The potential for haptic touch technology to supplement human empathetic touch during radiotherapy

Radiotherapy for cancer is an effective treatment but requires precise delivery. Patients are required to remain still in the same position during procedure which may be uncomfortable. This combined with high anxiety experienced by patients, and feelings of isolation, have indicated a need for comfort interventions. Care conveyed through empathetic touch promotes comfort, individual attention and presence and provides both psychological and physical comfort at the same time. Evidence in nursing and care literature showed that empathetic touch interventions have a significant role in promoting comfort, facilitating communication between care recipients and caregivers. However, the application of empathetic touch interventions may be challenging to administer due to the safety concern in the radiotherapy environment. The emergence of haptic technologies that enable the communication of touch remotely may have a potential to fill this gap. We take inspiration from both clinical empathetic touch in radiotherapy practice, as well as affective haptic technologies to envision the opportunities for haptic technologies as a complimentary comfort intervention to supplement human empathetic touch during radiotherapy

Managing the transition to work: the role of the planning network in British town planning education

The development of town planning education in the United Kingdom can be traced back over at least sixty years and has always enjoyed a close relationship with practitioners, employers and the professional body, the Royal Town Planning Institute (RTPI). In order to ensure an intake of sufficient quality to a growing profession, the Institute offered its own exams until the 1980s and then initiated the current system of accrediting both undergraduate and postgraduate programmes of study. This system of accreditation emphasises the importance of relevant knowledge, skills and values as well as core and specialised studies. The vocational nature of town planning requires that graduates have the breadth of understanding as well as the practical skills in order to practice effectively. Thus accredited courses have over time developed strong links with employers and practitioners. Rapid developments in the scope and range of planning, and the skills needed to work in it, have reflected changes in public policy and growing number of agencies concerned with the built environment. The system of regular quinquennial visits to accredit courses has helped ensure that this acceptance of change has become part of the culture of planning schools

A systematic review of evidence about advanced roles for therapeutic radiographer

Background: Advances in technology linked to specialist techniques and growing cancer care demand a greater level of autonomy, responsibility, and accountability in the Therapeutic Radiographer (TR) clinical practice driving the subsequent development of new roles, including “advanced practice roles”. The evidence is scattered, and the concept has evolved depending on the advances in treatments and increasing workload. This study aims to identify and synthesise the advanced roles in radiotherapy describing the scope of practice of the advanced practitioners. Methods: The systematic PRISMA review of the literature was carried out with PROSPERO registration: CRD42020177103. Articles were deemed eligible for inclusion if they were peer-reviewed and focused on the advanced practice of TR. The literature was scrutinised for advanced roles, tasks, or activities practised by TR. Thematic analysis was used to organise roles into themes (dimensions). Results: A total of 443 articles were screened for relevance of which 87 studies were selected for quality appraisal. Advanced roles were listed into seven different dimensions: patient care and support; treatment planning; treatment imaging and delivery; management and leadership; quality and risk management; research and service development; and education and training. Conclusion: This review highlights the variability of both advanced radiotherapy role implementation and description of the scope of this advanced level. TR has moved beyond the traditional scope of practice with skills-mix initiatives involving the collaboration of multidisciplinary teams. In two decades of advanced practice development in radiotherapy, the roles that become established are those that meet local service needs

Patient and practitioner perspectives on the design of a simulated affective touch device to reduce procedural anxiety associated with radiotherapy: a qualitative study

Objective: The aim of this study was to elicit the views of relevant stakeholders on the design of a device using simulated affective touch to reduce procedural anxiety surrounding radiotherapy and imaging. Design: This qualitative study collected data from focus groups which were then analysed using inductive thematic analysis in line with Braun and Clarke's methods. Participants and setting: Twenty patients and carers were recruited, as well as 10 healthcare practitioners involved in either delivering radiotherapy or imaging procedures. Results: Patients, carers and healthcare practitioners agreed on some aspects of the device design, such as ensuring the device is warm and flexible in where it can be used on the body. However, patient and healthcare practitioner cohorts had at times differing viewpoints. For example, healthcare practitioners provided professional perspectives and required easy cleaning of the device. Meanwhile patients focused on anxiety-relieving factors, such as the tactile sensation of the device being either a vibration or pulsation. There was no consensus on who should control the device. Conclusions: The desired features of a simulated affective touch device have been investigated. Different priorities of patients and their carers and healthcare practitioners were evident. Any design must incorporate such features as to appease both groups. Areas where no consensus was reached could be further explored, alongside including further patient and public involvement in the form of a project advisory group

Not as simple as "fear of the unknown": A qualitative study exploring anxiety in the radiotherapy department

