ePosters

Systematic review of selective radiological procedures of injured patients compared to immediate full body computed tomography

Elio Arruzza, ¹ Shayne Chau, ¹ Janine Dizon ¹

¹University of South Australia, Adelaide, Australia

Objective: Trauma is a leading cause of mortality globally.¹ The high diagnostic accuracy of computed tomography (CT) compared to other modalities makes it an attractive imaging tool for initial trauma imaging, despite its high radiation dose.² This review assessed the value of immediate full‐body CT as part of the primary survey, in comparison to selective conventional radiological procedures in terms of mortality rate, emergency department/hospital/intensive care unit length of stay, duration of mechanical ventilation, and incidence of multiple organ dysfunction syndrome/multiple organ failure.

Methods: A search strategy was developed using the keywords: computed tomography OR CT AND X‐ray OR other imaging modalities AND trauma. Keywords were applied in the following electronic databases: Scopus, Cochrane and PUBMED. Reference list of included studies were searched for additional references. Studies were limited to diagnostic studies, English and from 1947 to present. Assessment of study quality was conducted using CASP for Diagnostic Studies. Data was analysed using statistical pooling. The review protocol was registered in PROSPERO.

Results: A total of 1570 titles and abstracts through literature search were obtained and after screening for abstracts, 1546 duplicates and non‐relevant studies were excluded. The remaining 24 studies were fully read. Final results are pending but will be available at time of presentation.

Conclusion: Preliminary data suggests that full‐body CT demonstrates a decrease in mortality and emergency department length of stay. Findings on other outcomes will be discussed at the presentation. Further randomised controlled studies are warranted to investigate the viability of full‐body CT for trauma patients.

References

1. World Health Organization. Injuries and violence: the facts. 1st edn. Geneva: WHO; 2014.

2. Sierink J, Saltzherr T, Reitsma J, et al. Systematic review and meta‐analysis of immediate total‐body computed tomography compared with selective radiological imaging of injured patients. Br J Surg 2011;99(S1):52‐58.

Paediatric trauma C‐spine: MRI as a one stop modality?

Jeff Chen ¹

¹Monash Health, Monash Children's Hospital, Clayton, Australia

Background: Spinal injuries are rarer in children than adults, accounting for 1–10% of all reported spinal injuries.¹ Spinal fractures are more commonly observed in older children, while ligamentous injury is more frequent in the under 10 years age group.² While computed tomography (CT) has been considered superior to conventional magnetic resonance imaging (MRI) in the detection of fracture, in younger children, CT has been found less reliable in the assessment of cervical spine injury.^1,3,4 The application of the 3T MRI Enhanced T1 High‐Resolution Isotropic Volume Excitation (eTHRIVE) sequence has enabled the detection of pathologies such as rotatory subluxation and fractures can largely replace CT and reduce patient radiation exposure.

Method: Modified 3D T1 fat‐suppressed weighted gradient echo sequence was acquired in sagittal plane using Philips 3T Ingenia MRI. The MPR and isovolumetric images were generated in axial and coronal planes with 0.5 mm thickness.

Result: This sequence provides isotropic resolution in three dimensions with a short acquisition time, ideal for the paediatric population. Inversion of image greyscale simulates CT style appearance,⁵ demonstrating successful detection of paediatric rare cervical spine fractures or ligamentous injuries in the trauma setting of two patients studied.

Conclusion: 3T MRI with isotropic 3D T1 eTHRIVE was shown to be accurate with excellent detection of cervical spine fractures and characterisation of traumatic injuries. This technique has the potential to replace CT imaging resulting in a significant reduction in ionising radiation. Thus, MRI using eTHRIVE could provide a one‐stop‐shop for imaging of paediatric cervical spine trauma.

References

1. Viswanathan V, Gopinathan N, Crawford A. Cervical spine evaluation in pediatric trauma: a review and an update of current concepts. Indian J Orthop 2018;52(5):489.

2. Hale A, Alvarado A, Bey A, et al. X‐ray vs. CT in identifying significant C‐spine injuries in the pediatric population. Childs Nerv Syst 2017;33(11):1977‐83.

3. Hutchings L, Atijosan O, Burgess C, Willett K. Developing a spinal clearance protocol for unconscious pediatric trauma patients? J Trauma 2009;67(4):681‐86.

4. Booth TN. Cervical spine evaluation in pediatric trauma. AJR Am J Roentgenol 2012;198:W417‐25.

5. Ang E, Robertson A, Malara F, et al. Diagnostic accuracy of 3‐T magnetic resonance imaging with 3D T1 VIBE versus computer tomography in pars stress fracture of the lumbar spine. Skeletal Radiology 2016;45(11):1533‐40.

Escaping to fantasy land: using leading‐edge technology to distract children during medical procedures

Jeff Chen ¹

¹Monash Health, Monash Children's Hospital, Clayton, Australia

Background: Paediatric magnetic resonance imaging (MRI) is becoming less stressful for children as more dedicated paediatric facilities are using a child‐friendly environment, child life therapy (i.e. play therapy, role‐playing) and new technologies to reduce anxiety.^1,2 However, intravenous (IV) cannulation post‐contrast studies remains a significant challenge and often reduces cooperation where general anaesthesia is required. Virtual reality (VR) is now being utilised in some centres to manage patients with pain, disability, anxiety and depression.^2–4 This inspired the MRI department to trial VR, together with child life therapy and Phillips Healthcare’s ambient (visual and auditory) experience to test the suitability and efficacy in paediatric imaging procedures.

Methods: Patients attended the MRI department prior to the scheduled scan to meet the play therapist and engage with the kitten MRI. If successful, patients then transitioned to the mock MRI with VR goggles. Following this, the recommendation was either VR or general anaesthesia for their imaging study. Parental consent was obtained.

Results: Over a 6‐month period, 38 children (28 male, 10 female) aged 4–14 years had IV cannulation using VR. The success rate for cannulation was 100% and all 38 children (100%) in the trial reported they would be happy using VR again. In combination with topical analgesia, we also identified VR significantly reduced subjective pain children experienced during the insertion of an IV cannula, with an average pain score of two out of 10.^5,6

Conclusion: The innovative combination of VR/child life therapy/ambient experience has proven to be successful in improving the child’s healthcare experience.

References

1. Hallowell LM, Stewart SE, de Amorim e Silva CT, Ditchfield MR. Reviewing the process of preparing children for MRI. Pediatr Radiol 2007;38:271‐279.

2. Cahoon GD, Kean MJ, Seal M. Developing a protocol for virtual reality preparation of children undergoing magnetic resonance imaging. 26th Annual Meeting of the Society for Magnetic Resonance Technologists (SMRT). Honolulu USA; 2017.

3. Liszio S, Masuch M. Virtual reality MRI. Proceedings of the 2017 Conference on Interaction Design and Children ‐ IDC '17.

4. McBeth R, Dooley P. Virtual reality helps children cope with MRI scans – Health Informatics New Zealand. Available at https://www.hinz.org.nz/news/390808/Virtual‐reality‐helps‐children‐cope‐with‐MRI‐scans.htm [Accessed 14 October 2018].

5. Cummings EA, Reid GJ, Finley GA, et al. Prevalence and source of pain in pediatric inpatients. Pain 1996;68:25‐21.

6. Wainstein J, Chimin G, Landau Z, et al. The use of a CoolSense device to lower pain sensation during finger pricking while measuring blood glucose in diabetes patients–a randomized placebo. Diabetes Technol Ther 2013;15(8):688‐94.

Research interest, confidence and experience in diagnostic imaging is similar to other allied health disciplines

Amy Dennett, ¹ Travis Cauchi, ¹ Paul Kelly, ¹ Georgina Ashby ¹

¹Eastern Health, Box Hill, Australia

Objective: In 2019, a large metropolitan health service implemented an allied health research and translation fellow to enhance the research culture and opportunities for allied health professionals working in diagnostic imaging. We aimed to measure self‐reported research participation, interest and experience of current allied health professionals working in diagnostic imaging and compare the findings to a similar survey conducted in 2015 with clinicians working in allied health therapies.

Methods: A cross sectional survey was conducted with ethics approval. The primary outcome measure, the Research Spider survey, measures 10 domains of research interest/experience on a 5‐point Likert scale. The levels of research interest and experience were described using medians and inter‐quartile ranges (IQR), and results compared to 2015 data.

Results: 85 responses were received by clinicians working in diagnostic imaging (39% response rate). Overall, clinicians in diagnostic imaging rated themselves as having ‘some interest’ and ‘little experience’ in research. There was no difference between interest and experience among different imaging professions (interest P = 0.277, experience P = 0.0305) or other allied health therapy professionals (interest P = 0.137, experience P = 0.331). Participants reported greatest interest in finding and reviewing literature and lowest interest in applying for funding. Participants expressed desire for practical opportunities such as participating in workshops.

Conclusion: Clinicians working in diagnostic imaging express interest but currently have a lack of opportunities to participate in research. Given the similarities between diagnostic imaging and other allied health therapies, strategies used to promote research culture in allied health therapy could be leveraged to provide opportunities for diagnostic imaging.

Eyes too big for your belly – reducing fasting times for CT

Edel Doyle ¹

¹RMIT University, Bundoora, Australia

Reducing the fasting time for computed tomography (CT) to 1 hour is easier for out‐patients and reduces the delay for in‐patients, leading to improved experience for all patients, as well as improved throughput in busy CT departments.

Patients are routinely requested to fast for 4–6 hours (no food or fluids) prior to their CT scan,¹ except for diabetics or patients from the emergency department who are usually not required to fast. There appears to be no rationale for these varying timeframes. Historically, it was related to the higher incidence of vomiting associated with the use of high‐osmolar ionic intravenous (IV) contrast agents.²

Patients were historically requested to fast in CT so that if they vomit (known side effect of administering IV contrast), they are less likely to aspirate if their stomach is empty. It has been suggested that many patients, especially in‐patients, fast for longer than is necessary.³ Research has shown that oncology out‐patients who did not fast prior to CT correlate with an improved patient experience, reducing discomfort and inconvenience.¹

References

1. Barbosa PNVP, Bitencourt AGV, Tyng CJ, et al. Preparative fasting for contrast‐enhanced CT in a cancer center: a new approach. AJR Am J Roentgenol 2018;210(5):941‐47.

