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Ultra‐Hypofractionated Whole Breast Radiotherapy (U‐WBRT) has been proven to be a viable treatment option for breast cancer patients receiving radiation therapy, however, due to its novelty our understanding of its non‐clinical benefits is still evolving. With increasing U‐WBRT selection during COVID and in rural and regional settings such as the Western New South Wales Local Health District (WNSWLHD), it's important to quantify the savings when compared to other fractionation schedules (e.g. Conventional fractionation (C‐WBRT) involving 25 fractions and Moderate hypofractionation (M‐WBRT) with 15 fractions.) Using literature sourced from Medline, Embase, Pubmed and reports from relevant websites and organisations this narrative review investigates quantifiable methods of assessing non‐clinical benefits of U‐WBRT in rural settings according to the triple bottom line philosophy. This review was able to identify a standard set of quantifiable metrics that can compare the non‐clinical benefits of various fractionation schedules, with relevance to a rural setting. These include: fractionation trends, financial subsidy, average linear accelerator (Linac) minutes, hospital visits, travel time and distance, Linac energy consumption, travel and Linac carbon emissions. By identifying these metrics, non‐clinical benefits between the fractionation schedules can easily be quantified and compared. Ultra‐Hypofractionated Whole Breast Radiotherapy (U‐WBRT) has been proven to be a viable treatment option for breast cancer patients receiving radiation therapy, however, due to its novelty our understanding of its non‐clinical benefits is still evolving. This review was able to identify a standard set of quantifiable metrics that can compare the non‐clinical benefits of various fractionation schedules, with relevance to a rural setting. By identifying these metrics, non‐clinical benefits between the fractionation schedules can easily be quantified and compared.

Background Mycoplasma species have been associated with economically important diseases affecting ruminants worldwide and include contagious bovine pleuropneumonia (CBPP), contagious caprine pleuropneumonia (CCPP) and contagious agalactia, listed by the World Organisation for Animal Health (OIE). The Mycoplasma Team at the Animal and Plant Health Agency provides an identification service for Mycoplasma and Ureaplasma species of veterinary importance to the United Kingdom (UK), supporting the detection of new and emerging pathogens, as well as contributing to the surveillance of endemic, and the OIE listed diseases exotic to the UK. Mycoplasma and other Mollicutes species were identified from diagnostic samples from farmed ruminants in England and Wales using a combination of culture and 16S rRNA gene-based PCR-denaturing gradient gel electrophoresis, submitted between 2005 and 2019. Results A total of 5578 mollicutes identifications, which include mycoplasmas and the related acholeoplasmas and ureaplasmas, were made from farmed ruminant animals during the study period. Throughout the study period, the pathogen Mycoplasma bovis was consistently the most frequently identified species, accounting for 1411 (32%) of 4447 molecular identifications in cattle, primarily detected in the lungs of pneumonic calves, followed by joints and milk of cattle showing signs of arthritis and mastitis, respectively. M. bovirhinis , M. alkalescens , M. dispar , M. arginini and Ureaplasma diversum , were also common. Mixed species, principally M. bovis with M. alkalescens, M. arginini or M. bovirhinis were also prevalent, particularly from respiratory samples. The non-cultivable blood-borne haemoplasmas Candidatus ‘Mycoplasma haemobos’ and Mycoplasma wenyonii were identified from cattle, with the latter species most often associated with milk-drop. M. ovipneumoniae was the predominant species identified from sheep and goats experiencing respiratory disease, while M. conjunctivae preponderated in ocular samples. The UK remains free of the ruminant mycoplasmas listed by OIE. Conclusions The continued high prevalence of M. bovis identifications confirms its ongoing dominance and importance as a significant pathogen of cattle in England and Wales, particularly in association with respiratory disease. M. ovipneumoniae has seen a general increase in prevalence in recent years, notably in coughing lambs and should therefore be considered as a primary differential diagnosis of respiratory disease in small ruminants.