Objective Little is understood about the anxiety experienced by cancer patients undergoing radiotherapy or investigative imaging. Our aim was to identify sources of anxiety, the points along the cancer journey where anxiety occurred and methods to alleviate it. Methods Six focus groups were conducted with cancer patients (n = 17), caregivers (n = 3) and healthcare practitioners (HCPs; n = 10) in the radiotherapy department. Patients described specific elements in the care pathway which induced anxiety, while HCPs focused on their perception of the patient experience. Thematic analysis was used to analyse data. Results Three broad themes emerged: The Environment, The Individual and The Unknown. The physical environment of the hospital, inside the scanner for example, emerged as a key source of anxiety. The impact of cancer on patients' individual lives was significant, with many feeling isolated. The majority of participants described anxiety associated with the unknown. HCPs reported difficulty in identifying the anxious patient. Conclusions Anxiety is experienced throughout the cancer pathway. Common sources include the physical environment and the uncertainty associated with having cancer. Identifying both anxiety-inducing factors, and the anxious patients themselves, is crucial to enable targeted interventions to alleviate anxiety

Prospective Study Delivering Simultaneous Integrated High-dose Tumor Boost (≤70 Gy) With Image Guided Adaptive Radiation Therapy for Radical Treatment of Localized Muscle-Invasive Bladder Cancer

PurposeImage guided adaptive radiation therapy offers individualized solutions to improve target coverage and reduce normal tissue irradiation, allowing the opportunity to increase the radiation tumor dose and spare normal bladder tissue.Methods and MaterialsA library of 3 intensity modulated radiation therapy plans were created (small, medium, and large) from planning computed tomography (CT) scans performed at 30 and 60 minutes; treating the whole bladder to 52 Gy and the tumor to 70 Gy in 32 fractions. A “plan of the day” approach was used for treatment delivery. A post-treatment cone beam CT (CBCT) scan was acquired weekly to assess intrafraction filling and coverage.ResultsA total of 18 patients completed treatment to 70 Gy. The plan and treatment for 1 patient was to 68 Gy. Also, 1 patient's plan was to 70 Gy but the patient was treated to a total dose of 65.6 Gy because dose-limiting toxicity occurred before dose escalation. A total of 734 CBCT scans were evaluated. Small, medium, and large plans were used in 36%, 48%, and 16% of cases, respectively. The mean ± standard deviation rate of intrafraction filling at the start of treatment (ie, week 1) was 4.0 ± 4.8 mL/min (range 0.1-19.4) and at end of radiation therapy (ie, week 5 or 6) was 1.1 ± 1.6 mL/min (range 0.01-7.5; P=.002). The mean D98 (dose received by 98% volume) of the tumor boost and bladder as assessed on the post-treatment CBCT scan was 97.07% ± 2.10% (range 89.0%-104%) and 99.97% ± 2.62% (range 96.4%-112.0%). At a median follow-up period of 19 months (range 4-33), no muscle-invasive recurrences had developed. Two patients experienced late toxicity (both grade 3 cystitis) at 5.3 months (now resolved) and 18 months after radiation therapy.ConclusionsImage guided adaptive radiation therapy using intensity modulated radiation therapy to deliver a simultaneous integrated tumor boost to 70 Gy is feasible, with acceptable toxicity, and will be evaluated in a randomized trial

Quality assuring "Plan of the day" selection in a multicentre adaptive bladder trial: Implementation of a pre-accrual IGRT guidance and assessment module

Background and purpose Hypofractionated bladder RT with or without image guided adaptive planning (HYBRID) is a multicentre clinical trial investigating "Plan of the Day" (PoD) adaptive radiotherapy for bladder cancer. To ensure correct PoD selection a pre-accrual guidance and assessment module was developed as part of an image guided radiotherapy quality assurance (IGRT QA) credentialing programme. This study aimed to evaluate its feasibility and effectiveness across multiple recruiting centres.Materials and methods Individuals from participating centres remotely accessed an image database in order to complete the PoD module. An assessment score of ≥83% was required in order to receive QA approval. A questionnaire was used to gather user feedback on the module. PoD decisions for the first patient at each recruiting centre were retrospectively reviewed for protocol adherence.Results 71 radiation therapists (RTTs) from 10 centres completed the PoD module. The median assessment score was 92% (Range: 58-100%) with 79% of RTTs passing the assessment on first attempt. All questionnaire respondents reported that the PoD module prepared them for plan selection. In 51/60 of on-trial treatments reviewed, the PoD selected by the centre agreed with QA reviewers.Conclusions The PoD QA module was successfully implemented in a multicentre trial and enabled pre-accrual assessment of protocol understanding. This increased operator confidence and resulted in appropriate PoD selection on-trial