2. Lee BY, Ok JJ, Abdelaziz Elsayed AA, Kim Y, Han DH. Preparative fasting for contrast‐enhanced CT: reconsideration. Radiology 2012;263(2):444‐50.

3. Sorita A, Thongprayoon C, Ahmed A, et al. Frequency and appropriateness of fasting orders in the hospital. Mayo Clinic Proceedings 2015;90(9):1225‐32.

Seeing the truth about dose: how to establish FRLs for X‐rays

Edel Doyle, ^1,2 Lili Hoskins, ² Wale Onifade, ² Alan Sturm ²

¹RMIT University, Bundoora, Australia, ²Royal Darwin & Palmerston Hospitals, Tiwi, Australia

Background: Since 1996, the International Commission on Radiological Protection (ICRP) has recommended the use of diagnostic reference levels (DRLs). The ICRP has described it as ‘a form of investigation level used as a tool to aid optimisation of protection in the medical exposure of patients for diagnostic and interventional procedures’.¹ Used in conjunction with justification, DRLs can assist in keeping patient radiation exposure as low as reasonably achievable (ALARA).²

Methods: kV, mAs, clinical EXI, DI and dose area product (DAP) was recorded for 20 patients from each general X‐ray room for postero‐anterior (PA) chest X‐ray (CXR), left lateral (L.Lat) CXR and antero‐posterior (AP) CXR. The median DAP was calculated for each projection in each X‐ray room across both hospitals.³ The facility reference levels (FRL) were then compared to published international DRLs.

Results: The FRL for a PA CXR was calculated as 12 μGy.m² with differences noted between vendors. The FRL for the L.Lat CXR was 38 μGy.m² and 8 μGy.m² for an AP CXR.

Conclusion: This project provided a baseline measurement of FRLs for CXR projections which facilitated the quality improvement team in optimising radiation doses between the X‐ray rooms. It also provides data for the medical imaging department to know what the radiation dose for a CXR is locally when providing information to patients and referrers. This also prompted discussion with the radiation safety officer and further investigations were performed.

References

1. International Commission on Radiological Protection. Diagnostic reference levels in medical imaging. ICRP Publication 2017; 135. Ann. ICRP 46(1).

2. Seeram E, Brennan PC. Radiation protection in diagnostic X‐ray imaging. Jones & Bartlett Learning, 2017.

3. Australian Government. Australian Radiation Protection and Nuclear Safety Agency. National Diagnostic Reference Level Service. Available at https://www.arpansa.gov.au/research‐and‐expertise/surveys/national‐diagnostic‐reference‐level‐service/in‐more‐detail [Accessed 26 November 2019].

Using optical coherence tomography for an innovative multimodal imaging approach to diagnose vision complaints

Amanda Edgar, ¹ Craig Woods, ¹ Jayson Ward ²

¹Deakin University, Geelong, Australia ²Warrnambool Eyecare, Warrnambool, Australia

Introduction: Papilloedema is an ocular emergency. It is secondary to a number of sinister conditions that require timely interventions in order to prevent mortality. For healthcare practitioners, papilloedema is a complicated clinical diagnosis due to these sinister causes and need to exclude the benign, such as pseudopapilloedema.^1,2 Often magnetic resonance imaging (MRI) is a critical step in confirming a diagnosis and cause of papilloedema. Using this imaging technique alone is challenging due to the small size of the optic nerve head.³

Case Presentation: With informed consent, an innovative application of multimodal imaging to diagnose papilloedema and its cause is presented for a patient who attended with acute decreased vision and severe migraine. Optical coherence tomography (OCT) imaging of the optic nerve head and maculae provided confirmatory images of the severe oedema of the optic nerve head with subretinal oedema. MRI diffusion and susceptibility weighted imaging and post‐contrast venogram identified a partial dural venous thrombosis.

Management and Outcome: A homogenous dural‐based enhanced lesion suspicious of a dural metastasis was diagnosed. The patient was prescribed 20 Gy cranial radiotherapy to the whole brain in five fractions resulting in regression of the visual symptoms.

Discussion: OCT is a fast and non‐invasive method to diagnose papilloedema.⁴ This case demonstrates how to perform careful OCT image interpretation to quantify and visualise oedema that could indicate the potential deadly causes of papilloedema. OCT can be used as a part of a multimodal imaging approach to supplement the diagnose of papilloedema and justify the need for further investigative MRI.

References

1. Carta A, Favilla S, Prato M, et al. Accuracy of funduscopy to identify true edema versus pseudoedema of the optic disc. Invest Ophthalmol Vis Sci 2012;53(1):1‐6.

2. Trick GL, Bhatt SS, Dahl D, et al. Optic disc topography in pseudopapilledema: a comparison to pseudotumor cerebri. J Neuro‐ophthalmol 2001;21(4):240‐44.

3. Gass A, Barker GJ, Riordan‐Eva P, et al. MRI of the optic nerve in benign intracranial hypertension. Neuroradiology 1996;38:769‐73.

4. Menke MN, Feke GT, Trempe CL. OCT measurements in patients with optic disc edema. Invest Ophthalmol Vis Sci 2005;46(10):3807‐11.

Radiation therapy student reflections on communication skills training following their first clinical placement

Toni Kelly, ^1,2 Yolanda Surjan, ² Marianne Rinks, ¹ Helen Warren‐Forward ²

¹Illawarra Cancer Care Centre, Illawarra Shoalhaven Cancer and Haematology Network, Wollongong, Australia ²The University of Newcastle, Newcastle, Australia

Objectives: The University of Newcastle radiation therapy degree includes a clinical reasoning module that provides students the opportunity to learn about and engage with different communication skills prior to attending their first clinical placement. This study aimed to investigate students’ post‐clinical perceptions on how well the module prepared them for interacting with patients and radiation therapists (RTs).

Methods: Data was collected via an online survey comprising 48 closed and open‐response questions assessing confidence, thoughts on how the module assisted in their preparation for clinical and on perceptions on their interpersonal skills with patients and fellow RTs. Survey data were analysed quantitatively (counts and weighted sum average (WSA) of Likert scales) and qualitatively using thematic analysis.

Results: Participants rated the module as helpful (WSA 2.25/4) which was evidenced through increasing confidence levels when measured over three timepoints (before module, after module and after clinical) in their ability to communicate with patients (WSA scores 1.13, 2.88 and 3.38) and RTs (WSA scores 1.0, 2.13 and 3.25). Participants were more confident in discussing general issues (WSA 3.63) than treatment related issues (WSA 2.5) with patients. Direct feedback from clinical RTs provided positive reinforcement and further development of their interpersonal communication skills.

Discussion/Conclusion: The clinical reasoning module successfully improved students’ confidence and provided communication skill preparation strategies for clinical interactions both with patients and RTs. Student reflections of both module and clinical experiences provided a user perspective as well as a mechanism for improvement and vision for future university curriculum‐based clinical preparation.

A comparison of physical and non‐physical grids on radiation dose and diagnostic image quality

Russell Chan Han Wei, ¹ Nur Farah Amirah Mohamed Salleh, ¹ Mei Choo Chong ¹

¹Changi General Hospital, Singapore

Introduction: Non‐physical grids are relatively new software advancement within the medical imaging field. This development, which utilises digital anti‐scatter correction software, allows for the elimination of physical grids among diagnostic radiographers. This therefore enables the minimisation of exposure factors required for any given examination that traditionally requires a physical grid.^1,2

Objective: This paper aims to compare the radiation dose and diagnostic image quality attained from both physical and non‐physical grids.

Methods: Quantitative and qualitative studies were conducted in a restructured hospital in Singapore using two different X‐ray systems from Fujifilm and Philips. Each system has its own image acquisition detector, a physical grid and a non‐physical grid. The systems were tested on a phantom mimicking an average‐sized human abdomen. First, the quantitative study was executed to demonstrate the changes to radiation dose acquired to the phantom. Second, a qualitative study was done to gather information from reporting radiologists regarding image quality.

Results: It was demonstrated that the diagnostic image qualities of abdomen X‐rays attained using non‐physical grid software are superior (or at least, similar) to those attained via physical grids, even when radiation dose accrued to the phantom is significantly reduced by approximately 49.2%.

Conclusion: Because radiographers abide by the ALARA principle to attain diagnostically acceptable images for reporting radiologists to review, this paper shows that non‐physical grid software are promising substitutes for traditional physical grids – not only for the abdomen region for future patients, but also for other regions that would typically require a physical grid.

References

1. Ahn S, Chae K, Goo J. The Potential role of grid‐like software in bedside chest radiography in improving image quality and dose reduction: an observer preference study. Korean J Radiol 2018;19(3):526.

2. Lisson C, Lisson C, Kleiner S, Regier M, Beer M, Schmidt S. Iterative scatter correction for grid‐less skeletal radiography allows improved image quality equal to an antiscatter grid in adjunct with dose reduction: a visual grading study of 20 body donors. Acta Radiologica 2018;60(6):735‐41.

Assessing pain response in participants receiving image guided analgaesia injection

Giovanni Mandarano, ¹ Paul Smith ²

¹Deakin University, Geelong, Australia ²Epworth Medical Imaging, Geelong, Australia

Background: This ethics approved research investigated if the routine one‐week period from when patients receive image guided analgaesia injection and then return to their referrer, was appropriate.

Objectives: To identify the time‐point that pain subsides, following routine image guided analgaesia injection in the subacromial bursa, cervical spine nerve root and lumbar spine nerve root.

Method: A single centre prospective cohort study allowed consenting participants to be surveyed, using the Wong‐Baker FACES^® Pain Rating Scale, to identify the time‐point which pain was alleviated. Pain levels were recorded at four key time‐points: time‐point 1, immediately prior to analgaesia injection; time‐point 2, immediately afterwards; time‐point 3, three days post‐procedure and time‐point 4, seven days post‐procedure.