Introduction Safety and quality improvement are essential to clinical practice in radiation therapy as planning and treatment increase in complexity and sophistication. An incident learning system (ILS) is a safety and quality improvement tool that can aid risk mitigation to improve patient safety and quality of care. The aim of this study was to quantify the impact of implementing a new e‐ILS, Learning In Radiation ONcology (LIRON), on reporting and safety culture within a local health district (LHD). Methods The ILS (LIRON) was implemented in 2020 with the intent of tracking actual incidents, near misses and procedural non‐compliances for analysis of root causes and contributing factors. A survey was conducted after 12 months of LIRON use, and distributed to radiation oncologists, radiation therapists and radiation oncology medical physicists within the LHD. Results were compared with the responses to a pre‐ILS implementation survey, to review changes in staff perceptions of safety culture, barriers to reporting and ILS understanding. Results Survey response rates were similar at baseline and at the 12‐month follow‐up, 64% and 63%, respectively. Findings showed increased ILS participation (49–71%), increased perception of no barriers to reporting (34–43%) and increased encouragement to report (37–43%). Greater confidence in the department's ability to learn from the ILS was evident (24–46%). Conclusion Initial findings of LIRON implementation show positive impact but warrant further long‐term review for greater understanding of its impact on staff perceptions, safety culture and improving departmental processes. Introduction of an incident learning incident (ILS) was shown to have had a positive impact on reporting and safety culture within a local health district (LHD). Survey findings correlate with existing literature that ILSs are effective tools for improving patient safety and departmental safety facilitating quality improvement.

Introduction Radiation oncology patient pathways are complex. This complexity creates risk and potential for error to occur. Comprehensive safety and quality management programmes have been developed alongside the use of incident learning systems (ILSs) to mitigate risks and errors reaching patients. Robust ILSs rely on the safety culture (SC) within a department. The aim of this study was to assess perceptions and understanding of SC and ILSs in two closely linked radiation oncology departments and to use the results to consider possible quality improvement (QI) of department ILSs and SC. Methods A survey to assess perceptions of SC and the currently used ILSs was distributed to radiation oncologists, radiation therapists and radiation oncology medical physicists in the two departments. The responses of 95 staff were evaluated (63% of staff). The findings were used to determine any areas for improvement in SC and local ILSs. Results Differences were shown between the professional cohorts. Barriers to current ILS use were indicated by 67% of respondents. Positive SC was shown in each area assessed: 69% indicated the departments practised a no‐blame culture. Barriers identified in one department prompted a QI project to develop a new reporting system and process, improve departmental learning and modify the overall ILS. Conclusion An understanding of SC and attitudes to ILSs has been established and used to improve ILS reporting, feedback on incidents, departmental learning and the QA program. This can be used for future comparisons as the systems develop. The aims were to assess attitudes to and understanding of safety culture (SC) and incident learning systems (ILSs) in two closely‐linked radiation oncology departments using a customised survey. Sixty‐three per cent of staff participated. Barriers identified in one department prompted a quality improvement project to develop a new radiation oncology‐specific reporting system, with a focus on improving departmental learning and modifying the overall ILS.

Contouring organs at risk (OARs) manually in paediatric patients undergoing cranial-spinal radiation therapy (CSI) is a time-consuming, labour-intensive task. This study aims to assess the accuracy and clinical acceptability of auto-contours produced by the Siemens DirectORGANS auto-contouring software on paediatric patients receiving CSI treatment. Auto-contours of OARs were produced using the Siemens DirectORGANS Auto-contouring Software from 20 paediatric CSI patients datasets that had previously been manually contoured by a paediatric specialist radiation therapist (RT) for plan production. Manual and auto-contours were retrospectively analysed using quantitative (Dice Similarity Coefficient, Hausdorff Distance, Mean Distance to Agreement) and qualitative (Likert ratings, Turing test) assessment techniques. Auto-contoured structures were clinically acceptable for use without edits 72.8% of the time, and manual contours were clinically acceptable for use 91.7% of the time. The liver was the only auto-contoured structure that performed better than the manual equivalent. Poor performance by the auto contouring tool was noted for structures surrounded by low contrast edges, such as the breasts, oesophagus, and brainstem, in both quantitative and qualitative assessment techniques. Brain auto-contours were deemed not suitable for clinical use. The clinical acceptability of many of the auto-contours favours the implementation of this auto-contouring system for clinical use. However, prior to use, all contours should be critically assessed and edited accordingly. Our study results indicate that whilst auto-contouring tools are designed for adult populations, they are suitable for use on paediatric patients when used with caution.

