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The global COVID‐19 pandemic has impacted all facets of life. In medical radiation science (MRS) education, the effects on continuity of learning were felt by educators, students and clinical supervisors both nationally and internationally. The focus of this commentary is on the common elements that impacted MRS students, specifically related to cancelled clinical placements and the interruption to their academic progress at university. An outline is provided of some innovative strategies implemented by universities and clinical departments to support students’ academic progress, continuity of clinical experiences, their transition from students to practitioners and overall strategies to support student wellbeing. The recent published literature illustrates novel responses to shared challenges faced, and an opportunity to learn from collective experiences. The global COVID‐19 pandemic has impacted all facets of life. In medical radiation science education, the effects on continuity of learning were felt by educators, students and clinical supervisors both nationally and internationally. This commentary discusses some innovative strategies implemented by universities and clinical departments to support students’ progress and wellbeing.

Advancing technology in radiation therapy can significantly influence clinical practice and improvement of patient outcomes. In the process, innovations in technology require that changes to clinical practice are adopted within education settings. This commentary aims to describe the uptake of new technology and ways that academics provide an up‐to‐date curriculum when today's innovation is tomorrow's contemporary practice. Advancing technology in radiation therapy can significantly influence clinical practice and improvement of patient outcomes. In the process, innovations in technology require that changes to clinical practice are adopted within education settings. This commentary aims to describe the uptake of new technology and ways that academics provide an up‐to‐date curriculum when today's innovation is tomorrow's contemporary practice.

The aim was to explore various national and international clinical decision‐making tools and dose comparison methods used for selecting cancer patients for proton versus X‐ray radiation therapy. To address this aim, a literature search using defined scoping review methods was performed in Medline and Embase databases as well as grey literature. Articles published between 1 January 2015 and 4 August 2020 and those that clearly stated methods of proton versus X‐ray therapy patient selection and those published in English were eligible for inclusion. In total, 321 studies were identified of which 49 articles met the study’s inclusion criteria representing 13 countries. Six different clinical decision‐making tools and 14 dose comparison methods were identified, demonstrating variability within countries and internationally. Proton therapy was indicated for all paediatric patients except those with lymphoma and re‐irradiation where individualised model‐based selection was required. The most commonly reported patient selection tools included the Normal Tissue Complication Probability model, followed by cost‐effectiveness modelling and dosimetry comparison. Model‐based selection methods were most commonly applied for head and neck clinical indications in adult cohorts (48% of studies). While no ‘Gold Standard’ currently exists for proton therapy patient selection with variations evidenced globally, some of the patient selection methods identified in this review can be used to inform future practice in Australia. As literature was not identified from all countries where proton therapy centres are available, further research is needed to evaluate patient selection methods in these jurisdictions for a comprehensive overview. The aim was to explore clinical decision‐making tools and dose comparison methods used for proton therapy patient selection using a scoping review approach. Six different clinical decision‐making tools and 14 dose comparison methods were identified for adult and paediatric cohorts. Variability in patient selection was evident between countries.

Introduction The COVID‐19 outbreak has had far‐reaching impacts on cancer services worldwide. It has yet to be described how the pandemic has impacted patient selection methods for proton therapy (PT) specifically. This survey aimed to investigate the current international methods implemented for PT patient selection and to determine whether COVID‐19 has impacted PT practice. Methods A 44‐question survey was conducted from 29th January 2024 to 18th March 2024 using the Qualtrics platform. PT centres in 21 countries were invited to respond to the survey regarding patient selection methods used currently and prior to the pandemic, as well as impacts of COVID‐19 on patient selection and service provision. The survey was disseminated with assistance from The Particle Therapy Co‐operative Group. Results Nine centres completed the survey: four in Europe, three in the United States of America (USA), and two in Asia. Diagnosis or indications lists, clinical trials group assignment, dose distribution, dose metrics, and expert recommendations were the most reported patient selection approaches within the last five years. Only one centre in the USA reported changes to patient selection approaches during the height of the pandemic, mainly ceasing use of clinical trial group assignment. Six of the nine centres continued to treat patients infected with COVID‐19. Five respondents indicated various suspensions or delays for certain treatment groups. Conclusions The findings show most respondents did not alter their patient selection approaches during the pandemic. These findings, however, cannot be generalised to all PT centres due to the small sample size of respondents. Through an international survey, we aimed to investigate the current international methods implemented for proton therapy patient selection and to determine whether COVID‐19 has impacted practice. Only one of nine respondents reported changes to patient selection approaches during the height of the pandemic, mainly ceasing use of clinical trial group assignment. The findings show most respondents did not alter their patient selection approaches; however, they implemented other measures, including various suspensions or delays for certain treatment groups.

This scoping review aimed to determine whether the COVID‐19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy (PT) centres. This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines. A literature search was performed in Medline, Embase, Web of Science and Scopus, as well as grey literature. Keywords such as “COVID‐19” and “Proton Therapy” were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 11 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Six of 11 articles included statements regarding treatment of COVID‐19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of unconventional therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment target volumes and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Few publications detailed changes to patient selection or workflow methods during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in PT, collecting this data could aid in future planning for PT in Australia. This scoping review aimed to determine whether the COVID‐19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy (PT) centres. Recurring impacts on PT provision included more frequent use of unconventional therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment target volumes and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended.