Results: Subacromial bursa pain participants (N = 67) experienced immediate pain relief (P < 0.0001), with a further statistically significant (P = 0.0091) pain reduction at time‐point 3 which lasted until time‐point 4. Cervical spine nerve root participants (N = 43) experienced immediate pain relief (P < 0.0001) and this was maintained until time‐point 4. Lumbar nerve root pain participants (N = 93) also experienced significant pain reduction (P < 0.0001) immediately, however, pain levels increased at time‐point 3 and this was maintained to time‐point 4.

Discussion/Conclusion: This study provides data to support recommending when participants can return to their referrer to re‐evaluate their ongoing management. Participants receiving analgaesia for subacromial bursa or lumbar nerve root pain can return to their referrer after day three, whereas those receiving analgaesia for cervical nerve root pain can return immediately.

To determine an imaging regimen for VMAT SRS: are we going overboard with image guidance?

Vanathy Manivasahan, ¹ Henry Ho, ¹ Rachel Beldham‐Colins, ¹ Catherine Owen, ¹ Cherry Augustin, ¹ Najmun Nahar ¹

¹Western Sydney Local Health District, Sydney, Australia

Aim: The aim of this study is to determine the need for image guidance between arcs for linac based stereotactic radiosurgery (SRS) patients using the VMAT technique with flattening filter free beam (FFF).

Methods: A retrospective study was conducted on 15 SRS patients treated using the co‐planar VMAT technique. The departmental guideline for SRS imaging consists of four‐step CBCT: pre‐CBCT, verification CBCT, mid‐CBCT and post‐CBCT with bony match. If the mid image requires a move based on predefined tolerance, then a verification CBCT is to be performed. Each patient had four CBCTs with varying fractionation and in total 50 CBCT images were analysed to determine the intrafraction movement. The data analysed was compared with the predefined tolerance to determine whether a mid‐CBCT is required for treatment.

Results: The average translational error of 0.3 mm +/‐ 0.2 mm in craniocaudal direction, 0.1 mm +/‐ 0.2 mm in lateral and anteroposterior directions were recorded. A 0.3 +/‐ 0.1 degrees in rotation, pitch and roll were recorded. In some patients, these changes were only noted in the post‐treatment CBCT.

Conclusion: The data analysed indicates that there is minimal intrafraction motion. Factors such as predefined image tolerance, time taken to obtain and analyse the mid treatment image, the quick treatment delivery using FFF, the margins used for planning and imaging dose were all taken into consideration in decision making. As a result, the imaging policy was changed to pre‐ and verification CBCT only for linac based VMAT SRS treatment.

Using online technology to raise awareness of values and ethics in radiography, student perspectives

John McInerney ¹

¹Monash University, Royal Melbourne Hospital, Melbourne, Australia

Introduction: Ethics and values are increasingly significant aspects of patient‐centred healthcare. While it is widely agreed that ethics and values are essential for healthcare delivery, there is also an acknowledgement that these are areas that are challenging to teach.^1,2 The purpose of this study is to report a small‐scale evaluative research project of a web‐based technology with the educational potential to facilitate learning in relation to ethics, values, self‐reflection and peer‐based learning.

Methods: Five radiography students took part in a semi‐structured focus group with the aim of exploring their experiences of using Values Exchange, an online ethical decision‐making framework, to examine practice‐based ethical issues. Transcripts were interrogated for key themes.

Results: From the thematic analysis three major themes emerged, understanding and appreciating others, addressing the theory‐practice gap and delivering a safe and effective learning environment. Perceived limitations of the platform included students’ fear of misinterpreted responses and possibility of poor group dynamics.

Conclusion: There are varied approaches to how ethics and values are taught and assessed within health‐related environments. Values Exchange is one such teaching tool and has been investigated and described positively by radiography students in this study. Online teaching tools can have a positive effect in helping students identify their own values but require skilled implementation to reap positive rewards.

References

1. Godbold R, Lees A. Ethics education for health professionals: a values based approach. Nurse Educ Pract 2013;13(6):553‐60.

2. Seedhouse D. Ethics: the heart of health care. 3rd edn. Wiley: UK, 2009.

Colouring outside the lines: a visionary digital teaching tool for students

Karly‐rose Mclaren, ¹ John Ryan, ¹ Cathy Jager, ¹ Mary‐Ann Carmichael ¹

¹RMIT University, Bundoora, Australia

The expertise required to practice as a radiation therapist (RT) is evolving.¹ RTs are responsible for contouring organs at risk and soft‐tissue image matching.^1,2 Reducing interobserver and intraobserver variability in soft tissue delineation between students and qualified RTs is a key concern for educators in the university setting.^2,4 Appropriate education is a necessity for reducing this variability. The implementation of a cloud‐based software (Proknow™) as a teaching tool in March 2019 for university students has been a successful intervention from the informal and formal feedback received from students. Initial observations by the academic staff has seen an improvement in student planning submissions.

(Proknow™) is a novel cloud‐based software application founded in 2016 that specialises in empowering professionals to improve contouring accuracy and analyse plan metrics for radiation therapy planning.³ By providing visual and timely feedback to students this software aims to improve the quality of the professionals produced by the university.

This presentation will examine the pathway of implementation of new software in the teaching environment and look at the different directions this visionary tool may direct us towards in the future. This is the first time this software has been used by a university in Australia and a structured ethics approved evaluation is underway and the initial qualitative findings will be presented.

References

1. Coffey M, Leech M, Poortmans P. Special commentary benchmarking radiation therapist (RTT) education for safe practice: The time is now. 2016. Available at http://dx.doi.org/10.1016/j.radonc.2016.03.008 [Accessed 26 October 2019].

2. Bell LJ. Increasing consistency and accuracy in radiation therapy via educational interventions is not just limited to radiation oncologists. J Med Radiat Sci 2016;63(3):145‐47.

3. Elekta AB. ProKnow | Radiation Oncology Plan Studies, Contouring & Analytics. Available at https://proknowsystems.com/ [Accessed 26 October 2019].

4. Breunig J, Hernandez S, Lin J, et al. A system for continual quality improvement of normal tissue delineation for radiation therapy treatment planning. Int J Radiat Oncol Biol Phys 2012;83(5).

Improving our vision of the radiation dose contributors during uterine artery embolisation: a review article

Don Nocum, ¹ Warren Reed, ² John Robinson, ² Eisen Liang, ¹ Nadine Thompson ¹

¹Sydney Adventist Hospital, Wahroonga, Australia ²University of Sydney, Lidcombe, Australia

Background: Uterine artery embolisation (UAE) is an interventional angiography procedure for the treatment of symptomatic fibroids and/or adenomyosis in women.^1,2 Although UAE is a less invasive procedure,³ ionising radiation is used to visualise and access the uterine arteries for embolisation and treatment.

Aim: The purpose of this review was to examine the literature on radiation exposure measurements and identify the factors contributing to the total radiation exposure of female patients undergoing UAE to form a clear vision of radiation dose reduction techniques for patients undergoing UAE.

Methods: A Medline, ProQuest Central, ScienceDirect and Scopus database search from 2000 to 2018 was performed and 40 articles were deemed acceptable for review following the inclusion and exclusion criteria set. Ethics review was not required.

Results: The reviewed literature demonstrated that the reported radiation exposure doses appear to be below the threshold for any tissue (deterministic) radiation risks. The total radiation exposure of UAE patients is affected independently by multiple patient, operator expertise and technique, angiographic imaging and X‐ray unit variables.

Discussion: A clear vision for dose reduction is required by both the radiographer and radiologist when performing interventional procedures. Uterus preservation can be attained post‐UAE with dose reduction and optimisation, however, a longitudinal study on UAE patients and their risk of radiation‐induced tissue and/or stochastic effects is recommended.

Conclusion: This review article serves as a foundation point for understanding the contributions to radiation dose reduction techniques for UAE and is applicable to all involved in this procedure or interventional radiology procedures.

References

1. Braude P, Reidy J, Nott V, Taylor A, Forman R. Embolization of uterine leiomyomata: current concepts in management. Hum Reprod Update 2000;6:603‐608.

2. Worthington‐Kirsch RL, Popky GL, Hutchins FL. Uterine arterial embolization for the management of leiomyomas: quality‐of‐life assessment and clinical response. Radiology 1998;208:625‐29.

3. Liang E, Brown B, Rachinsky M. A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: results in 117 women. Aust NZ J Obstet Gynaecol 2018;1‐6.

Who? What? Where? A snapshot of research presentations at recent ASMIRT conferences

Jo‐anne Pinson ^1,2,3

¹Monash Health & Peninsula Health, Melbourne, Australia ²Monash University, Clayton, Australia ³Department Health & Human Services, Melbourne, Australia

Introduction: Health and medical research underpins improvements in our quality of life. A Victorian government directive for developing research led by allied health professionals was published in 2018 to embed a stronger research culture across allied health.¹ Conferences are great opportunities to share scientific knowledge, providing evidence to challenge or improve current practices. This study is a review of research presented at recent ASMIRT conferences to gauge Australian research culture.

Objective: To review:

• Contributors (by city) of oral and poster presentations at recent ASMIRT conferences

• Institutions with the highest number of oral and poster conference abstracts

• Comparative analysis between radiography and radiotherapy streams

• Determine publication rates of conference abstracts to full research papers.

Methods: A retrospective analysis of 516 abstracts published between 2015 and 2017 in the Journal of Medical Radiation Sciences (excluding international) using PubMed, Google Scholar and Google was conducted.^2–4

Results: At the time of abstract submission, data analysis was not complete. This study will present a final analysis with the conference presentation to full publication rate determined for radiography and radiotherapy streams. Preliminary results indicate the conference presentation to full publication rate for the radiotherapy stream is at least twice that of the radiography stream. The RANZCR rate reported in 2004 was 41% for radiation oncology and 29% for radiology.⁵

Conclusion: With government initiatives driving the need for increased medical research, this study will report a conference baseline for each stream. A comparative study in 3–5 years would be interesting to chart changes.