Introduction Building research capacity within the radiation therapist workforce/profession is essential to guarantee research is embedded into core practices. Assessment of current capacity levels within organisation, department and individual domains needs to occur to establish a baseline and ensure research capacity building (RCB) strategies will be targeted successfully. This exploratory study aimed to identify the areas within each domain where radiation therapists would benefit from extra research assistance, that being research support and process changes, particularly in relation to the workplace and health sector. Methods Practising radiation therapists (RTs) within Australia were recruited through professional organisations and invited to complete the online Research Capacity Culture Tool (RCCT). The survey was conducted using Qualtrics with data exported to SPSS.V27 for analysis. Descriptive statistics and the Radiation Therapy Specific Survey Analysis Approach (RTSSAA) for the Research Capacity and Culture Tool were used to analyse and report the results. Results Survey participation rate was 121/2640 (4.6%). Within the Organisation and Department domains, the most research assistance was required in infrastructure (n = 92–37) and support (n = 66–45) categories, respectively. Participants from private sector (Organisation: 42.7%, Department: 53.7%) and metropolitan centres (Organisation: 32.6%, Department: 47.5%) required a higher rate of assistance when compared to their counterparts in both categories. The individual domain showed similar levels of assistance required across health sectors and work locations. Workplaces showed similar levels of complexity of research activity; private sector (62.5%) recorded the highest level of no research activity. Conclusion This study has provided insight into how the research capacity and culture of organisations and departments in which individuals' work will influence their abilities and opportunities to perform research. This exploratory study (n = 121) assessed areas within each research capacity domain where Australian radiation therapists would benefit from extra research assistance, particularly in relation to the workplace and health sector. The study showed within the Organisation and Department domains participants from private sector and metropolitan centres required a higher rate of assistance when compared to their counterparts in both categories. The Individual domain showed similar levels of assistance required across health sectors and work locations. Workplaces showed similar levels of complexity of research activity; the private sector recorded the highest level of ‘no research activity’.

Palliative radiation therapy (RT) is a vital treatment modality for managing symptoms from metastatic disease, but access barriers and workflow inefficiencies can delay or preclude care delivery. Simulation‐free RT (SFRT) offers an effective, value‐based solution by eliminating the traditional computed tomography (CT) simulation process and utilising existing diagnostic or staging CT scans for treatment planning. This process reduces patient burden and accelerates time to treatment, prioritising patient‐centred care over traditional treatment pathways. Key technical considerations include managing dosimetric and geometric variations through appropriate patient selection and quality assurance processes. The successful implementation of SFRT requires a collaborative, multidisciplinary team approach, drawing on expertise from established centres to familiarise the team with the process. Access to diverse diagnostic imaging datasets and collaboration with various imaging providers is crucial. While careful patient selection is essential, our experience demonstrates that SFRT exemplifies value‐based healthcare principles by optimising resource utilisation while prioritising patient‐centred care, particularly valuable in rural settings where travel distances significantly impact treatment access. This paper aims to review the benefits and technical aspects, as well as provide key considerations for implementing SFRT in palliative RT settings. Palliative radiation therapy is a vital treatment modality for managing symptoms from metastatic disease, but access barriers and workflow inefficiencies can delay or preclude care delivery. Simulation‐free radiation therapy (SFRT) offers an effective, value‐based solution by eliminating the traditional simulation step and utilising existing diagnostic computed tomography (CT) scans for treatment planning. This paper aims to review the benefits and technical aspects, as well as provide key considerations for implementing SFRT in palliative radiation therapy settings.

