Mammographic compression practices of force- and pressure-standardisation protocol: A scoping review.

INTRODUCTION: As an efficient, effective and moderately inexpensive modality, mammography has been implemented as a cancer screening tool and in diagnostic management. However, appropriate breast compression is necessary for optimal outcomes. Current key measures of compression force are subjective and variable, giving rise to the concept of a 'personalised' pressure-standardisation protocol. METHODS: A scoping review of the literature was performed using the Arksey and O'Malley framework to explore the existing force- and pressure-standardisation protocols in clinical application. A comprehensive search strategy and standardised study selection and evaluation were completed. This synthesis of existing knowledge can lead to the implementation of mechanically standardised mammographic compression pressure as a feasible tailored approach to clinical practice. Four databases (PubMed, MEDLINE, Embase and Scopus) were searched from the databases' inception to 13 December 2019 for relevant information, and eighteen articles were selected for analysis. RESULTS: In addition to current protocol comparison, emerging key concepts include the reasoning behind standardisation, the benefits of improved diagnostic outcomes/decreased pain with negligible change in image quality and average glandular dose (AGD), and the recommendation of a 10kPa (approximate) pressure-standardisation protocol. Research to date is largely based abroad (Netherlands), with a strong focus on screening practices. Consequently, several gaps in the current literature were identified as potential directions for future investigation. CONCLUSIONS: As a suggested mammographic guideline, compression pressures of approximately 10kPa aid in image acquisition reproducibility both within and between women; pain levels decrease, with minimal variations to breast thickness, AGD and image quality.

Are further studies needed to justify the use of proton therapy for paediatric cancers of the central nervous system? A review of current evidence.

Clinical implementation of proton therapy demonstrated its potential to overcome some limitations of the more traditional, photon-based radiotherapy, due to physical and radiobiological advantages of protons. However, questions concerning the long-term effects of protons on paediatric patients need outcome analysis of the reported literature in order to be answered. The current paper has analysed the available clinical trials and comparative studies (protons vs photons) for paediatric cancers of the central nervous system (CNS) analysing the reported outcomes and follow-up times in order to evaluate the safety of proton therapy for this patient group. Based on the literature analysis, proton therapy for treatment of paediatric cancers of the CNS was found to provide survival and tumour control outcomes comparable, and frequently superior, to photon therapy. Furthermore, the use of protons was shown to decrease the incidence of severe acute and late toxicities, including reduced severity of endocrine, neurological, IQ and QoL deficits. Most commonly, the reported median follow-up time was up to 5 years. Only a few studies reported promising, longer follow-up results. Considering that these patients are likely to survive many of the malignancies reported on, the incidence of long term sequellae impacting growth, development and quality of life into adulthood, should be viewed longitudinally for completeness. The evidence surrounding proton therapy in paediatric tumour management supports its effectiveness and potential benefits in reducing the incidence of late-onset toxicities and second malignancies. For stronger evidence, it is highly desired for future studies to improve current reporting by (1) highlighting the paediatric patient cohort's outcome (in mixed patient groups), (2) reporting the follow-up time, (3) clearly indicating the toxicity criteria used in their evaluation, and (4) identifying the risk group. With this suggested clarity of future reporting, meaningful data to support treatment choice may then be available.

Current status of proton therapy outcome for paediatric cancers of the central nervous system - Analysis of the published literature.

INTRODUCTION: The most common solid tumours that develop in children are cancers of the central nervous system. Due to the increased rate of survival over the past decades, greater focus has been placed on the minimisation of long term side effects. In childhood cancer survivors, over 60% report one or more radiation-related late toxicities while half of these adverse events are graded as life-threatening or severe. Proton therapy enables high conformity with the planning target volume and a reduction in dose to areas beyond the target. Owing to the unique nature of dose delivery with proton therapy a reduction of low doses to normal tissues is achievable, and is believed to allow for a decrease in long-term treatment-related side effects. This paper aims to review the published literature around the effectiveness of proton therapy for the treatment of paediatric cancers of the central nervous system, with a focus on treatment outcomes and treatment-related toxicities. METHODS: A search strategy utilising the Medline database was created with the intent of including all articles reporting on proton therapy, paediatric cancers, CNS tumours and treatment outcomes. The final search strategy included the following limitations: limited to humans, English, published from 2000 onwards. The final article count total was 74. RESULTS AND CONCLUSIONS: Proton therapy for the treatment of paediatric cancers of the central nervous system was found to provide survival and tumour control outcomes comparable to photon therapy. Reduced incidence of severe acute and late toxicities was also reported with the use of proton therapy. This includes reduced severity of endocrine, neurological, IQ and QoL deficits. Currently, extensive follow-up of proton patient populations still needs to be made to determine incidences of late-onset toxicities and secondary malignancies. Current evidence surrounding proton therapy use in paediatric patients supports its effectiveness and potential benefits in reducing the incidence of severe toxicities in later life.

Radiation therapy staffing model 2014.

INTRODUCTION: In 2001, the Radiation Therapy Advisory Panel (RTAP) of the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) (formerly known as Australian Institute of Radiography) published a model for radiation therapist staffing in Australian radiation oncology departments. Between 2012-2013, the model was reviewed to ensure it reflected current radiation therapy practice, technology, and to facilitate forward planning of the radiation therapy workforce. METHOD: Twenty-four sites from all states participated and provided data on megavoltage simulation, planning and treatment delivery. For simulation and planning activity, the length of time to complete was collected against relevant Medicare Benefits Schedule (MBS) items. For treatment delivery, time to complete activities was collected against a common set of activities. Modelling assumptions are clearly identified in the methodology. RESULTS: A new model was developed retaining the essential model parameter of full-time equivalent (FTE) radiation therapists (RTs) per linear accelerator operating hour as in the 2001 model but based on contemporary practice and data. The model also includes significant refinements that improve the model's overall utility and flexibility for both workforce planning purposes and for individual services to use the model according to their own organisational needs and service delivery profiles. CONCLUSION: The ASMIRT believes that the 2014 RT staffing model provides the utility and flexibility for radiation oncology services to best plan RT staffing establishments according to their needs and reflecting the diversity between services and within the sector. It should also provide a robust and valid basis for governments and service planners to use as a guide in workforce planning into the future.