References

1. Victorian Government. Victorian Allied Health Research Framework. State of Victoria, Department of Health and Human Services. Victorian Government, Melbourne, 2018.

2. NZIMRT‐AIR. The Cloud: Shaping Our Future. NZIMRT‐AIR 10th Annual Scientific Meeting 2015. Wellington, New Zealand. J Med Radiat Sci 2015;62(S1):1‐94.

3. ASMMIRT. Rise and Shine. ASMMIRT 2016 11th Annual Scientific Meeting 2016, Brisbane. J Med Radiat Sci 2016;63(S1):1‐125.

4. ASMMIRT. Reach. ASMMIRT 2017 12th Annual Scientific Meeting 2017, Perth, Western Australia. J Med Radiat Sci 2017;64(S1):1‐113.

5. Bydder SA, Joseph DJ, Spry NA. Publication rates of abstracts presented at annual scientific meetings: how does the Royal Australian and New Zealand College of Radiologists compare? Australas Radiology 2004;48(1):25‐28.

Enhancing the versatility of the Halcyon™ treatment unit

Laura Sanders ¹

¹Icon, Toowoomba, Australia

Background: The Varian Halcyon™ radiotherapy system is an innovative new treatment delivery unit, which is easily identified by its closed bore appearance. The Halcyon™ has many desirable features including accelerated treatment times, operational efficiency and a human‐centred design. These advantages have meant many historic standard linac features such as a light field, optical distance indicator, jaws, single projection imaging and flattening filter have been omitted.

Aim: The purpose of this investigation was to maximise the usage and versatility of the Halcyon™ treatment unit, adapting C‐arm treatment techniques to suit the characteristics of the Halcyon™.

Discussion: Since the introduction of Halcyon™, a multidisciplinary team was tasked with adapting current traditional C‐arm linear accelerator‐based protocols for the Halcyon™ through a retrospective investigation. The Halcyon™ utilises only modulated treatments (IMRT or RapidArc^®) and as such an investigation was required to find alternative solutions for traditionally non‐modulated techniques like breast, skin and extended distances. The initial investigation focussed on creating a solution for breast treatments, as the breast cohort contributes significantly to overall workload in our organisation. Our conventional Hybrid‐IMRT breast technique was adapted to suit the Halcyon characteristics and produce comparable dosimetry to our gold standard linac technique. Subsequent investigations focussed on developing a modulated approach to skin treatments historically treated with electrons.

Conclusion: Volumetric techniques are easily streamlined using the Halcyon™, resulting in increased efficiency in both planning and treatment delivery. Planning and treating historically non‐modulated treatment sites required retrospective investigation to develop innovative new treatment approaches of comparable quality.

Empathic clinical communication training for patients undergoing MRIs using virtual reality

Daniel Sapkaroski ¹

¹Monash University, Melbourne, Australia ²Peter MacCallum Cancer Centre, Melbourne, Australia

Background: Approximately 2 million (1.2%) MRI scans worldwide are prematurely terminated.¹ The termination rate could potentially be decreased if health professionals working in MRI are better prepared to encounter claustrophobic patients.² Immersive virtual reality simulated learning environments (VRSLE) offer a novel approach for recreating real‐world scenarios with the advantages of repetition and determinism in a safe environment.

Aim: The aim of this study was to establish whether the mode of delivery, VRSLE versus clinical role‐play, could have a measurable effect on clinical empathic communication skills for a specific medical imaging scenario.

Methods: A randomised split‐cohort study was performed with trainee practitioners (N = 70) and qualified practitioners (N = 9).

Results: Participants in the trainee (TVR) and clinicians (CVR) group using the VR intervention reported an 11% and 12% improvement post‐training (P < 0.05) than those assigned to the role‐play intervention. Empirical assessment of communication training scores showed that participants in TVR performed 5% better on average than their role‐play counterparts (P < 0.05).

Conclusion: The level of empathic language used by participants was shown to differ following a training intervention designed to improve interactions with patients that present for an MRI scan. The ability to have an individualised immersive VR experience without the judgement of peers, may be a contributing factor why group TVR and CVR participants reported and group TVR participants demonstrated a significant improvement in clinical communication skills over their role‐play counterparts.

References

1. Dewey M, Schink T, Dewey CF. Claustrophobia during magnetic resonance imaging: cohort study in over 55,000 patients. J Magn Reson Imaging 2007;26(5):1322‐27.

2. Munn Z, Moola S, Lisy K, Riitano D, Murphy F. Claustrophobia in magnetic resonance imaging: a systematic review and meta‐analysis. Radiography 2015;21(2):e59‐e63.

A 15‐year review of incident reporting in two integrated cancer centres

Sandie Smith, ^1,2 Andrew Wallis, ^1,2 Odette King, ^1,2 Daniel Moretti, ^1,2 Phillip Vial, ^1,2,3,4 Jesmin Shafiq, ⁴ Michael Barton, ^1,2,3,4 Aitang Xing, ^1,2,3 Geoff Delaney ^1,2,3,4

¹Liverpool Cancer Therapy Centre, Liverpool, Australia ²Macarthur Cancer Therapy Centre, Campbelltown, Australia ³Ingham Institute for Applied Medical Research, Liverpool, Australia ⁴University of Western Sydney, Liverpool, Australia

Incident learning systems (ILS) have been implemented in many organisations globally to improve safety in radiation therapy.¹ Reported incidents over the period of 15 years between two integrated cancer centres were analysed to provide an insight into the effectiveness of an in‐house ISL.

There were 1727 incidents submitted over the 15‐year period. The average number of reported incidents were analysed and their severity assessment code (SAC) compared. SAC score grades the severity of incidents into four severity levels: SAC 1 being the highest and SAC 4 being the lowest (Table). Two 7‐year periods were considered for analysis and the average for the first period (2005–2011) was six reported incidents per 1000 attendances compared to two incidents per 1000 treatment attendances for the later period (2012–2018). The data correlated well with literature in that the development of new technologies, especially IGRT, has impacted the severity of incidents reported with a reduction in SAC 1 and SAC 2 errors.² This can be attributed to the quality assurance aspect of IGRT where the incident is identified prior to treatment delivery rather than after, reducing the severity of any potential incidents.

This review was limited by the variations in incident classification in the ILS, with a large proportion of incidents classified as ‘other’. Review of our ILS has shown that due to process changes the severity of errors has decreased, but it has also highlighted that taxonomy improvements are essential for better categorisation of incidents in the future.

References

1. Ford EC, Evans SB. Incident learning in radiation oncology: a review. Medical Physics 20181;45(5):e100‐119.

2. Greenham S, Manley S, Turnbull K, et al. Application of an incident taxonomy for radiation therapy: Analysis of five years of data from three integrated cancer centres. Rep Pract Oncol Radiother 2018;23(3):220‐27.

Educating for collaborative healthcare opportunities (ECHO): engaging medical radiation students in rural interprofessional education

Tony Smith, ¹ Emma Cooper, ² Jamie Marjoribanks, ³ Georgina Boyle ⁴

¹The University of Newcastle, Taree, Australia ²The University of Newcastle, Tamworth, Australia ³The University of Newcastle, Port Macquarie, Australia ⁴The University of Newcastle, Coffs Harbour, Australia

The University of Newcastle Department of Rural Health (UONDRH) is funded under the Australian Government Multidisciplinary Rural Health Training (RHMT) Program. The UONDRH supports students from medicine, nursing and allied health on rural placements in the Hunter New England and Mid‐North Coast regions. The aim is to support students to have productive placements and encourage them to consider a rural career path after graduation.

It is a requirement of the RHMT Program to ‘support opportunities for inter‐disciplinary learning’, hence, the UONDRH provides opportunities for rural‐based students from different disciplines to learn together, and so better prepare them to work together in the future. The UONDRH has conducted interprofessional education (IPE) since 2001 and now conducts 40 or more IPE activities every year across multiple sites. Activities are of varying duration and cover a range of topics, such as stroke, palliative care, dementia, communication, and ageing gracefully. Collectively, they are called Education for Collaborative Healthcare Opportunities (ECHO).

The UONDRH employs four medical radiation science (MRS) clinical academics at different sites to support MRS students. The MRS staff work as part of a multidisciplinary team to develop and deliver ECHO. With some 700 MRS placement‐weeks per year across the region, students often engage in IPE. Though MRS students are sometimes sceptical about engaging in IPE at first, post‐participation evaluation shows they better value the role of other health professionals, appreciate the importance of collaborative teamwork, and understand the need for holistic patient care. More IPE is needed in MRS curricula at all universities.

Closing the Gap in cancer care: initiatives to foster cultural safety and improve access

Amber Summers¹

¹Icon Cancer Centre, Toowoomba, Australia

Objectives: Aboriginal and Torres Strait Islander peoples receive a poorer cancer prognosis compared to non‐Indigenous Australians. Indigenous access to cancer care is limited by several factors, including differences in cultural understanding surrounding cancer and distrust of mainstream health institutions.¹

It is believed that radiation therapy is being under‐utilised by the Indigenous community. In response, several strategies were implemented to increase presentation and attendance by Indigenous Australians at a rural, private radiation therapy practice.

Methods: A local Indigenous health service, traditional owners and Elders and the clinic’s Reconciliation Action Plan working group were consulted to implement initiatives to reduce barriers to engaging in healthcare. One of these initiatives involved community consultation to select a culturally safe, Indigenous word to name one of the clinic’s linear accelerators.

Indigenous patient referrals into the clinic are tracked using an oncology information system. It is expected that by implementing a number of culturally safe strategies there will be an increase in utilisation of the radiation therapy service and a decrease in Indigenous cancer burden across the local region.

If strategies are yielding positive outcomes, there will be scope to implement them at other sites across a broader, monitored network.

Results: Presently, service utilisation is being monitored to determine whether the first round of initiatives has been successful. Data evaluation will be conducted to determine whether strategies must be re‐evaluated.