ObjectiveThis study aimed to review the impact of bone conduction hearing implants (BCHIs) surgery on patients’ quality of life (QoL) across general, physical, social and overall well-being domains.DesignA prospective correlational study.SettingSingle tertiary referral center in the UK.ParticipantsAll adult patients undergoing their first BCHI over a 10-year and 6-month period (between June 1, 2012, and December 31, 2022). A total of 163 were included out of 195 potentially eligible participants.Main outcome measureThe Glasgow Health Status Inventory (GHSI) was used to assess patients’ QoL pre and post BCHI surgery.ResultsBCHI surgery showed significant improvements across all GHSI QoL domains; total (p<0.0001), general (p<0.0001), social (p<0.0001) and physical (p<0.0001).ConclusionThe largest of its kind, this study recognizes the wide-reaching impact of BCHIs on patients’ QoL, evidencing them as a highly effective and life-improving surgical intervention.

Background Genetic skeletal disorders are a heterogeneous group of syndromic or non-syndromic diseases characterized by abnormal bone, joint or cartilage development. These disorders generally occur sporadically in ruminants. Although a genetic etiology is often suspected, only a limited number of causal variants have been identified and no comprehensive genetic analyses of a cohort of bovine and ovine skeletal developmental defects have been published. The aims of our study were (1) to propose a nosology of genetic skeletal disorders in cattle and sheep and (2) to contribute to the nosology with a number of novel genomically characterized cases. Results Based on a literature review, the proposed nosology of skeletal disorders in cattle and sheep with a confirmed molecular cause was found to comprise 43 different disorders associated with 45 different genes. In addition, horn traits were also included. The disorders were grouped into 21 categories based on the human medical nosology. Thirty novel bovine and nine ovine cases of congenital skeletal disorders were investigated. These represented 19 different disorders, which were grouped into 9 categories. Whole-genome sequencing (WGS) data were generated based on sample availability for either complete trios, affected paternal halfsiblings or isolated single cases. We identified 21 SNVs or small indels for 12 skeletal disorders. Of these, 17 were considered candidate variants affecting 16 different genes, including 11 that were classified as pathogenic and six as likely pathogenic. Additionally, the remaining 4 SNVs were of uncertain significance. Two aneuploidies (trisomy and partial monosomy) were the cause of two different disorders. For eight cases affected by six disorders no variant could be identified. Different modes of inheritance were detected, including spontaneous dominant de novo mutations, autosomal recessive alleles, an X-linked dominant allele, as well as aneuploidies. The overall molecular genetic diagnostic rate was 64%. Conclusions Genomic analysis revealed considerable heterogeneity of the described phenotypes in terms of mode of inheritance, affected genes, and variant type. We propose, for the first time in veterinary medicine, a nosology of genetic skeletal disorders in ruminants that may be useful for more precise differential clinicopathological diagnosis. We emphasize the potential of WGS to enhance genetic disease diagnosis and the importance of adopting a nosology for disease categorization.

Introduction Radiation therapists implemented telephone follow‐up (TFU) in 2015 as an additional point of care post‐treatment. The purpose of this study was to determine whether TFU identified patients who required additional post‐treatment care before the next scheduled review. Methods Between January 2015 and July 2016, all patients who were prescribed curative intent treatment aged 18 years or over were called 10 days post‐radiation therapy (RT). Eight questions were developed and included asking patients how they were coping, if their side effects were improving, if they needed to contact the hospital and if more dressings were required. Patients who could not be contacted after two attempts were excluded from the study. Microsoft Excel and Statistical Package for Social Sciences (SPSS) were used to analyse the responses. Results Data were collected from 850 patients. A total of 28/846 (3%) of patients reported they were not coping after RT, with 26/830 (3%) reporting their side effects were getting worse. A total of 97/826 (12%) of patients felt they needed to contact the hospital because they were unwell. This study identified 104/677 (15%) of patients who responded required more dressings, with 67/104 (65.7%) and 10/104 (9.8%) of this cohort identified in the breast, and head and neck groups, respectively. Conclusion Radiation therapist‐led TFU has shown to be beneficial in identifying a small cohort of breast and head and neck cancer patients who required additional care post‐radiation treatment. RT‐led TFU effectively identified patients who required additional post‐treatment care. The information gained identified patients in need of assistance prior to scheduled medical follow‐up and allowed for timely support and advice to be given. Additional research is needed to determine the level of psychosocial support required by these patients