Use of IV contrast media in radiotherapy planning CT scans: A UK audit

Aim: This article reports on a UK survey of radiotherapy centres. The primary aim was to define the extent and range of practice for which intravenous (IV) contrast is used within radiotherapy planning (RTP) Computerised Tomography (CT) scans, including how well centres adhere to RCR guidelines (2004, 2010). The secondary aim was to identify whether current guidelines are adequate or should be redefined to reflect new evidence based practice. Materials and method: A UK wide survey was undertaken, questionnaires were sent electronically via survey monkey to all 80 UK cancer centres obtained from the Society and College of Radiographers (SCoR) website. Questionnaires included closed, open and Likert Scale questions to allow complete analysis of protocols and opinions relating to IV contrast use and implementation. Data was collected within a four-week period during October 2014. Results: Eighty three percent of centres responded, 98% of responding centres now routinely deliver IV contrast. However, only 6% of centres deliver IV contrast to all 8 of the RCR 2004 recommended tumour sites. RCR 2010 compliance was also poor with the most common response to method of eGFR calculation stated as unknown. Fifteen percent of centres also did not have extravasation policies. Conclusion: The results suggest that it is perhaps time to reconsider a revision to the existing guidelines based on new evidence regarding good practice. There are many areas such as flow rates, timings, dosimetric corrections and advanced techniques which require further research to enable standardised guidelines to be identified. Keywords: Radiotherapy, IV contrast, Pre-treatment, Plannin

Assessment of deep inspiration breath hold (DIBH) amplitude and reduction in cardiac dose in left breast cancer patients

Introduction The primary aim of this study was to examine the impact of deep inspiration breath-hold (DIBH) amplitude on subsequent mean heart dose and V30 during radiotherapy. The secondary aim was to investigate if patient age influenced DIBH amplitude. Method A retrospective study of 30 patients with left-sided breast cancer was completed. Patient were randomly selected from the total number of patients dual scanned in free breathing (FB) and DIBH over a 2-year period. Plans were retrospectively virtually simulated and statistical analysis performed. Results All patients achieved decreased V30 and mean cardiac dose using DIBH. A positive correlation was found between DIBH amplitude and cardiac V30 dose reduction (p=0.007, R=0.48). Ratio of amplitude increase from FB to DIBH and cardiac V30 reduction was positively correlated and statistically significant (p=0.04, R=0.38); Ratio of amplitude increase of at least 15 times FB achieved 100% V30 dose reduction, however this was also achieved with ratio increase as low as 6.25 times FB. A statistically significant positive correlation was identified between DIBH amplitude and mean cardiac dose reduction (p=0.003, R=0.523). No correlation was found between patient age and amplitude ratio increase (p=0.602, R=-0.099) Conclusion A 100% reduction in cardiac V30 can be achieved with a DIBH amplitude increase of 15 times FB. A full reduction can also be achieved at much lower levels (6.25 times FB in current study); however there appears to be no pre-determining patient factors to identify this. DIBH amplitudes of 1cm-4cm reduce cardiac mean dose by at least 50%

Does the intervention of mindfulness reduce levels of burnout and compassion fatigue and increase resilience in pre-registration students? A pilot study

Introduction: In the current clinical working environment it is important that therapeutic radiography students are fully prepared not just clinically but emotionally for a working professional life. Mindfulness has shown promise, as a self-care strategy, in the improvement of burnout, resilience and compassion fatigue in other professions; however, it has not been used with therapeutic radiography students. Methods: Eight pre-registration therapeutic radiography students were recruited to undergo a five week mindfulness course; six students from the year below were recruited to act as a control arm (no mindfulness). Data was collected using a series of validated tools at baseline, week five, month three and 12 months after the start of the study: 1. The five-facet mindfulness short form questionnaire (FFMQ-SF)1 2. Maslach Burnout Inventory Student Survey (MBI-SS)2 3. Professional Quality of Life (ProQOL) 5 questionnaire3 4. Connor Davidson Resilience-short form scale (CD-RISC)4 Results: The MBI-SS scale demonstrated 29% of the sample experienced emotional exhaustion and 43% increased cynicism. The other tools showed a positive trend with the intervention; however, these were not statistically significant. Conclusion: Although no statistically significant differences were demonstrated between the study arms, some interesting trends have been noted. The key finding was the identification of burnout experienced by almost a third of the study sample. This suggests that a new area of study is warranted to further investigate the factors contributing to burnout in the student population