Conclusion: Work has been undertaken to implement strategies and preliminary results show an increase in the number of presentations to the clinic for treatment.

Reference

1. Lyford M, Haigh M, Baxi S, et al. An exploration of underrepresentation of Aboriginal cancer patients attending a regional radiotherapy service in Western Australia. Int J Environ Res Public Health 2018;15(2):337.

Feasibility of atlas‐based auto‐segmentation for head and neck organs at risk

Kenton Thompson, ¹ Sweet Ping Ng, ¹ Nicholas Hardcastle, ¹ Nigel Anderson ¹

¹Peter MacCallum Cancer Centre, Melbourne, Australia

Objectives: Delineation of organs at risk (OARs) is required to optimise the benefit of modern radiation therapy. Manually contouring head and neck (H&N) OARs is time consuming. This work investigates the efficacy of atlas‐based auto‐segmentation (ABAS).

Methods: 40 H&N datasets were added to the Smart Segmentation (Varian Medical Systems, Palo Alto, USA) ABAS library. The Varian‐provided and user‐defined atlases were validated on 10 H&N datasets not included in the library. Dice similarity coefficient (DSC) was calculated for brain stem, parotids and spinal cord using Plastimatch (MGH, Boston, USA).

Results: Five Varian provided atlases with the highest similarity score were selected, the median DSC and 95% confidence interval on 10 H&N datasets for brain stem, left parotid, right parotid and spinal cord were 0.72 (0.69–0.76), 0.74 (0.70–0.77), 0.73 (0.70–0.76) and 0.59 (0.48–0.63).

To compare, five user‐defined atlases with the highest similarity score were selected, the median DSC and 95% confidence interval for the same 10 H&N datasets and structures were 0.81 (0.75–0.83), 0.82 (0.74–0.83), 0.78 (0.75–0.80) and 0.7 (0.65–0.74).

Estimated time for ABAS and manual contouring was 2–3 and 15–20 minutes, respectively.

Discussion/Conclusion: This study has shown that utilising user‐defined atlases is feasible and has the potential to improve the performance of ABAS for H&N OAR segmentation. ABAS may require some manual alteration. However, when there are many structures to contour and required changes are small to moderate, it is likely that it will be more efficient. This tool has the capacity to improve H&N planning workflow.

The role of the radiographer in educating speech pathologists undertaking videofluoroscopic swallowing studies

Helen Warren‐Forward, ¹ Hetal Parsotam, ¹ Melissa Shields, ¹ Bernice Mathisen, ² Rachael Unicomb, ¹ Heather Shaw Bonilha, ⁴ Jonathan McNulty, ⁶ Ciara O'Toole, ³ Anna Hearne, ⁷ Sue Pownall ⁵

¹University of Newcastle, Newcastle, Australia ²Southern Cross University, Bilinga, Australia ³University College Cork, Cork, Ireland ⁴Medical University of South Carolina, Charleston, United States ⁵Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom ⁶University College Dublin, Dublin, Ireland ⁷Massey University, Auckland, New Zealand

Background: A videofluoroscopic swallowing study is a dynamic procedure conducted by radiographers and speech pathologists (SPs) to visualise swallowing to diagnose and treat dysphagia in children and adults. Given the requirement to feed patients during these assessments, SPs may be exposed to both primary and scatter radiation.

Aim: The main aims were to assess radiation protection practices utilised by SPs performing videofluoroscopic swallowing studies, and whether radiographers have a role in providing practical training.

Methods: An online questionnaire was distributed to SPs from six different countries (Australia, Canada, Ireland, New Zealand, United Kingdom and the United States). Responses were analysed quantitatively using frequencies and chi‐square analysis (P = 0.05) and qualitatively using thematic analysis.

Findings: While SPs identified distance (83%) as a valid method of radiation protection, less than 40% stood the recommended 2 metres from the patient during screening. The use of thyroid shields (94%) were used more frequently than lead gowns (72%). Differences (P < 0.0001) existed between Australian and US participants regarding the use and position of radiation badges with 43% of Australian respondents stating they always used a badge, compared to 75% of US participants. Australian SPs wore badges under shielding (92%) at waist level (69%), while US participants wore them outside shielding (97%) at thyroid level (94%). Thematic analysis revealed the significance of the radiographer in providing education to the SP.

Conclusion: This research identified that SPs were knowledgeable about radiation protection principles, though did not always adopt these principles in practice. Radiographers have an important role in ongoing SPs education.

Evaluation of an information pamphlet for HPV‐positive oropharyngeal cancer patients

Alisha Wintour, ¹ Elizabeth Brown, ¹ Sandro Porceddu, ¹ Patsy Yates ²

¹Princess Alexandra Hospital, Brisbane, Australia ²Queensland University of Technology, Brisbane, Australia

Objectives: Human papillomavirus (HPV), a sexually transmitted infection, has been found to be a causative factor for oropharyngeal cancer (OPC). This dual diagnosis can lead to unique psychosocial issues that clinicians are not well equipped to address. The primary objective of this study was to undertake a preliminary evaluation of the effectiveness of an information pamphlet about HPV+OPC in addressing common information gaps which exist for this patient population.

Methods: Eligible patients were randomly assigned (1:1) to either receive the information intervention or not. Patients in both groups completed questionnaires regarding quality of life, distress, anxiety and HPV knowledge at two time points: week one (W1) and week three (W3) of treatment. Patients assigned to the intervention group received the information pamphlet in week two.

Results: 22 HPV+OPC patients were recruited. Mean distress levels of participants within the intervention group reduced when compared to the control group (intervention group W1: 4.55 ± 2.46, W3: 4.09 ± 2.38; Control group W1: 1.64 ± 1.5, W3: 2.09 ± 1.51). A similar trend was demonstrated in mean depression scores with the intervention group score reducing from 12.2 ± 2.40 to 11.3 ± 3.30 and the control group score increasing from 13.2 ± 2.92 to 13.54 ± 2.87.

Conclusion: The results of this study suggest that the information pamphlet is a beneficial tool to assist in minimising some of the psychosocial impacts that a dual diagnosis of HPV and OPC has on patients.

Developing a RapidPlan model for hippocampal‐avoidant WBRT

Patrick Estoesta, ¹ Michael O'Connor, ¹ Ee Siang Choong ¹

¹Chris O'Brien Lifehouse, Camperdown, Australia

Objectives: A multi‐institutional phase II trial, RTOG 0933, demonstrated that hippocampal‐avoidant whole brain radiotherapy (HA‐WBRT) provided improved preservation of memory and quality of life compared to historical controls.¹ Similarly, NRG CC001, a phase III trial that randomised patients to standard WBRT with memantine or HA‐WBRT with memantine, demonstrated better cognitive preservation and quality of life without difference in intracranial tumour control or overall survival.² The objective of this study is to create a HA WBRT RapidPlan VMAT model. In addition to this, comparison between an optimisation template and the model will be performed to assess the best treatment planning approach.

Methods:

1. Create an optimised VMAT beam arrangement and planning template to create a WA HBRT plan. Use this beam arrangement and planning template on 22 patients to create a RapidPlan model.

2. Compare the dosimetric difference between plans created with a template and RapidPlan model by applying them to 10 patients to assess which planning approach produces dosimetrically better plans.

3. A paired 2‐tailed student t‐test will be used to assess plan differences with clinical significance set at P = 0.05.

Results: The RapidPlan model can achieve clinically significant lower maximum dose and better organ sparing.

Discussion: The use of RapidPlan allows for streamlining the treatment planning improving efficiency and plan quality as it requires less manual iteration and relies less on planner experience to produce a clinically acceptable plan. This technique will improve the current departmental treatment standard for patients with non‐SRS suitable brain metastases.

References

1. Gondi V, Pugh SL, Tome WA, et al. Preservation of memory with conformal avoidance of the hippocampal neural stem‐cell compartment during whole‐brain radiotherapy for brain metastases (RTOG 0933): a phase II multi‐institutional trial. J Clin Oncol 2014;32(34):3810‐16.

2. Brown PD, et al. Hippocampal avoidance during whole‐brain radiotherapy plus memantine for patients with brain metastases: phase III trial NRG Oncology CC001. J Clin Oncol 2020;38(10):1019‐29.

WEB: closing the net on cerebral aneurysm treatments

Penelope Stewart ¹

¹Monash Health, Clayton, Australia

For 26 years, interventional neuroradiology has used coils for the endovascular treatment of cerebral aneurysms in our clinical centre. In recent years, a new technology known as the ‘woven endo bridge’ (WEB) is becoming a valuable option for neuro‐interventionists, especially in the treatment of wide‐necked aneurysms.

At our clinical centre, 17 cerebral aneurysms have been treated with WEBs over the past three and a half years. In cases of wide‐necked aneurysms, when surgery is not desirable, coils have required intracranial stents as an adjunct therapy option for successful obliteration of the aneurysm. The WEB device can safely secure aneurysms which have been unsuitable for endovascular treatment, or high risk due to their morphology or position. The procedural time is significantly less than for endovascular coiling, which is advantageous for the patient, reducing anaesthetic time. WEB treatment rarely needs adjunct therapies such as balloon assistance or stenting. Dual anti‐platelet therapy is no longer required, which is advantageous, particularly in the setting of acute subarachnoid haemorrhage. Imaging within the angiographic suite include 2D, 3D and coned beam CT techniques which characterise the device, pathology and surrounding structures in great detail. The radiographer’s role is key in the work up to these implantations and during the procedure.

This presentation will show some case studies and imaging techniques used to demonstrate the use of the WEB, with improved outcomes for patients.

Effect of dietary counselling interventions on gastrointestinal toxicities in pelvic radiotherapy patients: a systematic review

Lauren Andreou, ^1,2 Yolanda Surjan, ¹ Tracy Burrows, ^1,3 Katherine Brain ^1,4

¹School of Health Sciences, The University of Newcastle, Callaghan, Australia ²Central Coast Cancer Centre, Gosford, Australia ³Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia ⁴John Hunter Hospital, New Lambton Heights, Australia

Objective: Gastrointestinal (GI) toxicities are common in patients receiving radiotherapy (RT) to the pelvis. This systematic review aims to evaluate the effectiveness of nutritional interventions (NI) involving dietary counselling (DC) on GI toxicities in patients receiving pelvic RT.