Introduction This study aimed to determine a maximal pelvic separation and waist circumference in pelvic patients to guide radiation therapists in acquiring kilovoltage (kV) planar images of acceptable quality for treatment verification. Methods A pelvic anthropomorphic phantom modified with different bolus thicknesses was imaged at various default kV exposure settings. Radiation therapists rated image quality and acceptance/rejection of these images for treatment verification. Results Sixteen radiation therapists participated in the study. Image quality was inversely proportional to phantom size. AP and lateral kV images were acceptable for treatment verification up to a waist circumference of 143 cm. Conclusions Exposure settings for kV image verification of large patients should be individualised to avoid unnecessary patient radiation dose through repeated imaging. Exposure settings for radiotherapy image verification of large patients should be individualised to avoid unnecessary patient radiation dose through repeated imaging. This study found that radiation therapists rated image quality to be unacceptable for use in image verification beyond pelvic AP separation of 46.5 cm, lateral separation of 60 cm and the corresponding waist circumference of 169 cm.

Research describing proctitis or pelvic radiation disease symptoms of prostate cancer patients one year after external beam radiotherapy (EBRT) plus high-dose-rate (HDR) brachytherapy is limited. This study aimed to assess prostate cancer patients' pelvic radiation disease symptoms from baseline to 12 months post-radiotherapy. Men with prostate cancer referred for EBRT and HDR brachytherapy were recruited. Patients' age, diagnosis, staging, PSA, past medical history, and treatment were recorded. Pelvic radiation disease symptoms were assessed via the Phase III EORTC proctitis module. Patients completed questionnaires before radiotherapy (baseline) and at one, three, six, and 12 months afterwards. To assess acute toxicity, symptoms one month after radiotherapy were compared with baseline. To assess post-treatment recovery, symptoms at three, six, and 12 months post radiotherapy were compared with one month. Symptom changes over time were assessed with linear mixed effect models. Two hundred and sixty-six patients were recruited. Mean scores were below 2 at all time-points. The proportion of patients experiencing symptoms were also calculated. Linear mixed effect models showed that time-point, age, and T-stage were associated with some pelvic radiation disease symptoms. Patients receiving EBRT plus HDR brachytherapy to the prostate experienced mild pelvic radiation disease symptoms. Determining the proportion of patients with symptoms provided the most meaningful data.

Objective. To explore variations in patterns of care over three decades for a subgroup of rectal cancer patients in South Australia according to sociodemographic characteristics. Methods. This study evaluated three decades of retrospective data from the South Australian Clinical Cancer Registry. A total of 4,131 patients diagnosed with rectal cancer between 1982 and 2015 and treated in South Australian public hospitals were included. Study outcomes were age at diagnosis, area of primary residence, cancer stage, and primary treatment (surgery, chemotherapy, or radiotherapy). Results. There was a significantly lower likelihood of conventional therapy for the elderly. Adjusted odds of receiving surgery or radiotherapy decreased by 70% and those of receiving chemotherapy by 90% in the 80+ age group, compared to the 50–59 age group. No significant variation was detected according to area-level socioeconomic status or remoteness. Conclusion. Socioeconomic factors showed little impact on the receipt of therapies for rectal cancer patients in South Australia. Variation in treatment by age, irrespective of disease stage or period of diagnosis, requires further investigation.

Paediatric cancer patients have a risk of late side effects after curative treatment. Proton radiation therapy (PRT) has the potential to reduce the incidence and severity of toxicities produced by conventional photon radiation therapy (XRT), which may improve the health-related quality of life (HRQoL) in children. This systematic review aimed to identify the evidence of HRQoL outcomes in childhood cancer survivors following XRT and PRT. Medline, Embase, and Scopus were systematically searched. Thirty studies were analysed, which described outcomes of 1986 childhood cancer survivors. Most studies (n = 24) described outcomes for children with a central nervous system (CNS) tumour, four studies reported outcomes for children with a non-CNS tumour, and two studies combined CNS and non-CNS diagnoses within a single cohort. No studies analysed routine HRQoL collection during paediatric radiation oncology clinical practice. There is insufficient quality evidence to compare HRQoL outcomes between XRT and PRT. Therefore, the current state of the literature does not conclude that PRT produces superior HRQoL outcomes for childhood cancer survivors. Standardised clinical implementation of HRQoL assessment using patient-reported outcomes is recommended to contribute to improvements in clinical care whilst assisting the progression of knowledge comparing XRT and PRT.

Health-related quality of life (HRQoL) is not routinely evaluated using patient-reported outcome measures (PROMs) in paediatric radiation therapy (RT). This study aimed to identify barriers and facilitators to HRQoL implementation in paediatric RT clinical practice and requirements for a digital PROM platform, from the perspectives of healthcare professionals. Exploratory semi-structured interviews were conducted with multidisciplinary clinicians from two hospitals providing care to paediatric RT patients. Interviews were transcribed verbatim, descriptively coded and analysed using content analysis. Consolidated Framework for Implementation Research (CFIR) was used as a theoretical framework for data collection, analysis and interpretation. Nine interviews were held with nurses (n = 3), radiation therapists (n = 3), radiation oncology registrars (n = 2) and a consultant family therapist. Participants identified digital, clinical and child-friendly features to inform platform development. All participants recognised the proposed digital platform to be of value by generating new information to support patient care. The perceived alignment with clinical workflows, potential to provide staff satisfaction and individual scope to act on PROM results were key facilitators. Clinical time pressures, transient staffing and reluctance for change were identified as potential barriers. Engagement of clinical staff and training in addressing psychosocial concerns were recommended to support clinical actioning of results and foster successful clinical uptake. This study used CFIR to systematically identify requirements for a digital platform and barriers to routine patient-reported HRQoL collection in the paediatric RT setting. The facilitators and complexities of PROM implementation can inform platform development and future implementation strategies.