Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role.

INTRODUCTION: Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers. METHOD: A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied. RESULTS: Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: 'Current MRIgRT', 'Training' and 'Future Practice'. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers. CONCLUSION: Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge. IMPLICATIONS FOR PRACTICE: Role development and changes in education for therapeutic radiographers.

International survey; current practice in On-line adaptive radiotherapy (ART) delivered using Magnetic Resonance Image (MRI) guidance.

BACKGROUND AND PURPOSE: The uptake of new technologies has varied internationally and there have often been barriers to implementation. On-line adaptive radiotherapy (ART) promises to improve patient outcome. This survey focuses on the implementation phase of delivering ART and professional roles and responsibilities currently involved in the workflow and changes which may be expected in the future. MATERIALS AND METHODS: A 38 question survey included aspects on current practice; professional responsibilities; benefits and barriers; and decision making and responsibilities. For the purposes of the questionnaire and paper, ART was considered where tumour and /or organs at risk were contoured and re-planning was performed on-line. The questionnaire was electronically distributed via radiotherapy networks. RESULTS: Nineteen international responses were received. Europe (n = 11), United States of America (n = 4); Canada (n = 2), Australia (n = 1) and Hong Kong (n = 1). The majority of centres started using ART in either 2018 (n = 7) or 2019 (n = 6). Four centres started treating with ART between 2015 and 2017, and the first was in 2014. Centres initially treated prostate and oligometastases patients, expanding to treat prostate, oligometastases, pancreas and rectum. The majority of centres were working in conventional roles, however moving towards radiographers taking more responsibility in contouring organs at risk (OAR), target and dosimetry. The three most important criteria chosen by medical doctors to determine if ART should be used were overall gross anatomy changes of target and OAR, target not covered by planning target volume (PTV) and OAR close to the high dose area. There was no clear consensus on the minimum improvement in dose to target or reduction in dose to OAR to warrant adaption. CONCLUSION: On-line ART has been implemented successfully internationally. Initial practice maintains conventional professional roles and responsibilities, however there is trend to changing roles for the future. There is little consensus regarding the triggers of adaption.

Report on the impact of a service improvement programme in a well-established radiologically inserted gastrostomy service.

BACKGROUND: The present study aimed to evaluate whether the implementation of a service improvement programme improved the occurrence of radiologically inserted gastrostomy (RIG) tube displacements, post-insertion. METHODS: A retrospective observational study of cancer patients was conducted over a 2-year period divided into two time points. Eighty-two RIG insertions were audited retrospectively; 42 in Time 1 and 40 in Time 2. RESULTS: Some 70% (n = 57) of patients had head and neck (H&N) malignancy, 24% (n = 20) had gastrointestinal cancer and 6% (n = 5) had a variety of other malignancies. Following the implementation of the service improvement programme, the number of RIG tube displacements almost halved from nine (21%) to five (12%). CONCLUSIONS: The present study offers persuasive evidence indicating that the implemented service improvement programme improved patient care; however, further research incorporating a more robust evaluation is necessary. People with advanced disease are living longer and so there is a need to maintain good nutritional support. This innovation offers the potential to enhance patients' quality of care and minimise complications.

Working while receiving chemotherapy: a survey of patients' experiences and factors that influence these.

The purpose of this study was to estimate the number of patients who continue to work when undergoing ambulatory chemotherapy and to identify personal or treatment-related factors that influence this. Patients undergoing final cycles of adjuvant chemotherapy for breast or colorectal cancer or first-line chemotherapy for lymphoma at two cancer treatment centres were approached to take part in a cross sectional survey (n= 55, RR 55%). Sixty-four per cent (n= 35) of respondents were working when cancer was diagnosed. Fifty-four per cent (n= 19) of respondents were working when chemotherapy began but as treatment progressed only 29% (n= 10) continued to work in any capacity. The most important influencing factor when making decisions about work was the need to concentrate on looking after oneself. Overall, respondents found their employers and colleagues supportive but there was some evidence they became less supportive as treatment progressed. While this was a small study it highlights the need for health care professionals to understand patient's needs and wishes in relation to work while undergoing chemotherapy by including this issue as part of routine assessment. Strategies to allow those who wish to continue to work during treatment should be put in place early to support this.

Evaluating the antioxidant status of weanling pigs fed dietary vitamins A and E.

Two experiments evaluated the relationship of vitamin E (source and level) and vitamin A (level) on the apparent absorption and retention of both vitamins in weaned pigs. Both experiments used a combined total of 460 crossbred pigs ([Yorkshire x Landrace] x Duroc), housed in elevated 1.2- x 1.2-m crates containing five pigs per pen. Experiment 1 was a 2 x 2 x 2 factorial arrangement of treatments in a randomized complete block design conducted in seven replicates. Levels of vitamin A (2,200 or 13,200 IU/kg), vitamin E (15 or 90 IU/kg), and two vitamin E sources (D-alpha-tocopheryl acetate [D-TAc] or DL-alpha-tocopheryl acetate [DL-TAc]) were evaluated over a 35-d period. Vitamin A or E levels and the two vitamin E sources did not affect pig performances to 20 kg BW. Serum retinol and alpha-tocopherol concentrations increased (P < 0.01) as the dietary level of each vitamin increased. Serum alpha-tocopherol declined as dietary vitamin E level increased when vitamin A level increased resulting in an interaction (P < 0.05). Serum alpha-tocopherol concentrations were higher (P < 0.05) at 35-d postweaning when D-TAc was the vitamin E source. Experiment 2 was a 3 x 2 factorial arrangement of treatments conducted in six replicates. Three levels of vitamin A (2,200, 13,200, or 26,400 IU/ kg) and two sources of vitamin E (D-TAc or DL-TAc) each provided at 40 IU/kg diet were evaluated over a 35-d period. Pig performances to 35-d postweaning were not affected by the dietary variables. Serum alpha-tocopherol (P < 0.01) and retinol (P < 0.05) concentrations increased as their respective vitamin level increased. Serum (P < 0.05) and liver (P < 0.01) alpha-tocopherol concentrations both declined as dietary vitamin A levels increased resulting in interaction responses. Serum alpha-tocopherol concentration was higher (P < 0.05) at 35-d postweaning when d-TAc was the vitamin E source. Dietary vitamin E sources had no effect on serum or liver retinol concentrations. These results demonstrated that both supplemental vitamin A and vitamin E increased in the blood as their dietary levels increased. However, as dietary vitamin A level increased, serum and liver alpha-tocopherol concentrations declined, suggesting a reduced absorption and retention of alpha-tocopherol when weaned pigs were fed high dietary vitamin A levels.