Methods: Papers published between 2013 and 2020 were extracted from five electronic databases, including MEDLINE, EMBASE, CINAHL, CENTRAL and Scopus. Studies included randomised controlled trials (RCTs) involving adults ≥ 18 years, undergoing curative pelvic RT, receiving a NI involving DC with or without supplements. DC was defined as written or face‐to‐face dietary advice provided before or during RT. Outcomes included GI toxicities reported by validated assessment tools. The Academy of Nutrition and Dietetics Quality Criteria Checklist was utilised to assess quality and risk of bias.

Results: A total of 1922 studies were retrieved, with 12 papers encompassing 11 individual RCTs included. Seven studies included a supplement in addition to DC, while four included DC only. Supplements included, in descending order, probiotics, prebiotics, probiotic + soluble fibre, high protein liquid supplement and fat emulsion. Of the 11 studies, only one involved individualised DC, while the remaining studies prescribed the consumption or avoidance of fats, fibre, lactose, protein and FODMAP.

The most common toxicities reported were diarrhoea (n = 11 studies), pain/cramping (n = 9), bloating/flatulence (n = 5) and constipation (n = 6). Three studies found an improvement in diarrhoea incidence, while nil papers reported any improvement in constipation.

Conclusion: Results varied between studies. Further quality studies are required to assess the effectiveness of DC on GI toxicities in patients receiving pelvic RT.

Fully adaptive MRgRT for prostate bed: initial Australian experience and potential benefits

David Crawford, ¹ Michael Jameson, ¹ Stacy Alvares, ¹ Louise Hogan, ¹ Conrad Loo, ¹ Claire Pagulayan, ¹ Urszula Jelen, ¹ Tania Twentyman, ¹ Zoe Moutrie, ¹ Monique Henke, ¹ Sandy Sampaio, ¹ Jeremy de Leon, ¹ David Crawford ¹

¹GenesisCare, Darlinghurst, Australia

Background/Objective: In prostate bed treatments the anterior target border is defined by the posterior bladder wall and the posterior border by the anterior rectal wall. The known interfractional changes in both these organs result in a highly variable target volume.¹ The Adapt to Shape (ATS) workflow on the MR linac (MRL) aims to account for these changes through re‐contouring and re‐planning based on improved visualisation of the anatomy of the day. We report the initial Australian experience treating post‐prostatectomy patients on the MRL.

Methods: All patients underwent a CT and MRI and contoured as per FROGG guidelines.² Plans were created using a template built from five previous prostate bed patient CT datasets. All fractions were delivered using an ATS workflow. A handover document was used for each patient to develop a library of comparable bladder sizes for matching to the MR of the day.

Results: Two patients completed treatment on the MRL using an ATS workflow. Treatment was well tolerated and treatment times averaged 30 minutes. Clinical target volume of the adapted plans varied significantly over the course of treatment, averaging between 85% and 155% of the reference volume.

Discussion: The ATS workflow allows cost functions to be manually adjusted, accounting for interfractional volume changes. This creates a new treatment plan with improved accuracy and dosimetric properties.

Conclusion: Given the internal anatomy variations throughout a prostate bed treatment course, it seems clinically beneficial to use an adaptive approach.

References

1. Latorzeff I, Sargos P, Loos G, et al. Delineation of the prostate bed: the “invisible target’ is still an issue? Front Oncol 2017;7:108.

2. Sidhom M, Kneebone A, Lehman M, Wiltshire K. Post‐prostatectomy radiation therapy: consensus guidelines of the Australian and New Zealand Radiation Oncology Genito‐Urinary Group. Radiother Oncol 2008;88(1):10‐19.

Dealing with electron streaming effect on MR linac: clinical experience

David Crawford, ¹ Michael Jameson, ¹ Stacy Alvares, ¹ Conrad Loo, ¹ Claire Pagulayan, ¹ Urszula Jelen, ¹ Tania Twentyman, ¹ Zoe Moutrie, ¹ Monique Henke, ¹ Sandy Sampaio, ¹ Jeremy de Leon, ¹ David Crawford ¹

¹GenesisCare, Darlinghurst, Australia

Background/Objective: Use of MR linacs (MRLs) is increasing and present challenges with respect to dose deposition in a magnetic field. As secondary electrons exit the patient surface they spiral in the direction of the magnetic field depositing dose on superior aspects of the patient in a phenomenon referred to as ‘electron streaming effect’ (ESE).¹ For treatment of a supraclavicular node on the MRL, it is necessary to mitigate the ESE to ensure skin dose to the patient’s neck and chin area is avoided.

Methods: The patient was set up as per standard protocol but with the addition of a custom‐made 8 mm thickness thermoplastic bolus moulded to the chin and neck. To explore the extent of the ESE, the clinical plan for delivery was recalculated using the same beam model but in the absence of the magnetic field. This guided placement of the in‐vivo films used during treatment and ensured the bolus covered sufficiently.

Results: The In‐Vivo film taped to the outer exterior of the bolus measured a total dose of 2.3 Gy. The film placed directly under the bolus, on the surface of the patient’s skin measured 0 Gy.

Discussion: Adding thermoplastic bolus to the patient’s skin effectively reduces the ESE seen in the presence of a magnetic field and is an essential clinical consideration for treatment sites in superior regions of the body, specifically thorax and head and neck.

Conclusion: The ESE was modelled and measured. Thermoplastic bolus of 8 mm was found to absorb the streamed electrons effectively.

Reference

1. Malkov V, Hackett S, Wolthaus J, Raaymakers B. Monte Carlo simulations of out‐of‐field surface doses due to the electron streaming effect in orthogonal magnetic fields. Phys Med Biol 2019;64(11).

Victoria’s first Halcyon™: turning a carpark into a state‐of‐the‐art radiotherapy treatment facility

Max Enge, ¹ Yolanda Aarons ¹

¹Icon Cancer Centre, Coburg, Australia

In 2019, Icon Group partnered with John Fawkner Private Hospital to establish a new radiation therapy service for the north‐western corridor of metropolitan Melbourne. But with space at an absolute premium, how do you accommodate a linear accelerator and all the essential services within a standalone facility, but having only 25% of the space normally required for a standard department?

The approach was to use an innovative modular construction technique, where six separate pods were prefabricated offsite, ready to be craned into place, along with our Varian Halcyon™ v2.0 Linac, the first of its kind in Victoria.

From concept design to implementation, and throughout the first 12 months of operations there have been many hurdles. Overcoming initial workflow challenges around adequate and functional workspace and in‐patient transfers, we have also adapted to the Halcyon’s single energy VMAT approach to treating patients. Including being able to offer radiotherapy to certain cohorts of stereotactic and skin patients that would have otherwise had to travel long distances to undergo treatment.

Our experience will highlight how these challenges were overcome using creative and innovative ideas and show how a service can be established in areas previously deemed unworkable by informing design and workflow solutions that could also assist current and future sites.

A comparative analysis of proton and carbon ions in the treatment of paediatrics

Annabel Russell, ¹ Abby Duncan, ¹ Hannah Ferres, ¹ Jamie Carling ¹

¹University of South Australia, Adelaide, Australia

Objectives: Paediatric cancers account for less than 1% of all cancer diagnoses¹ and most commonly present as leukaemia or central nervous system (CNS) tumours². Radiation therapy (RT) as a treatment option poses significant risk to a child’s developing tissues, bringing about an interest in the use of modern treatment techniques. Through thorough comparison of proton and carbon ions, we aim to identify how the use of particle therapy can be utilised to deliver highly targeted doses of radiation to the tumour while sparing a child’s growing structures.³

Method: A review of current peer‐reviewed scientific literature was undertaken, utilising numerous reputable databases. Topic‐related keywords such as ‘radiotherapy’, ‘paediatric', ‘protons’, ‘carbon ions’, ‘treatment outcomes’ produced pertinent results from which our research was concluded.

Results: Physical and radiobiological advantages of proton and carbon ions over traditional photon‐based RT were successfully examined, concluding that the treatment technique allows precise targeted tumour volume irradiation and successful sparing of healthy tissues.⁴ The theoretical advantages of carbon ion therapy have not yet been proven to the extent of proton therapy, where the benefits for paediatric cancers are intuitively clear. This can be attributed to the relative radiobiological effectiveness and long term outcome uncertainties associated with carbon ion therapy.⁵

Conclusion: Carbon ion and proton ion therapy allows for a greater conformal dose delivery of radiation that aims to reduce dose to the surrounding organs at risk and minimise patient side effects. This has been proven to be particularly beneficial for paediatrics with CNS malignancies.

References

1. American Cancer Society. Key statistics for childhood cancers. American Cancer Society. 2019. Available at https://www.cancer.org/cancer/cancer‐in‐children/key‐statistics.html [Accessed 20 August 2020].

2. Johns Hopkins. Types of brain and spinal cord tumors in children. [Internet] Johns Hopkins Medicine University. Available at https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/brain_tumor/center/pediatric/tumors/ [Accessed 13 August 2020].

3. Targeting Cancer. Proton therapy [Internet]. Sydney NSW: The Royal Australian and New Zealand College of Radiologists. 2017. Available at https://www.targetingcancer.com.au/radiation‐therapy/ebrt/proton‐therapy/ [Accessed 8 August 2020].

4. Kelada O. The potential advantages and disadvantages of cancer therapy using charged particles compared with megavoltage x‐rays. Particle Therapy Cancer Institute [Internet]. 2011. Available at https://www.researchgate.net/publication/235899732_The_potential_advantages_and_disadvantages_of_cancer_therapy_using_charged_particles_compared_with_megavoltage_x‐rays [Accessed 14 August 2020].

5. Cancer.Net. Proton therapy. American Society of Clinical Oncology [Internet]. 2018. Available at https://www.cancer.net/navigating‐cancer‐care/how‐cancer‐treated/radiation‐therapy/proton‐therapy [Accessed 16 August 2020].

Ink tattoos, henna, UV tattoos or SGRT? A vision for improving breast patients’ experiences

Lucy Wood, ¹ Chloe Zerna ¹

¹University of South Australia, Adelaide, Australia

Patients receiving external beam radiation therapy (EBRT) are traditionally given permanent Indian ink tattoos as a visual guide for their breast cancer treatment.

While the tattoos act as a tool for the radiation therapist, for some patients, these marks tell a permanent story of their struggle with illness.¹ This emerging awareness has spurred the need for new options. Progressing new techniques or reforming potentially problematic traditional methods will foster a more positive holistic experience for the patient, and thus a higher quality of patient care.

New approaches are being tested such as henna, UV tattoos and surface guided radiation therapy (SGRT).² These methods vary – but are often comparable – in set‐up accuracy and consistency. For example, UV and henna tattoos are comparable to ink in their set‐up accuracy, while SGRT promises improvement through advanced body scanning technology.^3,4 However, factors such as maintenance, funding and professional training may prevent alternatives from being employed.

Widening our tunnel‐vision of ink tattoos by including viable alternatives, we aim to also bring into focus considerations such as the role of body‐positivity and emotional wellbeing during and after treatment. Furthermore, allowing patients to make informed decisions about which option they would prefer may offer a sense of agency in the clinical setting.

Each practice within radiation therapy is evolving. It is time to bring the vision of improved patient care for breast patients to the forefront and progress to new techniques.

References

1. Moser T, Creed M, Walker R, Meier G. Radiotherapy tattoos: women's skin as a carrier of personal memory. What do we cause by tattooing our patients? Breast J 2020;26(2):316‐18.

2. Rigley J, Robertson P, Scattergood L. Radiotherapy without tattoos: could this work? Radiography 2020;26(4):288‐93.

3. Wurstbauer K, Sedlmayer F, Kogelnik HD. Skin markings in external radiotherapy by temporary tattooing with henna: improvement of accuracy and increased patient comfort. Int J Radiat Oncol Biol Phys 2001;50(1):179‐81.

4. Landeg SJ, Kirby AM, Lee SF, et al. A randomized control trial evaluating fluorescent ink versus dark ink tattoos for breast radiotherapy. Br J Radiol 2016;89(1068):20160288.

Measuring quality of life in childhood cancer: what insights can be gained from the literature?

Victoria Bedford, ¹ Michala Short, ² Shona Crabb ¹

¹University of Adelaide, Adelaide, Australia ²University of South Australia, Adelaide, Australia

Objectives: This scoping review examined the health‐related quality of life (QOL) tools being used to capture patient‐reported outcomes of children with cancer, either during or directly after radiation therapy. The aim was to use this work to guide future research in the field of patient‐reported QOL outcomes for future patients undergoing proton radiation therapy in Australia.

Methods: Six databases were searched between July and September 2020, spanning all published and grey literature and following established scoping review methods.^1–3 Title, abstract and full‐text screening was performed by three reviewers and was managed in Covidence software. Extracted data such as patient diagnosis, age, questionnaire format (paper or digital), availability of a parent‐proxy version, timing and measured domains were tabulated for analysis.

Results: Of the 407 articles found, 27 met pre‐defined eligibility criteria. These studies described 37 QOL tools being used in the paediatric oncology setting, with some being available in digital format. The most highly cited tool was the PedsQL Core Questionnaire version 4.0 which was cited 18 times. All tools captured baseline QOL plus at least one other data point for comparison. The most comprehensive tools continued data capture annually at follow‐up appointments.

Discussion/Conclusion: Identification of 37 different tools provided valuable insights on which tools are most commonly used and in what contexts. It enabled a thorough evaluation regarding their format (digital versus paper) and the timing of QOL assessments in young patients. Future research is needed to evaluate these tools based on their validity, reliability and psychometric properties.

References

1. Colquhoun HL, Levac D, O'Brien KK, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol 2014;67:1291‐94.

2. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8:19‐32.

3. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA‐ScR): checklist and explanation. Ann Intern Med 2018;169:467‐73.

Navigating imaging technology in paediatric oncology

Elizabeth McGahan ¹

¹Queensland Children's Hospital, South Brisbane, Australia

Capanna technique¹ is by no means a new procedure being used in orthopaedic theatres across Australia and around the world. However, in November 2020 at the Queensland Children’s Hospital we were fortunate to be involved in the hospital’s first navigation assisted Capanna surgery.

The Capanna technique² was first introduced in 1988 and is a method of reconstructing large osseous defects through a combination of block allograft resection and vascularised bone transfer. This procedure has been performed numerous times by the hospital’s orthopaedic oncology team – however, it has never been performed onsite with navigation.

In November 2020, the orthopaedic team resected an osteosarcoma in an 11‐year‐old patient with the RB1 gene and a history of retinoblastoma. Pre‐operative imaging (CT and MRI) was conducted and used for planning purposes. These images were also sent to the Queensland Bone Bank to find a suitable ‘match’ of femur, which would be used for the block allograft.

Combined with the use of the ground‐breaking technology from the Siemens CIOS Spin in Theatre, the block allograft was resected with increased accuracy resulting in decreased blood loss and a shorter anaesthetic time. This case was a success as a result of teamwork and multi‐disciplinary collaboration.

References

1. Capanna R. A new technique for reconstructions of large metadiaphyseal bone defects. Orthopedics and Traumatology 1993;159‐77.

2. Li JM, Chen GM, Lu YM, et al. Factors influencing osseous union following surgical treatment of bone tumors with use of the Capanna technique. J Bone Joint Surg 2019;2036‐43.

The use of susceptibility‐weighted imaging in MRI brain examinations

Nur Shahirah Kiong ¹

¹Singapore General Hospital, Singapore

Introduction: Susceptibility‐weighted imaging (SWI) is a magnetic resonance imaging (MRI) technique that utilises differences in tissue magnetic susceptibility to generate magnitude, phase, susceptibility‐weighted and minimum intensity projection images. SWI can pick up minute susceptibility differences, which may otherwise be missed on conventional MRI sequences. It complements MRI in the diagnosis of low‐flow vascular malformations and aids in the timely evaluation of infarcts.

Aims:

• Demonstrate the complementary role that SWI plays in aiding the diagnosis of brain pathologies

• Demonstrate how SWI can determine the presence of haemorrhagic conversion in infarcts and if anti‐thrombotic drugs should be administered in such patients.

Discussion: Treatment of brain infarcts caused by occlusion is commonly resolved through the administration of thrombolytic drugs. However, there is a possibility that infarcts develop haemorrhagic cores and result in brain bleeds. Detection of haemorrhagic conversion through an SWI scan before thrombolytic drugs are administered would greatly help decrease the rate of symptomatic haemorrhage in such patients and determine the necessity of administering anti‐thrombolytic therapy.^1,2

SWI is highly sensitive to differences in magnetic susceptibility and therefore plays a major role in detecting haemosiderin and in the timely treatment of infarcts.² However, this unique characteristic of SWI, also demonstrates calcifications, deoxyhaemoglobin and iron deposits. Thus, while SWI is good at detecting abnormalities, it is important to note that it is complementary to T1 and T2‐weighted imaging and with clinical correlation, to distinguish between various conditions.

References

1. Carmago ES, Walter JK. Neuroimaging of ischaemia and infarction. NeuroRx 2005;2:265‐76.

2. Hermier M, Nighoghossian N. Contribution of susceptibility‐weighted imaging to acute stroke assessment. Stroke 2004;35:1989‐94.

Victoria’s first Halcyon™: keeping it simple

Yolanda Aarons, ¹ Max Enge, ¹ Sam Towns ¹

¹Icon Group, Coburg, Australia

The K.I.S.S principle states that wherever possible, complexity should be avoided in a system – as simplicity guarantees the greatest levels of user acceptance and interaction. Unlike standard linear accelerators with various permutations of energies and imaging, the Halcyon™ has been paired back with 100% of treatments being image‐guided and modulated using a single energy 6 MV FFF beam. So, it begs the question, can a standalone machine as simple and streamlined as the Halcyon™ offer a well‐rounded radiation oncology service?

As one of the few sites in Australia to establish a radiation oncology service around a Halcyon™ treatment machine, Icon Cancer Centre at John Fawkner Hospital are pushing the envelope on what a single machine department can achieve.

We share our dosimetric comparisons around the use of the machines unique dual‐layered MLC (as a departure from jaws) for small field applications and skin treatments in the absence of electrons. We will also discuss our in‐house statistics around how the Halcyon™ set‐up and treatment times stack up against standard linear accelerators. Risk analysis data around geographic misses and collisions compared to standard machines will also be explored, in order to answer the question on everyone’s mind: Is the simplest answer most often the best?

Looking back to the future: literature review of appropriate use of gonad protection

Edel Doyle¹

¹RMIT University, Bundoora, Australia

The standard practice in diagnostic imaging to use gonad shielding has repeatedly been questioned, stemming from a lack of evidence supporting radiation effects on human fertility at the doses typically used in imaging practice.¹ Consequently, the American Association of Physicists in Medicine has stated that the use of gonad shielding provides negligible protection to a patient, and the practice should be ceased.² Furthermore, in 2007, the International Commission on Radiological Protection reduced the gonad tissue weighting factor from 0.2 to 0.08,³ supporting the fact that the radiation effects to the gonads is minimal. The difference between gonad shields and placing lead shielding across the patient's abdomen also needs to be considered. Current evidence from published literature strongly suggests that gonad shielding provides little radiation protection but offers only psychological assurance to radiographers and patients.

References

1. Marsh RM, Silosky M. Patient shielding in diagnostic imaging: discontinuing a legacy practice. Am J Roentgenol 2019;212:755‐757.

2. American Association of Physicists in Medicine. AAPM position statement on the use of patient gonadal and fetal shielding, PP 32‐A. Pediatr Radiol 2019;49:1104.

3. International Commission on Radiological Protection. The 2007 recommendations of the International Commission on Radiological Protection. ICRP Publication 103 2007. Available at http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103

AI‐based detection of positioning error in skull X‐ray images based on convolutional neural network

Takuya Hirokane¹, Taiki Magome¹, Tatsuya Hayashi², Maiko Hashimoto³, Masahiko Takahashi³, Norio Hayashi⁴

¹Komazawa University, Tokyo, Japan, ²Teikyo University, Tokyo, Japan, ³Isesaki Municipal Hospital, Gunma, Japan, ⁴Gunma Prefectural College of Health Sciences, Gunma, Japan

Objectives: The purpose of this study was to develop an automated detection system of positioning error in skull X‐ray image to assist inexperienced radiographers.

Methods: The convolutional neural network (CNN) model was developed for the classification of skull X‐ray images. In this study, 104 skull X‐ray images (AP image: 43, RL image: 43, LR image: 10, Towne image: 8) were used; and positioning error images were created by randomly translating original images. The CNN model was trained to predict each image class, i.e. AP, RL, LR, Towne and ‘positioning error’. To increase prediction performance, the number of input images into the CNN model was increased by virtually generating images with a deep convolutional generative adversarial network. Prediction performance of the CNN model was evaluated with accuracy, sensitivity and specificity.

Results: Image classes of skull X‐ray images were automatically predicted by the CNN model. The value of accuracy, sensitivity and specificity was 0.975, 0.937 and 0.984, respectively.

Conclusion: Our results showed the potential to automatically detect positioning error of skull X‐ray images with an AI‐based system. The proposed system could be useful to assist young radiographers.

Obesity in medical imaging: is patient‐centred care being achieved?

Catherine Do¹, Lang Lim¹

¹Monash University, Melbourne, Australia

Background: Obesity is an epidemic that has become increasingly prevalent around the globe. Experiences of discrimination are common towards people who are obese. This review aims to highlight how attitudes of healthcare workers affect the health experiences of obese patients, with a focus on medical imaging.

Methods: PubMed and Scopus databases were used. Keywords such as ‘obesity’ and ‘medical imaging’ were entered; results were limited to peer‐reviewed articles in English from 2010 to 2019. Extension outside of radiology was included due to limited availability of articles. Attitudes of other healthcare professionals also provide insight into the negative health experiences of obese patients. From the resultant yield (following removal of duplicates), the seven most relevant articles were included in the final review. Selection criteria included bias and difficulties experienced by obese patients within a healthcare setting.

Results: Initial analysis of the papers reveal that obesity has many challenges within medical imaging. Negative stereotyping may affect practitioner behaviour subconsciously, leading to intimidation and embarrassment, which can reduce patient adherence and ability to fully engage in medical encounters. From the review, it appears that there is insufficient literature specific to the opinions of patients themselves and how they perceive that discouraging attitudes may affect their clinical experience. This suggests a gap in our patient‐centred healthcare model.

Conclusion: Obese patients face discrimination; therefore we must understand the challenges in order to provide optimal care. It appears that the perspectives of obese patients have not been captured and therefore further research is required.

The role of traditional Chinese medicine as complementary medicine to conventional cancer treatments

Tsz Yu Kwok¹

¹University of South Australia, Adelaide, Australia

Objective: The use of complementary therapies is becoming more common among cancer patients, with 65% of cancer respondents to an Australian study self‐reporting the use of complementary medicine, of which traditional Chinese medicine (TCM) was one of the most common forms.^1‐3 Some patients believe in the benefit of herbal therapy without proven evidence.¹ Doctors in Australia are also not equipped with adequate TCM knowledge to provide appropriate advice to patients.¹ Hence, safety issues are potentially present. This study evaluates current evidence regarding the role of TCM concurrently used with conventional cancer treatments and investigates the underlying safety issues.

Methods: A literature review was conducted with PubMed and Cochrane databases. Peer‐reviewed papers were limited to those published in the past 10 years.

Results: Synergistic effects of some commonly administered herbs were evaluated for their cellular effects in mammals.⁴ Some herbs can facilitate the recovery of healthy structures (e.g. gynostemma pentaphyllum assists in the recovery of leukocytes); additionally, some increase tumour sensitivity and promote cancer cell apoptosis (e.g. toona sinesis and lung cancer cells).⁴ Randomised controlled trials studied the effect of TCM, showing its benefit in the safe and effective control of side effects.^5,6 However, some herbs can cause adverse effects. For example, dang gui can increase oestrogen levels and stimulate the growth of oestrogen receptor‐positive breast cancer cells.³

Conclusion: TCM is a safe and effective complementary medicine when used appropriately. However, the reluctance of users to disclose its use and health practitioners’ lack of knowledge may potentially cause harm.

References

1. Oh B, Butow P, Mullan B, Beale P, et al. The use and perceived benefits resulting the use of complementary and alternative medicine by cancer patients in Australia. Asia‐Pac J Clin Oncol 2010; 6(4):342‐49.

2. Horneber M, Bueschel G, Dennert G, et al. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther 2012;11(3):187‐203.

3. McPherson L, Cochrane S, Zhu X. Current usage of traditional Chinese medicine in the management of breast cancer: a practitioner’s perspective. Integr Cancer Ther 2016;15(3):335‐42.

4. Jia L, Ma S, Hou X, et al. The synergistic effects of traditional Chinese herbs and radiotherapy for cancer treatment. Oncol Lett 2013;5(5):1439‐47.

5. Wang C, Wang P, Ouyang H, et al. Efficacy of traditional Chinese medicine in treatment and prophylaxis of radiation‐induced oral mucositis in patients receiving radiotherapy: a randomized controlled trial. Integr Cancer Ther 2018;17(2):444‐50.

6. Liu J, Wang S, Zhang Y, Fan H, Lin H. Traditional Chinese medicine and cancer: history, present situation, and development. Thorac Cancer 2015;6(5):561‐69.

EOS micro‐dose

Thi Ngoc Anh Nguyen¹

¹Queensland University of Technology, Brisbane, Australia

Background: Patients with adolescent idiopathic scoliosis (AIS) must undergo repeated X‐ray exposure for diagnosis, monitoring, surgical planning and post‐operative follow up. To reduce life‐time risk of developing cancer, the bi‐planar digital X‐ray by the EOS system has been used recently; its newly adopted micro‐dose protocol has been introduced with promising benefits.

Objective: This study will investigate the clinical effectiveness of EOS micro‐dose protocol by comparing its induced radiation dose and image quality with EOS standard low‐dose protocol and conventional digital radiography (DR) for AIS patients.

Method: A systematic review was undertaken using four electronic databases: Medline, Embase, Cochrane Library and CINAHL. Only studies with human subjects were included (i.e. anthropomorphic phantom based studies were excluded).

Results: Six studies were identified. Entrance skin dose, effective dose and organ dose were statistically lower in micro‐dose protocol compared with DR, and 5–7 times lower than low‐dose EOS protocol. Its intra‐operator repeatability was better than inter‐operator reproducibility for all parameters. There was good agreement for reliability of 3D spinal models and standard 2D radiographic measurement (such as Cobb angle) when comparing low‐dose to micro‐dose protocol. Image quality of micro‐dose protocol was reported reduced with slightly less clarity.

Conclusion: Standard DR and low‐dose EOS protocol were still recommended for initial representation of AIS patients for their most accurate assessment. Micro‐dose can be used in radiological follow‐up with less dose, adequate image quality and reliable measurement.

A vision for paediatric radiotherapy: reducing radiation‐induced skin cancer in childhood cancer survivors

Tamika Cassar¹, Ellen Hevey¹, Nicole Zervos¹

¹RMIT University, Bundoora, Australia

Introduction: An increased prevalence of secondary skin cancers among childhood cancer survivors treated with radiation therapy is documented.¹ The smaller stature, closer proximity of developing organs and longer expected survival of paediatrics increases their susceptibility to radiation‐induced toxicities. This literature review investigates how advancements in radiation therapy influence entrance dose and consequentially, the future of paediatric patients.

Methods: 32 literature reviews and research reports published from 2012 to 2019 were investigated to explore radiotherapy techniques and modalities associated with increased radiation induced skin cancers (RISCs).

Results: The literature indicated the importance of further research and increased awareness about RISCs in paediatrics being vital for long term improvements in survival. Paediatric Normal Tissue Effects in the Clinic (PENTEC) guidelines are still being developed and practices are under consolidation.² It is evident that increased modulation reduces integral dose and the possibility of late toxicities developing in paediatric patients, although the future of paediatric therapy is focussed on tissue sparing rather than skin sparing.

Conclusion: The literature review found that skin dose is consequentially increased when using multidirectional proton beams with the aim of decreasing integral dose.³ Proton and other heavy ion therapies are being investigated to determine their place in the future of paediatric radiotherapy treatments.⁴ Evidently, the incorporation of multidirectional proton beams and the challenges, therapeutic compromises and process of proton therapy should be investigated further to promote long‐term survival in paediatric patients.

References

1. Stapleton J, Tatum K, Devine K, et al. Skin cancer surveillance behaviors among childhood cancer survivors. Pediatr Blood Cancer 2015;63(3):554‐57.

2. Constine L, Ronckers C, Hua C, et al. Pediatric Normal Tissue Effects in the Clinic (PENTEC): an international collaboration to analyse normal tissue radiation dose‐volume response relationships for paediatric cancer patients. Clin Oncol (R Coll Radiol) 2019;31(3):199‐207.

3. Whaley JT, Kirk M, Cengel K, et al. Protective effect of transparent film dressing on proton therapy induced skin reactions. Radiat Oncol 2013;8:19.

4. Moskvin V, Lasley FD, Ray GL, et al. Acute skin toxicity associated with proton beam therapy in spine and brain patients. J Radiat Oncol 2014;3(2):195‐203.

J Med Radiat Sci. 68(2021) 80–101